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| 2. |
- Benkel, Inger, et al.
(författare)
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Hospital staff opinions concerning loved ones' understanding of the patient's life-limiting disease and the loved ones' need for support
- 2012
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Ingår i: Journal of Palliative Medicine. - : Mary Ann Liebert Inc. - 1096-6218 .- 1557-7740. ; 15, s. 51-55
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to investigate the opinions of nurses, assistant nurses, and doctors about whether the patient's loved ones understand that the patient has a life-limiting disease, and if they talk about these matters with the patient or staff. The study was quantitative in design with data collected by means of a semi-structured questionnaire. The study was conducted at geriatric, oncology, and urology wards at a university hospital in western Sweden. Results indicate a perception that loved ones understand the seriousness and consequences of the disease. Professional caregivers perceived an association between the loved ones' understanding of the fatal disease and their ability to cope with the situation. In addition, the study found that follow-up activities after the patient's death are mostly lacking. © 2012, Mary Ann Liebert, Inc.
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| 3. |
- Benkel, I., et al.
(författare)
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How to Estimate Understanding: Professionals' Assessment of Loved Ones' Insight into a Patient's Fatal Disease
- 2014
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Ingår i: Journal of Palliative Medicine. - : Mary Ann Liebert Inc. - 1096-6218 .- 1557-7740. ; 17:4, s. 448-452
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Tidskriftsartikel (refereegranskat)abstract
- Background: Loved ones of a patient with an incurable disease will accompany the patient to the end of life. Health care professionals must discuss difficult matters with loved ones and be sure that they really understand the seriousness of the patient's disease. The study explore how the professionals do when they explore the grounds on which they make their assessment of loved ones' insight into a patient's fatal disease. Method: A qualitative design was chosen to gain deeper knowledge of professionals' perception of loved ones' understanding. The transcribed interviews were analysed using content analysis giving a richer understanding of the meaning of the content. Result: The participants assessed loved ones' insight into the fatal disease based on the course and content of the conversations they had with the loved ones. The professionals' assessments were based on how the loved ones talked and expressed themselves in words and behavior and on the type of questions posed by the loved ones. The loved ones' observations and hope as denial or a strategy also contributed to their assessment. Conclusion: Ways to communicate with loved ones are crucial when making an assessment. The different ways loved ones use hope and other strategies made it problematic for the professionals to use these as indicators of state of mind in this matter. Training in conversation skills could be one way to support professionals when discussing and managing these difficult situations.
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| 4. |
- Benkel, Inger, et al.
(författare)
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Using coping strategies are not denial: helping the loved ones to adjust living with a patient with a palliative diagnose.
- 2010
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Ingår i: Journal of Palliative Medicine. - : Mary Ann Liebert Inc. - 1096-6218 .- 1557-7740. ; 13:9, s. 1119-1123
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Tidskriftsartikel (refereegranskat)abstract
- Background: When a patient receives the diagnosis of an incurable cancer, their loved ones have to face the fact that life will change. Realizing that the time together is with someone who is going to die, loved ones have to cope with the situation. Objective: The objective of this study was to increase the knowledge concerning what forms of coping strategies loved ones apply when a family member is faced with an incurable cancer. Design: The study had a qualitative approach using in-depth interviews as data from a sample of consecutive loved ones. The interviews were audiotaped, transcribed verbatim, and analyzed using a manifest content analysis. Results: The main findings showed that the strategies used by loved ones could be categorized into four different areas: thinking that the death is far off in the future; hoping for an improvement; living in the present; and utilizing the family and personal network. The loved ones used these strategies in order to learn to live with the fact that their spouse had been diagnosed with an incurable illness. Conclusion: The study shows that the manner in which the coping strategies are used is individual and also depends on how loved ones can cope with the concept of a dying person with whom they are very close. When loved ones have a need for support outside their personal network, it is important to understand that this need is directly related to coping strategies and that it is not a result of denial.
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| 6. |
- Bowman, Jason K, et al.
(författare)
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Goals of Care Conversations Documented by an Embedded Emergency Department-Palliative Care Team during COVID
- 2023
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Ingår i: Journal of Palliative Medicine. - : Mary Ann Liebert Inc. - 1096-6218 .- 1557-7740. ; 26:5, s. 662-666
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Tidskriftsartikel (refereegranskat)abstract
- Background: There has been growing interest around integrating palliative care (PC) into emergency department (ED) practice but concern about feasibility and impact. In 2020, as the COVID pandemic was escalating, our hospital's ED and PC leadership created a new service of PC clinicians embedded in the ED. Objectives: To describe the clinical work of the embedded ED-PC team, in particular what was discussed during goals of care conversations. Design: Prospective patient identification followed by retrospective electronic health record chart extraction and analysis. Settings/Subjects: Adult ED patients in an academic medical center in the United States. Measurements/Results: The embedded ED-PC team saw 159 patients, whose mean age was 77.5. Nearly all patients were admitted, 48.0% had confirmed or presumed COVID, and overall mortality was 29.1%. Of the patients seen, 58.5% had a serious illness conversation documented as part of the consult. The most common topics addressed were patient (or family) illness understanding (96%), what was most important (92%), and a clinical recommendation (91%). Clinicians provided a prognostic estimate in 57/93 (61.3%) of documented discussions. In the majority of cases where prognosis was discussed, it was described as poor. Conclusion: Specialist PC clinicians embedded in the ED can engage in high-quality goals of care conversations that have the potential to align patients' hospital trajectory with their preferences.
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| 7. |
- Carlsson, Maria E., et al.
