bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessing symptoms of terminally-ill patients by different raters: A prospective study
Authors: ZLOKLIKOVITS SILKE , ANDRITSCH ELISABETH , FRÖHLICH BRIGITTE , VEREBES JULIJANE , DIETMAIER GABRIELE , SAMONIGG HELLMUT 
Published: April 2008

Objective: For patients who are terminally ill, the efficiency of symptom management is dependent, among other factors, on an accurate assessment by proxy raters. The aim of this prospective study is to describe differences in symptom severity ratings between patients and their nurses, physicians, and family members during their stay in different departments with acute care, and to identify variables associated with the accuracy of the ratings by others.Methods: Physical, psychological, social, and functional disorders were assessed for 41 in-patients with a standardized 13-item Symptom List for Quality Assurance in Palliative Care drafted by the Working Group on the Core Documentation for Palliative Care Units in Germany. Symptom assessment was completed by different raters (patient, nurse, physician, family member) within the first four days after admission. Socio-demographic, disease-related, and hospitalization data were taken from patient charts.Results: Reliability of the symptom list was computed with Cronbach's alpha measures for the present sample. Between-group-comparisons on the individual items and on the sum-score level were analyzed separately for the different rater-pairs: patients-nurses (n= 41), patients-physicians (n= 39), patients-family members (n= 12). Multiple regression analyses calculated predictive variables of the staff's deviation scores.Significance of results: Significant differences for nurses and physicians were found on the sum-score level for psychological and social symptoms, but not for physical and functional symptoms. Family members rated the intensities of the symptoms generally higher than the patients. Suggestions for further analyses are presented and discussed.
Depression in patients with advanced illness: An examination of Ontario complex continuing care using the Minimum Data Set 2.0
Authors: GRUNEIR ANDREA , SMITH TREVOR FRISE , HIRDES JOHN , CAMERON ROY 
Published: April 2008

Objective: In this study, we examined the prevalence of depression, its recognition, and its treatment in continuing care patients with advanced illness (AI).Methods: All data were obtained from the Ontario (Canada) provincially-mandated MDS 2.0 form for chronic care. Of 3,801 patients, 524 met our empiric definition of AI, which was predicated on a previously validated algorithm. The MDS-embedded Depression Rating Scale (DRS) was used to measure psychological well-being and a score of 3 or greater indicated potential depression.Results: Twenty-nine percent of patients with AI scored greater than 3, making them nearly twice as likely to be potentially depressed as other patients (OR 1.8, 95% CI 1.5–2.2). Despite this patients with AI were less likely to have received antidepressants (28.9% vs. 38.2%), even among those with a diagnosis (45.3% vs. 58.4%). Using logistic regression, correlates of potential depression were identified and surprisingly patients with cancer were substantially less likely to be depressed (AOR 0.37, 95% CI 0.2–0.6). Further investigation revealed that cancer patients were more likely to be treated for depression and to be recognized as being within the terminal phase of illness.Significance of results: These findings suggest that a high proportion of terminally ill patients had unmet needs for psychological support. As well, they suggest that cancer patients received better targeted end-of-life care, which resulted in an overall decrease in psychological distress when compared to other patients with similarly advanced illness.
Factors associated with location of death of children with cancer in palliative care
Authors: KURASHIMA ANDRÉA YAMAGUCHI , LATORRE MARIA DO ROSÁRIO DIAS , TEIXEIRA SILVIA APARECIDA DE PAIVA , DE CAMARGO BEATRIZ 
Published: April 2008

