The latest medical research on Palliative Medicine
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Identifying People in Need of Palliative Care Services in Rural Tamil Nadu: A Survey.Indian Journal of Palliative Care
As a part of initiating community-based palliative care program in the field practice areas of Urban Health Training Centre (UHTC), Villupuram, it was necessary for us to identify people who need palliative care to plan our services.
This study aims to assess the need for palliative care and its determinants in the villages under the UHTC, Villupuram, and to know their sociodemographic characteristics and morbidity profile.
A community-based cross-sectional survey was conducted in the four villages under UHTC between April and September 2016. A house-to-house survey was conducted by a trained team using a structured questionnaire. The available member of the households was interviewed about the need for palliative care and the morbidity profile among all the members of their household. Written informed consent was obtained before the interview. Data were entered and analyzed using EpiInfo (version 220.127.116.11) software. Prevalence ratio, age- and gender-wise prevalence of people in need of palliative care was calculated.
The overall prevalence of people in need of palliative care was found to be 4.5/1000 population (95% confidence interval: 3.2-6.3). Among them, 73.5% were elderly people. The most common condition requiring palliative care was old age-related weakness (41.2%).
The need for palliative care services among elderly people was found to be high. This data can be used for planning and implementing community-based palliative care services for the people in our field practice areas.
Cluster Analysis of Symptoms of Bangladeshi Women with Breast Cancer.Indian Journal of Palliative Care
Breast cancer (BC) patients may experience multiple symptoms due to the disease itself, cancer treatment or combination of both.
The aim of the present study was to express multiple symptoms experienced by the patients with BC as clusters.
This was a retrospective study. We examined symptom profiles of 120 patients with BC who attended the Centre for Palliative Care, Bangabandhu Sheikh Mujib Medical University in Dhaka, Bangladesh, from January 2009 to December 2013. We included all case sheets of BC patients, which had documentation of needed information. Following symptoms were analyzed: pain, nausea, loss of appetite, constipation, weakness, cough, breathlessness, sleeplessness, lymphedema, sadness, anxiety, and depression. Hierarchical cluster analysis was used to identify the natural groupings within the set.
We could identify three clusters, namely (1) "neuropsychiatric," (2) "gastro-respiratory," and (3) "miscellaneous" symptom clusters. The symptoms in cluster 2 comprised of cough, breathlessness, nausea, and constipation. Cluster 1 was characterized by pain, depression, anxiety, weakness, sleeplessness, and loss of appetite. Cluster 2 was comprised of cough, breathlessness, nausea, and constipation. Cluster 3 consisted of two symptoms lymphedema and sadness. The results revealed that the multiple symptoms of patients with BC experienced had been clustered together. Neuropsychiatric symptoms and weakness formed a significant strong relationship with each other.
Knowledge obtained from this study could be beneficial for better understanding, assessment, and management of symptom clusters in women with BC. It may also help patients to plan ahead for them to seek management of concurrent symptoms to improve their quality of life.
End-of-life Care and Social Security Issues among Geriatric People Attending a Tertiary Care Hospital of Eastern India.Indian Journal of Palliative Care
The care of sick members is the hallmark of a civilized society. End-of-life care and social security for elderly are emerging issues nowadays.
The aim of this study is to explore the desires of the elderly regarding the end-of-life care decisions along with to find out social security measures among the study population.
The cross-sectional study conducted in the geriatric outpatient department of a tertiary care hospital.
The study period was 4 months from August to November 2017. The geriatric patients attending geriatric outpatient department were interviewed using a predesigned and pretested questionnaire. Convenient sampling was used and a total of 138 participants were included in the study.
Proportions were used in the study.
A total of 63.77% participants expected to die at home surrounded by their family members during their time of death followed by hospital (31.88%). Majority (63.77%) stated their opinions to die a senile death. Organ donation after death was the willingness shown by as high as 70.3%, but registered organ donors were 6.5%. 94.2% participants expected to be cremated after their death while others buried in accord to their religious practices. Only 7.24% of participants had a legal will of their financial establishments. It was observed that even half of the population (47.8%) did not have any form of health or life insurance.
