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Association between palliative care and healthcare outcomes among adults with terminal non-cancer illness - population based matched cohort study

QUINN, Kieran L. ; STUKEL, Therese ; STALL, Nathan M. ; HUANG, Anjie ; ISENBERG, Sarina ; TANUSEPUTRO, Peter ; GOLDMAN, Russell ; CRAM, Peter ; KAVALIERATOS, Dio ; DETSKY, Allan S. ; BELL, Chaim M.
BMJ (Clinical research ed.), 07/2020, vol.370, 11 p.

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Thème : Soins. Cote : eD02.00

DEMANDE ; CANADA ; ADULTE ; ANALYSE COMPARATIVE

OBJECTIVE: To measure the associations between newly initiated palliative care in the last six months of life, healthcare use, and location of death in adults dying from non-cancer illness, and to compare these associations with those in adults who die from cancer at a population level.
DESIGN: Population based matched cohort study.
SETTING: Ontario, Canada between 2010 and 2015.
PARTICIPANTS: 113 540 adults dying from cancer and non-cancer illness who were given newly initiated physician delivered palliative care in the last six months of life administered across all healthcare settings. Linked health administrative data were used to directly match patients on cause of death, hospital frailty risk score, presence of metastatic cancer, residential location (according to 1 of 14 local health integration networks that organise all healthcare services in Ontario), and a propensity score to receive palliative care that was derived by using age and sex.
MAIN OUTCOME MEASURES: Rates of emergency department visits, admissions to hospital, and admissions to the intensive care unit, and odds of death at home versus in hospital after first palliative care visit, adjusted for patient characteristics (such as age, sex, and comorbidities).
RESULTS: In patients dying from non-cancer illness related to chronic organ failure (such as heart failure, cirrhosis, and stroke), palliative care was associated with reduced rates of emergency department visits (crude rate 1.9 (standard deviation 6.2) v 2.9 (8.7) per person year; adjusted rate ratio 0.88, 95% confidence interval 0.85 to 0.91), admissions to hospital (crude rate 6.1 (standard deviation 10.2) v 8.7 (12.6) per person year; adjusted rate ratio 0.88, 95% confidence interval 0.86 to 0.91), and admissions to the intensive care unit (crude rate 1.4 (standard deviation 5.9) v 2.9 (8.7) per person year; adjusted rate ratio 0.59, 95% confidence interval 0.56 to 0.62) compared with those who did not receive palliative care. Additionally increased odds of dying at home or in a nursing home compared with dying in hospital were found in these patients (n=6936 (49.5%) v n=9526 (39.6%); adjusted odds ratio 1.67, 95% confidence interval 1.60 to 1.74). Overall, in patients dying from dementia, palliative care was associated with increased rates of emergency department visits (crude rate 1.2 (standard deviation 4.9) v 1.3 (5.5) per person year; adjusted rate ratio 1.06, 95% confidence interval 1.01 to 1.12) and admissions to hospital (crude rate 3.6 (standard deviation 8.2) v 2.8 (7.8) per person year; adjusted rate ratio 1.33, 95% confidence interval 1.27 to 1.39), and reduced odds of dying at home or in a nursing home (n=6667 (72.1%) v n=13 384 (83.5%); adjusted odds ratio 0.68, 95% confidence interval 0.64 to 0.73). However, these rates differed depending on whether patients dying with dementia lived in the community or in a nursing home. No association was found between healthcare use and palliative care for patients dying from dementia who lived in the community, and these patients had increased odds of dying at home.
CONCLUSIONS: These findings highlight the potential benefits of palliative care in some non-cancer illnesses. Increasing access to palliative care through sustained investment in physician training and current models of collaborative palliative care could improve end-of-life care, which might have important implications for health policy.

