Palliative Care Commons^™

When Healthcare Leadership And Philanthropy Lead To An Improved Patient Experience: The Paul Lepsoe Music Initiative, Sara Olivier Rn Bscn Mn, Corianne Bell Ba Mus, Cheryl Jones Registered Psychotherapist, Mta, Phd, Jerry M. Maniate Md, M.Ed, Frcpc, Facp

Patient Experience Journal

Through an unprecedented collaboration between an academic acute tertiary care hospital (The Ottawa Hospital (TOH) and a community-based professional orchestra (Ottawa Symphony Orchestra (OSO), the Paul Lepsoe Music Initiative represented an innovative partnership focused on improving patient care via (a) the integration of live music in waiting areas of the hospital’s Cancer Center and (b) the creation of individualized music therapy interventions on the inpatient Palliative Care Unit. Patient, family, and volunteer/staff feedback further refined the intervention throughout the duration of the Initiative; a qualitative process that provided insight into the overall patient experience and opportunities for patients and families …

Conference Proceedings: Select Abstracts Presented At 2021 Advocate Aurora Health Scientific Day

Journal of Patient-Centered Research and Reviews

Abstracts published within this supplement were presented at the 47th annual Advocate Aurora Health Scientific Day, held virtually on May 26, 2021. This research symposium provides a forum for disseminating results from studies conducted by faculty, fellows, residents, and other allied health professionals associated with Midwest-based health system Advocate Aurora Health, which publishes the Journal of Patient-Centered Research and Reviews.

A Light In The Dark: End-Of-Life Conversations In Advanced Cancer Patients Improve Caregiver Grief, Nicole Meeks

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

Wright AA, Zhang B, Ray A, Mack JW, Trice E, Balboni T, Mitchell SL, Jackson VA, Block SD, Maciejewski PK, & Prigerson HG. Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. JAMA. 2008;300(14):1665-1673. https://doi.org/10.1001/jama.300.14.1665

for a patient with end stage cancer and an anxious caregiver.

Palliative Care And Life-Sustaining/Local Procedures In Colorectal Cancer In The United States Hospitals: A Ten-Year Perspective, Zahra Mojtahedi, Ja Seol Koo, Ji Yoo, Pearl Kim, Hee-Taik Kang, Jinwook Hwang, Moon Kyung Joo, Jay J. Shen

School of Medicine Faculty Research

Background: In recent years, palliative care utilization has been increasing while life-sustaining/local procedures have been declining at the end of life. Palliative care utilization widely varies based on tumor type. Limited information is available on inpatient palliative care in colorectal cancer. Aims: This study investigated inpatient palliative care utilization and its association with patient demographics, hospital charges, and procedures among colorectal cancer patients admitted to US hospitals between 2008 and 2017. Receipt of life-sustaining and local procedures and surgeries were also investigated during the ten years. Methods: Data were extracted from the National inpatient sample (NIS) database containing de-identified information …

Treatment Of Orbital Lesions Using Cyberknife Stereotactic Radiosurgery, Emily Morahan

Student Research Poster Presentations 2021

The purpose of the research done was to evaluate the use of CyberKnife Stereotactic Radiosurgery (SRS) for treating orbital lesions. Efficacy and tolerability of such treatment was analyzed with data drawn from multiple sources, regarding dose and fractionation, quality of life following treatment(s) and prognosis. CyberKnife SRS is the newest, most advanced model of radiation delivery systems, featuring a robotic arm capable of manipulating the linear accelerator into thousands of unique angles. The addition of new angles allows for a more precise concentration of radiation delivered to the lesions. In the case of optic lesions, it is crucial to minimize …

Association Of Incident Cancer To Low-Value Care And Healthcare Cost Burden Among Elderly Medicare Beneficiaries, Chibuzo Iloabuchi

Graduate Theses, Dissertations, and Problem Reports (ETD)

In the United States (US), 25% of healthcare spending is considered wasteful because it is spent reimbursing low-value care. Low-value care is the utilization of healthcare services, medical tests, and procedures that have unclear or no clinical benefit to patients but still exposes them to risk. World-wide, low-value care imposes a significant economic burden on patients, payers, governments, and society. Cancer care among older adults > 65 years is one of the biggest drivers of healthcare expenditure in the US and accounts for nearly 40% of all spending, and low-value care among cancer patients is prevalent and contributes to the financial …

