Early Palliative Care in Advanced Lung Cancer A Qualitative Study
BACKGROUND Early ambulatory palliative care (PC) is an emerging practice, and its key elements have not been defined. We conducted a qualitative analysis of data from a randomized controlled trial that demonstrated improved quality of life, mood, and survival in patients with newly diagnosed metastatic non-small cell lung cancer who received early PC integrated with standard oncologic care vs standard oncologic care alone. Our objectives were to (1) identify key elements of early PC clinic visits, (2) explore the timing of key elements, and (3) compare the content of PC and oncologic visit notes at the critical time points of clinical deterioration and radiographic disease progression. METHODS We randomly selected 20 patients who received early PC and survived within 4 periods: less than 3 months (n = 5), 3 to 6 months (n = 5), 6 to 12 months (n = 5), and 12 to 24 months (n = 5). We performed content analysis on PC and oncologic visit notes from the electronic health records of these patients. RESULTS Addressing symptoms and coping were the most prevalent components of the PC clinic visits. Initial visits focused on building relationships and rapport with patients and their families and on illness understanding, including prognostic awareness. Discussions about resuscitation preferences and hospice predominantly occurred during later visits. Comparing PC and oncologic care visits around critical time points, both included discussions about symptoms and illness status; however, PC visits emphasized psychosocial elements, such as coping, whereas oncologic care visits focused on cancer treatment and management of medical complications. CONCLUSIONS Early PC clinic visits emphasize managing symptoms, strengthening coping, and cultivating illness understanding and prognostic awareness in a responsive and time-sensitive model. During critical clinical time points, PC and oncologic care visits have distinct features that suggest a key role for PC involvement and enable oncologists to focus on cancer treatment and managing medical complications.
Available from: PubMed Central
- "Advance care planning discussions in settings other than hospitals might be more natural and less stressful. Recent study also supports this model of care and stated that early discussion should emphasize managing symptoms, strengthening coping, and cultivating illness understanding . Education programs should encourage patients and families to actively participate in this discussion as early as possible. "
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ABSTRACT: Purpose. The purpose of this study was to identify variables that influenced completion of advanced directives in the context of adaptation from national data in older adults. Knowledge gained from this study would help us identify factors that might influence end of life discussions and shed light on strategies on effective communication on advance care planning. Design and Method. A model-testing design and path analysis were used to examine secondary data from 938 participants. Items were extracted from the data set to correspond to variables for this study. Scales were constructed and reliabilities were tested. Results. The final path model showed that physical impairment, self-rated health, continuing to work, and family structure had direct and indirect effects on completion of advanced directives. Five percent of the variance was accounted for by the path analysis. Conclusion. The variance accounted for by the model was small. This could have been due to the use of secondary data and limitations imposed for measurement. However, health care providers and families should explore patient's perception of self-health as well as their family and work situation in order to strategize a motivational discussion on advance directive or end of life care planning.
Journal of aging research 12/2013; 2013(2):470812. DOI:10.1155/2013/470812
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ABSTRACT: The diagnosis of cancer is often associated with pain, suffering and dying. Many of these aspects also apply to patients dying from non-malignant disease. Being confronted with a malignancy posts an existential threat for many patients that is linked with loss of control, challenge of autonomy and fear of the future. In contrast, patients with non-malignant disease do not realise the scope of their diagnosis and the potentially life-limiting nature of their disease. The prognosis of patients with chronic organ failure is often shorter than that of some patients with malignancies. Patients with malignant and non-malignant disease suffer from pain and many other symptoms. Tumour-oriented therapies, side effects and changes of the body image add to the suffering of cancer patients. Although consequences of the disease and the therapies are often not visible in patients with non-malignant disease, the increasing functional decline, psychosocial burden, lack of co-ordination of care, and information needs burden patients. Wishes at the end of life are similar in cancer and non-cancer patients. Access to palliative care is much easier for cancer patients than for non-cancer patients.
Zeitschrift für Evidenz Fortbildung und Qualität im Gesundheitswesen 01/2013; 107(2):136–139. DOI:10.1016/j.zefq.2013.02.001
JAMA Internal Medicine 01/2013; 173(4):1-2. DOI:10.1001/jamainternmed.2013.1888 · 13.12 Impact Factor
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.