Origine : PubMed

Effectiveness of a brief advance directive intervention in primary care - a randomized clinical trial

RANDO-MATOS, Yolanda ; VIVES-ARGILAGOS, Toni ; RODERO-PEREZ, Estrella ; SOLSONA-DIAZ, Lluís ; BALLVE-MORENO, José Luis ; MORENO-FARRES, Noemí ; SORANDO-ALASTRUEY, Rosa ; ADROER-MARTORI, Raquel ; SANFELIU-SOTO, Núria ; ALMEDA-ORTEGA, Jesús
Patient education and counseling, 18/06/2020, Pagination inconnue

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Nurses' decision-making about cancer patients' end-of-life skin care in Wales - an exploratory mixed-method vignette study protocol

SAMURIWO, Ray ; LOVELL-SMITH, Candida ; ANSTEY, Sally ; JOB, Claire ; HOPKINSON, Jane
BMJ Open, 05/07/2020, vol.10, n°7, 8 p.

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Palliative care skills in cf - perspectives of adults with cf, caregivers, and cf care team members

TRANDEL, Elizabeth T. ; KAVALIERATOS, Dio ; BASILE, Melissa ; HOBLER, Mara R. ; GEORGIOPOULOS, Anna M. ; CHEN, Elaine ; GOGGIN, Jessica L. ; GOSS, Christopher H. ; HEMPSTEAD, Sarah E. ; FARO, Albert ; DELLON, Elisabeth P.
Pediatric pulmonology, 08/05/2020, Pagination inconnue

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Grieving, bodily

GILMOUR, Julie
BEREAVEMENT CARE, Printemps 2019, vol.38, n°1, p. 3-5

Adult child-parent dyadic interactions at the end of life - a scoping review

HERBST, Franziska A. ; GAWINSKI, Laura ; SCHNEIDER, Nils ; STIEL, Stephanie
BMJ supportive and palliative care, 07/08/2019, Pagination inconnue

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Patterns of palliative care beliefs among adults in the United States - analysis of a national cancer database

CHENG, Brian T. ; WANGMO, Tenzin ; HAUSER, Joshua M.
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, 10/08/2019, Pagination inconnue

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Opportunities to improve utilization of palliative care among adults with cystic fibrosis - a systematic review

MARMOR, Meghan ; JONAS, Andrea ; MIRZA, Alicia ; RAD, Elika ; WONG, H. ; ASLAKSON, Rebecca A.
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, 19/08/2019, Pagination inconnue

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Hospitalisation d’un parent en soins palliatifs - perceptions d’enfants d’âge adulte sur les changements vécus dans la relation

LAPERLE, Philippe ; ACHILLE, Marie ; DANEAULT, Serge
MEDECINE PALLIATIVE, 06/2019, vol.18, n°3, p. 134-142

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Models of non-hospice palliative care - a review

BEASLEY, Amy ; BAKITAS, Marie A. ; EDWARDS, Rebecca ; KAVALIERATOS, Dio
Annals of palliative medicine, 02/2019, vol.8, n°Suppl 1, p. S15-S21

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Family members' opinions about bereavement care after cardiac intensive care unit patients' deaths

ERIKSON, Alyssa ; PUNTILLO, Kathleen ; MCADAM, Jennifer
Nursing in critical care, 18/06/2019, Pagination inconnue

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How to conserve dignity in palliative care - suggestions from older patients, significant others, and healthcare professionals in Swedish municipal care

OSTLUND, Ulrika ; BLOMBERG, Karin ; SODERMAN, Annika ; WERKANDER HARSTADE, Carina
BMC palliative care, 24/01/2019, vol.18, n°1, 12 p.

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Considerations and recommendations for conducting qualitative research interviews with palliative and end-of-life care patients in the home setting - a consensus paper

SIVELL, Stephanie ; PROUT, Hayley ; HOPEWELL-KELLY, Noreen ; BAILLIE, Jessica ; BYRNE, Anthony ; EDWARDS, Michelle ; HARROP, Emily ; NOBLE, Simon ; SAMPSON, Catherine ; NELSON, Annmarie
BMJ supportive and palliative care, 03/2019, vol.9, n°1, 7 p.

