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Off-label-prescriptions in daily clinical practice - a cross-sectional national survey of palliative medicine physicians

HAGEMANN, Vera ; BAUSEWEIN, Claudia ; REMI, Constanze
PROGRESS IN PALLIATIVE CARE, 04/07/2019, vol.27, n°4, p. 154-159

Document en ligne

Thème : Soins.

PRESCRIPTION ; DEMARCHE PALLIATIVE ; PRATIQUE MEDICALE ; MEDECIN ; ALLEMAGNE

Background: Off-label-use is an indispensable element of palliative medicine. Up to one third of all drugs are prescribed beyond their licence. It is challenging to find the right balance between potential risks and benefits in the context of limited therapeutic options. To date, little is known how physicians deal with this challenge in daily practice.
Objectives: To evaluate (1) the awareness of German palliative medicine physicians of off-label-use, (2) the basis for decision-making for off-label-use, (3) the existence of guidelines for off-label prescribing and (4) practical problems arising in clinical practice.
Methods: Anonymous online survey among German palliative medicine physicians. Medical directors and consultants/other doctors were surveyed independently with two different questionnaires. The questionnaires included questions regarding documentation, legal and practical aspects of off-label drug use.
Results: In total, 578/605 emails sent were delivered. One hundred and forty-one questionnaires were fully completed, 8 partially. Response rate 23%. The majority of participants worked in specialist palliative home care and palliative care units (n = 134). One hundred and two (68%) participants were aged >50 years and 103 (69%) practised medicine >20 years. One hundred and twelve medical directors participated, 95 (85%) reported that no guidance on documentation of off-label-use was available. In total, 30/37 consultants and other doctors indicated experience as basis for their decision making on off-label-use. Twenty-four (75%) of the consultants and other doctors regularly used off-label-therapies with little or no evidence base. Uncertainties exist regarding drug safety, legal issues and the cost coverage.
Conclusions: More recommendations on the management of off-label drug use are necessary. Participants demand greater legal security including unbureaucratic prescribing.

Origine : Taylor and Francis+NEJM

Interdisciplinary perspectives on the value of massage therapy in a pediatric hospice

EGELI, Deetria ; BAINBRIDGE, Lesley ; MILLER, Tanice ; POTTS, James
JOURNAL OF HOSPICE AND PALLIATIVE NURSING, 08/2019, vol.21, n°4, p. 319-325

Document en ligne

Thème : Soins.

INTERDISCIPLINARITE ; MASSAGE ; PEDIATRIE ; UNITE SOINS PALLIATIFS ; CANADA ; PHENOMENOLOGIE ; MEDECIN ; PERCEPTION

Canuck Place Children’s Hospice in Vancouver, Canada, has been hosting a massage therapy practicum within the hospice since 2011. The practicum is delivered by upper-level massage therapy students who are supervised by a registered massage therapist and clinical instructor through West Coast College of Massage Therapy. This study aimed to explore clinicians’ perspectives on the value of providing massage therapy to support children in hospice care, their families, and staff. The research participants (n = 6) comprised Canuck Place clinicians who have experience with the massage therapy practicum. In this descriptive phenomenological inquiry, semistructured interviews and thematic analysis were used. The findings demonstrated that Canuck Place clinicians valued the massage therapy practicum for its practical support in terms of creating access to massage therapy and self-care in the hospice. Massage therapy was also valued for supporting physical wellness (injury prevention/maintenance and symptom management) and psychosocial wellness (supporting dignity, interconnection, intraconnection, and rest/relaxation and providing a source of comfort/nurturing). This study is the first to explore clinicians’ perceptions of massage therapy within a pediatric hospice and contributes to understanding massage therapy’s potential role in the support of children, families, and staff within a hospice setting.

Origine : journals.lww.com

Characterizing palliative radiotherapy education in hospice and palliative medicine fellowship - a survey of fellowship program directors

MARTIN, Emily J. ; JONES, Joshua A.
JOURNAL OF PALLIATIVE MEDICINE, 02/08/2019, Pagination inconnue

Document en ligne

Thème : Formation.

