1] Hematology/Oncology, University of Wisconsin Carbone Cancer Center, K6/518 CSC, 600 Highland Avenue, Madison, WI 53792, USA  Palliative Medicine Service, University of Wisconsin Carbone Cancer Center, K6/518 CSC, 600 Highland Avenue, Madison, WI 53792, USA.
Despite improvements in cancer therapies, cancer is the leading cause of death worldwide. Many patients experience severe, unnecessary symptoms during treatment as well as at the end of life. Often, patients receive 'aggressive' care at the end of life that is discordant with their preferences. Palliative care is an approach that focuses on communication and quality of life, including treatment of physical, psychosocial, and spiritual suffering. This approach is appropriate for patients with life-limiting cancer, throughout the course of their disease. A growing body of evidence supports the integration of palliative care into routine cancer care, owing to the benefits in symptom control, quality of life, patient satisfaction, and resource utilization. Palliative care can be delivered in inpatient, outpatient, and home-based settings. The specialty and associated infrastructure is expanding rapidly with support from the international medical community. The ideal model of how to incorporate palliative care providers into the care of patients with cancer is yet to be defined; future research is needed to develop delivery systems and improve access to palliative care services. Through collaboration between oncologists and palliative care teams, there is hope of improving the quality of care for patients with both curable and life-limiting cancers.
"A decision to forgo 'disease-directed' chemotherapy e that is, chemotherapy aimed at shrinking or stabilising the tumour e does not entail 'doing nothing' for patients. Instead, 'palliative' or hospice care focuses on relief of pain and other symptoms, and on enhancing patients' general physical, psychosocial and spiritual wellbeing (Rocque and Cleary, 2013). Whilst anticancer drugs may have a role to play in treating patients near the end-of-life, by definition, palliative care should not include anticancer drugs that could negatively impact on quality-of-life. "
[Show abstract][Hide abstract] ABSTRACT: There is evidence from some countries of a trend towards increasingly aggressive pharmacological treatment of patients with advanced, incurable cancer. To what extent should this be understood as a progressive development in which technological innovations address previously unmet needs, or is a significant amount of this expansion explained by futile or even harmful treatment? In this article it is argued that while some of this growth may be consistent with a progressive account of medicines consumption, part of the expansion is constituted by the inappropriate and overly aggressive use of drugs. Such use is often explained in terms of individual patient consumerism and/or factors to do with physician behaviour. Whilst acknowledging the role of physicians and patients’ expectations, this paper, drawing on empirical research conducted in the US, the EU and the UK, examines the extent to which upstream factors shape expectations and drive pharmaceuticalisation, and explores the value of this concept as an analytical tool.KeywordsUnited StatesUnited Kingdompharmaceuticalizationend-of-life cancer careexpectationsovertreatmentpatient preferencesclinical benefit
Social Science & Medicine 12/2014; 131. DOI:10.1016/j.socscimed.2014.12.007 · 2.89 Impact Factor
"Providing end-of-life care in a hospital is challenging, because hospital care is typically focused on prolonging life. Several studies have described the unmet needs of patients dying in hospitals, such as poor symptom control and insufficient communication [1-6]. Gaps in end-of-life care have been identified, e.g. the lack of awareness of approaching death, and shortcomings in healthcare professionals’ knowledge of and skills in palliative care [1-8]. "
[Show abstract][Hide abstract] ABSTRACT: Background
The quality of care of patients dying in the hospital is often judged as insufficient. This article describes the protocol of a study to assess the quality of care of the dying patient and the contribution of an intervention targeted on staff nurses of inpatient wards of a large university hospital in the Netherlands.
We designed a controlled before and after study. The intervention is the establishment of a network for palliative care nurse champions, aiming to improve the quality of hospital end-of-life care. Assessments are performed among bereaved relatives, nurses and physicians on seven wards before and after introduction of the intervention and on 11 control wards where the intervention is not applied. We focus on care provided during the last three days of life, covered in global ratings of the quality of life in the last three days of life and the quality of dying, and various secondary endpoints of treatment and care affecting quality of life and dying.
With this study we aim to improve the understanding of and attention for patients’ needs, and the quality of care in the dying phase in the hospital and measure the impact of a quality improvement intervention targeted at nurses.
BMC Health Services Research 03/2013; 13(1):115. DOI:10.1186/1472-6963-13-115 · 1.71 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Patients with cancer frequently suffer from debilitating physical symptoms and psychological distress, particularly at the end of life. Interventions to help alleviate these problems are often complex and multifactorial. Palliative care services and therapeutic interventions have developed in a variable manner, often with limited evaluation of clinical effectiveness and affordability, resulting in a relatively weak evidence base. The health care provided to patients with advanced-stage cancer does not always correlate with what is known about their preferences for care. In this Review, we discuss the preferences of patients with cancer regarding their end of life care, including the importance of early provision of palliative care, and the central role of advance care planning in meeting patients' preferences. It has been shown that many patients with cancer wish to die at home. We discuss the factors that contribute to the place of death, including environmental factors, disease-specific issues, and the availability of resources. There has been a recent upward trend in the number of patients with cancer who die in their preferred place of care, and important contributors-such as community palliative care, advance care planning, and improvements in palliative care services as a result of robust research studies-are considered.
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