Journal of palliative medicine
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Background: Little is known about the aggressiveness of cancer care at the end of life (ACCEoL) for children with cancer in countries where palliative care (PC) is scarce. Objective: The aim of this study was to determine the frequency and time trends of ACCEoL in the pediatric population in a Western European country. Setting/Subjects: We conducted a retrospective cohort study analyzing children between 0 and 17 years who died of cancer in public hospitals in Portugal, from January 2010 to December 2015. ⋯ The prevalence of ACCEoL remained stable over the period. Conclusions: In our cohort about 9 out of 10 children with cancer experienced at least one indicator of ACCEoL, a rate higher than in countries with well-developed PC services. There is a need to improve the care in the last months of life for children with cancer.
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Background: Recent research indicates that psychedelic-assisted therapy (PAT) may be a safe and effective treatment for several psychiatric disorders, including those experienced by people with serious physical illness. Understanding health care workers' (HCWs') attitudes and knowledge about the clinical application of psychedelics for patients with serious illness is important in progressing research and identifying factors to consider in potential future implementation of PAT. Aim: The aim of this systematic review was to synthesize quantitative, qualitative, and mixed methods studies that explored HCWs' attitudes and knowledge about the role of psychedelics in treating psychological distress in patients with serious illness. ⋯ Five themes were developed: Polarized views about PAT for patients with serious illness; attitudes often informed by PAT research knowledge and heuristic methods; stronger evidence base needed to increase HCWs' confidence and support implementation of PAT; barriers may hinder PAT's potential integration into existing care models; and team-based approach and clinical education are essential to facilitate PAT. Conclusion: Although support for PAT varied, most HCWs perceived potential benefits in treating refractory distress, desired education about PAT, and called for further research to develop a stronger evidence base. Limitations of the review and included studies are discussed, along with implications of the findings and recommendations for future research.
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Background: Inpatient hospices (IHs) can alleviate distress and address economic burdens on patients with terminal cancer. However, there have been inconsistent findings regarding IHs in terms of cost savings and medication use. Objective: We aimed to examine cost savings associated with IHs, according to the timing of first hospitalization before death, and analyze their use of medication, among Korean patients with terminal lung cancer. ⋯ IHs used 2.103 times more opioid analgesics (95% CI: 1.980-2.233, p < 0.001). They also used more antiemetics, delirium medications, and antianxiety agents, as well as fewer antidepressive agents, systemic steroids, diuretics, total parenteral nutrition, and antibiotics (all p < 0.05). Conclusions: Patients with terminal lung cancer in IHs in Korea were more likely to receive symptom-oriented medications and experienced reduced hospitalization costs only during the 30 days preceding death.
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Background: Caregivers are engaging in recreational travel with the neuro-oncology patients they care for, yet there is little scientific research on this phenomenon. Aim: The purpose of this study is to examine the experiences of recreational travel among caregiver-patient with brain cancer dyads from the perspective of the caregivers. Specifically, we examined (1) context (i.e., why and when) of recreational travel, (2) the caregiver's travel preparations, and (3) the impact of the travel on caregivers. ⋯ Caregivers most often described the emotional impact of travel, which was often complex and bittersweet. Conclusions: Travel with a patient with brain cancer may be an important goal for caregivers and could help create meaning and memories, but can also present challenges. Early and clear communication from the care team can play a role in supporting meaningful trips.