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  1. Lim MA, Ang BT, Lam CL, Loh EC, Zainuddin SI, Capelle DP, et al.
    Eur J Cancer Care (Engl), 2021 Sep;30(5):e13456.
    PMID: 33913192 DOI: 10.1111/ecc.13456
    OBJECTIVE: Suffering is a common experience in palliative care. In our study, we aimed to determine the effect of 5-min mindfulness of love on suffering and the spiritual quality of life of palliative care patients.

    METHODS: We conducted a parallel-group, blinded, randomized controlled study at the University of Malaya Medical Centre (UMMC), Malaysia from February 2019 to April 2019. Sixty adult palliative care patients with an overall suffering score of 4/10 or above based on the Suffering Pictogram were recruited and randomly assigned to either the 5-min mindfulness of love group (N = 30) or the 5-min supportive listening group (N = 30).

    RESULTS: There were statistically significant improvements in the overall suffering score (mean difference = -2.9, CI = -3.7 to -2.1, t = -7.268, p = 0.000) and the total FACIT-Sp-12 score (mean difference = 2.9, CI = 1.5 to 4.3, t = 4.124, p = 0.000) in the intervention group compared to the control group.

    CONCLUSION: The results provided evidence that 5-min mindfulness of love could affect the actual state of suffering and the spiritual quality of life of palliative care patients.

    Matched MeSH terms: Hospice and Palliative Care Nursing*
  2. 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: Hospice and Palliative Care Nursing*
  3. Krakauer EL, Kane K, Kwete X, Afshan G, Bazzett-Matabele L, Ruthnie Bien-Aimé DD, et al.
    JCO Glob Oncol, 2021 06;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: Hospice and Palliative Care Nursing*
  4. 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: Hospice and Palliative Care Nursing*
  5. Look ML, Tan SB, Hong LL, Ng CG, Yee HA, Lim LY, et al.
    BMJ Support Palliat Care, 2021 Dec;11(4):433-439.
    PMID: 32788274 DOI: 10.1136/bmjspcare-2020-002382
    CONTEXT: There has been increasing evidence of the role of mindfulness-based interventions in improving various health conditions. However, the evidence for the use of mindfulness in the palliative care setting is still lacking.

    OBJECTIVES: The objective of our study was to determine the efficacy of a single session of 20 min mindful breathing in alleviating multiple symptoms in palliative care.

    METHODS: Adult palliative care in patients with at least one symptom scoring ≥5/10 based on the Edmonton Symptom Assessment Scale (ESAS) were recruited from September 2018 to December 2018. Recruited patients were randomly assigned to either 20 min mindful breathing and standard care or standard care alone.

    RESULTS: Forty patients were randomly assigned to standard care plus a 20 min mindful breathing session (n=20) or standard care alone (n=20). There was statistically significant reduction of total ESAS score in the mindful breathing group compared with the control group at minute 20 (U=98, n 1 = n 2 = 20, mean rank 1 = 15.4, mean rank 2 = 25.6, median reduction 1 = 6.5, median reduction 2 = 1.5, z=-2.763, r=0.3, p=0.005).

    CONCLUSION: Our results provided evidence that a single session of 20 min mindful breathing was effective in reducing multiple symptoms rapidly for palliative care patients.

    Matched MeSH terms: Hospice and Palliative Care Nursing*
  6. 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*
  7. Namazi H, Kulish VV, Wong A
    Sci Rep, 2015;5:13583.
    PMID: 26316014 DOI: 10.1038/srep13583
    Cancer is a class of diseases characterized by out-of-control cells' growth which affect DNAs and make them damaged. Many treatment options for cancer exist, with the primary ones including surgery, chemotherapy, radiation therapy, hormonal therapy, targeted therapy and palliative care. Which treatments are used depends on the type, location, and grade of the cancer as well as the person's health and wishes. Chemotherapy is the use of medication (chemicals) to treat disease. More specifically, chemotherapy typically refers to the destruction of cancer cells. Considering the diffusion of drugs in cancer cells and fractality of DNA walks, in this research we worked on modelling and prediction of the effect of chemotherapy on cancer cells using Fractional Diffusion Equation (FDE). The employed methodology is useful not only for analysis of the effect of special drug and cancer considered in this research but can be expanded in case of different drugs and cancers.
    Matched MeSH terms: Hospice and Palliative Care Nursing
  8. Cheong WL, Mohan D, Warren N, Reidpath DD
    J Palliat Med, 2019 May;22(5):545-552.
    PMID: 30570416 DOI: 10.1089/jpm.2018.0447
    Background:
    The state of palliative care research is closely linked to the development of palliative care services in a country or region.
    Objective:
    To systematically review the current state of palliative care research in the Asia Pacific region and analyze its relationship with the performance of each country in the region on the Economist Intelligence Unit's 2015 Quality of Death Index.
    Design:
    Systematic review and bibliographic analysis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol 2015 (PRISMA-P).
    Data Sources:
    The PubMed/MEDLINE, EMBASE, SCOPUS, CINAHL, and PsychiNFO databases were searched on February 4, 2018.
    Results:
    One thousand six hundred sixty-seven articles were reviewed. Eighteen out of 32 countries in the region published research. Around 74.15% (1236) of the articles were produced by high-income countries. Research output (articles per 1 m population) was closely linked to country performance on the Economist Intelligence Unit's 2015 Quality of Death Index (adjusted R2= 0.85). Palliative care research in the region is overwhelmingly focused on cancer (80.13% of articles reviewed). The most common themes of research were "palliative care service (24.45%)" and "clinical" (15.38%).
    Conclusions:
    Palliative care research in the region is growing but remains largely centered on the high-income countries, with many low- and middle-income countries having little published research output. Much work is required to drive research in these countries to generate the evidence required for the development of palliative care services. The emphasis on cancer in research also indicates that the needs of patients suffering from noncancer-related diseases may be neglected.
    Matched MeSH terms: Hospice and Palliative Care Nursing/organization & administration*; Hospice and Palliative Care Nursing/statistics & numerical data*
  9. Guan NC, Beng TS, Sue-Yin L, Kanagasundram S
    Indian J Palliat Care, 2021 02 17;27(1):83-88.
    PMID: 34035622 DOI: 10.4103/IJPC.IJPC_122_20
    Context: While pain is a common complaint among palliative cancer patients, there is little research looking into nonpharmacological methods for the reduction of pain in the palliative setting.

