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Clinical spectrum of children receiving palliative care in Malaysian Hospitals

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
Fulltext Concordance in the Assessment of Effectiveness of Palliative Care between Patients and Palliative Care Nurses in Malaysia: A Study with the Palliative Care Outcome Scale

Koh KC, Gupta ED, Poovaneswaran S, Then SL, Teo MJ, Gan TY, et al.

Indian J Palliat Care, 2017 Jan-Mar;23(1):46-52.
PMID: 28216862 DOI: 10.4103/0973-1075.197961

CONTEXT: The Palliative Care Outcome Scale (POS) is an easy-to-use assessment tool to evaluate the effectiveness of palliative care. There is no published literature on the use of POS as an assessment tool in Malaysia.

AIM: To define the concordance in the assessment of quality of life between patients with advanced cancers and their palliative care nurses using a Malay version of the POS.

SETTINGS AND DESIGN: This study was conducted in the palliative care unit of the Hospital Tuanku Ja'afar Seremban, Malaysia, from February 2014 to June 2014.

SUBJECTS AND METHODS: We adapted and validated the English version of the 3-day recall POS into Malay and used it to define the concordance in the assessment of quality of life between patients and palliative care nurses. Forty patients with advanced stage cancers and forty palliative care nurses completed the Malay POS questionnaire.

STATISTICAL ANALYSIS USED: The kappa statistical test was used to assess the agreement between patients and their palliative care nurses.

RESULTS: Slight to fair concordance was found in all items, except for one item (family anxiety) where there was no agreement.

CONCLUSIONS: The Malay version of the POS was well accepted and reliable as an assessment tool for evaluation of the effectiveness of palliative care in Malaysia. Slight to fair concordance was shown between the patients and their palliative care nurses, suggesting the needs for more training of the nurses.

Matched MeSH terms: Palliative Care
Fulltext Core Symptoms of Major Depressive Disorder among Palliative Care Patients

Huey NS, Guan NC, Gill JS, Hui KO, Sulaiman AH, Kunagasundram S

Int J Environ Res Public Health, 2018 08 16;15(8).
PMID: 30115817 DOI: 10.3390/ijerph15081758

A valid method to diagnose depression in palliative care has not been established. In this study, we aim to determine the prevalence of depression and the discriminant validity of the items of four sets of diagnostic criteria in palliative care. This is a cross-sectional study on 240 palliative care patients where the presence of depression was based on the Diagnostic and Statistical Manual of Mental Disorders, DSM⁻IV Criteria, Modified DSM⁻IV Criteria, Cavanaugh Criteria, and Endicott's Criteria's. Anxiety, depression, and distress were measured with Hospital Anxiety and Depression Scale and Distress Thermometer. The prevalence of depression among the palliative care patients was highest based on the Modified DSM⁻IV Criteria (23.3%), followed by the Endicott's Criteria (13.8%), DSM⁻IV Criteria (9.2%), and Cavanaugh Criteria (5%). There were significant differences (p < 0.05) in the depressive symptoms showed by DSM⁻IV item 1 (dysphoric mood), item 2 (loss of interest or pleasure), and Endicott's criteria item 8 (brooding, self-pity, or pessimism) among the palliative patients, even after adjustment for the anxiety symptoms and distress level. We found that dysphoric mood, loss of interest, and pessimism are the main features of depression in palliative patients. These symptoms should be given more attention in identifying depression in palliative care patients.

Matched MeSH terms: Palliative Care
Fulltext Cross-sectional descriptive study of management modalities and quality of life of surgical patients in a palliative care unit

Amjad, N.M., Karim, K.A., Naing Soe, Y.

