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1.
Liz Forbat Karemah Fran?ois Lynne O&#x;Callaghan Julie Kulikowski 《Journal of pain and symptom management》2018,55(5):1253-1259
Context
Family meetings are increasingly used in palliative care, yet have little empirical evidence of their impact in inpatient settings.Objectives
To examine whether relatives report more empathy after a family meeting in a specialist palliative care inpatient ward.Methods
Pre/post self-complete questionnaires measuring relational empathy and information needs were administered. Qualitative interviews were also conducted. Data were collected during nine months from one inpatient specialist palliative care unit. Participants from 52 family meetings completed pre/post questionnaires, and 13 relatives participated in an interview that was analyzed thematically.Results
Families reported more empathy from staff after a family meeting (Wilcoxon test: n = 47; P > 0.001; Z score ?4.17). Some families with relatives who do not speak with each other reported that meeting facilitators were unable to manage the pre-existing dynamics.Conclusion
Family meetings improve reported empathy. It would be beneficial to have more specific preparation and planning by the clinical team for meetings with people who have a history of familial conflict, and those where the staff's agenda is around discharge planning. Published guidelines could be adapted to better support staff to run meetings where there are complex family dynamics. Adoption of family meetings in outpatient settings has the potential to improve perceptions of empathy with a larger patient group. 相似文献2.
Peter May Melissa M. Garrido Egidio Del Fabbro Danielle Noreika Charles Normand Nevena Skoro J. Brian Cassel 《Journal of pain and symptom management》2018,55(3):766-774.e4
Context
Inpatient palliative care (PC) is associated with reduced costs, but the optimal model for providing inpatient PC is unknown.Objectives
To estimate the effect of palliative care consultations (PCCs) and care in a palliative care unit (PCU) on cost of care, in comparison with usual care (UC) only and in comparison with each other.Methods
Retrospective cohort study, using multinomial propensity scoring to control for observed confounding between treatment groups. Participants were adults admitted as inpatients between 2009 and 2015, with at least one of seven life-limiting conditions who died within a year of admission (N = 6761).Results
PC within 10 days of admission is estimated to reduce costs compared with UC in the case of both PCU (?$6333; 95% CI: ?7871 to ?4795; P < 0.001) and PCC (?$3559; 95% CI: ?5732 to ?1387; P < 0.001). PCU is estimated to reduce costs compared with PCC (?$2774; 95% CI: ?5107 to ?441; P = 0.02) and length of stay compared with UC (?1.5 days; ?2.2 to ?0.9; P < 0.001). The comparatively larger effect of PCU over PCC is not observable when the treatment groups are restricted to those who received PC early in their admission (within six days).Conclusion
Both PCU and PCC are associated with lower hospital costs than UC. PCU is associated with a greater cost-avoidance effect than PCC, except where both interventions are provided early in the hospitalization. Both timely provision of PC for appropriate patients and creation of more PCUs may decrease hospital costs. 相似文献3.
James P. Donnelly Kim Downing Jason Cloen Patricia Fragen Alyssa W. Gupton Jen Misasi Kelly Michelson 《Journal of pain and symptom management》2018,55(4):1077-1084.e2
Context
Pediatric palliative care has no evidence-based needs assessment measure. The Parent and Child Needs Survey (PCNeeds) is a new instrument designed to assess the needs of children in palliative care, including children receiving end-of-life care, and their families.Objectives
This study examines the psychometrics of and respondents' perceptions about the PCNeeds.Methods
Parents of children in four outpatient pediatric palliative care programs completed the PCNeeds and the World Health Organization Quality of Life–Brief tool (WHOQOL-BREF). Parents answered questions about demographics and the experience of completing the PCNeeds. Internal scale reliability was measured with Cronbach's alpha. Validity was assessed by correlating the PCNeeds total and subscale scores with the WHOQOL-BREF subscales. Additional respondent perceptions were obtained via written comments and analyzed using content analysis.Results
The 93 respondents were predominantly female (n = 69, 74%); white (n = 79, 85%); college graduates (n = 71, 76%); and married or partnered (n = 75, 81%). Internal reliability was acceptable (Cronbach's α = 0.83), and validity correlations with the WHOQOL-BREF subscales were consistent with theoretical expectations (moderate negative correlations ranging from ?0.36 to ?0.51). The most frequently cited need not addressed by our survey was sibling impact (n = 17, 18%). Twelve parents (13%) indicated that no content was missing. The least met needs were financial impact, family impact, and the child's physical problems besides pain. Sixty-eight percent of parents (n = 63) rated completion of the survey as “easy” or “very easy.”Conclusion
Initial psychometric analysis of the PCNeeds is encouraging, but further study of reliability and validity with more diverse respondents is needed. 相似文献4.
