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Palliative Care and Cancer at the End of Life

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Care Sciences & Services".

Deadline for manuscript submissions: closed (15 March 2023) | Viewed by 31051

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Special Issue Editors

Prof. Dr. Leticia Rubio Lamia

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Guest Editor

Department of Human Anatomy and Legal and Forensic Medicine, School of Medicine, IBIMA CE-18, University of Malaga, 29071 Malaga, Spain
Interests: palliative care knowledge; legal and forensic medicine; forensic toxicology; forensic analysis of mineralized samples (teeth and bones)

Dr. Cristina M. Beltrán Aroca

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Assistant Guest Editor

Sección de Medicina Legal y Forense, Departamento de Ciencias Morfológicas y Sociosanitarias, Facultad de Medicina y Enfermería, Universidad de Córdoba, 14004 Córdoba, Spain
Interests: legal and forensic medicine; bioethics; forensic pathology; medical education; forensic anthropology; healthcare law

Special Issue Information

Dear Colleagues,

Quality of care at the end of life is necessary. According to the World Health Organization, the number of people over the age of 60 in the world population will almost double by 2050. Therefore, more palliative care support will be required for some illnesses and clinical syndromes, chronic progressive illnesses or advances stages diseases like cancer. Healthcare services will need to provide appropriate services for demographic changing populations, and this will require greater knowledge, intervention, evaluation, therapies, and welfare of patients, among others, to obtain quality care and assistance for these patients. In this context, the outbreak of the SARS-COV2 pandemic should also be considered as a determining factor in the evolution of palliative care.

Although palliative care has been developed and implemented in many countries, most studies suggest that health professionals are poorly prepared for end-of-life care and do not feel capable of managing patients who need this care. In addition, some studies have observed that health professionals are poor at communicating bad news. Proper communication with patients constitutes a key domain in palliative care and is especially important in the decision to carry out a palliative management plan. Thus, there is a need for in-depth investigations to determine possible gaps in the knowledge, communication, assistance, and therapies in palliative care.

On the other hand, teams that care for these patients are multidisciplinary. Therefore, studies on knowledge, attitude, and management of palliative care in these professionals are also needed. A multidimensional approach is also important in palliative care patients and requires further work in public health areas to overcome barriers.

This Special Issue of the International Journal of Environmental Research and Public Health (IJERPH) focuses on the current state of knowledge in palliative care at the end of life and the relationship between quality of care and well-being of patients, their families, and public health.

New research papers, reviews, case reports, and conference papers are welcome to this issue. Papers dealing with new approaches to assessment and management of these patients are also welcome. Other manuscript types accepted include methodological papers, instrument validation papers, position papers, brief reports, and commentaries.

We will accept manuscripts from different disciplines including ethics, education, healthcare impact, pharmacology, pain management, intervention and evaluation, cancer, palliative care, etc.

Prof. Dr. Leticia Rubio Lamia
Dr. Cristina M. Beltrán Aroca
Guest Editors

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Keywords

palliative care knowledge
ethics
education
attitude
communication
therapies and pharmacology
evaluation
intervention
oncology and cancer

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Published Papers (12 papers)

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Research

14 pages, 1041 KiB

Open AccessArticle

Hope-Based Program for Portuguese Outpatients with Advanced Chronic Illness in a Community Setting: A Randomized Control Trial

by Ana Querido and Carlos Laranjeira

Int. J. Environ. Res. Public Health 2023, 20(2), 1566; https://doi.org/10.3390/ijerph20021566 - 14 Jan 2023

