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Integration of pediatric palliative care into cardiac intensive care - a champion-based model

MOYNIHAN, Katie M. ; SNAMAN, Jennifer M. ; KAYE, Erica C. ; MORRISON, Wynne E. ; DEWITT, Aaron G. ; SACKS, Loren D. ; THOMPSON, Jess L. ; HWANG, Jennifer M. ; BAILEY, Valerie ; LAFOND, Deborah A. ; WOLFE, Joanne ; BLUME, Elizabeth D.
Pediatrics, 08/2019, vol.144, n°2, Pagination inconnue

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Thème : Age de la vie, situations spécifiques liées à la fin de vie.

PEDIATRIE ; DEMARCHE PALLIATIVE ; SOIN INTENSIF ; MODELE

Integration of pediatric palliative care (PPC) into management of children with serious illness and their families is endorsed as the standard of care. Despite this, timely referral to and integration of PPC into the traditionally cure-oriented cardiac ICU (CICU) remains variable. Despite dramatic declines in mortality in pediatric cardiac disease, key challenges confront the CICU community. Given increasing comorbidities, technological dependence, lengthy recurrent hospitalizations, and interventions risking significant morbidity, many patients in the CICU would benefit from PPC involvement across the illness trajectory. Current PPC delivery models have inherent disadvantages, insufficiently address the unique aspects of the CICU setting, place significant burden on subspecialty PPC teams, and fail to use CICU clinician skill sets. We therefore propose a novel conceptual framework for PPC-CICU integration based on literature review and expert interdisciplinary, multi-institutional consensus-building. This model uses interdisciplinary CICU-based champions who receive additional PPC training through courses and subspecialty rotations. PPC champions strengthen CICU PPC provision by (1) leading PPC-specific educational training of CICU staff; (2) liaising between CICU and PPC, improving use of support staff and encouraging earlier subspecialty PPC involvement in complex patients' management; and (3) developing and implementing quality improvement initiatives and CICU-specific PPC protocols. Our PPC-CICU integration model is designed for adaptability within institutional, cultural, financial, and logistic constraints, with potential applications in other pediatric settings, including ICUs. Although the PPC champion framework offers several unique advantages, barriers to implementation are anticipated and additional research is needed to investigate the model's feasibility, acceptability, and efficacy.

Origine : PubMed

The divorced family-focused care model - a nursing model to enhance child and family mental health and well-being of doubly bereaved children following parental divorce and subsequent parental cancer and death

MARCUSSEN, Jette ; HOUNSGAARD, Lise ; BRUUN, Poul ; LAURSEN, Merete Golles ; THUEN, Frode ; WILSON, Rhonda
Journal of family nursing, 2019, vol.25, n°3, p. 419-446

Document en ligne

Thème : Deuil et travail du deuil.

PERSONNE ENDEUILLEE ; MORT ; PARENT ; DIVORCE ; PHENOMENOLOGIE ; MODELE ; CANCER ; SOIN INFIRMIER ; SOUTIEN DEUIL

The experience of parental death concomitant with parental divorce occurs for 46% of Danish children and 50% of American children who lose a parent to death. This experience of loss and double bereavement compounds increased risk of mental health problems. The aim of this study was to explore nursing interventions for double bereaved children that promoted their well-being. A phenomenological-hermeneutic approach was used to conduct 20 interviews with nurses in family cancer care. Ricoeur's theoretical framework was followed with naïve reading, structural analysis, and critical interpretation, resulting in the formulation of a new model of nursing care for these children: the Divorced Family-Focused Care Model. Four themes were apparent: (a) collection of information about family structure, (b) assessment of support needs, (c) initiation of well-being support, and (d) coordination and follow-up focused on the child's well-being. The new intervention model has implications for health care education and implementation of health care policies.

Origine : PubMed

Validation and application of a prognostic model for patients with advanced pancreatic cancer receiving palliative chemotherapy

HUANG, Pei-Wei ; CHANG, Ching-Fu ; HUNG, Chia-Yen ; HSUEH, Shun-Wen ; CHANG, Pei-Hung ; YEH, Kun-Yun ; CHEN, Jen-Shi ; CHEN, Yen-Yang ; LU, Chang-Hsien ; HUNG, Yu-Shin ; CHOU, Wen-Chi
Cancer medicine, 06/08/2019, p. 1-10

