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The purpose of this study is to clarify the current state of nursing for the sexuality of patients with cancer at the end-of-life. In December 2018, we asked 313 nurses from 18 palliative care units in Kanagawa Prefecture about their awareness, feelings, and behavioral intentions and hands-on experience for the environment in which patients with cancer nurture love with their partners at the end-of-life. The collection rate of the questionnaire was 52.7% (165 cases). Eighty-two nurses (49.7%) had experience supporting the environment in which patients with cancer nurture love with their partners at the end-of-life. The contents of the support were “Recommend physical contact”, “Listening”, “Recommend hug”, and “Take sufficient time when entering the room, such as waiting for a reply after knocking or calling out”. Meanwhile, at ward conferences, only 11 (6.7%) had talked about the environment in which patients with cancer nurture love with their partners at the end-of-life. It has been suggested that, at present, support for the environment in which patients with cancer nurture love with their partners at the end-of-life is left to individuals and not systematically.
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Objective: To investigate the factors that make observed survival of patients with terminal cancer shorter than oncologists’ estimation. Methods: We retrospectively surveyed the medical records of terminal cancer patients who were referred to our palliative care unit with a predicted survival of 1–3 months and discharged dead from hospital within 3 months. Results: A total of 249 patients were eligible for analysis. One hundred and two patients (41%) had observed survival of less than one month (OS1), and 147 (59%) lived for 1–3 months (OS1–3) as expected. Depressed level of consciousness above Japan Coma Scale II and severely reduced oral intake (a few mouthfuls or less) were associated with unexpected shorter survival. The number of patients who died within two days after sudden deterioration of general condition was significantly higher in OS1 than OS1–3. Conclusion: Although survival of patients with the above factors may be shorter than oncologists’ estimation, it is necessary to examine the physician-side factors that contribute to the inaccuracy of prognosis.
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Delirium occurs in 30-40% of patients with terminal cancer, and 90% of patients are delirious immediately before death. Symptoms such as agitation and hallucination are often refractory to the standard pharmacological therapy. Also, the medication options for delirium in terminally ill patients are often limited due to a difficulty in swallowing or a lack of intravenous access. We herein report a case series of six patients with terminal cancer whose derilium symptoms were treated by asenapine sublingual tablets during the intervention period by the palliative care team. Asenapine was selected when other antipsychotics were ineffective or unavailable for agitation caused by delirium. All patients suffered dyspnea or choking sensations due to dysphagia or respiratory dysfunction. Sedative effect was observed among all patients without apparent adverse events. Sublingual asenapine could be an option for the management of restlessness due to terminal delirium when both oral and intravenous drug administration routes are not available.
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The aim of this study was to investigate the practical abilities of discharge planning nurses to support discharge of terminal cancer patients. A survey was mailed to 477 discharge planning nurses (DPNs) who were employed at 120 designated regional cancer centers in Japan. Responses from 198 (valid response rate 41.5%) DPNs were subjected to analysis. The median number of years of DPN experience of the subjects was 2.5 years, and 90.2% of them had more than 10 years of nursing experience. Among the discharge planning abilities, “To Coordinate Post-discharge Care Balance” was significantly higher in the group with more nursing experience and in the group with longer DPN experience; “To Estimate Post-discharge Care Balance” and “To Prepare for Transition from the Hospital to a Care Facility” was significantly higher in the group with longer DPN experience and in the group with more experience working in home and community care. But “To make an agreement with the patient and their families” was not significantly different for experienced DPNs. It was suggested that in order to improve the quality of discharge planning, it is necessary to create a system that allows staffing based on individual experience and sharing of knowledge and experience of veteran DPNs.
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Introduction: The aim of this study was to identify daily life issues of female terminal cancer patients who are parenting and living in their own home, and the current practice of providing support for them.Method: Semi-structured interviews were conducted with three visiting nurses who had experience in providing support to female patients with terminal cancer who were parenting while living at home. The data collected were categorized using a qualitative and inductive classification approach.Results: Categories related to issues included: insufficient support systems; and lack of time to provide support to satisfy the needs of both the patients and their families because of rapid progression of the disease. Categories related to the current practice of provision of support included: assistance to make home care possible when time was limited and support services were unavailable; understanding the situation the parenting patients with cancer were in and assisting their decision-making; relief of the patients' emotional and physical pain; assessing how well the family, including the children, understood the situation, and to support the family in expressing their feelings.Conclusion: This study revealed issues specific to providing support to parenting patients such as insufficient support services. Furthermore, visiting nurses were found to provide support with an understanding of the fact that the patients were parenting children.
