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Prevalence of and comorbid health conditions associated with pediatric prescription opioid use in the us

BANERJEE, Souvik ; ROLAND, Carl L. ; WILLKE, Richard ; MARDEKIAN, Jack ; GARRISON, Louis P.
Journal of pain and palliative care pharmacotherapy, 02/10/2017, vol.31, n°3-4, p. 218-227

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Thème : Médicaments - Pharmacie. Cote : 00.07JPP

ANALGESIQUE OPIOIDE ; PRESCRIPTION ; DOULEUR ; PRISE EN CHARGE ; PEDIATRIE

Prescription opioids are among the most effective analgesics to treat moderate to severe pain; however, little is known about the use of prescription opioids in children, particularly those receiving an extended-release formulation for the treatment of chronic pain. In this retrospective study, the authors determined the prevalence of prescription opioid use among 7–17-year-old children and associated comorbid health conditions from 2010 to 2013 using Truven Health MarketScan (MarketScan) and Optum Clinformatics DataMart (Optum). The primary end points were prevalence of using any prescription opioids, using only prescription short-acting opioids (SAOs), and at least one prescription of a long-acting opioid (LAO). The prevalence of prescription opioid use among children is non-negligible and has been trending downwards: 6.90% in 2010 and 5.93% in 2013 using MarketScan and a similar trend using Optum: 5.47% in 2010 and 4.51% in 2013. Very few children had claims for LAOs, with only 0.04% (4979 children) in MarketScan and 0.03% (1117 children) in Optum. Given the very small number of children, primarily in the 12–17 age group, who are prescribed LAOs, there is a need to focus on a better understanding of the patterns of SAO use in children.

Origine : CrossRef

Serotonin syndrome in tapentadol literature - systematic review of original research

GRESSLER, Laura E. ; HAMMOND, Drayton A. ; PAINTER, Jacob T.
Journal of pain and palliative care pharmacotherapy, 02/10/2017, vol.31, n°3-4, p. 228-236

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Thème : Médicaments - Pharmacie. Cote : 00.07JPP

PRISE EN CHARGE ; SYNDROME ; METHODE ; AGONISTE FORT

The potential association between serotonin syndrome and tapentadol is not well described in the literature. This study aimed to review the literature and identify methodological issues that could lead to inaccurately reported rates of serotonin syndrome associated with tapentadol use. A systematic review of English articles using MEDLINE, Cochrane Controlled Trials Register, and Scopus was performed. Additional studies were identified by cross-referencing article bibliographies. Original research that examined the safety of tapentadol in patients with nonconfounding indications were examined. In total, 22 studies met inclusion criteria. There were 13 randomized clinical trials, 7 open-label trials, and 2 observational studies. All studies either did not mention whether serotonergic medication use was prohibited or disallowed use. Frequently reported adverse events were nausea, diarrhea, constipation, fatigue, vomiting, and somnolence. No studies reported serotonin syndrome development. No included trials differentiated between the development of adverse events in patients taking serotonergic drugs and those who were not. This differentiation is necessary to evaluate the increased risk of adverse events in patients prescribed tapentadol concomitantly with other serotonergic medications. Therefore, the current tapentadol literature has important limitations that prevent the adequate characterization of the potential association between tapentadol and serotonin syndrome.

Origine : CrossRef

Continuous intravenous lidocaine infusion for the management of pain uncontrolled by opioid medications

REEVES, David J. ; FOSTER, Alexandra E.
Journal of pain and palliative care pharmacotherapy, 02/10/2017, vol.31, n°3-4, p. 198-203

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Thème : Médicaments - Pharmacie. Cote : 00.07JPP

LIDOCAINE ; DOULEUR REBELLE ; PRISE EN CHARGE ; SYMPTOME

Limited data exist describing the outcomes of patients receiving continuous lidocaine infusions. The objective of this study was to evaluate the effect of use of continuous lidocaine infusions for pain management at a community teaching hospital. A retrospective chart review was performed that included adult patients receiving continuous systemic lidocaine infusions for the treatment of pain. Twenty-one patients were included in the analysis. Dosing ranged from 0.25 to 2.8 mg/kg/h, with a median infusion time of 64 hours. Eight patients (38%) experienced a response (≥20% reduction in pain score during the infusion compared with prior to the infusion). Among responding patients, there was a decrease in pain scores at rest after starting lidocaine (compared with prior to lidocaine) (6.5 vs. 3.7, P = .001) that was maintained 24 hours after lidocaine discontinuation. There were no differences in pain scores before, during, or after lidocaine in the entire study sample. A difference in oral morphine equivalent intake was present comparing usage during the infusion vs. day +1 (P = .006) and day +2 (P < .001). Similarly, a difference was present comparing morphine equivalent usage on day −2 with day +2 (P = .008) and day −1 with day +1 (P = .006). Continuous infusions of systemic lidocaine appear to be beneficial in some patients experiencing uncontrolled pain and may improve pain scores while decreasing opioid requirements. Overall beneficial effects of systemic lidocaine may last longer than the infusion itself.

