VigiPallia : Résultats

Recherches dans le fonds documentaire/
Toutes les bibliographies thématiques/
R/
Rapports de l'ONFV

##titre_notice##

##grp1_nom##

- ##grp2_nom## : ##grp2_synthese_detail##

##reservable_synthese##

##detail_synthese##

PRONOSTIC

0 sélectionnée(s) / 305 réponse(s)

(1) 2 3 4 ... 16 > »

Accuracy of the surprise question on an inpatient oncology service - a multidisciplinary perspective

SINGH, Sarguni ; GRAHAM, Zachary ; RODRIGUEZ, Adrian ; LEE, Darrell ; WENGER, Barbara ; MIN, Sung-Joon ; FISCHER, Stacy
JOURNAL OF HOSPICE AND PALLIATIVE NURSING, 08/2019, vol.21, n°4, p. 300-304

Document en ligne

Thème : Soins.

CANCEROLOGIE ; OUTIL ; PRONOSTIC ; DEMARCHE PALLIATIVE ; PERSONNEL SANTE

The surprise question (SQ), “Would you be surprised if your patient died within a year?”, has been studied in the cancer population as a prognostic prompt. Studies have almost exclusively directed the SQ to physicians, whereas perspectives of nurses remain underevaluated. We asked the SQ for patients admitted to an inpatient medical oncology service to medical oncology, palliative care, and hospital medicine teams and bedside nurses. We performed a 1-year retrospective chart review to identify how concordant various provider types were in their prognostic estimations and identified the missed opportunity rate (MOR) defined as the number of patients who died within a particular time frame but who the providers had predicted would be alive and may not have had a palliative approach. Oncologists had higher MORs for the 6-month and 1-year SQ when compared with hospital medicine providers. Bedside nurses were least concordant in their estimations of prognosis and had higher MORs for all time frames of the SQ. Missed opportunities might have significant implications for the end-of-life care for cancer patients, and continued research is needed to understand what influences provider prognostication and how this impacts palliative care utilization for patients with life-limiting disease.

Origine : journals.lww.com

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

Document en ligne

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

Space for intuition - the ‘Surprise’-Question in haemato-oncology - qualitative analysis of experiences and perceptions of haemato-oncologists

GERLACH, Cristina ; GOEBEL, Swantje ; WEBER, Sascha ; WEBER, Martin ; SLEEMAN, Katherine E.
PALLIATIVE MEDICINE, 05/2019, vol.33, n°5, p. 531-540

Thème : Soins. Cote : 00.07PAL

DEMARCHE PALLIATIVE ; PRONOSTIC ; PRISE DECISION ; RECHERCHE QUALITATIVE ; CANCER

Background: Early integration of palliative care can improve outcomes for people with cancer and non-cancer diagnoses. However, prediction of survival for individuals is challenging, in particular in patients with haematological malignancies who are known to have limited access to palliative care. The ‘Surprise’-Question can be used to facilitate referral to palliative care.
Aim: To explore experiences, views and perceptions of haemato-oncologists on the use of the ‘Surprise’-Question in the haemato-oncology outpatients clinics of a university hospital in Germany.
Design: A qualitative study using individual semi-structured interviews transcribed verbatim and analysed thematically based on the framework approach.
Setting/participants: The study took place at the haemato-oncology outpatient clinic and the bone marrow transplantation outpatient clinic of a university hospital. Nine haemato-oncologists participated in qualitative interviews.
Results: Thematic analysis identified 4 themes and 11 subthemes: (1) meaning and relevance of the ‘Surprise’-Question; (2) feasibility; (3) the concept of ‘surprise’ and (4) personal aspects of prognostication. A key function of the ‘Surprise’-Question was to stimulate intuition and promote patient-centred goals of care by initiating a process of pause reflection change of perspective. It was easy and quick to use, but required time and communication skills to act on. Participants’ training in palliative care enhanced their willingness to use the ‘Surprise’-Question.
Conclusion: Irrespective of its use in prognostication, the ‘Surprise’-Question is a valuable tool to facilitate consideration of patient-centred goals and promote holistic care in haemato-oncology. However, prognostic uncertainty, lack of time and communication skills are barriers for integration into daily practice. Further research should involve haematology patients to integrate their needs and preferences.

