Factors associated with lower quality of life among patients receiving palliative care

Title.  Factors associated with lower quality of life among patients receiving palliative care.
Aim.  This paper is a report of a study conducted to (1) assess the quality of life (QoL) and physical functioning status of patients diagnosed with advanced cancer and receiving palliative care; (2) determine if there was a statistically significant relationship between their physical functioning and QoL and (3) identify the demographic and disease-related variables related to their QoL.
Background.  Achieving the best possible QoL is a major goal in palliative care. However, research findings about the relationship between QoL and demographic variables have been inconsistent.
Method.  Three hundred patients with advanced cancer were recruited from four district hospitals in Hong Kong between February 2005 and July 2006. Their QoL and physical functioning status were assessed by face-to-face interview, using the McGill Quality of Life Questionnaire (Hong Kong version) and the Palliative Performance Scale respectively.
Results.  Participants reported reduced ambulation, inability to perform hobbies or housework, and the need for occasional assistance in self-care (mean: 64·6 out of 100, sd : 19·3, range: 20–100). QoL was fair (mean: 6·2 out of 10, sd : 1·5, range: 0·9–10). There was a weak positive association between physical functioning and QoL scores. Multiple regression analysis showed that patients who were older, female, had ever been married, or had higher physical functioning tended to have better QoL.
Conclusion.  More could be done in symptom and psychosocial management to improve patients' QoL, in particular for those who are younger, male or single, or who have lower physical functioning.     

姑息治疗提高晚期癌症患者生活质量

目的:探讨应用姑息治疗对提高晚期癌症患者生活质量(qualityoflife,QOL)的影响。方法:对96例晚期癌症患者进行姑息治疗,采用QOL观察指标对本组病例治疗前、后评分,将QOL分为好≥41分;中21～40分;差≤20分共3个等级进行评估。结果:本组病例QOL评分,治疗前≤40分、治疗后≥41分者为71例;治疗前≤20分、治疗后≥21分者为12例;治疗前后无效者13例。QOL提高者占86%,无效为14%。结论:姑息治疗能提高晚期癌症患者的QOL。     

姑息性护理在肺癌病人癌因性疲乏的应用进展

介绍姑息性护理和癌因性疲乏的概念,阐述肺癌病人癌因性疲乏的状况,分析癌因性疲乏对肺癌病人的影响,以及姑息性护理在肺癌病人癌因性疲乏中的应用,为国内学者更好地认识和评价姑息性护理及肺癌病人的癌因性疲乏,为不断提高肺癌病人的生活质量作为参考。     

舒缓疗护模式结合人生回顾干预对癌症晚期患者应对方式、心理状态及生活质量的影响

目的 探讨舒缓疗护模式结合人生回顾干预对癌症晚期患者应对方式、心理状态及生活质量的影响.方法 选取2018年10月至2020年10月收治的70例晚期癌症患者为研究对象,采用抽签法将其随机分为对照组和观察组,各35例.对照组采用常规护理,观察组在常规护理基础上应用舒缓疗护模式结合人生回顾干预,比较两组的干预效果.结果 干...     

Assessing agreement between terminally ill cancer patients' reports of their quality of life and family caregiver and palliative care physician proxy ratings

Context

Proxy ratings, if valid, may provide an alternative approach to evaluating patient quality of life (QoL) at the end of life.

Objectives

To examine agreement between terminally ill cancer patients’ self-reported QoL and proxy assessment of patient QoL by their family caregiver (FCG) and palliative care physicians (PCPs) at two time points.

Methods

Patients admitted to an acute palliative care unit and their FCGs and PCPs completed the McGill Quality of Life Questionnaire (MQOL) at Days 3 and 6 after admission. Response bias and response precision were examined at the individual and group levels. Furthermore, we examined patient factors affecting agreement and responsiveness of proxy MQOL scores to changes in patients’ QoL between Days 3 and 6.

Results

Statistically and clinically significant mean differences were detected between the patient and both proxy groups’ reports of QoL on Day 3, with the magnitude of the differences decreasing somewhat by Day 6. Proxies underestimated patients’ QoL compared with patients' self-report. Response precision based on intraclass correlation values and proportion of approximate agreement was poor to fair at both time points. Agreement was better for patients with greater physical burden and more cognitive difficulties. Proxies' responsiveness to change from Day 3 to Day 6 was low, and proxies were not able to detect minimally important changes in QoL.

