Survey on hospice care attitude of family members of advanced cancer patients at different ages

BACKGROUND Hospice care plays an important role in improving the quality of life of advanced cancer patients,but controversy remains over whether age affects the attitudes of family members toward hospice care.AIM To investigate the attitudes of family members of advanced cancer patients of different ages toward hospice care.METHODS The study participants were 175 family members of patients with advanced cancer from January 2020 and October 2022.The participants were divided into youth(<40 years,n=65),middle-aged(40–60 years,n=59),and elderly(>60 years,n=51)groups.Researchers investigated and compared the degree of awareness regarding hospice care,attitudes,and whether the family members of patients would choose hospice care.RESULTS Among the family members of 175 patients,approximately 28%(49/175)were aware of hospice care.Awareness of hospice care,the proportion of hospice care acceptance and adaptation attitudes,and the proportion of those who chose hospice care in the youth group were higher in the middle-aged and elderly groups(P<0.05).No statistically significant difference was found in these three indicators between the middle-aged and elderly groups(P>0.05).Hospice care was chosen mainly to relieve pain and reduce unnecessary treatment,whereas the reasons for not choosing hospice care were mainly distrust and ethical concerns.CONCLUSION The family members of patients with advanced cancer had relatively low awareness of hospice care,while youth had a higher awareness of hospice care,acceptance,and adaptation attitudes,and were more willing to choose hospice care.

A Review of Grief Counselling Practices for Family Members of Oncology Patients in Hospice Care

In cancer patients, especially terminal patients, the family members of the patients will develop more serious sadness and find it difficult to face death rationally, which affects the quality of life and activities. Because of this, in the clinical treatment of oncology patients, strengthening hospice care for family members, doing a good job of death education, assisting them to face and participate in the clinical treatment of oncology in a positive way, and avoiding excessive grief can simultaneously improve the quality of life of patients and their families.

Nursing undergraduates’experiences of a simulation-centred educational program in hospice care in Macao:A qualitative research

Objectives:The study aimed to explore the experiences of nursing undergraduates participating in a simulation-centred educational program in hospice care in Macao,China.Methods:This descriptive qualitative study was based on the data collected through semi-structured individual interviews.Seventeen nursing undergraduates in Macao,China who attended the simulation-centred program in hospice care participated in this qualitative from November to December 2020.This program included three parts:introduction to hospice care(2 h),management of terminal symptoms(10 h),and hospice situation simulations(6 h).The interview data were analyzed using qualitative content analysis.Results:This study revealed two themes and six sub-themes.Theme 1 was developing competencies in caring for dying patients and their families,which included four subcategories of sensitivity to patients’needs,knowledge of hospice care,skills of symptom control and comfort supply,and communication skills.Theme 2 was improving the ability to self-care and support colleagues,which included two subcategories of reflection on life and death and sharing and supporting among colleagues.Conclusion:This program improved the competency of nursing undergraduates in hospice care and participants’learning experience was good.

Research on the Development of Hospice Care in Beijing

In recent years, hospice care in Beijing has developed rapidly. In order to further promote the development of hospice care in Beijing, this paper first analyzes the current situation of hospice care in Beijing, and then analyzes the existing problems of hospice care in Beijing, such as insufficient funds, lack of medical staff, no unified public information platform and low acceptance of hospice care. In view of the existing problems, the paper puts forward relevant policy suggestions for the development of hospice care in Beijing, such as increasing financial support, strengthening the propaganda and education of hospice care, strengthening the training of professional talents, improving the voluntary service system, formulating reasonable access standards, and building a unified public information platform, so as to further promote the effective, healthy and rapid development of hospice care in Beijing development.