Premier aphorisme d’Hippocrate et soins palliatifs

SARDIN, Bertrand
MEDECINE PALLIATIVE, 06/2019, p. 1-5

Document en ligne

Thème : Soins.

DEMARCHE PALLIATIVE ; TEMPS ; PRONOSTIC ; ETHIQUE SOIN ; VULNERABILITE

Introduction: « La vie est courte, l’art est long, l’occasion fugitive, l’expérience trompeuse, le jugement difficile. Or, il faut non seulement se montrer soi-même accomplissant son devoir, mais faire aussi que le malade, les assistants et les éléments extérieurs accomplissent le leur ». Dans le contexte des soins palliatifs, le premier aphorisme d’Hippocrate résonne d’une étonnante modernité.
Trois axes de réflexion: Les trois premières affirmations questionnent sur le temps en soins palliatifs. Temps compté lorsque l’annonce déclenche un compte à rebours, temps accordé, partagé, temps de vie, du mourir voire du long mourir ? Comment vivre ce temps perçu comme incertain ? Quand initier le temps de la rencontre qui va mettre en place des soins palliatifs ? Les deux assertions suivantes expriment l’irréductible incertitude de la prise en charge palliative aussi bien en termes de pronostic qu’en termes d’éthique dans une société où les repères traditionnels s’effacent devant des revendications sociétales et la promotion d’une éthique liquide. Enfin la dernière phrase incite les soignants à réfléchir en termes de devoirs et d’engagements, de transdisciplinarité. Promouvoir l’émergence d’une culture palliative reposant sur une démarche « palliactive » : affirmer le refus de l’euthanasie, redéfinir les buts, les missions et les moyens des soins palliatifs dans leur triple dimension de proximité, d’appui et de recours. Plaider pour une mise en place plus précoce des soins palliatifs et non se limiter à l’urgence des fins de vie. Refonder la formation non seulement en termes de contenus mais aussi d’auditoires. Analyser et comprendre les fonctionnements locaux de la prise en charge palliative car il n’existe pas de soins palliatifs génériques mais des organisations et des structures qui sont hétérogènes.
Conclusion: Le premier aphorisme nous invite à réfléchir en termes d’écologie palliative. Cette écologie palliative doit partir d’un constat lucide de la vulnérabilité de notre société, des fragilités et des dépendances d’individus de plus en plus isolés alors même que les moyens accordés restent insuffisants. Si les soins palliatifs ne doivent pas refuser la technique et les alternatives technologiques, ils doivent rester fondés sur l’humain et sur la rencontre entre les personnes.

Accuracy of the surprise question on an inpatient oncology service - a multidisciplinary perspective

SINGH, Sarguni ; GRAHAM, Zachary ; RODRIGUEZ, Adrian ; LEE, Darrell ; WENGER, Barbara ; FISCHER, Stacy
JOURNAL OF HOSPICE AND PALLIATIVE NURSING, 08/2019, vol.21, n°4, p. 300–304

Thème : Recherche - Evaluation - Méthodologie.

OUTIL ; CANCEROLOGIE ; INTERDISCIPLINARITE ; ETUDE RETROSPECTIVE ; PRONOSTIC

Telling the truth to dying children - end-of-life communication with families

LOVGREN, Malin ; MELIN-JOHANSSON, Christina ; UDO, Camilla ; SVEEN, Josefin
Acta paediatrica, 12/07/2019, Pagination inconnue

Document en ligne

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

VERITE ; ETAPE MOURIR ; ENFANT ; PRONOSTIC ; COMMUNICATION ; FIN VIE

Communicating a terminal prognosis is challenging for patients, families and healthcare professionals. However, positive effects have been reported when children are told about their diagnosis and prognosis, including fewer symptoms of anxiety and depression and enhanced adherence to treatment. When research about prognostic communication was first published in the 1950s and 1960s, it recommended protecting children from bad news. By the late 1960s, a more open approach was recommended and by the late 1980s the advice was to always tell children. There has been a growing awareness of the complexity of prognostic disclosure and the need to balance often competing factors, such as hope and patient and family considerations, on a case-to-case basis.