RADIOTHERAPIE ; DEMARCHE PALLIATIVE ; MEDECIN ; ETATS-UNIS ; BESOIN FORMATION

Background: Educational deficiencies among hospice and palliative medicine (HPM) physicians contribute to suboptimal utilization of palliative radiotherapy (PRT) for patients with advanced cancer.
Objective: to survey HPM fellowship program directors regarding the need for PRT education in HPM fellowship.
Design: We conducted a cross-sectional survey of HPM fellowship program directors in June 2018. We used a 5-point Likert-type scale to assess agreement with statements related to PRT education.
Setting/Subjects: program directors for all United States Accreditation Council for Graduate Medical Education-accredited HPM fellowship programs with at least one enrolled fellow at the time of survey distribution were included.
Results: eighty-one of 120 eligible program directors completed the survey (68% response rate). Nearly all of the respondents agreed that HPM physicians should possess a working knowledge of PRT and that the principles of PRT should be formally taught in HPM fellowship. Thirty percent of HPM fellowship programs, however, lacked a PRT curriculum and only 14% of programs provided more than two hours of PRT education. Limited didactic time, lack of interest among fellows, and lack of collaboration with radiation oncologists were not perceived to be significant barriers to incorporating PRT education into HPM fellowship. More than 75% of program directors indicated that they would consider implementing a PRT curriculum designed specifically for HPM physicians if one were available.
Conclusion: There is a need for PRT education in HPM fellowship. This need may be best addressed by developing a widely accessible PRT curriculum designed to meet the needs of HPM physicians.

Origine : PubMed

Palliative radiotherapy education for hospice and palliative medicine fellows - a national needs assessment

MARTIN, Emily J. ; JONES, Joshua A.
JOURNAL OF PALLIATIVE MEDICINE, 02/08/2019, Pagination inconnue

Document en ligne

Thème : Formation.

RADIOTHERAPIE ; MEDECIN ; FORMATION PROFESSIONNELLE ; DEMARCHE PALLIATIVE ; ETATS-UNIS

Background: Insufficient knowledge of palliative radiotherapy (PRT) among hospice and palliative medicine (HPM) physicians is thought to be a barrier to the provision of high-quality palliative care.
Objective: to assess the need for PRT education in HPM fellowship.
Design: A cross-sectional survey of HPM fellows was conducted in June 2018.
Setting/Subjects: The survey was distributed to accredited HPM fellowship programs in the United States for distribution to enrolled fellows; 114 fellows responded to the survey.
Results: Nearly all respondents agreed that the principles of PRT should be taught in HPM fellowship, yet 51% had received no PRT education and 35% had received only one or two hours. Only 25% of respondents rated their working knowledge of PRT as sufficient, 40% felt confident in identifying radiation oncology emergencies or managing radiotherapy side effects, and 52% felt confident in assessing which patients to refer for radiotherapy. More than 75% agreed that were they more knowledgeable about PRT, they would be more likely to consider referral to radiation oncology, to collaborate with radiation oncologists, and to advocate for a short course of treatment based on a patient's prognosis or goals or care. Fellows who received PRT education in fellowship had significantly greater knowledge of and more favorable attitudes toward the use of radiotherapy. This difference was the greatest among fellows who had received at least five hours of PRT education.
Conclusion: There is a need for PRT education in HPM fellowship. Efforts to address this need may lead to more appropriate utilization of PRT for patients with advanced cancer.

Origine : PubMed

Compassion fatigue among oncologists - the role of grief, sense of failure, and exposure to suffering and death

LAOR-MAAYANY, Rony ; GOLDZWEIG, Gil ; HASSON-OHAYON, Ilanit ; BAR-SELA, Gil ; ENGLER-GROSS, Adi ; BRAUN, Michal
Supportive care in cancer, 08/08/2019, p. 1-7

Document en ligne

Thème : Psychologie, psychanalyse.

CANCEROLOGIE ; MEDECIN ; EPUISEMENT PROFESSIONNEL ; COMPASSION ; SATISFACTION ; DEUIL

PURPOSE: Oncologists cope with unique work characteristics that increase their risk of developing compassion fatigue-that is, burnout and secondary traumatic stress-and can result in reduced capacity and interest in being empathetic to the suffering of others (Stamm B. The concise ProQOL manual, 2010). At the same time, oncologists can experience compassion satisfaction-that is, the positive aspects of caring. This study explored the associations of compassion fatigue and compassion satisfaction with oncologists' grief and sense of failure beyond their reported exposure to suffering and death.
METHODS: Seventy-four oncologists completed self-administered questionnaires examining compassion fatigue, compassion satisfaction, grief, exposure to suffering and death, and sense of failure.
RESULTS: The oncologists reported that they face the loss of approximately 50% of their patients, and that their patients suffer from profound emotional and physical pain. High levels of compassion fatigue and grief, and moderate levels of sense of failure, were reported. Findings showed a lack of association between exposure to suffering and death and compassion fatigue and satisfaction. However, grief and sense of failure were found to predict both aspects of compassion fatigue: secondary traumatic stress (p < 0.001, p < 0.003, respectively) and burnout (p < 0.002, p < 0.025, respectively).
CONCLUSIONS: These results highlight the importance of the oncologists' subjective experiences of grief and sense of failure, beyond their reports of exposure to suffering and death, in terms of their levels of compassion fatigue. Implications of these findings include the need to develop interventions for oncologists that will allow them to acknowledge, process, and overcome negative experiences of failure and grief.

