Efficacy of the structured life review and the short-term life review on the spiritual well-beingof terminally ill cancer patients

GOALS: The aims of this study were to evaluate the treatment efficacy of the structured life review interviews and the Short-Term Life Review on the spiritual well-being of terminally ill cancer patients, in order to improve patients’ quality of life. SUBJECTS and METHODS: Participants were patients in palliative care units in Japan. In the study 1, the structured life review interviews were conducted with 12 patients. They completed the QOL scale of the SELT-M (Skalen zur Erfassung von Lebens qualitat bei Tumor- kranken–Modified Version) questionnaire before and after the interviews. In the study 2, the Short-Term Life Review was conducted with 30 patients. They reviewed their lives in the first session and they confirmed the contents in the album based on the life review in the second session. Duration of the treatment was one week. Measurement instruments included Func- tional Assessment Chronic Illness Therapy- Spiritual (FACIT-Sp). RESULTS: After the structured life review, the mean overall QOL score and Spirituality subscale score of the SELT-M significantly increased, from 2.57 ± 0.61 to 3.58 ± 1.0 (p=0.013) and 2.57 ± 0.61 to 3.14 ± 2.25 (P=0.023), respectively. After the Short-Term Life Review, the mean FACIT-Sp scores significantly increased from 16 ± 8.2 to 24 ± 7.1. CONCLUSION: Both the structured life review and the Short-Term Life Review may be effective in improving the spiritual well-being of terminally ill cancer patients, being higher feasibility for the Short-Term Life Review. We need to use these therapies understanding characteristics of each therapy.

Characteristics of Nursing Care for Terminally Ill Patients in Hospice/Palliative Care Unit

The purpose of this study was to clarify the characteristics of nursing care for patient with terminally ill in the hospice/palliative care units. Semi-structured interviews on “communication, care, spiritual pain care and prediction of worsening of symptoms” were conducted, incorporating items indicated as important principles of palliative care by Lugton et al. Sixteen nurses at five hospice/ palliative care facilities in urban areas of Japan were surveyed in 2013, and results were analyzed qualitatively. Following characteristics by hospice/palliative care nurses (HPN) were categorized as [HPN sharing meaningful time with the patient] and [HPN’s continual attempts to understand the world in which the patient lives] in the communication;as [HPN providing comfortable care so that patients can value their last moments] and [HPN’s efforts to attend to patients so they can die as they hope to] in the care;and as [HPN’s observation in a range that does not interfere with the patient’s comfort] and [HPN senses that something is different from before] in the prediction of worsening of symptoms. Common characteristic was 【HPN’s support for patients approaching a natural death】. In this study, spiritual pain care was included in the communication and care, and could not be extracted alone. It was suggested that an HPN provides communication, care and prediction of worsening of symptoms with excellent judgment and technological competency, while placing importance on offering support for the patient’s natural death.

Simple Life Review for Terminally Ill Cancer Patients with Low Cognitive Function

Objective: The aims of the study were to develop a Simple Life Review Interview as psychotherapy for terminally ill cancer patients with slight cognitive impairment, and to examine the feasibility and effects of this approach on spiritual well-being and quality of life. Methods: The participants were 5 terminally ill cancer patients in a palliative care unit. They completed questionnaires for the Functional Assessment of Chronic Illness Therapy-Spiritual (FACIT-Sp) scale, Good Death Inventory (Hope, Burden, Human Relationship, Respect as an Individual), and Distress and Impact Thermometer. Results: The Simple Life Review Interview consisted of viewing a DVD and reviewing the patient's life using questions that are applicable to terminally ill cancer patients with slight cognitive impairment. Overall, the FACIT-Sp score and the scores for Hope, Human Relationship, and Respect as an Individual on the Good Death Inventory increased, while the Burden score and the Distress and Impact Thermometer score decreased. However, there were some exceptions to these results. Conclusion: The Simple Life Review is feasible for terminally ill cancer patients with some cognitive impairments, and might be effective for improving spiritual well-being, Good Death, and psychological distress in these patients.