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Introduction: Antiepileptic drugs were occasionally administered to manage seizures in terminally-ill cancer patients. When enteral route is no longer feasible due to dysphagia or depressed level of consciousness, subcutaneous route could be an option. We reported three cases of terminally cancer patients who received subcutaneous levetiracetam (LEV) due to an inability to administer via intravenous route. Cases: The age of 3 cases was 83, 75, 82 years, respectively. In all cases, the prognosis prediction at the start of subcutaneous LEV was about 1 month. In all cases, the route of administration of LEV was changed from intravenous to subcutaneous. No exacerbation of convulsions, or injection site reaction was confirmed after subcutaneous LEV administration. Discussion: We believe that subcutaneous LEV administration may be one of the treatment options for seizures in patients with terminal cancer for whom intravenous administration of LEV is no longer feasible.
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PURPOSE: Physician Orders for Life-Sustaining Treatment (POLST) form is a legal document for terminally ill patients to make medical decisions with physicians near the end-of-life. A multicenter prospective study was conducted to evaluate the feasibility of POLST administration in actual oncological practice. MATERIALS AND METHODS: Patients with terminal cancer, age ≥ 20 years, and capable of communicating were eligible. The primary endpoint was the completion rate of POLST. Data about physicians' or patients' barriers were also collected. RESULTS: From June to December 2017, 336 patients from seven hospitals were eligible. Median patient age was 66 years (range, 20 to 94 years); 52.7% were male; and 60.4% had poor performance status. Primary cancer sites were hepato-pancreato-biliary (26.2%), lung (23.2%), and gastrointestinal (19.9%). Expected survival duration was 10.6±7.3 weeks, with 41.2% receiving hospice care, 37.9% showing progression after cancer treatment, and the remaining patients were under active treatment (15.8%) or initially diagnosed with terminal cancer (5.1%). POLST forms were introduced to 60.1% of patients, and 31.3% signed the form. Physicians' barriers were reluctance of family (49.7%), lack of rapport (44.8%), patients' denial of prognosis (34.3%), lack of time (22.7%), guilty feelings (21.5%), and uncertainty about either prognosis (21.0%) or the right time to discuss POLST (16.6%). The patients' barriers were the lack of knowledge/understanding of POLST (65.1%), emotional discomfort (63.5%), difficulty in decision-making (66.7%), or denial of prognosis (14.3%). CONCLUSION: One-third of patients completed POLST forms, and various barriers were identified. To overcome such barriers, social engagement, education, and systematic support might be necessary.
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Humans , Male , Denial, Psychological , Education , Feasibility Studies , Hospice Care , Lung , Prognosis , Prospective Studies , Terminally Ill , UncertaintyABSTRACT
BACKGROUND: Terminally ill cancer patients suffer from refractory symptoms, and the last option of treatment is to consider sedatives. However, due to concerns that sedation may shorten survival time, some people prefer not to take sedatives. The purpose of this study was to investigate the effects of sedative administration on survival time among terminally ill cancer patients.METHODS: Two hundreds and thirty-seven patients who were hospitalized to the hospice care unit of public hospitals in Seoul from January, 2015 to March, 2016 were analyzed retrospectively. The univariate and multivariate Cox's proportional hazard regression model was used to determine independent factors related to survival time.RESULTS: The usage of sedation was necessary because the incidence of insomnia was 61.4% in the lorazepam only group, and the incidence of delirium was highest in the haloperidol group and the haloperidol with lorazepam group. Interestingly, multivariate analysis showed that male (HR, 1.766; P < 0.001), decreased consciousness (HR, 1.803; P=0.003), anorexia (HR, 1.506; P=0.012), resting dyspnea (HR, 1.757; P < 0.001), elevated serum bilirubin (HR, 1.657; P=0.001), and the haloperidol with lorazepam group (HR, 0.535, P < 0.001) were each significantly associated with survival time. Furthermore, patients in the haloperidol with lorazepam group survived longer than patients with no such medications.CONCLUSION: There is no evidence that treatment with sedative medication shortens the survival time of patients with terminally ill cancer with refractory symptoms.