Origine : CrossRef

Gabapentin for cough in cancer

RAZZAK, Rab ; WALDFOGEL, Julie M. ; DOBERMAN, Danielle J. ; FELICIANO, Josephine L. ; SMITH, Thomas J.
Journal of pain and palliative care pharmacotherapy, 02/10/2017, vol.31, n°3-4, p. 195-197

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Thème : Médicaments - Pharmacie. Cote : 00.07JPP

TOUX ; PRISE EN CHARGE ; SYMPTOME ; CANCER RESPIRATOIRE ; THERAPEUTIQUE MEDICAMENTEUSE ; ANTICONVULSIVANT

Cough is a common problem among cancer patients, especially lung cancer patients. Gabapentin has been shown to be effective in reducing cough number and severity in patients with idiopathic refractory cough. The authors report here the successful use of gabapentin at usual doses to treat cough in cancer patients, including two with lung cancer, with minimal side effects. Gabapentin may be a useful addition to the symptom management toolbox for palliation of cancer symptoms.

Propofol-based palliative sedation to treat antipsychotic-resistant agitated delirium

COVARRUBIAS-GÓMEZ, Alfredo ; LÓPEZ COLLADA-ESTRADA, Maria
Journal of pain and palliative care pharmacotherapy, 02/10/2017, vol.31, n°3-4, p. 190-194

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Thème : Médicaments - Pharmacie. Cote : 00.07JPP

DELIRE ; PRISE EN CHARGE ; DETRESSE PSYCHOLOGIQUE ; AGITATION ; SEDATION PALLIATIVE ; THERAPEUTIQUE MEDICAMENTEUSE

Delirium is a common problem in terminally ill patients that is associated with significant distress and, hence, considered a palliative care emergency. The three subtypes of delirium are hyperactive, hypoactive, and mixed, depending on the level of psychomotor activity and arousal disturbance. When agitated delirium becomes refractory in the setting of imminent dying, the agitation may be so severe that palliative sedation (PS) is required. Palliative sedation involves the administration of sedative medications with the purpose of reducing level of consciousness for patients with refractory suffering in the setting of a terminal illness. Propofol is a sedative that has a short duration of action and a very rapid onset. These characteristics make it relatively easy to titrate. Reported doses range from 50 to 70 mg per hour. The authors present a case of antipsychotic-resistant agitated delirium treated with a propofol intravenous infusion.

Origine : CrossRef

Le domicile comme lieu révélateur d’un choc des intimités

MICHEAU, Brigitte
JALMALV JUSQU'A LA MORT, ACCOMPAGNER LA VIE, 2018, n°134, p. 55-64

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Thème : Soins. Cote : 00.07JAL

PRISE EN CHARGE ; DOMICILE ; VULNERABILITE ; PATIENT ; INTIMITE ; ACCOMPAGNEMENT ; RESPECT

Le système de santé privilégie aujourd’hui la prise en charge de malades au domicile. Au-delà des interrogations d’ordre financier et structurel que cela implique, cela ne va pas sans questionner la notion de vulnérabilité du malade. Mais également la vulnérabilité de chacune des personnes agissant autour du malade au domicile. Le domicile n’est pas un terrain neutre. Il est le lieu de l’intime. Celui qui permet au malade, lorsque sa maladie évolue, de « trouver refuge ». La prise en charge du malade au domicile implique l’intervention d’une équipe médicale. Cette équipe accompagne le malade et ses proches avec des compétences de soignants. Ces caractéristiques médicales rejoignent celles des bénévoles. La complémentarité entre les diverses interventions est un gage de réussite dans la prise en charge du malade et des proches. L’échange d’informations entre tous les protagonistes est un rouage essentiel permettant de minimiser d’éventuels conflits et de rester au plus près du désir du malade. Ce carrefour d’informations pourra également éviter que le malade ne ressente comme une intrusion la venue à son domicile des divers intervenants.
Il est important de noter que l’accompagnement aujourd’hui n’est pas l’apanage des phases terminales. La prise en charge d’un malade se fait dès l’annonce d’une maladie grave, nécessitant que tous les paramètres au-delà du médical soient pris en compte dès la première hospitalisation. Les différentes phases, soins curatifs, soins palliatifs, phase ultime, sont autant d’étapes à reconnaître et à étudier, pour une prise en charge globale de la maladie…

Origine : Cairn

Advance care plan barriers in older patients with end-stage renal disease - a qualitative nephrologist interview study

O'RIORDAN, Julien ; NOBLE, Helen ; KANE, P. M. ; SMYTH, Andrew
BMJ supportive and palliative care, 25/06/2019, Pagination inconnue

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

FIN VIE ; PLANIFICATION ; SOIN ; DIALYSE ; ARRET THERAPEUTIQUE ; INSUFFISANCE RENALE ; PHASE TERMINALE ; PRISE EN CHARGE ; PERSONNE AGEE

