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Article

Do perceptions of spiritual care affect attitudes towards care for dying patients in a group of Turkish nursing students?

KARADAG, Ezgi
Journal of religion and health, 10/04/2019, Pagination inconnue

Thème : Soins.

SPIRITUALITE ; TURQUIE ; SOIN INFIRMIER ; ETUDIANT ; ATTITUDE ; REPRESENTATION MORT ; ECHELLE MESURE ; EVALUATION

The present study was designed to determine the relation between attitudes to death and perceptions of spiritual care in nursing students. It is a descriptive study and included 290 fourth-year nursing students (intern students). Data were collected with a descriptive characteristics form, Frommelt Attitude Towards Care of the Dying Instrument and Spirituality and Spiritual Care Rating Scale. SPSS version 21 was used for data analysis. There was a significant positive relation between the mean scores for Spirituality and Spiritual Care Rating Scale and Frommelt Attitude Towards Care of the Dying Instrument. It can be recommended that courses about death and spiritual care should be offered and integrated into nursing curricula.

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Article

Development of a new measure to assess primary palliative care perceived competence

LIPPE, Megan ; DAVIS, Andra ; THREADGILL, Hunter ; RICAMATO, Allison
Nurse educator, 15/04/2019, Pagination inconnue

Thème : Formation.

EVALUATION ; COMPETENCE PROFESSIONNELLE ; DEMARCHE PALLIATIVE ; FORMATION INITIALE ; ETUDIANT ; OUTIL ; SOIN INFIRMIER

BACKGROUND: Many nursing schools have begun to address the gap in palliative care education. Recently released entry-to-practice competencies in palliative care can guide educators as they incorporate such material into their curriculum. In an effort to evaluate learning, educators need a reliable instrument that aligns with the updated competencies.
PURPOSE: This article describes the development of a new instrument to evaluate perceived competence to provide primary palliative care.
METHODS: The psychometric properties and performance of the new instrument in evaluating perceived competence were tested via an interprofessional palliative care simulation with medical, nursing, and social work students. Perceived competence was measured before and after the simulation.
RESULTS: The new instrument demonstrates strong reliability and validity, represents a unidimensional construct, and captures changes in perceived competence across time and disciplines.
CONCLUSIONS: The new instrument is acceptable for assessing perceived competence to provide palliative care, particularly for nursing students.

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Article

Enhancing advance care planning conversations by nurses in a bone marrow transplantation unit

IZUMI, Shigeko ; BURT, Malinda ; SMITH, Jennifer C. ; MCCORD, Keren ; FROMME, Erik K.
Oncology nursing forum, 01/05/2019, vol.46, n°3, p. 288-297

Thème : Formation.

PLANIFICATION ; ANTICIPATION ; SOIN ; COMMUNICATION ; RELATION PERSONNEL SOIGNANT PATIENT ; INFIRMIERE ; GREFFE ; MOELLE OSSEUSE ; ETATS-UNIS ; EVALUATION ; FORMATION

OBJECTIVES: To describe the impact of advance care planning (ACP) education on nurses' confidence in ACP knowledge and practice and to identify barriers to facilitate ACP conversation in a bone marrow transplantation unit.
SAMPLE & SETTING: 60 nurses working in the bone marrow transplant unit at Oregon Health and Science University, an academic medical center.
METHODS & VARIABLES: The aim of this quality improvement project was to increase ACP conversations by nurses. The authors used a single-group pre-/post-test design to assess the effectiveness of a 30-minute educational intervention in changing nurses' confidence and practice. Group interviews were conducted to identify barriers to ACP.
RESULTS: The educational intervention increased nurses' confidence in knowledge about ACP. The number of nurses who discussed ACP with patients also increased, but it was not statistically significant. Lack of time, inefficient workflow, and concerns about questioning providers' understanding of patient preferences were identified as barriers for nurses engaging in and documenting ACP conversations.
IMPLICATIONS FOR NURSING: In addition to appropriate education, strategies that help tailor ACP practice to fit into nurse workflow and promote collaboration with other healthcare team members are needed to change nurses' ACP practice.

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Article

Assessing quality of life in palliative care settings - head-to-head comparison of four patient-reported outcome measures (EORTC QLQ-C15-PAL, FACT-Pal, FACT-Pal-14, FACT-G7)

KING, Madeleine T. ; AGAR, Meera ; CURROW, David ; HARDY, Janet ; FAZEKAS, Belinda ; MCCAFFREY, Nikki
Supportive care in cancer, 16/04/2019, p. 1-13

Thème : Recherche - Evaluation - Méthodologie.

