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The other barrier was related to the appraisal of other HCPs' clinical practices. Participating HCPs expressed in general a positive self-view, but were more critical of other HCPs. Conclusion Currently, implementation of measures to improve care for patients with advanced cancer appears to be challenging due to cultural and organizational factors, and how HCPs perceive themselves and other HCPs. HCPs' perception of challenges in patient care as not related to themselves (externalization) might be an essential obstacle. Interventions targeting both HCP-related and organizational factors are needed. Particularly important are measures aimed at reducing fragmentation and improving collaboration in care.Background To assess the efficacy and toxicity profiles of palliative radiation therapy (RT) for macroscopic hematuria (MH) caused by urothelial cancer. Methods A total of 25 urothelial cancer patients with MH who underwent palliative RT between 2008 and 2018 were analyzed in this retrospective study. The hematuria-free survival (HFS) time was defined as the period from complete resolution of MH to the recurrence of MH, death, or the last follow-up examination. Adverse events were classified according to the Common Terminology Criteria for Adverse Events version 4.0. Results By the end of the median follow-up duration of 90 days (11-886 days), complete resolution of MH had been achieved in 22 patients (88%), and the median interval between the start of RT and resolution of MH was 9 days (2-179 days). Of the 22 patients in whom the symptom resolved, 9 (41%) developed recurrent MH, and the median time to relapse of MH was 129 days (30-692 days). The median RT dose was 30 Gy (20-40 Gy). Nine (36%) patients received a blood transfusion before the RT. The three-month HFS rate was 52.1%. There was a significant difference in the three-month HFS rate between patients with and without a history of pretreatment blood transfusion (HFS rate 34.6% vs. 61.5%, p = 0.03). Grade 2 urinary tract pain and grade 3 diarrhea were seen in one patient each. Conclusion Palliative RT appeared to be effective with limited toxicities for urothelial cancer patients with MH.Background The intensity of predeath grief is associated with postdeath grief in family caregivers of patients in palliative care. Different factors during caregiving may influence this association. Objective To examine (1) the intensity of grief in relation to preparedness for caregiving, caregiver burden, and social support, and (2) if these variables moderate associations between predeath and postdeath grief. Methods This prospective correlational study used unpaired t-test to compare grief in relation to preparedness for caregiving, caregiver burden, and social support. Hierarchical multiple linear regression analysis investigated moderation effects. Family caregivers were recruited from 10 palliative homecare facilities. The Anticipatory Grief Scale, Texas Revised Inventory of Grief, Preparedness for Caregiving Scale, Caregiver Burden Scale, and Multidimensional Scale of Perceived Social Support were used. Ethical approval for the study was granted by the Regional Ethical Review Board in Stockholm, Sweden. Results In total, 128 family caregivers participated. Those with high caregiver burden scored significantly higher intensity of predeath but not postdeath grief. Caregiver burden and social support moderated the association between intensity of predeath grief and postdeath grief. There was a stronger association between predeath and postdeath grief among caregivers with low caregiver burden or low social support. Preparedness for caregiving had no moderating effect. Discussion Attention should be directed to caregiver burden and social support during family caregiving, as these variables seem to be significant for the intensity of grief before and after the patient's death. Acknowledging predeath grief during caregiving and recognizing pre- and postdeath grief as parts of the same process are of importance in clinical practice and when designing supportive interventions.Breathlessness is a distressing symptom that is often seen in palliative care patients with respiratory failure and it can make care in the home setting difficult. Humidified High Flow Nasal Oxygen is a relatively new intervention for respiratory failure, but it has not been researched greatly in a palliative care setting. One device with the capacity to deliver high flow humidified oxygen to spontaneously breathing patients is the myAIRVO2 humidifier.1 The myAIRVO2 is a humidifier with an integrated flow generator that delivers warmed and humidified respiratory gases to a spontaneously breathing patient.1 The following case report describes how the technology was used at home for symptom control in a 76 year old patient with severe chronic obstructive pulmonary disease with associated pulmonary hypertension. The patient was successfully discharged from hospital and managed at home using high-flow nasal oxygen for approximately one month up until his death. In this last month of life, he reported that he was more comfortable on high-flow nasal oxygen than on traditionally-administered oxygen. Humidified High Flow Nasal Oxygen is potentially beneficial to aid in symptom control for palliative care patients in an inpatient and community setting.Background During end-of-life care, the place in which the patients spend time influences their quality of life. Objective To clarify what it means to spend last days at home and in inpatient hospice. Design This study was a part of a nationwide multicenter questionnaire survey of bereaved family members of cancer patients evaluating the quality of end-of-life care in Japan. Setting/Subjects A nationwide questionnaire survey was conducted with 779 family members of cancer patients who had died at inpatient hospices. We asked participants about the perceived benefits of spending last days at home and inpatient hospice during the patient's last days. Measurements A nationwide questionnaire. Results Of participants, 37.6% (n = 185 [95% confidence interval, 