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1519 records – page 1 of 152.

End of Life Care for Patients Dying of Stroke: A Comparative Registry Study of Stroke and Cancer.

https://arctichealth.org/en/permalink/ahliterature274386
Source
PLoS One. 2016;11(2):e0147694
Publication Type
Article
Date
2016
Author
Heléne Eriksson
Anna Milberg
Katarina Hjelm
Maria Friedrichsen
Source
PLoS One. 2016;11(2):e0147694
Date
2016
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Communication
Disease Management
Family
Female
Humans
Male
Neoplasms - epidemiology
Odds Ratio
Palliative Care - standards
Prevalence
Quality of Health Care
Registries
Retrospective Studies
Stroke - diagnosis - epidemiology
Sweden - epidemiology
Terminal Care - standards
Abstract
Although stroke is a significant public health challenge and the need for palliative care has been emphasized for these patients, there is limited data on end-of-life care for patients dying from stroke.
To study the end-of-life care during the last week of life for patients who had died of stroke in terms of registered symptom, symptom management, and communication, in comparison with patients who had died of cancer.
This study is a retrospective, comparative registry study.
A retrospective comparative registry study was performed using data from a Swedish national quality register for end-of-life care based on WHO`s definition of Palliative care. Data from 1626 patients who had died of stroke were compared with data from 1626 patients who had died of cancer. Binary logistic analyses were used to calculate odds ratios, with 95% CI.
Compared to patients who was dying of cancer, the patients who was dying of stroke had a significantly higher prevalence of having death rattles registered, but a significantly lower prevalence of, nausea, confusion, dyspnea, anxiety, and pain. In addition, the stroke group had significantly lower odds ratios for health care staff not to know whether all these six symptoms were present or not. Patients who was dying of stroke had significantly lower odds ratio of having informative communication from a physician about the transition to end-of-life care and of their family members being offered bereavement follow-up.
The results indicate on differences in end-of-life care between patients dying of stroke and those dying from cancer. To improve the end-of-life care in clinical practice and ensure it has consistent quality, irrespective of diagnosis, education and implementation of palliative care principles are necessary.
Notes
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Cites: Palliat Med. 2012 Jun;26(4):313-2121737480
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Cites: J Pain Symptom Manage. 2015 Nov;50(5):659-75.e326212095
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Cites: BMC Med Ethics. 2007;8:717577420
Cites: Int J Stroke. 2007 May;2(2):139-4318705975
Cites: Palliat Med. 2010 Mar;24(2):146-5319926644
Cites: Acta Oncol. 2011 Jun;50(5):642-721391772
PubMed ID
26845149 View in PubMed
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Meanings of eating deficiencies for people admitted to palliative home care.

https://arctichealth.org/en/permalink/ahliterature274515
Source
Palliat Support Care. 2015 Oct;13(5):1231-9
Publication Type
Article
Date
Oct-2015
Author
Viktoria Wallin
Ida Carlander
P-O Sandman
Cecilia Håkanson
Source
Palliat Support Care. 2015 Oct;13(5):1231-9
Date
Oct-2015
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Attitude to Death
Family Relations
Feeding Behavior - physiology - psychology
Female
Home Care Services
Humans
Interviews as Topic
Male
Middle Aged
Palliative Care - psychology
Qualitative Research
Sweden
Terminally Ill - psychology
Abstract
Food and eating are embedded in people's everyday social lives: at home with family members and as part of social interactions. For people with progressive life-limiting conditions, however, eating is often obstructed. The objective of the present study was to explore the meanings of living with eating deficiencies at the end of life among people admitted to specialist palliative home care.
This qualitative inductive study employed an interpretive descriptive approach. A dozen persons, with various diagnoses and eating deficiencies, admitted to two specialist palliative home care units, participated. Data were collected through individual repeated interviews. Data collection and analysis were guided by the interpretive description method.
The results reveal that eating deficiencies among people with progressive life-limiting conditions are existentially loaded markers of impending death. Finding ways to overcome declined food intake and hampered eating enabled our participants to feel able to influence their own well-being and remain hopeful. The results also showed that the eating deficiencies influenced participants' relationships and social interactions in ways that hampered their possibilities of sharing valuable moments together with friends and family members during the final period of life.
Efforts to minimize the distress that people experience in relation to the challenges they face with eating deficiencies are important for well-being at the end of life. Person-centered approaches to acknowledge and support individuals' own ways of experiencing and dealing with their eating deficiencies are recommended that include a multidimensional perspective on food and eating.
PubMed ID
25335943 View in PubMed
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"The unpredictable death"-The last year of life for patients with advanced COPD: Relatives' stories.

