Articles: palliative-care.
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Palliative medicine · Feb 2022
Observational StudyCapturing what matters: A retrospective observational study of advance care planning documentation at an academic medical center during the COVID-19 pandemic.
Advance care planning allows patients to share their preferences for medical care with the aim of ensuring goal-concordant care in times of serious illness. The morbidity and mortality of the COVID-19 pandemic has increased the importance and public visibility of advance care planning. However, little is known about the frequency and quality of advance care planning documentation during the pandemic. ⋯ This study found low rates of advance care planning documentation for patients both with and without COVID-19 during an evolving global pandemic. Advance care planning documentation was associated with palliative care consultation, highlighting the importance of such consultation to ensure timely, patient-centered advance care planning.
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Patients with small intestinal neuroendocrine tumours (siNETs) usually present with advanced disease. Primary tumour resection without curative intent is controversial in patients with metastatic siNETs. The aim of this meta-analysis was to investigate survival after primary tumour resection without curative intent compared with no resection in patients with metastatic siNETs. ⋯ Primary tumour resection is associated with increased survival in patients with advanced, metastatic siNETs, even after adjusting for important confounders.
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J Pain Symptom Manage · Feb 2022
ReviewInterventions to Improve Prognostic Understanding in Advanced Stages of Life-Limiting Illness: A Systematic Review.
Among patients with advanced life-limiting illness, an inaccurate understanding of prognosis is common and associated with negative outcomes. Recent years have seen an emergence of new interventions tested for their potential to improve prognostic understanding. However, this literature has yet to be synthesized. ⋯ Prognostic understanding interventions hold the potential to improve patient understanding and thus informed decision making, but limitations exist. Future research should examine why many patients receiving intervention may continue to maintain inaccurate perceptions, and identify which intervention components can best enhance informed, value-consistent decision making.
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J Pain Symptom Manage · Feb 2022
Observational StudyIdentification of Palliative Care needs in cancer patients in a Surgical Emergency Centre.
Advanced cancer is associated with a significant symptom burden, and timely identification of palliative care (PC) needs, and provision of appropriate PC can improve treatment outcomes, reduce healthcare cost, and enhance patient and family satisfaction with care. Several tools have been used to identify PC needs in different clinical settings and patient groups. ⋯ Patients with PC needs comprise a significant proportion of SEC cancer admissions. This study shows the clear need for investment in staff and infrastructure to provide integrated palliative and end-of-life care as part of surgical services. The SPICTTM and SQ were shown to predict for early death in this cohort. Further validation of PC needs assessment tools is needed to guide the cost-effective implementation of PC services in low resource settings.
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Multicenter Study
Death and Dying in Hospitalized Pediatric Patients: A Prospective Multicenter, Multinational Study.
Background: For hospitalized children admitted outside of a critical care unit, the location, mode of death, "do-not-resuscitate" order (DNR) use, and involvement of palliative care teams have not been described across high-income countries. Objective: To describe location of death, patient and terminal care plan characteristics of pediatric inpatient deaths inside and outside the pediatric intensive care unit (PICU). Design: Secondary analysis of inpatient deaths in the Evaluating Processes of Care and Outcomes of Children in Hospital (EPOCH) randomized controlled trial. ⋯ Hospital palliative care consultation was more common in older children and independently associated with a lower adjusted odds (95% confidence interval) of dying in PICU [0.59 (0.52-0.68)]. Conclusion: Most pediatric inpatient deaths occur in PICU where patients were less likely to have a DNR or palliative care consult. Palliative care consultation could be better integrated into end-of-life care for younger children and those dying in PICU.