Hanne B. Alfheim Leiv A. Rosseland Kristin Hofsø Milada C. Småstuen Tone Rustøen 《Journal of pain and symptom management》2018,55(2):387-394
Context
Intensive care unit (ICU) patients experience physical and psychological challenges related to ICU admission in the acute and recovery phases after a critical illness. Involvement of family caregivers (FCs) is essential in the patients' struggle to survive critical illness. FCs report a high symptom burden related to ICU admission. Previous research has investigated mainly single symptoms. Little is known about multiple symptom burden related to FC experiences in an ICU.Objective
This study aimed: 1) to describe the occurrence, severity, and distress related to multiple symptoms in FCs of ICU patients, and 2) to identify associations between the background characteristics and symptom burden of FCs.Methods
This cross-sectional study investigated multiple symptoms in adult FCs of ICU patients. FCs completed a self-report symptom assessment questionnaire within 2 weeks after the patient's admission to the ICU.Results
FCs (N=211) experienced a median of 9 (range 0–24) symptoms, among which, worrying (91%) was the most occurring. Severity and distress varied between symptoms. Younger age, being a spouse of an ICU patient, and having more comorbidities were significantly associated with the number of symptoms.Conclusions
FCs of ICU patients experience multiple symptoms, among which, psychological symptoms are most occurring. Age, relationship to the patient, and comorbidities were significantly associated with the number of symptoms reported by FCs. Comprehensive symptom assessment may identify FCs who are at risk of developing a high symptom burden when the patient is admitted to the ICU. 相似文献5.
Amanda Su Lindsay Lief David Berlin Zara Cooper Daniel Ouyang John Holmes Renee Maciejewski Paul K. Maciejewski Holly G. Prigerson 《Journal of pain and symptom management》2018,55(6):1591-1598.e1
Context
Deaths in the intensive care unit (ICU) are increasingly common in the U.S., yet little is known about patients' experiences at the end of life in the ICU.Objectives
The objective of this study was to determine nurse assessment of symptoms experienced, and care received by ICU patients in their final week, and their associations with nurse-perceived suffering and dignity.Methods
From September 2015 to March 2017, nurses who cared for 200 ICU patients who died were interviewed about physical and psychosocial dimensions of patients' experiences. Medical chart abstraction was used to document baseline patient characteristics and care.Results
The patient sample was 61% males, 70.2% whites, and on average 66.9 (SD 15.1) years old. Nurses reported that 40.9% of patients suffered severely and 33.1% experienced severe loss of dignity. The most common symptoms perceived to contribute to suffering and loss of dignity included trouble breathing (44.0%), edema (41.9%), and loss of control of limbs (36.1%). Most (n = 9) remained significantly (P < 0.05) associated with suffering, after adjusting for physical pain, including fever/chills, fatigue, and edema. Most patients received vasopressors and mechanical ventilation. Renal replacement therapy was significantly (<0.05) associated with severe suffering (adjusted odds ratio [AOR] 2.53) and loss of dignity (AOR 3.15). Use of feeding tube was associated with severe loss of dignity (AOR 3.12).Conclusion
Dying ICU patients are perceived by nurses to experience extreme indignities and suffer beyond physical pain. Attention to symptoms such as dyspnea and edema may improve the quality of death in the ICU. 相似文献6.