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

MODELE ; PRONOSTIC ; CANCER DIGESTIF ; PANCREAS ; CHIMIOTHERAPIE ; ETUDE RETROSPECTIVE ; TAIWAN

BACKGROUND: We previously developed a robust prognostic model (GS model) to predict the survival outcome of patients with advanced pancreatic cancer (APC) receiving palliative chemotherapy with gemcitabine plus S-1 (GS). This study aimed to validate the application of the GS model in APC patients receiving chemotherapy other than the GS regimen.
PATIENTS AND METHODS: We retrospectively analyzed 727 APC patients who received first-line palliative chemotherapy other than the GS regimen between 2010 and 2016 at four institutions in Taiwan. The patients were categorized into three prognostic groups based on the GS model for comparisons of survival outcome, best tumor response, and in-group survival differences with monotherapy or combination therapy.
RESULTS: The median survival times for the good, intermediate, and poor prognostic groups were 13.4, 8.4, and 4.6 months, respectively. The hazard ratios for the comparisons of intermediate and poor to good prognostic groups were 1.51 (95% confidence interval [CI]), 1.22-1.88, P < .001) and 2.84 (95% CI, 2.34-3.45, P < .001). The best tumor responses with either partial response or stable disease were 57.5%, 40.4%, and 17.2% of patients in the good, intermediate, and poor prognostic groups (P < .001), respectively. For patients in the good prognostic group, first-line chemotherapy with monotherapy and combination therapy had similar median survival times (13.8 vs 12.9 months, P = .26), while combination therapy showed a better median survival time than monotherapy in patients in the intermediate and poor prognostic groups (8.5 vs 8.0 months, P = .038 and 5.7 vs 3.7 months, P = .001, respectively).
CONCLUSION: The results of our study supported the application of the GS model as a general prognostic tool for patients with pancreatic cancer receiving first-line palliative chemotherapy with gemcitabine-based regimens.

Origine : PubMed

Models of pediatric palliative oncology outpatient care-benefits, challenges, and opportunities

BROCK, Katharine E. ; SNAMAN, Jennifer M. ; KAYE, Erica C. ; BOWER, Kimberly A. ; WEAVER, Meaghann S. ; BAKER, Justin N. ; WOLFE, Joanne ; ULLRICH, Christina
Journal of oncology practice, 19/07/2019, Pagination inconnue

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Thème : Age de la vie, situations spécifiques liées à la fin de vie.

MODELE ; PEDIATRIE ; DEMARCHE PALLIATIVE ; CANCEROLOGIE ; HOSPITALISATION JOUR

PURPOSE: Although the bulk of current pediatric palliative care (PPC) services are concentrated in inpatient settings, the vast majority of clinical care, symptom assessment and management, decision-making, and advance care planning occurs in the outpatient and home settings. As integrated PPC/pediatric oncology becomes the standard of care, novel pediatric palliative oncology (PPO) outpatient models are emerging. The optimal PPO model is unknown and likely varies on the basis of institutional culture, resources, space, and personnel.
METHODS: We review five institutions' unique outpatient PPO clinical models with their respective benefits and challenges. This review offers pragmatic guidance regarding PPO clinic development, implementation, and resource allocation.
RESULTS: Specific examples include a floating clinic model, embedded disease-specific PPC experts, embedded consultative or trigger-based supportive care clinics, and telehealth clinics.
CONCLUSION: Organizations that have overcome personnel, funding, and logistical challenges can serve as role models for centers developing PPO clinic models. In the absence of a one-size-fits-all model, pediatric oncology and PPC groups can select, tailor, and implement the model that best suits their respective personnel, needs, and capacities. Emerging PPO clinics must balance the challenges and opportunities unique to their organization, with the goal of providing high-quality PPC for children with cancer and their families.

Origine : PubMed

Predictors of depression and anxiety in family members 3 months after child's admission to a pediatric ICU

IWATA, Masayuki ; HAN, Soojeong ; HAYS, Ross ; DOORENBOS, Ardith Z.
The American journal of hospice and palliative care, 30/06/2019, Pagination inconnue

Document en ligne

Thème : Soins.