Objective:The aim of this study was to identify factors associated with location of death of patients receiving palliative care in a pediatric oncology unit.Methods:A palliative care program was developed in the pediatric department in order to provide specialized attention to the patient and family in end-of-life. The program is coordinated by a nurse, delivering a simultaneous interdisciplinary team approach with focus on identification and training of a family care provider as well as local resources supplemented by support of a social worker and the community. All 87 patients in palliative care were followed by the team. The factors associated with the location of death (home or hospital) were evaluated for the 71 patients who died prior to analysis.Results: Forty-two (59%) patients died at home. Factors significantly associated with dying at home were: male with an Odds Ratio (OR) = 3.80, 95% Confidence Interval (CI) = 1.26–11.76; public health insurance (OR) = 4.95, 95%[CI] = 1.03–26.75, low educational level of the caregiver (OR) = 11.11 95%[CI] = 1.65–94.66 and low educational level of the mother (OR) = 7.07 95%[CI] = 1.37–40.14. Gender was the only independent factor associated with location of death: a boy had a higher risk of dying at home, (OR) = 4.25, 95%[CI] = 1.37–13.21 when compared to a girl.Significance of results:In our society we are still not able to provide hospice care or home care for all children, although increasing emphasis has been placed on utilizing local resources. Even though we had increased the number of desired home deaths, it is still a challenge to meet patients and families' requests. A team approach, the recognition of the factors involved, and adequate health and community support have helped us to meet the child and family's needs.
Family decision making at end of life
Authors: MEEKER MARY ANN , JEZEWSKI MARY ANN 
Published: April 2008

Objective: To enhance understanding of the phenomenon of family surrogate decision-making at the end of life (EOL) by means of a systematic review and synthesis of published research reports that address this phenomenon.Methods: Garrard's (1999) methods for conducting a systematic review of the literature were followed. Fifty-one studies focusing on family decision-making experiences, needs, and processes when assisting a dying family member were selected following electronic database searches and ancestry searches.Results: In studies using hypothetical scenarios to compare patients' choices and surrogates' predictions of those choices, surrogates demonstrated low to moderate predictive accuracy. Increased accuracy occurred in more extreme scenarios, under conditions of forced choice, and when the surrogate was specifically directed to use substituted judgment. In qualitative explorations of their perspectives, family members voiced their desire to be involved and to accept the moral responsibility attendant to being a surrogate. Quality of communication available with providers significantly influenced family satisfaction with decision-making and EOL care. Group or consensual decision-making involving multiple family members was preferred over individual surrogate decision-making. Surrogates experienced long-term physical and psychological outcomes from being decision-makers.Significance of results: Functioning as a surrogate decision-maker typically places great moral, emotional, and cognitive demands on the family surrogate. Clinicians can provide improved care to both patients and families with better understanding of surrogates' needs and experiences.
Does ethnicity matter? Bereavement outcomes in two ethnic groups living in the United Kingdom
Authors: KOFFMAN JONATHAN , DONALDSON NORA , HOTOPF MATTHEW , HIGGINSON IRENE J. 
Published: April 2008

Background: Sociologists, anthropologists, and psychologists agree that grief is a universal phenomenon. Reactions to it are, however, socially constructed and patterned.Objective: To compare the outcomes of bereavement among family or close friends of deceased first-generation black Caribbean and white native-born patients living in the United Kingdom.Design: Comparative cross-sectional questionnaire survey in three inner London health authorities administered 10 months after the patient's death.Participants: Family and close friends of 50 deceased first-generation black Caribbean and 50 native-born white patients with advanced disease.Main outcome measures: 28-item General Health Questionnaire (GHQ-28), Core Bereavement Items scale, a 17-item measure of grief.Results: The intensity of grief, measured using the Core Bereavement Items was similar between the two groups. Seventy-two respondents had visited their family doctor subsequent to bereavement, and of these, black Caribbean respondents reported more psychological problems. Depression and anxiety measured by the GHQ-28 were significantly higher among black Caribbean respondents (28.00 vs. 21.2) (t-test = −2.28,p= 0.025). Multiple regression analysis revealed this difference was best accounted for by bereavement concerns such as legal and housing problems.Conclusions: This study has observed higher psychological morbidity among the bereaved Caribbean individuals. Family doctors are a source of support for three-quarters of respondents, and they may need to focus on the needs of black and minority ethnic minorities.
Outcome expectations and self-regulation in cancer patients: Reliability, initial factor structure, and relationships with benefit finding
Authors: GRAVES KRISTI D. , CARTER CINDY L. 
Published: April 2008