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

Courses of change in good emotional preparedness for death and accurate prognostic awareness and their associations with psychological distress and quality of life in terminally ill cancer patients' last year of life

TANG, Siew Tzuh ; CHOU, Wen-Chi ; CHANG, Wen-Cheng ; CHEN, Jen-Shi ; HSIEH, Chia-Hsun ; WEN, Fur-Hsing ; CHUNG, Shih-Chi
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, 02/07/2019, Pagination inconnue

Document en ligne

Thème : Soins.

CONSCIENCE ; PRONOSTIC ; ETAPE MOURIR ; ETUDE LONGITUDINALE ; PHASE TERMINALE ; CANCER ; REPRESENTATION MORT ; DETRESSE PSYCHOLOGIQUE ; EMOTION ; ANXIETE ; DEPRESSION ; QUALITE VIE

BACKGROUND: Emotional preparedness for death is a distinct but related concept to prognostic awareness (PA). Both allow patients to prepare psychologically and interpersonally for death but they have primarily been examined in cross-sectional studies.
OBJECTIVE: To (1) explore the courses of change in good emotional preparedness for death and accurate PA and (2) evaluate their associations with severe anxiety symptoms, severe depressive symptoms, and quality of life (QOL) in cancer patients' last year.
METHODS: For this prospective, longitudinal study, we consecutively recruited 277 terminally ill cancer patients. Aims 1 and 2 were examined by univariate and multivariate generalized estimating equation analyses, respectively.
RESULTS: The prevalence of good emotional preparedness for death was 54.43%–65.85% in the last year, with a significant decrease only 91–180 vs. 181–365 days before death (odds ratio [95% CI] = 0.67 [0.47, 0.97]). Good emotional preparedness for death was associated with a lower likelihood of severe anxiety symptoms (adjusted odds ratio [95% CI] = 0.47 [0.27, 0.79]) and severe depressive symptoms (0.61 [0.39, 0.95]), but not with quality of life (ß [95% CI] = 0.49 [-2.13, 3.11]). However, accurate PA improved substantially (55.12%–70.73%) as death approached and accurate PA was positively associated with severe depressive symptoms (2.63 [1.63, 4.25]).
CONCLUSIONS: Good emotional preparedness for death and accurate PA remained largely stable and improved substantially, respectively, in cancer patients' last year. Both measures were significantly associated with psychological distress. Healthcare professionals should not only cultivate accurate PA but also promote cancer patients' emotional preparedness for death, which may improve their psychological well-being.

Origine : PubMed

Acute care utilization and place of death among patients discharged from an inpatient palliative care unit

WEBBER, Colleen ; HSU, Amy T. ; TANUSEPUTRO, Peter ; FITZGIBBON, Edward J. ; LI, Cecilia
JOURNAL OF PALLIATIVE MEDICINE, 15/07/2019, p. 1-6

Document en ligne

Thème : Soins. Cote : e00.07JOU

UNITE SOINS PALLIATIFS ; RETOUR DOMICILE ; ETUDE COHORTE ; ETUDE RETROSPECTIVE ; PRONOSTIC ; LIEU DECES ; TRAJECTOIRE MALADIE ; HOSPITALISATION

Background: Discharging patients from inpatient palliative care units to the community is aligned with patients' desires to be cared for and die at home. However, there is little research examining patient outcomes after discharge.
Objective: To describe the outcomes of patients discharged from an inpatient palliative care unit.
Design: A single-institution retrospective cohort study using medical record data linked to regional acute care hospital and home care data.
Setting/Participants: Patients (n = 75) discharged to the community over a one-year period from a 31-bed inpatient palliative care unit in an academic continuing care facility.
Measurements: Survival, postdischarge hospitalizations and emergency department visits, and place of death.
Results: Patients discharged to the community had poor prognosis. Over one-third had a discharge Palliative Performance Score <50. The median survival after discharge was 96 days, and 36% of decedent patients died in an acute care hospital. Thirteen percent of patients were hospitalized, and 23% visited an emergency department within 30 days of discharge, often for reasons that could have been managed in the community. Certain groups of patients were at greater risk of acute care use and in-hospital deaths, including younger patients, patients with nonmalignant diseases, and patients discharged home or retirement home, compared to long-term care settings.
Conclusions: Patients discharged from an inpatient palliative care setting are at risk of postdischarge hospitalizations, emergency department visits, and in-hospital deaths, despite having community supports in place. Variations in outcomes can point to groups of patients who may require greater intensity of supports postdischarge.

