Palliative medicine
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Palliative medicine · Jul 2003
Determinants of the place of death among terminally ill cancer patients under home hospice care in Japan.
Although the place of death of patients with terminal cancer is influenced by multiple factors, few studies have systematically investigated its determinants. The purpose of this study was to examine the influence of the patients' sociodemographic, clinical and support network variables on the place of death of terminally ill cancer patients under the care of home care agencies in Japan. ⋯ Overall, this model could accurately classify 95% of the places of death, which is higher than other published studies. A clearer understanding of factors that might influence the place of death of terminally ill cancer patients would allow healthcare professionals to modify healthcare systems and tailor effective interventions to help patients die at their place of preference.
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Palliative medicine · Jul 2003
The impact on the family of terminal restlessness and its management.
The purpose of this qualitative study was to explore and describe the impact of terminal restlessness and its management upon family members who were witness to the event. Approximately 25%-85% of terminally ill patients may experience the symptoms associated with terminal restlessness during the hours or days before their death. They may be physically agitated and cognitively impaired and often appear to be suffering. ⋯ Using a phenomenological research approach, two focus groups and 20 individual interviews were held with bereaved family members and hospice staff. A content analysis of the data resulted in the emergence of several core themes that reflected the participants' perceptions and experiences; the multidimensionality of suffering, the need for communication, feelings of ambivalence, the need for information and sensitivity and respect. It is suggested that the development and implementation of a multiprofessional team protocol could address the specific concerns, information and care needs of these families at this critical time.
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Palliative medicine · Jul 2003
Factors influencing constipation in advanced cancer patients: a prospective study of opioid dose, dantron dose and physical functioning.
The relationship between opioid dose, dantron dose, bowel function and physical functioning (measured with the modified Barthel Index) was determined in a sample of 50 inpatients with advanced cancer. Data were collected prospectively from chart review and patient interviews one week after admission to allow for protocol-driven management of constipation to be established. Bowel scores were significantly reduced in 35 patients treated with opioids compared with 15 patients not treated with opioids. ⋯ Higher doses of dantron were associated with better physical functioning (but not opioid dose) suggesting that for any given dose of opioid, fitter patients were treated with larger doses of laxatives. Factors other than opioid dose and physical functioning may be more important in contributing to constipation in this group of patients. Less potent opioid drugs, such as codeine, are just as likely to cause constipation as more potent opioids.
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Palliative medicine · Jun 2003
Effect of a palliative home care team on hospital admissions among patients with advanced cancer.
This was a quasi-experimental study designed to determine whether, in patients with advanced cancer, a palliative home care team (PHCT) modified hospital utilization in the last six months before death. Of 2503 cancer deaths in the municipality of Genoa, Italy, in 1991, 189 (7.5%) received care from a PHCT. Three hundred and seventy-eight controls matched for primary tumour were selected. ⋯ The difference between groups was most marked in the last month of life, and disappeared among those patients who were in care for more than 120 days (throughout the course of their illness). We conclude that a PHCT appears to reduce days in hospital and allows patients to spend more time at home. Differences in time in care between groups requires further investigations.