Seelwan Sathitratanacheewin Ruth A. Engelberg Lois Downey Robert Y. Lee James A. Fausto Helene Starks Ben Dunlap James Sibley William Lober Elizabeth T. Loggers Nita Khandelwal J. Randall Curtis 《Journal of pain and symptom management》2018,55(1):75-81
Context
Recent analyses of Medicare data show decreases over time in intensity of end-of-life care. Few studies exist regarding trends in intensity of end-of-life care for those under 65 years of age.Objectives
To examine recent temporal trends in place of death, and both hospital and intensive care unit (ICU) utilization, for age-stratified decedents with chronic, life-limiting diagnoses (<65 vs. ≥65 years) who received care in a large healthcare system.Methods
Retrospective cohort using death certificates and electronic health records for 22,068 patients with chronic illnesses who died between 2010 and 2015. We examined utilization overall and stratified by age using multiple regression.Results
The proportion of deaths at home did not change, but hospital admissions in the last 30 days of life decreased significantly from 2010 to 2015 (hospital b = ?0.026; CI = ?0.041, ?0.012). ICU admissions in the last 30 days also declined over time for the full sample and for patients aged 65 years or older (overall b = ?0.023; CI = ?0.039, ?0.007), but was not significant for younger decedents. Length of stay (LOS) did not decrease for those using the hospital or ICU.Conclusion
From 2010 to 2015, we observed a decrease in hospital admissions for all age groups and in ICU admissions for those over 65 years. As there were no changes in the proportion of patients with chronic illness who died at home nor in hospital or ICU LOS in the last 30 days, hospital and ICU admissions in the last 30 days may be a more responsive quality metric than site of death or LOS for palliative care interventions. 相似文献7.
Fangyi Li Minggen Zhou Zijun Zou Weichao Li Canxia Huang Zhijie He 《Asian nursing research.》2018,12(4):299-303
Purpose
Developing a risk prediction model for invasive fungal disease based on an analysis of the disease-related risk factors in critically ill patients in the intensive care unit (ICU) to diagnose the invasive fungal disease in the early stages and determine the time of initiating early antifungal treatment.Methods
Data were collected retrospectively from 141 critically ill adult patients with at least 4 days of general ICU stay at Sun Yat-sen Memorial Hospital, Sun Yat-sen University during the period from February 2015 to February 2016. Logistic regression was used to develop the risk prediction model. Discriminative power was evaluated by the area under the receiver operating characteristics (ROC) curve (AUC).Results
Sequential organ failure assessment (SOFA) score, antibiotic treatment period, and positive culture of Candida albicans other than normally sterile sites are the three predictors of invasive fungal disease in critically ill patients in the ICU. The model performs well with an ROC-AUC of .73.Conclusion
The risk prediction model performs well to discriminate between critically ill patients with or without invasive fungal disease. Physicians could use this prediction model for early diagnosis of invasive fungal disease and determination of the time to start early antifungal treatment of critically ill patients in the ICU. 相似文献8.
Bernard L. Prado Ali Haider Syed Naqvi Roberto C. Pestana Janet L. Williams Seyedeh Dibaj Diane Liu Julio Allo Vera De La Cruz Eduardo Bruera 《Journal of pain and symptom management》2019,57(1):86-92
Context
Optimal benefits from palliative care (PC) are achieved when first consults (PC1) occur early, in the outpatient setting. Late PC1, like those in the intensive care unit (ICU), limit these benefits.Objectives
The objective of this study was to determine the proportion of PC1 over time in the outpatient, ICU, and inpatient non-ICU settings. We also examined patients' baseline characteristics and the timing of PC access (from PC1 to death) by the setting of PC1.Methods
We retrospectively evaluated consecutive cancer patients' records at our cancer center to ascertain the annual number of PC1 and its distribution across settings (2011–2017). ICU PC1 (n = 309) and a random sample of an equal number of outpatient and inpatient non-ICU PC1 were reviewed to retrieve patients' characteristics and death date.Results
PC1 total annual number increased by 58% from 2011 (n = 2286) to 2017 (n = 3615). We found a significant decrease in the proportion of ICU PC1 (from 2.3% in 2011 to 1% in 2017, P < 0.001). There were no significant changes in the proportion of PC1 at outpatient versus inpatient settings (P = 0.2). Hematologic cancer patients were more likely to have an ICU PC1 (P < 0.001). Median survival (months) was 7.7 (6.3–9.7), 3.4 (2.4–4.5), and 0.1 (0.1–0.1) for outpatient, inpatient, and ICU, respectively (P < 0.01).Conclusion
PC1 total annual number has increased, and the proportion of PC1 at ICU, a very late clinical setting, is decreasing. Further efforts are needed to integrate PC in hematologic cancer care. 相似文献9.
