Cancer nursing
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In Dutch healthcare, patients and physicians are responsible for medical end-of-life decisions. These include nontreatment decisions, withholding or withdrawing parenteral hydration and nutrition where the patient can no longer drink or eat, relieving pain and other symptoms with drugs that might shorten life, euthanasia, and physician-assisted suicide. The objective of this study is to investigate the views of nurses on their role with regard to discussing these kinds of decisions, as well as their actual role in the decision-making process. ⋯ Three-quarters of the nurses had been involved in an end-of-life decision-making process in the previous 2 years, mostly by talking with the physician and the patient's family. It is concluded that physicians should discuss these decisions with nurses more often. The finding that characteristics of the nurses influence their role in end-of-life decision-making processes emphasizes the importance of developing mechanisms to ensure that end-of-life decisions are made in a consistent manner and do not depend on the demographic characteristics of nurses.
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Cancer pain is estimated to occur in 30% to 70% of patients with early-stage cancer and 60% to 95% with advanced cancer. Current research shows that cancer pain continues to be undertreated despite the availability of analgesics and established guidelines to maximize their effectiveness. The purpose of this study was to describe oncology patients' pain experience during an episode of hospitalization with particular emphasis on exploring the relationship between oncology patients' beliefs about pain and the treatment they received. ⋯ Patients who held this belief reported higher current pain, worst pain intensity, and higher average pain intensity in the previous 24 hours. Effective pain management in the inpatient oncology setting continues to be an important clinical issue, and patients do not receive all available pain treatment. There may be an important association between patients' beliefs about pain and pain management and the pain management they receive.
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Intraoperative mapping is a well-established and safe technique to maximize the excision of tumors involving the eloquent cortex while minimizing neurological damage. Although different techniques are used, very little has been documented about how the patients feel, what they think about, or how they approach this type of surgery without an anesthetic. Considering the inconsistency of literature, a phenomenology study was conducted with the purpose to describe the human experience of patients before, during, and immediately after awake craniotomy. ⋯ It is most important for a healthcare team to understand the patients' experiences. Immediately before and after surgery, the patients seem to concentrate more on keeping their emotions in check and focus on the risk of subsequent defect or disability, rather than on the brain cancer and what it may imply on life. During the surgery, they become particularly involved in the task: they feel directly responsible for the results of surgery relating this to the effectiveness of collaboration with the neurosurgeons.
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The objective of this study was to describe end-stage disease in patients suffering from advanced head and neck cancer (hnc). It is one of the most unpleasant and agonizing way a person may die and is a challenging problem for all involved with its treatment. Until today, only few detailed information about the final phase of life of hnc patients in a hospice setting are available. ⋯ The goal of palliative treatment of terminal hnc patients is offering the most convenient way to "live" the final days of their lives in dignity. The short survival time in hospice indicates that incurable patients may be referred to terminal care institutions too late in their dying trajectory. Physicians should be encouraged to talk to their terminally ill patients about the status and incurability of the disease as early as possible to facilitate patient and family decision making on how to prepare for the impending end of life.
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Multicenter Study
Factors influencing family caregivers' ability to cope with providing end-of-life cancer care at home.
Dying at home is a goal promoted by many healthcare providers and governments as a way to enhance the dying experience for cancer patients and their family members. A key element to realizing this goal is the availability of a family member who is willing to provide care at home. Little research has been conducted on the factors that influence family caregivers' ability to cope with providing end-of-life cancer care at home. ⋯ Semistructured interviews with 29 active family caregivers were conducted and thematically analyzed. Our findings suggest 5 factors that influenced the caregivers' ability to cope: (1) the caregiver's approach to life, (2) the patient's illness experience, (3) the patient's recognition of the caregivers' contribution to his or her care, (4) the quality of the relationship between the caregiver and the dying person, and (5) the caregiver's sense of security. Findings provide important information to assist in informing health services and policies directed at enhancing family caregivers' coping abilities.