International Medical Journal Malaysia, 2016;15(1):35-43.
MyJurnal

Introduction: The goal of palliative care is the provision of the best quality of life (QOL) for terminally ill
and dying patients. Advances in medical treatment has seen an increase in overall survival of all stages of
malignant diseases. This includes advanced and/or inoperable malignancies where management is mainly
palliative involving different modalities. Methods: We designed a cross-sectional descriptive study of
surgical patients in a palliative care unit in a 1000-bedded teaching hospital in Kuantan, Malaysia.
Objectives of this study are: to study the demographic characteristics and indications for admission of
surgical patients in palliative care unit, to study the options of treatment modalities and their
complications, to identify the barriers in decision making in surgical treatment and finally to objectively
assess the quality of life of these patients by utilizing QUALITY OF LIFE (WHOQOL) –BREF –questionnaire.
Results: One hundred and one eligible patients (53%) male, (47%) female of mean age of 54yrs, majority
Malay and Chinese patients were included in the study. All patients had malignancies and they were Breast
(30%), Lower gastrointestinal (GI) (24%), (18%) upper GI, (15%) hepato-biliary, and (7%) pancreatic cancers.
Thirty two percents of patients had emergency treatment while the rest had supportive treatment. Barriers
to decision making were mainly due to patient factors in 71%, while 12% was due to the disease presenting
at an advanced stage and 15% due to limitation of care. The final results of overall quality of life rating
were shown as poor (1%), neither poor nor good (42%), good (52%) and very good (2%). Conclusions:
Palliative care and end of life decision making from surgical point of view is a delicate issue. Like all other
fields in medicine, palliative care must be evidence-based with specific goal directed therapy. Our study
shows that we are able to positively impact the quality of life in more than two thirds of our patients. Our
aim is to achieve 100% success. As such, it is imperative to inculcate the goal of palliative care to all grades
of health care personnel. ‘To cure sometimes, To relieve often, To comfort always’ should not be mere
words.

Matched MeSH terms: Palliative Care
Denosumab as a long-term palliative therapy in parathyroid carcinoma

Tong CV, Loh LT, Hussein Z

QJM, 2017 01;110(1):55.
PMID: 28011854 DOI: 10.1093/qjmed/hcw207
Matched MeSH terms: Palliative Care
Development of the rural Palliative Care Services by the Kuala Lipis District Hospital

Lai CK, Tay KT, Abdullah R

Med J Malaysia, 2021 03;76(2):233-235.
PMID: 33742634

In recognising the palliative care (PC) needs globally and in Malaysia, services were developed to serve the rural area of Kuala Lipis, Pahang. This communication describes the initial a Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis, stages of development towards achieving a successful implementation. PC services were led by Kuala Lipis district hospital include inpatient referrals, outpatient and community care through home visits. These services involve multi-disciplinary team inclusive of representatives from health clinics and allied health. Referrals and opioid usage have demonstrated an increasing trend since its implementation in October 2018. Implementation of rural PC services is feasible; however, long-term sustainability needs to addressed.

Matched MeSH terms: Palliative Care; Hospice and Palliative Care Nursing
Distress Reduction for Palliative Care Patients and Families With 5-Minute Mindful Breathing: A Pilot Study

Beng TS, Ahmad F, Loong LC, Chin LE, Zainal NZ, Guan NC, et al.

Am J Hosp Palliat Care, 2016 Jul;33(6):555-60.
PMID: 25632044 DOI: 10.1177/1049909115569048

A pilot study was conducted to evaluate the efficacy of 5-minute mindful breathing in distress reduction. Twenty palliative care patients and family caregivers with a distress score ≥4 measured by the Distress Thermometer were recruited and randomly assigned to mindful breathing or "listening" (being listened to). Median distress reductions after 5 minutes were 2.5 for the mindful breathing group and 1.0 for the listening group. A significantly larger reduction in the distress score was observed in the mindful breathing group (Mann-Whitney U test: U = 8.0, n1 = n2 = 10, mean rank1 = 6.30, mean rank2 = 14.70, z = -3.208, P = .001). The 5-minute mindful breathing could be useful in distress reduction in palliative care.

Matched MeSH terms: Palliative Care/methods*; Palliative Care/psychology
Doped silica fibre thermoluminescence measurements of radiation dose in the use of 223Ra

Bradley, Sani SFA, Shafiqah ASS, Collins SM, Hugtenburg RP, Rashid HAA, et al.

Appl Radiat Isot, 2018 Aug;138:65-72.
PMID: 28427834 DOI: 10.1016/j.apradiso.2017.04.019

Using tailor-made sub-mm dimension doped-silica fibres, thermoluminescent dosimetric studies have been performed for α-emitting sources of 223RaCl2 (the basis of the Bayer Healthcare product Xofigo®). The use of 223RaCl2 in the palliative treatment of bone metastases resulting from late-stage castration-resistant prostate cancer focuses on its favourable uptake in metabolically active bone metastases. Such treatment benefits from the high linear energy transfer (LET) and associated short path length (<100µm) of the α-particles emitted by 223Ra and its decay progeny. In seeking to provide for in vitro dosimetry of the α-particles originating from the 223Ra decay series, investigation has been made of the TL yield of various forms of Ge-doped SiO2 fibres, including photonic crystal fibre (PCF) collapsed, PCF uncollapsed, flat and single-mode fibres. Irradiations of the fibres were performed at the UK National Physical Laboratory (NPL). Notable features are the considerable sensitivity of the dosimeters and an effective atomic number Zeff approaching that of bone, the glass fibres offering the added advantage of being able to be placed directly into liquid. The outcome of present research is expected to inform development of doped fibre dosimeters of versatile utility, including for applications as detailed herein.

