Palliative Care Unit (palliative + care_unit)

Distribution by Scientific Domains


Selected Abstracts


Rapid titration with intravenous morphine for severe cancer pain and immediate oral conversion

CANCER, Issue 1 2002
Sebastiano Mercadante M.D.
Abstract BACKGROUND Cancer pain emergencies presenting with severe excruciating pain require a rapid application of powerful analgesic strategies. The aim of the current study was to evaluate a method of rapid titration with intravenous morphine to achieve relief of cancer pain of severe intensity. METHODS Forty-nine consecutive patients admitted to a Pain Relief and Palliative Care Unit for severe and prolonged pain were enrolled in the study. Pain was evaluated on a numeric scale of 0,10 (0 indicated no pain and 10 indicated excruciating pain). After the initial assessment (T0), an intravenous line was inserted and boluses of morphine (2 mg every 2 minutes) were given until the initial signs of significant analgesia were detected or severe adverse effects occurred (T1). A continuous reassessment was warranted and the effective total dose administrated intravenously was assumed to last approximately 4 hours and was calculated for 24 hours. The dose immediately was converted to oral morphine (a 1:3 ratio for low doses and a 1:2 ratio for high doses). RESULTS Data from 45 patients was analyzed. A significant decrease in pain intensity was achieved in a mean of 9.7 minutes (95% confidence interval [95% CI], 7.4,12.1 minutes), using a mean dose of intravenous morphine of 8.5 mg (95% CI, 6.5,10.5 mg). The doses administered rapidly were converted to oral morphine and pain control was mantained until the patient's discharge, which occurred in a mean of 4.6 days (95% CI, 4.1,5.2 days). The incidence of adverse effects was minimal. CONCLUSIONS The results of the current study demonstrate that cancer pain emergencies can be treated rapidly in the majority of cancer patients with an acceptable level of adverse effects. Intravenous administration of morphine requires initial close supervision and continuity of medical and nursing care. Cancer 2002;95:203,8. © 2002 American Cancer Society. DOI 10.1002/cncr.10636 [source]


Self-efficacy beliefs and levels of anxiety in advanced cancer patients

EUROPEAN JOURNAL OF CANCER CARE, Issue 2 2010
K. MYSTAKIDOU md, associate professor
MYSTAKIDOU K., TSILIKA E., PARPA E., GOGOU P., THEODORAKIS P. & VLAHOS L. (2010) European Journal of Cancer Care19, 205,211 Self-efficacy beliefs and levels of anxiety in advanced cancer patients The aims of this study were to investigate the self-efficacy and anxiety in advanced cancer patients in a palliative care unit. The subject is some 99 advanced cancer patients, treated for pain relief and cancer-related symptoms. Patients completed the General Perceived Self-Efficacy Scale (GSE) and the Spielberger's State-Trait Anxiety Inventory (STAI). The Eastern Cooperative Oncology Group was used to measure patients' performance status. Statistically significant associations were found between GSE, patients' gender, performance status, opioids and all the STAI scales. The multiple regression analysis revealed that self-efficacy was predicted by patients' age, performance status, gender, as well as by their high levels on two STAI scales, in a model explaining 39.7% of the total variance. In advanced cancer patients, self-efficacy is significantly correlated with levels of anxiety, patients' physical condition and demographic characteristics. Also, it seems to be influenced by components of the STAI, patients' age, physical performance and gender. [source]


Healthcare professionals' perceptions of existential distress in patients with advanced cancer

JOURNAL OF ADVANCED NURSING, Issue 7 2010
Esther Mok
mok e., lau k-p., lam w-m., chan l-n., ng j.s.c. & chan k-s. (2010) Healthcare professionals' perceptions of existential distress in patients with advanced cancer. Journal of Advanced Nursing,66(7), 1510,1522. Abstract Title.,Healthcare professionals' perceptions of existential distress in patients with advanced cancer. Aim., This paper is a report of an exploration of the phenomenon of existential distress in patients with advanced cancer from the perspectives of healthcare professionals. Background., Existential distress is an important concern in patients with advanced cancer; it affects their well-being and needs to be addressed in the provision of holistic care. Method., Focus groups were conducted from November 2008 to February 2009 with physicians, nurses, social workers, occupational therapists, physiotherapists, and chaplains working in a palliative care unit that served patients with advanced cancer in Hong Kong. Data collection and analysis were guided by the grounded theory approach. All categories were saturated when five focus groups had been held with a total number of 23 participants. Findings., We found three causal conditions of existential distress: anticipation of a negative future, failure to engage in meaningful activities and relationships, and having regrets. Three basic (caring, relating and knowing) and six specific (positive feedback, religious support, new experiences, task setting, exploring alternatives and relationship reconciliation) intervening strategies were identified. Whether the intervening strategies would be effective would depend on patients' openness and readiness; healthcare professionals' self-awareness, hopefulness, and interest in knowing the patients; and a trusting relationship between patients and healthcare professionals. A sense of peace in patients was considered a consequence of successful interventions. Conclusion., This paper acknowledges the lack of an accepted conceptual framework of existential distress in patients with advanced cancer. It is based on healthcare professionals' views, and further studies from the perspectives of patients and their families are needed. [source]