Objective:The purpose of this research was to investigate outcome expectation and self-regulation measures within a sample of cancer patients and to explore relationships of these variables with benefit finding. The outcome expectation and self-regulation measures were evaluated for reliability and initial factor structure.Method:A convenience sample of 141 cancer patients completed study measures while waiting for appointments at a cancer center.Results:The measures demonstrated good reliability (alphas = .88 and .92, for outcome expectation and self-regulation respectively). Initial factor structure suggested six outcome expectation factors (managing symptoms, expressing emotions, talking about cancer, learning about cancer, managing self-image, and managing needs) and one self-regulation factor. Gender and treatment status were related to outcome expectations but not self-regulation. Outcome expectations and self-regulation were significant predictors of benefit-finding,F(8, 80) = 3.1,p= .005.Significance of the research:Measures of outcome expectations and self-regulation are reliable, are related to gender and clinical variables, and may be useful as predictors of cancer patients' ability to find benefits in their cancer experience.
Atypical antipsychotics in the management of delirium: A review of the empirical literature
Authors: BOETTGER SOENKE , BREITBART WILLIAM 
Published: April 2008

Objectives: To review the existing literature of atypical antipsychotics in the treatment of delirium and make recommendations regarding their use in the treatment of delirium.Methods: I conducted a literature search in Pubmed, Psychlit, and Embase for studies using atypical antipsychotics in the treatment of delirium. In the absence of studies, case reports were used.Results: Overall 13 studies examined the use of risperidone, olanzapine, and quetiapine, two cases were reported about ziprasidone, and no publication was found using aripiprazole in the treatment of delirium. Among the existing studies were retrospective and prospective, open label studies in addition to one with a double blind design using risperidone. Risperidone, olanzapine, and quetiapine may be all similarly effective in the treatment of delirium, whereas there may be limited efficacy in the use of olanzapine in the hypoactive subtype of delirium in elderly populations, which may generalize to the other atypical antipsychotics. The use of atypical antipsychotics in the treatment of delirium is safe and carries a low burden of side effects.Significance of results: Although atypical antipsychotics are widely used in the treatment of delirium, well-designed studies do not exist. Among the existing studies, stronger data supports the use of risperidone and olanzapine, and also quetiapine may be considered in the treatment of delirium. Recommendations are made based on the existing data and literature. The need for well-designed studies to validate the use of atypical antipsychotics in the treatment of delirium continues.
Predictors of death within six months in patients with advanced
AIDS
Authors: BRECHTL JOHN R. , PATRICK PATRICIA A. , VISINTAINER PAUL , BRAND DONALD A. 
Published: April 2008

Objectives: This study sought to identify potential
predictive variables of death within 6 months in patients with advanced
AIDS.Methods: Investigators enrolled a consecutive series of
patients with advanced AIDS admitted to a skilled nursing facility in New
York City over a 1-year period. Demographic, clinical, laboratory, and
outcome data were abstracted from medical records using a standardized
data collection instrument.Results: Of the 152 patients enrolled during the study
period, 61 patients (40%) died within 6 months from date of admission.
Serum albumin, percent deviation from ideal body weight, and number of
comorbidities at the time of admission proved to be the best combination
of predictors of death within 6 months.Significance of results: The decrease in AIDS mortality over
the past decade, along with an increase in prevalence due to longer
survival, has been attributed primarily to the successful use of highly
active antiretroviral therapy (HAART). HAART regimens, however, can also
produce both short-term adverse effects and long-term complications. The
prognostic model developed by this study may be useful in guiding
treatment decisions in patients with advanced AIDS for whom a more
palliative care plan may be sought.
A pilot examination of the impact of cancer patients' fatigue on their spousal caregivers
Authors: PASSIK STEVEN D. , KIRSH KENNETH L. 
Published: April 2008