Origine : PubMed

The (un)availability of prognostic information in the last days of life - a prospective observational study

WHITE, Nicola ; REID, Fiona ; HARRIES, Priscilla ; HARRIS, Adam J. L. ; MINTON, Ollie ; MCGOWAN, Catherine ; LODGE, Philip ; TOOKMAN, Adrian J. ; STONE, Patrick
BMJ Open, 09/07/2019, vol.9, n°7, p. 1-7

Document en ligne

Thème : Soins. Cote : eD02.03.00

PRONOSTIC ; ETUDE LONGITUDINALE ; UNITE SOINS PALLIATIFS ; ROYAUME UNI ; ETAPE MOURIR

Objectives The aims of this study were (1) to document the clinical condition of patients considered to be in the last 2 weeks of life and (2) to compare patients who did or did not survive for 72 hours.
Design A prospective observational study.
Setting Two sites in London, UK (a hospice and a hospital palliative care team).
Participants Any inpatient, over 18 years old, English speaking, who was identified by the palliative care team as at risk of dying within the next 2 weeks was eligible.
Outcome measures Prognostic signs and symptoms were documented at a one off assessment and patients were followed up 7 days later to determine whether or not they had died.
Results Fifty participants were recruited and 24/50 (48%) died within 72 hours of assessment. The most prevalent prognostic features observed were a decrease in oral food intake (60%) and a rapid decline of the participant’s global health status (56%). Participants who died within 72 hours had a lower level of consciousness and had more care needs than those who lived longer. A large portion of data was unavailable, particularly that relating to the psychological and spiritual well-being of the patient, due to the decreased consciousness of the patient.
Conclusions The prevalence of prognostic signs and symptoms in the final days of life has been documented between those predicted to die and those who did not. How doctors make decisions with missing information is an area for future research, in addition to understanding the best way to use the available information to make more accurate predictions.

Origine : PubMed

Prognostication in palliative care

CHU, Christina ; WHITE, Nicola ; STONE, Patrick
Clinical medicine, 07/2019, vol.19, n°4, p. 306-310

Document en ligne

Thème : Ethique et déontologie. Cote : eD13.02

PRONOSTIC ; DEMARCHE PALLIATIVE ; DECISION MEDICALE ; COMMUNICATION ; RELATION MEDECIN FAMILLE ; RELATION MEDECIN PATIENT

An accurate prognosis about how long a terminally ill patient has left to live, when disclosed sensitively in open discussions, can facilitate patient-centred care and shared decision making. In addition, several guidelines, policies and funding streams rely, to some extent, on a clinician estimated prognosis. However, clinician predictions alone have been shown to be unreliable and over-optimistic. The factors underlying clinicians' prognostic decisions (particularly at the very end of life) are beginning to be elucidated. As an alternative to clinicians' subjective estimates, a number of prognostic algorithms and scores have been developed and validated, but only a few have consistently shown superiority to clinician predictions. Therefore, an element of uncertainty remains and this needs to be acknowledged when having conversations with patients and their families. Guidelines are available to advise clinicians about how to prepare for, participate in and record prognostic conversations.

Origine : PubMed

Palliation of malignant ascites

HODGE, Caitlin ; BADGWELL, Brian D.
Journal of surgical oncology, 07/2019, vol.120, n°1, p. 67-73

Document en ligne

Thème : Médecine.

DEMARCHE PALLIATIVE ; QUALITE VIE ; CANCER ; PRONOSTIC ; ASCITE ; CHIMIOTHERAPIE

Malignant ascites (MA) carries a poor prognosis. It can have a significant impact on quality of life (QOL), with increasing abdominal distention, pain, and dyspnea. Diuretics typically do not work well for MA. Paracentesis is effective in providing temporary symptom relief but requires frequent repeat procedures. Options for durable symptom management include indwelling catheters, peritoneal ports, peritoneovenous shunts, intraperitoneal (i.p.) catumaxomab, and hyperthermic i.p. chemotherapy. These interventions do not necessarily improve overall survival but may improve QOL.

Origine : PubMed

Concurrent palliative care in the surgical management of head and neck cancer

MCCAMMON, Susan D.
Journal of surgical oncology, 07/2019, vol.120, n°1, p. 78-84

Document en ligne

Thème : Médecine.