Matched MeSH terms: Palliative Care
Duration of Referral-to-Death and its Associated Factors Among Cancer and Noncancer Patients: Retrospective Cohort Study of a Community Palliative Care Setting in Malaysia

Yip YY, Hwong WY, McCarthy SA, Hassan Chin AA, Woon YL

J Palliat Care, 2023 Apr;38(2):111-125.
PMID: 36464769 DOI: 10.1177/08258597221143195

Background: Addressing timely community palliative care integration is prioritized due to the increased burden of noncommunicable diseases. Objectives: To compare referral-to-death duration among palliative cancer and noncancer patients and to determine its associated factors in a Malaysian community palliative care center. Methods: This retrospective cohort study included decedents referred to a Malaysian community palliative care center between January 2017 and December 2019. Referral-to-death is the interval between the date of community palliative care referral and to date of death. Besides descriptive analyses, negative binomial regression analyses were conducted to identify factors associated with referral-to-death among both groups. Results: Of 4346 patients referred, 86.7% (n = 3766) and 13.3% (n = 580) had primary diagnoses of cancer and noncancer respectively. Median referral-to-death was 32 days (interquartile range [IQR]: 12-81) among cancer patients and 19 days (IQR: 7-78) among noncancer patients. The shortest referral-to-death among cancer patients was for liver cancer (median: 22 days; IQR: 8-58.5). Noncancer patients with dementia, heart failure, and multisystem organ failure had the shortest referral-to-death at 14 days. Among cancer patients, longer referral-to-death was associated with women compared to men (IRR: 1.26; 95% CI: 1.16-1.36) and patients 80 to 94 years old compared to those below 50 years old (IRR: 1.19; 95% CI: 1.02-1.38). Cancer patients with analgesics prescribed before or upon referral had 29% fewer palliative care days compared to no prescribing analgesics. In contrast, noncancer patients 50 to 64 years old had shorter referral-to-death compared to those below 50 years old (IRR: 0.51; 95% CI: 0.28-0.91). Conclusion: Shorter referral-to-death among noncancer patients indicated possible access inequities with delayed community palliative care integration. Factors associated with referral-to-death are considered in developing targeted approaches ensuring timely and equitable community palliative care.

Matched MeSH terms: Palliative Care
Fulltext End-of-life care in patients with advanced lung cancer

Lim RB

Ther Adv Respir Dis, 2016 10;10(5):455-67.
PMID: 27585597 DOI: 10.1177/1753465816660925

Despite advances in the detection, pathological diagnosis and therapeutics of lung cancer, many patients still develop advanced, incurable and progressively fatal disease. As physicians, the duties to cure sometimes, relieve often and comfort always should be a constant reminder to us of the needs that must be met when caring for a patient with lung cancer. Four key areas of end-of-life care in advanced lung cancer begin with first recognizing 'when a patient is approaching the end of life'. The clinician should be able to recognize when the focus of care needs to shift from an aggressive life-sustaining approach to an approach that helps prepare and support a patient and family members through a period of progressive, inevitable decline. Once the needs are recognized, the second key area is appropriate communication, where the clinician should assist patients and family members in understanding where they are in the disease trajectory and what to expect. This involves developing rapport, breaking bad news, managing expectations and navigating care plans. Subsequently, the third key area is symptom management that focuses on the goals to first and foremost provide comfort and dignity. Symptoms that are common towards the end of life in lung cancer include pain, dyspnoea, delirium and respiratory secretions. Such symptoms need to be anticipated and addressed promptly with appropriate medications and explanations to the patient and family. Lastly, in order for physicians to provide quality end-of-life care, it is necessary to understand the ethical principles applied to end-of-life-care interventions. Misconceptions about euthanasia versus withholding or withdrawing life-sustaining treatments may lead to physician distress and inappropriate decision making.

Matched MeSH terms: Palliative Care/methods*
Fulltext Essential Package of Palliative Care for Women With Cervical Cancer: Responding to the Suffering of a Highly Vulnerable Population

Krakauer EL, Kane K, Kwete X, Afshan G, Bazzett-Matabele L, Ruthnie Bien-Aimé DD, et al.