(författare)
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Predictors for Development of Pressure Ulcer in End-of-Life Care : A National Quality Register Study
- 2017
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Ingår i: Journal of Palliative Medicine. - : Mary Ann Liebert Inc. - 1096-6218 .- 1557-7740. ; 20:1, s. 53-58
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Tidskriftsartikel (refereegranskat)abstract
- Background: The scientific knowledge about pressure ulcers (PUs) is growing, but there is a shortage of studies of PUs at end of life. The recommendations regarding PU prevention in palliative care (PC) are based on consensus documents. Aim: To use data from a national register to identify predictors for development of PUs at the end of life. Design: A retrospective, descriptive, and comparative study design was used. Setting/Participants: All deceased patients over 17 years old (n = 60,319) and registered in the Swedish Register of Palliative Care (SRPC) during 2014 were included. Statistical Analysis: Logistic regression. Results: In the full model, all health units except general palliative home care had a significantly higher incidence of PUs than did the nursing homes. The well-known predictors of PUs in general, diabetes, post-fracture state, infections, and multiple sicknesses, are predictors even in dying patients. Dementia was significantly associated with lower likelihood of PUs, while pain was associated with more PUs. Intravenous drip or enteral feeding was associated with a significantly decreased likelihood of developing PUs. Conclusions: The SRPC could be a unique resource for quality improvement and research. The present study cannot prove causation, but it can report correlations between background variables and PU prevalence. More studies, with different designs, are warranted to establish the roles of risk factors for PU in end-of-life care.
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| 8. |
- Erichsén, Eva, et al.
(författare)
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Constipation in specialized palliative care : prevalence, definition and patient perceived symptom distress
- 2015
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Ingår i: Journal of Palliative Medicine. - : Mary Ann Liebert. - 1096-6218 .- 1557-7740. ; 18:7, s. 585-592
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Tidskriftsartikel (refereegranskat)abstract
- Context: The prevalence of constipation among patients in palliative care has varied in prior research, from 18-90 %, depending on different study factors.Objectives: The aim of this study was to describe and explore the prevalence and symptom distress of constipation, using different definitions of constipation, in patients admitted to specialized palliative care settings.Methods: Data was collected in a cross-sectional survey from 485 patients in 38 palliative care units in Sweden. Variables were analyzed using logistic regression and summarized as odds ratio (OR).Result: The prevalence of constipation varied between 7 – 43 %, depending on the definition used. Two constipation- groups were found: (i) Medical constipation- group (MCG; ≤ 3 defecations/week n=114; 23%); (ii) Perceived constipation- group (PCG; Patients with a perception of being constipated the last two weeks; n= 171; 35%). Three sub-groups emerged: patients with (a) only medical constipation (7 %), (b) only perceived constipation (19 %), and (c) with both medical and perceived constipation (16%). There were no differences in symptom severity between groups; 71% of all constipated patients had severe constipation.Conclusion: The prevalence of constipation may differ, depending on the definition used and how constipation is assessed. In this study we found two main groups and three sub-groups, analyzed from the definitions of frequency of bowel movements and experience of being constipated. To be able to identify constipation, the patients’ definition has to be further explored and assessed.
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| 9. |
- Ferreira, Diana H., et al.
(författare)
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Testosterone Levels in People Taking Regular Low-Dose Sustained-Release Morphine for Persisting Breathlessness : An Exploratory Study
- 2023
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Ingår i: Journal of Palliative Medicine. - : Mary Ann Liebert Inc. - 1096-6218 .- 1557-7740. ; 26:3, s. 402-405
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Tidskriftsartikel (refereegranskat)abstract
- Background: The intermediate- and long-term effects of regular low-dose sustained-release (SR) morphine on the testosterone levels of people with persistent breathlessness are unknown. Methods: Exploratory analysis of a randomized controlled trial of the effects of regular SR morphine (0/8/16/24 mg every 24 hours) for persistent breathlessness associated with chronic obstructive pulmonary disease. Total testosterone was measured at baseline and at cessation (greater than or equal to three months on stable medication). Results: Among 20 participants (9 males; median treatment duration between measurements 169 days [IQR 162-175]), only 3 had substantial declines in testosterone levels during the study (morphine 8, 16, 24 mg groups). All three had worsening illness at the time of the second assessment. There was no apparent relationship between change in testosterone, morphine dose, and change in breathlessness. Conclusions: Substantial declines in testosterone were uncommon and were not apparently related to changes in morphine dose or breathlessness, but they were possibly related with worsening illness.
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| 10. |
- Friedrichsen, Maria, 1966-, et al.
(författare)
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Concerns about losing control when breaking bad news to terminally ill patients with cancer : Physicians' perspective
- 2006
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Ingår i: Journal of Palliative Medicine. - : Mary Ann Liebert. - 1096-6218 .- 1557-7740. ; 9:3, s. 673-682
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To study and explore problems perceived by physicians when breaking bad news to advanced cancer patients about discontinuing or not offering tumor-specific treatment due to incurable cancer. Design: A qualitative phenomenographic interview study. Setting: The county of Östergötland in Sweden. Participants: Thirty physicians with different demographic characteristics. Results: According to the physicians' answers breaking bad news was perceived as involving a risk of losing control in different ways, regarding emotions, oneself, confidence, professionalism and patient trust. Four different main categories described as problems were identified, perceptions focusing on existential thoughts, relationships, knowledge, and perceptions related to time and environmental disturbances. Conclusion: Physicians perceived that breaking bad news to dying patients with cancer involved a risk of losing control. Existential thoughts and a lack of knowledge contribute to this risk. Theoretical education in existentiality/spirituality and clinical practice in a palliative context may help maintaining control. © Mary Ann Liebert, Inc.
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