Objective:In this pilot project we examined the quality of life of spouses of cancer patients who had significant fatigue.Methods:We assessed both the spouses of cancer patients and the patients who presented with chemotherapy-induced fatigue and anemia. Study endpoints included the impact that cancer patients' fatigue had on their spouses' quality of life, including their own levels of fatigue, depressive symptoms, activity levels, work absenteeism, and marital adjustment. We examined the extent to which changes in patients' fatigue from baseline to one month follow-up were associated with changes in spouses' quality of life indices.Results:25 couples completed the study. Seven (28%) spousal caregivers reported handling fewer responsibilities at work, 8 (32%) had reduced their work hours, and 8 (32%) felt that they were less effective overall at work. Spousal caregivers also missed a significant amount of time at work during the month long study, missing an average of 2.7 (SD= 2.95) days, with an additional 1.29 (SD= 2.97) sick days and 1.76 (SD= 2.63) vacation days during that time. Spouses reporting greater levels of caregiver strain were more likely to have increased fatigue at baseline (F1,23= 8.11,p< .01), and worse dyadic adjustment at both time points (baseline:F1,23= 7.80,p< .01; follow-up:F1,21= 9.24,p< .01). Also, those with more caregiver strain were less likely to engage in social activity at baseline (F1,23= 6.11,p< .05) and more likely to engage in less work by the one month follow-up (F1,20= 8.36,p< .01).Significance of results:Spouses who were identified as having elevated burden experienced more personal fatigue, had worse dyadic adjustment, reported poor energy levels, and tended to engage in fewer work and social activities; the impact of patient's fatigue level on these parameters was highly variable in this small pilot study.
Patient desires: A model for assessment of patient preferences for care of severe or terminal illness
Authors: KNOPS KAREN M. , SRINIVASAN MALATHI , MEYERS FREDRICK J. 
Published: April 2008

Objective:Patient-centered care is better achieved through a comprehensive understanding of patients' preferences for how they want to live their life and how they want to influence their own death. Though much has been written on identifying goals of care, it is often difficult for clinicians to articulate patient goals to guide care planning. We explored the literature on patient's preferences for their care in chronic or life-limiting illness to develop a model for assessment of patient perspectives. We then illustrated our model with composite patients from our clinics and we provide questions to guide patient discussion.Methods:We searched MEDLINE from 1986 to 2004 for primary research articles that relate primarily to a patient's preferences for his or her care. We reviewed over 3500 titles, abstracts, and research papers. Hundreds of articles described patients' quality of life, health status, or satisfaction. We excluded consensus guidelines, non-English papers, reviews, and articles focused on medical professional perspectives. Forty-eight studies focused primarily on patient preferences. Using an iterative process, we identified unique issues and broader themes in patients' desires for their care.Results:Studies focused on patients with cancer, those in hospice or those with terminal disease. Three domains emerged: patient feelings about disease, feelings about suffering, and feelings about the circumstances of death. Attention was given to the differences between patients in terms of the strength and persistence of feelings in each domain.Significance of results:Based on existing data, there are three fundamental domains of patient perspective that influence preferences for care. These domains can be assessed by the care team to guide the development of a plan of care and to identify areas of conflict. Our review identifies gaps in the end-of-life literature and areas for future work in patient preferences.
Methadone in the treatment of pain and terminal delirum in advanced
cancer patients
Authors: MORYL NATALIE , KOGAN MARIA , COMFORT CHRISTOPHER , OBBENS EUGENIE 
Published: April 2008