Associated and predictive factors of sleep disturbance in advanced cancer patients

PSYCHO-ONCOLOGY, Issue 10 2007
Tatsuo Akechi
Abstract Little attention has been paid to sleep disturbance experienced by advanced cancer patients. The purpose of the present study was to investigate longitudinal change in sleep disturbance and to identify factors that associated with and predicted sleep disturbance among 209 consecutive terminally ill cancer patients. Patients were assessed twice for sleep disturbance by one item of the structured clinical interview for assessing depression, once at the time of their registration with a palliative care unit (PCU) (baseline) and again at the time of their PCU admission (follow-up), and possible associated medical and psychosocial factors were evaluated. The proportions of patients with obvious sleep disturbance at baseline and follow-up were 15.3 and 25.9%, respectively. Sixty-seven percent of the subjects showed some sleep status changes, including both aggravation and improvement, between baseline and follow-up. Being younger, having diarrhea and living alone were significantly associated with sleep disturbance at baseline, and the increase of psychological distress was the only significant predictive factor for sleep disturbance at follow-up. These findings suggest that psychological distress is a possible key cause of sleep disturbance and management of psychological distress may be one promising strategy for prevention of sleep disturbance among advanced cancer patients. Copyright © 2006 John Wiley & Sons, Ltd. [source]


Cause and place of death in patients dying with colorectal cancer

COLORECTAL DISEASE, Issue 3 2007
O. M. Jones
Abstract Objective, Few studies on colorectal cancer look at the one-third of patients for whom treatment fails and who need a management strategy for death. This paper has examined the mode and place of death in patients with colorectal cancer. Method, This study was a review of 209 deaths, analysed between January 2001 and September 2004 by retrospective review of a prospectively collected database. Results, A total of 118 patients (group 1) had undergone resection of their primary colorectal cancer, 20 (group 2) had had a defunctioning stoma or bypass surgery and the remaining 71 patients (group 3) had either had no surgery, an open and close laparotomy or had a colonic stent. One hundred and fifty-six (75%) patients died of colorectal cancer with the remainder dying of other causes. The number of admissions to hospital and the number of days spent in hospital from diagnosis to death were greatest in group 1. Overall, only 34 patients (22%) dying from colorectal cancer died at home. Forty (26%) died in hospital and 70 (45%) died in a palliative care unit. Conclusions, Patients dying from colorectal cancer who undergo surgical resection of their primary tumour spend more time between diagnosis and death in hospital. They are also more likely to die in hospital than patients treated by surgical palliation or nonsurgically. Patients who are treated palliatively from the outset (group 3) are most likely to die at home. If hospital is accepted as an appropriate place for death from colorectal cancer, then greater provision for this should be made. [source]


Parents' experiences of a Family Support Program when a parent has incurable cancer

JOURNAL OF CLINICAL NURSING, Issue 24 2009
Kari E Bugge
Aims and objectives., The Family Support Program was created to support children and parenting when one of the parents has incurable cancer. We chose a family-based approach to support parent's coping and to help families pull together, identify strengths in the family and learn how to seek help. Background., Cancer is usually a new experience for young families. In most cases, parents do not have the necessary knowledge about their children's need for information and support about their parent's serious illness and impending death. Design., A qualitative evaluation study based on data collected through in-depth interviews focusing on parent's experiences with the Family Support Program. Methods., Participants were patients with incurable cancer and their partners and ex-partners with children aged between 5,18 years. Thirteen parents were in-depth interviewed. Results., Parents described how the Family Support Program helped them gain greater insight into their children's thoughts and reactions and into how the situation affected their daily living. Parents reported that conflicts were reduced, they could talk more openly about the situation in the family and that they were shown how to support their children's coping. Conclusion., The Family Support Program met the parents in the study's needs for more information and support about how to cope with their children during the patient's terminal illness. Relevance to clinical practice., The Family Support Program is described in detail in a manual that makes it easy for other health workers to use the same programme. The Family Support program was in use in outpatient clinics, oncology wards and palliative care units and was provided both from nurses and social workers trained in cancer care. Parent's in the study would like the Family Support Program to be available to all patients who receive the poor prognosis that their cancer cannot be cured. [source]