Conclusion

The findings suggest that moderate agreement between patient and proxy ratings of QoL develops over time but that precision at the individual level, which is more clinically relevant, is less reliable. New strategies for improving proxy reliability are needed.     

Impact of availability of an inpatient hospice unit on the parent hospital's quality of palliative care for Taiwanese cancer decedents, 2001-2006

Context

Hospice care has increasingly been shown to affect quality of palliative care at both the individual and institutional levels. However, an institutional effect has only been addressed in single comprehensive cancer centers/selected community hospitals.

Objectives

To investigate the impact of an inpatient hospice unit on the parent hospital’s quality of palliative care.

Methods

This was a retrospective cohort study using administrative data from the entire population of 204,850 Taiwanese pediatric and adult cancer patients who died in 2001–2006. Outcome variables were adjusted by multivariate logistic regression for five groups of confounding variables: 1) patient demographics and disease characteristics, 2) primary hospital characteristics, 3) primary physician specialty, 4) health care resources at the hospital and regional levels, and 5) historical trend.

Results

Taiwanese cancer patients who received primary care in a hospital with an inpatient hospice unit (whether or not they received hospice care) were significantly less likely to be intubated (adjusted odds ratio [AOR]: 0.71; 95% confidence interval [CI]: 0.58, 0.86) and use mechanical ventilation support (AOR: 0.70; 95% CI: 0.56, 0.87) in their last month of life. They also were more likely to use hospice care before death (AOR: 3.51; 95% CI: 1.57, 7.86). Furthermore, if they used hospice care, they tended to be referred earlier than cancer patients being cared for in a hospital without an inpatient hospice unit.

Conclusion

Integrating both acute care and palliative care approaches to caring for terminally ill cancer patients in the same hospital may influence the quality of palliative care throughout the hospital as evidenced by our findings that these patients have lower likelihood of being intubated with mechanical ventilation support in the last month of life, greater propensity to receive hospice care in the last year of life, and a trend toward earlier referral to hospice care. The generalizability of these results may be limited to patients who died of a noncancer cause and by the two groups not being exactly matched for patients’ characteristics.     

人文关怀护理对乳腺癌术后放疗病人生活质量的影响

[目的]探讨人文关怀护理对乳腺癌术后放疗病人生活质量的影响。[方法]将80例乳腺癌术后放疗病人随机分为对照组和干预组各40例,对照组采用乳腺癌术后放疗的常规护理,干预组在乳腺癌术后放疗常规护理的基础上采用人文关怀护理,采用生活质量评分量表(QOL)评定两组病人的生活质量并进行比较。[结果]干预组病人生活质量明显高于对照组,经比较差异有统计学意义(P0.01)。[结论]人文关怀护理能有效减轻乳腺癌术后放疗病人放疗的不良反应和心理压力,提高病人生活质量。     

Quality of life in newly diagnosed cancer patients

The aim of this study was to examine which domains of quality of life are most strongly affected in patients with newly diagnosed cancer, and to examine if quality of life was related to gender, age, educational level, cohabitation, time since diagnosis, treatment or type of cancer in these patients. Ferrans and Powers Quality of Life Index and the Cancer Rehabilitation Evaluation System, short form, were completed by 131 newly diagnosed Norwegian adult cancer patients. The patients had different cancer diagnoses, with breast cancer being the most common type. None of them were terminally ill, and 80% had been diagnosed within the last 6 months. The patients turned out to be satisfied with their lives, especially with the family and marital domains. They were least satisfied with health, functioning and sex life. Analyses of variance and multiple regression analysis were conducted to examine the impact on quality of life of cohabiting, age, gender, educational level, cancer diagnosis, treatment and time since diagnosis. Those cohabiting had significantly higher quality of life compared with those living alone. In contrast the younger group (19-39 years) living alone had significantly lower quality of life than the older groups living alone. Although age was only significantly associated with quality of life in one sub-scale, the elderly people reported their quality of life to be better in almost all sub-scales. Time since diagnosis was not associated with quality of life, while treatment was associated with quality of life as measured by Ferrans and Powers Quality of Life Index. Gender and educational level were only associated with one or two domains in quality of life, respectively.     