Bystanders’ Perspectives On The Provision Of Informal, Hospital-Based Care To Bedridden Patients With Cancer In Sri Lanka, B. Sunil S. De Silva

Nursing ETDs

Due to the nursing shortage in Sri Lanka, patients need informal caregivers, known as bystanders, to help provide patient care. This study described bystanders’ perspectives on informal, hospital-based care to bedridden patients with cancer in Sri Lanka. In this qualitative descriptive study, 17 bystanders at Apeksa/Cancer Hospital, Sri Lanka, were recruited using snowballing sampling. Data were collected through telephone interviews and analyzed using content and thematic analyses. Findings showed that paid and unpaid bystanders cover all caregiving tasks with minimum interaction with nurses. Unpaid bystanders described the need for same-sex bystanders and additional help with patients’ mobilization and specialized care. …

Conference Proceedings: Aurora Scientific Day 2020

Journal of Patient-Centered Research and Reviews

Abstracts published in this supplement were among those presented at the 46th annual Aurora Scientific Day research symposium, held virtually on May 20, 2020. The symposium provides a forum for describing research studies conducted by faculty, fellows, residents, and allied health professionals affiliated with Wisconsin-based Aurora Health Care, a part of the Advocate Aurora Health health system, which publishes the Journal of Patient-Centered Research and Reviews.

Unexpected Hope For A Multiple Myeloma Patient, Minodora Cezarina Onisâi, Iuliana Iordan, Mihaela Gaman, Horia Bumbea, Ana-Maria Vlădăreanu

Journal of Mind and Medical Sciences

Multiple myeloma (MM) is a plasma cell neoplasm, characterized by periods of remission and relapses. The emergence of novel therapies, with multiple mechanisms of action and fewer adverse reactions, brings more and better options and also a higher survival rate. However, MM is still an incurable disease, and patients eventually become refractory to an extensive range of therapies. We present the case of a patient diagnosed with MM standard risk, who was at first refractory to multiple treatment regimens, and then had an unexpected and stable complete response to a newer drug of the same class.

Challenges In Teaching Palliative Care Module Virtually During Covid-19 Era, Shanaz Hussein Cassum, Khairunnisa Mansoor, Amina Hirji, Amber David, Amina Aijaz Khowaja

School of Nursing & Midwifery

With the COVID-19 pandemic hitting the global community, routine activities of universities, offices, and industries have been hindered. People are being forced to rethink the ways of working virtually from home for providing education, business, and health services in this social distancing during the COVID era. This sudden shift also posed challenges of online teaching in a private university, in urban Karachi, Pakistan. The Aga Khan University, School of Nursing and Midwifery recently conducted an online palliative care module using a virtual learning environment and Microsoft Teams for Trainee Nurse Interns. Although the first experience of online teaching and learning …

Utilization Of Evidence-Based Telehealth For Routine Follow-Up Visits In Outpatient Palliative Care, Nienke Sahelijo Bsn, Rn, Dnp-Fnp Student, Kori Fitzgerald Dnp, Fnp-C, Joseph F. Burkard Dncs, Crna

Doctor of Nursing Practice Final Manuscripts

Objectives: Palliative care services constitute a vital part of the oncology treatment plan. Much of the suffering associated directly with cancer itself or as a result of treatments can be mitigated with the early incorporation of palliative services. Unfortunately, access to palliative care remains elusive due to a lack of qualified providers. This evidence-based project was implemented in an effort to address gaps in care for advanced cancer patients. The goal was to provide telehealth visits for follow-up of stable patients to manage symptoms and psychosocial challenges with equivalent or improved satisfaction as compared to their last in-office visit …

Increasing Palliative Care Team Involvement In Pediatric Oncology Patients, Sana Farooki

Research Days

No abstract provided.