https://arctichealth.org/en/permalink/ahliterature274516
Source
Palliat Support Care. 2015 Oct;13(5):1213-22
Publication Type
Article
Date
Oct-2015
Author
Kristina Ek
Birgitta Andershed
Eva Sahlberg-Blom
Britt-Marie Ternestedt
Source
Palliat Support Care. 2015 Oct;13(5):1213-22
Date
Oct-2015
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Attitude to Death
Cough - etiology
Disease Progression
Dyspnea - etiology
Family - psychology
Female
Humans
Interviews as Topic
Male
Palliative Care - methods - psychology
Pulmonary Disease, Chronic Obstructive - complications - psychology
Qualitative Research
Retrospective Studies
Sweden
Terminally Ill - psychology
Abstract
The end stage of chronic obstructive pulmonary disease (COPD) is described as prolonged, and the symptom burden for patients with COPD is often high. It progresses slowly over several years and can be punctuated by abrupt exacerbations that sometimes end in sudden death or a recovery of longer or shorter duration. This makes it difficult to identify the critical junctures in order to prognosticate the progress and time of death. Patients with COPD often express a fear that the dying process is going to be difficult. There is a fear that the dyspnea will worsen and lead to death by suffocation. The present article aimed to retrospectively describe the final year of life for patients with advanced COPD with a focus on death and dying from the perspective of relatives.
Interviews were conducted with the relatives of deceased family members who had advanced COPD. In total, 13 interviews were conducted and analyzed by means of content analysis.
All relatives described the patients as having had a peaceful death that did not correspond with the worry expressed earlier by both the patients and themselves. During the final week of life, two different patterns in the progress of the illness trajectory emerged: a temporary improvement where death was unexpected and a continued deterioration where death was inevitable.
The patients and their relatives lived with uncertainty up until the time of death. Little support for psychosocial and existential needs was available. It is essential for the nurse to create relationships with patients and relatives that enable them to talk about dying and death on their own terms.
PubMed ID
25315360 View in PubMed
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Differences in discontinuation of statin treatment in women and men with advanced cancer disease.

https://arctichealth.org/en/permalink/ahliterature298923
Source
Biol Sex Differ. 2018 10 20; 9(1):47
Publication Type
Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Date
10-20-2018
Author
Helena Bergström
Elsa Brånvall
Maria Helde-Frankling
Linda Björkhem-Bergman
Author Affiliation
Department of Neurobiology, Care Sciences and Society (NVS), Division of Clinical Geriatrics, Karolinska Institutet, Blickagången 16, Neo floor 7, SE-141 83, Huddinge, Sweden.
Source
Biol Sex Differ. 2018 10 20; 9(1):47
Date
10-20-2018
Language
English
Publication Type
Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Aged
Aged, 80 and over
Cohort Studies
Female
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage
Male
Middle Aged
Neoplasms - drug therapy - mortality
Palliative Care
Sweden - epidemiology
Withholding Treatment - statistics & numerical data
Abstract
Statins are often discontinued in patients with advanced cancer since the net effect of treatment is considered negative. However, guidelines concerning discontinuation of statin treatment are lacking. The aim of this study was to investigate any differences in time of discontinuation of statin treatment between men and women with advanced cancer disease.
Medical records from 195 deceased palliative cancer patients from a previous study cohort were reviewed. Patients treated with statins 2 years before death were identified as "statin users." The time of discontinuation of statin therapy was identified and correlated to time of death. Only patients that had incurable cancer disease at time of statin discontinuation were included in the analysis.
Fifty-four patients were identified as statin users, 29 women and 25 men. The average time span between discontinuation of statin treatment and time of death was significantly longer in women than in men, 10 months compared to 4 months (p?
PubMed ID
30342545 View in PubMed
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End-of-life decisions guiding the palliative care of cancer patients visiting emergency department in South Western Finland: a retrospective cohort study.