EVALUATION ; QUALITE VIE ; DEMARCHE PALLIATIVE ; ECHELLE MESURE

Purpose: Head-to-head comparison of reliability, validity and responsiveness of four patient-reported outcome measures (PROMS) suitable for assessing health-related quality of life (HRQOL) in palliative care settings: EORTC QLQ-C15-PAL, FACT-G7, FACIT-Pal and short-form FACIT-Pal-14.
Methods: Secondary analysis of two phase III randomised trials: ketamine for chronic cancer pain, octreotide for vomiting in inoperable malignant bowel obstruction. Sub-groups were defined by Australia-modified Karnofsky performance status (AKPS) and participants’ global impression of change (GIC). Two aspects of reliability were assessed: internal consistency (Cronbach alpha, a); test–retest reliability (intra-class correlation coefficient (ICC)) of patients with stable AKPS and those who self-reported ‘no change’ on GIC. Construct validity was assessed via pre-determined hypotheses about sensitivity of PROM scores to AKPS groups and responsiveness of PROM change scores to GIC groups using analysis of variance.
Results: FACIT-Pal had better internal consistency (a ranged 0.59–0.80, 15/18 = 0.70) than QLQ-C15-PAL (0.51–0.85, 4/8 = 0.70) and FACT-G7 (0.54–0.64, 0/2 = 0.70). FACIT scales had better test–retest reliability (FACIT-Pal 11/27 ICCs = 0.70, FACT-G7 2/3 ICCs = 0.70) than QLQ-C15-PAL (2/30 ICCs = 0.70, 18/30 = 0.5). Four scales demonstrated sensitivity to AKPS: QLQ-PAL-15 Physical Functioning and Global QOL, FACT-G Functional Wellbeing and FACIT-Pal Trial Outcome Index (TOI). Nine scales demonstrated responsiveness: three in the ketamine trial population (QLQ-C15-PAL Pain, FACIT-Pal-14, FACT-G7), six in the octreotide trial population (QLQ-C15-PAL Fatigue; FACIT-Pal PalCare, TOI, Total; FACT-G Physical Wellbeing and Total).
Conclusions: No PROM was clearly superior, confirming that choosing the best PROM requires careful consideration of the research goals, patient population and the domains of HRQOL targeted by the intervention being investigated.

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Article

Emotion and symptom-focused engagement (EASE) - a randomized phase II trial of an integrated psychological and palliative care intervention for patients with acute leukemia

RODIN, Gary ; MALFITANO, Carmine ; RYDALL, Anne ; SCHIMMER, Aaron ; MARMAR, Charles M. ; MAH, Kenneth ; LO, Christopher ; NISSIM, Rinat ; ZIMMERMANN, Camilla
Supportive care in cancer, 17/04/2019, p. 1-14

Thème : Recherche - Evaluation - Méthodologie.

ESSAI CONTROLE RANDOMISE ; CANCER HEMATOLOGIQUE ; EVALUATION ; EFFICACITE ; EMOTION ; SYMPTOME

PURPOSE: We designed a novel, manualized intervention called Emotion And Symptom-focused Engagement (EASE) for acute leukemia (AL) and report here on a phase II randomized controlled trial (RCT) to assess its feasibility and preliminary efficacy.
METHODS: Patients were recruited within 1 month of hospital admission and randomized to EASE plus usual care (UC) or UC alone. EASE includes (1) EASE-psy, a tailored psychotherapy delivered over 8 weeks, and (2) EASE-phys, weekly physical symptom screening over 8 weeks to trigger early palliative care. The primary outcome was traumatic stress symptoms; secondary outcomes included physical symptom burden and quality of life. Assessments were conducted at baseline and at 4, 8, and 12 weeks. Between-group differences were evaluated using multilevel modeling.
RESULTS: Forty-two patients were randomized to EASE (n = 22) or UC (n = 20), with 76% retention at 12 weeks. Predefined feasibility outcomes were met: 86% (19/22) of EASE participants completed = 50% of EASE-psy sessions (goal = 64%); 100% received Edmonton Symptom Assessment System (ESAS, modified for AL) screenings, 64% (14/22) of whom completed = 50% of planned screenings (goal =50%); and 100% with scores = 4/10 on any physical ESAS-AL item had = 1 meeting with the EASE-phys team (goal 100%). Significant treatment-group differences favoring EASE were observed in traumatic stress symptoms at 4 and 12 weeks, and pain intensity and interference at 12 weeks (all p < .05).
CONCLUSIONS: EASE is feasible in patients newly diagnosed with AL and shows promise of effectiveness. These results warrant a larger RCT to provide evidence for its more routine use as a standard of care.