Home-based care of the elderly is needed so that they can live their last days of life peacefully. Awareness about health and life insurance should be increased by urgent intervention.
Validation of the Caregiving Knowledge Questionnaire-My: Measuring Knowledge Regarding Positioning and Feeding among Malaysian Informal Caregivers of Stroke Patients.Indian Journal of Palliative Care
The majority of caregivers for stroke patients in Malaysia are informal caregivers, although there are no valid tools to measure their knowledge regarding caregiving. Therefore, this study validated the Caregiving Knowledge Questionnaire (CKQ-My) as an assessment of Malaysian stroke caregivers' knowledge regarding patient positioning and feeding.
Back-to-back translation was used to produce a bilingual version of the questionnaire. Hand drawings were used to replace photographs from the original questionnaire. Face validity and content validity were assessed, and construct validity was determined by comparing responses from informal caregivers, medical students, and primary care doctors. Finally, the internal consistencies of the subscales were determined.
Pretesting showed that the translated version was sufficiently easy to understand. Internal consistency for the positioning subscale (28 items, Cronbach's α = 0.70) and feeding subscale (15 items, Cronbach's α = 0.70) was good. Mean scores for the positioning subscale for caregivers (mean: 17.1 ± 3.9), medical students (mean: 18.9 ± 3.1), and doctors (mean 21.5 ± 2.2) were significantly different (F = 5.28, P ' = 0.011). Mean scores for the feeding subscale for caregivers (mean 13.1 ± 2.5), medical students (mean 16.1 ± 1.9), and doctors (mean 16.1 ± 2.4) also differed significantly (F = 6.217, P = 0.006).
CKQ-My has good internal consistency and construct validity for the subscales measuring stroke caregivers' knowledge about positioning and feeding of stroke patients. It has potential as an assessment of effectiveness of caregiver training and for future studies on long-term stroke outcomes in Malaysia.
Impact of Educational Training in Improving Skills, Practice, Attitude, and Knowledge of Healthcare Workers in Pediatric Palliative Care: Children's Palliative Care Project in the Indian State of Maharashtra.Indian Journal of Palliative Care
The "Children's Palliative Care Project" was initiated in October 2010 in the Indian state of Maharashtra with a view to improve the quality of life of children with life-limiting conditions. This study evaluates its education and training component through a questionnaire.
A cross-sectional survey was carried out pre-/post-training among 258 doctors, nurses, social workers, and counselors at three sites in Maharashtra in March 2015. Descriptive statistics were used for data analysis.
Sixty-two participants responded. Posttraining, doctors and the nurses had a better level of knowledge, skill set, and attitude; whereas social workers and counselors fared better with prevailing care practices. Participants advocated using morphine only when other analgesics had failed and suggested ways for better service delivery of care.
The study gives a rough idea of the prevailing practice of pediatric palliative care among the health-care workers (who participated in the survey) and suggests practical ways to improve it.
Impact of Different Sociodemographic Factors on Mental Health Status of Female Cancer Patients Receiving Chemotherapy for Recurrent Disease.Indian Journal of Palliative Care
Deterioration in mental health and poor quality of life (QOL) among women suffering from breast and ovarian cancer is not a direct result of the illness but mediated by many other psychosocial variables.
The study intended to examine if there was any effect of educational level, residential status, family type, duration of treatment, and income level of family on anxiety, depression, and QOL among the breast and ovarian cancer patients, undergoing second- or subsequent-line chemotherapy.
Forty married female cancer patients with breast and ovarian cancer, aging between 40 and 60 years, education level ranges from no formal education to postgraduate degree, income level ranges from Rs. 1000 per month to Rs. 20000 per month, and undergoing second- or subsequent-line chemotherapy for the past 1-10 years were studied. Levels of anxiety and depression were determined by Hospital Anxiety and Depression Scale. The QOL was measured by using WHO QOLBREF scale.
Mean and standard deviation and Levene's F values were calculated. If Levene's F value was significant, then Mann-Whitney U-test was done or else independent samples t-test was used.
