End of life care and the approach of death.
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51 to 75 of 969Phelps AC, Maciejewski PK, Nilsson M, Balboni TA, Wright AA, Paulk ME, Trice E, Schrag D, Peteet JR, Block SD, Prigerson HG (2009)cohort or longitudinalMEDLINE-indexed journal, not yet read by usJAMA265 citations Religious coping and use of intensive life-prolonging care near death in patients with advanced cancer.
Context: Patients frequently rely on religious faith to cope with cancer, but little is known about the associations between religious coping and the use of intensive life-prolonging care at the end of life.
Objective: To determine the way religious coping relates to the use of intensive life-prolonging end-of-life care among patients with advanced cancer.
Design, setting, and participants: A US multisite, prospective, longitudinal cohort of 345 patients with advanced cancer, who were enrolled between January 1, 2003, and August 31, 2007. The Brief RCOPE assessed positive religious coping. Baseline interviews assessed psychosocial and religious/spiritual measures, advance care planning, and end-of-life treatment preferences. Patients were followed up until death, a median of 122 days after baseline assessment.
Main outcome measures: Intensive life-prolonging care, defined as receipt of m…
matched on Terminal Care (mesh), Attitude to Death (mesh), Advance Care Planning (mesh), end of life (text), terminal illness (text)
The impact of advance care planning on end of life care in elderly patients: randomised controlled trial.
Objective: To investigate the impact of advance care planning on end of life care in elderly patients.
Design: Prospective randomised controlled trial.
Setting: Single centre study in a university hospital in Melbourne, Australia.
Participants: 309 legally competent medical inpatients aged 80 or more and followed for six months or until death.
Interventions: Participants were randomised to receive usual care or usual care plus facilitated advance care planning. Advance care planning aimed to assist patients to reflect on their goals, values, and beliefs; to consider future medical treatment preferences; to appoint a surrogate; and to document their wishes.
Main outcome measures: The primary outcome was whether a patient's end of life wishes were known and respected. Other outcomes included patient and family satisfaction with hospital stay and levels of stress, anxiety, and depression in…
matched on Terminal Care (mesh), Advance Care Planning (mesh), Terminally Ill (mesh), end of life (text)
Bajwah S, Oluyase AO, Yi D, Gao W, Evans CJ, Grande G, Todd C, Costantini M, Murtagh FE, Higginson IJ (2020)meta-analysisMEDLINE-indexed journal, not yet read by usThe Cochrane database of systematic reviews138 citations The effectiveness and cost-effectiveness of hospital-based specialist palliative care for adults with advanced illness and their caregivers.
Background: Serious illness is often characterised by physical/psychological problems, family support needs, and high healthcare resource use. Hospital-based specialist palliative care (HSPC) has developed to assist in better meeting the needs of patients and their families and potentially reducing hospital care expenditure. There is a need for clarity on the effectiveness and optimal models of HSPC, given that most people still die in hospital and also to allocate scarce resources judiciously.
Objectives: To assess the effectiveness and cost-effectiveness of HSPC compared to usual care for adults with advanced illness (hereafter patients) and their unpaid caregivers/families.
Search methods: We searched CENTRAL, CDSR, DARE and HTA database via the Cochrane Library; MEDLINE; Embase; CINAHL; PsycINFO; CareSearch; National Health Service Economic Evaluation Database (NHS EED) and two trial…
matched on Palliative Care (mesh), Terminal Care (mesh)
Interventions for improving palliative care for older people living in nursing care homes.
Background: Residents of nursing care homes for older people are highly likely to die there, making these places where palliative care is needed.
Objectives: The primary objective was to determine effectiveness of multi-component palliative care service delivery interventions for residents of care homes for older people. The secondary objective was to describe the range and quality of outcome measures.
Search strategy: The grey literature and the following electronic databases were searched: Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effectiveness (all issue 1, 2010); MEDLINE, EMBASE, CINAHL, British Nursing Index, (1806 to February 2010), Science Citation Index Expanded & AMED (all to February 2010). Key journals were hand searched and a PubMed related articles link search was conducted on the final list o…
matched on Hospice Care (mesh), Palliative Care (mesh)
Hoerger M, Greer JA, Jackson VA, Park ER, Pirl WF, El-Jawahri A, Gallagher ER, Hagan T, Jacobsen J, Perry LM, Temel JS (2018)cohort or longitudinalMEDLINE-indexed journal, not yet read by usJournal of clinical oncology : official journal of the American Society of Clinical Oncology177 citations Defining the Elements of Early Palliative Care That Are Associated With Patient-Reported Outcomes and the Delivery of End-of-Life Care.