Origine : PubMed

Exploring and managing the impostor phenomenon in palliative care - a case series

LAWTON, Andrew J. ; LAWTON, Christopher W. ; DIETZ, Sarah Scott B. ; STEVENS, Erin E. ; WEIS, Jo M.
JOURNAL OF PALLIATIVE MEDICINE, 13/08/2019, Pagination inconnue

Document en ligne

Thème : Ethique et déontologie.

DEMARCHE PALLIATIVE ; ETUDE CAS ; MEDECIN ; ETHIQUE ; RESSENTI ; DETRESSE PSYCHOLOGIQUE

The impostor phenomenon (IP) describes the experience of questioning one's abilities and fearing exposure as an intellectual fraud, despite objective evidence of success. The IP has been identified in high-achieving professionals across a variety of disciplines, including clinical medicine, and can be associated with significant anxiety and psychological distress. In this series, we present three authentic cases that demonstrate how the IP may manifest in palliative care practice. Acknowledging the current emphasis on clinician wellness and burnout, we suggest that the IP may be one important source of distress for many early-career clinicians in palliative care. With the physician as the focus of each case, we explore the difficult emotions faced and highlight how palliative care clinicians may be uniquely vulnerable to the IP. We then identify concrete strategies to help clinicians manage feelings of IP and enhance their professional well-being.

Origine : PubMed

Continuity of physicians' dedication to inpatient hospice and palliative care - a 14-year nationwide survey in Taiwan

CHENG, Bo-Ren ; LIN, Ming-Hwai ; CHANG, Hsiao-Ting ; WANG, Yi-Jen ; CHEN, Tzeng-Ji ; CHOU, Li-Fang ; HWANG, Shinn-Jang
International journal of environmental research and public health, 15/08/2019, vol.16, n°16, p. 1-9

Document en ligne

Thème : Soins. Cote : eD02.03.02.00

TAIWAN ; UNITE SOINS PALLIATIFS ; MEDECIN ; PRATIQUE PROFESSIONNELLE ; PRATIQUE MEDICALE

Background: The work continuity of physicians in hospice and palliative medicine (HPM) has a great impact on the quality of care and practice experiences. However, nationwide studies providing a general overview of the work continuity of HPM physicians are scarce.
Methods: Data relating to inpatient HPM care provided from July 2000 to December 2013 were obtained from the National Health Insurance Research Database of Taiwan. Specifically, the numbers of hospitals, patients, patient hospitalization days, and physicians involving HPM in each year were calculated. The years of HPM work experience and total HPM workdays of each physician were also computed.
Results: Of the 40,965,153 inpatient records during the study, 121,258 (0.3%) records were related to inpatient HPM care, with 60 participating hospitals and 604 attending physicians. The annual number of HPM physicians increased with time from 77 in 2000 to 217 in 2013. The largest percentage (38.4%) of physicians practiced HPM for only one year, while only 23 (3.8%) physicians practiced HPM in each year without interruption. Of the 217 HPM physicians in 2013, 45 (20.7%) were newcomers, 78 (36.0%) had 1-4 years of prior HPM work experience, 54 (24.9%) had 5-9 years, and 40 (18.4%) had at least 10 years. Conclusions: Among HPM physicians in Taiwan, only a small percentage exhibited long-term dedication to the field, whereas most HPM physicians had short practice periods. More strategies are needed to improve work continuity among HPM physicians.

Origine : PubMed

Coaching palliative care conversations - evaluating the impact on resident preparedness and goals-of-care conversations

RODENBACH, Rachel ; KAVALIERATOS, Dio ; TAMBER, Anoo ; TAPPER, Corey ; RESICK, Judith ; ARNOLD, Robert M. ; CHILDERS, Julie
JOURNAL OF PALLIATIVE MEDICINE, 28/08/2019, Pagination inconnue

Document en ligne

Thème : Formation.

DEMARCHE PALLIATIVE ; MEDECIN ; ETUDIANT ; FORMATION ; COMMUNICATION

Background: There is increasing need for nonspecialty physicians to deliver palliative care (PC) services to meet patient needs, but many physicians feel inadequately prepared.
Objective: We aimed to improve the PC skills of resident physicians through a learner-centered, just-in-time coaching intervention.
Design: Our quality improvement initiative consisted of two didactics and brief thrice-weekly coaching sessions that focused on real-time PC questions. Upper level internal medicine residents participated during an inpatient hospitalist rotation.
Measurements: Residents completed pre/postrotation surveys of their preparedness in discussing PC topics. Electronic medical record data of documentation of goals-of-care (GOC) discussions and Physician Orders for Life-Sustaining Treatment (POLST) completion in at-risk hospitalized patients (age >65 with two or more hospitalizations in the past six months, or age >90) were obtained and compared with before hospitalization. These data were also compared with data from patients on the same resident hospitalist service during the six-month period before the intervention began.
Results: During the 14-month intervention period, 42 residents cared for 232 at-risk patients. Among at-risk patients, 12.9% had a documented GOC discussion before hospitalization, which rose to 57.3% before discharge. Among at-risk patients preintervention, these rates were 5.2% and 25.0%, respectively. Residents reported their preparedness increased across many elements of GOC discussions and rated coaching sessions as useful and relevant to their training. Rates of POLST completion did not differ between preintervention and intervention groups.
Conclusions: Brief coaching sessions can integrate PC education into a busy clinical service, improve residents' primary PC skills, and improve GOC documentation.