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Humans , Male , Anorexia , Bilirubin , Consciousness , Delirium , Dyspnea , Haloperidol , Hospice Care , Hospices , Hospitals, Public , Hypnotics and Sedatives , Incidence , Lorazepam , Multivariate Analysis , Palliative Care , Retrospective Studies , Seoul , Sleep Initiation and Maintenance Disorders , Terminally IllABSTRACT
PURPOSE: The purpose of this study was to compare the differences in the performance of life-sustaining treatment after signing a do-not-resuscitate (DNR) order between terminal cancer patients who died in the cancer unit and hospice unit. METHODS: We performed a retrospective analysis of 174 patients who died in the cancer unit (CU) and 68 patients who died in the hospice unit (HU) from January 1, 2016 to December 31, 2016 at a hospital specializing in cancer treatment. RESULTS: The rate of life-sustaining treatment administration was lower for patients who died in the HU than that of those who died in the CU. The period until death after signing a DNR order was 7 days for CU patients and 19.5 days for the HU patients. The period from admission to death was also significantly longer in HU patients (32.5 days) than that in CU patients (21.5 days, p < .001). Of the patients who died in the CU, 54% were referred to the HU but did not use the service. Most of the people who signed DNR informed consents were spouses and offspring; only 4.6% of patients signed DNRs. CONCLUSION: It is hard to say that life-sustaining treatment increases the survival period, but it can improve symptom control and quality of life in hospices. Activation of consultation-based hospice is necessary for patients who cannot use the hospice unit. To increase patient's active participation in the life-sustaining treatment decision of terminal cancer patients, it is necessary that an advanced practice nurse specialized in counseling and education is involved in the decision.
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Humans , Counseling , Education , Hospice Care , Hospices , Quality of Life , Resuscitation Orders , Retrospective Studies , SpousesABSTRACT
BACKGROUND: Establishing and designating specialized hospice palliative care units (HPCUs) has been an important part of national policy to promote hospice palliative care in Korea in the recent decade. However, few studies have sought to identify patterns and barriers for utilizing HPCU over the period of national policy implementation. We aimed to investigate factors related with utilizing HPCU for terminal cancer patients after consultation with a palliative care team (PCT). METHODS: We reviewed medical records for 1,028 terminal cancer patients who were referred to the PCT of the National Cancer Center in 2010 and 2014. We compared the characteristics of the patients who decided to utilize HPCU and those who did not. We also analyzed factors influencing choices for a medical institution and reasons for not selecting an HPCU. RESULTS: The patients' mean age was 61.0 ± 12.2, with lung cancer patients (24.3%) comprising the largest percentage of these patients. The percentage of referred patients who utilized an HPCU was 53.9% in 2014, increasing from 44.6% in 2010. Older age and awareness of terminal illness were found to be positively associated with utilization of an HPCU. The most common reason for not selecting an HPCU was “refusing hospice facility” (34.9%), followed by “near death,”“poor accessibility to an HPCU,” and “caregiving problems.” CONCLUSION: Compared to 2010, HPCU utilization by terminal cancer patients increased in 2014. Improving awareness of terminal condition among patients and family members and earlier discussion of end-of-life care would be important to promote utilization of HPCU.
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Humans , Hospices , Korea , Lung Neoplasms , Medical Records , Palliative Care , Referral and ConsultationABSTRACT
Introduction: We report on a patient with end-stage lung cancer who developed the relatively rare condition of emphysematous cystitis. Case: A 72-year-old man was diagnosed with carcinomatous meningitis while being treated for lung cancer and bone metastasis. Anticancer therapy was terminated, and he was transferred to our palliative care unit. During the transfer, he exhibited progressively impaired consciousness and bilateral leg paralysis. Imaging studies performed to assess his medical state revealed intrathecal nodes associated with carcinomatous meningitis and emphysema in the bladder wall. Emphysematous cystitis was diagnosed. The bladder was irrigated and drained, and antibiotic therapy was administered. Although the bladder wall emphysema resolved, the patient died of progression of carcinomatous meningitis on the 10th day after transfer. Discussion: The development of emphysematous cystitis is reported to be likely in patients with underlying diseases, such as malignant tumor, diabetes mellitus, and neurogenic bladder, as well as in those with a history of steroid use. Our patient also exhibited many risk factors, including a history of steroid use and bladder and rectal disturbance due to carcinomatous meningitis, in addition to cancer. In end-stage cancer patients, the risk of developing emphysematous cystitis is expected to be higher than in normal persons because they have often used steroids for malaise, anorexia, and other conditions, and exhibit metastasis to the central nervous system, drug-induced dysuria, and other complications. Caution should be exercised in end-stage cancer patients to recognize emphysematous cystitis, which can be life-threatening in some cases.
