Patients With Advanced Cancer Requiring Intensive Care: Reasons for ICU Admission, Mortality Outcomes, and the Role of Palliative Care

2021 ◽  
Vol 32 (3) ◽  
pp. 324-331
Author(s):  
Varsha N. Patel ◽  
Stephanie D. Stone
Keyword(s):  
Palliative Care ◽  
Critical Care ◽  
Intensive Care ◽  
Critical Care Nurses ◽  
Factors Associated ◽  
Patients With Cancer ◽  
The Past ◽  
Care Services ◽  
Palliative Care Services

Medical advancements in oncology and critical care during the past 2 decades have led to more patients with cancer being admitted to intensive care units. This article discusses the most common reasons for intensive care unit admission and factors associated with mortality among patients with cancer. It also reviews the multiple benefits of palliative care services in caring for critically ill patients with cancer and opportunities for critical care nurses working with these patients.

scholarly journals Factors associated with the aggressiveness of care at the end of life for patients with cancer dying in hospital: a nationwide retrospective cohort study in mainland Portugal

ESMO Open ◽  
2020 ◽  
Vol 5 (6) ◽  
pp. e000953
Author(s):  
Diogo Martins-Branco ◽  
Silvia Lopes ◽  
Rita Canario ◽  
Joao Freire ◽  
Madalena Feio ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Metastatic Disease ◽  
Medical Oncology ◽  
Public Hospitals ◽  
Factors Associated ◽  
Patients With Cancer ◽  
Care Services ◽  
Mainland Portugal ◽  
Palliative Care Services

IntroductionThere is growing concern about the aggressiveness of cancer care at the end of life (ACCEoL), defined as overly aggressive treatments that compromise the quality of life at its end. Recognising the most affected patients is a cornerstone to improve oncology care. Our aim is to identify factors associated with ACCEoL for patients with cancer dying in hospitals.MethodsAll adult patients with cancer who died in public hospitals in mainland Portugal (January 2010 to December 2015), identified from the hospital morbidity database. This database provided individual clinical and demographic data. We obtained hospital and region-level variables from a survey and National Statistics. The primary outcome is a composite ACCEoL measure of 16 indicators. We used multilevel random effects logistic regression modelling (p<0·05).ResultsWe included 92 155 patients: median age 73 years; 62% male; 53% with metastatic disease. ACCEoL prevalence was 71% (95% CI 70% to 71%). The most prevalent indicators were >14 days in the hospital (43%, 42–43) and surgery (28%, 28–28) in the last 30 days. Older age (p<0·001), breast cancer (OR 0·83; 95% CI 0·76 to 0·91), and metastatic disease (0·54; 95% CI 0·50 to 0·58) were negatively associated with ACCEoL. In contrast, higher Deyo-Charlson Comorbidity Index (p<0·001), gastrointestinal and haematological malignancies (p<0·001), and death at cancer centre (1·31; 95% CI 1·01 to 1·72) or hospital with medical oncology department (1·29; 95% CI 1·02 to 1·63) were positively associated with ACCEoL. There was no association between hospital palliative care services at the hospital of death and ACCEoL.ConclusionClinical factors related to a better understanding of disease course are associated with ACCEoL reduction. Patients with more comorbidities and gastrointestinal malignancies might represent groups with complex needs, and haematological patients may be at increased risk because of unpredictable prognosis. Improvement of hospital palliative care services could help reduce ACCEoL, particularly in cancer centres and hospitals with medical oncology department, as those services are usually under-resourced, thus reaching few.

Hospital-Based Palliative Care

2019 ◽  
pp. 13-31
Author(s):  
Patricia Maani-Fogelman
Keyword(s):  
Palliative Care ◽  
Interpersonal Communication ◽  
Communication Skills ◽  
Complex Needs ◽  
Care Services ◽  
Medical Clinics ◽  
Palliative Care Services ◽  
Role Of Nursing ◽  
Consultation Time

Hospital-based palliative care (HBPC) is often the primary contact between patients and the field of palliative care. As such, HBPC programs must be built to withstand the challenges and demands of the changing healthcare landscape and the shifting, often complex needs of the inpatient consultation. Time, energy, strong interpersonal communication skills, and dedication are key elements to building a successful HBPC program. Attention to detail and attentiveness to patient wishes round out the foundation of the continuum. HBPC is a forum for expansion of palliative care services into the medical clinics, outreach facilities, community-based practices, and home care venues. The role of nursing across this spectrum of care amid advancing chronic illness is a vital aspect of programmatic success. Ongoing education and research must be offered and resourced for HBPC and palliative care in general to remain steadfast and successful against the background of national healthcare reform.

Determining Futility

2003 ◽  
Vol 12 (2) ◽  
pp. 214-223
Author(s):  
JOSEPH C. d'ORONZIO
Keyword(s):  
Palliative Care ◽  
Critical Care ◽  
Family Support ◽  
Therapeutic Intervention ◽  
Ethics Committee ◽  
Critical Care Medicine ◽  
Hospital Policy ◽  
Care Services ◽  
Palliative Care Services ◽  
Hospital Protocols

The challenge of determining that therapeutic intervention is futile is a recurrent ethical theme in critical care medicine. The process by which that determination is reached often involves demanding collaborative and interdisciplinary conversation and deliberation within the context of hospital policy, including ethics committee guidelines. The subsequent decision as to what happens next depends on resources, such as palliative care services, hospice, other hospital protocols, and, of course, family support.