Objective: This prospective study documents the use of
methadone as part of an opioid rotation strategy in patients with
uncontrolled pain and severe delirium admitted for terminal care to a
tertiary cancer palliative care hospital.Methods: We reviewed the treatment of 20 patients with severe
pain and delirium at the end of life who's delirium did not improve
24 h or longer after starting a neuroleptic medication.Results: Ten male and 10 female patients, 47 to 77 years old,
were rotated or “switched” to methadone due to uncontrolled
pain in the setting of delirium, limiting further opioid dose escalation.
At 2 weeks, a total of 10 patients had expired. Of the 10 patients who
were alive 2 weeks after starting methadone, 7 patients were stable on an
average of 1.1 mg/h methadone, 2 patients were restarted on morphine
IV and one on Percocet. The calculated average equianalgesic dose of
methadone was 9% (2%–17%) of the previous morphine-equivalent dose.
Of the 20 patients who were switched to methadone for what appeared to be
terminal delirium, the pain control was significant in 15, moderate in 3,
and unchanged in 2 patients. Average analgesia was good to excellent
(average Numeric Analog Scale rating [NAS] decreased from 8.2 to
2.5). Sedation had decreased from 1.65 to 0.55 on a scale of 0 to 3. Of
the 20 patients, improvement of cognitive status was significant in 9,
moderate in 6, partial in 2, and none in 3 patients. The Memorial Delirium
Assessment Scale (MDAS) showed improvement from an average of 23.6 prior
to the switch to 10.6 3 days after. Decreased alertness on methadone was
devoid of agitated features.Significance of results: Our study suggests that methadone
can be effective in the treatment of both refractory pain and what appears
to be terminal delirium. Most patients in our group had at least a
short-term improvement in mental status as well as significant and lasting
improvement in analgesia.
Brief psychotic disorder mimicking the symptoms of cerebrovascular
attack evoked by symptoms that symbolized death in a patient with terminal
stage stomach cancer: Case report and review of the literature
Authors: ONISHI HIDEKI , OKUNO SHIGEKO , YAE SUZU , SAIRENJI MOTONORI , ONOSE MASANARI , MIZUNO YASUHIRO , KAWANISHI CHIAKI 
Published: April 2008

Objective: We report here a terminally ill patient with
stomach cancer who developed a brief psychotic disorder mimicking
cerebrovascular attack after a short episode of nasal bleeding. Close
examination of the patient revealed that nasal bleeding was an event that
symbolized deterioration of the general condition leading to death for the
patient.Methods: A 77-year-old male, who was diagnosed as having
stomach cancer and was receiving palliative care, presented with tremor
and insomnia just after a short episode of nasal bleeding and showed
reduced response to stimuli mimicking cerebrovascular attack. Laboratory
data were unremarkable. The next day, catatonic behavior developed. He had
no history of psychiatric illness or drug or alcohol abuse. After
receiving haloperidol, psychiatric symptoms disappeared and he returned to
the previous level of functioning within 3 days. The patient explained
that he had seen a patient whose general condition deteriorated after
nasal bleeding and regarded nasal bleeding as a symptom of deteriorating
general condition leading to death and thereafter became afraid of the
nasal bleeding.Results and Significance of results: Although, nasal bleeding
is common and usually not severe in medical settings, for the patient, it
was an event that symbolized deterioration of the general condition
leading to death. Brief psychotic disorder in cancer patients is rare in
the literature, although patients receiving terminal care share various
kinds of psychological burden. Medical staff in the palliative care unit
should be aware of the psychological distress experienced by each patient
and consider brief psychotic disorder as part of the differential
diagnosis when patients show unexplained neurological-like and/or
psychiatric symptoms.
Caring for the spiritual pain of patients with advanced cancer: A phenomenological approach to the lived experience
Authors: TAMURA KEIKO , KIKUI KAZUKO , WATANABE MICHIYO 
Published: April 2008

Objective: The aim of this research was to reveal, from the perspective of the “lived experience” shared by cancer patients and their nurses, how patients facing death create lived experience in the context of palliative care. This research also aims to elucidate the meaning nurses find in patients' experiences while caring for their patients.Methods: The participants in this study were cancer patients who were given opportunities to discuss events and concerns in their daily lives, with the interactions guided by the researchers. Transcriptions of conversations with the patients were analyzed using the method for empirical data classification set forth by Giorgi (1985) with appropriate modification.Results: This study found that when the nurse correctly interprets the meaning of the concerns (Heidegger, 1962) of the patient facing death and shares that meaning with the patient, fundamental questions naturally arise for the patient. Answering these questions becomes possible only through interactions that require the reexamination of the values of the patient and the nurse.Significance of research: This research elucidates the spiritual pain experienced by cancer patients and discusses opportunities for nurses to address the spiritual care of these patients.