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palliative care - Top 30 Publications

The Changing Paradigm of Radiotherapy in the Elderly Population.

There is increasing awareness of the special needs for care of the elderly cancer patient. Newer precise conformal radiotherapy techniques allow the safe delivery of higher doses of radiotherapy to the target tumor while reducing the dose to surrounding critical organs. This has led to a shortening of radiotherapy protocols for both curative and palliative indications. We review these novel techniques and protocols and the published clinical studies that include elderly patients treated with these techniques. Despite the fact that the elderly are a growing significant proportion of cancer patients, and the need for radiotherapy in the elderly is expected to rise with increasing life expectancy, they are underrepresented in most clinical studies of radiotherapy, and there are few studies specifically investigating radiotherapy in the elderly. The treatment of early-stage primary lung cancer with stereotactic body radiotherapy is a prime example how new highly conformal techniques and shortened treatment protocols are changing the approach to radiotherapy in the elderly. With improved imaging and radiotherapy treatment precision, it is expected that such techniques will become increasingly used in other cancer sites. It is important for radiation oncologists to be aware of the special needs of the elderly cancer patient and in particular to assess these patients based on functional status and not only chronological age. In addition, geriatric oncologists should be aware of modern radiotherapy techniques that can be particularly appropriate for the elderly patient.

Validity of Administrative Data in Identifying Cancer-related Events in Adolescents and Young Adults: A Population-based Study Using the IMPACT Cohort.

Despite the importance of estimating population level cancer outcomes, most registries do not collect critical events such as relapse. Attempts to use health administrative data to identify these events have focused on older adults and have been mostly unsuccessful. We developed and tested administrative data-based algorithms in a population-based cohort of adolescents and young adults with cancer.

Surrogate Decision Making When Patients Cannot Decide within the Veterans Health Administration System.

Trust in Physicians, Continuity and Coordination of Care, and Quality of Death in Patients with Advanced Cancer.

Provider-centered factors contribute to unexplained variation in the quality of death (QOD). The relationship between healthcare providers (HCPs) and patients, bidirectional communication, and consistency of longitudinal care planning are important provider-centered factors.

Response to the Article "Overall Survival among Cancer Patients Undergoing Opioid Rotation to Methadone Compared to Other Opioids".

External validation and clinical utility of a prediction model for 6-month mortality in patients undergoing hemodialysis for end-stage kidney disease.

End-stage kidney disease is associated with poor prognosis. Health care professionals must be prepared to address end-of-life issues and identify those at high risk for dying. A 6-month mortality prediction model for patients on dialysis derived in the United States is used but has not been externally validated.

Quasi-experimental evaluation of a multifaceted intervention to improve quality of end-of-life care and quality of dying for patients with advanced dementia in long-term care institutions.

Improvement in the quality of end-of-life care for advanced dementia is increasingly recognized as a priority in palliative care.

The Impact of Teaching Prognostication at the End of Life: A Pre-Post Interventional Study.

Providing accurate and valid prognostic information significantly influences end-of-life care. Disclosing a poor prognosis can be among the most difficult of physician responsibilities, thus having appropriate knowledge during training is crucial for appropriate prognostication.

Surgical treatment for colorectal cancer in octogenarians and nonagenarians.

Advances in surgical techniques and perioperative care have improved cancer-related outcomes. However, there are still concerns regarding the safety of octogenarian and nonagenarian patients during surgery. Clinicians may be reluctant to perform a radical resection for colorectal cancer and administer adjuvant or palliative cytotoxic chemotherapy to octogenarian and nonagenarian patients. In the elderly, setting a primary goal based on multidisciplinary team discussions prior to treatment is important. The overall treatment scheme, risks, and potential benefits should be discussed with elderly patients and their families. In this review, we will discuss multidimensional aspects of colorectal cancer surgery for octogenarian and nonagenarian patients with respect to age-related physiological declines, preoperative assessments, appropriate surgical procedures, and short-term and oncologic outcomes. In this era of an aging society, clinicians should provide objective evidence to octogenarian and nonagenarian patients regarding estimated short-term and oncologic outcomes. However, there is a limited number of studies concerning outcomes following colorectal cancer surgery in octogenarians and nonagenarians. In the future, a prospective study with a larger cohort would be helpful to collect objective data on octogenarian and nonagenarian patients.

Metastatic high-grade myxofibrosarcoma: review of a clinical case.

