Journal of pain and symptom management
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J Pain Symptom Manage · Jan 2010
End-of-life decision making for cancer patients in different clinical settings and the impact of the LCP.
Differences in the general focus of care among hospitals, nursing homes, and homes may affect the adequacy of end-of-life decision making for the dying. We studied end-of-life decision-making practices for cancer patients who died in each of these settings and assessed the impact of the Liverpool Care Pathway for the Dying Patient (LCP), a template for care in the dying phase. Physicians and relatives of 311 deceased cancer patients completed questionnaires. ⋯ We conclude that cancer patients who die in the hospital are more intensively treated during the last phase of life than those who die elsewhere. The LCP has an impact on the use of potentially life-shortening medication during the dying phase. Communication about medical decision making tends to be better in the nursing home and at home.
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J Pain Symptom Manage · Jan 2010
Survival of women with cancer in palliative care: use of the palliative prognostic score in a population of Brazilian women.
The objective of this study was to estimate the survival time of patients referred to the palliative care unit of the National Cancer Institute of Brazil (INCA), using the Palliative Prognostic (PaP) score, and thereby evaluate this tool in a location and population different from that in which the instrument was originally developed. In this prospective study, the instrument, after translation and adaptation to Brazilian Portuguese, was applied to 250 women consecutively referred to the palliative care unit of INCA, who had been followed up as outpatients between June 2005 and August 2006. The PaP score subdivided a heterogeneous population into three homogeneous risk groups with respect to survival time, and the differences between groups were statistically significant. ⋯ The percentage survival at 30 days for the three groups was 91.4%, 57.1%, and 0%, respectively. The longer survival time found in the first group in this study would appear to reflect the referral of patients in better clinical condition for outpatient follow-up in this institute. These data suggest that the PaP score is a consistent and easily applied instrument that allows more accurate prognostication in advanced cancer patients with no possibility of cure, irrespective of the geographical location.
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Hospice and palliative care organizations need to measure and analyze quality of care, in response to national palliative care practice guidelines and new hospice regulatory requirements. Little is known about hospices' readiness to meet this new mandate. ⋯ Current organizational activities, data collection rates, and use of electronic data systems may limit hospices' preparation and practices related to quality improvement and research participation; larger size and designation of a change leader are associated with greater capacity. Hospices may need technical assistance and training to provide for meaningful measurement of quality of care.
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Continuous deep sedation (CDS) until death can form an effective part of palliative care. In The Netherlands and Belgium, CDS is sometimes regarded as an alternative to euthanasia, and the involvement of palliative care specialists is low. Provision of CDS through opioids alone is not recommended. ⋯ This study provides baseline data for monitoring future trends in the United Kingdom and highlights the need for a fuller understanding of the circumstances in which CDS occurs in particular care settings.
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J Pain Symptom Manage · Jan 2010
Disparities in the contribution of low- and middle-income countries to palliative care research.
Important aspects of the palliative care needs of patients from low- and middle-income countries (LMIC) are largely unexplored. About 44 million of the 56 million annual deaths worldwide occur in developing countries, and it is estimated that more than 33 million of those concerned would benefit from palliative care. In this context, the understanding of specific social and cultural needs is fundamental to the development of appropriate health policy and clinical practice concerning palliative and end-of-life care. ⋯ Palliative care research should be a priority in LMIC, where many patients could benefit tremendously from it, and publication of findings in these countries should be encouraged.