\u27Death is difficult in any language\u27: A qualitative study of palliative care professionals\u27 experiences when providing end-of-life care to patients from culturally and linguistically diverse backgrounds

Background: Ethnic minority patients have unique challenges in accessing health services. These include language difficulties, unfamiliarity with the health system, lower rates of cancer screening and survival, higher rates of reported side effects from cancer treatment and poorer quality of life. Little is known about this patient group when transitioning to palliative care. Aim: To elicit the experiences of palliative care health professionals when providing care for patients from culturally and linguistically diverse backgrounds which differ from mainstream Australian language and culture. Design: An emergent qualitative design, informed by theoretical and procedural direction from grounded theory research. Setting/participants: Four focus groups held with palliative care staff (n=28) in a single specialist palliative care service in Australia. Results: The following themes emerged: 1) determining the rules of engagement around discussion of diagnosis and prognosis; 2) navigating the challenge of language to patient understanding; 3) understanding migration experiences to establish trust; 4) maintaining the balance between patient safety and comfort care; 5) providing a good death experience through accommodation of beliefs; and 6) navigating the important role of family members while privileging patient preferences. Conclusion: Underlying provider perceptions of caring for patients was that death is difficult in any language. Care was conceptualised as considering cultural and linguistic backgrounds within individualistic care. Understanding the migration experience and building trust were key elements of this individualised approach. Acknowledgement of the key role played by families in patient care and safety are strategies to minimise barriers and understand the concerns of this patient group

Leczenie chorej na ostrą białaczkę szpikową z obecnością mutacji FLT3-ITD

Acute myeloid leukemia (AML) is an aggressive myeloid malignancy characterised by ineffective haematopoiesis. A hallmark of AML is an unusual cytogenetical and molecular diversity, which define the treatment and has a huge impact on the patient’s treatment response and overall survival. Mutations most commonly detected in AML are the one in FMS-like tyrosine kinase 3 gene (FLT3). We hereby present a case report of a patient with AML with FLT3-ITD mutation treated with standard induction and consolidation chemotherapy combined with midostaurin.Ostra białaczka szpikowa (OBS) jest agresywną, nowotworową chorobą szpiku kostnego charakteryzującą się nieefektywną hematopoezą. Chorobę tę cechuje niezwykła różnorodność cytogenetyczno-molekularna, co przekłada się na dobór terapii oraz odsetek odpowiedzi na chemioterapię i przeżycie pacjentów. Jednym z częstszych zaburzeń genetycznych obserwowanych u chorych na OBS jest mutacja w genie kinazy tyrozynowej 3 typu FMS (FLT3). W poniższym artykule przedstawiono opis przypadku chorej z OBS z mutacją FLT3-ITD poddanej standardowemu leczeniu indukująco-konsolidującemu w połączeniu z midostauryną

Patient reported outcomes of pastoral care in a hospital setting

This study aimed to establish whether Pastoral Care (PC) visits were an effective component of a hospitalized patient’s overall health experience. Outcomes of PC visits were reported by 369 patients in 7 sites across Australia. The patient reported outcomes of PC visits included: the patients felt they could be honest with themselves, with a sense of peace, a better perspective of their illness, less anxiety, and felt more in control. Five factors of the PC visit significantly related to higher patient’s overall outcomes: (a) having more Pastoral Care visits (p \u3c 0.5 0 R 0.778, CI 0.17–1.38); (b) the patient was able to talk about what was on their mind (p \u3c 0.01, OR1.48, CI 0.58–2.37); (c) they had something to be hopeful about (p \u3c 0.01 OR1.18, CI 0.51–1.85); 4); the visit focused on decisions about the patient’s health care (p \u3c 0.05, OR0.70, CI 0.05–1.35); and (d) a belief in God/Higher Being (p \u3c 0.01, OR 1.01, CI 0.43–1.71)

Culturally and linguistically diverse palliative care patients\u27 journeys at the end-of-life

Objective: To understand the clinical and psychosocial journey of culturally and linguistically diverse (CALD) palliative care patients. Method: This study was conducted at a subacute hospital with a specialist palliative care unit and a community palliative care service in a metropolitan region of New South Wales, Australia. Medical records of 100 deceased patients from CALD backgrounds over a 12-month period from 2014 to 2015 were recorded on a data mining tool. The cohort had transitioned to either community or inpatient palliative care services with a life-limiting illness. We used descriptive statistical analyses to identify the patients’ end-of-life journeys in the physical, psychological, spiritual, and social palliative care domains. Staff case notes were used to enrich the quantitative data. Result: The most common symptoms burdening the patients were decreased mobility (82%), pain (76%), and poor appetite (60%). The majority of patients (87%) were diagnosed with cancer. Language was a major barrier to the assessment and management of symptoms. The vast majority of patients were born in Europe and Asia. Twenty-nine percent of the patients preferred to use English. However, among patients who required an interpreter on admission, only 9% used professional interpreters. Family distress around patients’ lack of food consumption was prominent, along with provider concern when this led to families “force feeding” patients. Only 5% of files documented patients’, and 21% of files documented families’, cultural wishes or needs. Care of the body after death was only documented in 20% of files. Significance of results: The increasing cohort of older people from CALD backgrounds will have significant implications for the planning and delivery of palliative care services. There is an emerging need to address the physical, psychological, spiritual, and social palliative care domains in the end-of-life journeys of patients from CALD backgrounds to ensure the provision of quality care