Cited by 2 | Viewed by 2410

Abstract

Background: Hope is widely considered a subjective phenomenon able to bring beneficial consequences to human health and existence. Maintaining hope amid a life-threatening disease and during palliative care is critical. The study aims to examine the effectiveness of a psychosocial supportive Hope Promotion Program (HPP) in enhancing hope, comfort, and quality of life in Portuguese adult outpatients with advanced and progressive chronic illness. Method: Using a parallel Randomized Control Trial (RCT) with pre-post design, 56 cancer outpatients from two day hospitals. Participants were randomly assigned to either a control group (n = 28) or an intervention group (n = 28). The primary outcome measure was hope. Secondary measures included comfort and quality of life. Participants were assessed at baseline, day 15, and day 30 of follow-up. Results: Baseline characteristics were similar between the two groups. In the intervention group, there was a significant increase in the total hope scores after the HPP (day 15). Significant differences were still present after one month (p < 0.05). There was also a significant increase in comfort and quality of life scores in the intervention group one month after HPP (p = 0.018). Conclusions: The HPP may be an effective intervention to increase hope and improve comfort and quality of life among palliative patients. Future studies should increase sample size, diversify settings, and include longer and more detailed follow-ups. Full article

(This article belongs to the Special Issue Palliative Care and Cancer at the End of Life)

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10 pages, 903 KiB

Open AccessArticle

Is Hospital Hospice Service Associated with Efficient Healthcare Utilization in Deceased Lung Cancer Patients? Hospital Charges at Their End of Life

by Dong Jun Kim and Sun Jung Kim

Int. J. Environ. Res. Public Health 2022, 19(22), 15331; https://doi.org/10.3390/ijerph192215331 - 20 Nov 2022

Viewed by 1803

Abstract

In July 2015, South Korea began applying National Health Insurance reimbursement to inpatient hospice service. It is now appropriate and relevant to evaluate how hospice care is associated with healthcare utilization in terminal lung cancer patients. We used nationwide NHI claims data of lung cancer patients from 2008–2018 and identified a sample of patients deceased after July 2016. We transposed the dataset into a retrospective cohort design where a unit of analysis was each lung cancer patients’ healthcare utilization. The differences in hospital charges per day were investigated depending on the patient’s use of hospice service before death with the Generalized Linear Model (GLM) analysis. Additionally, subgroup analysis and the propensity score matching method were used to validate the model using the claims information of 25,099 patients. About 17.0% of patients used hospice services (N = 4260). With other variables adjusted, hospice service utilization by deceased lung cancer patients was associated with statistically significant lower hospital charges per day at the end of life (1 month, 3 months, and 6 months before death) compared to non-users. A similar trend was found in the propensity score matching model analysis. We found lower end-of-life hospital charges per day among lung cancer patients who received hospice services near death. The ever-expanding aging population requires health policymakers and the National Health Insurance program to expand hospice services for terminal cancer patients in underserved regions and hospitals that do not provide hospice. Full article

(This article belongs to the Special Issue Palliative Care and Cancer at the End of Life)

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14 pages, 548 KiB

Open AccessArticle

Implementation of a Standard Care Program of Therapeutic Exercise in Metastatic Breast Cancer Patients

by Bella Pajares, Cristina Roldán-Jiménez, Emilio Alba and Antonio I. Cuesta-Vargas

Int. J. Environ. Res. Public Health 2022, 19(18), 11203; https://doi.org/10.3390/ijerph191811203 - 6 Sep 2022

Cited by 3 | Viewed by 2602

Abstract

Background: There is little information on the feasibility and benefit of therapeutic exercise (TE) in women with metastatic breast cancer (MBC). The aim of this article is to describe the implementation of a TE intervention in MBC patients, and to determine the recruitment, compliance and improvement in outcomes after its completion. Methods: The “Therapeutic Exercise program in MBC” (TEP-MBC) consists of 1 h of individualized TE supervised by a physiotherapist in a group format, consisting of four groups of seven to eight participants. TEP-MBC was delivered twice a week, lasting 12 weeks (22 sessions), with patients considered to have completed the program when attending at least 17 sessions (>75% attendance). After referral, patients underwent a clinical interview and a physical and functional assessment. This information was complemented with patient-reported outcomes. Data about referral, compliance and assessment were collected. Results: Only 11 of the 30 patients completed the program. Drop-out was mainly related to personal issues and symptoms arising from the disease or treatment. All patients who completed the program improved cancer-related fatigue and increased their functional parameters. Conclusions: The TEP-MBC was safe and feasible in patients with MBC, although with low compliance. The high variability in baseline measures reflects the heterogeneous level of function. Full article