https://arctichealth.org/en/permalink/ahliterature298976
Source
BMC Palliat Care. 2018 Dec 17; 17(1):128
Publication Type
Journal Article
Date
Dec-17-2018
Author
Outi M Hirvonen
Jenni E Alalahti
Kari J Syrjänen
Sirkku M Jyrkkiö
Author Affiliation
Department of Oncology and Radiotherapy, Turku University Hospital, PO Box 52, FI-20521, Turku, Finland. outi.hirvonen@tyks.fi.
Source
BMC Palliat Care. 2018 Dec 17; 17(1):128
Date
Dec-17-2018
Language
English
Publication Type
Journal Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Cohort Studies
Decision Making
Emergency Service, Hospital - statistics & numerical data
Female
Finland - epidemiology
Humans
Male
Medical Records
Middle Aged
Neoplasms
Palliative Care
Patient Admission - statistics & numerical data
Retrospective Studies
Young Adult
Abstract
Until recently, palliative care (PC) resources in Finland have been sparse. To meet the increasing need for PC an end-of-life (EOL) care project has been ongoing in South Western Finland since 2012, and in 2015, a weekday palliative outpatient clinic was established in Turku University Hospital (TUH). The aim of this study was to explore the effect of the project and the PC clinic on the management practices of EOL cancer patients attending the Emergency Department (ED) of TUH from 2013 to 2016.
The medical records of all cancer patients (ICD-10 codes C00-97) admitted to the ED of TUH between August 1-December 31, in 2013 and 2016, were analyzed: n?=?529, n?=?432 respectively (2013 and 2016). The analysis focused on those patients in EOL care; n?=?77, n?=?63, respectively. The late palliative patients were defined by PC decision, thus termination of life-prolonging cancer-specific treatments. The EOL patients were in the imminently dying phase of their illness. The site of referral after an ED visit was also verified together with the documentation on advance care plans (ACP), and the impact of palliative outpatient visits.
In 2016, the number of late palliative and EOL patients admitted to the ED has shown a tendency to decrease. The quality of the documentation for treatment goals, do-not-resuscitate (DNR) orders, living wills and connections to primary care providers has improved since 2013. Prior visits to palliative outpatient clinic correlated well with the more comprehensive ACP information: i) DNR order (p?=?0.0001); ii) connection to primary care (p?=?0.003); iii) documented ICD-10 code Z51.5 (p?=?0.0001).
Even modest investments in resources for PC can induce an objective change in the allocation of health care resources, and improve the ACP for the cancer patients at their EOL. A visit to a palliative outpatient clinic may offer one approach for improving the quality and completion of ACP documentation.
PubMed ID
30558583 View in PubMed
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Predictive factors and treatment outcome of laryngeal carcinoma recurrence.

https://arctichealth.org/en/permalink/ahliterature290272
Source
Head Neck. 2017 Mar; 39(3):555-563
Publication Type
Journal Article
Date
Mar-2017
Author
Aaro Haapaniemi
Janne Väisänen
Timo Atula
Olli-Pekka Alho
Antti Mäkitie
Petri Koivunen
Author Affiliation
Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Source
Head Neck. 2017 Mar; 39(3):555-563
Date
Mar-2017
Language
English
Publication Type
Journal Article
Keywords
Adult
Age Factors
Aged
Aged, 80 and over
Carcinoma, Squamous Cell - complications - pathology - therapy
Chemoradiotherapy, Adjuvant - methods
Cohort Studies
Databases, Factual
Female
Finland
Hospitals, University
Humans
Kaplan-Meier Estimate
Laryngeal Neoplasms - complications - pathology - therapy
Laryngectomy - methods
Male
Middle Aged
Multivariate Analysis
Neoplasm Recurrence, Local - epidemiology - pathology - therapy
Palliative Care
Prognosis
Proportional Hazards Models
Retrospective Studies
Risk assessment
Salvage Therapy
Sex Factors
Survival Analysis
Treatment Outcome
Abstract
Up to 30% of patients with laryngeal squamous cell carcinoma (SCC) present with recurrence after treatment. We analyzed factors associated with the risk of cancer recurrence and prognosis after recurrence.
A nationwide laryngeal SCC cohort from Finnish university hospitals during 2001 to 2005 with initial successful therapy (n = 316) was analyzed.
Laryngeal SCC recurred in 22% of patients. The median time to recurrence was 9 months, with 90% occurring within 36 months after treatment. The World Health Organization (WHO) performance status >0, neck metastasis at presentation, and nonsurgical treatment were independent prognostic factors for recurrence. Patients with local recurrence had a 5-year overall survival (OS) of 53% compared with 5% in patients with regional/distant recurrences. OS for glottic and nonglottic laryngeal SCC recurrence was 45% and 0%, respectively.
The type of treatment affected the risk of recurrence in this retrospective series. Local recurrences carried a chance for successful salvage treatment. Routine follow-up beyond 36 months remains controversial. © 2016 Wiley Periodicals, Inc. Head Neck 39: 555-563, 2017.
PubMed ID
27902867 View in PubMed
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Contemporary radiooncological management of bone metastases from breast cancer: factors associated with prescription of different fractionation regimens (short or long course) in a rural part of North Norway with long travel distance.