OBJECTIVES: Older patients with end-stage renal disease are willing participants in advance care planning but just over 10% are engaged in this process. Nephrologists fear such conversations may upset patients and so tend to avoid these discussions. This approach denies patients the opportunity to discuss their end-of-life care preferences. Many patients endure medically intensive end-of-life scenarios as a result. This study aims to explore the rationale underpinning nephrologists' clinical decision-making in the management of older patients with end-stage renal disease and to make recommendations that inform policymakers and enhance advance care planning for this patient group.
METHODS: A qualitative interview study of 20 nephrologists was undertaken. Nephrologists were asked about their management of end-stage renal disease in older patients, conservative management, dialysis withdrawal and end-of-life care. Eligible participants were nephrologists working in Ireland. Five nephrologists participated in a recorded focus group and 15 nephrologists participated in individual digitally recorded telephone interviews. Semistructured interviews were conducted; thematic analysis was used to distil the results.
RESULTS: Three key themes emerged: barriers to advance care planning; barriers to shared decision-making; and avoidance of end-of-life care discussion.
CONCLUSIONS: Advance care planning is not an integral part of the routine care of older patients with end-stage renal disease. Absence of formal training of nephrologists in how to communicate with patients contributes to poor advance care planning. Nephrologists lack clinical experience of conservatively managing end-stage renal disease and end-of-life care in older patients. Key policy recommendations include formal communication skills training for nephrologists and development of the conservative management service.

Origine : PubMed

Communicating caregivers' challenges with cancer pain management - an analysis of home hospice visits

HAN, Claire J. ; CHI, Nai-Ching ; HAN, Soojeong ; DEMIRIS, George ; PARKER-OLIVER, Debra ; WASHINGTON, Karla ; CLAYTON, Margaret F. ; REBLIN, Maija ; ELLINGTON, Lee
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, 05/2018, vol.55, n°5, p. 1296-1303

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Thème : Soins. Cote : eD02.03.03

AIDANT NATUREL ; FAMILLE ; SERVICE SOINS AIDE DOMICILE ; RELATION INTERPERSONNELLE ; PRISE EN CHARGE ; DOULEUR ; CANCER ; ROLE ; INFIRMIERE

CONTEXT: Family caregivers (FCGs) of hospice cancer patients face significant challenges related to pain management. Addressing many of these challenges requires effective communication between FCGs and hospice nurses, yet little empirical evidence exists on the nature of communication about pain management between hospice nurses and FCGs.
OBJECTIVES: We identified ways in which FCGs of hospice cancer patients communicated their pain management challenges to nurses during home visits and explored nurses' responses when pain management concerns were raised.
METHODS: Using secondary data from audio recordings of hospice nurses' home visits, a deductive content analysis was conducted. We coded caregivers' pain management challenges and immediate nurses' responses to these challenges.
RESULTS: From 63 hospice nurse visits, 101 statements describing caregivers' pain management challenges were identified. Thirty percent of these statements pertained to communication and teamwork issues. Twenty-seven percent concerned caregivers' medication skills and knowledge. In 52% of the cases, nurses responded to caregivers' pain management challenges with a validating statement. They provided information in 42% of the cases. Nurses did not address 14% of the statements made by caregivers reflecting pain management challenges.
CONCLUSION: To optimize hospice patients' comfort and reduce caregivers' anxiety and burden related to pain management, hospice nurses need to assess and address caregivers' pain management challenges during home visits. Communication and educational tools designed to reduce caregivers' barriers to pain management would likely improve clinical practice and both patient- and caregiver-related outcomes.

Origine : PubMed

Symptom intensity of hospice patients - a longitudinal analysis of concordance between patients' and nurses' outcomes

DE GRAAF, Everlien ; ZWEERS, Daniëlle ; DE GRAEFF, Alexander ; STELLATO, Rebecca K. ; TEUNISSEN, Saskia C. C. M.
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, 02/2018, vol.55, n°2, p. 272-281

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Thème : Médecine. Cote : eD03.01

