ABSTRACT
OBJECTIVES: Although death is not uncommon for hospitalised patients with cancer, there are few interventions in oncology that are designed to create a dignified, compassionate end-of-life (EOL) experience for patients and families. The 3 Wishes Project (3WP), a programme in which clinicians elicit and implement final wishes for dying patients, has been shown effective in intensive care units (ICUs) at improving the EOL experience. The objective was to initiate 3WP on an oncology ward and evaluate its effect on family member experiences of their loved one's EOL. We hypothesised that the 3WP can be implemented in the non-ICU setting and help oncological patients and their families with transition to the EOL. METHODS: When the patient's probability of dying is greater than 95%, patients and families were invited to participate in the 3WP. Wishes were elicited, implemented and categorised. Audiorecorded, semistructured interviews were conducted with family members, transcribed and analysed using content analysis. RESULTS: 175 wishes were implemented for 52 patients with cancer (average cost of US$34). The most common wish (66%) was to personalise the environment. Qualitative analysis of 11 family member interviews revealed that the 3WP facilitates three transitions at the EOL: (1) the transition from multiple admissions to the final admission, (2) the transition of a predominantly caregiver role to a family member role and (3) the transition from a focus on the present to a focus on legacy. CONCLUSION: The 3WP can be implemented on the oncology ward and enhance the EOL experience for hospitalised patients with cancer.
ABSTRACT
OBJECTIVES: Hypersensitivity reactions (HSRs) are defined as reactions with reproducible signs and symptoms, triggered by an exposure to a stimulus at a dose tolerated by normal subjects. Although discontinuing the allergenic medication can eliminate the potential for HSRs, it can also lead to significant morbidity and mortality due to suboptimal treatment of the underlying disease. Therefore, desensitization protocols have been developed that offer a safe process that delivers full therapeutic doses in an incremental fashion without eliciting life-threatening reactions. DATA SOURCES: This article uses a case study to discuss the process of chemotherapy desensitization, associated complications, and identify areas of improvement in the management of HSRs within an academic medical center. CONCLUSION: HSRs are a complex pathophysiologic response that requires an experienced oncology nurse at the bedside to manage potentially life-threatening symptoms. IMPLICATIONS FOR NURSING PRACTICE: Thorough education and training is needed among nursing staff to manage HSRs during the chemotherapy desensitization process.