Origine : PubMed

Interprofessional spiritual care training for geriatric care providers

BANDINI, Julia I. ; THIEL, Mary Martha ; MEYER, Elaine C. ; PAASCHE-ORLOW, Sara ; ZHANG, Qian ; CADGE, Wendy
JOURNAL OF PALLIATIVE MEDICINE, 27/08/2019, Pagination inconnue

Document en ligne

Thème : Formation.

RELIGION ; SPIRITUALITE ; PERSONNE AGEE ; BESOIN FONDAMENTAL ; FORMATION PROFESSIONNELLE ; MEDECIN ; GERIATRIE

Background: Despite the importance patients place on religion and spirituality, many patients with advanced diseases report that their religious and spiritual needs are not met by their health care team, and many nonchaplain clinicians feel unprepared to address religious and spiritual issues in their practice.
Objectives: The purpose of this study was to assess the efficacy of a one-day workshop on spiritual care for nonchaplain clinicians who provide care to elderly long-term care patients.
Methods: Clinician participants (N = 68) were given a pre-survey at the beginning of the workshop, a post-survey at the conclusion of the workshop, and a three-month follow-up survey to evaluate their comfort in engaging in spiritual issues before and after the workshop. An average ability score of 13 items in the survey was calculated as well as an average comfort score, which was an average of three items in the survey. Ability scores and comfort scores were analyzed using a pairwise t-test, comparing pre- versus post-workshop and post- versus three-month scores.
Results: Overall average scores for clinicians' self-reported perceived ability in engaging in issues around spirituality with patients and their families increased from before the workshop to the post-workshop and three months later. Participants' self-perceived comfort increased from before the workshop to immediately following the workshop.
Discussion: This study suggests that a spiritual care training program targeted toward geriatric clinicians has the potential to provide clinicians with the tools, skills, and support they need to approach basic spiritual care with their patients and family members.

Origine : PubMed

Use of antibiotics among end-of-life hospitalized patients with advanced directives - status examination and association with infectious disease consultation and physician burnout

FEDOROWSKY, Rina ; BACHNER, Yaacov G. ; BORER, Abraham ; CIOBOTARO, Pnina ; KUSHNIR, Talma
Infection control and hospital epidemiology, 28/08/2019, p. 1-7

Document en ligne

Thème : Médicaments - Pharmacie.

ANTIBIOTIQUE ; FIN VIE ; HOPITAL ; DIRECTIVE ANTICIPEE ; CONSULTATION ; EPUISEMENT PROFESSIONNEL ; MALADIE INFECTIEUSE ; MEDECIN

BACKGROUND: Overuse of antibiotics in end-of-life patients with advanced directives increases bacterial resistance and causes morbidity and mortality. Consultations with infectious disease (ID) physicians and burnout, which can affect antibiotic days of therapy (DOT) prescribed by physicians, have not been examined so far.
OBJECTIVES: To assess antibiotic use by physicians in end-of-life (EOL) patients with advanced directives and to investigate the association between ID consultations, physician burnout, and antibiotic DOT in those patients.
DESIGN: A descriptive correlational study.
SETTING: Acute-care and post-acute-care hospitals.
PARTICIPANTS: The study included 213 physicians and 932 their hospitalized patients in the last 2 weeks of life.
METHODS: We distributed questionnaires and analyzed the data collected regarding ID consultation, EOL antibiotics prescription with and without an advanced directive, and physician burnout to 278 physicians, and 213 were completed (response rate 76%).
RESULTS: Of the 932 deaths, 435 of 664 (>50%) were EOL patients with advanced directives. Of these patients, 74% received antibiotics, 29.9% had bacterial resistance cultures, and antibiotics were discontinued in only 5%. Half of the physicians lacked knowledge concerning antibiotics use issues and had significantly fewer consultations with ID physicians in EOL patients with advanced directives (mean rate, 0.27) than those without advanced directives (mean rate, 0.47). ID physicians reported significantly higher emotional exhaustion levels (mean rate, 29) than other medical specialties (mean rate, 19.2). Antibiotic DOT was significantly higher when patients had ID consultations (mean rate, 21.6) than in patients who did not (mean rate, 16.2). In post-acute-care hospitals and/or geriatric wards, antibiotic DOT was significantly higher than in other types of hospitals and/or wards. Depersonalization level was negatively related to antibiotic DOT (P < .05).
CONCLUSIONS: Antibiotics are overused in EOL patients with advanced directives. ID physician burnout and impact of ID consultation should be further assessed.