UNITE SOINS PALLIATIFS ; ETUDE LONGITUDINALE ; INFIRMIERE ; DEMARCHE PALLIATIVE ; PRISE EN CHARGE ; CONTROLE SYMPTOME

Context: Nearing death, hospice patients are increasingly unable or unwilling to self-report their symptom intensity and rely on nurses' assessments.
Objectives: We hypothesized that concordance between patients' and nurses' assessments of symptom intensity improves over time.
Method: A prospective longitudinal study was conducted from January 2012 to June 2015 using dyads of patient- and nurse-reported outcome measures, collected in daily hospice practice in the first three weeks after admission. Main outcomes were symptom intensity and well-being, measured using the Utrecht Symptom Diary (USD) and USD-Professional. Absolute concordance was the proportion of dyads with no difference in scores between USD and USD-Professional per week after admission. For agreement beyond chance, the squared weighted Kappa for symptom intensity and the one-way agreement intraclass correlation coefficient for well-being were used.
Results: The most prevalent symptoms, fatigue, dry mouth, and anorexia also had the highest intensity scores assessed by patients and nurses. Symptom intensity was underestimated more frequently than overestimated by the nurses. The absolute concordance was fair to good (35%-69%). Agreement beyond chance was low to fair (0.146-0.539) and the intraclass correlation for well-being was low (0.25-0.28). Absolute concordance and agreement beyond chance did not improve over time.
Conclusion: Concordance between patients' and nurses' assessment of symptom prevalence is good, and both patients and nurses reveal identical symptoms as most and least prevalent and intense. However, nurses tend to underestimate symptom intensity. Concordance between patients and nurses symptom intensity scores is poor and does not improve over time.

Origine : PubMed

Drug management in end-of-life hospitalized palliative care cancer patients - the RHESO cohort study

VALLARD, Alexis ; MORISSON, Stéphanie ; TINQUAUT, Fabien ; CHAUVIN, Franck ; ORIOL, Mathieu ; CHAPELLE, Céline ; SOTTON, Sandrine ; MAGNE, Nicolas ; TARDY, Bernard ; BOURMAUD, Aurélie
Oncology, 20/06/2019, 11 p.

Document en ligne

Thème : Médecine.

DEMARCHE PALLIATIVE ; FIN VIE ; SOIN ; CANCER ; PHASE TERMINALE ; QUALITE SOIN ; PRISE EN CHARGE ; THERAPEUTIQUE MEDICAMENTEUSE ; ETUDE COHORTE

Objective: Little data about the management of drugs in terminally ill palliative care cancer patients is available. The present study aimed at describing the evolution of anticancer and non-anticancer treatments (NACTs) in cancer patients in palliative care units. The second objective was to identify factors leading to the medical decision to withdraw or not NACTs.
Methods: Data from 1,091 cancer patients hospitalized in palliative care units were prospectively collected in 2010-2011, through a multicenter, observational French cohort.
Results: The median overall survival after admittance in palliative care units was 15 days. Specific anticancer treatments were systematically stopped in the first 24 h in palliative care units, but for 4.5% of patients. Regarding NACTs, patients were heavily treated with strong opioids (74%), corticosteroids (51%), and antidepressants (21.8%) until death. Antiulcer agents (63.4%), antibiotics (25.7%), thrombosis prevention (21.8%), antidiabetics (7.6%), and transfusions (4%) were often also continuously prescribed. In multivariate analysis, ECOG PS 4 was an independent predictor of continuous prescription of morphine and an independent predictor of discontinuation of corticosteroids, proton-pump inhibitors, antidiabetics, and preventive anticoagulant therapy. Infection symptoms independently predicted continuous prescription of paracetamol. Paralysis and cancer palpable mass independently predicted corticosteroid withdrawal. Brain metastases independently predicted antiulcer withdrawal. Hemorrhage independently predicted preventive anticoagulant withdrawal. Availability to a venous access independently predicted paracetamol and antiulcer continuous prescriptions. Co-prescriptions independently predicted continuous prescriptions (antibiotics with antiulcer, antifungals with antibiotics) or withdrawal (preventive anticoagulant with antiplatelets and antifungals).
Conclusions: NACT prescription remained commonplace in terminally ill palliative cancer patients, although their benefit is questionable.

Origine : PubMed

Diuretics combined with compression in resistant limb edema of advanced disease - a case series report

GRADALSKI, Tomasz
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, 01/01/2018, vol.55, n°4, p. 1179-1183

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Thème : Médecine. Cote : eD03.05

DEMARCHE PALLIATIVE ; MALADIE GRAVE ; PERSONNE AGEE ; UNITE SOINS PALLIATIFS ; VOIE INTRAVEINEUSE ; PRISE EN CHARGE ; LYMPHOEDEME ; OEDEME

Introduction: The extremity edema of advanced disease is a common, multifactorial feature, which impairs patients' activities and quality of life. The most frequently chosen management is based on combined decongestive physiotherapy or pharmacotherapy (with diuretics or steroids). Subcutaneous lymphatic drainage in refractory edema may decrease the swelling, prevent spontaneous lymphorrhea, but also increase the risk of infection. Safe and effective conservative management in diuretics-resistant edemas is lacking. The objective of this prospective, observational study was to assess the effectiveness and tolerability of combined physiotherapeutic and diuretic therapy in edemas refractory to parenteral diuretics.
Methods: A group of 19 patients with advanced disease and severe bilateral leg edema resistant to parenteral diuretic therapy were treated for three days with a combination of multilayer short-stretch compression bandaging and furosemide in hypersaline intravenous infusion.
Results: A clinically meaningful decrease in mean limb volume (of 1.52 L; 20.6%; P < 0.0001)-strongly correlating with patients' weight loss (rho = 0.71; P = 0.0001), with a lowering of the intensity of complaints-was achieved. The treatment was well tolerated, without decreasing the performance status in any patient. Stable levels of blood pressure, laboratory kidney profile (potassium, sodium, creatinine clearance), and serum albumin were observed. Maintenance of the achieved results with a good compliance was seen during an informal follow-up at the hospice.
Conclusion: The combination of compression therapy with hypersaline diuretics could be considered as a valuable option for refractory cases of limb edema in advanced disease.