DEMARCHE PALLIATIVE ; QUALITE VIE ; SUICIDE ; SOINS SUPPORT ; PRISE DECISION ; EMOTION ; PRONOSTIC ; TRAJECTOIRE MALADIE ; CANCER ; TETE ; COU ; CHIRURGIE

Head and neck cancer affects vital functions of speech, swallowing, breathing, and appearance. Overall survival remains poor and symptom burden is high for both patients with incurable disease at the end of life and for long-term survivors. Early and concurrent palliative care helps guide treatment decision making and support quality of life during and after treatment. Both narrative competence and directive counsel can affect the concordance of patient goals and tolerance of treatment and outcomes.

Origine : PubMed

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

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

Document en ligne

Thème : Médecine.

DEMARCHE PALLIATIVE ; COMMUNICATION ; CANCER ; ADULTE ; ENQUETE ; QUESTIONNAIRE ; MEDECIN ; PRONOSTIC ; CONSULTATION ; PLANIFICATION ; EDUCATION PATIENT ; INFORMATION MALADE

In spite of a referral letter as an important document for communicating between physicians, whether it could also be useful as a source of information for patients has not yet established. We included cancer patients in palliative care setting, all of whom completed a standardized questionnaire regarding their opinion concerning the utility of a referral letter as a source of information and its requirements to achieve a better understanding. Completed questionnaires were received from 50 cancer patients. Ninety-four percent of participants agreed that a referral letter could be of great importance for procuring medical information to them. There was only minor divergence among the participants respecting age, gender, or education. Particular requirements were diagnosis, treatment plan, prognosis, list of drugs, and contact data of involved physicians. Additional important topics were laboratory values, alternatives to current therapy, side effects and supportive therapy, and advices regarding lifestyle and naturopathy. The majority of patients also concluded to accept technical terms in doctor's letters if a glossary supported their comprehension. The majority of patients prefer a concise description of medical information in a referral letter. This form of a letter would boost patients' involvement and help them transfer medical information to other therapists or relatives.

Origine : PubMed

Accurate prognostic awareness and preference states influence the concordance between terminally ill cancer patients' states of preferred and received life-sustaining treatments in the last 6 months of life

WEN, Fur-Hsing ; CHEN, Jen-Shi ; CHANG, Wen-Cheng ; CHOU, Wen-Chi ; HSIEH, Chia-Hsun ; TANG, Siew Tzuh
PALLIATIVE MEDICINE, 12/06/2019, Pagination inconnue

Document en ligne

Thème : Soins.

FACTEUR ; PREFERENCE ; CANCER ; PATIENT ; ETUDE LONGITUDINALE ; TAIWAN ; PRONOSTIC ; FIN VIE

BACKGROUND: Factors facilitating/hindering concordance between preferred and received life-sustaining treatments may be distorted if preferences and predictors are measured long before death.
AIM: To examine factors facilitating/hindering concordance between cancer patients' preferred and received life-sustaining-treatment states in their last 6 months.
DESIGN: Longitudinal, observational design.
SETTING/PARTICIPANTS: States of preferred and received life-sustaining treatments (cardio-pulmonary resuscitation, intensive care unit care, cardiac massage, intubation with mechanical ventilation, intravenous nutritional support, and nasogastric tube feeding) were examined in 218 Taiwanese cancer patients by a latent transition model with hidden Markov modeling. Multivariate logistic regression modeling was used to examine factors facilitating/hindering concordance between preferred and received life-sustaining-treatment states.
RESULTS: Concordance between preferred and received life-sustaining-treatment states was poor (40.8%, kappa value (95% confidence interval): 0.05 [-0.03, 0.14]). Patients who accurately understood their prognosis and preferred comfort care were significantly more likely to receive preferred life-sustaining treatments before death than those who did not know their prognosis but wanted to know, those who were uniformly uncertain about what life-sustaining treatments they preferred to receive, and those who preferred nutritional support but declined other life-sustaining treatments. Patient age, physician-patient end-of-life-care discussions, symptom distress, and functional dependence were not associated with concordance between preferred and received life-sustaining-treatment states.
CONCLUSION: Prognostic awareness and preferred states of life-sustaining treatments were significantly associated with concordance between preferred and received life-sustaining-treatment states. Personalized interventions should be developed to cultivate terminally ill cancer patients' accurate prognostic awareness, allowing them to formulate realistic life-sustaining-treatment preferences and facilitating their receiving value-concordant end-of-life care.