Finding Common Threads: How Patients, Physicians And Nurses Perceive The Patient Gown, Christy M. Lucas, Cheryl Dellasega

Patient Experience Journal

Evidence-based care is standard practice in medicine, but the patient gown has fallen outside the scope of scholarly research. The current gown renders a patient vulnerable, diminishing patients’ sense of identity, agency, and dignity with its one-size-fits-none design. The impact on providers is similarly neglected. Our objective was to explore how patients and providers derive meaning from patient gowns. A convenience sample at an academic medical center was interviewed utilizing a standardized framework developed by a medical student and two PhD-prepared researchers with experience in qualitative methods. The study was inductive in nature, seeking to understand perceptions of the patient …

The Influence Of End Of Life Education On Stress, Anxiety, And Attitude Of The Healthcare Profession Student, Chiquesha Davis

DNP Final Reports

Providing comfort and support to the dying patient is a significant part of the dying process. When soothing a patient, who is dying, the goal is to prevent or relieve suffering as much as possible. Respecting the patient's health and quality of life goals and decisions is essential. Healthcare profession students can experience multiple levels of anxiety, stress, and a negative attitude while taking care of the dying patient. The implementation of a successful intervention is at the cornerstone of helping reduce stress, anxiety, and attitude change in healthcare profession students. The application can also have a positive impact on …

Extra Medullar Granulocytic Sarcoma: A Case Report Of An Exceptional Localization, Bouhani Malek, Sakhri Saida, Jaidane Olfa, Adouni Olfa, Chargui Riadh, Rahal Khaled

Journal of Mind and Medical Sciences

Granulocytic sarcoma is a rare type of tumor composed of extramedullary immature cells. The breast location is very rare; it accounts for less than 8% of cases. The present study reports the case of a 36-year-old female with a medical history of myelodysplastic syndrome. She was referred because of a lump in the left breast. We have diagnosed a case of granulocytic sarcoma of the breast by core biopsy. Histology and immunohistochemistry showed hypercellular smears with immature myeloid cells. The blast cells were myeloperoxidase positive.

The patient underwent a lumpectomy. Five months later, she developed a contralateral recurrence, treated by …

The Serine/Threonine Protein Kinase (Akt)/ Protein Kinase B (Pkb) Signaling Pathway In Breast Cancer, Daniela Miricescu, Camelia Cristina Diaconu, Constantin Stefani, Ana Maria Alexandra Stanescu, Alexandra Totan, Ioana Ruxandra Rusu, Ovidiu Gabriel Bratu, Dan Spinu, Maria Greabu

Journal of Mind and Medical Sciences

According to statistical data published in 2019, breast cancer is among the leading causes of death in women worldwide. The serine/threonine kinase (AKT) or protein kinase B (PkB) signaling pathway is activated by phosphorylation processes, which further is associated with cell growth, proliferation, and survival, but also with activation of glucose metabolism. Mutations of the AKT signaling pathway components (especially PI3KCA and PTEN) have been observed in breast cancer patients, which are associated with resistance to hormonal treatment. Many clinical trials are testing the effect of AKT inhibition in order to block the growth and proliferation of breast cancer cells. …

Blood Cancers And Oral Health, Silvia Spivakovsky Dds, Gwen Nichols Md, Laura Romundstad Crnp, Msn, Elizabeth Kitlas Lmsw

The Journal of the Michigan Dental Association

Managing Blood Cancer Patients' Oral Complications: Preventive Strategies during and after Treatment

Blood cancers, encompassing leukemia, lymphoma, myeloma, myelodysplastic syndromes (MDS), and myeloproliferative neoplasms (MPN), bring complex challenges to patient management due to their impact on hematopoiesis, immunity, and overall health. This review focuses on equipping dental practitioners with essential insights into preventing and managing intricate oral manifestations during and after treatment. Patient care strategies are outlined for leukemia subtypes such as acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), chronic lymphocytic leukemia (CLL), and chronic myeloid leukemia (CML), emphasizing the need for tailored dental approaches. In lymphomas encompassing Hodgkin …

Oral Complications In Cancer Patients: A Review Of Practical Interventions In The Dental Setting, Caroline Bissonnette Dds, Kristin Mcnamara Dds, John Kalmar Dmd, Phd

The Journal of the Michigan Dental Association

Cancer prevalence in the United States is significant, with an estimated 40% of the population experiencing this diagnosis at some point in their lives. In 2020 alone, 1,806,590 new cancer cases were projected, encompassing 53,260 cases involving oral and oropharyngeal malignancies. Amidst barriers like financial constraints and irregular dental visits (highlighted by a 2014 American Dental Association survey indicating that 32.3% of the general population avoids yearly dentist appointments), patients battling cancer often encounter not just routine dental needs, but the intricate challenges arising from their malignancy and treatments. Dental professionals, pivotal in orchestrating optimal treatment strategies for cancer patients, …

End-Of-Life Healthcare Use Of Medicare Patients With Melanoma Based On Patient Characteristics And Year Of Death, Rebecca N. Hutchinson, F. Lee Lucas, Kathleen Fairfield

Journal of Maine Medical Center

Background: Many cancer patients receive overly-intensive care at end-of-life (EOL), despite recognition that this is a marker of poor quality. There is limited knowledge about care received by patients dying with melanoma.