Among all the variables, education, residential status, and income affect significantly on anxiety, depression, and QOL.
Early detection of psychosocial variables is essential for better screening of the cancer patients undergoing chemotherapy, and therefore, further psychological intervention can be planned accordingly.
End-of-life Care: Beliefs, Attitudes, and Experiences of Iranian Physicians.Indian Journal of Palliative Care
Most of the patients suffering from cancer are diagnosed at late stages of cancer, which curative interventions are unable to improve their quality of life.
To survey Iranian physicians' attitudes and practices toward end-of-life (EOL) care.
We conducted a cross-sectional survey among physicians participating in a national annually conducted educational seminar.
The survey results show that 80% of physicians had between 1 and 3 EOL patients. About 72% of patients received medical care in hospitals. The difference in best setting for care of terminally ill patients was statically significant after controlling for the length of practice and physician belief. The results also showed that that the participants believed that that the level of physicians' knowledge in this field was unacceptable.
Physicians of our study were interested to participating in continuing education programs focused on EOL patients.
The Development of the Community-based Palliative Care Model in a District Health System, Phitsanulok Province, Thailand.Indian Journal of Palliative Care
Palliative care (PC) refers to a set of basic health services in Thailand and is in the early stage of implementation.
The aim of this study is to develop a community-based PC model in a district health system (DHS) based on the form of action and evaluation.
A three-step action research: look, think, and act was designed with mixed methods of data collection.
A key finding was the confusion on the terminology of the PC, challenge of the referral system of PC patients in DHS, medical equipment and supplies for the PC patients, and insufficient access to opioid analgesics at home. The model of development comprised the training of health professionals, the management of the medical equipment and supplies by people sector, and the development of a referral guideline of the PC patient in DHS. The evaluation showed the higher score of the accessibility to PC than the score of accommodation for patients. It also showed the higher score of the care continuity over the longitudinal continuity for patients. For the carers, the score of guilt is higher than the score of the care burden.
A community-based PC model should be monitored by district health managment. The methods of this study are expected to be useful advice on how to solve similar problems in the other regions of similar context.
Early Competing Deaths in Locally Advanced Head-and-Neck Cancer.Indian Journal of Palliative Care
The competing (noncancer) deaths have increased with aggressive treatment approach and better disease control in locally advanced head-and-neck cancer.
The aim of this study is to find incidence, cause and predictors of early competing mortality in locally advanced head-and-neck cancer patients undergoing combined modality therapy.
In this retrospective study, a total of 125 locally advanced head-and-neck patients treated from January 2013 to June 2017 were analyzed. The total number of deaths, cause, and the time of death from the start of therapy was recorded. To study the risk factors of competing deaths, univariate and multivariate logistic regression was applied. Data were analyzed using SPSS v. 24 software.
A total of 51 deaths (31 cancer deaths and 20 competing deaths) recorded at a median follow-up of 16 months (1-62 months). The incidence of early competing mortality was 12% (n = 15) with a median time of 2.7 months from treatment initiation. Sepsis was major cause of early competing death (n = 13). On univariate and multivariate logistic regression analysis, competing death was significantly associated with pharyngeal (oropharynx, hypopharynx, and larynx) site primary (odds ratio [OR] = 3.562; 95% confidential interval [CI] = 1.207-10.517; P = 0.016), and Stage IVA/IVB disease (OR = 5.104; 95% CI = 1.123-23.202; P = 0.021).
Competing deaths is one of the multifaceted problems in locally advanced head-and-neck cancer patients. Sepsis being single most cause of early competing deaths in Stage IVA/IVB pharyngeal and laryngeal cancer.
A Comparison of Symptom Management for Children with Cancer in Iran and in the Selected Countries: A Comparative Study.Indian Journal of Palliative Care
The aim of this study is to describe the experiences of other countries regarding the status of pediatric palliative care in the field of symptom management and to compare it with the current status in Iran to achieve an appropriate level of symptom management for children with cancer.
This is a comparative study. The research population includes the palliative care systems of Jordan, England, Australia, and Canada, which were ultimately compared with Iran's palliative care system.