The decision for hospice care in patients with terminal illness in Shanghai:A mixed-method study

Objectives To investigate why patients with terminal illness and their families in Shanghai choose the hospice ward and their decision-making process.Methods This was a mixed-method study consisting of a cross-sectional survey and a descriptive qualitative study.Medical decision-makers for patients hospitalized in hospice wards were recruited between September 2019 and July 2021.A medical decision-maker is a family member who makes medical decisions for a patient.All 146 participants completed a self-developed 10-item questionnaire that included five items about their demographic characteristics and five items about the decision-making process.The semi-structured interviews were conducted with nine participants to understand the family’s decision-making process when they chose a hospice ward.The interviews were analyzed using qualitative content analysis.Results The mean age of the 146 participants was 57.6 years old.Of the decision-makers,56.85%were the patients’children.Family-dominated discussions involving other family members were the main decision-making mode(84.93%).Patient participation in the decision-making process was reported in 43.15%of families.The participation of doctors(17.81%)and nurses(2.05%)were reported in a small number of families.The most common reason for choosing the hospice ward was the inability to find any other hospital for the patients(82.19%).The most common ways to learn about the service were neighbors and friends(38.36%)and social media(28.77%).Two themes and six categories emerged from the interviews.The first theme was reasons for choosing hospice wards.The reasons included being unable to care for the patients at home,staying in a hospice ward could reduce the psychological stress for home care,being unable to be admitted into tertiary/secondary hospitals,and thinking a hospice ward was a suitable place for the family.The second theme was the decision process of choosing a hospice ward.This theme included the following two categories,i.e.,ways to learn about the hospice ward and family-discussion decision mode.Conclusion To most families having dying patients,a hospice ward is a reasonable and balanced choice after the families experience huge care stress and practical difficulties.The participation of patients should be encouraged in the family discussion so that their wishes can be known.More efforts will be needed to guide the families with dying patients to make reasonable medical choices.Social media can be a good way to improve public awareness of hospice services in the future.Meanwhile,healthcare providers should be more involved in the decision-making process.

A review of the research on music therapy in hospice care

Objective:To summarize the research progress of music therapy in hospice care and to provide reference for further research.Methods:A wide range of literatures on music therapy and hospice care at home and abroad were searched and read,and the literature was integrated,judged,analyzed,and summarized.Results:The related research on music therapy in hospice care mainly focused on western developed countries such as Europe and the United States.China is still in the stage of theoretical exploration,lacking qualitative research based on case investigation and empirical research based on data statistics.Conclusions:Music therapy supports the management of symptoms in hospice care,which can meet the diverse needs of patients and their family members including physical,psychological,social,and spiritual.

A preliminary study on the application of storytelling among hospice care interest group

Purpose:To explore the effect of storytelling on hospice care learning in the interest group.Methods:Storytelling was used among 7 master of science in nursing(MSN)students in the hospice care interest group.The effect of storytelling was evaluated by the combination of students’reflect diary and the evaluation form.Results:Five themes were extracted from diary including:relieving the suffering of the patients,understanding and respecting patients’choice,communicating,team working,and family supporting.Among 5 items of the evaluation form,there were 4 items which were scored as either agree or strongly agree.Conclusions:Students reflected that the storytelling helped them recognize the importance of relieving the suffering,respecting and understanding,communicating,team working,and family supporting in the hospice care.

A Review on Problems of China＇s Hospice Care and Analysis of Possible Solutions

NTRODUCTIONHospice care is a type of care and a philosophy of care that focuses on the palliation of a terminally ill or a seriously ill patient＆#39;s pain and symptoms,and attends to their emotional and spiritual needs.[1] Taiwan scholar Xie Mei introduced the concept of hospice care to the mainland of China in 1982 and the practice of hospice care in the mainland of China began then.[2] Tianjin Medical University had set up the Institute of Hospice Care.[3] Major state-owned hospitals have established hospice wards.There are also some hospice agencies set up through private fund raising.However,after all these years of development,the supply of the hospice care service in our country is still much less than the demand,between which the gap is big.There are three main reasons causing the gap.The details are as follow.