Acceptance Process Model of Patients’ Life with Terminally Ill in Home Hospice and Development of a Narrative Approach for Nurses

The prime aim of this study was to find a psychological process model of patients with terminally ill in home hospice investigating the contents of a narrative, and the secondary aim was to create a narrative approach program for nurses. Ten patients narrated their thinking or feelings along with some prepared questions in two sessions. Patients’ narrative data were categorized by a qualitative analysis and 34 categories were chosen. They perceived good points in home hospice like “Being able to spend time freely”, “Close relationships with care staffs and strong confidence”, though they perceived trouble points like “Suffering from putting burden on the people around me” or “Worries about economic problems”. They perceived psychological changes through illness like “Having peace of mind and becoming kind” “Desire for a natural death”. Moreover they perceived their life like “Acceptance of one’s life including illness” “My life lived with satisfaction”. They regarded as important things such as “Spending life time usefully” “Feelings of my family members and of those around me”, and as hopes “Hope to leave my living proof” “Living left time to the fullest”. From these categories, we propose an acceptance model of patients’ life and a narrative program for nurses.

What Contributes to Satisfaction with Care for Family Caregivers of Terminal Cancer Patients Admitted to General Wards? A Qualitative Study

Satisfaction with care is an important indicator for family caregivers of patients with terminal cancer and is linked to the quality of life. Despite this, few studies have examined the aspects of satisfaction with care of family caregivers of inpatients with cancer in general wards. This qualitative study aimed to elucidate the elements of satisfaction with the care that inpatients with terminal cancer in general wards and their family caregivers receive from medical staff, as perceived by the family caregivers. Semi-structured interviews were conducted with 10 family caregivers of inpatients with terminal cancer. Participants were asked about the care received until then from medical staff, the features of satisfactory care, and the aspects of care they felt were unsatisfactory or could become satisfactory with improvement. The data were analyzed with the content analysis method and the six categories were extracted. For family caregivers of inpatients with terminal cancer in general wards, along with the care identified as important in palliative care, the methods of alleviating symptoms and explaining the patient’s condition were also important. The results highlight the importance of determining a patient-oriented approach and explanations together with each patient and family caregiver, based on an understanding of the long treatment process.

Relation between Family Functioning and Quality of Life among Family Caregivers of Patients with Terminal Cancer Hospitalized in General Wards

Caring for a patient with terminal cancer poses difficulties for family caregivers. Although families of patients with cancer have been classified by type, little is known about the relation between family functioning and quality of life (QOL) in family caregivers. This study aimed to develop a typology of family functioning in family caregivers of patients with terminal cancer and then examine the relation between the family functioning and QOL of family caregivers. From December 2013 to August 2014, fifty-one family caregivers of patients with terminal cancer were recruited at three hospitals in Tokyo, Japan. Perceptions of family functioning were assessed with the Family Relationship Index, and its three subscores were classified into three groups by cluster analysis. Caregivers’ QOL was measured with the Caregiver Quality of Life Index-Cancer. The average total FRI score among 51 caregivers was 8.5 (SD = 2.8). Family functioning was categorized into three clusters: supportive (n = 12), communicative (n = 30), or conflictive (n = 8). Their QOL was categorized into two groups: the communicative group, with relatively high confliction, showed high QOL comparable to the supportive group. Family functioning in the families of patients with terminal cancer hospitalized in general wards was not good. For improving the QOL of family caregivers, it may be important for the family members to express their feelings and distress if they have conflicts.

Palliative oral care in terminal cancer patients:Integrated review

BACKGROUND Palliative care(PC)aims to improve quality of life in patients and its families against life threatening diseases,through suffering’s prevention and relief.It is the duty of the dental surgeon to possess the knowledge needed to treat a patient with little life span,in order to establish an adequate treatment plan for each situation.AIM To synthesize the published evidence on oral conditions,impact,management and challenges in managing oral conditions among palliative patients.METHODS Articles were selected from PubMed and Scopus electronic platforms,using a research strategy with diverse descriptors related to“palliative care”,“cancer”and“oral health”.The article’s selection was done in two phases.The first one was performed by the main researcher through the reading of the abstracts.In the second phase two researchers selected eligible articles after reading in full those previous selected.Data was tabulated and analyzed,obtaining information about what is found in literature related to this subject and what is necessary to be approached in future researches about PC.RESULTS As results,the total of 15 articles were eligible,being one a qualitative analysis,13(92.8%)clinical trials and one observational study.Of the 15 articles,8(53.4%)involved questionnaires,while the rest involved:one systematic review about oral care in a hospital environment,2 oral exams and oral sample collection,one investigation of terminal patient’s(TP)oral assessment records,2 collection of oral samples and their respective analysis and one treatment of the observed oral complications.CONCLUSION It can be concluded that the oral manifestations in oncologic patients in terminal stage are,oral candidiasis,dry mouth,dysphagia,dysgeusia,oral mucositis and orofacial pain.Determining a protocol for the care of these and other complications of cancer–or cancer therapy–based on scientific evidence with the latest cutting-edge research results is of fundamental importance for the multidisciplinary team that works in the care of patients in PC.To prevent complications and its needed to initial the dentist as early as possible as a multidisciplinary member.It has been suggested palliative care protocol based on the up to date literature available for some frequent oral complications in TP with cancer.Other complications in terminal patients and their treatments still need to have further studying.