Palliative Care—What, Who and When?

2011 ◽  
Vol 4 (11) ◽  
pp. 624-632
Author(s):  
Emma Cope ◽  
Patrick Daly
Keyword(s):  
Palliative Care ◽  
General Practice ◽  
Royal College ◽  
Palliative Care Team ◽  
Care Team ◽  
Ageing Population ◽  
Care Services ◽  
Specialist Services ◽  
Palliative Care Services

Palliative care is a speciality which has grown considerably in recent years gaining recognition as its own subspecialty of medicine by the Royal College of Physicians in 1987. GPs have always had a role in providing palliative care, and as our ageing population increases, the number of people living with incurable illnesses will continue to rise. This article aims to provide an understanding of palliative care medicine, the role of the GP in the palliative care team, guidance to help identify those patients who may benefit from palliative care services and when referral to specialist services may be needed. We have also highlighted key documents pertaining to palliative care applicable to general practice.

Using a supportive care framework to understand and improve palliative care among cancer patients in Africa

2015 ◽  
Vol 14 (3) ◽  
pp. 284-301 ◽  
Author(s):  
David S. Busolo ◽  
Roberta L. Woodgate
Keyword(s):  
Palliative Care ◽  
Supportive Care ◽  
Cancer Patients ◽  
Care Needs ◽  
African Countries ◽  
Research Education ◽  
Patients With Cancer ◽  
Care Services ◽  
Incidence And Mortality ◽  
Palliative Care Services

ABSTRACTObjective:Cancer incidence and mortality are increasing in Africa, which is leading to greater demands for palliative care. There has been little progress in terms of research, pain management, and policies related to palliative care. Palliative care in Africa is scarce and scattered, with most African nations lacking the basic services. To address these needs, a guiding framework that identifies care needs and directs palliative care services could be utilized. Therefore, using the supportive care framework developed by Fitch (Fitch, 2009), we here review the literature on palliative care for patients diagnosed with cancer in Africa and make recommendations for improvement.Method:The PubMed, Scopus, CINAHL, Web of Science, Embase, PsycINFO, Social Sciences Citation Index, and Medline databases were searched. Some 25 English articles on research from African countries published between 2004 and 2014 were selected and reviewed. The reviewed literature was analyzed and presented using the domains of the supportive care framework.Results:Palliative care patients with cancer in Africa, their families, and caregivers experience increasing psychological, physical, social, spiritual, emotional, informational, and practical needs. Care needs are often inadequately addressed because of a lack of awareness as well as deficient and scattered palliative care services and resources. In addition, there is sparse research, education, and policies that address the dire situation in palliative care.Significance of Results:Our review findings add to the existing body of knowledge demonstrating that palliative care patients with cancer in Africa experience disturbing care needs in all domains of the supportive care framework. To better assess and address these needs, holistic palliative care that is multidomain and multi-professional could be utilized. This approach needs to be individualized and to offer better access to services and information. In addition, research, education, and policies around palliative care for cancer patients in Africa could be more comprehensive if they were based on the domains of the supportive care framework.

scholarly journals Advance care planning in palliative care: a national survey of health professionals and service managers

2015 ◽  
Vol 39 (2) ◽  
pp. 146 ◽  
Author(s):  
Marcus Sellars ◽  
William Silvester ◽  
Malcolm Masso ◽  
Claire E. Johnson
Keyword(s):  
Palliative Care ◽  
Advance Care Planning ◽  
National Survey ◽  
Health Professionals ◽  
Care Planning ◽  
The Past ◽  
Care Services ◽  
Palliative Care Services ◽  
Advance Care ◽  
Service Managers

Objective To identify the attitudes, knowledge and practices regarding advance care planning (ACP) in palliative care. Methods A nationwide online survey was distributed to Australian palliative care services associated with the Palliative Care Outcomes Collaboration (n = 105). Seventy-three health professionals (HPs) and 59 service managers completed the survey. Results Regarding ACP, 51% of service managers reported relevant policies and procedures were in place in their service and 44% included ACP in job descriptions. Most HPs were confident in undertaking ACP, including initiating discussions with patients and complying with documents; however, only 44% reported receiving ACP specific training. Although 58% of HPs reported having conversations about ACP with more than 11 patients in the past 6 months, only 44% of managers report that it is offered to most patients. Thirty per cent of HPs were aware of others not adhering to patient wishes in the past 6 months and only 43% of HPs (and 37% of managers) believed ACP is done well within their service. Conclusions This first national survey examining ACP in palliative care services demonstrates there is a need to improve systems to support ACP and to understand circumstances in which ACP wishes are not followed. What is known about the topic? ACP is increasingly recognised as an important part of care of people in hospital and community settings. However, currently there is no empirical evidence about the national uptake and quality of ACP in palliative care settings specifically. What does this paper add? This nationwide survey shows improvements on past small-scale research showing that ACP is supported by palliative care health professionals; however, the organisational ACP processes and systems did not support best practice in this regard. What are the implications for practitioners? Palliative care organisations should incorporate ACP systems (including greater access to ACP policies and guidelines) that support health professionals to complete ACP with clients who want to. Greater access to support, such as ACP training and resources, would assist with development of ACP documentation and adherence.

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