Origine : PubMed

C-reactive protein/albumin ratio is an independent prognostic predictor of survival in advanced cancer patients receiving palliative care

ZHANG, Jing ; ZHANG, Chenbo ; LI, Qingxian ; ZHANG, Jiawen ; GU, Xiaoli ; ZHAO, Weiwei ; CHEN, Menglei ; LIU, Minghui ; ZHANG, Zhe ; LIAO, Xinghe ; CHENG, Wenwu
JOURNAL OF PALLIATIVE MEDICINE, 12/06/2019, Pagination inconnue

Document en ligne

Thème : Recherche - Evaluation - Méthodologie.

PRONOSTIC ; OUTIL ; ESPERANCE VIE ; CANCER ; DEMARCHE PALLIATIVE ; CHINE ; ETUDE COHORTE

Background: The C-reactive protein/albumin (CRP/Alb) ratio has been reported as a prognostic factor of survival for patients with a variety of cancers. However, its prognostic impact for advanced cancer patients receiving palliative care remains presently unknown.
Objective: The present study assessed the prognostic value of the CRP/Alb ratio, and compared this with that of the Glasgow Prognostic Score (GPS) and Palliative Prognostic Index (PPI) in a cohort of advanced cancer patients receiving palliative therapy.
Methods: The medical records of 262 eligible patients who died of advanced cancer from February 1, 2013 to December 30, 2017 in the palliative care unit of the Fudan University Shanghai Cancer Center were retrospectively reviewed for the analysis.
Results: The present results revealed that a CRP/Alb ratio =1.31 (hazard ratio [HR], 2.33 [1.78–3.05], p < 0.001) can predict poor prognosis through univariate analysis. In addition, the multivariate analysis revealed that CRP/Alb (HR, 2.09 [1.54–2.84], p < 0.001), GPS (HR, 1.81 [1.07–3.07], p < 0.001), and PPI (HR, 3.35 [2.25–4.99], p < 0.001) were all independent prognosis factors. To compare the discriminatory performance of the CRP/Alb ratio with that of other established prognostic indexes in palliative care settings, the c-statistics, integrated discriminatory improvement index, net reclassification index, and receiver operating characteristic curves were generated, and it was demonstrated that the CRP/Alb ratio (c-statistics, 0.64 [0.61–0.68]) was able to discriminate advanced cancer patients with different survivals, with analogous discriminatory ability as GPS (c-statistics, 0.63 [0.59–0.66]) and PPI (c-statistics, 0.64 [0.60–0.68]). Notably, the combination of multiple prognostic indexes exerted higher discriminatory ability, compared with any single predictive index (c-statistics, 0.69 [0.66–0.73], p < 0.001).
Conclusions: The present study suggests that the CRP/Alb ratio is a promising prognostic factor in predicting cancer patient survival in palliative care settings. Incorporating both objective parameters and the subjective index may improve the prediction accuracy of prognosis.

Origine : PubMed

A multicenter study of the causes and consequences of optimistic expectations about prognosis by surrogate decision-makers in ICUs

WHITE, Douglas B. ; CARSON, Shannon ; ANDERSON, Wendy ; STEINGRUB, Jay ; BIRD, Garrett ; CURTIS, J. Randall ; MATTHAY, Michael ; PETERSON, Michael ; BUDDADHUMARUK, Praewpannarai ; SHIELDS, Anne-Marie ; ERNECOFF, Natalie ; SHOTSBERGER, Kaitlin ; WEISSFELD, Lisa ; CHANG, Chung-Chou H. ; PIKE, Francis ; LO, Bernard ; HOUGH, Catherine L.
Critical care medicine, 31/05/2019, Pagination inconnue

Document en ligne

Thème : Soins.