DEPRESSION ; ANXIETE ; FAMILLE ; SOIN INTENSIF ; PEDIATRIE ; MODELE ; ADMISSION

OBJECTIVES: Family members of children admitted to intensive care units (ICUs) suffer from severe stress, which sometimes results in long-term psychological problems. We aimed to identify associations between demographic and psychosocial variables at early stages of a child's admission to the ICU and depression and anxiety in family members at approximately 3 months after admission. We also explored predictive models for depression and anxiety at 3 months after admission.
METHODS: This study is a secondary analysis of data from a previous clinical trial of palliative care for family members in ICUs, in which 380 family members of 220 children reported demographic and psychosocial status at approximately 1 week after ICU admission (baseline), at discharge from the ICUs, and at 3 months after the child's admission to the ICU. Clinical data were extracted from the children's medical records. We used linear regression models and stepwise linear regression for the analyses.
RESULTS: After controlling for significant confounders of gender (female) and child mortality, worse psychological status at baseline, represented by reported depression, anxiety, and acute stress symptoms, was associated with more severe depression and anxiety at 3 months. Also, a better family relationship at baseline was associated with lower depression and anxiety at 3 months.
CONCLUSION: We suggest a need to screen family members of children admitted to the ICU with validated scales and intervening with those at high risk of depression and anxiety.

Origine : PubMed

Establishing key criteria to define and compare models of specialist palliative care - a mixed-methods study using qualitative interviews and Delphi survey

FIRTH, Alice M. ; O'BRIEN, Suzanne M. ; GUO, Ping ; SEYMOUR, Jane Elizabeth ; RICHARDSON, Heather ; BRIDGES, Christopher ; HOCAOGLU, Mevhibe B. ; GRANDE, Gunn ; DZINGINA, Mendwas ; HIGGINSON, Irene J. ; MURTAGH, Fliss Em
PALLIATIVE MEDICINE, 28/06/2019, p. 1-11

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Thème : Soins. Cote : e00.07PAL

DEMARCHE PALLIATIVE ; MODELE ; ROYAUME UNI

BACKGROUND: Specialist palliative care services have various configurations of staff, processes and interventions, which determine how care is delivered. Currently, there is no consistent way to define and distinguish these different models of care.
AIM: To identify the core components that characterise and differentiate existing models of specialist palliative care in the United Kingdom.
DESIGN: Mixed-methods study: (1) semi-structured interviews to identify criteria, (2) two-round Delphi study to rank/refine criteria, and (3) structured interviews to test/refine criteria.
SETTING/PARTICIPANTS: Specialist palliative care stakeholders from hospice inpatient, hospital advisory, and community settings.
RESULTS: (1) Semi-structured interviews with 14 clinical leads, from eight UK organisations (five hospice inpatient units, two hospital advisory teams, five community teams), provided 34 preliminary criteria.
(2) Delphi study: Round 1 (54 participants): thirty-four criteria presented, seven removed and seven added. Round 2 (30 participants): these 34 criteria were ranked with the 15 highest ranked criteria, including setting, type of care, size of service, diagnoses, disciplines, mode of care, types of interventions, ‘out-of-hours’ components (referrals, times, disciplines, mode of care, type of care), external education, use of measures, bereavement follow-up and complex grief provision.
(3) Structured interviews with 21 UK service leads (six hospice inpatients, four hospital advisory and nine community teams) refined the criteria from (1) and (2), and provided four further contextual criteria (team purpose, funding, self-referral acceptance and discharge).
CONCLUSION: In this innovative study, we derive 20 criteria to characterise and differentiate models of specialist palliative care - a major paradigm shift to enable accurate reporting and comparison in practice and research.

Origine : PubMed

Nurse-led integration of palliative care for chronic obstructive pulmonary disease - an integrative literature review

ORA, Linda ; MANNIX, Judy ; MORGAN, Lucy ; WILKES, Lesley
Journal of clinical nursing, 20/07/2019, Pagination inconnue

Document en ligne

Thème : Soins.

INFIRMIERE ; DEMARCHE PALLIATIVE ; MALADIE RESPIRATOIRE ; MALADIE CHRONIQUE ; MODELE ; SOIN INFIRMIER ; PLANIFICATION ; ANTICIPATION ; SOIN