Origine : PubMed

Caregiver exposure to critical events and distress in home-based palliative care in Germany a cross-sectional study using the stressful caregiving adult reactions to experiences of dying (scared) scale

GALATSCH, Michael ; PRIGERSON, Holly G. ; SCHNEPP, Wilfried ; ZU SAYN-WITTGENSTEIN, Friederike ; LI, Jian
BMC palliative care, 24/01/2019, vol.18, n°1, p. 1-8

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Thème : Soins. Cote : eD02.03.03

FAMILLE ; ACCOMPAGNEMENT ; DOMICILE ; PRISE EN CHARGE ; ALLEMAGNE ; STRESS ; ECHELLE MESURE ; PERSONNE AGEE ; DETRESSE PSYCHOLOGIQUE

BACKGROUND: Lay family caregivers of patients receiving palliative care often confront stressful situations in the care of their loved ones. This is particularly true for families in the home-based palliative care settings, where the family caregivers are responsible for a substantial amount of the patient's care. Yet, to our knowledge, no study to date has examined the family caregivers' exposure to critical events and distress with home-based palliative care has been reported from Germany. Therefore, we attempt to assess family caregiver exposure to the dying patient's critical health events and relate that to the caregiver's own psychological distress to examine associations with general health within a home-based palliative care situation in Germany.
METHODS: A cross-sectional study was conducted among 106 family caregivers with home-based palliative care in the Federal State of North Rhine Westphalia, Germany. We administered the Stressful Caregiving Adult Reactions to Experiences of Dying (SCARED) Scale. Descriptive statistics and linear regression models relating general health (SF-36) were used to analyze the data.
RESULTS: The frequency of the caregiver's exposure, or witness of, critical health events of the patient ranged from 95.2% "pain/discomfort" to 20.8% "family caregiver thought patient was dead". The highest distress scores assessing fear and helpfulness were associated with "family caregiver felt patient had enough'" and "family caregiver thought patient was dead". Linear regression analyses revealed significant inverse associations between SCARED critical health event exposure frequency (beta=.408, p=.025) and total score (beta=.377, p=.007) with general health in family caregivers.
CONCLUSIONS: Family caregivers with home-based palliative care in Germany frequently experience exposure to a large number of critical health events in caring for their family members who are terminally ill. These exposures are associated with the family caregiver's degree of fear and helplessness and are associated with their worse general health. Thus the SCARED Scale, which is brief and easy to administer, appears able to identify these potentially upsetting critical health events among family caregivers of palliative care patients receiving care at home. Because it identified commonly encountered critical events in these patients and related them to adverse general health of family caregivers, the SCARED may add to clinically useful screens to identify family caregivers who may be struggling.

Origine : PubMed

Palliative care in the hip fracture patient

SULLIVAN, Nicole M. ; BLAKE, Lindsay E. ; GEORGE, Masil ; MEARS, Simon C.
Geriatric orthopaedic surgery and rehabilitation, 2019, vol.10, 7 p.

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Thème : Soins. Cote : eD02.00

DEMENCE ; PRISE DECISION ; GERIATRIE ; PRISE EN CHARGE ; MOURANT

Introduction: Older patients with hip fracture have a 20% to 30% mortality rate in the year after surgery. Nonoperative care has higher 1-year mortality rates and is generally only pursued in those with an extraordinarily high surgical risk. As the population ages, more patients with hip fracture may fall into this category. The orthopedic surgeon is typically the main consultant responsible for deciding between surgery and conservative management, and the reasoning behind one decision over the other is often poorly understood. We undertook a review to determine decision-making tools for surgery in high-risk patients with hip fracture.
Materials and Methods: A review was conducted using PubMed to determine articles published using the terms palliative care, conservative care, nonoperative, hip fracture, orthopedic procedures, fracture fixation, and surgery. Our search resulted in 13 articles to review. These were further screened to determine tools for use in surgical decision-making.
Results: Several potential decision-making tools were found in our search. The potential tools to identify patients who would benefit from nonoperative treatment included the Palliative Performance Scale for severe dementia, the Lawton Instrumental Activities of Daily Living and Katz Activities of Daily Living scales for prefracture immobility, a combination of clinical signs and laboratory tests to determine risk of imminent death, and the Charlson Comorbidity Score for additional serious comorbidities. No tools have been prospectively tested in a clinical setting.
Discussion: Evaluation of each patient using a variety of decision making tools should help the orthopedic surgeon determine which patients would be better suited to non-operative management. After determining the benefit of non-operative care, they must effectively allow the fracture to heal while ameliorating pain. Palliative care physicians can fulfill this role by providing support and symptom relief.
Conclusions: Surgical decision-making for hip fracture repair in the elderly patients is not straight forward. Several tools may be helpful to the surgeon in determining who may be better suited for nonoperative care or a palliative care referral. Prospective data do not exist in these decision-making tools.

