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Latest & greatest articles for palliative care
The Trip Database is a leading resource to help health professionals find trustworthy answers to their clinical questions. Users can access the latest research evidence and guidance to answer their clinical questions. We have a large collection of systematic reviews, clinical guidelines, regulatory guidance, clinical trials and many other forms of evidence. If you wanted the latest trusted evidence on palliative care or other clinical topics then use Trip today.
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PalliativeCare for the Patient with Incurable Cancer or Advanced Disease: Part 1: Approach to Care Guidelines & Protocols Advisory Committee PalliativeCare for the Patient with Incurable Cancer or Advanced Disease Part 1: Approach to Care Effective Date: February 22, 2017 Scope This guideline presents palliativecare assessment and management strategies for primary care practitioners caring for adult patients aged = 19 years with incurable cancer and end stage chronic disease of many types (...) , and their families. NOTE: Care gaps have been identified at important transitions for this group of patients: • upon receiving a diagnosis of incurable cancer; • when discharged from active treatment to the community; • while still ambulatory but needing pain and symptom management; and • at the transition when End-of-Life care may be needed. Diagnostic code: 239 (neoplasm of unspecified nature) Palliativecare planning fee code: G14063 Key Recommendations • Identify patients who would benefit from palliative
PalliativeCare for the Patient with Incurable Cancer or Advanced Disease: Part 3: Grief and Bereavement Guidelines & Protocols Advisory Committee PalliativeCare for the Patient with Incurable Cancer or Advanced Disease Part 3: Grief and Bereavement Effective Date: February 22, 2017 Scope This guideline addresses the needs of adult patients with incurable cancer or advanced disease (but can be useful for adults dying of any cause), as well as the needs of their caregivers or family, including (...) contacting the Physician Health Program. Refer to Associated Document: Resource Guide for Patients and Caregivers. BCGuidelines.ca: PalliativeCare for the Patient with Incurable Cancer or Advanced Disease 2 Part 3: Grief and Bereavement (2017) Grief } Assessment of Grief • Consider using the Adult Attitudes to Grief Scale 3 (Appendix A: Adult Attitudes to Grief Scale – Patient Handout, Practitioner Score Sheet, and Protocol for Use). The Adult Attitudes to Grief Scale is a brief, self-reported, evidence
Impact of intervention aimed at improving the integration of oncology units and local palliativecare services: results of the multicentre prospective sequential MIRTO study Chemotherapy (CT) in patients with advanced cancer (ACP) near the end of life is an increasing practice of oncology units. A closer integration with palliativecare (PC) services could reduce the use of potentially harmful CT. This prospective study is aimed at assessing whether a more integrated care model could reduce CT
What is the value of palliativecare provision in low-resource settings? 28588999 2018 11 13 2059-7908 2 1 2017 BMJ global health BMJ Glob Health What is the value of palliativecare provision in low-resource settings? e000139 10.1136/bmjgh-2016-000139 Anderson R Eleanor RE Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA. Grant Liz L Global Health Academy, University of Edinburgh, FRCPE, Edinburgh, UK. eng Journal Article 2017 02 14 England BMJ (...) Glob Health 101685275 2059-7908 Competing interests: None declared. 2016 07 26 2016 11 03 2017 6 8 6 0 2017 6 8 6 0 2017 6 8 6 1 epublish 28588999 10.1136/bmjgh-2016-000139 bmjgh-2016-000139 PMC5335766 Afr J Prim Health Care Fam Med. 2014 Nov 14;6(1):E1-8 26245417 Lancet. 2013 Sep 21;382(9897):1060-9 23697823 J Pain Palliat Care Pharmacother. 2003;17(3-4):xxix-xxxvi 15022945 Lancet. 2016 May 21;387(10033):2133-44 26578033 Science. 2009 Oct 30;326(5953):682-8 19900925 Indian J Palliat Care. 2016 Jul
Effects of Early Integrated PalliativeCare in Patients With Lung and GI Cancer: A Randomized Clinical Trial Purpose We evaluated the impact of early integrated palliativecare (PC) in patients with newly diagnosed lung and GI cancer. Patients and Methods We randomly assigned patients with newly diagnosed incurable lung or noncolorectal GI cancer to receive either early integrated PC and oncology care (n = 175) or usual care (n = 175) between May 2011 and July 2015. Patients who were assigned (...) to the intervention met with a PC clinician at least once per month until death, whereas those who received usual care consulted a PC clinician upon request. The primary end point was change in quality of life (QOL) from baseline to week 12, per scoring by the Functional Assessment of Cancer Therapy-General scale. Secondary end points included change in QOL from baseline to week 24, change in depression per the Patient Health Questionnaire-9, and differences in end-of-life communication. Results Intervention
Palliativecare - nausea and vomiting Palliativecare - nausea and vomiting - NICE CKS Clinical Knowledge Summaries Share Palliativecare - nausea and vomiting: Summary Nausea is an unpleasant sensation of the need to vomit, which is often accompanied by autonomic symptoms (for example pallor, cold sweat, salivation, and tachycardia). Vomiting (emesis) is the forceful ejection of stomach contents through the mouth. There are many causes of nausea and vomiting in the palliativecare setting (...) the stage of the person’s illness, their prognosis, the severity of their symptoms, and the wishes of the person and their family. Simple measures may help relieve nausea and vomiting in palliativecare. They include: Ensuring access to a large bowl, tissues, and water. Eating snacks consisting of a few mouthfuls rather than large meals. Drinking cool fizzy drinks rather than still or hot drinks. Relaxation techniques. Parenteral hydration, if appropriate. Cognitive behavioural therapy (for anticipatory