Paul Rood Getty Huisman - de Waal Hester Vermeulen Lisette Schoonhoven Peter Pickkers Mark van den Boogaard 《Australian critical care》2018,31(3):180-187
Background
Delirium occurs frequently in intensive care unit (ICU) patients and is associated with numerous deleterious outcomes. There is a large variation in reported delirium occurrence rates, ranging from 4% to 89%. Apart from patient and treatment-related factors, organisational factors could influence delirium incidence, but this is currently unknown.Objective
To systematically review delirium incidence and determine whether or not organisational factors may contribute to the observed delirium incidence in adult ICU patients.Methods
Systematic review of prospective cohort studies reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Included articles were independently assessed by two researchers. Quality of the articles was determined using the Strengthening the Reporting of Observational Studies in Epidemiology checklist. Subsequently, apart from patient characteristics, a meta-regression analysis was performed on available organisational factors, including hospital type, screening method and screening frequency.Data Sources
PubMed, Embase, CINAHL, and Cochrane Library databases were searched from inception to 27 January 2017, without language limitation.Results
A total of 9357 articles were found, of which 19 articles met the inclusion criteria and were considered as true delirium incidence studies. The articles were of good methodological quality (median [interquartile range] 32/38 [30–35] points), published between 2005 and 2016, originated from 17 countries. A total of 9867 ICU patients were included. The incidence rate of delirium varied between 4% and 55%, with a mean ± standard deviation of 29 ± 14%. Data relating to three organisational factors were included in the studies, but they were not significantly associated with the reported delirium incidence: hospital type (p 0.48), assessment methods (p 0.41), and screening frequency (p 0.28).Conclusions
The mean incidence of delirium in the ICU was 29%. The organisational factors found including methods of delirium assessment, screening frequency, and hospital type were not related to the reported ICU delirium incidence. 相似文献10.
Shelli L. Feder Meredith Campbell Britton Sarwat I. Chaudhry 《Journal of pain and symptom management》2018,55(3):930-937
Context
The number of patients discharged from acute care hospitals to skilled nursing facilities (SNFs) is rising. These patients have increasingly complex needs and many experience poor outcomes while under SNF care, including hospital readmissions. Patients' goals of care (GoC) are viewed as a factor contributing to unplanned hospital readmissions from SNFs. However, clinicians' perspectives of GoC for hospitalized patients discharged to SNFs are not well-described.Objectives
To explore how clinicians view GoC for hospitalized patients discharged to SNFs.Methods
Qualitative study using semi-structured interviews and thematic analysis.Results
Forty-one clinicians from one acute care hospital and two SNFs completed interviews ranging in length from 14 to 52 minutes (mean = 32 minutes). Of the sample, 22% were nurses, 20% physicians, 15% were from care management, and 15% were from social services. Respondents viewed patients' GoC for continuing treatment at the SNF as important, but acknowledged that they were infrequently discussed during hospitalization. Many respondents felt that patients and families had unrealistic GoC for SNF care. Factors that contributed to unrealistic GoC included patients' limited knowledge of disease processes, prognosis, and treatment options; and inconsistent or insufficient communication of GoC among hospital and SNF clinicians, the patient, and family members. Respondents associated a lack of GoC or unrealistic GoC with patients' dissatisfaction with SNF care, unplanned transitions to hospice, and hospital readmissions.Conclusions
Respondents reported that GoC conversations infrequently occurred during hospitalization, contributing to unrealistic patient and family expectations for SNF care and poor patient outcomes. Interventions are needed that facilitate timely, accurate, and consistent GoC discussions across care continuums. 相似文献11.
