Displaying publications 1 - 20 of 119 in total

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  1. Zhang MWB, Ho RCM, Ng CG
    Technol Health Care, 2017 Dec 04;25(6):1173-1176.
    PMID: 28946598 DOI: 10.3233/THC-170868
    In psychiatry, mindfulness based intervention has been increasingly popular as a means of psychosocial intervention over the last decade. With the alvanche of technological advances, there has been a myriad of mindfulness based applications. Recent reviews have highlighted how these applications are lacking in functionalities and without demonstrated efficacy. Other reviews have emphasized that there is a need to take into consideration the design of an application, due to placebo effects. It is the aim of this technical note to illustrate how the 5-Minutes Mindfulness application, which is an application designed to provide mindfulness exercises to relieve distress and suffering amongst palliative patients, have been conceptualized. The conceptualized application builds on previous evidence of the efficacy of 5-Minutes Mindfulness demonstrated by pilot and randomized trials. In terms of design, the currently conceptualized application has been designed such that placebo effects could be controlled for.
    Matched MeSH terms: Palliative Care/methods*
  2. Nies YH, Ali AM, Abdullah N, Islahudin F, Shah NM
    Patient Prefer Adherence, 2018;12:1955-1964.
    PMID: 30319245 DOI: 10.2147/PPA.S168638
    Purpose: The objective of this study was to explore the experiences and side-effects of breast cancer patients on chemotherapy in Malaysia.
    Participants and methods: Purposive sampling of 36 breast cancer patients who have completed chemotherapy and agreed to participate in semi-structured in-depth interviews. A constant comparative method and thematic analysis were used to analyze the interviews.
    Results: Data were categorized into six main themes: know nothing of chemotherapy; fear of chemotherapy; patients' beliefs in alternative treatments; symptom management; staying healthy after chemotherapy; and concerns of patients after chemotherapy.
    Conclusion: Despite complaints about the bad experiences of their chemotherapy-induced side-effects, these patients still managed to complete the entire course of chemotherapy. Moreover, there is a need for a clinical pharmacy service in the oncology clinic setting in Malaysia in order to provide relevant information to help patients understand the chemotherapy received.

    Study site: two tertiary care hospitals in Malaysia as well as the National Cancer Society Malaysia.