The results showed that in the leading countries in the field of palliative care, such as Australia and Canada, much effort has been made to improve palliative care and to expand its service coverage. In the UK, as a pioneer in the introduction of palliative care, a significant portion of clinical performance, education and research, is dedicated to childhood palliative care. Experts in this field and policymakers are also well aware of this fact. In developing countries, including Jordan, palliative care is considered a nascent specialty, facing many challenges. In Iran, there is still no plan for providing these services coherently even for adults.
Children with cancer experience irritating symptoms during their lives and while they are hospitalized. Regarding the fact that symptom management in developed countries is carried out based on specific and documented guidelines, using the experiences of these successful countries and applying them as an operational model can be useful for developing countries such as Iran.
Management of Malignant Wound Myiasis with Ivermectin, Albendazole, and Clindamycin (Triple Therapy) in Advanced Head-and-Neck Cancer Patients: A Prospective Observational Study.Indian Journal of Palliative Care
Myiasis, tissue infestation by housefly larvae, is commonly found in malignant fungating wounds of cancer patients from climatic condition and lower socio-economic strata.
It was aimed to study the effectiveness of systemic Ivermectin, Albendazole& Clindamycin (Triple Therapy) in reducing signs & symptoms associated with maggots in malignant head and neck wounds.
25 adult, advanced head and neck cancer patients presenting with maggots either from wound, oral cavity or nostril, with ECOG score 3 or less were enrolled in this study. Symptoms were assessed using Edmonton Symptom Assessment Scale (ESAS) and wound by Wound Assessment Tool - Hospice, at baseline and then Days 1, 3, 5, and 7. All patients received 3 days course of oral Ivermectin 12 mg per day, Albendazole 400 mg twice per day and Clindamycin 300 mg three times per day for 5 days along with Terpentine oil dressing. All patients received oral Morphine as per their pain score.
Mean age (yrs) and weight (Kg) were 42.15 ± 8.23 and 52.31 ± 5.18 respectively. 84% patients were male. Mean oral morphine dose was 100.38 mg. There was significant decrease in number of maggots from day 0 (77.28 ± 13.465) to day 1 (20.60 ± 7.263; 73.34% reduction) to day 3 (1.52 ± 2.104; 92.62% reduction). We found statistically significant improvement (P = <0.05) in scores of wound and all other related symptoms on days 1, 3, 5 & 7, except bleeding, edema, nausea, anxiety, appetite loss and feeling of wellbeing, which remained same on Day 1, but improved afterward. Side effects were self-limiting.
Systemic treatment with Ivermectin, Albendazole and Clindamycin (Triple Therapy) enhances the removal of maggots, early recovery and relief from distress and associated symptoms.
How "Elderly Staying Alone" Cope Up with their Age and Deteriorating Health: A Qualitative Exploration from Rural Wardha, Central India.Indian Journal of Palliative Care
This study is done to explore the various changes and problems faced by the "elderly people staying alone" and how they cope up to maintain their life amidst the physical, familial, social, and financial crisis in their lives.
This qualitative study was carried out in the villages surrounding Bhidi Rural Health and Training Center, located in the Vidarbha region of Maharashtra. A triangulation of free listing and pile sorting exercise was used. Elderly >65 years of age of either sex, living alone in their own houses, for at least 2 years were included in the study. Twenty-four such individuals were selected purposively who could figure out the different words and concepts regarding the three domains of our study for the purpose of line listing, namely, change of life since staying alone, problems faced while staying alone, and how they cope up with the problem of living alone. The data were analyzed using Anthropac software. The study findings were presented to the participants, who later pointed out few recommendations to be made.
The "elderly staying alone" face the problems of lack of family, social, and financial support in their day-to-day life. They cope with these problems by a number of ways. Although there are a number of government schemes to protect the elderly, none of these policies are dedicated to this special group of elderlies.
There is no social structure that can take care of this vulnerable group of elderlies in rural India. It is high time for the government to step in to bring some societal and familial reforms that will safeguard the elderly staying alone from the ongoing familial, social, and financial hardship.