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4 Mar, 17 | by bbutcher

Caregivers’ Perspectives on the Use of Long-Term Oxygen Therapy for the Treatment of Refractory Breathlessness: A Qualitative Study

Aileen Collier, Katrina Breaden, Jane L. Phillips, Meera Agar, Caroline Litster, David C. Currow.

J Pain Symptom Manage. 2017 Jan;53(1):33-39.

 

A qualitative study of the perspectives of 20 caregivers in the palliative setting of patients on long-term oxygen therapy (LTOT) for the treatment of refractory breathlessness was conducted using semi-structured interviews.

The main theme reported was that caregivers felt helpless and regarded oxygen as a life sustaining for people on LTOT and was vital in managing distressing symptoms and quality of life. However it also had financial costs and burdens including equipment, the noise from the concentrator, struggling with independence and leaving the house. The authors conclude that the possible harms of LTOT are underrated and highlight the importance of providing information and education about the appropriate use of LTOT.

 

Composed by Elaine Boland.

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20 Feb, 17 | by bbutcher

Prevalence of cancer chemotherapy-related problems, their relation to health-related quality of life and associated supportive care: a cross-sectional survey.

Wagland, Richardson A, Ewings S, Armes J, Lennan E, Hankins M, Griffiths P.

Support Care Cancer. 2016 Dec;24(12):4901-4911.

 

This study surveyed the prevalence of 17 problems whilst undergoing chemotherapy and people’s experiences of supportive care in 363 patients from six cancer centres in the UK. The EQ5D measure was also used. The response rate was 43%. The most common problem was tiredness/fatigue with 90% responders. Over 50% reported changes in sense of taste, difficulty managing everyday tasks, trouble sleeping, constipation, low mood, feeling sick, anxious, loss of appetite and unable to concentrate/forgetful.  In a multivariate model, difficulty with everyday tasks and work was significantly associated with health-related quality of life. Patients experienced less severe problems if they received supportive care; over a fifth stated that they never received support for emotional and social problems.

 

Composed by Elaine Boland.

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31 Jan, 17 | by bbutcher

Association Between Palliative Care and Patient and Caregiver Outcomes: A Systematic Review and Meta-analysis.

Kavalieratos D, Corbelli J, Zhang D, Dionne-Odom JN, Ernecoff NC, Hanmer J, Hoydich ZP, Ikejiani DZ, Klein-Fedyshin M, Zimmermann C, Morton SC, Arnold RM, Heller L, Schenker Y.

JAMA. 2016 Nov 22;316(20):2104-2114. doi: 10.1001/jama.2016.16840.

A narrative meta-analysis of randomized clinical trials (RCT) of palliative care interventions in adults with life-limiting illness was performed. 43 RCTs were included and involved 12,731 patients and 2479 caregivers (cancer and non-cancer). 23 RCTs were included in the meta-analysis. Palliative care interventions were associated with statistically and clinically significant improvements in physical symptoms and quality of life at 1 to 3 months. There was no association between palliative care and survival. There were improvements in patient and caregiver satisfaction with care, advance care planning and lower health care utilization with palliative care. When only the low risk of bias RCTs were meta-analysed, no statistically significant and clinically important associations remained.

 

Composed by Elaine Boland

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15 Jan, 17 | by bbutcher

Relationship between Opioid Treatment and Rate of Healing in Chronic Wounds.

Shanmugam VK, Couch KS, McNish S, Amdur RL.

Wound Repair Regen. 2016 Nov 16. doi: 10.1111/wrr.12496. [Epub ahead of print]

450 people participated in this longitudinal observational study to investigate the relationship between opioids and wound healing.  Using fixed-effects models and time-to-event analysis, opioid dose was significantly associated with total wound surface area (p<0.0001); subjects with mean opioid dose ≥10mg were significantly less likely to heal than those with no opioid (HR 0.67 [0.49-0.91], p=0.011) after adjusting for wound size. People who never had opioids healed faster than those who received opioids (p=0.0009). The authors plan to correlate the exposure of opioids and clinical outcome data with tissue mRNA expression array data which might help understand the molecular mechanisms that may contribute to delayed wound healing.

 

Composed by Elaine Boland

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31 Aug, 16 | by Jenny Thomas

JAMA Neurol. 2016 May 16. doi: 10.1001/jamaneurol.2016.0383. [Epub ahead of print]

The Association of Chemotherapy-Induced Peripheral Neuropathy Symptoms and the Risk of Falling.

Kolb NA, Smith AG, Singleton JR, et al

A secondary analysis of a prospective study was performed to determine the association between the symptoms of taxane/platinum chemotherapy-induced peripheral neuropathy (CIPN) and the risk of falls. From 116 patients with breast, ovarian, or lung cancer, 32 had CIPN symptoms. Seventy-four falls or near falls were reported over an average follow-up of 2 months. Those with CIPN were nearly 3 times more likely to report a fall or near fall than those without, with 8/32 (25%) with CIPN obtaining medical care for falls, compared to 6/84 (7%) without CIPN. The authors suggest education and monitoring of patients receiving neurotoxic chemotherapy may facilitate fall prevention strategies.

Shortcuts are compiled by Jason Boland

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22 Aug, 16 | by Jenny Thomas

Nephrol Dial Transplant. 2016

End-of-life care for people with chronic kidney disease: cause of death, place of death and hospital costs.

