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PubMedDate not supplied

The palliative use of high-dose corticosteroids in three terminally ill patients with pain.

Corticosteroids are valuable pharmacological adjuncts utilized in the management of the diverse symptoms observed in terminally ill patients, including bone, neuropathic, and hepatic pain, asthenia and fatigue, and anorexia, and serve as an adjunct for the treatment of nausea and vomiting. If relief of suffering is the goal and mandate of palliative care, high-dose corticosteroids should be utilized in terminally ill patients for quickly reducing pain and improving quality of life for both patients and family members. In patients with a limited life expectancy of days to several weeks, long-term side effects will not occur and therefore should not preclude the continuous use of corticosteroids until the patient's death. Three case studies are presented.

Adult↗
PubMed1999

Informal care and terminal illness.

This paper is based on a study of the care and services received by people in the year before death in one Yorkshire health authority. In the spring of 1997 in-depth interviews were carried out with bereaved relatives and carers of a weighted sample of 33 people who had died in one Yorkshire health authority in the previous 18 months. Deaths where people were judged to have needed no input from palliative care services were excluded. The sample covers a range of different caring arrangements, experiences of caring for someone who is dying, support from formal services, place and manner of death. All those interviewed were providing some form of informal care or support to those who died, in some cases 24-h care. The interviews provided a valuable insight into ordinary people's experiences of death and of caring for someone who is dying. Most importantly for the purposes of this study, they gave insight into their experiences of services to support both the dying person and themselves in their caring role. The paper discusses the ways in which care of the terminally ill is distinctive. It explores the role of informal care in relation to the wider character and history of the local community, in particular the significance of its declining industrial base, and secondly, the availability of appropriate services to support those caring for the terminally ill. Finally, it makes recommendations about service planning and delivery which challenge the current framework for providing services to the terminally ill.

Journal Article↗
PubMed2005

A burden to others: a common source of distress for the terminally ill.

Recent research into the desire for death among people with terminal illness has begun to recognize the importance of "feeling oneself a burden to others" as a factor in suicidal behaviour. In this study, 69 patients with advanced cancer underwent semi-structured interviews. The sense of self-perceived burden was found to be a common experience, reported by 39.1% of participants as a minimal or mild concern and by 38% as a moderate to extreme concern. The sense of burden showed a low correlation with physical symptoms (r = 0.02-0.24) and higher correlations with psychological problems (r = 0.35-0.39) and existential issues (r = 0.45-0.49). Comparisons of participants with high or low levels of self-perceived burden showed the importance of this factor for overall quality of life. In summary, self-perceived burden is an important but underestimated dimension of social cognition in the medically ill.

Aged↗
PubMed2004

Ten years' activity of the first Italian public hospice for terminally ill patients.

We present a review of the first 10 years of the hospice at the Geriatric Institute Pio Albergo Trivulzio of Milan, Italy's first public hospice for the admission of terminally ill patients. Over 1200 patients were admitted to the nine-bed hospice between October 1991 and December 2001, most of whom (63%) were referred by the Home Palliative Care Units operating in Milan. The hospice patients are elderly (nearly 60% are 70 or more years of age, median 72 years). Admission to the hospice was until the patient's death (74% of patients) after a brief time (4 weeks on average). From the very outset, we have striven to focus our attention on the daily application of the programmes of care inspired by the philosophy and practice of palliative medicine, i.e. the holistic approach and attention devoted to quality of life, multidimensional assessment, and the services of a multiprofessional team to provide, alongside medical and nursing assistance, psychosocial and spiritual support, bereavement support, etc. The continuing education of health workers and the systematic use of a clinical audit tool specifically designed for palliative care, are the two key elements which, in our judgement, have proved to be the most fruitful in reaching the objectives described above. These 10 years of the Pio Albergo Trivulzio Hospice have made a significant contribution towards defining a concrete Italian model which can be applied to the care of the terminally ill inpatient.

Aged↗
PubMed1992

A randomized trial of the cost effectiveness of VA hospital-based home care for the terminally ill.