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Psychological processes of suffering of palliative care patients in Malaysia - a thematic analysis

TAN, Seng Beng ; LOH, Ee Chin ; LAM, Chee Loong ; NG, Chong Guan ; LIM, Ee Jane ; BOEY, Christopher Chiong Meng
BMJ supportive and palliative care, 03/2019, vol.9, n°1, Pagination inconnue

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Training general practitioners contributes to the identification of palliative patients and to multidimensional care provision - secondary outcomes of an RCT

THOONSEN, Bregje ; GERRITZEN, Stefanie H. M. ; VISSERS, Kris C. P. ; VERHAGEN, Stans ; VAN WEEL, Chris ; GROOT, Marieke M. ; ENGELS, Yvonne
BMJ supportive and palliative care, 03/2019, vol.9, n°1, 8 p.

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Utility of a referral letter to improve comprehensibility of cancer patients in palliative care - a single-center study

KLOEPPEL, Eva-Marie ; HANAYA, Hani ; SEILACHER, Eckart ; SCHROTH, Sarah ; LIEBL, Patrick ; KEINKI, Christian ; JOLIN KOESTER, Marie ; HUEBNER, Jutta
Journal of cancer education, 01/01/2018, vol.33, n°2, p. 487-492

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BETTENCOURT-SILVA, Rita ; AGUIAR, Beatriz ; SÁ-ARAÚJO, Vânia ; BARREIRA, Rosa ; GUEDES, Vania ; MARQUES RIBEIRO, Maria Joao ; CARVALHO, Davide ; ÖSTLUNDH, Linda ; PAULO, Marília Silva
BMJ Open, 14/06/2019, vol.9, n°6, p. 1-5

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Thème : Santé. Cote : eD01.03

ADULTE ; DIABETE ; PRISE EN CHARGE ; BASE DONNEES

INTRODUCTION: Worldwide, an estimated 40 million people are in need of palliative care each year, but only 14% receive it. The incidence of diabetes mellitus (DM) in patients receiving palliative care is higher than in the general population. This association is intended to grow as a result of the rising burden of DM worldwide, ageing populations and the improved overall survival time of several diseases over the last few decades. Recommendations for DM management in the context of palliative care are mainly based on expert opinion as there is a lack of suitable evidence base and randomised clinical trials in palliative care are scarce. The aim of our systematic review is to identify the best DM management practices in order to reduce important DM-related symptoms and acute complications in patients receiving palliative care.
METHODS AND ANALYSIS: The authors will study the DM treatment and management literature, surveying the different approaches employed to treat adult palliative patients. Core health bibliographic databases will be searched from January 1990 to May 2019. Data sources will include Ovid MEDLINE, Embase, PubMed, Web of Sciences, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Scopus, Cumulative Index to Nursing and Allied Health Literature and grey literature. Details regarding diet, oral and injectable glucose-lowering medicines, insulin regimens and blood glucose monitoring strategies will be evaluated. We defined the primary outcomes to compare between DM management approaches as the presence of symptoms (polyuria, polydipsia and polyphagia) and acute complications of DM (hypoglycaemia, hyperglycaemic hyperosmolar state and diabetic ketoacidosis), and secondary outcomes as hospital admissions and deaths due to DM-related complications, health-related quality of life and glycaemic control.
ETHICS AND DISSEMINATION: The systematic review methodology does not require ethics approval due to the nature of the study design. The results of the systematic review will be published in a peer-reviewed journal and will be publicly available.
PROSPERO REGISTRATION NUMBER: CRD42018115772.

Origine : PubMed

The last breath-enriching end-of-life moments

SHAPIRO, Martin F.
JAMA internal medicine, 28/05/2019, Pagination inconnue

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Aspects pratiques relatifs à la mise en œuvre d’une sédation par midazolam

VANDERHOEVEN, Sandrine
REVUE DE L'INFIRMIERE, 03/2019, vol.68, n°249, p. 36-39

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Challenges of the transition - a case of noncompliance in an adult with congenital heart disease

JERSAK, Taylor ; GUSTIN, Jillian ; HUMPHREY, Lisa
JOURNAL OF PALLIATIVE MEDICINE, 12/2019, vol.22, n°12, p. 1621-1623

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