AIMS AND OBJECTIVES: To uncover what is known about nurse-led models or interventions that have integrated palliative care into the care of patients with Chronic Obstructive Pulmonary Disease (COPD).
BACKGROUND: COPD is a highly symptomatic, incurable disease characterised by chronic symptoms that without appropriate palliation, can lead to unnecessary suffering for patients and their caregivers. While palliative care practices can relieve suffering and improve quality of life, most palliative models of care remain cancer-focused. New models, including nurse-led care that integrate palliative care for patients with COPD could address patient suffering and therefore need to be explored.
METHOD: A mixed-studies integrative review was undertaken. Seven databases were searched for articles published between 2008 and 2018. The PRISMA framework was applied to the search and six studies met the review eligibility criteria. Content analysis of the articles was undertaken and data were compared, looking for different nurse-led models and outcomes related to palliative care in COPD.
RESULTS: Nurse-led, integrated palliative care models for patients with COPD are rare and just four of the six articles found in this review had published results. Advance Care Planning was found to be the most common focus for nurse-led interventions in COPD and in all cases, results demonstrated an improvement in end of life discussions and completion of advance care directives. Of the reviewed articles, none used a qualitative framework to explore nurse-led models that integrated palliative care in COPD.
CONCLUSION: While nurse-led Advance Care Planning was one type of palliative care practice associated with positive patient outcomes, there is a need for deeper exploration of nurse-led models that holistically address the bio-psycho-social-spiritual needs of patients with COPD, and their caregivers.
RELEVANCE TO CLINICAL PRACTICE: Integrating nurse led supportive care clinics into COPD services could be a way forward to address the unmet bio-psycho-social-spiritual needs of patients with COPD, and their caregivers.

Origine : PubMed

Electronic health record mortality prediction model for targeted palliative care among hospitalized medical patients - a pilot quasi-experimental study

COURTRIGHT, Katherine R. ; CHIVERS, Corey ; BECKER, Michael ; REGLI, Susan H. ; PEPPER, Linnea C. ; DRAUGELIS, Michael E. ; O'CONNOR, Nina R.
Journal of general internal medicine, 16/07/2019, p. 1-7

Document en ligne

Thème : Recherche - Evaluation - Méthodologie.

DEMARCHE PALLIATIVE ; HOPITAL ; MODELE ; PRONOSTIC

Background: Development of electronic health record (EHR) prediction models to improve palliative care delivery is on the rise, yet the clinical impact of such models has not been evaluated.
Objective: To assess the clinical impact of triggering palliative care using an EHR prediction model.
Design: Pilot prospective before-after study on the general medical wards at an urban academic medical center.
Participants: Adults with a predicted probability of 6-month mortality of = 0.3.
Intervention: Triggered (with opt-out) palliative care consult on hospital day 2.
Main Measures: Frequencies of consults, advance care planning (ACP) documentation, home palliative care and hospice referrals, code status changes, and pre-consult length of stay (LOS).
Key Results: The control and intervention periods included 8 weeks each and 138 admissions and 134 admissions, respectively. Characteristics between the groups were similar, with a mean (standard deviation) risk of 6-month mortality of 0.5 (0.2). Seventy-seven (57%) triggered consults were accepted by the primary team and 8 consults were requested per usual care during the intervention period. Compared to historical controls, consultation increased by 74% (22 [16%] vs 85 [63%], P < .001), median (interquartile range) pre-consult LOS decreased by 1.4 days (2.6 [1.1, 6.2] vs 1.2 [0.8, 2.7], P = .02), ACP documentation increased by 38% (23 [17%] vs 37 [28%], P = .03), and home palliative care referrals increased by 61% (9 [7%] vs 23 [17%], P = .01). There were no differences between the control and intervention groups in hospice referrals (14 [10] vs 22 [16], P = .13), code status changes (42 [30] vs 39 [29]; P = .81), or consult requests for lower risk (< 0.3) patients (48/1004 [5] vs 33/798 [4]; P = .48).
Conclusions: Targeting hospital-based palliative care using an EHR mortality prediction model is a clinically promising approach to improve the quality of care among seriously ill medical patients. More evidence is needed to determine the generalizability of this approach and its impact on patient- and caregiver-reported outcomes.

Origine : PubMed

Integrating palliative care into the chronic illness continuum - a conceptual model for minority populations

GAZAWAY, Shena ; STEWART, Merry ; SCHUMACHER, Autumn
Journal of racial and ethnic health disparities, 27/06/2019, p. 1-9

Document en ligne

Thème : Médecine.