姑息护理对住院癌症患者生活质量的影响

目的:探讨姑息护理对住院癌症患者生活质量的影响。方法:将420例入选癌症患者随机分为研究组和对照组各210例,对照组给予常规治疗护理,研究组由姑息护理小组实施姑息护理。问卷调查和评定两组患者入组前和入组1个月后的生活质量。结果:研究组住院后1个月生活质量明显优于入组前,且优于对照组(P<0.01)。结论:姑息护理有效提高了癌症患者的生活质量。     

晚期癌症病人家庭临终护理的研究进展

综述近年来国内外晚期癌症病人家庭护理模式的研究进展,探讨我国开展晚期癌症病人家庭临终护理存在的问题和解决方法,指出未来应着重培养专业的家庭临终医护人员,健全家庭临终护理的模式,从而为病人和家属提供全面、专业的照护与支持;逐步将家庭临终护理加入医保范围,加大对家庭临终护理的政策和财力支持,普及和推广家庭临终护理;加大宣传,帮助人们更新思想观念,关注人的基本权利。     

Exploring community nurses' perceptions of life review in palliative care

Aims and objectives. This exploratory study aimed to identify community nurses’ understanding of life review as a therapeutic intervention for younger people requiring palliative care. The objectives set out to: (i) Describe the participants’ understanding of reminiscence and life review (ii) Detail their current ideas regarding a structured approach to using life review in the community setting. (iii) Outline their understanding of the possible advantages and limitations of life review in relation to palliative care. (iv) Identify future training requirements. Background. The literature review illustrated how the eighth developmental stage of Erikson's theory, ego‐integrity vs. despair, is a ‘crisis’ often faced by older people entering the final stage of life. Life review is considered a useful therapeutic intervention in the resolution of this crisis. Younger terminally ill people in the palliative stage of an illness may face the same final crises due to their reduced lifespan. Therefore, this study explored the benefits and limitations of life review as an intervention in palliative care. Method. The study used a purposive sample of community nurses responsible for delivering generic and specialist palliative care. A qualitative method of data collection in the form of three focus group interviews was used. Subsequent data were manually analysed, categorized and coded with associations between the themes identified. Results. The findings suggested that community nurses have limited knowledge pertaining to the use of life review and tend to confuse the intervention with reminiscence. Furthermore, they believed that life review could potentially cause harm to practitioners engaged in listening to another person's life story. However, the participants concur that with appropriate training they would find life review a useful intervention to use in palliative care. Conclusions. The results led to the identification of a number of key recommendations: Community nurses require specific education in the technicalities of life review and additional interpersonal skills training. The need for formalized support through clinical supervision is also recognized and discussed. Finally, suggestions are offered regarding the need to generate wider evidence and how, possibly, to integrate life review into existing palliative care services. Relevance to clinical practice. This study has demonstrated that community nurses are keen to extend the support offered to younger terminally ill people who are in the palliative stage of their illness. Despite having limited knowledge of life the main components and underpinning theory pertaining to life review participants could appreciate the potential of life review as a therapeutic intervention in palliative care and were keen to learn more about its use and gain the necessary knowledge and skills.     

Exploring nursing outcomes for patients with advanced cancer following intervention by Macmillan specialist palliative care nurses

