Hospitalizations and re-hospitalizations at the end-of-life among cancer patients; a retrospective register data study.

BACKGROUND: Patients with incurable cancer are frequently hospitalized within their last 30 days of life (DOL) due to numerous symptoms and concerns. These hospitalizations can be burdensome for the patient and the caregivers and are therefore considered a quality indicator of end-of-life care. This retrospective cohort study aims to investigate the rates and potential predictors of hospitalizations and re-hospitalizations within the last 30 DOL. METHODS: This register data study included 383 patients with non-curable cancer who died in the pre-covid period between July 2018 and December 2019. Descriptive statistics with Chi-squared tests for the categorical data and logistic regression analysis were used to identify factors associated with hospitalization within the last 30 DOL. RESULTS: A total of 272 (71%) had hospitalizations within the last 30 days of life and 93 (24%) had > 1 hospitalizations. Hospitalization was associated with shorter time from palliative care unit (PCU) referral to death, male gender, age < 80 years and systemic anticancer therapy (SACT) within the last 30 DOL. The most common treatment approaches initiated during re-hospitalizations remained treatment for suspected or confirmed infection (45%), pleural or abdominal paracentesis (20%) and erythrocytes transfusion (18%). CONCLUSION: Hospitalization and re-hospitalization within the last 30 DOL were associated with male gender, age below 80, systemic anticancer therapy and suspected or confirmed infection.

Mental Health Signs Relevant for an Assessment Tool Suitable for Student and Novice Nurses: A Document Analysis.

Novice nurses' mental health assessment practice is characterised by lack of consistency, despite mental health assessment being a core issue in professional nursing and patient safety across health services. This study aimed to identify mental health signs relevant for an assessment tool suitable for student and novice nurses. A document analysis approach was applied, and content analysis was used to analyse data extracted from carefully selected documents. Four main categories of mental health issues were identified: risk issues, symptom issues, psychological issues and self-care issues. Mental health signs were thereafter grouped in ten sub-categories characterising mental health concerns. These were: risk concerns, psychotic concerns, mood, affect and energy concerns, substance use concerns, somatic concerns, perception concerns, communication concerns, cognitive concerns, anxiety concerns and self-care concerns. The identified signs are considered relevant for student and novice nurses to learn and can be further developed into a clinical assessment tool for use in nursing education to strengthen mental health assessment competence in nursing education.

Acting with dedication and expertise: Relatives' experience of nurses' provision of care in a palliative unit.

OBJECTIVES: Admission of a cancer patient to a palliative unit when near the final stage of their disease trajectory undoubtedly impacts their relatives. The aim of our study was to illuminate and interpret relatives' lived experiences of health personnel's provision of care in a palliative ward. METHODS: A phenomenological/hermeneutic approach was employed that was inspired by the philosophical tradition of Heidegger and Ricoeur and further developed by Lindseth and Nordberg. The perspectives of the narrator and the text were interpreted by highlighting relatives' views on a situation in which they have to face existential challenges. The analysis was undertaken in three steps: naïve reading, structural analysis, and comprehensive understanding, including the authors' professional experiences and theoretical background. RESULTS: Six subthemes appeared: the dying person, the bubble, the sight, the cover, the provision for children's needs, and the availability of immediate help. These components were further constructed into three themes: the meaning of relating, the meaning of action, and the meaning of resources. Our comprehensive understanding of the results suggests that the most important theme is "acting with dedication and expertise." SIGNIFICANCE OF RESULTS: The following aspects are crucial for relatives of cancer patients hospitalized in a palliative ward: time and existence, family dynamics, and care adjusted to the situation. Our study results led to reflections on the impact of how nurses behave when providing care to patients during the palliative phase, and how they interact with relatives in this situation. We found that cancer patients in a palliative unit most appreciate nurses who act with dedication and expertise.

Anxiety, depression, and quality of life in caregivers of patients with cancer in late palliative phase.

BACKGROUND: Limited research has been done on mental health and health-related quality of life (QOL) of primary caregivers (PCs) to patients staying at home with advanced cancer. This study examines anxiety, depression, and QOL in PCs of patients with cancer in the late palliative phase. PATIENTS AND METHODS: The sample consisted of 49 PCs of women with breast cancer and 47 PCs of men with prostate cancer. QOL was rated with the Medical Outcome Study Short Form (SF-36), and mental health with the Hospital Anxiety and Depression Scale (HADS). The findings were compared with age-adjusted norm data (norm). RESULTS: Physical QOL was significantly higher than norm in both genders, while mental QOL was significantly lower in male PCs. The level of anxiety was significantly higher than norm in both genders. No significant difference for level of depression was found in either gender, while caseness of HADS-defined depression was significantly more prevalent in female PCs compared with norm. CONCLUSION: PCs of both genders had significantly more anxiety than norm samples. Health care personnel in contact with PCs should consider screening them for mental symptoms and QOL and, if necessary, recommend further evaluation by their doctors.