DEMARCHE PALLIATIVE ; MALADIE CHRONIQUE ; ACCES SOIN ; ETATS-UNIS ; MODELE ; CULTURE

Although the use of palliative care has increased in recent years, chronically ill Americans within a racial/ethnic minority (non-White) population underutilize this supportive and comfort-giving healthcare service. Consequently, chronically ill minority Americans experience increased pain, symptom burden, and inappropriate use of healthcare resources compared to their white counterparts. A literature review was conducted to compile and synthesize the current state of research pertinent to improving the use of palliative care among chronically ill minority Americans. Selection criteria produced 18 relevant publications, which aided in developing a conceptual model that assimilated early, episodic, and late palliative care phases along the chronic illness continuum. The goal of the conceptual model was to provide a roadmap for healthcare professionals to use when designing, implementing, managing, and/or evaluating palliative care services for chronically ill minority Americans. The literature review demonstrated that minority patients benefitted the most from culturally tailored, systematic interventions (such as advanced care planning education) in all phases of palliative care, which led to increases in advance directive completion, better symptom control, and hospice utilization. The article concludes with a discussion and fictional case study portraying the importance of culturally tailored early palliative care as a catalyst for engaging minority patients in palliative care services.

Origine : PubMed

Delivering an advance care planning facilitated model

FRETWELL, Christine ; WORLOCK, Pat ; GLEESON, Aoife
International Journal of Palliative Nursing, 06/2019, vol.25, n°6, p. 264-273

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Thème : Soins. Cote : 00.07INT

MODELE ; COMMUNICATION ; FORMATION ; PROJET SOIN ANTICIPE ; FIN VIE

Background: Advance care planning is increasingly recognised as an integral part of achieving excellence at the end of life (EoL), but barriers still prevent individuals from having the opportunity to discuss their wishes and preferences for the future.
Aim: To describe the development and initial evaluations of an innovative facilitated ACP model, the ACP Triple E, which empowers individuals through education to engage in ACP conversations.
Methods: This model uses a collaborative approach involving all sectors of a large university health board to equip all health and social care professionals with the knowledge, skills and confidence to engage in ACP discussion and also raise public awareness of the benefits of ACP.
Conclusion: This model includes recognised elements that support successful implementation of ACP. Initial evaluations of the model are extremely positive. Further analysis of the data is now needed to evaluate the model's flexibility and its ability to change practice and achieve strategic objectives.

Origine : PubMed

A tripartite model of community attitudes to palliative care

O'CONNOR, Moira ; BREEN, Lauren J. ; WATTS, Kaaren J. ; JAMES, Henry ; WEAVER, Rhys
The American journal of hospice and palliative care, 20/06/2019, Pagination inconnue

Document en ligne

Thème : Soins.

DEMARCHE PALLIATIVE ; MODELE ; ATTITUDE

BACKGROUND: Despite a growth in palliative care services, access and referral patterns are inconsistent and only a minority of people who would benefit from such care receive it. Use of palliative care is also affected by community attitudes toward palliative care. As such, determining community attitudes toward palliative care is crucial. We also need to determine what predicts attitudes in order to provide appropriate information and education.
OBJECTIVES: The 2 research questions were: (1) What are community attitudes toward palliative care? and (2) what are the determinants of community attitudes toward palliative care?
DESIGN: A tripartite model of attitudes was used, which articulates attitudes as comprising knowledge and experience, emotions, and beliefs. A cross-sectional descriptive survey was used.
PARTICIPANTS: A community sample of 180 participants completed the survey.
RESULTS: The average attitude and belief responses were very positive, the average emotions responses were somewhat positive. The sample had good knowledge of palliative care. Lowest knowledge scores were reported for the items: "Euthanasia is not part of palliative care," "Palliative care does not prolong or shorten life," and "Specialist palliative care is only available in hospitals." After controlling place of birth and age, it was found that beliefs, emotions, and knowledge each accounted for a significant proportion of unique variance in attitude toward palliative care. Each variable had a positive relationship with attitude.
CONCLUSION: Beliefs, emotions, and knowledge all need to be incorporated into palliative care community education programs.

Origine : PubMed

Development of palliative and end of life care - the current situation in Saudi Arabia

ALSHAMMARAY, Sami ; DURAISAMY, Balaji ; ALBALAWI, Yousef ; RATNAPALAN, Savithiri
Cureus, 26/03/2019, vol.11, n°3, p. 3-10

Document en ligne

Thème : Santé. Cote : eD01.01.01

POLITIQUE SANITAIRE ; ARABIE SAOUDITE ; PLAN ACTION ; MODELE ; SOIN

As part of the health care reforms and transformation project of the Vision 2030, a group of expert healthcare professionals was tasked with the development of a model of care for patients with life-shortening illnesses in Saudi Arabia. This Care Design Group (CDG 1-3) held a series of workshops and conducted surveys and online discussions to systematically document and develop a model of care. These interventions were aimed at achieving a national standard of care. This short article is a description of this very successful process of development.