We present the particular clinical and histological features of a metastatic high-grade myxofibrosarcoma (MFS) of the left buttock in a 77-year-old male patient. The tumor was biopsied and surgically removed in order to increase the patient's comfort, due to its increased size and aggressive clinical behavior. Computed tomography (CT) revealed metastases in the pleura and mediastinal lymph nodes, so limb-sparing tumor excision followed by palliative care was the best practice for the patient until the fatal outcome. The histological assessment revealed a tumor composed partly of solid sheets of spindled and pleomorphic cells, partly of areas with prominent myxoid matrix and numerous elongated capillaries. Mitotic figures are frequent, often atypical, followed by numerous giant cells with abundant eosinophilic elongated cytoplasm, resembling myoid cells often multinucleated. A panel of immunohistochemical stainings, including muscle-specific actin (MSA), S-100, CD34, desmin and myogenin were performed with a negative result, which aided excluding other soft tissue tumors like rhabdomyosarcoma and leiomyosarcomas, while Ki-67 was highly expressed in more than 70% of the tumor cells. This tumor received 6 points in accordance with the Fédération Nationale des Centres de Lutte Contre le Cancer (modified FNCLCC) and was defined as a high-grade MFS [stage IV, G3 pT2bN0M1, according to the 8th edition of TNM Classification of Malignant Tumors, ICD-O 8811÷3 in World Health Organization (WHO) Classification 2013]. Due to the clinical findings combined with the histological profile, the fatal prognosis was expected, though the time period was shorter than predicted, confirming the aggressive nature of the tumor. Even if traditionally was considered MFS as a non-metastatic lesion, recent case reports and studies, including our case revealed that this tumors in fact have the potential to be fatal due to metastatic disease.

Long-term peritoneal port-catheter in a patient with cardiac ascites.

A peritoneal port-catheter was inserted in a 70-year-old man because of repeated paracentesis due to cardiac ascites. Instead of frequent hospital admissions, the patient could drain his ascites at home, which dramatically improved his quality of life and enabled him to perform his daily activities.

Information needs about palliative care and euthanasia: A survey of patients in different phases of their cancer trajectory.

We assessed information provision and information needs about illness course, treatments, palliative care and euthanasia in cancer patients.

Evaluation of Emergency Department Management of Opioid-Tolerant Cancer Patients with Acute Pain.

There are no previously published studies examining opioid doses administered to opioid-tolerant cancer patients during Emergency Department (ED) encounters.

Development of Entrustable Professional Activities for Hospice and Palliative Medicine Fellowship Training in the United States.

Entrustable Professional Activities (EPAs) represent the key physician tasks of a specialty. Once a trainee demonstrates competence in an activity, they can then be 'entrusted' to practice without supervision(1). A physician workgroup of the American Academy of Hospice and Palliative Medicine (AAHPM) sought to define Hospice and Palliative Medicine (HPM) EPAs.

The Implementation of Measuring What Matters in Research and Practice: Series Commentary.

Mental Health Determines the Quality of Life in Patients With Cancer-Related Neuropathic Pain in Quito, Ecuador.

To identify the main factors determining the health related quality of life (HRQL) in patients with cancer-related neuropathic pain in a tertiary care hospital.

Maintaining Integrity: How Nurses Navigate Boundaries in Pediatric Palliative Care.

To explore how nurses manage personal and professional boundaries in caring for seriously ill children and their families.

The prevalence of constipation at admission and after one week of palliative care: a multicenter study.

To assess the prevalence and intensity of constipation in advanced-cancer patients referred to palliative care, and to assess changes after one week of specialist palliative care.

Palliative care for respiratory disease: An education model of care.

That palliative care improves quality of life for seriously ill patients and their families is well known - but how can healthcare providers ensure that the palliative needs of all patients are being assessed and addressed? A growing number of curricula in core palliative care practices have been developed to ensure that clinicians from all specialties and disciplines have the necessary training to manage pain and symptoms and discuss care goals with patients and families. Through broad-based training in core palliative care skills, combined with referral to specialty palliative care for high-need patients, providers can improve quality of life for their patients with respiratory disease.

Enhancing the Empathic Connection: Using Action Methods to Understand Conflicts in End-of-Life Care.

Empathy is a core feature of patient-centered care. It enables practitioners to better understand the patient and family concerns that are key to patient and family satisfaction, prevention of anxiety and depression, and provider empowerment. Current methods of teaching communication skills do not specifically focus on enhancing the ability to "stand in the patient's shoes" as a way of connecting with the patient and/or family experience and understanding feelings that may be a source of conflict with providers. In this paper, we present a model for deepening empathic understanding based upon action methods (role-reversal and doubling) derived from psychodrama and sociodrama. We describe these techniques and illustrate how they can be used to identify hidden emotions and attitudes and reveal that which the patient and family member may be thinking or feeling but be afraid to say. Finally, we present data showing that these methods were valuable to participants in enhancing their professional experience and skills.