Origine : PubMed

End-of-life discussions in practice - survey among Canadian radiation oncologists

OH, Justin ; DENNIS, Kristopher ; LEFRESNE, Shilo ; LIVERGANT, Jonathan ; MCKENZIE, Michael
Annals of palliative medicine, 20/06/2019, p. 1-11

Document en ligne

Thème : Soins. Cote : eD02.04.01

FIN VIE ; COMMUNICATION ; CANADA ; MEDECIN ; CANCEROLOGIE ; RELATION MEDECIN PATIENT ; DEMARCHE PALLIATIVE ; LIEU DECES ; DIRECTIVE ANTICIPEE

BACKGROUND: Early end-of-life (EOL) discussions improve patient satisfaction, quality of care, and the cost-effectiveness of care. However, some US studies show that radiation oncologists (ROs) are unlikely to discuss EOL issues until the patients develop significant symptoms or the families initiate the discussion. There have been no prior studies describing the patterns of EOL discussions among Canadian ROs. The objectives of this study were: (I) to describe the patterns of EOL discussions among Canadian ROs; (II) to identify the barriers to EOL conversation among Canadian ROs; (III) to assess the attitudes of Canadian ROs toward Medical Assistance in Dying (MAiD).
METHODS: The 22-question online survey was distributed to the members of Canadian Association of Radiation Oncologists (CARO). Demographics, EOL discussion patterns, perception of EOL discussions, barriers, and the impact of MAiD were evaluated.
RESULTS: Sixty ROs responded out of 326. Prognosis (57%) and goals of care (58%) were routinely discussed, while advanced directive (40%) and planned site of death (12%) were not. More than 90% felt that early EOL discussions with palliative patients were important. The amount of palliative discussion training was correlated with confidence in EOL discussion (P <0.01), perceived importance of RO role in EOL (P=0.006), and the frequency of planned site of death discussion (P=0.041). The most frequently identified barriers were lack of time, uncertainty about prognosis, and concern for patient disappointment. Many ROs provided MAiD information upon request or case-by-case, but only 3% provided the information routinely.
CONCLUSIONS: Canadian ROs recognize the importance of EOL discussions, but they do not routinely incorporate advanced directive or site of death in their discussions. ROs with more palliative discussion training were more confident in EOL discussion and likely to engage in them earlier. Short structured training may improve the confidence and quality of EOL discussion. Time constraint is the number one barrier that may be alleviated by delegation of tasks and patient education tools. Discussion about MAiD is supported but not routine among Canadian ROs.

Origine : PubMed

Geriatricians' attitudes towards voluntary assisted dying - a survey of Australian and New Zealand society for geriatric medicine members

MUNDAY, Tanya ; POON, Peter
Australasian journal on ageing, 28/06/2019, Pagination inconnue

Document en ligne

Thème : Soins.

MEDECIN ; GERIATRIE ; SUICIDE MEDICALEMENT ASSISTE ; AUSTRALIE ; NOUVELLE-ZELANDE ; ATTITUDE

OBJECTIVE: To identify the attitudes of Australian and New Zealand geriatricians to legalisation of voluntary assisted dying.
METHODS: An anonymous, voluntary, online survey of Australian and New Zealand Society for Geriatric Medicine (ANZSGM) members.
RESULTS: A total of 226 members completed the survey equating to a 20% response rate. About 24% of respondents supported legalisation of voluntary assisted dying, whilst 53% opposed. If voluntary assisted dying was legalised, 12% would be willing to prescribe to an appropriate patient, and 61% would be willing to refer them onto a third party. Risk to vulnerable patients was the most important concern identified.
CONCLUSIONS: Support for voluntary assisted dying among surveyed ANZSGM members is low, but varies according to patient circumstances. Key areas of concern highlighted were risk to vulnerable patients, estimating prognosis, and capacity assessments. Further training is required for doctors on discussing voluntary assisted dying options, estimating prognosis, and capacity assessments prior to implementation.

Origine : PubMed

A qualitative study of physicians' conscientious objections to medical aid in dying

BOUTHILLIER, Marie-Eve ; OPATRNY, Lucie
PALLIATIVE MEDICINE, 08/07/2019, Pagination inconnue

Document en ligne

Thème : Soins.