https://arctichealth.org/en/permalink/ahliterature290404
Source
Int J Circumpolar Health. 2017; 76(1):1270080
Publication Type
Journal Article
Date
2017
Author
Carsten Nieder
Astrid Dalhaug
Ellinor Haukland
Bård Mannsåker
Adam Pawinski
Author Affiliation
a Department of Oncology and Palliative Medicine , Nordland Hospital , Bodø , Norway.
Source
Int J Circumpolar Health. 2017; 76(1):1270080
Date
2017
Language
English
Publication Type
Journal Article
Keywords
Adult
Age Factors
Aged
Aged, 80 and over
Bone Neoplasms - radiotherapy - secondary
Breast Neoplasms - mortality - pathology
Comorbidity
Dose Fractionation
Female
Health Services Accessibility
Health status
Humans
Middle Aged
Norway
Palliative Care - methods
Prognosis
Retrospective Studies
Rural Population
Severity of Illness Index
Transportation
Abstract
The aim of this study was to reduce barriers that prevent implementation of evidence-based recommendations about single-fraction palliative radiotherapy (PRT) and to demonstrate that single-fraction PRT yields similar outcomes as long-course treatment (=10 fractions) in patients with bone metastases from breast cancer. This retrospective study (2007-2014) included 118 Norwegian female patients. All patients received guideline-conform systemic therapy including bone-targeting agents. Median survival was 12.7 months. Long-course PRT was prescribed in 60% of patients, while 21% had PRT with a single fraction of 8 Gy to at least one target. Reirradiation rate was not significantly higher after 8 Gy (9%, compared to 5% after long-course PRT and 6% after 4 Gy x5). Patients with favorable baseline characteristics such as younger age and good performance status (PS) were significantly more likely to receive long-course PRT. Biological subtype and comorbidity did not correlate with fractionation. Prognosis was influenced by biological subtype, extra-skeletal disease extent, severe anemia and abnormal CRP. The limited need for reirradiation after single fraction PRT might encourage physicians to prescribe this convenient regimen, which would improve resource utilization. Even patients with PS3 had a median survival of 3 months, which indicates that they could experience worthwhile clinical benefit.
Notes
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Cites: BMC Cancer. 2011 Jan 24;11:29 PMID 21261987
Cites: J Natl Cancer Inst. 2005 Jun 1;97(11):798-804 PMID 15928300
Cites: Clin Transl Oncol. 2015 Nov;17(11):895-902 PMID 26081286
Cites: Breast Cancer Res Treat. 2011 Sep;129(2):495-503 PMID 21461730
Cites: J Clin Oncol. 2014 Sep 10;32(26):2913-9 PMID 25113773
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Cites: Anticancer Res. 2009 Jul;29(7):2641-4 PMID 19596940
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Cites: Radiother Oncol. 2006 Mar;78(3):245-53 PMID 16545474
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Cites: Clin Oncol (R Coll Radiol). 2012 Mar;24(2):112-24 PMID 22130630
PubMed ID
28452680 View in PubMed
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Physicians' decision-making in incompetent elderly patients: a comparative study between Austria, Germany (East, West), and Sweden.