AN IMMUNOCYTOCHEMICAL STUDY ON RELATIONS BETWEEN MAST CELL AND PEPTIDERGIC TERMINALS IN NASAL MUCOSA OF CHRONIC RHINITIS PATIENTS

Mast cell-nerve relation is a new topk explored deeply in different organs, but little documentation could be found in the literature on the relation in human nasal mucosa. We carried out this study using immunocytochemistry and found that substance P (SP) terminals were present in human nasal mucosa from six cases of chronic rhinitis. SP terminals were often found to be adjacent to or have a direct contact with mast cells (MCs). Electron-microscopic studies revealed that MCs could contact nonmyelinated nerve terminals. These results have important implications in the understanding of the pathogenesis of neurogenic inflammation seen in nasal mucosa and will probably cast new insight into the future treatment of such disease.

Premature Termination of Treatment among Adults Attending Treatment for Eating Disorders: A Critical Review

The article presents a critical review regarding the premature termination of eating disorder’s treatment among inpatients and outpatients, with the aim of identifying—emotional, psychodynamic and family-related aspects involved. The search strategy used the following MeSH terms combined by Boolean operators: “eating disorders” AND “treatment” OR “patient dropouts” OR “drop-out/dropouts” OR “attrition” OR “premature termination” AND “empirical study” OR “qualitative research”, for on Medline/PUBMED, PsycINFO and EMBASE databases. This article follows the PRISMA Guidelines. A total of 26 studies composed this review, of which 24 were original research articles, 1 was a review and 1 a theoretical article. Only two articles applied qualitative methods analyzing categories of content obtained by in-depth interviews, three combine quantitative and qualitative methods and other three present qualitative analyses while discussing quantitative studies. Further qualitative studies should be carried out to clarify meanings of dropout, premature termination of treatment, and attrition. Different expectations held by patients and by therapeutic teams, and the interpersonal difficulties of these types of patients, stand out as difficulties in constructing “therapeutic alliances”, with impacts on dropout, premature termination and attrition rates.

中青年宫颈癌终末期患者主要照顾者的负担及影响因素

目的探讨中青年宫颈癌终末期患者主要照顾者的负担及影响因素。方法选取河南省人民医院收治的宫颈癌终末期患者的主要照顾者95例为研究对象,采用一般资料调查表、照顾者负担量表(ZBI)、Katz日常生活活动能力测定评价表、社会支持评定量表(SSRS)及亚健康状态测量问卷进行调查。结果中青年宫颈癌终末期患者主要照顾者的负担总分为(51.60±8.21)分,属于中度水平。经多元回归分析显示:主要照顾者的社会支持(t=4.870,P=0.001)、主要照顾者的文化程度(t=2.405,P=0.041)、患者日常生活自理能力(t=2.913,P=0.024)、主要照顾者与患者的关系(t=3.729,P=0.015)、主要照顾者的照顾者的亚健康状态(t=4.641,P=0.036)是影响主要照顾者负担的主要因素。结论中青年宫颈癌终末期患者主要照顾者的负担水平较高,主要照顾者负担受多种因素影响,医护人员应根据影响因素制订有针对性的个体化身心调理方案,降低主要照顾者负担的水平,提高生活质量。

安宁疗护对临终患者家属心理支持的实践与意义探讨

安宁疗护作为综合性的医疗照护模式,在关注临终患者的同时,也深入到了患者家属的心理支持层面。探讨了安宁疗护对临终患者家属心理支持的实践与意义。通过全人关怀、症状控制、沟通与信息共享、家属参与、心理支持、灵性关怀及丧亲关怀等七大原则实践,安宁疗护为家属提供了全面的心理援助,这不仅有助于减轻家属的心理负担、增强家属的应对能力,还能保障家属的心理健康,提高家属对医疗服务的满意度。更重要的是,安宁疗护的推广可推动社会的进步,使临终关怀和家属心理支持成为公众关注的焦点,促进医疗体系更加人性化、全面化。