Palliativecare - oral Palliativecare - oral - NICE CKS Clinical Knowledge Summaries Share Palliativecare - oral: Summary Common oral problems in palliativecare include dry mouth, painful mouth, halitosis, alteration of taste, and excessive salivation. They may result from poor oral intake, drug treatments, local irradiation, oral tumours, or chemotherapy. Oral symptoms may significantly affect the person's quality of life, causing eating, drinking, and communication problems, and oral (...) discomfort and pain. When assessing a person with oral symptoms in palliativecare: Ask about dry mouth, oral pain, halitosis, alteration in taste, excessive salivation, bad breath, difficulty chewing, difficulty speaking, dysphagia, and bleeding. Examine the oral cavity for signs of dehydration, level of oral hygiene, ulceration and vesicles, erythema or white patches, local tumour, bleeding, and infection. The cause of most oral problems can be diagnosed on the basis of clinical features alone
Palliativecare - malignant skin ulcer Palliativecare - malignant skin ulcer - NICE CKS Clinical Knowledge Summaries Share Palliativecare - malignant skin ulcer: Summary A malignant ulcer is a proliferative or cavitating primary or secondary cancer in the skin. It may appear as a crater-like wound, a nodular 'fungus', or a 'cauliflower' lesion. Most malignant ulcers develop from a breast, head and neck, or skin cancer. Malignant ulcers are most likely to develop in people older than 70 years (...) of life as much as possible. Ensuring a professional with expertise in wound management is involved in the person's care (such as a district nurse, palliativecare or tissue viability nurse). This professional can advise on the need for cleansing, debridement, and the correct selection and use of dressings. Referral where appropriate to an oncologist or palliativecare specialist for advice if further cancer treatment is possible (such as radiotherapy, chemotherapy, hormone therapy, or surgical
Palliativecare - general issues Palliativecare - general issues - NICE CKS Clinical Knowledge Summaries Share Palliativecare - general issues: Summary Palliativecare is defined as the active holistic care of people with advanced, progressive illness. Professionals providing general palliativecare services should: Be involved as early as possible after diagnosis. Aim to meet the needs of the patient and their family within the limits of their knowledge and competence. Seek specialist advice (...) : Should be based on locally agreed protocols and guidelines, delivered within the context of a managed system or pathway. Requires a multidisciplinary team because of the potential multidimensional nature of problems in palliativecare. Have I got the right topic? Have I got the right topic? From age 16 years onwards. This CKS topic covers the general management issues related to palliativecare and incorporates guidance from the National Institute for Health and Care Excellence on Improving
Palliativecare - dyspnoea Palliativecare - dyspnoea - NICE CKS Clinical Knowledge Summaries Share Palliativecare - dyspnoea: Summary Breathlessness is an objective observable sign, whereas dyspnoea is a subjective described symptoms of difficulty in breathing. Anxiety is often a major component of dyspnoea. Dyspnoea can result from impaired ventilation or increased ventilatory demand, or both factors. There are multiple possible causes of dyspnoea in people with cancer, including: Direct (...) causes — such as primary lung cancer or lung metastases. Indirect effects of cancer — such as pleural effusion, superior vena cava syndrome, anaemia, pulmonary embolism, and surgery. Non-malignant causes — such as pneumonia, chronic obstructive pulmonary disease, heart failure, and anxiety. Assessment of someone with dyspnoea in a palliativecare setting involves asking about: Features of the dyspnoea (for example severity, timing, onset, and precipitating and exacerbating factors). Associated
Palliativecare - cough Palliativecare - cough - NICE CKS Clinical Knowledge Summaries Share Palliativecare - cough: Summary Cough is a defensive reflex that occurs in response to stimulation of irritant receptors which are found in the airways. It has two functions — to prevent foreign material entering the lower respiratory tract, and to clear secretions from the lungs and airways. Cough in people with cancer is most commonly associated with cancer of the airways, lungs, pleura (...) , and mediastinum, but tumours metastasizing to the thorax can also cause cough. In people with cancer, the most common cause of acute cough is respiratory tract infection. Other possible non-malignant causes include post-nasal drip, asthma, chronic obstructive pulmonary disease, and gastro-oesophageal reflux disease. When assessing someone with cough in palliativecare, the following should be elicited: The impact on the person's quality of life. The severity, time of onset, and duration of the cough
Palliativecare - constipation Palliativecare - constipation - NICE CKS Clinical Knowledge Summaries Share Palliativecare - constipation: Summary Constipation is defecation that is unsatisfactory because of infrequent stools, difficult stool passage, or seemingly incomplete defecation. Stools are often dry and hard, and may be abnormally large or abnormally small. About 80% of people with cancer will require treatment with laxatives at some time. People receiving palliativecare have multiple (...) causes of constipation, such as: Drugs, for example, opioid analgesics, antimuscarinic drugs, antacids. Secondary effects of disease, for example, dehydration, inadequate dietary fibre, inactivity, delirium, spinal cord compression, lack of privacy. Direct effects of malignant tumours, causing bowel obstruction, hypercalcaemia, nerve damage. When assessing a person with constipation in palliativecare: The history should include information about the frequency and character of stools, discomfort