Origine : PubMed

Improving the waiting times within a hospice breathlessness service

SIME, Caroline ; MILLIGAN, Stuart ; DONAL ROONEY, Kevin
BMJ open quality, 2019, vol.8, n°2, 7 p.

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Thème : Soins. Cote : eD02.00

SOIN ; PATIENT ; PRISE EN CHARGE ; MALADIE CHRONIQUE ; QUALITE SOIN ; ROYAUME UNI

Background: Breathlessness, a common symptom in advanced disease, is a distressing, complex symptom that can profoundly affect the quality of one's life. Evidence suggests that specialist palliative care breathlessness intervention services can improve physical well-being, personal coping strategies and quality of life. In the UK, the use of quality improvement methods is well documented in the National Health Service. However, within the independent hospice sector there is a lack of published evidence of using such methods to improve service provision.
Aim: The aim of this project was to reduce the waiting time from referral to service commencement for a hospice breathlessness service by 40%-from a median of 19.5 to 11.5 working days.
Methods: Using a quality planning and systems thinking approach staff identified barriers and blockages in the current system and undertook plan-do-study-act cycles to test change ideas. The ideas tested included offering home visits to patients on long-term oxygen, using weekly team 'huddles', streamlining the internal referral process and reallocating staff resources.
Results: Using quality improvement methods enabled staff to proactively engage in positive changes to improve the service provided to people living with chronic breathlessness. Offering alternatives to morning appointments; using staff time more efficiently and introducing accurate data collection enabled staff to monitor waiting times in real time. The reduction achieved in the median waiting time from referral to service commencement exceeded the project aim.
Conclusions: This project demonstrates that quality improvement methodologies can be successfully used in a hospice setting to improve waiting times and meet the specific needs of people receiving specialist palliative care.

Origine : PubMed

Palliative care referral and associated outcomes among patients with cancer in the last 2 weeks of life

LEDOUX, Mathilde ; RHONDALI, Wadih ; LAFUMAS, Véronique ; BERTHILLER, Julien ; TEISSERE, Marion ; PIEGAY, Céline ; COURAY-TARGE, Sandrine ; SCHOTT, Anne-Marie ; BRUERA, Eduardo ; FILBET, Marilène
BMJ supportive and palliative care, 03/2019, vol.9, n°1, Pagination inconnue

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Thème : Soins.

DEMARCHE PALLIATIVE ; QUALITE VIE ; CANCER ; MORT ; ETUDE RETROSPECTIVE ; SOINS SUPPORT ; CONSULTATION ; SOIN INFIRMIER ; EVALUATION ; PRISE EN CHARGE ; SYMPTOME

Background: Palliative care (PC) improves the quality of life of patients with advanced cancer. Our aim was to describe PC referral among patients with advanced cancer, and associated outcomes in an academic medical centre.
Methods: We reviewed the medical records of 536 inpatients with cancer who had died in 2010. Our retrospective study compared patients who accessed PC services with those who did not. Statistical analysis was conducted using non-parametric tests due to non-normal distribution. We also conducted a multivariate analysis using a logistic regression model including age, gender, type of cancer and metastatic status.
Results: Out of 536 patients, 239 (45%) had PC referral. The most common cancer types were respiratory (22%) and gastrointestinal (19%). Patients with breast cancer (OR 23.76; CI 6.12 to 92.18) and gynaecological cancer (OR 7.64; CI 2.61 to 22.35) had greater PC access than patients with respiratory or haematological cancer. Patients referred to PC had significantly less chemotherapy in the last 2 weeks of life than non-referred patients, with 22 patients (9%) vs 59 (19%; p<0.001). PC-referred patients had significantly fewer admissions to intensive care units in the last month of life than non-referred patients, with 14 (6%) vs 58 (20%; p<0.001).
Conclusions: There was a large variation in access to PC according to the type of cancer. There is a need to improve collaboration between the PC service and the respiratory, cancer and haematology specialists. Further research will be required to determine the modality and the impact of this collaboration.

Origine : PubMed

End-of-life measures in Huntington disease - HDQLIFE meaning and purpose, concern with death and dying, and end of life planning

CARLOZZI, Noelle E. ; BOILEAU, Nicholas R. ; PAULSEN, Jane S. ; PERLMUTTER, Joel S. ; LAI, Jin-Shei ; HAHN, Elizabeth A. ; MCCORMACK, Michael K. ; NANCE, Martha A. ; CELLA, David ; BARTON, Stacey K. ; DOWNING, Nancy R.
Journal of neurology, 12/06/2019, p. 1-17

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Thème : Médecine.