临床护士为终末期患者实施本土化叙事护理的体验

目的:了解临床护士结合中国传统文化为终末期患者实施叙事护理的体验,为本土化叙事护理的临床推广提供参考。方法:采用滚雪球抽样法,选取12名为终末期患者实施过叙事护理的临床护士进行半结构式访谈,采用主题分析法分析资料。结果:为终末期患者实施本土化叙事护理的过程中,临床护士的体验包括临床变革、实践历程、自我获益、困境与挑战4个主题。结论:通过对终末期患者实施本土化叙事护理,既缓解了临终患者的痛苦,也提升了护士的职业价值感,但叙事护理实践也面临着较多的挑战,需要来自管理层及组织层面的支持,以确保本土化叙事护理实践的可持续发展。

三级医院终末期患者转诊的家庭决策路径

目的深入了解三级医院终末期患者转诊中家庭决策的动机、模式及相关因素。方法采用目的抽样法选取北京市3家三级医院的终末期患者及家属作为研究对象,进行半结构式访谈,对访谈资料进行主题分析。结果根据主题饱和原则,最终纳入11例患者和15位家属。访谈资料经整理和分析后归纳为6大主题:决策前提、决策模式、家庭支持、转出医院方医疗团队支持、转诊通道状况、志愿者团队的介入及社会支持,在此基础上,构建终末期患者转诊的家庭决策流程图。结论深度剖析了三级医院终末期患者转诊中家庭决策的多方面因素,结果突显了内外在因素的重要性,同时强调了决策模式、家庭支持、医疗团队支持、转诊通道状况以及志愿者团队的介入和社会支持的综合影响,为改善终末期患者转诊流程和提升家庭决策的质量提供了深刻的理解,为未来改进医疗服务和决策支持提供了有益的建议。

护士参与终末期患者临终决策体验的质性研究

目的了解护士在参与终末期患者临终决策工作的感受及看法,为促进临床护士参与临终决策工作的实施提供参考依据。方法采用目的及滚雪球抽样方法,纳入14名护士,进行半结构深度访谈,运用解释现象学分析法分析访谈资料,提炼主题。结果护士参与终末期患者临终决策体验,可归纳为4个主题15个子主题,包括满足患者需求(信息传递、情感支持),自身的多重情感体验(职业价值、职业责任、成长与收获、悲伤、矛盾、共情疲劳),受到复杂的临床环境限制(繁忙的护理工作、承认医生权威、紧张的医护患环境、法律、伦理),实践能力和素养有待提高(经验与方法薄弱、参加教育和培训的需求强烈)。结论护士在参与终末期患者临终决策实践中承担着信息传递和情感支持的角色和责任分工;其次,护士在参与过程中存在复杂的多重情感体验同时也受到复杂的临床环境限制,也表达出想要通过参加教育培训以及丰富实践经验来提高自己的能力和素养的需求和渴望,希望为完善我国高质量的临终关怀服务体系提供支持。

1例终末期乳腺癌伴难治性癌性疼痛患者的安宁疗护

本文回顾1例乳腺癌终末期患者的安宁疗护实践,探讨癌症终末期难治性癌痛患者疼痛控制、恶心呕吐、姑息镇静的护理,聚焦癌症终末期患者心理支持及精神抚慰,为今后安宁疗护临床实践提供参考。

与死亡打太极——临终患者及家属死亡应对策略的质性研究

目的:探究临终患者及家属的死亡应对策略,为构建本土化安宁疗护服务模式提供现实依据。方法:采用目的抽样法及滚雪球法,对20名临终患者及21名家属进行半结构式访谈,运用解释现象学分析法和隐喻法进行资料分析和主题归纳。结果:包括五大主题:逃避、转折与迂回——掤手回掌;隐藏、忍耐与艰难决策——藏锋敛锐;平衡、摇摆与稳定——攻守衡之;柔和行为、转化表达——柔化而出;寄托、仪式与传承——顺势而为。结论:五大主题整合出临终患者及家属的死亡应对策略为“与死亡打太极”,研究结果为临终患者及家属的死亡应对提供了更多文化视角下的理解,建议未来在顺应优秀中华文化基础上构建中国特色安宁疗护实践模式。