https://arctichealth.org/en/permalink/ahliterature20764
Source
Int Psychogeriatr. 1999 Sep;11(3):313-24
Publication Type
Article
Date
Sep-1999
Author
M. Eisemann
J. Richter
B. Bauer
R M Bonelli
F. Porzsolt
R. Bonelli
Author Affiliation
Department of Psychiatry and World Health Organization Collaborating Centre, Umeå University, Sweden. martin.eisemann@psychiat.umu.se
Source
Int Psychogeriatr. 1999 Sep;11(3):313-24
Date
Sep-1999
Language
English
Publication Type
Article
Keywords
Adult
Advance Directives
Age Factors
Aged
Alzheimer Disease - diagnosis - psychology - therapy
Austria
Comparative Study
Cultural Characteristics
Decision Making
Ethics, Medical
Family
Female
Germany
Humans
Life Support Care
Male
Middle Aged
Neurofibromatosis 2
Palliative Care
Physicians
Questionnaires
Resuscitation
Resuscitation Orders
Severity of Illness Index
Sweden
Abstract
In order to investigate to what extent various determinants in the decision-making process for the treatment of severely ill incompetent patients are influenced by cultural and sociopolitical factors, 540 physicians in Austria, Germany (East and West), and Sweden, countries representing different healthcare systems, were surveyed using a self-administered questionnaire. It provided three case vignettes with different levels of information about the patient's treatment wishes in case of incompetence in a life-threatening situation. We found a general trend to a lower level of treatment in line with the patient's wishes when the information provided was more detailed. Remarkably, a substantial number of doctors did not comply with the patient's wishes. Ethical concerns and patient's wishes appeared as the most important factors whereas religious beliefs of the physician and hospital costs scored lowest. Because of the variability of treatment decisions and the importance of various factors determining the decision-making, an advance directive may be a feasible way of reducing the number of conflicts in critical situations. We recommend that ethical issues of clinical practice should be emphasized in the medical curriculum and in the training of physicians.
Notes
Erratum In: Int Psychogeriatr. 2003 Jun;15(2)Bonelli R [corrected to Bonelli RM]
PubMed ID
10547131 View in PubMed
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Treatment of locally advanced pancreatic carcinoma in Sweden. A health economic comparison of palliative treatment with best supportive care versus palliative treatment with gemcitabine in combination with best supportive care.

https://arctichealth.org/en/permalink/ahliterature20769
Source
Pharmacoeconomics. 1999 Apr;15(4):377-84
Publication Type
Article
Date
Apr-1999
Author
G. Ragnarson-Tennvall
N. Wilking
Author Affiliation
Swedish Institute for Health Economics, Lund, Sweden. grt@ihe.se
Source
Pharmacoeconomics. 1999 Apr;15(4):377-84
Date
Apr-1999
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Antimetabolites, Antineoplastic - economics - therapeutic use
Deoxycytidine - analogs & derivatives - economics - therapeutic use
Female
Humans
Male
Middle Aged
Palliative Care
Pancreatic Neoplasms - drug therapy - economics - therapy
Research Support, Non-U.S. Gov't
Survival Analysis
Sweden
Abstract
OBJECTIVE: Patients with pancreatic cancer have only short survival after diagnosis, irrespective of treatment. The aim of this study was to perform a health economic evaluation of present standard treatment (in most cases, palliative treatment in combination with best supportive care) versus palliative treatment with gemcitabine in combination with best supportive care in patients with locally advanced pancreatic carcinoma. DESIGN: The use of resources and associated costs according to present treatment practice were estimated and calculated retrospectively. Costs were calculated from diagnosis until death. Actual costs and treatment effects for the patient population were compared with expected treatment costs for the same population if they additionally received gemcitabine. SETTING: This economic analysis is based on a hypothetical comparison and was performed from a societal point of view. PATIENTS AND PARTICIPANTS: The study population consisted of all patients diagnosed with pancreatic cancer during the year April 1994 to March 1995 and resident in Stockholm County, Sweden. After exclusions, 184 patients were included in the economic analysis. INTERVENTIONS: The effects of gemcitabine treatment on survival and disease-related symptoms were extrapolated from the results of a recent randomised clinical trial in North America. MAIN OUTCOME MEASURES AND RESULTS: The estimated additional costs for chemotherapy, treatment of adverse effects and in- and outpatient care associated with gemcitabine treatment were approximately 132,000 Swedish kronor (SEK) per life-year gained. This result is comparable with costs per life-year gained for other accepted treatments, for example those of home dialysis and kidney transplants for chronic renal failure. CONCLUSIONS: Treatment with gemcitabine in patients with pancreatic cancer may be a cost-effective alternative, but the results need to be confirmed in future randomised trials.
PubMed ID
10537956 View in PubMed
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In the frontline of palliative medicine and psychosocial oncology.

https://arctichealth.org/en/permalink/ahliterature20933
Source
Acta Oncol. 1999;38(4):403-4
Publication Type
Article
Date
1999
Author
C. Bolund
Source
Acta Oncol. 1999;38(4):403-4
Date
1999
Language
English
Publication Type
Article
Keywords
Forecasting
Humans
Neoplasms - psychology - therapy
Norway
Palliative Care - trends
Social Support
Sweden
Notes
Comment On: Acta Oncol. 1999;38(4):491-410418717
PubMed ID
10418706 View in PubMed
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1519 records – page 1 of 152.