ABSTRACT
BACKGROUND: Preferences of patients with advanced cancer are well studied in Western countries but less so in Asian communities where end-of-life discussions can be seen as taboo. This may lead to patients receiving care that is incongruent with their wishes as their disease progress. It is important for healthcare providers to have a better understanding of patients' experiences and preferences especially in a multicultural country like Malaysia with its diverse beliefs and values to facilitate better planning for future medical care. OBJECTIVES: To explore the experiences and preferences of Malaysian patients with advanced cancer. DESIGN: Qualitative study of semi-structured interviews with thematic analysis. SETTING/SUBJECTS: Purposive sampling of 19 patients with Stage 4 cancer recruited from inpatient and outpatient settings in National Cancer Institute Malaysia. RESULTS: Three major themes emerged in the exploration of patients' experiences and care preferences in facing advanced cancer namely: 1) Dealing with poor prognosis 2) Spirituality as a source of strength and 3) Enablers of advance care planning. CONCLUSION: This study highlighted the preference for healthcare providers to be culturally sensitive during end-of-life care discussion and the need for improved spiritual care for Malaysian patients with advanced cancer. Further studies exploring the role of spiritual and cultural factors in advance care planning among Malaysians would be helpful in guiding these efforts.
ABSTRACT
Methadone has been increasingly used in the treatment of refractory cancer pain with different conversion methods and ratios described.A retrospective chart review of patients on methadone for cancer pain was conducted to assess its use as the primary opioid, focusing on pain characteristics, opioid rotation indication, previous analgesics, adverse effects and final methadone dose in comparison with the pre-rotation Morphine Equivalent Daily Dose (MEDD).Eight patients were rotated to methadone due to refractory moderate-severe cancer pain and achieved good pain relief. Three developed adverse effects (2 mild, 1 serious). None required withdrawal of methadone. The final methadone dose required varied significantly from predictions made based on equianalgesic conversion tables.Methadone is effective for the treatment of refractory cancer pain. The eventual required methadone doses for these patients were significantly different from predicted doses suggested by equianalgesic conversion tables and guidelines. This highlights the importance of individualized titration and careful clinical assessment during the rotation and in the days after, to prevent serious adverse effects.
Subject(s)
Analgesics, Opioid/administration & dosage , Cancer Pain/drug therapy , Methadone/administration & dosage , Pain, Intractable/drug therapy , Administration, Oral , Dose-Response Relationship, Drug , Female , Humans , Male , Middle Aged , Pain Management , Palliative Care/methods , Retrospective StudiesSubject(s)
Attitude to Death , Hospice Care , Palliative Care/psychology , Patient Acceptance of Health Care , Physician-Patient Relations , Bile Duct Neoplasms/complications , Bile Duct Neoplasms/psychology , Disease Progression , Home Care Services , Humans , Internship and Residency , Male , Neoplasm Metastasis , Patient Preference/psychology , Treatment Refusal/psychologySubject(s)
Hospice Care , Palliative Care , Anecdotes as Topic , Caregivers/psychology , Female , Humans , Malaysia , Middle Aged , Ovarian Neoplasms/physiopathology , Stress, Psychological , Terminal CareABSTRACT
Anaerobic gram-positive bacilli can occasionally be implicated in infections but are difficult to identify in culture by conventional biochemical methods. We report a case of liver abscesses caused by Eggerthella lenta, identified via 16S rRNA sequencing in a previously healthy patient, successfully treated with percutaneous drainage and ertapenem.