安宁疗护在临终患者疼痛管理中的应用

目的探讨安宁疗护在临终患者疼痛管理中的应用。方法选取医院老年科2021年1月—2022年12月收治的50例临终患者为研究对象,均伴有不同程度的疼痛。根据入院时间将患者分为观察组和对照组,各25例。对照组采用常规护理和疼痛管理,观察组在对照组基础上增加安宁疗护,对比两组患者疼痛视觉模拟量表(VAS)评分。结果干预后两组VAS量表评分降低,且观察组VAS量表评分低于对照组,差异有统计学意义(P<0.01)。结论安宁疗护能有效缓解临终患者疼痛,有助于改善生存质量。

恶性肿瘤临终病人生命末期尊严体验的质性研究

目的:了解恶性肿瘤临终病人生命末期的尊严体验,为改善照护质量提供参考依据。方法:采用目的抽样方法选取2022年7月—2023年8月在杭州市4所三级医院住院的18例恶性肿瘤临终病人,对其尊严体验进行半结构式访谈,采用内容分析法进行资料分析,提炼主题。结果:恶性肿瘤临终病人的尊严体验归纳为3个主题:对尊严的理解、尊严受损的因素、尊严得到维护的因素。结论:医护人员可通过改善工作态度、提升临床照护质量、多学科协作、实施个性化照护、建立良好的社会支持系统改善恶性肿瘤临终病人的尊严体验,提升生命末期的生存质量。

NT-pro BNP在老年心力衰竭合并衰弱诊断及预后评估的应用价值

目的:探究N末端B型利钠肽前体(NT-pro BNP)在老年心力衰竭合并衰弱诊断及预后评估的应用价值。方法:以2020年1月至2022年3月老年心力衰竭115例为研究对象,根据Fried衰弱诊断量表将患者分为衰弱组、衰弱前期组及无衰弱组,分析患者NT-pro BNP水平对患者合并衰弱的诊断价值及与衰弱程度的相关性;根据患者入组12个月内主要不良事件发生情况将衰弱组分为预后较好组及预后不良组,分析NT-pro BNP水平对患者预后的评估价值。结果:衰弱组、衰弱前期组及无衰弱组的NT-pro BNP、BNP及cTnⅠ、CK、CK-MB水平呈下降趋势,且衰弱组各指标高于衰弱前期组,衰弱前期组各指标高于无衰弱组(P<0.05);NT-pro BNP水平诊断老年心力衰竭患者合并衰弱的AUC值为0.773,95%CI为0.685~0.846,P<0.001,灵敏度为68.63%,特异度为76.56%;NT-pro BNP水平与衰弱程度呈正相关(r=0.521,P<0.001);衰弱组、衰弱前期组及无衰弱组的主要心血管不良事件发生率分为60.78%、34.62%及28.95%,其中衰弱组主要心血管不良事件发生率高于衰弱前期组及无衰弱组(P<0.05);预后不良组的NT-pro BNP、BNP及cTnⅠ、CK、CK-MB水平高于预后较好组(P<0.05);NT-pro BNP水平评估老年心力衰竭合并衰弱患者预后的AUC值为0.787,95%CI为0.650~0.889,P<0.001,灵敏度为87.10%,特异度为70.00%。结论:老年心力衰竭合并衰弱患者的NT-pro BNP水平异常升高,且该指标对患者出现衰弱症具诊断价值,对患者预后有评估价值。

临终患者多感官刺激疗法的最佳证据总结

目的总结安宁疗护中临终患者多感官刺激疗法的最佳证据,为临终患者的生命末期护理提供参考。方法按照“6S”证据金字塔模型,系统检索国内外数据库、指南网站及专业协会网站中关于临终患者多感官刺激的文献,检索时限自2003年1月至2023年11月。根据纳入与排除标准筛选文献后,由2名研究者对纳入的文献进行质量评价、证据提取与汇总。结果最终纳入15篇文献,其中指南1篇,临床决策3篇,证据总结2篇,专家共识1篇,系统评价7篇,随机对照试验1篇。从环境管理、感官刺激2个方面总结12条证据。结论总结的临终患者多感官刺激疗法最佳证据,可作为临床医护人员临终护理的指引或参考。