Purpose We describe the key elements of early palliative care (PC) across the illness trajectory and examine whether visit content was associated with patient-reported outcomes and end-of-life care. Methods We performed a secondary analysis of patients with newly diagnosed advanced lung or noncolorectal GI cancer (N = 171) who were randomly assigned to receive early PC. Participants attended at least monthly visits with board-certified PC physicians and advanced practice nurses at Massachusetts General Hospital. PC clinicians completed surveys documenting visit content after each encounter. Patients reported quality of life (Functional Assessment of Cancer Therapy-General) and mood (Hospital Anxiety and Depression Scale and Patient Health Questionnaire-9) at baseline and 24 weeks. End-of-life care data were abstracted from the electronic health record. We summarized visit content over ti…
matched on Palliative Care (mesh), Terminal Care (mesh), Advance Care Planning (mesh), end of life (text)
Family Perspectives on Aggressive Cancer Care Near the End of Life.
Importance: Patients with advanced-stage cancer are receiving increasingly aggressive medical care near death, despite growing concerns that this reflects poor-quality care.
Objective: To assess the association of aggressive end-of-life care with bereaved family members' perceptions of the quality of end-of-life care and patients' goal attainment.
Design, setting, and participants: Interviews with 1146 family members of Medicare patients with advanced-stage lung or colorectal cancer in the Cancer Care Outcomes Research and Surveillance study (a multiregional, prospective, observational study) who died by the end of 2011 (median, 144.5 days after death; interquartile range, 85.0-551.0 days).
Exposures: Claims-based quality measures of aggressive end-of-life care (ie, intensive care unit [ICU] admission or repeated hospitalizations or emergency department visits during the last month of li…
matched on Hospice Care (mesh), Terminal Care (mesh), Terminally Ill (mesh), end of life (text)
Improved quality of life at end of life related to home-based palliative care in children with cancer.
Background: Nearly 2000 children die due to a malignancy in the United States annually. Emerging data suggest that home is the desired location of care for children with cancer at end of life. However, one obstacle to enrollment in a pediatric palliative care (PPC) home care program may be fear that distressing symptoms at end of life cannot be adequately managed outside the hospital.
Objective: To compare the symptom distress and quality-of-life experience for children who received concurrent end-of-life care from a PPC home care program (PPC/Oncology) with that of those who died without exposure to the PPC program (Oncology).
Methods: We conducted a retrospective survey study of a cohort of bereaved parents of children who died of cancer between 2002 and 2008 at a U.S. tertiary pediatric institution.
Results: Sixty bereaved parents were surveyed (50% PPC/Oncology). Prevalence of consti…
matched on Palliative Care (mesh), Terminal Care (mesh), Terminally Ill (mesh), end of life (text)
Lim RB (2016)reviewMEDLINE-indexed journal, not yet read by usTherapeutic advances in respiratory disease32 citations End-of-life care in patients with advanced lung cancer.
Despite advances in the detection, pathological diagnosis and therapeutics of lung cancer, many patients still develop advanced, incurable and progressively fatal disease. As physicians, the duties to cure sometimes, relieve often and comfort always should be a constant reminder to us of the needs that must be met when caring for a patient with lung cancer. Four key areas of end-of-life care in advanced lung cancer begin with first recognizing 'when a patient is approaching the end of life'. The clinician should be able to recognize when the focus of care needs to shift from an aggressive life-sustaining approach to an approach that helps prepare and support a patient and family members through a period of progressive, inevitable decline. Once the needs are recognized, the second key area is appropriate communication, where the clinician should assist patients and family members in under…
matched on Palliative Care (mesh), Terminal Care (mesh), Hospice Care (keyword), Palliative Care (keyword), end of life (text)
Overview of Systematic Reviews of Advance Care Planning: Summary of Evidence and Global Lessons.