ATTITUDE ; FAMILLE ; SOIN INTENSIF ; PRONOSTIC ; FIN VIE ; SOUTIEN

Objectives: Optimistic expectations about prognosis by surrogate decision-makers in ICUs are common, but there are few data about the causes and clinical consequences. Our objective was to determine the causes of optimistic expectations about prognosis among surrogates and whether it is associated with more use of life support at the end of life.
Design: Prospective, multicenter cohort study from 2009 to 2012.
Setting: Twelve ICUs from multiple regions of the United States.
Subjects: The surrogates and physicians of 275 incapacitated ICU patients at high risk of death.
Interventions: None.
Measurements and Main Results: Surrogates and physicians completed a validated instrument assessing their prognostic expectations for hospital survival. We determined the proportion of surrogates with optimistic expectations, defined as a prognostic estimate that was at least 20% more optimistic than the physician’s, then determined how frequently this arose from surrogates miscomprehending the physicians’ prognosis versus holding more hopeful beliefs compared with the physician. We used multivariable regression to examine whether optimistic expectations were associated with length of stay, stratified by survival status, and time to withdrawal of life support among nonsurvivors. Overall, 45% of surrogates (95% CI, 38–51%) held optimistic expectations about prognosis, which arose from a combination of misunderstanding the physician’s prognostic expectations and from holding more hopeful beliefs compared with the physician. Optimistic expectations by surrogates were associated with significantly longer duration of ICU treatment among nonsurvivors before death (ß coefficient = 0.44; 95% CI, 0.05–0.83; p = 0.027), corresponding to a 56% longer ICU stay. This difference was associated with a significantly longer time to withdrawal of life support among dying patients whose surrogates had optimistic prognostic expectations compared with those who did not (ß coefficient = 0.61; 95% CI, 0.16–1.07; p = 0.009).
Conclusions: The prevalent optimism about prognosis among surrogates in ICUs arises both from surrogates’ miscomprehension of physicians’ prognostications and from surrogates holding more hopeful beliefs. This optimism is associated with longer duration of life support at the end of life.

Origine : PubMed

TRIPODORO, Vilma A. ; LLANOS, Victoria ; DE LELLIS, Silvina ; SALAZAR GÜEMES, Cecilia ; DE SIMONE, Gabriel G. ; GÓMEZ-BATISTE, Xavier
Medicina, 2019, vol.79, n°2, p. 95-103

Document en ligne

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

PRONOSTIC ; CANCER ; BESOIN FONDAMENTAL ; DEMARCHE PALLIATIVE ; OUTIL ; ARGENTINE

The early identification of patients with palliative needs has shown benefits in terms of quality of life and treatment goals. No prospective methods have been applied in Argentina to identify palliative needs in cancer patients. The NECPAL tool combines the physician's own insight with objective indicators of disease progression and indicators of chronic advanced conditions. The aim of this study was to identify prognostic factors of mortality in hospitalized and ambulatory patients with cancer and palliative needs according to the NECPAL tool in a University Hospital in Buenos Aires city. Study variables were obtained by interviews with 10 physicians in charge of 317 patients with cancer over a 2-year follow-up period. A total of 183 patients with palliative needs were labelled as NECPAL+. Of these, 137 died after a median 4-month follow-up period. The death rate was 11% patients/month. The mortality was higher in inpatients during the first month (p < 0.003). In the multivariate model, the best predictors of mortality combining relevant indicators were: inpatients (HR 1.87; 95% CI 1.24-2.84; p = 0.003), initial diagnosis other than breast cancer (HR 2.04; 95% CI 1.23-3.40; p = 0.006), metastatic disease (HR 1.67; 95% CI 1.15-2.42; p = 0.007), functional deterioration (HR 1.95; 95% CI 1.28-2.97; p = 0.002), and malnutrition (HR 1.53; 95% CI 1.04-2.23; p = 0.02 9). The major breakthrough was the systematic prospective identification of palliative needs in cancer patients for the first time in Argentina. The NECPAL tool can improve the prediction of mortality in hospital settings.