    Aim: This study aims to study the efficacy of 5-min mindful breathing for rapid reduction of pain in a palliative care setting.

    Methods: This is a sub-analysis of the previous randomized controlled study on distress reduction. Sixty patients were recruited and randomly assigned to either the intervention (5-min mindful breathing) or the control (5-min normal listening) group. Participants reported their pain on a 10-item analog scale at baseline, immediately after intervention and 10 min postintervention. Changes in pain scores were further analyzed.

    Results: Pain scores decreased for both the intervention and control groups. However, the reduction of pain did not reach statistical difference in both groups (P > 0.05).

    Conclusion: Five-minute mindful breathing is a quick and easy to administer therapy but does not have significant effects in terms of pain reduction in palliative settings. Future research and directions are nonetheless suggested and encouraged to look for short-term mindfulness-based therapies on pain reduction for this population.

    Matched MeSH terms: Hospice and Palliative Care Nursing
  10. Tan SB, Loh EC, Lam CL, Ng CG, Lim EJ, Boey CCM
    BMJ Support Palliat Care, 2019 Mar;9(1):e19.
    PMID: 27098972 DOI: 10.1136/bmjspcare-2015-001064
    Although suffering in palliative care has received increasing attention over the past decade, the psychological processes that underpin suffering remain relatively unexplored.

    OBJECTIVE: To understand the psychological processes involved in the experiencing of suffering at the end phase of life.

    METHODS: Semistructured interviews were conducted with 20 palliative care inpatients from an academic medical centre in Kuala Lumpur, Malaysia. The transcripts were thematically analysed with NVIVO9.

    RESULTS: 5 themes of psychological processes of suffering were generated: (1) perceptions, (2) cognitive appraisals, (3) hope and the struggles with acceptance, (4) emotions and (5) clinging. A model of suffering formation was constructed.

    CONCLUSION: The findings may inform the development of mechanism-based interventions in the palliation of suffering.

    Matched MeSH terms: Hospice and Palliative Care Nursing/methods*
  11. 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: Hospice and Palliative Care Nursing
  12. Chong LA, Khoo EJ, Kamar AA, Tan HS
    Asian Bioeth Rev, 2020 Aug 13.
    PMID: 32837563 DOI: 10.1007/s41649-020-00142-2
    Malaysia had its first four patients with COVID-19 on 25 January 2020. In the same week, the World Health Organization declared it as a public health emergency of international concern. The pandemic has since challenged the ethics and practice of medicine. There is palpable tension from the conflict of interest between public health initiatives and individual's rights. Ensuring equitable care and distribution of health resources for patients with and without COVID-19 is a recurring ethical challenge for clinicians. Palliative care aims to mitigate suffering caused by a life-limiting illness, and this crisis has led to the awareness and urgency to ensure it reaches all who needs it. We share here the palliative care perspectives and ethical challenges during the COVID-19 pandemic in Malaysia.
    Matched MeSH terms: Hospice and Palliative Care Nursing
  13. 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: Hospice and Palliative Care Nursing
  14. 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: Hospice and Palliative Care Nursing
  15. 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: Hospice and Palliative Care Nursing
  16. Mohd Arif Atarhim, Nurul Asyiqin Ibrahim, Chong Zhi Yin, Santhna Letchmi Panduragan, Hamidah Hassan
    MyJurnal
    Introduction: Early integration in palliative care for patients with advanced cancer has been correlated with an improvement quality of life, relieved depression while having survival benefits. Negative perceptions towards pal- liative care or misconception about the idea of palliative care were reported as one of the causes for late referral by physicians. The aim of this study was to determine the knowledge and perception of palliative care among can- cer patients in a tertiary hospital. Methods: A cross-sectional survey with populations of 139 cancer patients was conducted using convenience sampling. Quantitative data were collected by a structured questionnaire. A total of 92 responses were obtained. Results: Most of the participants were female (66.3%), Malay (71.7%) and attended secondary school (56.5%). The mean age of participants was 56.13 (±12.61) years while the mean income was RM 1944.20 (±2472.70). Majority of the participants had breast cancer (37.0%), followed by colorectal cancer (32.6%). Many of them were in stage IV (42.4%), followed by stage III (25.0%).Most of the cancer patients had a high level of knowledge and positive perception towards palliative care. They agreed that psychological, social and spiritual issues are a part of palliative care which helped to manage pain and other symptoms. Besides, responses portrayed positive perceptions of palliative care through the aspect of emotional reactions, cognitive reactions and palliative care needs. Conclusions: The current study has demonstrated that cancer patients in the tertiary hospital had better knowledge and perceptions in palliative care. High knowledge level and positive perception towards palliative care might increase the acceptance and palliative care practiced.
    Matched MeSH terms: Hospice and Palliative Care Nursing
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