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Objective To get further insight into the breakthrough pain experiences in advanced cancer patients in order to provide targeted nursing measures for breakthrough pain patients. Methods Semi structured interviews were performed in 12 advanced cancer patients. Colaizzi analysis program was used to analyze, induct and extract the themes. Results The breakthrough pain experiences of advanced cancer patients were as follows:overall perception of breakthrough pain;the experience when experiencing breakthrough pain; personal growth related to breakthrough pain. Conclusions Nurses should provide sufficient information to patients timely, consider patients′needs and combine with non-drug methods to better manage breakthrough pain to improve patients′experience about breakthrough pain.
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Objective To explore the relationships among post traumatic stress disorder(PTSD),gratitude and posttraumatic growth (PTG) for terminal cancer patients.Methods Totally 119 advanced cancer patients were investigated with the self-demographic questionnaire,posttraumatic growth inventory (PTGI),the PTSD cheeklist-civilian version (PCL-C) and the Gratitude Questionnaire-6 (GQ-6).Results For terminal cancer patients,the total score of PCL-C was 34.02±12.49.The scores on re-experience,avoidance/numbness,hypervigilance were 9.79±3.78,13.85±5.68,10.36±3.80.The total score of gratitude was 29.37±7.48.The total score of PTG was 51.34± 13.57.The scores of life appreciation,personal relationship and self-strength were 8.00± 2.99,21.18± 5.84,22.16± 6.10.The total scores of PTG were significantly statistical significance among different PTSD groups(F=16.267,P＜0.01)and gratitude groups(F=43.674,P＜0.0 1).The total scores of PCL-C (r=-0.694,P＜0.01),re-experience (r=-0.664,P＜0.01),avoidance/numbness (r=-0.671,P＜0.01),hypervigilance (r=0.753,P＜0.01) and gratitude(r=-0.611,P＜0.01) were all correlated with PTG.The total score of PCL-C and gratitude could explain 66.6％ variation of PTG.For the relationship between PTSD and PTG,the moderation effect of gratitude was not significant (P ＞0.05).Conclusion The gratitude and PTSD were important influence factors for terminal cancer patients' PTG,while the moderation effect of gratitude was not significant,so in clinical intervention we should pay more attentions to the actual effects of gratitude,and we should not pursuit gratitude education blindly.
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Pain is the most fearful symptom in cancer patients.The cancer patients suffered refractory pain with the progress of cancer.Not all cancer patients could obtain adequate pain relief by the mefhod of three-step pain relief ladder of WHO.With the reseach and recognition of the mechanisms,the pain can be effectively controlled by the right technique at the right time.It is summarized in this artical about the central and peripheral mechanism and the treatment progress of the terminal cancer pain.
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<p>Little is known about early death after admission during the terminal phase in advanced cancer patients. We retrospectively analyzed data from 510 advanced cancer patients who were at the end-of-life between August 2011 and August 2016, and found that 83 patients (16.3%) died within 3 days after admission to our institute. We divided the deceased patients into those who died within 3 days (early death group) and those who died after more than 4 days (non-early death group) after admission. Prevalence of delirium, cancer pain, dyspnea, nausea and vomiting, and fatigue patients showed no significant differences. Mean hydration at the end of life was significantly more per infusion for early death group than non-early death group. Continuous sedation and mean opioid use was significantly less for early death group than non-early death group. The risk factor of age, sex, clinical stage, histological state, overtreatment of chemotherapy, comorbidity had no significant associated with early death. The primary site of cancer, the number of metastatic sites, the consciousness level, and the performance status might be predictors for early death after admission in advanced cancer patients at the end-of-life.</p>
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<p>Aim: To clarify the predictive risk factors for bedsores of terminal cancer patients receiving home-based care. Methods: A retrospective study was conducted involving 95 terminal cancer patients receiving home-based care, including people using services provided by home-visit care providers until death. Results: The numbers of patients with and without bedsores were 31 and 64, respectively. Bivariate analyses revealed that significant variables were the Ohura-Hotta scale (P=0.02), hyperactive delirium (P=0.005), contracture (P=0.008), and anemia (P=0.02). According to multivariable logistic analysis, significant variables were contracture (OR=16.55, P=0.0002) and hyperactive delirium (OR=4.22, P=0.008) as independent risk factors for bedsores. Discussion: For terminal cancer patients receiving home-based care, hyperactive delirium should also be considered as a predictive risk factor for bedsores.</p>