    Matched MeSH terms: Palliative Care
  3. Gunavathy M, Rohana AG, Norlela S, Nor Azmi K
    Med J Malaysia, 2014 Jun;69(3):133-7.
    PMID: 25326355 MyJurnal
    Gastroenteropancreatic neuroendocrine tumours (GEP- nETs) are rare neoplasms with a complex spectrum of presentation. The study cohort (n=64) included the diagnoses of carcinoid, (n=26, 41%), insulinoma, (n=25, 39%), undetermined (n=10, 16%), VIPoma, glucagonoma and multiple endocrine neoplasia (MEn-1) (n= 3). Almost half of the patients (n=31) had distant metastasis at diagnosis, the commonest being carcinoid tumours. Presenting symptoms were due to either hormonal expressions or mass effects. diagnoses in all patients were made based on positive immunohistochemical staining for chromogranin and synaptophysin. Less than half (n=30) had either serum chromogranin A, urinary 5-hydroxyindole acetic acid (5-hIAA), serum insulin or C-peptide levels performed. Commonest diagnostic imaging modalities were computed tomography (CT) scan (94%) and abdominal ultrasound (15%). Curative or palliative surgery was performed in 58 patients. Systemic therapy included long acting somatostatin analogues (n=14), chemotherapy (n=7) and interferon-α2b (n=1). nine patients died, all of who had metastatic disease at diagnosis. All patients with insulinoma (n=25) were assessed by endocrinologists whilst carcinoid tumours were mainly managed by surgeons (n=16/26). Involvements of oncologists and gastroenterologists were minimal. This study showed that patients with GEP-nETs in Malaysia commonly presented late in the disease with presence of distant metastases. Less than half had adequate hormonal and biochemical examinations performed for diagnostic as well as prognostic purposes, and only a third received systemic therapy. Lack of institutionalbased database, clinical expertise and multi-disciplinary involvement contributed to the inadequate surveillance and management of the disease.
    Matched MeSH terms: Palliative Care
  4. Sharma S, Mohamad NA, Monga D, Achana S
    Med J Malaysia, 1996 Dec;51(4):453-6.
    PMID: 10968033
    Three hundred and five primigravid women were interviewed at term to assess the acceptability of epidural during labour, and reasons for the decisions. Data was collected on a prestructured proforma which consisted of background information, socio-economic status, knowledge about epidural analgesia, source of information and reasons for choice. Of the 305 patients only 17.3% were willing to receive epidural analgesia. This group consisted of 56.6% non-Malay women. Those employed in professional or skilled jobs (56.6%) also readily consented for epidural. Nearly half the women willing for epidural had received college (tertiary) education (43.3%) and more than a quarter (26.4%) were over 30 years of age. The majority of those who were unwilling had no prior knowledge about the procedure, and refused either out of fear, ignorance, resistance from husbands, on religious grounds or following poor feedback from friends. In order to advocate epidural analgesia, knowledge has to be targeted to the relatively less educated, unemployed women, mainly through the media or personally in the antenatal clinic by doctors and nurses. Services have to be improved as substandard analgesia may send out wrong messages and actually do more harm than good.
    Matched MeSH terms: Palliative Care/methods*
  5. Poudel A, Kc B, Shrestha S, Nissen L
    J Glob Health, 2019 12;9(2):020309.
    PMID: 31656599 DOI: 10.7189/jogh.09.020309
    Matched MeSH terms: Palliative Care*
  6. Cheong WL, Mohan D, Warren N, Reidpath DD
    Mult Scler Relat Disord, 2019 Oct;35:86-91.
    PMID: 31357123 DOI: 10.1016/j.msard.2019.07.009
    BACKGROUND: Despite the global consensus on the importance of palliative care for patients with multiple sclerosis (MS), many patients in developing countries do not receive palliative care. Improving access to palliative care for MS requires a contextual understanding of how palliative care is perceived by patients and health professionals, the existing care pathways, and barriers to the provision of palliative care.

    OBJECTIVE: This study aims to examine and contrast the perceptions of MS patients, neurologists, and palliative care physicians towards providing palliative care for patients with MS in Malaysia.

    METHODS: 12 MS patients, 5 neurologists, and 5 palliative care physicians participated in this qualitative study. Each participant took part in a semi-structured interview. The interviews were transcribed verbatim, and analysed using an iterative thematic analysis approach.

    RESULTS: Patients and neurologists mostly associated palliative care with the end-of-life and struggled to understand the need for palliative care in MS. Another barrier was the lack of understanding about the palliative care needs of MS patients. Palliative care physicians also identified the scarcity of resources and their lack of experience with MS as barriers. The current referral-based care pathway itself was found to be a barrier to the provision of palliative care.

    CONCLUSIONS: MS patients in Malaysia face several barriers in accessing palliative care. Overcoming these barriers will require improving the shared understanding of palliative care and its role in MS. The existing care pathway also needs to be reformed to ensure that it improves access to palliative care for MS patients.

    Matched MeSH terms: Palliative Care*
  7. Yang SL, Woon YL, Teoh CCO, Leong CT, Lim RBL
    PMID: 32826260 DOI: 10.1136/bmjspcare-2020-002283
    OBJECTIVES: To estimate past trends and future projection of adult palliative care needs in Malaysia.

    METHODS: This is a population-based secondary data analysis using the national mortality registry from 2004 to 2014. Past trend estimation was conducted using Murtagh's minimum and maximum methods and Gómez-Batiste's method. The estimated palliative care needs were stratified by age groups, gender and administrative states in Malaysia. With this, the projection of palliative care needs up to 2030 was conducted under the assumption that annual change remains constant.

    RESULTS: The palliative care needs in Malaysia followed an apparent upward trend over the years regardless of the estimation methods. Murtagh's minimum estimation method showed that palliative care needs grew 40% from 71 675 cases in 2004 to 100 034 cases in 2014. The proportion of palliative care needs in relation to deaths hovered at 71% in the observed years. In 2030, Malaysia should anticipate the population needs to be at least 239 713 cases (240% growth from 2014), with the highest needs among age group ≥80-year-old in both genders. Sarawak, Perak, Johor, Selangor and Kedah will become the top five Malaysian states with the highest number of needs in 2030.