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Article

An online international comparison of thresholds for triggering a negative response to the "surprise question" - a study protocol

WHITE, Nicola ; OOSTENDORP, Linda ; VICKERSTAFF, Victoria ; GERLACH, Christina ; ENGELS, Yvonne ; MAESSEN, Maud ; TOMLINSON, Christopher ; WENS, Johan ; LEYSEN, Bert ; BIASCO, Guido ; ZAMBRANO, Sofia ; EYCHMULLER, Steffen ; AVGERINOU, Christina ; CHATTAT, Rabih ; OTTOBONI, Giovanni ; VELDHOVEN, Carel ; STONE, Patrick
BMC palliative care, 09/04/2019, vol.18, n°1, 9 p.

Thème : Recherche - Evaluation - Méthodologie. Cote : eD15.00.01

DEMARCHE PALLIATIVE ; MORT ; PRONOSTIC ; EVALUATION ; ANALYSE COMPARATIVE ; PROTOCOLE RECHERCHE

BACKGROUND: The Surprise Question (SQ) "would I be surprised if this patient were to die in the next 12 months?" has been suggested to help clinicians, and especially General Practitioners (GPs), identify people who might benefit from palliative care. The prognostic accuracy of this approach is unclear and little is known about how GPs use this tool in practice. Are GPs consistent, individually and as a group? Are there international differences in the use of the tool? Does including the alternative Surprise Question ("Would I be surprised if the patient were still alive after 12 months?") alter the response? What is the impact on the treatment plan in response to the SQ? This study aims to address these questions.
METHODS: An online study will be completed by 600 (100 per country) registered GPs. They will be asked to review 20 hypothetical patient vignettes. For each vignette they will be asked to provide a response to the following four questions: (1) the SQ [Yes/No]; (2) the alternative SQ [Yes/No]; (3) the percentage probability of dying [0% no chance - 100% certain death]; and (4) the proposed treatment plan [multiple choice]. A "surprise threshold" for each participant will be calculated by comparing the responses to the SQ with the probability estimates of death. We will use linear regression to explore any differences in thresholds between countries and other clinician-related factors, such as years of experience. We will describe the actions taken by the clinicians and explore the differences between groups. We will also investigate the relationship between the alternative SQ and the other responses. Participants will receive a certificate of completion and the option to receive feedback on their performance.
DISCUSSION: This study explores the extent to which the SQ is consistently used at an individual, group, and national level. The findings of this study will help to understand the clinical value of using the SQ in routine practice.

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Article

Development and evaluation of an outpatient palliative care clinic

BENTON, Kathleen ; ZERBO, Kotwoallama Reine ; DECKER, Megan ; BUCK, Brian
JOURNAL OF HOSPICE AND PALLIATIVE NURSING, 04/2019, vol.21, n°2, p. 160-166

Thème : Soins. Cote : 00.07JHP

MODELE ; HOSPITALISATION JOUR ; DEMARCHE PALLIATIVE ; EVALUATION ; ETATS-UNIS ; ACCOMPAGNEMENT SPIRITUEL

Palliative care (PC) is an interdisciplinary team approach to address patients’ physical, psychosocial, and spiritual needs to improve quality of life among those who have faced a life-threatening illness. When PC services are provided in an outpatient setting, patients can stay in their homes and have all their physical, psychosocial, and spiritual needs met by a comprehensive health care team to ensure a good quality of life. Because outpatient PC clinics offer a viable option for delivering PC in communities but are not prevalent in the US health care system and were rarely described in the literature, this article has described the development and evaluation of an outpatient PC clinic that was dedicated to integrating spiritual care. Specifically, this article describes (1) the factors prompting development of the clinic and its growth, (2) how a chaplain was integrated into the PC provision process, and (3) the processes and outcomes of evaluation of this clinic.

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Article

Evaluation of the pronouncement of death policy implementation and outcomes - implications for advanced practice nursing

JACKSON, Hazel Anita ; OLIVER, JoAnn S. ; HOUSE, Kim
JOURNAL OF HOSPICE AND PALLIATIVE NURSING, 04/2019, vol.21, n°2, p. 139-143

Thème : Soins. Cote : 00.07JHP

EVALUATION ; SOIN INFIRMIER ; ETATS-UNIS ; POLITIQUE SANITAIRE ; MORT

In 2011, the Veterans Health Administration mandated that Veterans Affairs (VA) Medical Centers develop and implement a policy that allowed registered nurses (RNs) and advanced practice registered nurses (APRNs) to pronounce the death of residents who die in Veterans Affairs community living centers, previously known as nursing homes, provided that there is a written do-not-resuscitate order in their medical record. The purpose of this quality improvement project was to determine the extent to which the implementation of the RN/APRN death pronouncement policy affected death pronouncement time for residents who die after 5 PM and before 7:30 AM, on weekends and holidays. This project is significant because the previous physician-only death pronouncement policy was found to cause unnecessary delays in death pronouncement. A chart review of the medical records of all veterans' deaths pronounced by physicians 3 years before the implementation of the policy and 4 years after the RN/APRN policy was reviewed and implemented. The data analysis was conducted using descriptive analysis. A significant difference was found in the results (P < .05). The maximum for prepolicy deaths was 125 minutes. The maximum for postpolicy deaths was 7 minutes. The results supported the assumption that RN/APRN pronounced death without delay.