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Increased length of stay associated with antibiotic use in older adults with advanced cancer transitioned to comfort measures

DATTA, Rupak ; ZHU, Mojun ; HAN, Ling ; ALLORE, Heather ; QUAGLIARELLO, Vincent ; JUTHANI-MEHTA, Manisha
The American journal of hospice and palliative care, 11/06/2019, Pagination inconnue

Document en ligne

Thème : Médicaments - Pharmacie.

HOSPITALISATION ; ANTIBIOTIQUE ; PERSONNE AGEE ; CANCER ; ETUDE COHORTE ; SOIN CONFORT ; MODELE

Background: Antibiotic use may increase hospital length of stay (LOS) among older patients with advanced cancer who are transitioned to comfort measures.
Methods: We studied a cohort of patients with advanced cancer aged =65 years who were transitioned to comfort measures during admission from July 1, 2014, through November 30, 2016. We evaluated the association between antibiotic exposure and LOS using a Poisson regression model adjusted for age, gender, cancer type, comorbidities, infection, and intensive care unit admission.
Results: Among 461 patients with advanced cancer, median age was 74 years (range: 65-99), 49.0% (n = 226) were female, and 20.6% (n = 95) had liquid tumors. Overall, 82.9% (n = 382) received =1 antibiotic and 64.6% (n = 298) had =1 infection diagnosis during hospitalization. Infection diagnoses commonly included sepsis (35%, n = 161/461), pneumonia (25%, n = 117/461), and urinary tract infection (14%, n = 66/461). Among those receiving antibiotics, the most common choices included vancomycin (79%, n = 300/382), cephalosporins (63%, n = 241/382), and penicillins (45%, n = 172/382). In a multivariable Poisson regression model, LOS was 34% longer (count ratio = 1.34, [95% confidence interval: 1.20-1.51]) among those exposed versus unexposed to antibiotics.
Conclusions: Antibiotic use among patients with advanced cancer who are transitioned to comfort measures is associated with longer LOS. These data illustrate the importance of tradeoffs associated with antibiotic use, such as unintended increased LOS, when striving for goal-concordant care near the end of life.

Origine : PubMed

Effect of the types of pretreatment imaging modalities on the treatment response to palliative radiation for painful bone metastases from solid cancer - a single-center retrospective analysis

WADA, Yuki ; ANBAI, Akira ; KUMAGAI, Satoshi ; OKUYAMA, Eriko ; HATAKEYAMA, Kento ; TAKAGI, Noriko ; HASHIMOTO, Manabu
Radiation oncology, 07/06/2019, vol.14, n°1, p. 1-7

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Thème : Médecine. Cote : eD03.03.00

METASTASE OSSEUSE ; PRISE EN CHARGE ; MODELE ; SOIN ; RADIOTHERAPIE

BACKGROUND: Determining the appropriate gross tumor volume is important for irradiation planning in addition to palliative radiation for bone metastases. While irradiation planning is commonly performed using simulation computed tomography (CT), magnetic resonance imaging (MRI), bone scintigraphy, and 18fluorodeoxyglucose-positron emission tomography-CT (18FDG-PET-CT) are more sensitive for detecting bone metastasis and invasion areas. Therefore, this study evaluated whether pretreatment imaging modalities influenced the response to palliative radiation therapy (i.e., the irradiation effect) for painful bone metastases from solid malignant carcinomas.
METHODS: Consecutive patients with painful bone metastases treated with palliative radiation between January 2013 and December 2017 at our institution were included. We retrospectively investigated the pretreatment images from the different imaging modalities (CT, MRI, bone scintigraphy, and 18FDG-PET-CT) obtained between 1 month before and the initiation of palliative radiation and determined the primary site of carcinoma, histological type, metastatic lesion type (osteolytic, osteoblastic, or mixed), pathological fracture, and metastatic site (vertebral or not). We then evaluated the relationship between these factors and treatment response. We defined "response" as the condition in which patients achieved pain relief or reduced the use of painkiller medicines.
RESULTS: In total, 131 patients (78 men and 53 women) were included; the median age was 66 years (range, 24-89 years). Prescribed doses were 8-50 Gy/1-25 fractions with 2-8 Gy/fraction. Among the 131 patients, 105 were responders (response rate, 80%). The imaging modalities performed before irradiation were CT in 131 patients, MRI in 54, bone scintigraphy in 56, and 18FDG-PET-CT in 14. The Welch t-test and chi-square test showed no significant association between treatment response and each factor. Multiple logistic regression analysis including the imaging modality, metastatic site, and pathological fracture also showed no significant association with each factor.
CONCLUSIONS: There was no significant relationship between the type of pretreatment imaging and treatment response for painful bone metastases. Thus, setting the appropriate radiation field according to CT images and clinical findings could help avoiding further image inspection before palliative radiation for painful bone metastases.