Objective: We characterized healthcare utilization during EOL and patient characteristics associated with variations in care. We also described how utilization changed over time.

Methods: We used the Surveillance, Epidemiology, and End Results-Medicare database to identify 9099 melanoma patients aged 65+ at diagnosis between 2000 and 2009, who died by 12/31/2010. We included patients enrolled in Medicare part A and B six-months prior to diagnosis and not in managed …

Antiresorptive Bone Therapy Use In Advanced Lung Cancer And Associated Outcomes, Noor Naffakh

Theses and Dissertations--Pharmacy

Background/Rationale: Studies have shown antiresorptive agents decrease skeletal related events in metastatic non-small cell lung cancer. However, two prevalence studies have found low utilization rates of antiresorptive therapy in advanced lung cancer. The first study reported a rate of 14.8% during the 1995-2009 time period, while the second study reported a 33% usage rate during the time frame of 2002-2011. We believe these low utilization rates are associated with the poor prognosis of these patients. The prognosis of advanced lung cancer has improved significantly since these trials were conducted, and the utilization of denosumab has not been evaluated. We hypothesize …

Pharmacologic And Nonpharmacologic Approaches To Palliative Care In Oncology, Daniel Powell, Sunitha Johns, Samia Alam, Isabel E. Cwikla, Brendan Rasor, David W. Koh

Pharmacy and Wellness Review

In recent decades, few fields have changed as drastically as oncology. A wide variety of approaches must be taken in order to best care for cancer patients. With the globalization of health care and modern society, nontraditional management of cancer symptoms is once again increasing in popularity. The National Comprehensive Cancer Network (NCCN) has also recently updated their palliative care guidelines. These guidelines provide a detailed approach for the care of a wide range of cancer patients but largely focus on traditional pharmacotherapy. An increasing number of studies are being conducted on nonpharmacologic approaches to care for patients with cancer. …

Impact Of Palliative Care Consultation On End Of Life Care Measures: A Retrospective Analysis Of Patients In The Oncology Care Model, Alison Greidinger, Md, Maria Vershvovsky, Md, Evan Lapinsky, Md, Alison Rhoades, Md, Amy Leader, Drph, Vittorio Maio, Pharmd, Jared Minetola, Karen Walsh, Ms, Mba, Valerie Csik, Mph, Cpps, Ruben Rhoades, Md

Department of Medical Oncology Posters

Introduction

• In 2016 ASCO recommended that patients with advanced cancer receive dedicated palliative care (PC) services1. Early PC involvement is associated with lower spending, fewer 30-day readmission rates, decreased chemotherapy administration at the end of life (EOL) and increased hospice referrals2.
• Many patients are not referred and continue to receive chemotherapy and utilize high-acuity services near the EOL.
• The Oncology Care Model (OCM) is a CMS episode-based alternative payment model promoting high-value care.
• We evaluated the effect of PC visits on EOL outcomes including code status (CS) and spending in the last 30 days of life.

Increasing Adult's Awareness Of The Importance Of End-Of-Life Care Discussions, Taylor Gardner

Capstone Projects and Master's Theses

For many American families, end-of-life care is often not discussed, until advanced illness or injury has fully disrupted everyday life. There are many benefits to discussing end-of-life care prior to any medical complications. Research has shown that individuals who plan their end-of-life processes with a hospice service provider and family members report a higher quality of death than individuals receiving common health care during their final six months of life. In order to make families and friends more comfortable with end-of-life discussions, I will conduct two one-hour educational sessions to students at California State University, Monterey Bay.