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Article

Palliative care nursing communication - an evaluation of the comfort model

FUOTO, Abby ; TURNER, Kathleen M.
JOURNAL OF HOSPICE AND PALLIATIVE NURSING, 04/2019, vol.21, n°2, p. 124-130

Thème : Soins. Cote : 00.07JHP

SOIN INFIRMIER ; DEMARCHE PALLIATIVE ; COMMUNICATION ; EVALUATION ; SOIN CONFORT ; ETATS-UNIS

Despite the frequency, complexity, and intensity of communication that occurs between nurses, patients, and families, palliative care nurses often struggle with end-of-life communication. The primary goal of this quality improvement project was to increase nurse confidence and satisfaction engaging in end-of-life communication following the implementation of the COMFORT model; the secondary goal was to improve patient-family satisfaction with care provided in the palliative care unit. Fourteen palliative care nurses attended a 4-hour course to learn the tenets of the COMFORT model and practice through role-play exercises. A repeated-measures design was used to measure nurse confidence and satisfaction precourse, postcourse, and 3 months postcourse. A between-subjects pre-post design was used to compare family satisfaction survey scores in the 3-month period before versus the 3 months after implementation. Analysis revealed a statistically significant increase in all measures of nurse confidence and satisfaction from precourse to postcourse and from precourse to 3 months postcourse. There was no statistical difference between the family satisfaction survey scores before versus after training, although survey results were generally high at baseline and most respondents rated palliative services with the best possible response. This project demonstrates that COMFORT model training increased confidence and satisfaction of palliative care nurses engaged in end-of-life communication and demonstrates potential for use in other clinical areas that do not specialize in end-of-life nursing (eg, critical care) but find themselves in need of the communications skills to address end-of-life care.

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Article

Evaluation of the interrater reliability of end-of-life medical orders in the physician orders for life-sustaining treatment form

LOVADINI, Gustavo Bigaton ; FUKUSHIMA, Fernanda Bono ; SCHOUERI, Joao Francisco Lindenberg ; DOS REIS, Roberto ; FONSECA, Cecilia Guimarães Ferreira ; RODRIGUEZ, Jahaira Jeanainne Casanova ; COELHO, Cauana Silva ; NEVES, Adriele Ferreira ; RODRIGUES, Aniela Maria ; MARQUES, Marina Almeida ; JACINTO, Alessandro Ferrari ; HARRISON DENING, Karen ; BASSETT, Rick ; MOSS, Alvin H. ; STEINBERG, Karl E. ; VIDAL, Edison Iglesias de Oliveira
JAMA network open, 05/04/2019, vol.2, n°4, 11 p.

Thème : Soins. Cote : eD02.07

EVALUATION ; PRATIQUE MEDICALE ; FIN VIE ; MEDECIN ; ETUDE TRANSVERSALE ; BRESIL

Importance: Despite its spread in much of the United States and increased international interest, the Physician Orders for Life-Sustaining Treatment (POLST) paradigm still lacks supporting evidence. The interrater reliability of the POLST form to translate patients' values and preferences into medical orders for care at the end of life remains to be studied.
Objective: To assess the interrater reliability of the medical orders documented in POLST forms.
Design, Setting, and Participants: This cross-sectional study was conducted in a public university hospital in southeastern Brazil. Two independent researchers interviewed the same patients or decision-making surrogates (n = 64) during a single episode of hospitalization within a time frame of 1 to 7 days. Eligible participants were hospitalized adults aged 21 years or older who were expected to remain hospitalized for at least 4 days and whose attending physician responded no to the question, Would I be surprised if this patient died in the next year? Data collection occurred between November 1, 2015, and September 20, 2016, and first data analyses were performed on October 3, 2016.
Main Outcomes and Measures: Interrater reliability as measured by k statistics.
Results: Of the 64 participants interviewed in the study, 53 (83%) were patients and 11 (17%) were surrogates. Patients' mean (SD) age was 64 (14) years, and 35 patients (55%) and 8 surrogates (73%) were women. Overall, in 5 cases (8%), disagreement in at least 1 medical order for life-sustaining treatment was found in the POLST form, changing from the first interview to the second interview. The k statistic for cardiopulmonary resuscitation was 0.92 (95% CI, 0.80-1.00); for level of medical intervention, 0.89 (95% CI, 0.76-1.00); and for artificially administered nutrition, 0.92 (95% CI, 0.83-1.00).
Conclusions and Relevance: The high interrater reliability of the medical orders in POLST forms appears to offer further support for this advance care planning paradigm; in addition, the finding that this interrater reliability was not 100% underscores the need to ensure that patients or their surrogates have decision-making capacity and to confirm that the content of POLST forms accurately reflects patients' current treatment preferences.