33%-42%]) felt that the inpatient hospice was like a home. The family members who reported that the inpatient hospice felt like home significantly tended to report high satisfaction with the level of care (p  less then  0.01). Factors that the participants perceived as benefits of the inpatient hospice were "If anything changes, as health care professionals are easily available, he/she can handle it" (88.1%), "he/she is reassured" (78.4%), and "he/she is safe" (72.7%). On the contrary, factors that they perceived as benefits of home were "He/she can do what he/she wants to do without worrying about the eye of other people" (44.1%), "he/she can relax" (43.5%), and "he/she is free" (42.0%). Conclusions Spending the last days of life in either an inpatient hospice or at home has specific benefits. The place a patient spends his/her end-of-life days should be based on patient and family values.During the COVID-19 pandemic, much has changed in the delivery of palliative care (PC). However, cultural responsiveness remains critical to our mission. It is essential to our aims of identifying individual goals of care and providing relief of suffering for our patients. Cultural responsiveness may also enhance trust and could be a mitigating factor in the staggering health care disparities unmasked during this pandemic. In this study, the authors outline the rationale for renewed focus on this issue, and offer some initial suggestions for how culturally responsive PC can be provided even in this extraordinary time.Background Chronic breathlessness is a prevalent disabling syndrome affecting many people for years. Identifying the impact of chronic breathlessness on people's activities in the general population is pivotal for designing symptom management strategies. Objective This study aimed to evaluate the association between chronic breathlessness and activities respondents identify can no longer be undertaken ("activities forgone"). Design This population-based cross-sectional online survey used a market research company's database of 30,000 registrants for each sex, generating the planned sample size-3000 adults reflecting Australia's 2016 Census by sex, age group, state of residence, and rurality. Setting/Subjects The population of focus (n = 583) reported a modified Medical Research Council (mMRC) breathlessness scale ≥1 and experienced this breathlessness for ≥3 months. Measurements Activities forgone were categorized by mMRC using coding derived from the Dyspnea Management Questionnaire domains. Activities were classified as "higher/lower intensity" using Human Energy Expenditure scale. Results Respondents were male 50.3%; median age 50.0 (IQR 29.0); with 66% living in metropolitan areas; reporting 1749 activities forgone. For people with mMRC 1 (n = 533), 35% had not given up any activity, decreasing to 9% for mMRC 2 (n = 38) and 3% for mMRC 3-4 (n = 12). Intense sport (e.g., jogging and bike riding) was the top activity forgone 42% (mMRC 1), 32% (mMRC 2), and 36% (mMRC 3-4). For respondents with mMRC 3-4, the next most prevalent activities forgone were "sexual activities" (14%), "lower intensity sports" (11%), and "other activities" (11%). Conclusions People progressively reduce a wide range of activities because of their chronic breathlessness.Background Patients admitted to an acute care setting with a devastating brain injury are at high risk for morbidity and mortality. These patients and their families can benefit from the psychosocial and decision-making support of a palliative care consultation. Objective We aim to investigate the characteristics and impact of palliative care consultation for patients under the management of neurosurgical and critical care services with a devastating brain injury in a neurological intensive care unit (ICU) at a large tertiary-care hospital. Design Data were collected by retrospective review of the electronic medical record and metrics collected by the palliative care service. Data were analyzed using descriptive statistics. Linear regression analysis was performed to assess effect of timing of palliative care consultation. see more Results Fifty-five patients admitted to the neurological ICU under the management of the neurosurgical service received a palliative care consultation for the following hemorrhagic stroke (49%), metastatic cancer (22%), and traumatic brain injury (18%). Of these, 73% had at least one neurosurgical intervention. Palliative care was most frequently consulted for assistance in defining a patient's goals of care (88%). When compared with late consultation, early palliative care consultation was significantly associated with shorter mean length of stay (LOS) and positively correlated in linear regression analysis without an effect on mortality. Conclusions When compared with a late consultation, early palliative care consultation corresponded to shorter LOS without increasing mortality. One reason for this effect may be that palliative care can help to clarify and document goals of care earlier and more concretely.Objective To report our first case series of Dignity Therapy modified for a pediatric palliative care population. Background Dignity Therapy has been utilized successfully with terminally ill adult patients to help restore a sense of dignity and personhood as well as cope with existential distress near the end of life. To our knowledge, there are no published reports of this treatment modality in pediatric patients. Methods The authors report the experience of a single-center case series of Dignity Therapy in a pediatric palliative care population. The adult Dignity Therapy process was adapted to fit the pediatric population and their families. Modifications are explained in some detail, and specific cases are shared to illustrate the process. The goal of this case series is to report on the application of Dignity Therapy to the pediatric population. Setting/subjects Inclusion criteria for the cases series consisted of children and their families who were aware that death may occur soon, were English speaking, admitted to the hospital, and receiving care from the palliative care service.