Current opinion in supportive and palliative care
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Curr Opin Support Palliat Care · Mar 2015
ReviewHeart failure and palliative care: training needs assessment to guide priority learning of multiprofessionals working across different care settings.
International bodies acknowledge that palliative care principles and access to palliative care services should be offered to persons living with and dying from advanced illness such as heart failure. Without an appropriately trained workforce, however, appropriate goals of care and associated reductions in hospital utilizations may not be feasible.Marie Curie Cancer Care, British Heart Foundation Scotland and NHS Greater Glasgow and Clyde are working in partnership to improve the quality and access to palliative care for patients and their caregivers living with and dying from advanced heart failure. A training needs assessment has been undertaken as part of this programme in order to inform the development of training specific to heart failure and palliative care. ⋯ Well trained professionals will improve the coordination, earlier identification, quality of care provision and communication between all stakeholders. In doing so, the opportunity to facilitate preferred care wishes and preferred place of care for patients and families is optimised. Without this aligning, clinical practice with national guidance is not feasible.
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Curr Opin Support Palliat Care · Dec 2014
ReviewOpioids prescription for symptoms relief and the impact on respiratory function: updated evidence.
Opioids are used for treating dyspnea and other symptoms in oncological and nononcological patients. The relief of respiratory fatigue and anxiety that these opioids offer is well known. One of the scarcely frequent, but very much feared, side-effects is respiratory depression. The purpose of this review is to determine whether or not the situation of an advanced-stage patient under palliative care and the use of opioids are risk factors for respiratory depression. ⋯ A bibliographic review found three randomized double-blinded placebo-controlled studies and five prospective studies, six of which showed that opioids significantly relieve dyspnea (P<0.001). The use of morphine for symptomatic relief does not significantly change the level of saturation of oxygen in the blood. In addition, the functional studies do not indicate that the use of opioids for dyspnea relief causes high CO2 levels in blood (P=0.05). The opioids used for treating dyspnea do not significantly compromise respiratory function; they are safe and effective.
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Curr Opin Support Palliat Care · Dec 2014
ReviewRole of corticosteroids for fatigue in advanced incurable cancer: is it a 'wonder drug' or 'deal with the devil'.
Although corticosteroids are frequently used to palliate cancer-related symptoms, limited published studies are available. This review summarizes recent literature on the impact of corticosteroids on fatigue, its related symptoms, and the role of 'corticosteroid rotation' in improving the corticosteroid-related side-effects. ⋯ Recent studies confirm the short-term benefit of corticosteroids for the symptomatic treatment of cancer-related fatigue and anorexia cachexia in advanced incurable cancer. Future studies are needed to determine the optimal dose, type, and the role of corticosteroid rotation so as to optimize long-term efficacy and minimize side-effects.
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Studies in different countries and settings of care have reported the quality of care for the dying patients as suboptimal. Care pathways have been developed with the aim of ensuring that dying patients and their family members received by health professionals the most appropriate care. This review presents and discusses the evidence supporting the effectiveness of the end-of-life care pathways. ⋯ The overall amount of evidence supporting the dissemination of end-of-life care pathways is rather poor. One negative randomized trial suggests the pathways have the potential to reduce the gap between hospital and hospices. Further research is needed to understand the potential benefit of end-of-life care pathways.
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Curr Opin Support Palliat Care · Dec 2014
ReviewIndications and practice of artificial hydration for terminally ill cancer patients.
To update medical professionals on the role of artificial hydration in terminally ill cancer patients and to highlight recent research. ⋯ http://links.lww.com/COSPC/A6