BACKGROUND: Little information exists about the outcomes from nursing interventions, and few studies report new approaches to evaluating the complex web of effects that may result from specialist nursing care. AIMS: The aim of this study was to explore nursing outcomes for patients with advanced cancer that may be identified as resulting from the care of a Macmillan specialist palliative care nurse. METHODS/INSTRUMENTS: Seventy-six patients referred to 12 United Kingdom Macmillan specialist palliative care nursing services participated in a longitudinal study of their care over 28 days. Patients were interviewed and completed the European Organization for Research on Treatment of Cancer Quality of Life Scale and the Palliative Care Outcomes Scale at referral, and 3, 7 and 28 days following referral to a Macmillan specialist palliative care nursing service. A nominated carer was interviewed at baseline and 28 days. Notes recorded by Macmillan specialist palliative care nurses in relation to each patient case were analysed. FINDINGS: Significant improvements in emotional (P = 0.03) and cognitive functioning (P = 0.03) were identified in changes in patients' European Organization for Research on Treatment of Cancer Quality of Life Scale scores, and in Palliative Care Outcomes Scale patient anxiety scores (P = 0.003), from baseline to day 7. Analysis of case study data indicated that overall positive outcomes of care from Macmillan specialist palliative care nursing intervention were achieved in 42 (55%) cases. STUDY LIMITATIONS: Sample attrition due to patients' deteriorating condition limited the value of data from the quality of life measures. The method developed for evaluating nursing outcomes using data from patient and carer interviews and nursing records was limited by a lack of focus on outcomes of care in these data sources. CONCLUSIONS: A method was developed for evaluating outcomes of nursing care in complex situations such as care of people who are dying. Positive outcomes of care for patients that were directly attributable to the care provided by Macmillan specialist palliative care nurses were found for the majority of patients. For a small number of patients, negative outcomes of care were identified.     

Assessing palliative care needs: views of patients, informal carers and healthcare professionals

AIM: This paper reports a study to assess the palliative care needs of the adult population served by a healthcare provider organization in Northern Ireland from the perspectives of patients, informal carers and healthcare providers. BACKGROUND: Assessing palliative care need is a key factor for health service planning. Traditionally, palliative care has been associated with end-of-life care and cancer. More recently, the concept has been extended to include care for both cancer and non-cancer populations. Various approaches have been advocated for assessing need, including the exploration of professional provider and user perspectives of need. METHOD: Semi-structured qualitative interviews were undertaken with a purposive sample of patients and lay carers receiving palliative care services (n = 24). Focus groups were also conducted with multi-professional palliative care providers (n = 52 participants) and face to face interviews were undertaken with key managerial stakeholders in the area (n = 7). The focus groups and interviews concentrated on assessment of palliative care need. All the interviews were transcribed verbatim and analysed using Burnard's framework. FINDINGS: Professional providers experienced difficulty in defining the term palliative care. Difficulties in communication and information exchange, and fragmented co-ordination between services were identified. The main areas of need identified by all participants were social and psychological support; financial concerns; and the need for choice and information. All participants considered that there was inequity between palliative care service provision for patients with cancer and non-cancer diseases. CONCLUSION: All patients, regardless of diagnosis, should be able to access palliative care appropriate to their individual needs. For this to happen in practice, an integrated approach to palliative care is essential. The study methodology confirms the value of developing a comprehensive approach to assessing palliative care need.     

非恶性病病人的姑息护理

介绍了非恶性病病人姑息护理现状、应用领域、护理措施以及姑息护理研究与培训。     

Unmet nursing care needs of home-based disabled patients

BACKGROUND: In Taiwan, family members care for 80-90% of disabled people, but most have no professional training or knowledge of care for the disabled. Therefore, the adequacy of care received by the disabled needs to be assessed. AIMS: To evaluate the unmet nursing care needs of physically disabled patients and determine the relevant factors. METHODS: All 322 subjects were over 18 years of age, had a Barthel Index of less than 80 and became disabled 2 years prior to the commencement of this study. All subjects were outpatients of hospitals in central Taiwan and were contacted by phone to schedule an interview. Based on activity of daily living (ADL) scores, patients were divided into three groups: complete dependency, severe dependency and moderate dependency. After training, nurses evaluated the patients' ADL and completed the 20-item Assessment of Nursing Activity (ANA) questionnaire. Based on the ANA, subjects' unmet needs and caregivers' knowledge requirements were assessed. FINDINGS: The results showed the mean number of unmet needs was approximately five. Percentage of unmet needs was 44.8%. For complete dependency patients, the unmet needs score of patients and the needs score of caregiver's knowledge was highest, followed by the severe dependency group, and the moderate dependency group. Based on multiple linear regression, the factors that affected unmet need were as follows: age of patient, ADL score, education level of the caregivers, average daily duration of care and need of caregiving knowledge. Our findings indicate that the provision of counseling and educational support for family caregivers is required to promote quality of care for the disabled.