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Hui-Shan Shen Szu-Yin Chen Denise Shuk Ting Cheung Shu-Yi Wang Jung Jae Lee Chia-Chin Lin 《Journal of pain and symptom management》2018,55(6):1531-1539
Context
No study has examined the varying family experience of palliative sedation therapy (PST) for terminally ill patients in different settings.Objectives
To examine and compare family concerns about PST use and its effect on the grief suffered by terminally ill patients' families in palliative care units (PCUs) or intensive care units (ICUs).Methods
A total of 154 family members of such patients were recruited in Taiwan, of whom 143 completed the study, with 81 from the PCU and 62 from the ICU. Data were collected on their concerns regarding PST during recruitment. Grief levels were assessed at three days and one month after the patient's death with the Texas Revised Inventory of Grief.Results
Families' major concern about sedated patients in the PCU was that “there might be other ways to relieve symptoms” (90.2%), whereas families of ICU sedated patients gave the highest ratings to “feeling they still had something more to do” (93.55%), and “the patient's sleeping condition was not dignified” (93.55%). Family members recruited from the ICU tended to experience more grief than those from the PCU (P = 0.005 at Day 3 and < 0.001 at Month 1). PST use predicted higher levels of grief in family members recruited from the PCU (P < 0.001 at Day 3 and Month 1).Conclusion
Family experiences with the use of PST in terminally ill patients varied in different settings. Supportive care should address family concerns about PST use, and regular attention should be paid to the grief of individuals at higher risk. 相似文献2.
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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7.
Pamela Goldstein R.N. B.S.N. Decland M.Sc. F.A.C.P. Lois U. Horvitz 《Supportive care in cancer》1996,4(5):329-333
In 1994, the Harry R. Horvitz Palliative Care Center opened as a dedicated inpatient palliative care unit within a comprehensive Palliative Care Program in the United States. The program is designated by the World Health Organization as a national and international demonstration project in the provision of palliative care. The mission of the program and the inpatient unit is to provide excellent care for patients with advanced cancer and their families throughout the illness and during bereavement. The need for the 23-bed inpatient unit was documented by the increasing number of cancer deaths each year and the complex physical and psychosocial problems patients and families experience throughout the course of their illness. Health care professionals specially trained in palliative care are an essential component of a dedicated program within a cancer center. 相似文献
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Heidi Gruhler April Krutka Hannah Luetke-Stahlman Emmie Gardner 《Journal of pain and symptom management》2018,55(2):226-235
Context
Intermountain Healthcare, in collaboration with Cerner Corporation, developed a hospital-based electronic palliative care algorithm.Objectives
This study aims to improve identification of patients who would benefit from palliative care services, and calculate palliative care penetration rates.Methods
This study used a mixed-methods nonrandomized retrospective study design. Three 30-day iterations of clinical data were analyzed for patients identified by the electronic algorithm. During the second and third 30-day iterations, palliative care clinicians conducted chart reviews on a weekly basis for identified patients and determined whether the patients were appropriate for a palliative care consult. Positive predictive values (PPVs) were calculated. Based on the PPV, palliative care consult penetration rates were also calculated.Results
During the first iteration, the algorithm triggered 2995 times on 1384 unique patient encounters (69.3% of the total inpatient population). In the second iteration, the algorithm triggered 851 times on 477 unique patient encounters (26.4% of the total inpatient population). Eight hundred twenty-one chart reviews were completed on 420 unique patient encounters. The PPV was 68.3%. Based on the PPV, the projected palliative care penetration rate was 17.6%. During the third iteration, the algorithm triggered 1229 times on 539 unique patient encounters (33.3% of the total inpatient population). Nine hundred sixty-seven chart reviews were completed on 505 unique patient encounters. The PPV was 80.1%. Based on the PPV, the projected palliative care penetration rate was 26.4%.Conclusion
This study successfully optimized an electronic palliative care identification algorithm with a PPV of 80.1% and indicates appropriate palliative care penetration rates may be as high as 26.4% of the total inpatient population. 相似文献14.
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