Background: Advance care planning (ACP) involves important decision making about future medical needs. The high-volume and disparate nature of ACP research makes it difficult to grasp the evidence and derive clear policy lessons for policymakers and clinicians.
Aim: The aim of this study was to synthesize ACP research evidence and identify relevant contextual elements, program features, implementation principles, and impacted outcomes to inform policy and practice.
Design: An overview of systematic reviews using the Cochrane Handbook of Systematic Reviews of Interventions was performed. Study quality was assessed using a modified version of the AMSTAR (A MeaSurement Tool to Assess Reviews) tool.
Data sources: MEDLINE, EBM Reviews, Cochrane Reviews, CINAHL, Global Health, PsycINFO, and EMBASE were searched for ACP-related research from inception of each database to April 2017. Searches we…
matched on Palliative Care (mesh), Terminal Care (mesh), Palliative Care (keyword), Advance Care Planning (mesh), end of life (text)
Treatment preferences and advance care planning at end of life: the role of ethnicity and spiritual coping in cancer patients.
Background: Although studies have reported ethnic differences in approaches to end of life, the role of spiritual beliefs is less well understood.
Purpose: This study investigated differences between African American and White patients with cancer in their use of spirituality to cope with their cancer and examined the role of spiritual coping in preferences at end-of-life.
Methods: The authors analyzed data from interviews with 68 African American and White patients with an advanced stage of lung or colon cancer between December 1999 and June 2001.
Results: Similar high percentages of African American and White patients reported being "moderately to very spiritual" and "moderately to very religious." African American patients were more likely to report using spirituality to cope with their cancer as compared to their White counterparts (p = .002). Patients who reported belief in divine i…
matched on Terminal Care (mesh), Attitude to Death (mesh), Advance Care Planning (mesh), end of life (text)
Effect of dignity therapy on distress and end-of-life experience in terminally ill patients: a randomised controlled trial.
Background: Dignity therapy is a unique, individualised, short-term psychotherapy that was developed for patients (and their families) living with life-threatening or life-limiting illness. We investigated whether dignity therapy could mitigate distress or bolster the experience in patients nearing the end of their lives.
Methods: Patients (aged ≥18 years) with a terminal prognosis (life expectancy ≤6 months) who were receiving palliative care in a hospital or community setting (hospice or home) in Canada, USA, and Australia were randomly assigned to dignity therapy, client-centred care, or standard palliative care in a 1:1:1 ratio. Randomisation was by use of a computer-generated table of random numbers in blocks of 30. Allocation concealment was by use of opaque sealed envelopes. The primary outcomes--reductions in various dimensions of distress before and after completion of the study…
matched on Palliative Care (mesh), Terminally Ill (mesh), end of life (text), terminal illness (text)
A palliative care intervention in forgiveness therapy for elderly terminally ill cancer patients.
Palliative care is now considered an essential part of end-of-life care, yet little research examines the efficacy of interventions addressing the psychological treatment of dying patients. Forgiveness therapy has been shown to be effective in improving psychological well-being and may provide a valuable addition to a terminal cancer patient's overall treatment plan. This study experimentally tested the effectiveness of a four-week forgiveness therapy in improving the quality of life of elderly terminally ill cancer patients. Participants (n = 20) were randomly assigned to a forgiveness therapy group or to a wait-list control group, which received forgiveness therapy in the second four-week period. All participants completed instruments measuring forgiveness, hope, quality of life, and anger at pre-test, post-test 1, and post-test 2. The forgiveness therapy group showed greater improveme…
matched on Palliative Care (mesh), Terminally Ill (mesh), end of life (text), terminal illness (text)
Kesecioglu J, Rusinova K, Alampi D, Arabi YM, Benbenishty J, Benoit D, Boulanger C, Cecconi M, Cox C, van Dam M, van Dijk D, Downar J, Efstathiou N, Endacott R, Galazzi A, van Gelder F, Gerritsen RT, Girbes A, Hawyrluck L, Herridge M, Hudec J, Kentish-Barnes N, Kerckhoffs M, Latour JM, Malaska J, Marra A, Meddick-Dyson S, Mentzelopoulos S, Mer M, Metaxa V, Michalsen A, Mishra R, Mistraletti G, van Mol M, Moreno R, Nelson J, Suñer AO, Pattison N, Prokopova T, Puntillo K, Puxty K, Qahtani SA, Radbruch L, Rodriguez-Ruiz E, Sabar R, Schaller SJ, Siddiqui S, Sprung CL, Umbrello M, Vergano M, Zambon M, Zegers M, Darmon M, Azoulay E (2024)guidelineMEDLINE-indexed journal, not yet read by usIntensive care medicine85 citations European Society of Intensive Care Medicine guidelines on end of life and palliative care in the intensive care unit.
