ID-PALL: An Instrument to Help You Identify Patients in Need of Palliative Care

Palliative care is frequently associated with the end of life and cancer. However, other patients may need palliative care, and this need may be present earlier in the disease trajectory. It is therefore essential to identify at the right time patients who need palliative care and to distinguish between those in need of general palliative care and those for whom a referral to specialists is required. ID-PALL has been developed as an instrument to support professionals in this identification and to discuss a suitable palliative care project, in order to maintain the best quality of life for patients and their relatives. Recommendations for clinical practice are also proposed to guide professionals after the identification phase.

Women's Experiences of Care During Pregnancy in a Continuity of Midwifery Care Project in Rural Sweden

BACKGROUNDIn antenatal care, health checkups, information, and support is provided to women. Midwifery continuity models of care provide women access to evidence-based care.OBJECTIVEThe aim of this study was to evaluate women's experiences of pregnancy and antenatal care in a continuity of midwifery care project, as well as to gauge the impact the project had on the women's emotional well-being and satisfaction.METHODThis was a cohort study of 226 women enrolled in a continuity of care project in rural Sweden. Profiles of the women were created based on levels of depressive symptoms, worries, fear of birth, and sense of coherence. Data was collected through questionnaires. Odds ratios with 95% confidence intervals were calculated between the clusters for the explanatory variables.RESULTWomen in the two clusters differed in some background characteristics. Women in Cluster 2 had more visits to a doctor. They also received more counseling due to fear of birth and viewed the number of midwives as “too many.” They were less satisfied with the medical, emotional, and overall aspects of their antenatal care. Perceived health, preparedness for birth, and parenthood were rated lower by women in Cluster 2.CONCLUSIONThis study found that women's assessment of their antenatal care was associated with their emotional health. Negative feelings toward changes in pregnancy were often found in women with poorer emotional health, and these women reported being less prepared for birth and parenthood. Thus, it is important to identify women with emotional distress and to provide them additional support and continuity.

Underserved Pacific Islanders With Locally Advanced Cervical Cancer Receive Higher Rates of Standard-of-Care Radiation Treatment Through the Pacific Island Health Care Project and Military Health System Compared to the Average U.S. Population

ABSTRACT Introduction Brachytherapy, with external beam radiation, increases survival in the treatment of locally advanced cervical cancer (LACC). In 2016, Robin et al. reported only 44% of patients received standard-of-care (SOC) brachytherapy in the USA. The Pacific Island Health Care Project has provided humanitarian medical care to women from the U.S. Associated Pacific Islands (USAPI) for three decades at Tripler Army Medical Center (TAMC), a military health care system (MHS) facility. We evaluated whether this underserved and understudied patient population received SOC treatment for LACC at TAMC. Materials and Methods The TAMC tumor registry was searched for all cervical cancer cases from 1997 to 2019. Subjects were excluded if they did not have stage IB2-IVA disease and were not from USAPI. The primary outcome was the overall utilization of brachytherapy, and statistical analysis was performed using the chi-square test. Results We identified 214 women with cervical cancer treated at TAMC, of which 67 met the study criteria. Ninety-two percent had squamous cell carcinoma on histology. Of the patients identified, 48 (71.6%, P < .001) were treated with brachytherapy. Fifteen (22.4%) patients received external radiation alone, and four (6.0%) received chemoradiation without brachytherapy. A post-hoc power analysis was conducted with a power of 91.3%. Conclusions Women with cervical cancer from USAPI in the PIHCP program treated at TAMC received significantly higher rates of SOC radiation treatment than the U.S. population on average. This highlights the ability of PIHCP, through the MHS, to deliver SOC treatment for cervical cancer to an otherwise underserved patient population.

Importance of palliative care

Tom McEwan, Principal Educator (Midwifery) for NHS Education for Scotland, discusses how CW+'s Neonatal Palliative Care Project is a critical initiative for midwives