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Arango-Gutierrez, A., et al. (2023). "Factors associated with suffering from dying in patients with cancer: a cross-sectional analytical study among bereaved caregivers." BMC Palliative Care 22(1) (no pagination) Embase https://bmcpalliatcare.biomedcentral.com/
Background: In Colombia, cancer incidence is increasing, as is the demand for end-of-life care. Understanding how patients who die from cancer experience this phase will allow the identification of factors associated with greater suffering and actions to improve end-of-life care. We aimed to explore associations between the level of suffering of patients who died from cancer and were cared for in three Colombian hospitals with patient, tumor, treatment, and care characteristics and provided information. Method(s): Data on the last week of life and level of suffering were collected through proxies: Bereaved caregivers of patients who died from cancer in three participating Colombian hospitals. Bereaved caregivers participated in a phone interview and answered a series of questions regarding the last week of the patient's life. An ordinal logistic regression model explored the relationship between the level of suffering reported by bereaved caregivers with the patient's demographic and clinical characteristics, the bereaved caregivers, and the care received. Multivariate analyses were adjusted for place of death, treatments to prolong of life, prolongation of life during the dying process, suffering due to prolongation of life, type of cancer, age, if patient had partner, rural/urban residence of patient, importance of religion for the caregiver, caregivers' relationship with the patient, and co-living with the patient. Result(s): A total of 174 interviews were included. Median age of the deceased patients was 64 years (IQR 52-72 years), and 93 patients were women (53.4%). Most caregivers had rated the level of suffering of their relative as "moderately to extremely" (n = 139, 80%). In multivariate analyses, factors associated with a higher level of suffering were: unclear information about the treatment and the process before death Odds Ratio (OR) 2.26 (90% CI 1.21-4.19), outpatient palliative care versus home care OR 3.05 (90% CI 1.05-8.88), procedures inconsistent with the patient's wishes OR 2.92 (90% CI 1.28-6.70), and a younger age (18-44 years) at death versus the oldest age group (75-93 years) OR 3.80 (90% CI 1.33-10.84, p = 0.04). Conclusion(s): End-of-life care for cancer patients should be aligned as much as possible with patients' wishes, needs, and capacities. A better dialogue between doctors, family members, and patients is necessary to achieve this. Copyright © 2023, The Author(s).
Rijpstra, M., et al. (2023). "The clinical practice of palliative sedation in patients dying from COVID-19: a retrospective chart review." BMC Palliative Care 22(1) (no pagination) Embase https://bmcpalliatcare.biomedcentral.com/
Background: Clinical experts experienced challenges in the practice of palliative sedation (PS) during the COVID-19 pandemic. Rapid deterioration in patients' situation was observed while the indications for starting PS seemed to differ compared to other terminal patients. It is unclear to which extent clinical trajectories of PS differ for these COVID patients compared to regular clinical practice of PS. Objective(s): To describe the clinical practice of PS in patients with COVID versus non-COVID patients. Method(s): A retrospective analysis of data from a Dutch tertiary medical centre was performed. Charts of adult patients who died with PS during hospitalisation between March '20 and January '21 were included. Result(s): During the study period, 73 patients received PS and of those 25 (34%) had a COVID infection. Refractory dyspnoea was reported as primary indication for starting PS in 84% of patients with COVID compared to 33% in the other group (p < 0.001). Median duration of PS was significantly shorter in the COVID group (5.8 vs. 17.1 h, p < 0.01). No differences were found for starting dosages, but median hourly dose of midazolam was higher in the COVID group (4.2 mg/hr vs. 2.4 mg/hr, p < 0.001). Time interval between start PS and first medication adjustments seemed to be shorter in COVID patients (1.5 vs. 2.9 h, p = 0.08). Conclusion(s): PS in COVID patients is characterized by rapid clinical deterioration in all phases of the trajectory. What is manifested by earlier dose adjustments and higher hourly doses of midazolam. Timely evaluation of efficacy is recommended in those patients. Copyright © 2023, The Author(s).
Sawyer, J. M. (2023). "Understanding dying as a focal point for defining an integrative approach to health and social care." Journal of Ayurveda and Integrative Medicine 14(1) (no pagination) Embase http://www.journals.elsevier.com/journal-of-ayurveda-and-integrative-medicine
Long standing and poorly acknowledged tensions underpin what is considered success or failure in the field of health and social care. Such tensions threaten to undermine and limit much needed progress. In this article, I discuss the role of death and the dying process as a foundation upon which we might begin to address these tensions. I argue that through careful acknowledgement and attention to the stillness and silence of death we might better understand the impact the dying process has on the healthcare discourses that surround and orientate themselves to it. Training our eye to the rhythm of the human life course necessitates a greater appreciation of death and its influence in shaping a meaningful response to questions relating to care and the attention to human suffering. With this comes a move beyond a singular focus on the body as life's container, embracing human connections that transcend the physical and social worlds. Here our dependency and vulnerability are as much as what makes as human as our autonomy and rationality. Such an appreciation allows us to move away from values entrenched within notions of success and failure and towards a more integrative approach to health and social care. Copyright © 2022 The Authors
Psychology & Behavioral Sciences Collection is an essential full-text database for psychologists, counselors, researchers and students. It provides hundreds of full-text psychology journals, including many indexed in APA PsycInfo. It offers particularly strong coverage in child and adolescent psychology and counseling. Available via Bankstown Hospital Clinical Library's myAthens website. Register for access.
palliAGED is an online evidence-based guidance and knowledge resource about palliative care in aged care for use by health professionals and the aged care workforce