Unplanned hospitalizations for metastatic cancers:The changing patterns of inpatient palliative care,discharge to hospice care,and in-hospital mortality in the United States

Objective:To describe the rates and temporal trends of inpatient end-of-life care among patients hospitalized with metastatic cancer in the United States.Methods:We used data from the Nationwide Inpatient Sample to conduct a cross-sectional analysis of unplanned inpatient hospitalizations of patients aged 18 years or older with metastatic cancer from 2002 to 2011.Multivariable logistic regression was used to assess patient-and hospital-level predictors of discharge to hospice care,palliative care,and in-hospital mortality.Temporal trends in outcomes were characterized with use of joinpoint regression.Results:There were an estimated 350,241 unplanned hospitalizations per year of patients with a diagnosis of metastatic cancer.During their inpatient stay,5.8%of patients received palliative care,and among those discharged alive,12.2%were referred to hospice care.The rate of inpatient palliative care increased from 2.3%to 13.6%,the rate of discharge to hospice care increased from 4.1%to 15.6%,and the in-hospital mortality rate decreased from more than 14.0%to 9.8%.These patterns were consistent across cancer subtypes,and were most pronounced among patients with extreme risk of mortality.Conclusion:Despite increases in the provision of comfort-oriented care to patients with meta-static cancer,few receive such services.We recommend screening protocols in hospitals to identify patients who are good candidates for palliative care consultation and hospice referral.

A good death from the perspective of healthcare providers from the internal medicine department in Shanghai:A qualitative study

Objective:This study aimed to explore the understanding of healthcare providers working in the internal medicine department in Shanghai regarding a good death.Methods:The data of the study was collected using face-to-face semi-structured interviews.Through purposive sampling,16 physicians and 13 nurses who had experiences of caring for adult patients with life-threatening illnesses at the end-of-life stage in Shanghai were interviewed.The interviews were analyzed using qualitative content analysis.Results:Six characteristics of a good death emerged:no suffering,companionship and care,no worries or concerns,dying with dignity,involvement and acceptance,and less impact on the family.Eighteen categories were identified:dying without experiencing suffering;being relieved of symptoms and suffering;being relieved of psychological suffering;avoiding the use of futile treatment and resuscita-tion;being cared for and accompanied by family;receiving good health care;having a meaningful life without regrets;making good arrangements for family issues;having a chance to say goodbye;having a quality life before death;dying in a decent environment;the personal will to be respected;maintaining the integrity of the body;death of the patient being accepted by the family and healthcare providers;the death occurred despite the best efforts to care for the patient;limited financial and care burden;shortly affected quality of life of the patient;and improved family cohesion.Conclusion:Family members’early involvement in caring for patients at the end-of-life stage helps achieve a good death.For patients with a terminal illness,avoiding unnecessary medical treatment and resuscitation could be the first step in achieving better patient death and promoting the development of advanced care planning in the mainland of China.

Validation of the Trail Making Test B for the Cognitive Assessment of Patients with Cancer in Palliative Care

Introduction: Cognitive impairment is common in patients with cancer;however, studies examining the adaptation and validation of instruments for use in patients with cancer are scarce. Purpose: The purpose of this study was to validate the Trail Making Test B (TMT-B) for use in patients with cancer. Methods: Ninety-four outpatients receiving palliative treatment and 39 healthy companions were assessed. Patients were tested with the TMT-B and answered questions regarding the presence and intensity of pain, fatigue, quality of sleep, anxiety, and depression, at two time points with a 7-day inter-assessment interval. Results: The instrument discriminated between patients, who were slower, and healthy companions with respect to the time required to complete the test, but not in terms of the number of errors. The test was stable for the healthy companions across the two assessments in terms of time to complete the TMT-B and the number of errors;for patients, the instrument was stable only for the number of errors. Performance on the TMT-B did not correlate with pain, fatigue, depression, anxiety, or sensation of rest. Conclusions: TMT-B cannot be considered fully validated. Further studies incorporating and comparing other instruments evaluating executive function and mental flexibility are needed.

