144 research outputs found
The Relationships among Pain, Nonpain Symptoms, and Quality of Life Measures in Older Adults with Cancer Receiving Hospice Care
Objective.â Gathering firsthand or reported information about patients in the final stages of terminal cancer is difficult due to patient frailty, cognitive impairment, excessive fatigue, and severity of illness, as well as gatekeeping by hospice providers and caregivers, and highly variable documentation practices. We sought to further understand and elucidate endâofâlife experiences in older cancer patients through the application of validated tools employed in the hospice setting. This article summarizes data collected about pain, nonâpain symptoms, and other aspects of quality of life (QOL) as reported by older hospice patients or by their caregivers during the 2 weeks of hospice care. Design.â Data was collected from an ongoing Institutional Human Subjects Review Boardâapproved research project with 94 older adults with cancer or their caregivers receiving service in a home setting from 14 Midwestern hospices. Participants completed one or two telephone interviews. Instruments used to gather information include the Brief Pain Inventory and the Brief Hospice Inventory. Results.â Data analysis showed mean âworst painâ ratings significantly decreased from Interview 1 to Interview 2, and pain reports were significantly correlated with fatigue, anxiety, appetite, comfort, symptom control, and overall QOL. Conclusions.â Our findings reinforce previously held views that older patients with cancer experience pain and nonâpain symptoms. And both pain and nonâpain symptoms can impact and confound the treatment of other symptoms and interfere with the patient's overall QOL. The results of this study support the assertion that hospice care can have a positive impact on pain severity and related suffering, as well as patient QOL as death approaches.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/87068/1/j.1526-4637.2011.01113.x.pd
The Effect of a Translating Research into Practice (TRIP)âCancer Intervention on Cancer Pain Management in Older Adults in Hospice
Background.â Pain is a major concern for individuals with cancer, particularly older adults who make up the largest segment of individuals with cancer and who have some of the most unique pain challenges. One of the priorities of hospice is to provide a painâfree death, and while outcomes are better in hospice, patients still die with poorly controlled pain. Objective.â This article reports on the results of a Translating Research into Practice intervention designed to promote the adoption of evidenceâbased pain practices for older adults with cancer in communityâbased hospices. Setting.â This Institutional Human Subjects Review Boardâapproved study was a cluster randomized controlled trial implemented in 16 Midwestern hospices. Methods.â Retrospective medical records from newly admitted patients were used to determine the intervention effect. Additionally, survey and focus group data gathered from hospice staff at the completion of the intervention phase were analyzed. Results.â Improvement on the Cancer Pain Practice Index, an overall composite outcome measure of evidenceâbased practices for the experimental sites, was not significantly greater than control sites. Decrease in patient pain severity from baseline to postâintervention in the experimental group was greater; however, the result was not statistically significant ( P â=â0.1032). Conclusions.â Findings indicate a number of factors that may impact implementation of multicomponent interventions, including unique characteristics and culture of the setting, the level of involvement with the change processes, competing priorities and confounding factors, and complexity of the innovation (practice change). Our results suggest that future study is needed on specific factors to target when implementing a communityâbased hospice intervention, including determining and measuring intervention fidelity prospectively.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/93516/1/j.1526-4637.2012.01405.x.pd
Developing and testing a nurse-led intervention to support bereavement in relatives in the intensive care (BRIC study): a protocol of a pre-post intervention study
BACKGROUND: When a patient is approaching death in the intensive care unit (ICU), patients' relatives must make a rapid transition from focusing on their beloved one's recovery to preparation for their unavoidable death. Bereaved relatives may develop complicated grief as a consequence of this burdensome situation; however, little is known about appropriate options in quality care supporting bereaved relatives and the prevalence and predictors of complicated grief in bereaved relatives of deceased ICU patients in the Net
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