Effect Of Neoadjuvant Chemoradiation On Preoperative Pulmonary Physiology, Postoperative Respiratory Complications And Quality Of Life In Patients With Oesophageal Cancer, J. A. Elliott, L. O'Byrne, G. Foley, C. F. Murphy, Suzanne Doyle, S. King, E. M. Guinan, N. Ravi, V. Reynolds

Articles

Background: It remains controversial whether neoadjuvant chemoradiation (nCRT) for oesophageal cancer influences operative morbidity, in particular pulmonary, and quality of life. This study combined clinical outcome data with systematic evaluation of pulmonary physiology to determine the impact of nCRT on pulmonary physiology and clinical outcomes in locally advanced oesophageal cancer.

Methods: Consecutive patients treated between 2010 and 2016 were included. Three-dimensional conformal radiation was standard, with a lung dose–volume histogram of V20 less than 25 per cent, and total radiation between 40 and 41⋅4Gy. Forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and diffusion capacity …

Needs Assessment For Palliative Care In Pediatric Oncology: An Integrative Literature Review, Tabitha Negrete

Grace Peterson Nursing Research Colloquium

Abstract

Background: Cancer is the leading cause of non-accidental death in childhood. Cancer is the primary disease for which pediatric palliative care services are utilized worldwide. Improvement in pediatric palliative care has been identified as an ongoing research priority. There are still significant gaps in current knowledge of pediatric palliative care because education has not been integrated into curriculum and clinical experiences.

Objectives: The purpose of this integrative literature review aims to provide a comprehensive review of current research about the need of nursing education on palliative care for long-term care in pediatric oncology.

Methods: This integrative literature review focused …

Integrating Art And Narrative To Enhance Quality Of Life In Palliative Care, Jennifer Fortuna

The Open Journal of Occupational Therapy

Lacie Lee Wallace, a mixed-media artist from Wheeling, West Virginia, is featured on the cover of the Fall 2018 issue of The Open Journal of Occupational Therapy (OJOT). The photograph depicts Lacie holding a self-portrait painted by artist CeCey Rose. Lacie’s physical appearance in the photograph is strikingly different from the physical appearance of the woman featured in the painting. The portrait was created 4 years before Lacie was diagnosed with advanced stage colon cancer. In the year following the diagnosis, Lacie lost nearly 100 lbs. as a result of an aggressive treatment regimen. When the palliative care team at …

Educating Oncology Nurse Practitioners To Provide Basic Palliative Care, Lynn Adams, Dnp, Ms, Anp-Bc, Aocn

Doctor of Nursing Practice Projects

Background: Approximately 1.66 million Americans are diagnosed with cancer each year and another 589,430 die from the disease. As treatment options have expanded, many cancer patients are living longer with worsening symptoms and disabilities and an increased illness burden. These patients are ideal candidates for palliative care. Palliative care involves care delivered by a team of clinicians with specialty training and a focus on improving the quality of life for patients with serious illnesses. A number of major organizations have made formal recommendations regarding the integration of palliative care into comprehensive cancer care including the American Society of Clinical Oncology …

End-Of-Life Care And Opioid Use In India: Challenges And Opportunities, Aasems Jacob, Aju Mathew

Markey Cancer Center Faculty Publications

No abstract provided.

Clinicians’ Perspectives On Adopting A Lung Cancer Palliative Care Intervention, Shaunna Siler

Loma Linda University Electronic Theses, Dissertations & Projects

Despite the significant progress in implementing palliative care interventions for cancer patients, few intervention studies seek healthcare clinicians’ input prior to implementation. The purpose of this research was then to explore palliative care and oncology clinicians’ (e.g., physicians, nurses, social workers, and chaplains) perspectives on current challenges and useful practices in meeting the quality of life needs of lung cancer patients and family caregivers, and to increase the likelihood of the adoption of a palliative care intervention based on understanding current trends in palliative care delivery at three outpatient oncology sites. The conceptual framework used for this study was the …

Soothing Relaxation Journeys: Designing Evidence Based Music And Imagery Opportunities, Amy Clements-Cortés

Music Faculty Publications

This paper provides information on the creation of an original collection of music and imagery journeys based on the literature in oncology and palliative care. Background evidence is shared about music and relaxation, music relaxation in medical settings, and music and relaxation in oncology/hospice treatment. The development of the resource is illuminated with respect to principles that guided the design. The Journeys collection is a tool that can be used independently by persons experiencing a variety of issues including: anxiety, pain, stress, low self-esteem, and low mood, etcetera; as well as with groups when implemented by a healthcare professional. While …