All admissions to a 1,100-bed Department of Veterans Affairs (VA) hospital were screened to identify 171 terminally ill patients with informal caregivers who were then randomly assigned to VA hospital-based team home care (HBHC, N = 85) or customary care (N = 86). Patient functioning, and patient and caregiver morale and satisfaction with care were measured at baseline, one month, and six months. Health services utilization was monitored over the six-month study period and converted to cost. Findings included no differences in patient survival, activities of daily living (ADL), cognitive functioning, or morale, but a significant increase in patient (p = .02) and caregiver (p = .005) satisfaction with care at one month. A substitution effect of HBHC was seen. Those in the experimental group used 5.9 fewer VA hospital days (p = .03), resulting in a $1,639 or 47 percent per capita saving in VA hospital costs (p = .02). As a result, total per capita health care costs, including HBHC, were $769 or 18 percent (n.s.) lower in the HBHC sample, indicating that expansion of VA HBHC to serve terminally ill veterans would increase satisfaction with care at no additional cost.

Activities of Daily Living↗
PubMed1993

Interpleural analgesia for the treatment of severe cancer pain in terminally ill patients.

Interpleural analgesia was used to alleviate acute, severe exacerbations of chronic pain unrelieved by pharmacologic therapy in ten terminally ill cancer patients. Pain from metastatic disease to the neck, arms, chest, brachial plexus, thorax, or abdomen was effectively eliminated between 7 hr and 40 days in nine patients, who died with minimal or no pain. The technique was performed primarily using bupivacaine. No side effects were detected. Interpleural analgesia appears to be effective in rapidly controlling acute exacerbations of cancer pain in terminally ill patients. Moreover, it may also be a suitable therapy for moribund patients when used as a continuous-infusion technique.

Adult↗
PubMed2001

Spiritual support for terminally ill patients: nursing staff assessments.

This study is part of a larger questionnaire survey concerned with the views of nursing staff on physical, emotional and spiritual support for terminally ill patients and decision making on the transition to the terminal phase of treatment. This article discusses the results concerning the spiritual support offered to terminally ill patients. The results describe the readiness and willingness of nursing staff to provide spiritual support, the expression of spiritual needs by patients, the provision of spiritual support, and problems occurring in providing this support. A total of 328 nurses working on the in-patient wards of 32 community health centres took part. Data were collected with a questionnaire including both multiple choice items and open-ended questions. The data were processed with SPSS software and the responses to the open-ended questions were interpreted using content analysis. The results revealed shortcomings in nurses' readiness and willingness to provide spiritual support and clearly highlighted the need for further training. Half of the nurses said they only rarely offered spiritual support to their patients. The nurses drew attention to problems within themselves, their patients and with the availability of the chaplain's services. The results also pointed to factors related to the health centre and nursing staff.

Adult↗
PubMed2006

Requests to forgo potentially life-prolonging treatment and to hasten death in terminally ill cancer patients: a prospective study.

This study investigates the background and evolution of requests to forgo treatment and hasten death in terminally ill cancer patients. Physicians participating in a nationwide study on end-of-life decision making were asked whether they were treating a terminally ill cancer patient whose life expectancy was longer than 1 week but no longer than 3 months and who they would continue to treat until the patient's death. Of the 120 physicians who had a patient who met the inclusion criteria, 85 (70.8%) completed a questionnaire each month until the patient's death. The questionnaire provided information on the patient's symptoms, concerns, and requests involving end-of-life decisions. Most patients suffered from cancer of the gastrointestinal tract or the respiratory system, and 66% died within 2 months of the initial interview. The prevalence of requests involving end-of-life decisions increased during the last 3 months of a patient's life. The evolution of a request was especially related to an increase in the number of severe symptoms and concerns. Requests to forgo treatment were related to general weakness, whereas loss of dignity was a major reason for requests to hasten death. Physical suffering alone appeared to lead to less drastic requests than suffering blended by concerns and psychological problems leading to requests for hastened death. The results emphasize the importance of gaining insight into the patients' suffering to provide meaningful assistance.

Adult↗
PubMed2003

Family beliefs regarding the nutritional care of a terminally ill relative: a qualitative study.