J. Nicholas Dionne-Odom Richard Taylor Gabrielle Rocque Carol Chambless Thomas Ramsey Andres Azuero Nataliya Ivankova Michelle Y. Martin Marie A. Bakitas 《Journal of pain and symptom management》2018,55(6):1519-1530
Context
There is a scarcity of early palliative care interventions to support family caregivers of persons with advanced cancer living in the rural Southern U.S.Objective
The objective of this study was to adapt the content, format, and delivery of a six session, palliative care, telehealth intervention with monthly follow-up for rural family caregivers to enhance their own self-care and caregiving skills.Methods
Qualitative formative evaluation consisting of one-on-one, semistructured interviews with rural-dwelling persons with metastatic cancer (n = 18), their primary family caregiver (n = 20), and lay patient navigators (n = 26) were conducted to elicit feedback on a family caregiver intervention outline based on published evidence-based interventions. Transcribed interviews were analyzed using a thematic analysis approach. Coinvestigators reviewed and refined preliminary themes.Results
Participants recommended that intervention topical content be flexible and has an adaptable format based on continuous needs assessment. Sessions should be 20 minutes long at minimum, and additional sessions should be offered if requested. Faith and spirituality is essential to address but should not be an overarching intervention theme. Content needs to be communicated in simple language. Intervention delivery via telephone is acceptable, but face-to-face contact is desired to establish relationships. Other Internet-based technologies (e.g., video-conferencing) could be helpful, but many rural dwellers may not be technology savvy or have Internet access. Most lay navigators believed they could lead the intervention with additional training, protocols for professional referral, and supervision by specialty-trained palliative care clinicians.Conclusions
A potentially scalable palliative care intervention is being adapted for family caregivers of rural-dwelling persons with advanced cancer and will undergo piloting in a small-scale randomized controlled trial. 相似文献12.
Katherine L. Marcus Emily M. Balkin Hasan Al-Sayegh Elyssa Guslits Elizabeth D. Blume Clement Ma Joanne Wolfe 《Journal of pain and symptom management》2018,55(2):351-358
Context
Although access to subspecialty pediatric palliative care (PPC) is increasing, little is known about the role of PPC for children with advanced heart disease (AHD).Objectives
The objective of this study was to examine features of subspecialty PPC involvement for children with AHD.Methods
This is a retrospective single-institution medical record review of patients with a primary diagnosis of AHD for whom the PPC team was initially consulted between 2011 and 2016.Results
Among 201 patients, 87% had congenital/structural heart disease, the remainder having acquired/nonstructural heart disease. Median age at initial PPC consultation was 7.7 months (range 1 day–28.8 years). Of the 92 patients who were alive at data collection, 73% had received initial consultation over one year before. Most common indications for consultation were goals of care (80%) and psychosocial support (54%). At initial consultation, most families (67%) expressed that their primary goal was for their child to live as long and as comfortably as possible. Among deceased patients (n = 109), median time from initial consultation to death was 33 days (range 1 day–3.6 years), and children whose families expressed that their primary goal was for their child to live as comfortably as possible were less likely to die in the intensive care unit (P = 0.03) and more likely to die in the setting of comfort care or withdrawal of life-sustaining interventions (P = 0.008).Conclusion
PPC involvement for children with AHD focuses on goals of care and psychosocial support. Findings suggest that PPC involvement at end of life supports goal-concordant care. Further research is needed to clarify the impact of PPC on patient outcomes. 相似文献13.
