AIMS: This study aimed to identify, appraise, and integrate the evidence for the experiences and preferences of Muslim patients and/or families for end-of-life care in Muslim-majority countries.
DESIGN: Systematic review.
DATA SOURCES: PsychINFO, MEDLINE, Embase, Global Health, CINAHL, Cochrane Library and Registry of Clinical Trials, PubMed, Applied Social Sciences Index and Abstracts (ASSIA), Social Services Abstracts, Sociological Abstracts, Social Policy & Practice, and Scopus were searched until December 2018. Handsearching was performed, and gray literature was included. Qualitative studies analyzed using thematic analysis and quantitative component provided triangulation.
RESULTS: The initial search yielded n = 5098 articles, of which n = 30 met the inclusion criteria. A total of 5342 participants (4345 patients; 81.3%) were included; 97.6% had advanced cancer. Most (n = 22) studies were quantitative. Three themes and subthemes from qualitative studies were identified using thematic analysis: selflessness (burden to others and caregiver responsibilities), ambivalence (hope and hopelessness), and strong beliefs in Islam (beliefs in death and afterlife and closeness to Allah). Qualitative studies reported triangulation; demonstrating conflicts in diagnosis disclosure and total pain burden experienced by both patients and families.
CONCLUSION: Despite the scarce evidence of relatively low quality, the analysis revealed core themes. To achieve palliative care for all in line with the total pain model, beliefs must be identified and understood in relation to decision-making processes and practices.
AIM: To evaluate the preparedness and capacity of hospice and palliative care services in the Asia-Pacific region to respond to the COVID-19 pandemic.
METHOD: An online cross-sectional survey was developed based on methodology guidance. Asia-Pacific Hospice and Palliative Care Network subscribers (n = 1551) and organizational members (n = 185) were emailed. Descriptive analysis was undertaken.
RESULTS: Ninety-seven respondents completed the survey. Around half of services were hospital-based (n = 47, 48%), and public-funded (n = 46, 47%). Half of services reported to have confirmed cases (n = 47, 49%) and the majority of the confirmed cases were patients (n = 28, 61%). Staff perceived moderate risk of being infected by COVID-19 (median: 7/10). > 85% of respondents reported they had up-to-date contact list for staff and patients, one-third revealed challenges to keep record of relatives who visited the services (n = 30, 31%), and of patients visited in communities (n = 29, 30%). Majority of services (60%) obtained adequate resources for infection control except face mask. More than half had no guidance on Do Not Resuscitate orders (n = 59, 66%) or on bereavement care for family members (n = 44, 51%).
CONCLUSION: Recommendations to strengthen the preparedness of palliative care services include: 1) improving the access to face mask; 2) acquiring stress management protocols for staff when unavailable; 3) reinforcing the contact tracing system for relatives and visits in the community and 4) developing guidance on patient and family care during patient's dying trajectory.
BACKGROUND: On a global scale, with the increase of aging, the number of people in need of palliative care has increased significantly, which has a huge impact on the professional pressure of palliative nurses. Existing literature focuses on examining palliative care from the perspective of patients, but palliative nurses also face the threats to physical and mental health caused by job burnout.
EVALUATION: A systematic literature search has been carried out in the following databases as of October 2021:PubMed, EMBASE, CINAHL, Web of Science, and Scopus. The Cochrane Library and Joanna Briggs Institute Library were also searched to confirm if there are any available systematic reviews on the subject. Manually searched the reference list of included papers.
KEY ISSUES: Seventeen studies were included in this review. Five key issues in the palliative care nurse's experience: (1) psychological harm, (2) physical symptoms, (3) negative emotions, (4) Burnout caused by communication barriers, and (5) Lack of experience. Two key issues in the needs of palliative care nurses: (1) social support, and (2) training and education.
CONCLUSION: The pressure of facing death for a long time and controlling the symptoms of patients has a very important impact on the mental and physical health of palliative nurses. Nursing staff have needed to be satisfied, and it is essential to provide support and help relieve the pressure on palliative nurses.
OBJECTIVES: This survey aimed to clarify the current status of palliative care in the Asia-Pacific region.
