Journal of palliative medicine
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Advances in cancer treatment present challenges to patients with metastatic cancer who have to make treatment decisions in the face of newer and more effective treatments. Patients' awareness of disease status has been an important factor in making treatment choices. We conducted a systematic review of the published literature from 1997-2014 to evaluate the evidence of the impact of patients' awareness of disease status on treatment preferences and quality of life among patients with metastatic cancer. ⋯ The overall quality of the included 15 quantitative studies was adequate. A critical limitation of current literature is the lack of consistent conceptual or operational definitions for the concept of patients' awareness of disease status. The included studies conceptualized patients' awareness of disease status either as being informed or understanding one's disease prognosis. Significantly more patients who were aware of their disease status were less likely to choose life-extending treatment or measures. Mixed findings were shown regarding the impacts of patients' awareness of disease status on quality of life. Absence of qualitative studies limited the review's ability to critically synthesize the concept of awareness of disease status. Well-designed qualitative studies are needed to shed light on the conceptualization and operationalization of the concept to better capture the impact of patients' awareness of disease status on treatment preferences and quality of life.
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Pediatric palliative care increasingly became integrated into health care institutions worldwide over the last decade. However, in Mexico and other developing countries with large populations of children, little is known regarding the need for palliative care services. We aimed to assess the need for palliative and end-of-life care for children dying in public hospitals affiliated with Secretaria de Salud in Mexico. ⋯ A large proportion of pediatric deaths are associated with complex chronic conditions indicating the provision of adequate funding for professional education and palliative care initiatives for children in Mexico, should be a topic of the national health care agenda.
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Comparative Study
Improved quality of life at end of life related to home-based palliative care in children with cancer.
Nearly 2000 children die due to a malignancy in the United States annually. Emerging data suggest that home is the desired location of care for children with cancer at end of life. However, one obstacle to enrollment in a pediatric palliative care (PPC) home care program may be fear that distressing symptoms at end of life cannot be adequately managed outside the hospital. ⋯ This is the first North American study to assess outcomes among children with cancer who received concurrent oncology and palliative home care compared with those who received oncology care alone. Symptom distress experiences were similar in groups. However, children enrolled in a PPC home care program appear to have improved quality of life and are more likely to die at home.
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Comparative Study
Consciousness levels one week after admission to a palliative care unit improve survival prediction in advanced cancer patients.
Consciousness is an important factor of survival prediction in advanced cancer patients. However, effects on survival of changes over time in consciousness in advanced cancer patients have not been fully explored. ⋯ Consciousness levels one week after admission should be integrated into survival prediction in advanced cancer patients.
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Comparative Study
Predictors of six-month mortality among nursing home residents: diagnoses may be more predictive than functional disability.
Loss of daily living functions can be a marker for end of life and possible hospice eligibility. Unfortunately, data on patient's functional abilities is not available in all settings. In this study we compare predictive accuracy of two indices designed to predict 6-month mortality among nursing home residents. One is based on traditional measures of functional deterioration and the other on patients' diagnoses and demography. ⋯ For nursing home residents, comorbid diagnoses predict 6-month mortality more accurately than functional status. The HELP Index can be used to estimate 6-month mortality from hospital data and can guide prognostic discussions prior to and following nursing home admission.