    CONCLUSION: The need for palliative care in Malaysia will continue to rise and surpass its service provision. This trend demands a stepped-up provision from the national health system with advanced integration of palliative care services to narrow the gap between needs and supply.

    Matched MeSH terms: Palliative Care; Hospice and Palliative Care Nursing
  8. Biswal BM, Zakaria A, Baba AA, Ja'afar R
    Med J Malaysia, 2004 Mar;59(1):78-83.
    PMID: 15535340
    We conducted a questionnaire survey among 261 year-4 and year-5 medical students containing 27 questions related to cancer, radiotherapy, general oncology and palliative care to assess their knowledge, understanding, and exposure to oncology and palliative care in our medical school. Out of 261 students, 139 students returned their questionnaire for analysis. Twenty nine percent (29%) of the students had rarely visited the Radiotherapy and Oncology unit. There were profound deficiencies in the basic knowledge of cancer (46%), principles of radiotherapy treatment (59%), palliative care (64%), and cancer prevention (48%). They reported no specific teaching about early detection of common malignancies and cancer prevention. The main input of instruction about cancer came from surgery (46%) and pathology (28%) teachings. This study revealed that there is deficiency in cancer education in the undergraduate teaching program in our institution.
    Matched MeSH terms: Palliative Care*
  9. Khairidzan, M.K., Normalina, M., Ismail, M.A., Siraj, H., Nor Azlin, I.M., Zainol, R., et al.
    MyJurnal
    We present a case of a 45-year-old female who presented with blurring of right vision associated with constitutional symptoms. Examinations revealed right optic disc swelling with inferior exudative retinal detachment and hepatomegaly. Gynaecological examination showed a fungating cervical mass. Histopathological reports of cone biopsy confirmed the presence of large B cell non-Hodgkin lymphoma. HIV screening was positive. A diagnosis of HIV related lymphoma was made. Chemotherapy and antiretroviral treatment were instituted. The ocular signs resolved. However, the patient could not tolerate the side effects of medical therapy and opted for palliative treatment.
    Matched MeSH terms: Palliative Care
  10. Krakauer EL, Kane K, Kwete X, Afshan G, Bazzett-Matabele L, Ruthnie Bien-Aimé DD, et al.
    JCO Glob Oncol, 2021 06;7:886-895.
    PMID: 34115537 DOI: 10.1200/GO.21.00027
    The essential package of palliative care for cervical cancer (EPPCCC), described elsewhere, is designed to be safe and effective for preventing and relieving most suffering associated with cervical cancer and universally accessible. However, it appears that women with cervical cancer, more frequently than patients with other cancers, experience various types of suffering that are refractory to basic palliative care such as what can be provided with the EPPCCC. In particular, relief of refractory pain, vomiting because of bowel obstruction, bleeding, and psychosocial suffering may require additional expertise, medicines, or equipment. Therefore, we convened a group of experienced experts in all aspects of care for women with cervical cancer, and from countries of all income levels, to create an augmented package of palliative care for cervical cancer with which even suffering refractory to the EPPCCC often can be relieved. The package consists of medicines, radiotherapy, surgical procedures, and psycho-oncologic therapies that require advanced or specialized training. Each item in this package should be made accessible whenever the necessary resources and expertise are available.
    Matched MeSH terms: Palliative Care; Hospice and Palliative Care Nursing*
  11. Ng LF, Shumacher A, Goh CB
    Palliat Med, 2000 Mar;14(2):163-4.
    PMID: 10829153 DOI: 10.1191/026921600669696020
    Matched MeSH terms: Palliative Care/psychology*
  12. Taufiq Hidayat, Zahoor Iqbal, Ariffin Nasir, Norsarwany Mohamad, Fahisham Taib
    MyJurnal
    Food is considered as a social responsibility of caregivers to their children. It has cultural connotation for all races notwithstanding their background and religious belief; that social responsibility should not be separated even in terminally ill patients. We recorded a case scenario of a terminally ill child who faced difficult end of life with inability to take oral fluids or food due to mechanical obstruction of duodenum by the pelvic rhabdomyosarcoma. From cultural context, the physical act of giving food and fluids to a sick person is considered “a display of one’s affection”. It is understandable that, once the dying phase has reached, and the body starts to shut down, administering fluids may not be useful despite it is deemed necessary from cultural point of view. This case illustrates an ethical dilemma in managing a child with end stage metastatic disease with multiple systemic complications, compounded with futility of medical care and complex social circumstances. It is quite challenging for physicians and relatives to provide good end of life care to patients in palliative care setting. Ensuring good quality of care, quality of life and quality of death are paramount to avoid suffering and distress among the patients and family members.
    Matched MeSH terms: Palliative Care
  13. Kua VF, Ismail F, Chee Ee Phua V, Aslan NM
    Asian Pac J Cancer Prev, 2013;14(2):1121-6.
    PMID: 23621198
    BACKGROUND: Palliative chemotherapy with cisplatin/5-fluorouracil (5FU) is the commonest regimen employed for metastatic and recurrent head and neck squamous cell carcinoma (SCCHN) and nasopharyngeal carcinoma (NPC). However, this regimen is cumbersome requiring 5 days of admission to hospital. Carboplatin/5FU may be an alternative regimen without compromising survival and response rates. This study aimed to compare the efficacy and toxicity of carboplatin/5FU regimen with the cisplatin/5FU regimen.