Origine : PubMed

Imminent death - clinician certainty and accuracy of prognostic predictions

WHITE, Nicola ; REID, Fiona ; VICKERSTAFF, Victoria ; HARRIES, Priscilla ; TOMLINSON, Christopher ; STONE, Patrick
BMJ supportive and palliative care, 10/05/2019, p. 1-7

Document en ligne

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

ETAPE MOURIR ; ETUDE LONGITUDINALE ; ETUDE COHORTE ; ROYAUME UNI ; PRONOSTIC ; OUTIL

OBJECTIVES: To determine the accuracy of predictions of dying at different cut-off thresholds and to acknowledge the extent of clinical uncertainty.
DESIGN: Secondary analysis of data from a prospective cohort study.
SETTING: An online prognostic test, accessible by eligible participants across the UK.
PARTICIPANTS: Eligible participants were members of the Association of Palliative Medicine. 99/166 completed the test (60%), resulting in 1980 estimates (99 participants × 20 summaries).
MAIN OUTCOME MEASURES: The probability of death occurring within 72 hours (0% certain survival-100% certain death) for 20 patient summaries. The estimates were analysed using five different thresholds: 50/50%, 40/60%, 30/70%, 20/80% and 10/90%, with percentage values between these extremes being regarded as 'indeterminate'. The positive predictive value (PPV), negative predictive value (NPV) and the number of indeterminate cases were calculated for each cut-off.
RESULTS: Using a <50% versus >50% threshold produced a PPV of 62%, an NPV of 74% and 5% indeterminate cases. When the threshold was changed to =10% vs =90%, the PPV and NPV increased to 75% and 88%, respectively, at the expense of an increase of indeterminate cases up to 62%.
CONCLUSION: When doctors assign a very high (=90%) or very low (=10%) probability of imminent death, their prognostic accuracy is improved; however, this increases the number of ‘indeterminate’ cases. This suggests that clinical predictions may continue to have a role for routine prognostication but that other approaches (such as the use of prognostic scores) may be required for those cases where doctors’ estimates are indeterminate.

Origine : PubMed

How clinician–family interactions potentially impact clinicians’ conceptualization and discussions regarding prognostic uncertainties

PEOPLES, Hayley A. ; BOONE, Blair ; BLUMENTHAL-BARBY, Jennifer S. ; BRUCE, Courtenay R.
JOURNAL OF PALLIATIVE CARE, 30/04/2019, Pagination inconnue

Document en ligne

Thème : Soins.

MEDECIN ; PRONOSTIC ; FACTEUR ; COMMUNICATION ; RELATION MEDECIN FAMILLE ; RECHERCHE QUALITATIVE ; ETATS-UNIS ; ETHIQUE MEDICALE ; ETHIQUE SOIN

Objectives: Little is known about how clinicians perceive prognostic uncertainty. Our study objective was to identify factors that influence how prognostic uncertainty is viewed by physicians, as it relates to their communications with families.
Design: Thirty semi-structured interviews with qualitative content analysis (9 surgeons, 16 intensivists, 3 nurse practitioners, and 2 ?other? clinicians). We analyzed interviews using qualitative description with constant comparative techniques.
Setting: Open medical, surgical, neurosurgical, and cardiovascular intensive care units (ICUs) in a 900-bed academic, tertiary Houston hospital.
Interventions: NoneMain
Results: We identified 2 main factors that influence how clinicians perceive prognostic uncertainty and their perceptions about whether and why they communicate prognostic uncertainties to families: (1) Communicating Uncertainty to "Soften the Blow"; and (2) Communicating Uncertainty in Response to Clinicians' Interpretations of Surrogate Decision Makers' Perceptions of Prognostic Uncertainty. We also identified several subthemes.
Conclusions: Clinician'family interactions influence how clinicians perceive prognostic uncertainty in their communications with patients or families. We discuss ethical and clinical implications of our findings.

Origine : SAGE Journals

(1) 2 3 4 ... 16 > »

Confirmer la suppression du commentaire

Actions

Voir la sélection

Déplier les références

Replier les références

Envoyer par Mail

Imprimer la sélection

Imprimer les premières

Sauvegarder les premières

Envoyer les premières par mail

Affiner votre recherche

CANCER COMMUNICATION DEMARCHE PALLIATIVE ESPERANCE VIE ETUDE LONGITUDINALE ETUDE RETROSPECTIVE EVALUATION FIN VIE MEDECIN OUTIL PATIENT PHASE TERMINALE PRONOSTIC RELATION MEDECIN PATIENT SOIN

Type de document

Article

275

Brochure

Contribution congrès

Extrait ouvrage

Mémoire ou Thèse

Monographie

N special periodique

Vidéo