METHODS: Questionnaires were sent to a representative physician of each member country/region of the Asia Pacific Hospice Palliative Care Network (APHN). The questionnaire examined palliative care service provision, information regarding physician certification in palliative care, the availability of essential drugs for palliative care listed by the International Association for Hospice and Palliative Care (IAHPC) and the regulation of opioid-prescribing practice.
RESULTS: Of the 14 member countries/regions of the APHN, 12 (86%) responded. Some form of specialist palliative care services had developed in all the responding countries/regions. Eight member countries/regions had physician certifications for palliative care. Most essential drugs for palliative care listed by the IAHPC were available, whereas hydromorphone, oxycodone and transmucosal fentanyl were unavailable in most countries/regions. Six member countries/regions required permission to prescribe and receive opioids.
CONCLUSIONS: The development of palliative care is in different stages across the surveyed countries/regions in the Asia-Pacific region. Data from this survey can be used as baseline data for monitoring the development of palliative care in this region.
OBJECTIVE: To determine medications available and used in the management of six symptoms at the end of life among pediatric palliative care practitioners in Asia Pacific. To identify alternative pharmacological strategies for these six symptoms if the oral route was no longer possible and injections are refused.
DESIGN AND SETTING: An online survey of all Asia Pacific Hospice Palliative Care Network (APHN) members was carried out to identify medications used for six symptoms (pain, dyspnea, excessive respiratory secretions, nausea/vomiting, restlessness, seizures) in dying children. Two scenarios were of interest: (1) hours to days before death and (2) when injectables were declined or refused.
RESULTS: There were 54 responses from 18 countries. Majority (63.0%) of respondents were hospital based. About half of all respondents were from specialist palliative care services and 55.6% were from high-income countries. All respondents had access to essential analgesics. Several perceived that there were no available drugs locally to treat the five other commonly encountered symptoms. There was a wide variation in preferred drugs for treating each symptom that went beyond differences in drug availability or formulations.
CONCLUSION: Future studies are needed to explore barriers to medication access and possible knowledge gaps among service providers in the region, so that advocacy and education endeavors by the APHN may be optimized.
OBJECTIVE: This cross-sectional study examined the association between global quality of life and its various subscales with nutritional status among 61 (33 females and 28 males) advanced cancer patients cared for by selected hospices in peninsular Malaysia.
METHODS: The Patient Generated-Subjective Global Assessment (PG-SGA) and the Hospice Quality of Life Index (HQLI) were used to assess nutritional status and quality of life, respectively.
RESULTS: Nine (14.7%) patients were well-nourished, 32 (52.5%) were moderately or suspected of being malnourished while 20 (32.8%) of them were severely malnourished. The total HQLI mean score for these patients was 189.9-/+51.7, with possible scores ranging from 0 to 280. The most problem areas in these patients were in the domain of functional well-being and the least problems were found in the social/spiritual domain. PG-SGA scores significantly correlated with total quality of life scores (r2= 0.38, p<0.05), psychophysiological well-being (r2= 0.37, p<0.05), functional well-being (r2= 0.42, p<0.05) and social/ spiritual well-being (r2= 0.07, p<0.05). Thus, patients with a higher PG-SGA score or poorer nutritional status exhibited a lower quality of life.
CONCLUSION: Advanced cancer patients with poor nutritional status have a diminished quality of life. These findings suggest that there is a need for a comprehensive nutritional intervention for improving nutritional status and quality of life in terminally ill cancer patients under hospice care.
AREAS COVERED: A literature search was performed using PubMed between December 1, 2019-June 23, 2020. This review highlights the current state of knowledge on the viral replication and pathogenicity, diagnostic and therapeutic strategies, and management of COVID-19. This review will be of interest to scientists and clinicians and make a significant contribution toward development of vaccines and targeted therapies to contain the pandemic.
EXPERT OPINION: The exit strategy for a path back to normal life is required, which should involve a multi-prong effort toward development of new treatment and a successful vaccine to protect public health worldwide and prevent future COVID-19 outbreaks. Therefore, the bench to bedside translational research as well as reverse translational works focusing bedside to bench is very important and would provide the foundation for the development of targeted drugs and vaccines for COVID-19 infections.