RECHERCHE QUALITATIVE ; MEDECIN ; CONFLIT VALEUR ; ETHIQUE MEDICALE ; SUICIDE MEDICALEMENT ASSISTE ; QUEBEC

BACKGROUND: Under Quebec's Act respecting end-of-life care, physicians may refuse to provide medical aid in dying because of personal convictions, also called conscientious objections. Before legalisation, the results of our survey showed that the majority of physicians were in favour of medical aid in dying (76%), but one-third (28%) were not prepared to perform it. After 18 months of legalisation, physicians were refusing far more frequently than the pre-Act survey had anticipated.
AIM: To explore the conscientious objections stated by physicians so as to understand why some of them refuse to get involved in their patients' medical aid in dying requests.
DESIGN/PARTICIPANTS: An exploratory qualitative study based on semi-structured interviews with 22 physicians who expressed a refusal after they received a request for medical aid in dying. Thematic descriptive analysis was used to analyse physicians' motives for their conscientious objections and the reasons behind it.
RESULTS: The majority of physicians who refused to participate did not oppose medical aid in dying. The reason most often cited is not based on moral and religious grounds. Rather, the emotional burden related to this act and the fear of psychological repercussions were the most expressed motivations for not participating in medical aid in dying.
CONCLUSION: The originality of this research is based on what the actual perception is of doing medical aid in dying as opposed to merely a conceptual assent. Further explorations are required in order to support policy decisions such as access to better emotional supports for providers and interdisciplinary support.

Origine : PubMed

"It could have been me" - an interpretive phenomenological analysis of health care providers' experiences caring for adolescents and young adults with terminal cancer

TUTELMAN, Perri R. ; DRAKE, Emily K. ; URQUHART, Robin
Journal of adolescent and young adult oncology, 28/06/2019, Pagination inconnue

Document en ligne

Thème : Soins.

ADOLESCENT ; JEUNE ADULTE ; CANCER ; INFIRMIERE ; MEDECIN ; CANADA ; PHASE TERMINALE ; PHENOMENOLOGIE

Purpose: Adolescents and young adults (AYAs) with terminal cancer are a marginalized population with unique medical and psychosocial needs. AYAs commonly report challenges with their health care experiences, however, little is known about the experiences of the health care providers (HCPs) who deliver this specialized care. The purpose of the current study was to understand HCPs' experiences caring for AYAs with terminal cancer.
Methods:Nine HCPs (four nurses and five physicians) took part in in-depth semistructured interviews. Participants were eligible if they were a nurse or physician in Atlantic Canada; cared for at least one AYA patient with terminal cancer in the past 3 years; and were able to speak and understand English. Data were analyzed using interpretive phenomenological analysis.
Results: Analyses revealed four superordinate themes present in the data: (1) many unknowns and uncertainties associated with providing care for AYAs compounded by minimal or no training specifically concerning this population; (2) an intense emotional experience compared with caring for patients with terminal cancer of other ages; (3) personal identification with patients and their families; and (4) attempts to make sense of the circumstance thwarted by feelings of injustice and unfairness.
Conclusions: HCPs experienced unique emotional and logistical challenges when caring for AYAs with terminal cancer, which can influence the care they provide. HCPs' experiences highlight the need for training to support clinicians in caring for AYAs with terminal cancer to optimize their own well-being and delivery of health care services to this population.

Origine : PubMed

What do young doctors know of palliative care; how do they expect the concept to work? - a "palliative care" knowledge and opinion survey among young doctors

FERNANDO, G. V. M. C. ; PRATHAPAN, S.
BMC research notes, 16/07/2019, vol.12, n°1, p. 1-6

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Thème : Soins. Cote : eD02.03.02.00

MEDECIN ; CONNAISSANCE ; DEMARCHE PALLIATIVE ; OPINION ; SRI LANKA

Objectives: Discipline of palliative care is still evolving in developed parts of the world while it remains at an infantile stage in Sri Lanka which has not been formally assessed as of today. We aimed at evaluating the level of palliative care knowledge and opinions among young medical graduates. A descriptive cross-sectional study was carried out among pre-residency medical graduates of Sri Lanka through a social media based online survey. The pre-tested questionnaire assessed the level of knowledge on general principles, service organization, clinical management and ethical considerations while it also evaluated their opinions.
Results: Response rate was 35.8% (n = 351). The average score among the respondents was 37.25% [standard deviation (SD) = 11.975]. Specific knowledge on “general principles” was adequate (score = 50%) with an average of 62.61%, SD = 24.5 while “ethics” was observed to be the area with the poorest knowledge (average score = 19.55%, SD = 22). Average scores for “service organization” and “managerial aspects” were 34.54%, SD = 17.6 and 32.26%, SD = 22.3, respectively. The majority (> 90%) believed that de-novo establishment of hospice, hospital and community-based palliative services would sustainably improve holistic patient care. Measures must be taken to optimize basic palliative care knowledge among the undergraduates in view of achieving Universal Health Coverage in the long term.

Origine : PubMed

Interdisciplinary perspectives on the value of massage therapy in a pediatric hospice

EGELI, Deetria ; BAINBRIDGE, Lesley ; MILLER, Tanice ; POTTS, James
JOURNAL OF HOSPICE AND PALLIATIVE NURSING, 08/2019, vol.21, n°4, p. 319-325

Thème : Soins.