(This article belongs to the Special Issue Palliative Care and Cancer at the End of Life)

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10 pages, 912 KiB

Open AccessArticle

Care Needs and Symptoms Burden of Breast Cancer Patients in Jordan: A Cross-Sectional Study

by Omar Shamieh, Ghadeer Alarjeh, Houshen Li, Mahmoud Abu Naser, Fadi Abu Farsakh, Rashid Abdel-Razeq, Adib Edilbi, Ruba Al-Ani, Richard Harding and Ping Guo

Int. J. Environ. Res. Public Health 2022, 19(17), 10787; https://doi.org/10.3390/ijerph191710787 - 30 Aug 2022

Cited by 6 | Viewed by 2358

Abstract

Breast cancer is the most common malignancy in Jordan. Rigorous needs assessment for breast cancer patients can prioritize both cancer care and palliative care to propose the appropriate services effectively. We conducted a cross-sectional study of breast cancer patients in a cancer center in Jordan. We assessed symptom burden, comorbidities, and performance using the Edmonton Symptom Assessment System (ESAS), the Charlson Comorbidity Index (CCI), and the Australia-modified Karnofsky performance scale (AKPS). Descriptive analysis and regression models to predict the highest symptom burden were used. A total of 233 participants were enrolled: curative vs. palliative intent groups (147 (63%) vs. 86 (37%) patients), respectively. Tiredness was the most reported symptom in 189 patients (81%), while nausea was the least in 61 patients (26.2%). A relationship between the AKPS score and total ESAS was seen (correlation coefficient of −0.487; p < 0.0001). The prevalence of anxiety (p = 0.014), lack of appetite (p = 0.002), poor well-being (p < 0.001), and sleep disorder (p = 0.035) was higher in the palliative care intent group than in the curative one. We identified unmet needs in breast cancer patients. Both groups showed a prevalence of distressing symptoms suggesting that even those with non-palliative intent have high needs and should receive integrated palliative care. Full article

(This article belongs to the Special Issue Palliative Care and Cancer at the End of Life)

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10 pages, 518 KiB

Open AccessArticle

Validation of the Spanish Versions of FACIT-PAL and FACIT-PAL-14 in Palliative Patients

by Estefanía Moldón-Ballesteros, Inés Llamas-Ramos, Jose Ignacio Calvo-Arenillas, Olaia Cusi-Idigoras and Rocío Llamas-Ramos

Int. J. Environ. Res. Public Health 2022, 19(17), 10731; https://doi.org/10.3390/ijerph191710731 - 29 Aug 2022

Cited by 3 | Viewed by 1791

Abstract

Palliative patients require several types of care to improve their quality of life as much as possible, and valid and reliable assessment instruments are essential. The objective of this study is the Spanish validation of the Functional Assessment Chronic Illness Therapy-Palliative Care (FACIT-PAL) and its abbreviated version, FACIT-PAL-14, in palliative care patients. FACIT-PAL and FACIT-PAL-14 were translated into Spanish and administered to 131 terminal oncology patients in home palliative care units, hospital palliative care units, health center teams, and social health centers. The European Organization for Research and Treatment of Cancer questionnaire, EORTC-QLQ-C15-PAL version, was used to evaluate the criterion validity. The EORTC-QLQ-C15-PAL was employed as a “gold standard”, and it obtained significant results with FACIT scales. FACIT-PAL-14, FACIT-PAL, and its subscales reported high internal consistency, from 0.640 to 0.816. The exploratory factor analysis for FACIT-PAL-14 found a structure in three factors that explained the 70.10% variance, and the FACIT-PAL scale found a structure of five factors. Physical wellbeing from FACIT-PAL highly correlated to the EORTC-QLQ-C15-PAL (r = 0.700), but social and family wellbeing was correlated to a lesser extent (r = −0.323). FACIT-PAL and the TOI (Toi Outcome Index) were also highly correlated with the EORTC-QLQ-C15-PAL, with values of r = −0.708 and r = −0.709, respectively. The Spanish versions of FACIT-PAL and FACIT-PAL-14 were demonstrated to be valid and reliable scales in palliative care patients. Full article