End-of-life experiences of family caregivers of deceased patients with cancer: A nation-wide survey.

The purpose of this study was (1) to describe the end-of-life experience of family caregivers of cancer patients, (2) to describe talking about death and dying of the patient to minor children, and (3) to examine the association of family caregivers' experiences by their characteristics and talking about death and dying of the patient.

High Body Mass Index Is a Potential Risk Factor for Persistent Postoperative Pain after Breast Cancer Treatment.

Risk factors associated with persistent pain after breast cancer treatment are needed to develop prevention and treatment strategies to improve the quality of life for patients with breast cancer.

Nurses Exploring the Spirituality of Their Patients With Cancer: Participant Observation on a Medical Oncology Ward.

Attention for spirituality should be an integral part of professionals' caregiving. Particularly, nurses caring for patients with cancer might have opportunities to give attention to this dimension.

Examining trust in health professionals among family caregivers of nursing home residents with advanced dementia.

In a context of increasing emphasis on shared decision-making and palliative care in dementia, research on family caregivers' trust in health professionals in advanced dementia is surprisingly scant. The aim of the present study was to assess trust in nursing home health professionals of family caregivers of nursing home residents with advanced dementia, and possible correlates, such as family caregivers' satisfaction, involvement in care, care burden and patients' symptom burden.

Palliative care physicians' experiences of end-of-life communication: A focus group study.

The aim of this study was to explore palliative home care physicians' experiences regarding end-of-life breakpoint communication (BPC). This is a qualitative study where focus group interviews were conducted and analysed using qualitative content analysis. The results show that the participants saw themselves as being responsible for accomplishing BPC, and they were convinced that it should be regarded as a process of communication initiated at an early stage, i.e. proactively. However, BPC was often conducted as a reaction to the patient's sudden deterioration or sometimes not at all. The barriers to achieving proactive BPC included physicians' uncertainty regarding the timing of BPC, primarily due to difficulties in prognostication in terms of time of death, and uncertainty as to what BPC should include and how it should best be approached. Furthermore, there was insufficient documentation regarding previous BPC, which impeded proactive BPC. Although our study shows that physicians are ambitious when it comes to the communication of information to patients and families, there is a need for further training in how to conduct BPC and when to initiate the BPC process. Furthermore, there should be documentation that different professionals can access as this would appear to facilitate a proactive BPC process.

Palliative care needs in hospitalized cancer patients: a 5-year follow-up study.

The aims of this study were to describe and compare diagnoses, symptoms, and care needs in palliative cancer patients in two medium-sized hospitals in a county council with no specialized palliative care available 24/7; to analyze the relationships between diagnosis and symptoms/care needs; and to compare results and trends from two datasets (from 2007 and 2012).

Automatic referral to standardize palliative care access: an international Delphi survey.

Palliative care referral is primarily based on clinician judgment, contributing to highly variable access. Standardized criteria to trigger automatic referral have been proposed, but it remains unclear how best to apply them in practice. We conducted a Delphi study of international experts to identify a consensus for the use of standardized criteria to trigger automatic referral.

Postoperative delirium after pharyngolaryngectomy with esophagectomy: a role for ramelteon and suvorexant.

Postoperative delirium is common after extensive surgery, and is known to be associated with sleeping medications. In this study, we aimed to investigate the relationships between sleeping medications and postoperative delirium after pharyngolaryngectomy with esophagectomy.

Spirituality in adolescent patients.

Adolescence, the transition between childhood and adulthood, represents a time of rapid biological, neurocognitive, and psychosocial changes. These changes have important implications for the development and evolution of adolescent spirituality, particularly for adolescents with chronic or life-limiting illnesses. To contribute positively to adolescent spiritual formation, palliative care teams benefit from understanding the normative changes expected to occur during adolescence. This paper provides a narrative review of adolescent spirituality while recognizing the role of religious, familial, and cultural influences on spiritual development during the teenage years. By giving explicit attention to the contextual norms surrounding adolescence and still recognizing each adolescent-aged patient as unique, palliative care teams can help adolescents transition toward meaningful and sustainable spiritual growth. This paper reviews the clinical and research implications relevant to integrating adolescent spiritual health as part of comprehensive palliative care.

Definitions of healing and healing interventions across different cultures.

For centuries healing has been embedded in non-Western cultures. Traditional cultures believe that healing is derived from the divine and utilize a holistic approach to healing including the body, mind, and spirit. The community and environment are key elements in individual healing along with herbal remedies and ceremonies. Western cultures have accepted some traditional methods of relaxation and exercise, such as yoga and tai chi. In this paper we will examine some similar themes of traditional practices to better understand traditional patients' healing paradigm and find new tools as practitioners of Western medicine.