INTERDISCIPLINARITE ; MASSAGE ; PEDIATRIE ; UNITE SOINS PALLIATIFS ; PHENOMENOLOGIE ; MEDECIN ; CANADA

How do hospital-based nurses and physicians identify the palliative phase in their patients and what difficulties exist? - a qualitative interview study

FLIERMAN, Isabelle ; NUGTEREN, Ineke C. ; VAN SEBEN, Rosanne ; BUURMAN, Bianca M. ; WILLEMS, Dick L.
BMC palliative care, 09/07/2019, vol.18, n°1, p. 1-10

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Thème : Soins. Cote : eD02.07

INFIRMIERE ; MEDECIN ; PHASE PALLIATIVE ; RECHERCHE QUALITATIVE ; PAYS-BAS ; IDENTIFICATION

BACKGROUND: Early start of palliative care improves the quality of life of eligible patients and their relatives. However, in hospital, patients who could benefit from palliative care are often not identified timely. The aim of this study is to assess how hospital-based nurses and physicians define the palliative phase, how they identify the palliative phase and what difficulties they face.
METHODS: Semi-structured interviews were held with ten nurses and 18 physicians working at seven hospitals in the Netherlands. Data was analysed using thematic analysis.
RESULTS: Nurses and physicians feel insecure about how to define the palliative phase and differentiate between an acute and extended phase. Great variation existed in what life expectancy is attributed to each phase. A variety of ways to identify the palliative phase were described: 1) Prognostication. 2) Treatment trade-off. 3) Assessment of patients' preferences and needs. 4) Interprofessional collaboration. Professionals base prognostication on their experience but also search for clinical indicators. When benefits of treatment no longer outweigh the negatives, this was considered an, albeit late, identification point. To start a conversation on a patients' palliative care needs was found to be difficult. Therefore, some respondents wait for patients to vocalize preferences themselves. Many professionals rely on interprofessional collaboration for identification, however uncertainty exist about responsibilities. Difficulties in identification occurred because of variance in definitions, unpredictability of non-oncological diseases, focus on treatment and difficulties in communication and collaboration.
CONCLUSION: These results provide insight into the challenges and difficulties hospital-based professionals experience in timely identification of patients with palliative care needs.

Origine : PubMed

Medical oncologists' and palliative care physicians' opinions towards thromboprophylaxis for inpatients with advanced cancer - a cross-sectional study

HANNON, Breffni ; TABACK, Nathan ; ZIMMERMANN, Camilla ; GRANTON, John ; KRZYZANOWSKA, Monika
BMJ supportive and palliative care, 11/07/2019, Pagination inconnue

Document en ligne

Thème : Soins.

OPINION ; MEDECIN ; DEMARCHE PALLIATIVE ; CANCEROLOGIE ; THROMBOSE ; CANCER ; PREVENTION ; CANADA

BACKGROUND: Patients with advanced cancer are increasingly discharged from inpatient settings following focused symptom management admissions. Thromboprophylaxis (TP) is recommended for patients with cancer admitted to acute care settings; less is known about TP use in palliative care (PC) settings. This study explored the opinions of Canadian medical oncologists (MO) and PC physicians regarding the use of TP for inpatients with advanced cancer.
METHODS: A fractional factorial survey designed to evaluate the impact of patient factors (age, clinical setting, reason for admission, pre-admission performance status (Eastern Cooperative Oncology Group; ECOG), and risk of bleeding on anticoagulation) and physician demographics on recommending TP was administered by email to Canadian MO and PC physicians. Each respondent received eight vignettes randomly selected from a set of 32. Hierarchical regression was used to evaluate the odds of prescribing TP adjusted for patient factors.
RESULTS: 606 MO and 491 PC physicians were surveyed; response rates were 11.1% and 15.0%, respectively. MO were predominantly male (59.7%); PC female (60.3%); most worked in academic environments (90.3% MO; 73.9% PC). Multivariable hierarchical logistic regression demonstrated that all patient factors except age were associated with prescribing TP (ORs range: from 1.34 (95% CI 1.01 to 1.77) for good ECOG, to 2.53 (95% CI 1.9 to 3.37), for reversible reason for admission). Controlling for these factors, medical specialty was independently associated with recommending TP (OR for MO 2.09 (95% CI 1.56 to 2.8)).
CONCLUSIONS: MO have higher odds of recommending TP for inpatients with advanced cancer than PC physicians. Further research exploring the drivers of these differing practices is warranted.

Origine : PubMed

Palliative care and communication training in neurosurgery residency - results of a trainee survey

MIRANDA, Stephen P. ; SCHAEFER, Kristen G. ; VATES, G. Edward ; GORMLEY, William B. ; BUSS, Mary K.
Journal of Surgical Education, 22/06/2019, Pagination inconnue

Document en ligne

Thème : Formation.