The European Society of Intensive Care Medicine (ESICM) has developed evidence-based recommendations and expert opinions about end-of-life (EoL) and palliative care for critically ill adults to optimize patient-centered care, improving outcomes of relatives, and supporting intensive care unit (ICU) staff in delivering compassionate and effective EoL and palliative care. An international multi-disciplinary panel of clinical experts, a methodologist, and representatives of patients and families examined key domains, including variability across countries, decision-making, palliative-care integration, communication, family-centered care, and conflict management. Eight evidence-based recommendations (6 of low level of evidence and 2 of high level of evidence) and 19 expert opinions were presented. EoL legislation and the importance of respecting the autonomy and preferences of patients were …
matched on Palliative Care (mesh), Terminal Care (mesh), Palliative Care (keyword), end of life (text)
How nurses cope with patient death: A systematic review and qualitative meta-synthesis.
Aims and objectives: To review literature on nurses' coping strategies with patient death.
Background: Dealing with the loss of a patient was viewed as one of the most demanding and challenging encounters in clinical practice. Those nurses who are not competent in coping with patient death may be inadequate in supporting dying patients and their family members, and minimise the quality of end-of-life care. To get a broader understanding of how nurses cope with patient death and to develop meaningful and effective interventions, a systematic review which would help underpin the multidimensional approaches is needed.
Design: A systematic review.
Methods: Exhaustive searching in ten databases: CINAHL Plus, EMBASE, MEDLINE, AMED, PsycINFO, ProQuest Health & Medical Complete, ProQuest Dissertations & Theses Global, Google Scholar, EThOS and CareSearch. Meta-aggregation was used to synthesise …
matched on Terminal Care (mesh), Attitude to Death (mesh), end of life (text)
Hui D (2014)systematic reviewMEDLINE-indexed journal, not yet read by usCurrent opinion in oncology85 citations Definition of supportive care: does the semantic matter?
Purpose of review: 'Supportive care' is a commonly used term in oncology; however, no consensus definition exists. This represents a barrier to communication in both the clinical and research settings. In this review, we propose a unifying conceptual framework for supportive care and discuss the proper use of this term in the clinical and research settings.
Recent findings: A recent systematic review revealed several themes for supportive care: a focus on symptom management and improvement of quality of life, and care for patients on treatments and those with advanced stage disease. These findings are consistent with a broad definition for supportive care: 'the provision of the necessary services for those living with or affected by cancer to meet their informational, emotional, spiritual, social, or physical needs during their diagnostic, treatment, or follow-up phases encompassing issu…
matched on Palliative Care (mesh), Terminal Care (mesh)
Cancer family caregivers during the palliative, hospice, and bereavement phases: a review of the descriptive psychosocial literature.
Objective: Because caregiving to an adult with cancer is a dynamic process, a caregiver's perceived burden and psychosocial concerns may be different at different phases of the patient's disease. There is evidence of escalation in caregiver anxiety, depression, and psychological distress as the patient's functional status declines and as the patient nears death. The purpose of this review was to organize the literature in a meaningful way that can potentially capture the unique needs of caregivers to patients receiving palliative and/or hospice care, and caregivers who are in the post-death bereavement phase.
Method: A systematic review was conducted. Major databases were searched for non-intervention descriptive studies that included psychosocial variables of family caregivers to adults with cancer during the palliative, hospice, or bereavement phases.
Results: The 19 studies reviewed w…
matched on Hospice Care (mesh), Palliative Care (mesh)
Pace A, Dirven L, Koekkoek JAF, Golla H, Fleming J, Rudà R, Marosi C, Le Rhun E, Grant R, Oliver K, Oberg I, Bulbeck HJ, Rooney AG, Henriksson R, Pasman HRW, Oberndorfer S, Weller M, Taphoorn MJB, European Association of Neuro-Oncology palliative care task force (2017)guidelineMEDLINE-indexed journal, not yet read by usThe Lancet. Oncology184 citations European Association for Neuro-Oncology (EANO) guidelines for palliative care in adults with glioma.