OBJECTIVE: To develop a conceptual model of family caregiver beliefs and behavior related to nutritional care of the terminally ill by examining the perspectives of family members, patients, and health care providers. DESIGN: Qualitative study using in-depth, open-ended, face to face interviews, participant observation, and content analysis. PARTICIPANTS: A total of 47 participants from 4 groups: hospitalized palliative patients with cancer (n = 13), family members of hospitalized palliative patients with cancer (n = 13), health care providers on a palliative care unit (n = 11), and bereaved family members who had previously experienced the death of a relative on a palliative care unit. OUTCOME MEASURES: Participant views on nutritional care in the terminal phases of illness. RESULTS: There is marked variability in the ways family members respond to a dying cachectic anorexic relative. The overarching theme of "doing what's best" captures this variability and integrates the major categories into the key analytic model emerging from this study. CONCLUSION: We have developed a conceptual model of family beliefs regarding the nutritional care of a hospitalized terminally ill relative. The model has implications for education, practice, and research regarding nutritional care in the palliative care setting.

Adolescent↗
PubMed1998

Management of pain in terminally ill patients: physician reports of knowledge, attitudes, and behavior.

Physician knowledge, attitudes, and reported prescribing behaviors toward pain management in terminally ill patients was surveyed among primary care physicians (PCPs) and oncologists in a southern urban county. Response rates were 64% for PCPs and 100% for oncologists. The effects of knowledge and attitudes on reported behavior were analyzed after accounting for physician demographics, training, and experiences. Oncologists' knowledge and attitudes were close to ideal and behaviors less so. PCPs' knowledge was worse than oncologists, and attitudes and behaviors were even less optimal. Reported behaviors among PCPs correlated somewhat with attitudes, less with background factors, and rarely with knowledge. In multivariate analysis, demographic and experimental factors explained more of selected behaviors than attitudes or knowledge. However, all variables combined left the majority of variation in behaviors unexplained. Physician continuing education will not effect significant behavioral changes in the care of terminally ill patients solely by the traditional approach of attempting to modify knowledge and attitudes.

Health Knowledge, Attitudes, Practice↗
PubMed1992

The use of urinary catheters in terminally ill cancer patients.

Recent reports have commented on the need to improve our knowledge and management of urinary problems in terminally ill patients. We conducted a prospective study in 61 consecutive patients admitted to our palliative care unit (PCU), who were assessed for urinary problems, use of urinary catheters, and management of problems associated with the catheters. A total of 74% (45 of 61) of the patients required a catheter before death, with 23 (38%) being admitted to the PCU with a catheter, and 22 patients (36%) requiring a catheter during admission to PCU. We present our findings regarding the duration of catheter use, indications for catheters, type of catheters used, and complications of catheters. The data collected suggest that, although urinary problems and catheter use are common in terminal illness, if strict guidelines are followed there is no demonstrable mortality, and morbidity associated with catheter use is outweighed by patient benefit.

Aged↗
PubMed1996

The ethics of death-hastening or death-causing palliative analgesic administration to the terminally ill.

Double-effect reasoning is a nonconsequentialist analysis of a hard ethical case. In a hard ethical case, one can achieve some good end only if one also causes harm. Sometimes palliative analgesic administration to a terminally ill patient is a hard ethical case, for by it one relieves pain or distress while unavoidably hastening or causing the patient's death. Is it ethically in the clear to administer an analgesic to relieve pain or distress knowing that one will hasten or cause the patient's death? Using double-effect reasoning, the author argues that death-hastening or death-causing palliative analgesic administration to a terminally ill patient is sometimes ethically in the clear and, at times, even obligatory.

Analgesics, Opioid↗
PubMed1994

A decade beyond medical school: a longitudinal study of physicians' attitudes toward death and terminally-ill patients.

Physicians were surveyed soon after graduation from medical school in 1976 to determine their attitudes toward death and terminally-ill patients and their families. A follow-up survey of the 1093 respondents was made in 1986 to ascertain if changes had occurred in their attitudes. Eight of the eleven Likert-type items showed statistically significant differences over time and by attitudes toward terminally-ill patients and their families. These data present evidence to suggest that physicians in 1986 were more open in telling dying patients their prognosis than in 1976.

Adult↗
PubMed2005

Factors associated with difficulties encountered by nurses in the care of terminally ill cancer patients in hospitals in Japan.