Michael D. April Jose Aguirre Lloyd I. Tannenbaum Tyler Moore Alexander Pingree Robert E. Thaxton Daniel J. Sessions James H. Lantry 《The Journal of emergency medicine》2017,52(5):622-631
Background
Quick Sequential Organ Failure Assessment (qSOFA) is a prognostic score for patients with sepsis.Objective
Our aim was to compare the area under the receiver operating curve (AUROC), sensitivity, specificity, and likelihood ratios of qSOFA vs. systemic inflammation response syndrome (SIRS) in predicting in-hospital mortality among emergency department (ED) patients with suspected infection admitted to intensive care units (ICUs).Methods
We conducted a retrospective cohort chart review study of ED patients admitted to an ICU with suspected infection from August 1, 2012 to February 28, 2015. We included all patients with body fluid cultures sampled either during their ED stay without antibiotic administration or within 24 h of antibiotics administered in the ED. Trained chart abstractors blinded to the study hypothesis double-entered data from each patient's electronic medical record including demographic characteristics, vital signs, laboratory study results, physical examination findings, and in-hospital mortality. We then calculated the AUROC, sensitivity, specificity, and likelihood ratios for qSOFA and SIRS for predicting in-hospital mortality.Results
Of 214 patients admitted to an ICU with presumed sepsis, 39 (18.2%) died during hospitalization. The AUROC value was 0.65 (95% confidence interval [CI] 0.56–0.74) for SIRS vs. 0.66 (95% CI 0.57–0.76) for qSOFA; 2+ qSOFA criteria predicted in-hospital mortality with 89.7% sensitivity, 27.4% specificity, 1.2 positive likelihood ratio, and 0.4 negative likelihood ratio.Conclusions
Among ED patients admitted to an ICU, the SIRS and qSOFA criteria had comparable prognostic value for predicting in-hospital mortality. These prognostic values are similar to those reported by the Sepsis-3 guidelines for ICU encounters. 相似文献14.
Samar M. Aoun Gail Ewing Gunn Grande Chris Toye Natasha Bear 《Journal of pain and symptom management》2018,55(2):368-378
Context
The investigation of the situation of bereaved family caregivers following caregiving during the end-of-life phase of illness has not received enough attention.Objectives
This study investigated the extent to which using the Carer Support Needs Assessment Tool (CSNAT) intervention during the caregiving period has affected bereaved family caregivers' perceptions of adequacy of support, their grief and well-being, and achievement of their preferred place of death.Method
All family caregivers who participated in a stepped-wedge cluster trial of the CSNAT intervention in Western Australia (2012–2014) and completed the pre-bereavement study (n = 322) were invited to take part in a caregiver survey by telephone four to six months after bereavement (2015). The survey measured the adequacy of end-of-life support, the level of grief, the current physical and mental health, and the achievement of the preferred place of death.Results
The response rate was 66% (152, intervention; 60, control). The intervention group perceived that their pre-bereavement support needs had been adequately met to a significantly greater extent than the control group (d = 0.43, P < 0.001) and that patients have achieved their preferred place of death more often according to their caregivers (79.6% vs. 63.6%, P = 0.034). There was also a greater agreement on the preferred place of death between patients and their caregivers in the intervention group (P = 0.02).Conclusions
The results from this study provide evidence that the CSNAT intervention has a positive impact on perceived adequacy of support of bereaved family caregivers and achievement of preferred place of death according to caregivers. The benefits gained by caregivers in being engaged in early and direct assessment of their support needs before bereavement reinforce the need for palliative care services to effectively support caregivers well before the patient's death. 相似文献15.
Soon-Ock Choi Sook-Nam Kim Seong-Hoon Shin Ji-Seon Ryu Jeong-Won Baik Jung-Rim Kim Nae-Hyeon Kim 《Asian nursing research.》2018,12(4):286-292
Purpose
This study aimed to evaluate the outcomes of a community-based palliative care project conducted in Busan city, Korea, from 2013 to 2015.Methods
We selected four outcome indices based on the project's outcomes derived from a logic model and used a longitudinal and cross-sectional comparative design approach depending on the outcome index.Results
The utilization rate of palliative care increased from 9.2% in 2012 to 41.9% in 2015. Regarding symptom changes in 65 patients receiving palliative care at 3 and 6 months (mean age = 72 years, standard deviation = 9.64, 55.4% women), pain, anxiety, and depression had improved. Quality of life was higher among palliative care patients compared with patients who did not receive palliative care (t = 2.09, p = .039). Regarding recognition of palliative care, civil servants at public health centers who participated in the pilot project (2013–2014) scored higher than those at public health centers who began participation in 2015 (t = 2.67, p = .008).Conclusion
This is the first study in Korea that systematically evaluated community-based palliative care. The Busan Community-based Palliative Care Project improved the quality of life of palliative care patients by providing services at an appropriate level and by raising the recognition of palliative care in the community. To increase the utilization ratio of palliative care and the quality of service, strategies should be developed to supplement medical support systems. 相似文献16.