Palliative care for Parkinson’s disease patients and their caregivers

Parkinson's disease is still incurable and the long-term care needs of patients represent a huge challenge for health systems.Palliative care as an alternative therapy can greatly alleviate the suffering and burden on patients and caregivers through effective medical symptom management,the provision of mental health support,and the development of health plans.This paper explores the current status and challenges regarding palliative care for patients with Parkinson's disease in recent years through a literature review approach.The findings can provide scientific evidence for researchers,clinical practitioners and policy makers in this field.We not only reviewed the systematic and effective therapy,but also concluded a new multidisciplinary cooperation model.TCM teams such as acupuncturists,TCM pharmacists and TCM physiotherapists should be key members of the new multidisciplinary team for the palliative care of Parkinson's disease.

Focuses and trends of the studies on pediatric palliative care:A bibliometric analysis from 2004 to 2018

Objectives:To investigate the focuses and trends of the studies on pediatric palliative care(PPC)and provide directions for future research.Methods:Relevant papers about PPC published from 2004 to 2018 were analyzed using bibliometric analysis methods,including co-word analysis,biclustering analysis,and strategic diagram analysis.The included papers were divided into three groups based on the publication time,including 2004-2008,2009-2013,and 2014-2018.Results:A total of 1132 papers were published between 2004 and 2018,and there were 293 papers published between 2004 and 2008,396 between 2009 and 2013,and 443 between 2014 and 2018.There were 42 high-frequency MeSH terms/MeSH subheadings in papers published between 2004 and 2018,including 12 between 2004 and 2008,13 between 2009 and 2013,and 17 between 2014 and 2018.Conclusion:Studies on PPC were making progress,with the increasing number,expanding scope,and uneven global distribution.Integration palliative care into pediatrics,cancer treatments in pediatric oncology,education methods on PPC,and establishment of professional teams were the major themes during 2004e2008,then the themes changed into establishing interventions to enhance the quality of life of the patients and parents,building professional-family relationship,and investigating attitude of health personnel in PPC during 2009-2013 and subsequently turned into communication skills,end-oflife decision making,and guidelines making on PPC during 2014-2018.Underdeveloped and protential themes including effective approaches to deal with the ethical dilemmas,training programs on communication skills,family support and guideline making are worth studying in the future.

Home care with acupuncture increased the quality of life in a patient with advanced cancer with neuropathic pain induced by bone metastasis: a case report

A 66-year-old female patient was diagnosed with hepatocellular carcinoma accompanied by neuropathic pain induced by a metastatic tumor that compromised root and spinal canal. Although her pain was relieved following medical treatment, breakthrough pain occurring 1–2 times a day was still distressing.Neuropathic pain in her right lower limb caused discomfort and irritability and decreased her quality of life. We had limited options to adjust her prescription drug regime, due to the side effect of these drugs.Although acupuncture therapy was only performed at her home once a week, the efficacy was outstanding. The patient did not report any further instances of breakthrough pain, and she did not require additional bolus morphine. She could comfortably live in her familiar surroundings with her family and did not require any emergency room visits or admission into the hospital during the last month of her life.She had excellent quality of life in the terminal period of her life, and could even participate in a family function during this time. The present case report suggests that acupuncture may have a role in treating neuropathic pain induced by bone metastasis in patients with advanced cancer across clinical and inhome settings.

Advanced Chronic Obstructive Pulmonary Disease： Innovative and Integrated Management Approaches

Chronic obstructive pulmonary disease （COPD） is a leading cause of morbidity and mortality worldwide and results in an economic and social burden that is both substantial and increasing. By the year 2020, COPD will be the third leading cause of mortality and the fifth leading cause of disability worldwide, In a population based study conducted at multiple international sites, approximately 10% of participants 40 years of age or older were found to have airflow obstruction of at least moderate severity according to spirometric criteria. In China, the overall prevalence of COPD in individuals 40 years of age or older was 8.2%.m COPD is a slowly progressive respiratory disease, which, although preventable and treatable, is not curable. The final years for patients with advanced COPD are characterized by progressive functional decline, frequent exacerbations, poor quality of life, increasing dependency on informal caregivers and on the health care system. According to the literature, 5-year survival from diagnosis is estimated to be 78% in men and 72% in women with mild disease, but only 30% in men and 24% in women with advanced COPD.