FIN VIE ; MALADIE NEUROLOGIQUE ; PRISE EN CHARGE ; ECHELLE MESURE ; EVALUATION ; SOIN ; PLANIFICATION

BACKGROUND AND PURPOSE: Huntington disease (HD) is a progressive neurodegenerative disorder. There are no HD-specific measures to assess for end-of-life (EOL) preferences that have been validated for clinical use. The purpose of this study is to demonstrate reliability and validity of three HD-specific EOL measures for use in and clinical research settings.
METHODS: We examined internal reliability, test-retest reliability, floor and ceiling effects, convergent and discriminant validity, known groups' validity, measurement error, and change over time to systematically examine reliability and validity of the HDQLIFE EOL measures.
RESULTS: Internal consistency and test-retest reliability were >0.70. The measures were generally free of floor and ceiling effects and measurement error was minimal. Convergent and discriminant validity were consistent with well-known constructs in the field. Hypotheses for known groups validity were partially supported (there were generally group differences for the EOL planning measures, but not for meaning and purpose or concern with death and dying). Measurement error was acceptable and there were minimal changes over time across the EOL measures.
CONCLUSIONS: Results support the clinical utility of the HDQLIFE EOL measures in persons with HD.

Origine : PubMed

Dehydration in terminal illness - which path forward?

BRAR, Kanwarjeet ; MEKALA, Hema M. ; LIPPMANN, Steven
The journal of family practice, 10/2018, vol.67, n°10, p. E1-E3

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Thème : Médecine. Cote : eD03.01.01

SYMPTOME ; DESHYDRATATION ; PRISE EN CHARGE ; PHASE TERMINALE ; ETUDE CAS

While our natural tendency is to restore full hydration to patients, how do we proceed when death is imminent and being fully hydrated may prolong discomfort?

Origine : PubMed

Effectiveness of several external beam radiotherapy schedules for palliation of esophageal cancer

WALTERBOS, Natasja R. ; FIOCCO, Marta ; NEELIS, Karen J. ; VAN DER LINDEN, Yvette M. ; LANGERS, Alexandra M. J. ; SLINGERLAND, Marije ; DE STEUR, Wobbe O. ; PETERS, Femke P. ; LIPS, Irene M.
Clinical and translational radiation oncology, 07/2019, vol.17, p. 24-31

Document en ligne

Thème : Médecine. Cote : eD03.05

RADIOTHERAPIE ; CANCER DIGESTIF ; ETUDE RETROSPECTIVE ; PRISE EN CHARGE ; SYMPTOME ; MALADIE GRAVE

Background and purpose: Although external beam radiotherapy (EBRT) is frequently used for palliative treatment of patients with incurable esophageal cancer, the optimal schedule for symptom control is unknown. This retrospective study evaluated three EBRT schedules for symptom control and investigated possible prognostic factors associated with second intervention and overall survival (OS).
Material and methods: Patients with esophageal cancer treated with EBRT with palliative intent between January 2009 and December 2015 were evaluated. Univariate and multivariate Cox regression models estimated the effect of treatment schedule (20 Gy in 5 fractions, 30 Gy in 10 fractions or 39 Gy in 13 fractions) on OS. To study the effect of prognostic factors on time to second intervention (repeat EBRT, intraluminal brachytherapy or stent placement) a competing risk model with death as competing event was used.
Results: 205 patients received 20 Gy (31%), 30 Gy (38%) or 39 Gy (32%). Improvement of symptoms was observed in 72% with no differences between schedules. Median OS after 20 Gy, 30 Gy and 39 Gy was 4.6 months (95%CI 2.6-6.6), 5.2 months (95%CI 3.7-6.7) and 9.7 months (95%CI 6.9-12.5), respectively. Poor performance status (HR 2.25 (95%CI 1.53-3.29)), recurrent esophageal cancer (HR 1.69 (95%CI 1.15-2.47)) and distant metastasis (HR 1.73 (95%CI 1.27-2.35)) were significantly related to worse OS. Treatment with 30 Gy and 39 Gy was related to longer time to second intervention compared to 20 Gy (adjusted cause specific HR 0.50 (95%CI 0.25-0.99) and 0.27 (95%CI 0.13-0.56), respectively).
Conclusions: Palliative EBRT provides good symptom control in patients with symptomatic esophageal cancer. A higher dose schedule was related to a longer time to second intervention. Hence, selection based on life expectancy is vital to prevent unnecessary long treatment schedules in patients with expected short survival, and limit the chance of second intervention when life expectancy is longer.

Origine : PubMed

Early versus delayed palliative/supportive care in advanced cancer - an observational study

BANDIERI, Elena ; BANCHELLI, Federico ; ARTIOLI, Fabrizio ; MUCCIARINI, Claudia ; RAZZINI, Giorgia ; CRUCIANI, Massimiliano ; POTENZA, Leonardo ; D'AMICO, Roberto ; EFFICACE, Fabio ; BRUERA, Eduardo ; LUPPI, Mario
BMJ supportive and palliative care, 14/06/2019, Pagination inconnue

Document en ligne

Thème : Soins.