Pasithorn A. Suwanabol Arielle E. Kanters Ari C. Reichstein Lauren M. Wancata Lesly A. Dossett Emily B. Rivet Maria J. Silveira Arden M. Morris 《Journal of pain and symptom management》2018,55(4):1196-1215.e5
Context
The provision of palliative care varies appropriately by clinical factors such as patient age and severity of disease and also varies by provider practice and specialty. Surgical patients are persistently less likely to receive palliative care than their medical counterparts for reasons that are not clear.Objectives
We sought to characterize surgeon-specific determinants of palliative care in seriously ill and dying patients.Methods
We performed a systematic review of the literature focused on surgery and palliative care within PubMed, CINAHL, EMBASE, Scopus, and Ovid Medline databases from January 1, 2000 through December 31, 2016 according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Quantitative and qualitative studies with primary data evaluating surgeons' attitudes, knowledge, and behaviors or experiences in care for seriously ill and dying patients were selected for full review by at least two study team members based on predefined inclusion criteria. Data were extracted based on a predetermined instrument and compared across studies using thematic analysis in a meta-synthesis of qualitative and quantitative findings.Results
A total of 2589 abstracts were identified and screened, and 35 articles (26 quantitative and nine qualitative) fulfilled criteria for full review. Among these, 17 articles explored practice and attitudes of surgeons regarding palliative and end-of-life care, 11 articles assessed training in palliative care, five characterized surgical decision making, one described behaviors of surgeons caring for seriously ill and dying patients, and one explicitly identified barriers to use of palliative care. Four major themes across studies affected receipt of palliative care for surgical patients: 1) surgeons' experience and knowledge, 2) surgeons' attitudes, 3) surgeons' preferences and decision making for treatment, and 4) perceived barriers.Conclusions
Among the articles reviewed, surgeons overall demonstrated insight into the benefits of palliative care but reported limited knowledge and comfort as well as a multitude of challenges to introducing palliative care to their patients. These findings indicate a need for wider implementation of strategies that allow optimal integration of palliative care with surgical decision making. 相似文献17.
Leona Bannon Jennifer McGaughey Mike Clarke Daniel F. McAuley Bronagh Blackwood 《Australian critical care》2018,31(3):174-179
Background
Implementation of quality improvement interventions can be enhanced by exploring the perspectives of those who will deliver and receive them. We designed a non-pharmacological bundle for delirium management for a feasibility trial, and we sought to obtain the views of intensive care unit (ICU) staff, survivors, and families on the barriers and facilitators to its implementation.Objective
The objective of this study is to determine the barriers and facilitators to a multicomponent bundle for delirium management in critically ill patients comprising (1) education and family participation, (2) sedation minimisation and pain, agitation, and delirium protocol, (3) early mobilisation, and (4) environmental interventions for sleep, orientation, communication, and cognitive stimulation.Methods
Nine focus group interviews were conducted with ICU staff (n = 68) in 12 UK ICUs. Three focus group interviews were conducted with ICU survivors (n = 12) and their family members (n = 2). Interviews were digitally recorded, transcribed, and thematically analysed using the Braun and Clarke framework.Results
Overall, staff, survivors, and their families agreed the bundle was acceptable. Facilitating factors for delivering the bundle were staff and relatives' education about potential benefits and encouraging family presence. Facilitating factors for sedation minimisation were evening ward rounds, using non-verbal pain scores, and targeting sedation scores. Barriers identified by staff were inadequate resources, poor education, relatives' anxiety, safety concerns, and ICU culture. Concerns were raised about patient confidentiality when displaying orientation materials and managing resources for early mobility. Survivors cited that flexible visiting and re-establishing normality were important factors; and staff workload, lack of awareness, and poor communication were factors that needed to be considered before implementation.Conclusion
Generally, the bundle was deemed acceptable and deliverable. However, like any complex intervention, component adaptations will be required depending on resources available to the ICU; in particular, involvement of pharmacists in the ward round and physiotherapists in mobilising intubated patients. 相似文献18.