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Article

Estimating the short-term prognosis to adjust the transfer of patients with terminal cancer to medium-stay palliative care units

SANCHO ZAMORA, M. A. ; PLAZA CANTELI, S. ; PITA CARRANZA, A. J. ; GONZALEZ GARCIA, N.
Revista clinica Espanola, 05/03/2019, Pagination inconnue

Thème : Recherche - Evaluation - Méthodologie.

PRONOSTIC ; TRAJECTOIRE MALADIE ; CANCER ; PHASE TERMINALE ; UNITE SOINS PALLIATIFS ; EVALUATION ; ECHELLE MESURE ; ETUDE LONGITUDINALE ; SYMPTOME ; ESPERANCE VIE

BACKGROUND AND OBJECTIVES: Clinical management for terminal patients should consider various aspects, particularly the patient's functional assessment, which correlates well with the short-term prognosis. The prognosis could improve if the presence of symptoms strongly associated with a poorer progression were included. The study's main objective was to assess whether the prognosis according to the Palliative Performance Scale (PPS) improved with the presence/absence of pain-dyspnoea-delirium symptoms. The secondary objective was to determine caregiver satisfaction with the transfer to medium-stay palliative care units (MSPCUs), which are prepared for medium stays of approximately one month.
PATIENTS AND METHOD: We conducted a prospective, observational, multicentre (regional) study that analysed survival in MSPCUs according to the PPS dichotomized to > 20% and = 20%. We estimated the mean survival functions using the Kaplan-Meier method and compared them according to the Cox proportional hazards ratios (HR). Caregiver satisfaction was studied using an anonymous self-administered Likert questionnaire.
RESULTS: The study included 130 patients. The PPS = 20% and PPS > 20% subgroups had a median survival of 6 (3-13) days and 21 (11-42) days, respectively, with an unadjusted mortality HR 3.1-fold greater in the PPS = 20% subgroup. The HR did not change when adjusted for the symptoms. Eighty-three percent of the caregivers found the transfer beneficial, and 40% observed better patient care.
CONCLUSIONS: For patients transferred from general hospitals to MSPCUs, PPS scores = 20% were associated with survival shorter than one week, with a 3-fold higher mortality HR than patients with PPS scores > 20%, without the analysis adjusted for the presence of pain-dyspnoea-delirium providing greater prognostic accuracy. The caregivers found benefits mainly in the convenience of the facilities and distance.

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Article

Depression as mediator and or moderator on the relationship between hopelessness and patients' desire for hastened death

PARPA, Efi ; TSILIKA, Eleni ; GALANOS, Antonis ; NIKOLOUDI, Maria ; MYSTAKIDOU, Kyriaki
Supportive care in cancer, 21/03/2019, p. 1-6

Thème : Psychologie, psychanalyse.

DEPRESSION ; DESESPOIR ; DESIR MOURIR ; CANCER ; EVALUATION ; ECHELLE MESURE

PURPOSE: Previous findings have shown that depression in advanced stages of cancer is associated with hopelessness and frequently with wishes for hastened death. The current study tries to investigate the relationship between hopelessness and desire for hastened death and if depression may be a moderator and/or mediator role in patients with advanced cancer.
METHOD: The participants were 102 patients with advanced cancer which they completed the Beck Hopelessness Scale (BHS), the Greek Schedule of Attitudes towards Hastened Death (G-SAHD), and the Greek Beck Depression Inventory (BDI).
RESULTS: Depression was highly correlated with hopelessness and desire for hastened death. Mediation analyses revealed that hopelessness influenced desire for hastened death as well as indirectly by its effect on depression. Similarly, depression was found as moderator in the relationship between hopelessness with desire for hastened death.
CONCLUSIONS: Hopelessness and desire for hastened death in patients with advanced cancer should be diagnosed and treated by taking into consideration the optimum care of depression as a priority in palliative care.