OBJECTIVE: To identify the factors associated with difficulties encountered by nurses working in general wards in hospitals in Japan. METHODS: Questionnaires including items regarding difficulties in providing care to terminally ill cancer patients, the existence of a mentor regarding end-of-life issues, awareness of end-of-life issues, and demographic factors were administered to 375 staff nurses working in general in-patient wards. Multivariate regression analyses were employed to investigate correlations between factors. RESULTS: Multivariate regression analysis revealed that the existence of a mentor for end-of-life issues was associated with fewer difficulties in all areas other than "Knowledge and skill of nurses." Clinical experience was inversely related to difficulties in "Communication with patients and families" and "Personal issues." Greater awareness of end-of-life issues was related to higher difficulties in most areas. SIGNIFICANCE OF RESULTS: The existence of a mentor was correlated with fewer difficulties in most areas. Support by a palliative care team might be effective in reducing difficulties experienced by nurses and in improving care for terminally ill cancer patients. Basic communication training undertaken sooner after registration might be also useful.

Adult↗
PubMed1993

The family in hospital-based home care with special reference to terminally ill cancer patients.

Eighty-seven next of kin, 80 spouses and seven adult children, were the primary caregivers of terminally ill patients (87% cancer patients) cared for at the hospital-based home care (HBHC) unit of Motala Hospital during 1989-1990. All of the patients died in their homes. Next of kin were asked to complete self-questionnaires and to give written comments on their experiences and their perception of how the patient had felt about 13 aspects of home care provided by the HBHC staff. The response rate was 94%. In nine out of 13 areas, such as adequate information at the time of referral about the HBHC, security, support, immediate extra help when needed, high quality of nursing, and care and pain control, 86%-97% of next of kin were very satisfied (7-9 on a 9-point scale); whereas information provided about the disease, economic support, and support given after death were very satisfactory according to 72%, 58%, and 80% of relatives, respectively. Gender and time from diagnosis to death did not seem to affect responses. Next of kin of cancer patients were generally more satisfied than next of kin of other terminally ill patients. A total time of care of more than 60 days (median time) was associated with significantly more positive responses. Older spouses were significantly more satisfied with the HBHC than younger ones; despite this, 99% of all next of kin would choose HBHC again in a similar situation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2006

Predicted survival vs. actual survival in terminally ill noncancer patients in Dutch nursing homes.

Studies on the prediction of survival have mainly focused on hospital and hospice patients suffering from cancer. The aim of this study was to describe the predicted vs. the actual survival in terminally ill, mainly noncancer patients in Dutch nursing homes (NHs). A prospective cohort study was conducted in 16 NHs representative for The Netherlands. A total of 515 NH patients with a maximum life expectancy of 6 weeks, as assessed by an NH physician, were included. NH physicians were accurate in more than 90% of their prognoses for terminally ill--mainly noncancer--NH patients, when death occurred within 7 days. For a longer period of time, their predictions became inaccurate. In the category of patients who were expected to die within 8-21 days, predictions were accurate in 16.0%, and in the category of patients expected to die within 22-42 days, this was 13.0%. Predictions in these categories were mainly optimistic (patient died earlier) in 68.6% and 52.2%, respectively. The findings of this study suggest that accurate prediction of survival of (mainly) noncancer patients in NHs is only possible when death is imminent and seems to be dependent on an intimate knowledge of patients. Prognostication over a longer period of time tends to be less accurate, and, therefore, continues to be a challenging task for NH physicians.

Aged↗
PubMed1978

Caring for the terminally ill: one hospital's self-assessment and solutions.

Mount Sinai Hospital in Toronto established a committee for the total care of the terminally ill in order to evaluate the care currently being provided for such patients. Information was collected mostly by questionnaire; and subsequent programs, such as a consultation team to assist all hospital staff dealing with terminally ill patients, are being implemented.

Attitude to Death↗
PubMed1995

How can relations be improved between the family and the support team during the care of terminally ill patients?

The family and patient are a unit of treatment. The support team should try to develop good communication with the family to be able to offer help respectfully and tactfully throughout the different phases of the terminal illness. We review: (a) the influence of the terminal illness on the family, and (b) the important factors in the intervention of the support team and their relationship with the family.

Female↗