Maryellen Potts Kathleen B. Cartmell Lynne Nemeth Gautam Bhattacharjee Suparna Qanungo 《Journal of pain and symptom management》2018,55(5):1382-1397.e7
Context
To meet the growing need for palliative care in low-resource countries, palliative care programs should be evidence based and contextually appropriate. This study was conducted to synthesize the current evidence to guide future programmatic and research efforts.Objectives
This systematic review evaluated palliative care outcome measures, outcomes, and interventions in low-resource countries.Methods
After title searches, abstracts and full-text articles were screened for inclusion. Data were extracted to report on intervention models, outcome measures used, and intervention outcomes.Results
Eighteen papers were reviewed, reporting on interventions conducted across nine low-resource countries. These interventions evaluated home-based palliative care models; a community-managed model; palliative care integrated with hospitals, hospices, or HIV clinics; and models focused on patients' self-management. Three studies were randomized controlled trials. Other studies used nonrandomized trials, cohort studies, mixed methods, pre-post test evaluation, cost-accounting evaluation, and cross-sectional surveys. Thirteen studies measured physical outcomes, 10 using multidimensional instruments. Nine studies measured psychological outcomes, eight using multidimensional instruments. Nine studies measured social outcomes, seven using multidimensional instruments. Nine studies measured outcomes across multiple domains. Across outcomes evaluated, results were reported in the direction of benefit associated with palliative care interventions.Conclusion
Many palliative care intervention models exist to serve patients in low-resource countries. Yet, limited high-quality evidence from low-resource countries is available to document intervention outcomes. Rigorous experimental studies and greater measurement of multidimensional aspects of palliative care are needed to advance the science of palliative care in low-resource settings. 相似文献19.
Yuya Hagiwara Jennifer Healy Shuko Lee Jeanette Ross Dixie Fischer Sandra Sanchez-Reilly 《Journal of pain and symptom management》2018,55(1):89-93
Context
A cornerstone procedure in Palliative Medicine is to perform family meetings. Learning how to lead a family meeting is an important skill for physicians and others who care for patients with serious illnesses and their families. There is limited evidence on how to assess best practice behaviors during end-of-life family meetings.Objectives
Our aim was to develop and validate an observational tool to assess trainees' ability to lead a simulated end-of-life family meeting.Methods
Building on evidence from published studies and accrediting agency guidelines, an expert panel at our institution developed the Family Meeting Assessment Tool. All fourth-year medical students (MS4) and eight geriatric and palliative medicine fellows (GPFs) were invited to participate in a Family Meeting Objective Structured Clinical Examination, where each trainee assumed the physician role leading a complex family meeting. Two evaluators observed and rated randomly chosen students' performances using the Family Meeting Assessment Tool during the examination. Inter-rater reliability was measured using percent agreement. Internal consistency was measured using Cronbach α.Results
A total of 141 trainees (MS4 = 133 and GPF = 8) and 26 interdisciplinary evaluators participated in the study. Internal reliability (Cronbach α) of the tool was 0.85. Number of trainees rated by two evaluators was 210 (MS4 = 202 and GPF = 8). Rater agreement was 84%. Composite scores, on average, were significantly higher for fellows than for medical students (P < 0.001).Conclusion
Expert-based content, high inter-rater reliability, good internal consistency, and ability to predict educational level provided initial evidence for construct validity for this novel assessment tool. 相似文献20.