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Article

Spiritual well-being mediates the association between attachment insecurity and psychological distress in advanced cancer patients

SCHEFFOLD, Katharina ; PHILIPP, Rebecca ; VEHLING, Sigrun ; KORANYI, Susan ; ENGELMANN, Dorit ; SCHULZ-KINDERMANN, Frank ; HÄRTER, Martin ; MEHNERT-THEUERKAUF, Anja
Supportive care in cancer, 18/03/2019, p. 1-9

Thème : Psychologie, psychanalyse.

SPIRITUALITE ; BIEN ETRE ; BESOIN SECURITE ; DETRESSE PSYCHOLOGIQUE ; CANCER ; ALLEMAGNE ; EVALUATION ; DEPRESSION ; ANXIETE

PURPOSE: The diagnosis of a terminal disease bears existential challenges, which activate the attachment system. Attachment insecurity, as well as existential resources, such as spiritual well-being, influences patients' extent of psychological distress. Knowledge about the interrelation of these constructs is limited. Based on current research, we assume spiritual well-being to mediate the association of attachment insecurity and psychological distress.
METHODS: We obtained data from the baseline measurement of a randomized controlled trial in advanced cancer patients. Patients were sampled from the University Medical Centers of Hamburg and Leipzig, Germany. Main outcome measures included the Patient Health Questionnaire (PHQ-9), the Death and Dying Distress Scale (DADDS), the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp), and the Experience in Close Relationships Scale (ECR-M16) for assessing attachment insecurity. We tested the mediation hypothesis with two regression analyses using bootstrapping procedure.
RESULTS: A total of 190 patients were included. Spiritual well-being mediated the association of attachment insecurity and depression (R2 = 11%), as well as death anxiety (R2 = 15%), in fearful-avoidant attached patients. Neither dismissingly nor preoccupied attached patients differ in terms of spiritual well-being and psychological distress in comparison with secure attached patients.
CONCLUSION: Spiritual well-being plays a relevant role in advanced cancer patient's mental health through mediating the association of attachment and psychological distress. Developing a better understanding of the interdependency of the constructs of spiritual well-being and attachment can help to develop individually tailored advanced cancer care programs and psychotherapeutic interventions.

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Article

Symptom dimensions in people affected by long-term neurological conditions - a factor analysis of a patient-centred palliative care outcome symptom scale

WILSON, Rebecca ; HEPGUL, Nilay ; SAHA, Romi A. ; HIGGINSON, Irene J. ; GAO, Wei
Scientific reports, 21/03/2019, vol.9, n°1, p. 1-6

Thème : Recherche - Evaluation - Méthodologie. Cote : eD15.00.02

NEUROLOGIE ; SYMPTOME ; EVALUATION ; ECHELLE MESURE ; SYMPTOME

Long-term neurological conditions (LTNCs) often cause debilitating symptoms. Better understanding of symptom dimensions in LTNCs is needed to support health professionals and improve care. This can be achieved by exploring the factor structure of a standardised measure of symptoms in LTNC patients. The symptom subscale of the Integrated Palliative Outcome Scale for LTNCs (IPOS Neuro-S24) comprises 24 items measuring symptom severity. Descriptive statistics and psychometric properties of the scale were assessed, followed by differential item functioning (DIF), exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Data from N = 238 patients were analysed. The mean IPOS Neuro S-24 score was 27.0 (possible range 0–96) and floor effects were found for 21 items. The scale had good internal consistency (Cronbach’s alpha = 0.77). Weak evidence of DIF was found for nine items. All but one item (falls) loaded onto four factors with loadings > 0.3. The factors represented four clinically meaningful symptom dimensions: fatigue, motor symptoms, oral problems and non-motor symptoms. We identified a reliable four-factor structure of symptom experience in LTNC patients. The results suggest that symptom dimensions are common across LTNCs. The IPOS Neuro S-24 is an appropriate tool to measure symptoms in LTNC patients, which may improve care.

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Article

Subjective and objective assessment of taste and smell sensation in advanced cancer

MCGETTIGAN, Niamh ; DHUIBHIR, Pauline Uí ; BARRETT, Michelle ; SUI, Jessica ; BALDING, Lucy ; HIGGINS, Stephen ; O'LEARY, Norma ; KENNEDY, Aileen ; WALSH, Declan
The American journal of hospice and palliative care, 03/03/2019, Pagination inconnue

Thème : Psychologie, psychanalyse.