Patients with glioma present with complex palliative care needs throughout their disease trajectory. The life-limiting nature of gliomas and the presence of specific symptoms related to neurological deterioration necessitate an appropriate and early palliative care approach. The multidisciplinary palliative care task force of the European Association of Neuro-Oncology did a systematic review of the available scientific literature to formulate the best possible evidence-based recommendations for the palliative care of adult patients with glioma, with the aim to reduce symptom burden and improve the quality of life of patients and their caregivers, particularly in the end-of-life phase. When recommendations could not be made because of the scarcity of evidence, the task force either used evidence from studies of patients with systemic cancer or formulated expert opinion. Areas of palliativ…
matched on Palliative Care (mesh), Terminal Care (mesh), Advance Care Planning (mesh), end of life (text)
Current status of accurate prognostic awareness in advanced/terminally ill cancer patients: Systematic review and meta-regression analysis.
Background: No systematic meta-analysis is available on the prevalence of cancer patients' accurate prognostic awareness and differences in accurate prognostic awareness by publication year, region, assessment method, and service received.
Aim: To examine the prevalence of advanced/terminal cancer patients' accurate prognostic awareness and differences in accurate prognostic awareness by publication year, region, assessment method, and service received.
Design: Systematic review and meta-analysis.
Methods: MEDLINE, Embase, The Cochrane Library, CINAHL, and PsycINFO were systematically searched on accurate prognostic awareness in adult patients with advanced/terminal cancer (1990-2014). Pooled prevalences were calculated for accurate prognostic awareness by a random-effects model. Differences in weighted estimates of accurate prognostic awareness were compared by meta-regression.
Results:…
matched on Terminal Care (mesh), Terminally Ill (mesh), end of life (text)
Efficacy of advance care planning: a systematic review and meta-analysis.
Objective: To systematically review the efficacy of advance care planning (ACP) interventions in different adult patient populations.
Design: Systematic review and meta-analyses.
Data sources: Medline/PubMed, Cochrane Central Register of Controlled Trials (1966 to September 2013), and reference lists.
Study selection: Randomized controlled trials that describe original data on the efficacy of ACP interventions in adult populations and were written in English.
Data extraction and synthesis: Fifty-five studies were identified. Study details were recorded using a predefined data abstraction form. Methodological quality was assessed using the PEDro scale by 2 independent reviewers. Meta-analytic techniques were conducted using a random effects model. Analyses were stratified for type of intervention: 'advance directives' and 'communication.'
Main outcomes and measures: Primary outcome measur…
matched on Terminal Care (mesh), Advance Care Planning (mesh), end of life (text)
Racial and ethnic differences in advance care planning among patients with cancer: impact of terminal illness acknowledgment, religiousness, and treatment preferences.
Purpose: Despite well-documented racial and ethnic differences in advance care planning (ACP), we know little about why these differences exist. This study tested proposed mediators of racial/ethnic differences in ACP.
Patients and methods: We studied 312 non-Hispanic white, 83 non-Hispanic black, and 73 Hispanic patients with advanced cancer in the Coping with Cancer study, a federally funded multisite prospective cohort study designed to examine racial/ethnic disparities in ACP and end-of-life care. We assessed the impact of terminal illness acknowledgment, religiousness, and treatment preferences on racial/ethnic differences in ACP.
Results: Compared with white patients, black and Hispanic patients were less likely to have an ACP (white patients, 80%; black patients, 47%; Hispanic patients, 47%) and more likely to want life-prolonging care even if he or she had only a few days left to…
matched on Terminal Care (mesh), Advance Care Planning (mesh), Terminally Ill (mesh), end of life (text), terminal illness (text)
Nurse-facilitated preparation and life completion interventions are acceptable and feasible in the Australian palliative care setting: results from a phase 2 trial.