    MATERIALS AND METHODS: This retrospective study looked at patients who had palliative chemotherapy with either cisplatin/5FU or carboplatin/5FU for metastatic and recurrent SCCHN and NPC. It included patients who were treated at UKMMC from 1st January 2004 to 31st December 2009 with either palliative IV cispaltin 75 mg/m2 D1 only plus IV 5FU 750 mg/m2 D1-5 infusion or IV Carboplatin AUC 5 D1 only plus IV 5FU 500 mg/m2 D1-2 infusion plus IV 5FU 500 mg/m2 D1-2 bolus. The specific objectives were to determine the efficacy of palliative chemotherapy in terms of overall response rate (ORR), median progression free survival (PFS) and median overall survival (OS) and to evaluate the toxicities of both regimens.

    RESULTS: A total of 41 patients were eligible for this study. There were 17 in the cisplatin/5FU arm and 24 in the carboplatin/5FU arm. The ORR was 17.7 % for cisplatin/5FU arm and 37.5 % for carboplatin/5FU arm (p-value=0.304). The median PFS was 7 months for cisplatin/5FU and 9 months for carboplatin/5FU (p-value=1.015). The median OS was 10 months for cisplatin/5FU arm and 12 months for carboplatin/5FU arm (p-value=0.110). There were 6 treatment-related deaths (6/41=14.6%), four in the carboplatin/5FU arm (4/24=16.7%) and 2 in the cisplatin/5FU arm (2/17=11.8%). Grade 3 and 4 hematologic toxicity was also more common with carboplatin/5FU group, this difference being predominantly due to grade 3-4 granulocytopenia (41.6% vs. 0), grade 3-4 anemia (37.5% vs. 0) and grade 3-4 thrombocytopenia (16.6% vs. 0).

    CONCLUSIONS: Carboplatin/5FU is not inferior to cisplatin/5FU with regard to its efficacy. However, there was a high rate of treatment-related deaths with both regimens. A better alternative needs to be considered.

    Matched MeSH terms: Palliative Care/methods
  14. Ahmad Zubaidi ZS, Ariffin F, Oun CTC, Katiman D
    BMC Palliat Care, 2020 Dec 08;19(1):186.
    PMID: 33292214 DOI: 10.1186/s12904-020-00691-1
    BACKGROUND: Informal caregivers (IC) are often overshadowed by the attention required by the terminally ill. This study aims to reveal the estimated proportion of caregiver burden, psychological manifestations and factors associated with caregiver burden among IC in the largest specialized Palliative Care Unit (PCU) in Malaysia.