GOUT ; ODORAT ; CANCER ; PREVALENCE ; NUTRITION ; UNITE SOINS PALLIATIFS ; EVALUATION

CONTEXT: Taste and smell abnormalities (TSA) occur throughout the cancer trajectory regardless of cancer primary site and contribute to cancer-associated malnutrition. TSA etiology is poorly understood. Tumor-related inflammation is a possible cause.
OBJECTIVE: This study examined the prevalence, characteristics, and severity of TSA in advanced cancer and explored the relationship between TSA and nutritional status. No previous study combined subjective and objective measures for both taste and smell assessment in this population.
METHOD: Consecutive advanced cancer hospice patients were recruited. A modified version of the "Taste and Smell Survey" assessed subjective TSA. Validated taste strips and "Sniffin' Sticks" were the objective measures. The abridged patient-generated subjective global assessment evaluated nutritional status.
RESULTS: A 93% prevalence of TSA in 30 patients with advanced cancer was identified. When subjective and objective evaluations were combined, 28 had taste abnormalities, 24 smell abnormalities, and 24 both. Taste changes included "persistent bad taste" (n = 18) and changes in how basic tastes were perceived. Half reported smell was not "as strong" as prediagnosis, while more than half (n = 16) had an objective smell abnormality. Most (97%) were at risk of malnutrition. Fatigue, dry mouth, early satiety, and anorexia were common nutrition-impact symptoms. No statistically significant relationship was found between TSA and malnutrition scores.
CONCLUSIONS: TSA were highly prevalent. Subjective taste and smell changes did not always accord with objective TSA, suggesting both assessments are valuable. TSA characteristics varied, and particular foods tasted and smelled different and were not enjoyed as before. TSA are common, high-impact problems in advanced cancer.

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Article

Cancer pain and quality of life

RODRIGUEZ, Carmen ; JI, Ming ; WANG, Hsiao-Lan ; PADHYA, Tapan ; MAC MILLAN, Susan C.
JOURNAL OF HOSPICE AND PALLIATIVE NURSING, 04/2019, vol.21, n°2, p. 116-123

Thème : Médecine. Cote : 00.07JHP

DOULEUR ; CANCER ; QUALITE VIE ; EVALUATION ; HOSPITALISATION JOUR ; ECHELLE MESURE

Cancer pain is an unrelenting symptom with the potential to alter the quality of life of patients. To adequately manage pain, nurses caring for cancer patients need to fully understand each patient's pain experience. The purpose of this study was to identify the intensity, distress, frequency, or constancy of pain in patients treated for cancer or cancer symptoms and to better understand patient barriers to pain management. This cross-sectional study included patients (N = 105) treated for cancer or cancer symptoms at 2 outpatient medical centers. Assessments included the Pain Barriers Scale, the Cancer Symptom Scale, and the Multidimensional QOL Scale–Cancer. Descriptive statistics and Spearman correlations were used to analyze the data. Sixty-nine percent of patients reported present pain of moderate to severe intensity that caused distress, was frequent/constant, or interfered with their lives. Patients with the greatest pain distress reported the greatest intensity of pain (r = 0.77) and the greatest interference (r = 0.78) with daily lives. Cancer pain was associated with significant distress and interference with life activities and occurred frequently or constantly for many study patients.

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Development and validity of the nursing care scale and nurse’s difficulty scale in caring for dying patients with cancer and their families in general hospitals in Japan

KANNO, Yusuke ; SATO, Kazuki ; SHIMIZU, Megumi ; FUNAMIZU, Yuko ; ANDOH, Hideaki ; KISHINO, Megumi ; SENAGA, Tomomi ; TAKAHASHI, Tetsu ; MIYASHITA, Mitsunori
JOURNAL OF HOSPICE AND PALLIATIVE NURSING, 04/2019, vol.21, n°2, p. 174–182

Thème : Recherche - Evaluation - Méthodologie. Cote : e00.07JHP

ECHELLE MESURE ; SOIN INFIRMIER ; JAPON ; HOPITAL ; CANCER ; EVALUATION ; ETAPE MOURIR

This study develops and examines the validity and reliability of 2 scales, respectively, for evaluating nursing care and the experience of difficulties providing nursing care for dying patients with cancer and their families. A cross-sectional anonymous questionnaire was administered to nursing staff caring for dying patients with cancer and their families in 4 general hospitals and a university hospital in Japan. The instruments assessed were the Nursing Care Scale for Dying Patients and Their Families (NCD) and the Nurse’s Difficulty Scale for Dying Patients and Their Families (NDD). Of the 497 questionnaires sent to nurses, 401 responses (80%) were analyzed. Factor analyses revealed that the NCD and NDD consisted of 12 items with 4 subscales: "symptom management," "reassessment of current treatment and nursing care," "explanation to family," and "respect for the patient and family’s dignity before and after death." These scales had sufficient convergent and discriminative validity, sufficient internal consistency (a of subscales: NCD, 0.71-0.87; NDD, 0.74-0.93), and sufficient test-retest reliability (intraclass correlation coefficient of subscales: NCD, 0.59-0.81; NDD, 0.67-0.82) to be used as self-assessments and evaluation tools in education programs to improve the quality of nursing care for the dying patients and their families.