JCO Glob Oncol, 2021 Jun;7:873-885.
PMID: 34115527 DOI: 10.1200/GO.21.00026

Women with cervical cancer, especially those with advanced disease, appear to experience suffering that is more prevalent, complex, and severe than that caused by other cancers and serious illnesses, and approximately 85% live in low- and middle-income countries where palliative care is rarely accessible. To respond to the highly prevalent and extreme suffering in this vulnerable population, 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 essential package of palliative care for cervical cancer (EPPCCC). The EPPCCC consists of a set of interventions, medicines, simple equipment, social supports, and human resources, and is designed to be safe and effective for preventing and relieving all types of suffering associated with cervical cancer. It includes only inexpensive and readily available medicines and equipment, and its use requires only basic training. Thus, the EPPCCC can and should be made accessible everywhere, including for the rural poor. We provide guidance for integrating the EPPCCC into gynecologic and oncologic care at all levels of health care systems, and into primary care, in countries of all income levels.

Matched MeSH terms: Palliative Care; Hospice and Palliative Care Nursing*
Fulltext Establishing an online resource to facilitate global collaboration and inclusion of underrepresented populations: Experience from the MJFF Global Genetic Parkinson's Disease Project

Vollstedt EJ, Madoev H, Aasly A, Ahmad-Annuar A, Al-Mubarak B, Alcalay RN, et al.

PLoS One, 2023;18(10):e0292180.
PMID: 37788254 DOI: 10.1371/journal.pone.0292180

Parkinson's disease (PD) is the fastest-growing neurodegenerative disorder, currently affecting ~7 million people worldwide. PD is clinically and genetically heterogeneous, with at least 10% of all cases explained by a monogenic cause or strong genetic risk factor. However, the vast majority of our present data on monogenic PD is based on the investigation of patients of European White ancestry, leaving a large knowledge gap on monogenic PD in underrepresented populations. Gene-targeted therapies are being developed at a fast pace and have started entering clinical trials. In light of these developments, building a global network of centers working on monogenic PD, fostering collaborative research, and establishing a clinical trial-ready cohort is imperative. Based on a systematic review of the English literature on monogenic PD and a successful team science approach, we have built up a network of 59 sites worldwide and have collected information on the availability of data, biomaterials, and facilities. To enable access to this resource and to foster collaboration across centers, as well as between academia and industry, we have developed an interactive map and online tool allowing for a quick overview of available resources, along with an option to filter for specific items of interest. This initiative is currently being merged with the Global Parkinson's Genetics Program (GP2), which will attract additional centers with a focus on underrepresented sites. This growing resource and tool will facilitate collaborative research and impact the development and testing of new therapies for monogenic and potentially for idiopathic PD patients.

Matched MeSH terms: Palliative Care
Fulltext Facts and fallacies in palliative care

Khoo SB

Asia Pac Fam Med, 2003;2(3):143-147.

The concept of palliative care is still quite new in Malaysia. Through the experience of delivering palliative care in both the hospital and community settings, the author has realized that there are many false beliefs among the medical and nursing professionals, as well as patients and their caregivers. By exploring and providing factual explanations to these beliefs, the present article highlights the differences in approach between acute and palliative management and the importance of good communication skills, as well as correcting the myths of patients and their caregivers, with the aim of improving the understanding of palliative care., (C) 2003 Blackwell Science Ltd

Matched MeSH terms: Palliative Care
Fulltext First year's experience with an acute pain service--University Hospital Kuala Lumpur

Vijayan R, Delilkan AE

Med J Malaysia, 1994 Dec;49(4):385-400.
PMID: 7545779

An Acute Pain Service (APS) was started in University Hospital, Kuala Lumpur by the Department of Anaesthesiology in October 1992 for more effective control of postoperative pain. The main modalities of treatment included patient controlled analgesia (PCA) using morphine or pethidine with PCA devises, epidural opiate analgesia (EOA) using tramadol or fentanyl/bupivacaine mixture and subcutaneous administration of morphine or pethidine. Five hundred and fifty-one patients were managed in the first year, with an overall patient satisfaction score of 83%. The majority (98.5%) of them were after abdominal or major orthopaedic surgery. Eighty per cent of patients scored < 3 on the verbal numeric pain scale, where 0 is no pain and 10 is the worst imaginable pain, on the first postoperative day. Nausea and vomiting was an unpleasant side effect in 20% of patients.