DEMARCHE PALLIATIVE ; COMMUNICATION ; FORMATION ; ENQUETE ; NEUROCHIRURGIE ; MEDECIN ; ETUDIANT ; CONNAISSANCE ; MEDECINE

Objective: Neurosurgeons care for critically ill patients near the end of life, yet little is known about how well their training prepares them for this role. We surveyed a random sample of neurosurgery residents to describe the quantity and quality of teaching activities related to serious illness communication and palliative care, and resident attitudes and perceived preparedness to care for seriously ill patients.
Methods: A previously validated survey instrument was adapted to reflect required communication and palliative care competencies in the 2015 the Accreditation Council for Graduate Medical Education (ACGME) Milestones for Neurological Surgery. The survey was reviewed for content validity by independent faculty neurosurgeons, piloted with graduating neurosurgical residents, and distributed online in August 2016 to neurosurgery residents in the United States using the American Association of Neurological Surgeons (AANS)/Congress of Neurological Surgeons (CNS) Joint Section on Neurotrauma and Critical Care email listserv. Multiple choice and Likert scale responses were analyzed using descriptive statistics.
Results: Sixty-two responses were recorded between August 2016 and October 2016. Most respondents reported no explicit teaching on: explaining risks and benefits of intubation and ventilation (69%), formulating prognoses in neurocritical care (60%), or leading family meetings (69%). Compared to performing craniotomies, respondents had less frequent practice leading discussions about withdrawing life-sustaining treatment (61% vs. 90%, p < 0.01, "weekly or more frequently"), and were less often observed (18% vs. 87%, p < 0.01) and given feedback on their performance (11% vs. 58%, p < 0.01). Nearly all respondents (95%) felt "prepared to discuss withdrawing life-sustaining treatments," however half (48%) reported they "would benefit from more communication training during residency." Most (87%) reported moral distress, agreeing that they "participated in operations and worried whether surgery aligned with patient goals."
Conclusions: Residents in our sample reported limited formal training, and relatively less observation and feedback, on required ACGME competencies in palliative care and communication. Most reported preparedness in this domain, but many were receptive to more training. Better quality and more consistent palliative care education in neurosurgery residency could improve competency and help ensure that neurosurgical care aligns with patient goals.

Origine : PubMed

A brief home-based palliative care learning experience for medical students and resident doctors in Okinawa, Japan

NAGANO, Hiroaki ; OBARA, Haruo ; TAKAYAMA, Yoshihiro
Plos one, 2019, vol.14, n°6, p. 1-11

Document en ligne

Thème : Formation. Cote : eD14.01

FORMATION ; METHODE PEDAGOGIQUE ; ETUDIANT ; MEDECIN ; JAPON ; SOIN DOMICILE

BACKGROUND: The clinical component of medical education for students and resident doctors in Japan occurs almost entirely in the hospital setting. Because of this inpatient focus, graduate medical education clinical training often fails to expose physicians-in-training to the challenges that patients may face in the outpatient or home setting. This is a descriptive study in which we explore what participating students and resident doctors learned through our brief home-based teaching experience.
METHODS: From June 2016 to December 2017, attending physicians on the internal medicine service had medical students and resident doctors accompany them on home care visits. Participants were selected by convenience sampling based on their rotation availability. After the home visit and the interactive discussion, the participants were expected to prepare a reflective journal on their experience and learning. Thematic analysis was applied, and key themes were developed based on Kolb's ELT (Experiential learning theory). Three months after completion of the experience, semi-structured interviews were individually conducted assessing participants' self-perceived changes.
RESULTS: Thirty-two medical students(10) or residents(22)participated in a home visit. Thirty of these learners were able to complete a reflective journal. Using thematic analysis, we identified 2 domains and 6 key themes from the participants' perceptions. Participants recognized the importance of patient-centered care, inter-professional collaboration of the home care team, and reconceptualized the meaning of medical practice and their professional identity as a doctor. Three month post-experience interviews were completed on 12 of the original 30 participants who completed the reflective journal. 2 domains and 6 key themes from the residents' experiences and perceptions were generated. The participants reported an increased attention to the daily lives and social situations of their hospitalized patients, and an extension of their focus beyond the clinical medical treatment of the patient.
CONCLUSION: The experience of a brief visit to a patient's home is a novel educational approach that may potentially provide medical students and resident doctors with opportunities to learn about out-of-hospital, patient-centered, home-based medical care.

Origine : PubMed

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ACCOMPAGNEMENT CANCER COMMUNICATION DEMARCHE PALLIATIVE ETHIQUE EUTHANASIE FAMILLE FIN VIE FORMATION INFIRMIERE MEDECIN MORT PATIENT PERSONNEL SANTE RELATION MEDECIN PATIENT

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