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A model to improve behavioral health integration into serious illness care

CHEUNG, Stephanie ; SPAETH-RUBLEE, Brigitta ; SHALEV, Daniel ; LI, Mingjie ; DOCHERTY, Mary ; LEVENSON, Jon ; PINCUS, Harold
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, 05/06/2019, Pagination inconnue

Document en ligne

Thème : Médecine.

MODELE ; MALADIE GRAVE ; ACCES SOIN

Behavioral health problems are highly prevalent among people with serious medical illness. Individuals living with these comorbidities have complex clinical and social needs yet face siloed care, high health care costs, and poor outcomes. Interacting factors contribute to these inequalities including historical separation of behavioral and physical health provision. Several care models for integrating behavioral health and general medical care have been developed and tested, but the evidence base focuses primarily on primary care populations and settings. This paper advances that work by proposing a Behavioral Health - Serious Illness Care Model (BH-SIC Model). Developed through a mixed methods approach combining literature review, surveys, interviews, and input from an expert advisory panel, it provides a conceptual framework of building blocks for behavioral health integration tailored to serious illness care populations and the range of settings in which they receive care. The model is intended to serve as foundation to support the development and implementation of integrated behavioral health and serious illness care. The key components of the model are described, barriers to implementation discussed, and recommendations for policy approaches to address these barriers presented.

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A prospective study examining cachexia predictors in patients with incurable cancer

MAGNE VAGNILDHAUG, Ola Magne ; BRUNELLI, Cinzia ; HJERMSTAD, Marianne J. ; STRASSER, Florian ; BARACOS, Vickie ; WILCOCK, Andrew ; NABAL, Maria ; KAASA, Stein ; LAIRD, Barry ; SOLHEIM, Tora S.
BMC palliative care, 04/06/2019, vol.18, n°1, p. 1-10

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Thème : Médecine. Cote : eD03.05.05

CANCER ; CACHEXIE ; PATIENT ; SYMPTOME ; ANTICIPATION ; MODELE

BACKGROUND: Early intervention against cachexia necessitates a predictive model. The aims of this study were to identify predictors of cachexia development and to create and evaluate accuracy of a predictive model based on these predictors.
METHODS: A secondary analysis of a prospective, observational, multicentre study was conducted. Patients, who attended a palliative care programme, had incurable cancer and did not have cachexia at baseline, were amenable to the analysis. Cachexia was defined as weight loss (WL) >5% (6months) or WL>2% and body mass index<20kg/m2. Clinical and demographic markers were evaluated as possible predictors with Cox analysis. A classification and regression tree analysis was used to create a model based on optimal combinations and cut-offs of significant predictors for cachexia development, and accuracy was evaluated with a calibration plot, Harrell's c-statistic and receiver operating characteristic curve analysis.
RESULTS: Six-hundred-twenty-eight patients were included in the analysis. Median age was 65 years (IQR 17), 359 (57%) were female and median Karnofsky performance status was 70(IQR 10). Median follow-up was 109 days (IQR 108), and 159 (25%) patients developed cachexia. Initial WL, cancer type, appetite and chronic obstructive pulmonary disease were significant predictors (p 0.04). A five-level model was created with each level carrying an increasing risk of cachexia development. For Risk-level 1-patients (WL<3%, breast or hematologic cancer and no or little appetite loss), median time to cachexia development was not reached, while Risk-level 5-patients (WL 3-5%) had a median time to cachexia development of 51 days. Accuracy of cachexia predictions at 3 months was 76%.
CONCLUSION: Important predictors of cachexia have been identified and used to construct a predictive model of cancer cachexia.
TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01362816 .

Origine : PubMed

An evaluation of the cost-effectiveness of the different palliative care models available to cancer patients in Turkey

SAYGILI, Meltem ; CELIK, Yusuf
European journal of cancer care, 04/06/2019, Pagination inconnue

Document en ligne

Thème : Santé.