CHIMIOTHERAPIE ; DOULEUR ; CANCER ; PRISE EN CHARGE ; PHASE TERMINALE ; ANTICIPATION ; TRAJECTOIRE ; SOINS SUPPORT ; OBSERVATION ; ETUDE RETROSPECTIVE

OBJECTIVE: The positive impact of early palliative care interventions in advanced cancer patients has so far been largely evaluated in randomised controlled trials. This study aimed at providing information on the value of early palliative/supportive care, integrated with standard oncologic care, in a real-life setting.
METHODS: This was a retrospective observational study of 292 advanced cancer patients consecutively admitted at Carpi Hospital in Modena, Italy, between 2014 and 2017. For the purpose of this analysis, patients were classified into two groups (early and delayed palliative/supportive care patients), and analysed for different clinical indicators. Early and delayed palliative/supportive care were classified according to the time elapsed from advanced cancer diagnosis until palliative/supportive care start.
RESULTS: A total of 200 patients (68%), with at least three visits, were included in the analyses. The frequency of chemotherapy use in the last 60 days of life was 3.4% and 24.6% in the early and delayed groups, respectively (adjusted OR=0.1; 95% CI 0.0 to 0.4; p=0.002). The estimated survival probability at 1 year was 74.5% (95% CI 65.0% to 85.4%) and 45.5% (95% CI 37.6% to 55.0%), in the early and delayed groups, respectively. Performance status, pain and all the Edmonton Symptom Assessment Scale items, assessed at baseline and at 1 to 12 weeks after the intervention, showed significant improvement over time. However, no between-group differences were found with regard to symptom outcomes.
CONCLUSIONS: An earlier palliative/supportive care intervention was associated with reduced aggressiveness of therapy, in patients receiving community oncology care. Symptom burden was improved by early palliative/supportive care, independently of the timing of patient referral.

Origine : PubMed

Efficacy and toxicity of weekly carboplatin and paclitaxel as induction or palliative treatment in advanced esophageal cancer patients

DE MAN, Femke M. ; VAN EERDEN, Ruben A. G. ; OOMEN-DE HOOP, Esther ; VERAART, Joris N. ; VAN DOORN, Nadia ; VAN DOORN, Leni ; VAN DER GAAST, Ate ; MATHIJSSEN, Ron H. J.
Cancers, 13/06/2019, vol.11, n°6, p. 1-21

Document en ligne

Thème : Médecine. Cote : eD03.05

CANCER DIGESTIF ; THERAPEUTIQUE SYSTEME DIGESTIF ; CHIMIOTHERAPIE ; EFFICACITE ; ETUDE RETROSPECTIVE ; PRISE EN CHARGE ; TOXICITE

Many patients have advanced esophageal cancer at diagnosis. However, the most optimal treatment has not been identified. Therefore, we evaluated a weekly regimen of carboplatin (area under the curve (AUC)) of 4 and paclitaxel at 100 mg/m2 as an induction or palliative treatment. All patients with advanced (gastro)esophageal cancer treated with this regimen between 2002-2018 were included. Exclusion criteria were previous radiotherapy or treatment elsewhere. Data on toxicity, response, and survival were collected. Analyses were performed in two groups: induction (iCT) or palliative chemotherapy (pCT). Median progression free survival (PFS) and overall survival (OS) were estimated with the Kaplan-Meier method. A total of 291 patients was included (iCT: 122; pCT: 169). Most patients had T3 carcinoma (iCT: 54%; pCT: 66%) and stage IV disease (iCT: 42%; pCT: 91%). A toxicity grade 3 occurred mainly as hematological toxicity (iCT: 71%; pCT: 73%) and gastrointestinal toxicity (iCT: 3%; pCT: 5%). Response rates were 48% (iCT) and 44% (pCT). Esophagectomy or definitive chemoradiotherapy followed in 42% of iCT, resulting in a PFS of 22.1 months (interquartile range (IQR): 12.4-114.2) and OS of 26.8 months (IQR: 15.4-91.7). For pCT, PFS was 8.2 months (IQR: 5.1-14.5) and OS 10.9 months (IQR: 6.5-18.3). This retrospective cohort study demonstrated that weekly carboplatin (AUC4) and paclitaxel (100 mg/m2) is a well-tolerated and effective induction or palliative treatment regimen for patients with locally advanced or metastatic disease. Future research should directly compare this treatment regimen with other first-line treatment options to determine its true value for clinical practice.

Origine : PubMed

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ACCOMPAGNEMENT CANCER DEMARCHE PALLIATIVE DOMICILE DOULEUR ENFANT EVALUATION FAMILLE FIN VIE FRANCE PATIENT PERSONNE AGEE PERSONNEL SANTE PRISE EN CHARGE SYMPTOME

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