Background: Existential/spiritual needs of advanced cancer patients are not always met in healthcare. Potential barriers for health professionals exploring existential concerns include lack of time, training, tools, and confidence. Yet patients with life-threatening illnesses require holistic care, and interest in their existential/spiritual needs is growing. Preparation and life completion interventions have shown positive results in the existential/spiritual care of hospice-eligible patients in the United States. Nurses are in the ideal position to deliver such interventions, but have not been previously evaluated in this context.
Objective: The objective of this study was to explore the acceptability and feasibility of a nurse-facilitated preparation and life completion intervention (Outlook) in an Australian palliative care patient population.
Methods: Patients discussed their life s…
matched on Palliative Care (mesh), Terminal Care (mesh), end of life (text)
The Effect of Forgiveness Psychoeducation on Death Anxiety, Caregiver Burden, and Forgiveness Tendencies in Caregivers of Patients at the End of Life: A Randomized Controlled Trial.
Background: Providing caregivers with the skills and awareness of forgiveness is crucial to help them express their emotions, navigate the grieving process more smoothly, enhance their interaction with the patient, and make the time until the patient's death more meaningful.
Objective: To examine the effect of forgiveness psychoeducation on death anxiety, caregiver burden, and forgiveness tendencies in caregivers of patients at the end of life.
Methods: A randomized controlled experimental method was used, including a pretest, posttest, 1-month follow-up, and 3-month follow-up. The research sample included 56 caregivers of patients (experimental group = 28, control group = 28) at the end of life. During the study, forgiveness psychoeducation was administered to the experimental group, whereas no intervention was carried out in the control group. Data were collected using the Personal Inf…
matched on Terminal Care (mesh), Attitude to Death (mesh), end of life (text)
Peer mentoring: a culturally sensitive approach to end-of-life planning for long-term dialysis patients.
Background: This study is designed to explore the impact of peer mentoring on end-of-life decision making.
Methods: A controlled randomized intervention study with 203 patients from 21 dialysis centers across Michigan explored the impact of peer mentors, dialysis patients trained to help other patients, on end-of-life planning.
Results: Communicating information on advance directives (ADs) through peer mentoring significantly influenced the completion of ADs overall compared with distributing standard printed material or no specific designed intervention. However, the influence was most prominent among African Americans, not only increasing actual completion of ADs (P < 0.001) and comfort discussing ADs (P < 0.01), but also improving subjective well-being (P < 0.05) and anxiety (P < 0.05) during the study period. These effects of peer mentoring did not appear among white patients, althou…
matched on Terminal Care (mesh), Attitude to Death (mesh), end of life (text)
Music therapy reduces pain in palliative care patients: a randomized controlled trial.
Context: Treatment of pain in palliative care patients is challenging. Adjunctive methods of pain management are desirable. Music therapy offers a nonpharmacologic and safe alternative.
Objectives: To determine the efficacy of a single music therapy session to reduce pain in palliative care patients.
Methods: Two hundred inpatients at University Hospitals Case Medical Center were enrolled in the study from 2009 to 2011. Patients were randomly assigned to one of two groups: standard care alone (medical and nursing care that included scheduled analgesics) or standard care with music therapy. A clinical nurse specialist administered pre- and post-tests to assess the level of pain using a numeric rating scale as the primary outcome, and the Face, Legs, Activity, Cry, Consolability Scale and the Functional Pain Scale as secondary outcomes. The intervention incorporated music therapist-guided …
matched on Palliative Care (mesh), Terminal Care (mesh)
Addressing palliative care and end-of-life issues in patients with advanced cancer: a systematic review of communication interventions for physicians not specialised in palliative care.
Objective: To identify and summarise evaluated interventions aiming to improve the communication of palliative care (PC) and end-of-life (EoL) issues in physicians caring for cancer patients. Such interventions are needed with regard to the aim of an earlier communication of those issues in oncology daily practice, which is associated with a range of benefits for patients and caregivers but is often impeded by physicians' communication insecurities.
Design: Systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
Data sources: Relevant publications were systematically searched in MEDLINE, PsycINFO, CINAHL and Web of Science databases in September 2020 with an update in July 2021.
Eligibility criteria: We included publications reporting a quantitative evaluation of a communication intervention on one or more PC/EoL issues with a communi…
matched on Palliative Care (mesh), Palliative Care (keyword), end of life (text)