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<p>From January 2015 to January 2017, we encountered five terminal cancer patients with implantable cardioverter defibrillators (ICDs) in the palliative care unit of our hospital. Due to delirium or dementia, four of these five patients did not have the decision-making capacity to stop their ICD. Although one patient was capable of making his own decisions, his family did not agree with the medical professional considering the patient’s decision. The families of all five patients made decisions on behalf of the patients. The procedure for stopping the ICD was first discussed with the families at 2–21 days prior to the patients’ deaths. The ICDs were stopped between 3 h and 11 days prior to the patients’ deaths, following the consent of the families, which was obtained after 1–5 consultations. Through these experiences, we became aware of the following problems with regard to stopping ICDs: (1) the lack of experience of medical professionals in decision-making, (2) the lack of recognition of medical professionals to the distress caused to patients by ICDs, (3) the psychological burden and time constraint of discussions, and (4) the lack of knowledge of ICDs among patients and their families. These problems need to be addresses as part of advance care planning for cancer patients. </p>
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<p>The aims of this study were to clarify difficulties experienced by families facing the cessation of home-based care for terminal cancer patients, and to review the associated necessary nursing practices. We conducted semi-structured interviews with ten families. A qualitative research design was selected for this study, and the data was interpreted using content analysis techniques. The results were integrated into seven major categories: “unable to assess present symptoms for lack of understanding terminal cancer symptoms,” “feeling emotional pain during the patient’s aggravated condition,” “difficulties in coping with various patients’ physical symptoms: problems regarding inexperienced care,” “exhausted by living 24 hours a day with patient: lack of support, because of constraints from important people in the caregiver’s life,” and “difficulties faced by primary family caregivers in preparing a treatment environment.” Family caregivers were not able to prepare a treatment environment, because of a lack of understanding the symptoms of terminal cancer and an unwillingness to admit experiencing mental and physical burdens. The findings of this study suggested that the role of a nurse is to understand the family’s condition and values, provide required information in advance, and to adjust and prepare the treatment environment.</p>
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Abstract Under the national plan for addressing cancer, prevention and detection play important roles. However, the cost of treatments and late diagnosis represent a significant burden on health services. At the National Cancer Institute, more than half of patients present with tumors in advanced stages, and approximately 10% of patients seen for the first time exhibit terminal-stage malignancies, where there are no feasible cancer treatment options, and the patients are instead admitted to the hospital exclusively for palliative symptomatic management. In 2010, the National Cancer Plan began implementing a model of integrative management of palliative care in oncology that has gradually come to include symptomatic palliative care, involving ambulatory, distant and hospitalized management of patients with cancer, in its final stages and, more recently, in earlier stages.
Resumen En el marco del plan nacional para abordar el cáncer, la prevención y la detección juegan un papel importante. Sin embargo, el costo de tratamientos y diagnóstico tardío representan una carga significativa en los servicios de salud. En el Instituto Nacional del Cáncer, más de la mitad de los pacientes presentan tumores en etapas avanzadas, y aproximadamente10% de los pacientes que acuden a consulta por primera vez presentan malignidades en etapa terminal, donde no hay opciones factibles para de tratamiento del cáncer; en su lugar, los pacientes son admitidos en el hospital exclusivamente para manejo sintomático paliativo. En 2010, el Plan Nacional del Cáncer comenzó a implementar un modelo de gestión integral de los cuidados paliativos en oncología que ha logrado gradualmente incluir cuidados sintomáticos paliativos, incluyendo manejo ambulatorio, distante y hospitalizado de los pacientes con cáncer en fase final y, más recientemente, en las primeras fases.
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Humans , Palliative Care/organization & administration , Cancer Care Facilities/organization & administration , Academies and Institutes/organization & administration , Hospitals, Public/organization & administration , Medical Oncology/organization & administration , Terminal Care/organization & administration , Patient Education as Topic , Retrospective Studies , Delayed Diagnosis , Pain Management , Analgesics/therapeutic use , Mexico , Models, Theoretical , Neoplasms/therapy , Neoplasms/epidemiologyABSTRACT
Objective:To investigate the ethical challenges inhospice for community terminal cancer patients. Method:8 members of terminal Cancer Patients in palliative care wards were observed and interviewed. Datas were collected by narrative, communication,field note,work diary. Results:Get to know the ethical challenges in-hospice for community terminal cancer patients,and find the measures. Conclusions:The development of commu-nity hospice career need caring, life and death education,ethicaleducation,ethical environment improving,a harmo-nious ethical relationship and society,and life quality improving.