EVALUATION ; DEMARCHE PALLIATIVE ; MODELE ; CANCER ; TURQUIE

BACKGROUND: Three different models are commonly used to provide palliative care services to cancer patients in Turkey: comprehensive palliative care center (CPCC), hospital inpatient services (HIS) and home healthcare (HHC).
OBJECTIVES: The purpose of this study was to evaluate the cost-effectiveness of three alternative palliative care models for cancer patients.
METHODS: The study included a total of 160 patients diagnosed with cancer (CPCC:60, HIS:59, HHC:41). The patients' quality of life and their levels of satisfaction were used as the indicators of effectiveness, while direct and indirect costs incurred by service providers, patients and relatives were considered in estimating the costs of alternative models. The cost and effectiveness of the alternatives compared the "patient perspective" and "societal perspective" separately.
RESULTS: From a societal perspective, palliative care services provided the HIS model was found to be more cost-effective than the CPCC model. From a patient perspective, HHC was found to be more cost-effective compared to the other two models.
CONCLUSIONS: This study has the potential to provide substantial evidence to health managers and decision-makers with respect to health planning and the formulation of social security policies in Turkey.

Origine : PubMed

Chapter 4 - designing an intervention

DEMIRIS, George ; OLIVER, Debra Parker ; WASHINGTON, Karla T.
" Behavioral intervention research in hospice and palliative care ", Academic Press , 2019 , p. 41-59

Thème : Recherche - Evaluation - Méthodologie.

RECHERCHE ; THEORIE ; MODELE ; UNITE SOINS PALLIATIFS ; DEMARCHE PALLIATIVE

This chapter focuses on the design phase of the behavioral intervention research model. Once a problem is identified and understood, it is time to find or develop an intervention that may address the problem. A theory or a conceptual model often informs the hypothesized solution for a problem. Thus, this chapter also covers the purposes of theories and conceptual models and the differences between the two concepts. Finally, the chapter addresses the issues to be considered in the design of interventions for research in hospice and palliative care, focusing on the different settings where palliative care is delivered.

Chapter 4 - designing an intervention

DEMIRIS, George ; OLIVER, Debra Parker ; WASHINGTON, Karla T.
" Behavioral intervention research in hospice and palliative care ", Academic Press , 2019 , p. 41-59

Thème : Recherche - Evaluation - Méthodologie.

RECHERCHE ; THEORIE ; MODELE ; CONCEPT ; UNITE SOINS PALLIATIFS ; DEMARCHE PALLIATIVE

Implementing advance care planning with community-dwelling frail elders requires a system-wide approach - an integrative review applying a behaviour change model

COMBES, Sarah ; NICHOLSON, Caroline Jane ; GILLETT, Karen ; NORTON, Christine
PALLIATIVE MEDICINE, 07/2019, vol.33, n°7, p. 743-756

Document en ligne

Thème : Age de la vie, situations spécifiques liées à la fin de vie. Cote : e00.07PAL

PLANIFICATION ; ANTICIPATION ; PERSONNE AGEE ; SOIN ; VULNERABILITE ; MODELE

BACKGROUND: Facilitating advance care planning with community-dwelling frail elders can be challenging. Notably, frail elders' vulnerability to sudden deterioration leads to uncertainty in recognising the timing and focus of advance care planning conversations.
AIM: To understand how advance care planning can be better implemented for community-dwelling frail elders and to develop a conceptual model to underpin intervention development.
DESIGN: A structured integrative review of relevant literature.
DATA SOURCES: CINAHL, Embase, Ovid Medline, PsycINFO, Cochrane Library, and University of York Centre for Reviews and Dissemination. Further strategies included searching for policy and clinical documents, grey literature, and hand-searching reference lists. Literature was searched from 1990 until October 2018.
RESULTS: From 3043 potential papers, 42 were included. Twenty-nine were empirical, six expert commentaries, four service improvements, two guidelines and one theoretical. Analysis revealed nine themes: education and training, personal ability, models, recognising triggers, resources, conversations on death and dying, living day to day, personal beliefs and experience, and relationality.
CONCLUSION: Implementing advance care planning for frail elders requires a system-wide approach, including providing relevant resources and clarifying responsibilities. Early engagement is key for frail elders, as is a shift from the current advance care planning model focussed on future ceilings of care to one that promotes living well now alongside planning for the future. The proposed conceptual model can be used as a starting point for professionals, organisations and policymakers looking to improve advance care planning for frail elders.

Origine : PubMed

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