Kerr M, Matthews B, Medcalf JF, O’Donoghue D.

Associations between chronic kidney disease (CKD), place of death and hospital costs in adults with CKD in England in the final 3 years of life.

Using Hospital Episode Statistics data linked to Office for National Statistics mortality data, associations between place of death and hospital costs in adults with chronic kidney disease (CKD) in England was evaluated. From over 1.6 million adults, 13% had CKD. 11% of people with CKD died at home compared with 17% matched non-CKD group. CKD was associated with an increase in hospital costs of £3380 in the last year of life and a home death was associated with a reduction in hospital costs of £2811 in the CKD group in the last year of life. The most commonly recorded cause of death in people with CKD was heart disease and CKD was not on two-thirds of the death certificates.

Shortcuts are compiled by Jason Boland

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8 Aug, 16 | by Jenny Thomas

Support Care Cancer. 2016

Patient and health care provider perceptions of cancer-related fatigue and pain.

Williams LA, Bohac C, Hunter S, Cella D.

Surveys were used to determine the impact of fatigue and pain and compare perceptions of patients with cancer and oncologists/oncology nurses. From a random sample of adult patients from the general US population with a non-hematologic tumour treated with >2 months of systemic anticancer therapy, 550 of 1122 (49%) completed a survey. This was along with 400 of 533 oncologists (75%), and 400 of 617 oncology nurses (65%), who had to spend >75% of their work time in patient care and >50% providing direct care for adult patients with solid tumours receiving chemotherapy. 98% of patients reported fatigue; 72% of oncologists and 84% of oncology nurses thought this was the case.

From the patients, 58% reported that fatigue affected them more than pain during chemotherapy compared with 29% of oncologists and 25% of oncology nurses. 86% of patients reported pain while undergoing chemotherapy; 36% of oncologists and 51% of oncology nurses thought this. Oncologists/oncology nurses underestimated fatigue and pain for patients with cancer during chemotherapy, showing the importance of assessing symptoms by direct patient reporting.

Shortcuts are compiled by Jason Boland

Shortcuts

25 Jul, 16 | by Jenny Thomas

Int J Geriatr Psychiatry. 2016 Mar 27. doi: 10.1002/gps.4463. [Epub ahead of print]

The management of behavioural and psychological symptoms of dementia in the acute general medical hospital: a longitudinal cohort study.

White N, Leurent B, Lord K, et al

A longitudinal cohort study of 230 patients with dementia admitted to two UK hospitals assessed behavioural and psychological symptoms and documentation of non-pharmacological and pharmacological management. 75% of patients with dementia had behavioural and psychological symptoms (especially aggression and activity disturbance). Non-pharmacological management was used in 55% of patients, 36% had psychosocial interventions with little evidence of effectiveness monitoring. Patients were prescribed antipsychotics (12%), benzodiazepines (12%), antidepressants (16%), or sedatives (3%). Patients prescribed antipsychotics were nearly 6 times more likely to die, compared to those who were not.

Shortcuts are compiled by Jason Boland

Shortcuts

11 Jul, 16 | by Jenny Thomas

Palliat Med. 2016 Mar 24. pii: 0269216316640421. [Epub ahead of print]

Perspectives of people with mild intellectual disabilities on care relationships at the end of life: A group interview study.

Bekkema N, de Veer AJ, Hertogh CM, Francke AL.

Seven group interviews including 33 people with mild intellectual disabilities in the Netherlands explored care relationships at the end-of-life. The main themes were a) dealing with wishes and b) ‘being there’. it was important for the wishes of the ill person to be ascertained (including preferences relating to personal care, end of life and funeral),that these are recorded and honoured; there was an emphasis on control and respecting autonomy. They need people who are there, practically (providing help and care if needed), emotionally (listening and providing empathy, especially from familiar people), socially (including social activities) and spiritually (providing existential guidance and support), with an emphasis on providing positive experiences. The authors conclude that there is added value and potential of involving people with intellectual disabilities in studies on end-of-life care.

Shortcuts are compiled by Jason Boland

Shortcuts

27 Jun, 16 | by Jenny Thomas

PLoS One. 2016 Mar 24;11(3):e0151435. doi: 10.1371/journal.pone.0151435. eCollection 2016.

Patient Perspectives of Dignity, Autonomy and Control at the End of Life: Systematic Review and Meta-Ethnography.

Rodríguez-Prat A, Monforte-Royo C, Porta-Sales J et al

In a systematic review and meta-ethnography to explore the relationship between perceived dignity, autonomy and sense of control in patients at the end of life, 21 studies (400 participants) were included. There were three broad themes: a) dignity mediated by the loss of functionality, linked to the loss of control and of the value ascribed to one’s life; b) dignity as identity, which related to self-identity and the impact of social factors; and c) autonomy as a determining factor of perceived dignity, was linked to the desire for self-determination and control over dying. The authors suggest that dignity and autonomy are interconnected, multidimensional and dynamic concepts, similar to personal identity. Patients with an intrinsic sense of dignity maintained a positive view of themselves despite their illness, thus it is central to care to address the areas of life on which a patient’s dignity is based.

Shortcuts are compiled by Jason Boland

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