(This article belongs to the Special Issue Palliative Care and Cancer at the End of Life)

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10 pages, 344 KiB

Open AccessArticle

Assessment of Mood and Hope in Critically-Ill Patients as a Basis for the Improvement for the Palliative and Hospice Care

by Bożena Baczewska, Bogusław Block, Mariola Janiszewska, Krzysztof Leśniewski and Agnieszka Zwolak

Int. J. Environ. Res. Public Health 2022, 19(16), 9987; https://doi.org/10.3390/ijerph19169987 - 13 Aug 2022

Cited by 3 | Viewed by 2302

Abstract

The aim of the research is to present a level of hope in people in the terminal phase of cancer who differ in terms of mood: cheerful vs. sad. The study group consisted of 246 patients. Their average age was 59.5. The youngest respondent was 18 and the oldest was 90. The Personal Card tests by T. Witkowski (KI) and B.L. Block (NCN-36), designed for people struggling with serious life-threatening diseases, were used. The test consists of four scales distinguished by factor analysis. Each scale comprises of eight items. The following are used to study hope: the situational dimension—health; the telek-temporal dimension—goals; the spiritual dimension—religious beliefs; and the emotional-affective dimension—motivations. In the global view, the hope of the subjects was moderate. In the situational dimension—health, the telek-temporal dimension—goals, and the spiritual dimension—religious beliefs, people with a generally cheerful mood had stronger hope, in comparison to people with a sad mood. Only in the emotional-affective dimension—motivations, did people with a sad mood manifest stronger hope in comparison to people with a cheerful mood. The conducted research allowed us to conclude that mood is one of the determinants of hope in terminally ill cancer patients. Full article

(This article belongs to the Special Issue Palliative Care and Cancer at the End of Life)

9 pages, 324 KiB

Open AccessArticle

Important End-of-Life Topics among Latino Patients and Caregivers Coping with Advanced Cancer

by Lianel Rosario-Ramos, Keishliany Suarez, Cristina Peña-Vargas, Yoamy Toro-Morales, Rosario Costas-Muñiz, Eida Castro, Stephanie Torres and Normarie Torres-Blasco

Int. J. Environ. Res. Public Health 2022, 19(15), 8967; https://doi.org/10.3390/ijerph19158967 - 23 Jul 2022

Cited by 6 | Viewed by 1874

Abstract

There is a known end-of-life related disparity among Latino individuals, and there is a need to develop culturally sensitive interventions to help patients and caregivers cope with advanced cancer. Latino patients and caregivers coping with advanced cancer were asked to list important end-of-life topics to culturally inform a psychosocial intervention adaptation process. A qualitative study was conducted, and semi-structured interviews were performed, audio-recorded, and transcribed. Recordings and transcriptions were reviewed and analyzed using thematic content coding. The semi-structured interview described and demonstrated intervention components and elicited feedback about each. Free listing method was used to assess important topics among Latino advanced cancer patients (n = 14; stage III and IV) and caregivers. Patients and caregivers were given a list of 15 topics and asked which topics they deemed important to integrate into the intervention. Overall, more than half of the participants considered it important to include 13 of the 15 topics related to daily activities (eight subcategories), psychosocial support (three subcategories), discussing diagnosis and support (three subcategories), and financial difficulties (one subcategory). Patient-caregivers reported importance in most end-of-life topics. Future research and intervention development should include topics related to psychosocial support, daily activities, discussing diagnosis and support, and financial difficulties. Full article

(This article belongs to the Special Issue Palliative Care and Cancer at the End of Life)

16 pages, 770 KiB

Open AccessArticle

Physicians’ Experiences and Perceptions of Environmental Factors Affecting Their Practices of Continuous Deep Sedation until Death: A Secondary Qualitative Analysis of an Interview Study

by Stijn Vissers, Sigrid Dierickx, Lenzo Robijn, Joachim Cohen, Luc Deliens, Freddy Mortier and Kenneth Chambaere