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Parental strengths in caring for their dying child - long-term follow-up in Kenya

HALEY, Janice Marie
JOURNAL OF HOSPICE AND PALLIATIVE NURSING, 04/2019, vol.21, n°2, p. 144-151

Thème : Soins. Cote : 00.07JHP

ETAPE MOURIR ; ENFANT ; KENYA ; GUIDE ; ACCOMPAGNEMENT ; PARENT ; EVALUATION ; ECHELLE MESURE ; UNITE SOINS PALLIATIFS ; DEMARCHE PALLIATIVE

Research conducted using the Haley Transcultural Strengths Assessment Interview Guide used in several studies has identified 11 sources of strength routinely utilized by parents caring for their child with intensive needs and child in hospice/palliative care. Results of past studies demonstrated this Strengths Guide (SG) interview to be an intervention bringing a heightened realization of the importance and utilization of one's inner strengths. The purpose of this study was to assess the long-term impact of this SG with a population of parents who participated in a previous study using the SG. This descriptive study was conducted using a quantitative tool, the Personal Strength Rating Scale, comparing the post-SG interview results with those results obtained 3 years later. Participants in this study were parents caring for a child receiving palliative/hospice care at home in Kenya. Results revealed the long-term retention of strengths following the SG interview 3 years previously was, for most sources of strength, equal to or greater than those obtained immediately following the SG.

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Development and evaluation of an outpatient palliative care clinic

BENTON, Kathleen ; ZERBO, Kotwoallama Reine ; DECKER, Megan ; BUCK, Brian
JOURNAL OF HOSPICE AND PALLIATIVE NURSING, 04/2019, vol.21, n°2, p. 160-166

Thème : Santé. Cote : 00.07JHP

HOSPITALISATION DOMICILE SOINS PALLIATIFS ; EVALUATION ; SPIRITUALITE ; AUMONIER

Palliative care (PC) is an interdisciplinary team approach to address patients’ physical, psychosocial, and spiritual needs to improve quality of life among those who have faced a life-threatening illness. When PC services are provided in an outpatient setting, patients can stay in their homes and have all their physical, psychosocial, and spiritual needs met by a comprehensive health care team to ensure a good quality of life. Because outpatient PC clinics offer a viable option for delivering PC in communities but are not prevalent in the US health care system and were rarely described in the literature, this article has described the development and evaluation of an outpatient PC clinic that was dedicated to integrating spiritual care. Specifically, this article describes (1) the factors prompting development of the clinic and its growth, (2) how a chaplain was integrated into the PC provision process, and (3) the processes and outcomes of evaluation of this clinic.

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Symptom distress - implementation of palliative care guidelines to improve pain, fatigue, and anxiety in patients with advanced cancer

KOESEL, Niki ; TOCCHI, Christine ; BURKE, Larry ; YAP, Tracey ; HARRISON, Alison
Clinical journal of oncology nursing, 01/04/2019, vol.23, n°2, p. 149-155

Thème : Médecine. Cote : eD03.01

RECOMMANDATION ; DEMARCHE PALLIATIVE ; CONTROLE DOULEUR ; CONTROLE SYMPTOME ; ASTHENIE ; ANXIETE ; CANCER ; ECHELLE MESURE ; EVALUATION ; ETATS-UNIS

BACKGROUND: The integration of palliative care into standard oncology care is supported by research to improve quality of life and symptom distress in patients with advanced cancer. In 2016, the American Society of Clinical Oncology (ASCO) released practice guidelines for oncology palliative care that emphasized interprofessional assessment and management of this patient population.
OBJECTIVES: The purpose of this study was to evaluate the effect of clinical guidelines on symptom distress in patients with advanced cancer.
METHODS: In two oncology palliative care clinics, the Edmonton Symptom Assessment Scale (ESAS) scores for pain, fatigue, and anxiety were measured prior to consultation (T1) and at two subsequent visits (T2 and T3). A standardized documentation template was used to measure fidelity for key guideline components.
FINDINGS: Pain, fatigue, and anxiety ESAS scores were statistically lower from T1 to T3. The frequency of patients having a decrease of 2 or more points for all symptoms increased compared to baseline data. There was 100% compliance to the documentation template during the guideline implementation.

Origine : PubMed

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