Systematic review of the efficacy of antiemetics in the treatment of nausea in patients with far advanced cancer

Objectives: To systematically review studies of antiemetics used in the treatment of nausea in patients with far-advanced cancer. Data sources: Randomized controlled trials (RCT) and uncontrolled studies identified by electronic and hand searching. Review methods: Identified studies were appraised for quality and effect size. Results: Of 21 studies included, 2 were systematic reviews, 7 were RCT and 12 were uncontrolled studies or case series. Differences in interventions and outcomes amongst the RCT precluded any quantitative data synthesis and all seven studies were prone to bias. Whereas uncontrolled studies indicated a high response rate to standard regimens (75-93% for both nausea and vomiting), RCT showed much lower response rates to these agents (23-36% for nausea, 18-52% for vomiting). The two methods of antiemetic choice (choice based either on the inferred mechanism or empirical) were equally effective. There is reasonably strong evidence for the use of metoclopramide in cancer-associated dyspepsia and steroids in malignant bowel obstruction. There was conflicting evidence about the efficacy of serotonin antagonists compared with standard treatments (e.g. metoclopramide, dopamine antagonists and dexamethasone). There was little or no evidence of the efficacy of some commonly used and seemingly effective drugs such as haloperidol, cyclizine, and methotrimeprazine. Conclusion: Evidence supporting the existing consensus-based guidelines for management of nausea and vomiting in advanced cancer is sparse. Current approaches to treatment based on the neuropharmacology of the emetic pathway may be inappropriate in this setting. Well-designed studies of the impact of "standard" management and novel agents on nausea and vomiting in palliative populations are needed

Testing the feasibility of the Dignity Therapy interview: adaptation for the Danish culture

<p>Abstract</p> <p>Background</p> <p><b>'</b>Dignity Therapy' (DT) is a brief, flexible intervention, which allows patients to complete an interview and create a document regarding their life, identity and what they want to leave in writing for their loved ones. DT is based on the DT Question Protocol. Developed and tested in English speaking settings, DT has proven to be a feasible and effective way to enhance patient dignity, while diminishing suffering and depression. The aim of this study was to test the acceptability and feasibility of the DT Question Protocol among Danish health professionals and cancer patients, and to obtain preliminary estimates of patient uptake for DT. These results will be used to inform a larger evaluation study.</p> <p>Method</p> <p>Ten professionals were interviewed about their perception of DT and the Question Protocol. It was then tested with 20 patients at two palliative care sites and one gynecologic oncology department. Data was analyzed using content analysis techniques to evaluate the protocol for relevance, acceptability and comprehension. The interest and relevance of the intervention was also determined by examining the preliminary participation rate.</p> <p>Results</p> <p>Overall, DT was perceived to be comprehensible and relevant. Professionals highlighted six concerns that might warrant modification. These issues were examined using patient data. Some of their concerns overlapped with those raised by the professionals (e.g. <it>'unacceptable self-praise' </it>and '<it>interference with the lives of others'</it>). Tailoring DT to Danish culture required easily accommodated adjustments to the procedures and the DT Question Protocol. Some concerns expressed by health professionals may have reflected protectiveness toward the patients. While the intervention was relevant and manageable for patients admitted to palliative care, DT was less easily implemented at the gynecologic oncology department.</p> <p>Conclusion</p> <p>Based on patients' and professionals' reaction to the DT Question Protocol, and based on the preliminary proportion of participants accepting DT, the DT question protocol - with minor adaptations - appears to be a manageable, acceptable and relevant intervention for Danish patients admitted to palliative care.</p

Validity and reliability testing of the FAMCARE scale: measuring family satisfaction with advanced cancer care

The purpose of the study was to test the validity and reliability of the FAMCARE Scale which was developed to measure family satisfaction with advanced cancer care. The FAMCARE Scale was developed based upon earlier qualitative research which identified indicators of family care satisfaction and a subsequent Q-sort study that reduced those items to the most salient indicators of satisfaction according to a larger, representative sample (N = 210). A pilot test of the FAMCARE Scale using a convenience sample of 30 family members of advanced cancer patients was conducted. The scale achieved internal consistency estimates of 0.93 at two testing times, a test-retest correlation of 0.91, and estimates of criterion validity using the McCusker Scale of 0.80 and 0.77. Cluster analysis of the scale suggested 4 subdimensions. Although the scale requires further testing to establish its reliability and validity, these preliminary results indicate that the scale may be a psychometrically sound instrument useful for measurement of family satisfaction with advanced cancer care

Positioning nursing and midwifery research for the future: external and internal challenges

In the past 25 years Australian nursing and midwifery have made remarkable professional strides. The professions have moved boldly to embrace university-based education, developed innovative postgraduate curricula and have engaged in innovative clinical-academic partnerships to build research and clinical scholarship (Borbasi, Emden & Jackson, 2005). During this time, nursing and midwifery have also faced a number of challenges. As we take stock of our place in history, it is clear that our future has never been so promising or so critical. In forecasting the future for nursing and midwifery research, it is helpful to acknowledge our history---but it is more important to imagine what is possible, build on our capabilities, and strategically map a direction. A tactical scan of the external and internal environments shaping our research reveals a number of pressure points and policy drivers

Conceptual issues related to measurement in family research

Abstract not available

Indicators of quality of palliative care from a family perspective

Examined indicators that families of the terminally ill perceive to be important in the care of the patient and themselves. 20 families of patients being cared for on a palliative care ward were asked to describe the patient's illness experience and identify the things that were important in the care of the patient and family. There were 74 caregiver behaviors identified that were important to patient care and 77 behaviors identified as important to family care. Behaviors regarded as important by family members included making patients as comfortable as possible, the type of information provided by caregivers, and the ways in which such information is communicated. Complete lists of both behavior types are appended

Validity and reliability testing of the FAMCARE scale: Measuring family satisfaction with advanced cancer care

The purpose of the study was to test the validity and reliability of the FAMCARE Scale which was developed to measure family satisfaction with advanced cancer care. The FAMCARE Scale was developed based upon earlier qualitative research which identified indicators of family care satisfaction and a subsequent Q-sort study that reduced those items to the most salient indicators of satisfaction according to a larger, representative sample (N = 210). A pilot test of the FAMCARE Scale using a convenience sample of 30 family members of advanced cancer patients was conducted. The scale achieved internal consistency estimates of 0.93 at two testing times, a test-retest correlation of 0.91, and estimates of criterion validity using the McCusker Scale of 0.80 and 0.77. Cluster analysis of the scale suggested 4 subdimensions. Although the scale requires further testing to establish its reliability and validity, these preliminary results indicate that the scale may be a psychometrically sound instrument useful for measurement of family satisfaction with advanced cancer care.measurement family cancer satisfaction

Long-Term Palliative Care Workers: More Than a Story of Endurance

This study sought to explore the stories of long-term palliative care workers to generate an understanding of their experiences of working in palliative care for an extended period of time. Six health professionals participated in the study, each of whom were currently working in a palliative care service, and each of whom had been working continuously in palliative care services for a minimum of 5 years. Descriptions of their experiences provided insight into the reasons for choosing this work, the stages they went through along the way, and the factors that sustain and challenge them as they continue to work in the area. Five phases in the trajectory of working in palliative care were described: The Awakening, Making the Connection, Committing to the Philosophy, Reaping the Rewards, and Soldiering On. Results from this study may be helpful to educators and administrators who endeavour to develop and support this workforce. Furthermore, the descriptions provided in this study may provide direction for individuals working in palliative care who may be called on to reflect on their own work trajectory and their commitment to the field