Int. J. Environ. Res. Public Health 2022, 19(9), 5472; https://doi.org/10.3390/ijerph19095472 - 30 Apr 2022

Cited by 1 | Viewed by 2445

Abstract

As previous research has paid little attention to environmental factors affecting the practice of continuous deep sedation until death (CDS), we aimed to explore these using physicians’ experiences and perceptions. We performed an interpretative thematic analysis of primary data from a qualitative interview study conducted from February to May 2019 in Belgium with 47 physicians. Structural factors were identified: the lack of professional and/or technical support in monitoring sedated patients; the use of guidelines in team contexts; the time constraints for treating individual patients and work pressure; the structural knowledge gap in medical education; the legal context for assisted dying; and the lack of a clear legal context for CDS. Cultural factors were identified: the moral reservations of care teams and/or institutions towards CDS; the presence of a palliative care culture within care teams and institutions; the culture of fear of making clinical errors regarding CDS among a group of physicians; the professional stigma of performing assisted dying among some of the physician population; the different understandings of CDS in medical and policy fields; and the societal taboo around suffering at the end of life and natural death. To conclude, improving CDS practice requires a whole-system approach considering environmental factors. Full article

(This article belongs to the Special Issue Palliative Care and Cancer at the End of Life)

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19 pages, 940 KiB

Open AccessArticle

Impact of the COVID-19 Pandemic on Palliative Care in Cancer Patients in Spain

by Cristina M. Beltran-Aroca, Rafael Ruiz-Montero, Antonio Llergo-Muñoz, Leticia Rubio and Eloy Girela-López

Int. J. Environ. Res. Public Health 2021, 18(22), 11992; https://doi.org/10.3390/ijerph182211992 - 15 Nov 2021

Cited by 8 | Viewed by 2523

Abstract

Background: The COVID-19 pandemic outbreak has severely affected healthcare organizations worldwide, and the provision of palliative care (PC) to cancer patients has been no exception. The aim of this paper was to analyse the levels of health care provided by the Clinical Management Unit for PC in Córdoba (Spain) for cancer patients. Method: a retrospective cohort study was conducted. It analyzed the PC internal management database including all cancer patients treated in the period of 2018–2021. Results: 1967 cases were studied. There was a drop in cancer cases (p = 0.008), deaths at the PC hospital (p < 0.001), and referrals from primary care (p < 0.001). However, there was a rise in highly complex clinical situations (p = 0.020) and in ECOG performance status scores of 3–4 (p < 0.001). The pandemic was not shown to be a risk factor for survival in the PC program (0.99 [0.82–1.20]; p = 0.931). However, being female (p = 0.005), being older and having a high Karnofsky Performance Status (KPS) score (p < 0.001) could be indicators of a longer stay. Conclusion: The COVID-19 pandemic has presented a challenge in the management of patients requiring PC and has highlighted the urgent needs of the healthcare system if it is to continue providing a level of care which meets the needs of patients and their families. Full article

(This article belongs to the Special Issue Palliative Care and Cancer at the End of Life)

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10 pages, 973 KiB

Open AccessArticle

Palliative Care Coverage across European National Health Systems: Proposal of a Synthetic Indicator

by Miguel Antonio Sánchez-Cárdenas, Eduardo Garralda, Edgar Benítez, Natalia Arias-Casais, Danny van Steijn and Carlos Centeno

Int. J. Environ. Res. Public Health 2021, 18(20), 10753; https://doi.org/10.3390/ijerph182010753 - 13 Oct 2021