Matched MeSH terms: Palliative Care*
Geriatric Nutrition Risk Index is comparable to the mini nutritional assessment for assessing nutritional status in elderly hospitalized patients

Abd Aziz NAS, Mohd Fahmi Teng NI, Kamarul Zaman M

Clin Nutr ESPEN, 2019 02;29:77-85.
PMID: 30661705 DOI: 10.1016/j.clnesp.2018.12.002

BACKGROUND & AIMS: Malnutrition is common among hospitalized elderly patients, and the prevalence is increasing not only in Malaysia but also in the rest of the world. The Geriatric Nutrition Risk Index (GNRI) and the Mini Nutritional Assessment (MNA) were developed to identify malnourished individuals among this group. The MNA was validated as a nutritional assessment tool for the elderly. The GNRI is simpler and more efficient than the MNA, but studies on the use of the GNRI and its validity among the Malaysian population are absent. This study aimed to determine the prevalence of malnourished hospitalized elderly patients and assess the criterion validity of the GNRI and MNA among the geriatric Malaysian population against the reference standard for malnutrition, the Subjective Global Assessment (SGA), and determine whether the optimal cutoff value of the GNRI is suitable for the Malaysian population and determine the optimal tool for use in this population.
METHODS: A cross-sectional study was conducted among 134 geriatric patients with a mean age of 68.9 ± 8.4 who stayed at acute care wards in Hospital Tuanku Ampuan Rahimah, Klang from July 2017 to August 2017. The SGA, MNA, and GNRI were administered through face-to-face interviews with all the participants who gave their consent. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the GNRI and MNA were analyzed against the SGA. Receiver-operating characteristic (ROC) curve analysis was used to obtain the area under the curve (AUC) and suitable optimal cutoff values for both the GNRI and MNA.
RESULTS: According to the SGA, MNA, and GNRI, 26.9%, 42.5%, and 44.0% of the participants were malnourished, respectively. The sensitivity, specificity, PPV, and NPV for the GNRI were 0.622, 0.977, 0.982, and 0.558, respectively, while those for the MNA were 0.611, 0.909, 0.932, and 0.533, respectively. The AUC of the GNRI was comparable to that of the MNA (0.831 and 0.898, respectively). Moreover, the optimal malnutrition cutoff value for the GNRI was 94.95.
CONCLUSIONS: The prevalence of malnutrition remains high among hospitalized elderly patients. Validity of the GNRI is comparable to that of the MNA, and use of the GNRI to assess the nutritional status of this group is proposed with the new suggested cutoff value (GNRI ≤ 94.95), as it is simpler and more efficient. Underdiagnosis of malnutrition can be prevented, possibly reducing the prevalence of malnourished hospitalized elderly patients and improving the quality of the nutritional care process practiced in Malaysia.

Matched MeSH terms: Palliative Care
Fulltext Global health film club - bringing global health issues and activism to local communities

Nicholas Pang, Jiann Lin Loo

Malaysian Journal of Medicine and Health Sciences, 2019;15(106):50-50.
MyJurnal

Introduction: Global health awareness is sorely lacking in medical curricula and the general public, leading to increasing apathy and decreased levels of volunteerism. Much knowledge about pertinent global health issues is sequestered with academicians and researchers, with little public trickle down. The aim of the study was to increase awareness among Sabahan public about global health issues and promote discussion. Methods: A global health film club was established at community level and discussions about issues and potential individual action points was conducted. Films were screened every month in both UMS and Palliative Care Center Sabah. Global health issues ranging from First World manipulation of HIV/AIDS medication prices, deregulation of medical devices industries, heroin addiction, ADHD drug abuse, and stigma in psychiatry were covered. Public participants’ responses were collected qualitatively. Results: The films largely were well received by participants, with most participants prefer-ring the expose-type films over the more narrative approaches. Films spurred discussion about how foreign or global issues were related to local level, for example unscrupulous sale of medical devices in Malaysian populations and abuse of sleeping medications from local health providers. Also each film screening vastly increased participants’ awareness of pertinent issues, and spurred them to evangelise about said issues to others and take small actions. Conclusion: Global health is a somewhat neglected part of medical and community curricula. Lack of awareness about global health issues reduces the public’s capacity for collective action in exerting pressure on stakeholders, governments, and civil society in taking action. It is hoped such regular global health film screenings at local level brings literacy on urgent public health issues to the people for whom it matters most – the communities where ad-verse global health consequences eventually arise.

Matched MeSH terms: Palliative Care
Happiness at the end of life: A qualitative study

Beng TS, Ghee WK, Hui NY, Yin OC, Kelvin KWS, Yiling ST, et al.