    METHODS: This was a cross-sectional study involving IC attending a PCU. Caregiver burden and psychological manifestations were measured using previously translated and validated Zarit Burden Interview and DASS-21 questionnaires respectively. Two hundred forty-nine samples were selected for analysis.

    RESULT: The mean ZBI score was 23.33 ± 13.7. About half of the population 118(47.4%) was found to experienced caregiver burden whereby majority have mild to moderate burden 90(36.1%). The most common psychological manifestation among IC is anxiety 74(29.7%) followed by depression 51(20.4%) and stress 46(18.5%). Multiple logistic regression demonstrated that women who are IC to patients with non-malignancy were less likely to experience caregiver burden. IC who were highly educated and spent more than 14 h per day caregiving were at least twice likely to experience caregiver burden. Finally, those with symptoms of depression and anxiety were three times more likely to suffer from caregiver burden.

    CONCLUSION: Caregiver burden among IC to palliative patients is prevalent in this population. IC who are men, educated, caregiving for patients with malignancy, long hours of caregiving and have symptoms of depression and anxiety are at risk of developing caregiver burden. Targeted screening should be implemented and IC well-being should be given more emphasis in local policies.

    Matched MeSH terms: Palliative Care/methods*; Palliative Care/psychology; Palliative Care/standards
  15. Namasivayam P, Lee S, O'Connor M, Barnett T
    J Clin Nurs, 2014 Jan;23(1-2):173-80.
    PMID: 23651099 DOI: 10.1111/jocn.12242
    AIMS AND OBJECTIVES: To describe the process that nurses experienced in engaging with families in Malaysian palliative care settings and the challenges they faced.
    BACKGROUND: In palliative care settings, nurses and the terminally ill person's family members interact very closely with each other. It is important for nurses to work with families to ensure that the care of the terminally ill person is optimised.
    RESEARCH DESIGN: A qualitative design using grounded theory methods was used to describe how nurses engaged with families and the challenges they faced.
    METHODS: Twenty-two nurses from home care and inpatient palliative care settings across Malaysia participated in this study. Data were collected through seven interviews and eight focus group discussions conducted between 2007-2009.
    RESULTS: The main problem identified by nurses was the different expectations to patient care with families. The participants used the core process of Engaging with families to resolve these differences and implemented strategies described as Preparing families for palliative care, Modifying care and Staying engaged to promote greater consistency and quality of care. When participants were able to resolve their different expectations with families, these resulted in positive outcomes, described as Harmony. However, negative outcomes of participants not being able to resolve their different expectations with families were Disharmony.
    CONCLUSIONS: This study highlights the importance of engaging and supporting families of the terminally ill as well as providing a guide that may be used by nurses and carers to better respond to families' needs and concerns.
    RELEVANCE TO CLINICAL PRACTICE: The study draws attention to the need for formal palliative care education, inclusive of family care, to enable nurses to provide the terminally ill person and their family effective and appropriate care.
    KEYWORDS: Malaysia; beliefs; families; grounded theory; multicultural; nurses; nursing care; palliative care; terminally ill
    Matched MeSH terms: Hospice and Palliative Care Nursing/manpower*
  16. Krakauer EL, Kwete X, Kane K, Afshan G, Bazzett-Matabele L, Bien-Aimé DDR, et al.
    JCO Glob Oncol, 2021 06;7:862-872.
    PMID: 34115522 DOI: 10.1200/GO.21.00025
    PURPOSE: To enable design of optimum palliative care for women with cervical cancer, we studied the most common types of suffering and their severity, prevalence, and duration.

    METHODS: We first reviewed the literature on the major types, severity, prevalence, and duration of suffering associated with cervical cancer. We then conducted a modified Delphi process with experts in cervical cancer care to supplement the literature. For each type of suffering, we distinguished between decedents (those who die from cervical cancer in a given year) and nondecedents (those who have cervical cancer in a given year but do not die). By applying the suffering prevalence and duration estimates to the number of decedents, nondecedents, and family caregivers in 2017, we were able to estimate their palliative care needs and the intensity of palliative care needed to respond adequately to this suffering.