Cited by 6 | Viewed by 2277

Abstract

Background: The coverage of palliative care (PC) may be understood as a country’s capacity to offer prevention and relief from serious health-related suffering in relation to an existing need. The aim of this study is to estimate European countries´ coverage capacities. Method: Secondary analysis of three indicators, including the number of specialized services (SSPC), integration capacity scores (ICS) and the PC needs. By means of a K-medians clustering supervised algorithm, three coverage profiles were obtained: (1) Advanced: countries with high ICS and SSPC, and low PC needs; (2) Limited: countries with low ICS and SSPC, and low PC needs; and (3) Low: countries with low ICS and SSPC and high PC needs. Results: On average, the ratio of specialized services per population was 0.79 per 100,000 inhabitants, the average ICS was 19.62 and the average number of deceased patients with SHS per 100,000 inhabitants was 5.69. Twenty countries (41%) reached an advanced coverage profile. Nine countries (18%) demonstrated a limited coverage profile; and 20 countries (41%) fell under a low-coverage capacity. Conclusion: The level of palliative care coverage across Europe shows that 59% of European countries have either limited or very low availability of PC resources as regards their palliative care needs. Full article

(This article belongs to the Special Issue Palliative Care and Cancer at the End of Life)

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8 pages, 343 KiB

Open AccessArticle

Psychometric Testing of the Spanish Modified Version of the Mini-Suffering State Examination

by Daniel Gutiérrez-Sánchez, Rafael Gómez-García, Isabel María López-Medina and Antonio I. Cuesta-Vargas

Int. J. Environ. Res. Public Health 2021, 18(15), 7821; https://doi.org/10.3390/ijerph18157821 - 23 Jul 2021

Cited by 4 | Viewed by 2319

Abstract

Background: The mini-suffering state examination is a valid and reliable measure that have been used to assess suffering in patients with advanced cancer. The aim of this study was to carry out a psychometric analysis of the Spanish version of the mini-suffering state examination. Method: A validation study was conducted. Seventy-two informal caregivers of deceased patients in palliative care were included in this study. A psychometric testing of content validity, internal consistency, and convergent validity with the Spanish version of the quality of dying and death questionnaire was performed. Results: The original instrument was modified to be used by informal caregivers. The content validity was acceptable (0.96), and the internal consistency was moderate (α = 0.67). Convergent validity was demonstrated (r = −0.64). Conclusion: The Spanish modified version of the MSSE showed satisfactory measurement properties. The Spanish modified version of MSSE can be useful to facilitate screening, monitor progress, and guide treatment decisions in end-of-life cancer patients. Full article

(This article belongs to the Special Issue Palliative Care and Cancer at the End of Life)

12 pages, 3855 KiB

Open AccessArticle

Physicians’ and Nurses’ Knowledge in Palliative Care: Multidimensional Regression Models

by Jaime Martín-Martín, Mónica López-García, María Dolores Medina-Abellán, Cristina María Beltrán-Aroca, Stella Martín-de-las-Heras, Leticia Rubio and María Dolores Pérez-Cárceles

Int. J. Environ. Res. Public Health 2021, 18(9), 5031; https://doi.org/10.3390/ijerph18095031 - 10 May 2021

Cited by 9 | Viewed by 3943

Abstract

The increase in life expectancy has led to a growth in the number of people in need of palliative care. Health professionals must possess appropriate knowledge and skills. This study aimed to assess knowledge in palliative care through the Palliative Care Knowledge Test Spanish Version (PCKT-SV)^®. A cross-sectional analytical study was conducted in 40 primary care health services. A total of 600 PCKT-SV questionnaires were distributed among health professionals; 561 of them (226 nurses and 335 physicians) were properly filled up. Sociodemographic information, education, and work experience were also recorded. A total of 34.41% of the nurses and 67.40% of the physicians showed good or excellent knowledge of palliative care. Physicians’ scores for pain, dyspnea, and psychiatric disorders were higher than those of the nurses. Nurses scored significantly better in philosophy. Professionals with continuous training in palliative care showed a higher level of knowledge. Age and work experience of physicians and undergraduate training in nurses had significant weight in knowledge. Developing continuous training and enhancing undergraduate training in palliative care will lead to improved patient care at the end of life. Full article

(This article belongs to the Special Issue Palliative Care and Cancer at the End of Life)

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