Palliat Support Care, 2021 Mar 15.
PMID: 33715663 DOI: 10.1017/S1478951521000262

OBJECTIVE: Dying is mostly seen as a dreadful event, never a happy experience. Yet, as palliative care physicians, we have seen so many patients who remained happy despite facing death. Hence, we conducted this qualitative study to explore happiness in palliative care patients at the University of Malaya Medical Centre.
METHOD: Twenty terminally ill patients were interviewed with semi-structured questions. The results were thematically analyzed.
RESULTS: Eight themes were generated: the meaning of happiness, connections, mindset, pleasure, health, faith, wealth, and work. Our results showed that happiness is possible at the end of life. Happiness can coexist with pain and suffering. Social connections were the most important element of happiness at the end of life. Wealth and work were given the least emphasis. From the descriptions of our patients, we recognized a tendency for the degree of importance to shift from the hedonic happiness to eudaimonic happiness as patients experienced a terminal illness.
SIGNIFICANCE OF RESULTS: To increase the happiness of palliative care patients, it is crucial to assess the meaning of happiness for each patient and the degree of importance for each happiness domain to allow targeted interventions.

Matched MeSH terms: Palliative Care; Hospice and Palliative Care Nursing
Hayward House: A medical student's experience with a hospice and palliative care

Lim RBL

Family Physician, 1996;8:15-20.

Matched MeSH terms: Palliative Care
Hope in Palliative Care: A Thematic Analysis

Beng TS, Xin CA, Ying YK, Khuen LP, Yee A, Zainuddin SI, et al.

J Palliat Care, 2020 Aug 14.
PMID: 32791956 DOI: 10.1177/0825859720948976

BACKGROUND: Hope is a positive coping mechanism that is important at all stages of illness, more so for palliative care patients.
PURPOSE: To explore the experiences of hope of palliative care patients.
METHODS: A qualitative study was conducted at University of Malaya, Kuala Lumpur, Malaysia. Adult palliative care in-patients were recruited and interviewed with semi structured questions on hope. Transcripts from the interviews were thematically analyzed with qualitative data management software NVIVO.
FINDINGS: 20 palliative care patients participated in the study. The themes generated from thematic analysis were (1) The notions of hope, (2) The sources and barriers of hope and (3) The contents of hope.
CONCLUSION: Hope is an ever-present source of energy that gives people strength to carry on even in the most adverse situations. Understanding hope from the palliative care perspective may allow healthcare providers to develop strategies to better foster hope in the terminally ill.

Matched MeSH terms: Palliative Care; Hospice and Palliative Care Nursing
Fulltext Impact of a new conceptualized anti-reflux Trumpet stent on the quality of life of patients with advanced carcinoma of the cardio-oesophageal junction

Tata MD, Mahazir NQA, Keat OW, Burud IAS

Ghana Med J, 2022 Jun;56(2):95-99.
PMID: 37449258 DOI: 10.4314/gmj.v56i2.6

OBJECTIVES: To evaluate a newly developed, self-expandable anti-reflux Trumpet (ART) stent customized for cardio oesophageal junctional (COJ) cancer on the feasibility of deployment, stent migration, quality of life, and symptom relief.
DESIGN: Prospective case series, Proof of concept pilot study.
SETTING: Tertiary Health Care Center, Hospital Tuanku Jaafar, Seremban, Malaysia. Department of Surgery.
PARTICIPANTS: A total of 17 patients diagnosed with advanced COJ tumour and who had never undergone any surgical, endoscopic, or chemoradiotherapy and indicated for stenting were recruited.
INTERVENTIONS: The study period was over nine months, and follow-up was one-month post-stenting.
MAIN OUTCOME MEASURES: Endpoint measures were feasibility of deployment of the new design, symptoms relief, early stent migration, early complication, GERD Q score, and (QOL)assessment.
RESULTS: The ART stent was inserted successfully in all cases (17/17, 100%). There were two stent migrations due to the flexibility of the stent at the neck. There were no early or post-stenting one-month complications associated with the procedure. A good flow of contrast was seen in all the stents deployed. GERD Q score was low in all patients pre and post-stenting. Post-stenting there was a relief of dysphagia, weight gain, and a 60% improvement in QOL score.
CONCLUSIONS: ART stent is feasible and technically successful in COJ tumours. It provides good symptom relief, improves the QOL, and has minimal early complications.
FUNDING: None declared.

Matched MeSH terms: Palliative Care/methods

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