    RESULTS: There is a high prevalence among decedents of moderate or severe pain (84%), vaginal discharge (66%), vaginal bleeding (61%), and loss of faith (31%). Among both decedents and nondecedents, there is a high prevalence of clinically significant anxiety (63% and 50%, respectively), depressed mood (52% and 38%, respectively), and sexual dysfunction (87% and 83%, respectively). Moderate or severe financial distress is prevalent among decedents, nondecedents, and family caregivers (84%, 74%, and 66%, respectively). More than 40% of decedents and nondecedents are abandoned by their intimate partners. Most patients experience some combination of moderate or severe physical, psychological, social, and spiritual suffering. In total, 258,649 decedents and 2,558,857 nondecedents needed palliative care in 2017, approximately 85% of whom were in low- and middle-income countries where palliative care is rarely accessible.

    CONCLUSION: Among women with advanced cervical cancer, suffering is highly prevalent and often severe and multifaceted.

    Matched MeSH terms: Palliative Care; Hospice and Palliative Care Nursing*
  17. Yip CH, Taib NA
    Future Oncol, 2012 Dec;8(12):1575-83.
    PMID: 23231519 DOI: 10.2217/fon.12.141
    The incidence of breast cancer is rising in low- and middle-income countries (LMICs) due to 'westernization' of risk factors for developing breast cancer. However, survival remains low because of barriers in early detection and optimal access to treatment, which are the two main determinants of breast cancer outcome. A multidisciplinary approach to treatment gives the best results. An accurate diagnosis is dependent on a reliable pathology service, which will provide an adequate pathology report with prognostic and predictor information to allow optimal oncological treatment. Stratification of clinical practice guidelines based on resource level will ensure that women will have access to treatment even in a low-resource setting. Advocacy and civil society play a role in galvanizing the political will required to meet the challenge of providing opportunities for breast cancer control in LMICs. Collaboration between high-income countries and LMICs could be a strategy in facing these challenges.
    Matched MeSH terms: Palliative Care
  18. Choy YC, Puvenesvari S, Samad S
    Med J Malaysia, 1998 Sep;53(3):277-9.
    PMID: 10968166
    Coeliac plexus block has been described more than seventy years ago and is widely used for chronic pain management in upper visceral malignancies. The technique described here is a posterior approach using CT scan guidance with absolute ethyl alcohol. A case illustration of a patient with carcinoma of pancreas managed with coeliac plexus block for pain control is presented.
    Matched MeSH terms: Palliative Care/methods*
  19. Matched MeSH terms: Palliative Care
  20. Chong LA, Khalid F, Khoo TB, Teh SH, Kuan GL, Aina Mariana AM, et al.
    Med J Malaysia, 2017 02;72(1):32-36.
    PMID: 28255137 MyJurnal
    INTRODUCTION: Awareness for paediatric palliative care has resulted in the impetus for paediatrician-led palliative care services across Malaysia. However, there is paucity of local data on patients receiving hospital-based paediatric palliative care. We aim to review the clinical spectrum of patients referred to these services.

    METHODS: An observational study of children aged between 0-18 years receiving palliative care at 13 hospitals between 1st January and 31st December 2014 was carried out.

    RESULTS: There were 315 patients analysed, 90 (28.6%) and 46 (14.6%) were neonates and adolescents respectively. The main ICD-10 diagnostic categories for all patients were identified to be 'Congenital malformations, deformations and chromosomal abnormalities' 117 (37.1%), 'Diseases of nervous system' 76 (24.1%) and 'Neoplasms' 60 (19.0%). At referral 156 (50%) patients had holistic needs assessments. Patients with 'Diseases of nervous system' were assessed to have significantly more physical needs than the other two diagnostic categories. Majority of patients who knew of their diagnosis and prognosis were those with malignancy. Over a fifth of referrals were at their terminal admission. Of 144 who died, 111 (77.1%) had advanced care plans. There was bereavement follow-up in 98 (68.1%) patients.

    CONCLUSION: Patients referred for palliative care have varied diagnoses and needs. To ensure all paediatricians are competent to deliver quality care to all children, further education and training initiatives is imperative.

    Matched MeSH terms: Palliative Care
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