End-of-life care for cancer patients in an Internal Medicine department
Introduction Many cancer patients die in the hospital, in spite of their preference to end their lives at home. Internal Medicine wards are poorly equipped to care for dying patients. Staff members have no specific training in palliative care, and the organization of the ward lacks flexibility. The...
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doaj-710f7dd412304ca5a4a7d4167cca49472020-11-25T03:18:31ZengPAGEPress PublicationsItalian Journal of Medicine1877-93441877-93522013-03-016211011510.4081/itjm.2012.11059End-of-life care for cancer patients in an Internal Medicine departmentLuigi Lusiani0Gabriella Bordin1Giovanni Mantineo2Pietro Roncato3Lionella Favaro4Leopoldo Tessaro5Lorena Sandonà6Francesca Bordin7UO Medicina Interna, Presidio Ospedaliero di Castelfranco Veneto (TV), ULSS 8 Regione VenetoUO Medicina Interna, Presidio Ospedaliero di Castelfranco Veneto (TV), ULSS 8 Regione VenetoUO Medicina Interna, Presidio Ospedaliero di Castelfranco Veneto (TV), ULSS 8 Regione VenetoUOD Terapia del Dolore e Cure Palliative, Presidio Ospedaliero di Castelfranco Veneto (TV), ULSS 8 Regione VenetoUO Medicina Interna, Presidio Ospedaliero di Castelfranco Veneto (TV), ULSS 8 Regione VenetoUOD Terapia del Dolore e Cure Palliative, Presidio Ospedaliero di Castelfranco Veneto (TV), ULSS 8 Regione VenetoDirezione Medica, Presidio Ospedaliero di Castelfranco Veneto (TV), ULSS 8 Regione VenetoFondazione Sue Ryder ONLUS, RomaIntroduction Many cancer patients die in the hospital, in spite of their preference to end their lives at home. Internal Medicine wards are poorly equipped to care for dying patients. Staff members have no specific training in palliative care, and the organization of the ward lacks flexibility. The entire staff (physicians and nurses) of the Internal Medicine ward of our hospital took part in a specially designed training program, and a protocol for end-of-life care (EOL-care) was implemented to improve the comfort of patients with terminal cancer. The aim of this study was to analyze the impact of this protocol on clinical practice in the ward, in terms of the number of interventions and the degree of control of key symptoms. Materials and methods The EOL-care protocol, which was established in cooperation with the Sue Ryder Foundation, was a modified version of the Liverpool Care Pathway. The main objective was to ensure the comfort of the dying patient through judicious discontinuation of all non-essential medications and interventions, frequent and systematic assessment of the key symptoms, and greater emphasis on communication with the patient and his/her caregivers. We compared 82 unselected cases managed with conventional care, representing the 20% of the deaths that occurred in 2007-2008 in our ward (controls), and 27 consecutive cancer patients cared for with the EOL-care protocol between May 2009 and February 2010 (cases). Results Patients in the case group received fewer interventions than controls (catheterization rate: 0% vs 19.4%; invasive procedure rate: 0% vs 8.5%; parenteral nutrition: 0% vs 3.6%), but they obtained almost complete relief of symptoms (pain, dyspnea, respiratory tract obstruction by secretions, agitation, nausea/vomiting). The most prominent result was pain relief: systematic checks revealed persistent pain in only 2.9% of the EOL-care group versus 59.7% of the controls during the last 48 hours of life. Discussion This observational study provides evidence that the quality of EOL-care for cancer patients can be improved, even in non-specialized departments, through organizational rather than technological interventions.http://www.italjmed.org/index.php/ijm/article/view/68End-of-life careCancerPain control |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Luigi Lusiani Gabriella Bordin Giovanni Mantineo Pietro Roncato Lionella Favaro Leopoldo Tessaro Lorena Sandonà Francesca Bordin |
spellingShingle |
Luigi Lusiani Gabriella Bordin Giovanni Mantineo Pietro Roncato Lionella Favaro Leopoldo Tessaro Lorena Sandonà Francesca Bordin End-of-life care for cancer patients in an Internal Medicine department Italian Journal of Medicine End-of-life care Cancer Pain control |
author_facet |
Luigi Lusiani Gabriella Bordin Giovanni Mantineo Pietro Roncato Lionella Favaro Leopoldo Tessaro Lorena Sandonà Francesca Bordin |
author_sort |
Luigi Lusiani |
title |
End-of-life care for cancer patients in an Internal Medicine department |
title_short |
End-of-life care for cancer patients in an Internal Medicine department |
title_full |
End-of-life care for cancer patients in an Internal Medicine department |
title_fullStr |
End-of-life care for cancer patients in an Internal Medicine department |
title_full_unstemmed |
End-of-life care for cancer patients in an Internal Medicine department |
title_sort |
end-of-life care for cancer patients in an internal medicine department |
publisher |
PAGEPress Publications |
series |
Italian Journal of Medicine |
issn |
1877-9344 1877-9352 |
publishDate |
2013-03-01 |
description |
Introduction Many cancer patients die in the hospital, in spite of their preference to end their lives at home. Internal Medicine wards are poorly equipped to care for dying patients. Staff members have no specific training in palliative care, and the organization of the ward lacks flexibility. The entire staff (physicians and nurses) of the Internal Medicine ward of our hospital took part in a specially designed training program, and a protocol for end-of-life care (EOL-care) was implemented to improve the comfort of patients with terminal cancer. The aim of this study was to analyze the impact of this protocol on clinical practice in the ward, in terms of the number of interventions and the degree of control of key symptoms. Materials and methods The EOL-care protocol, which was established in cooperation with the Sue Ryder Foundation, was a modified version of the Liverpool Care Pathway. The main objective was to ensure the comfort of the dying patient through judicious discontinuation of all non-essential medications and interventions, frequent and systematic assessment of the key symptoms, and greater emphasis on communication with the patient and his/her caregivers. We compared 82 unselected cases managed with conventional care, representing the 20% of the deaths that occurred in 2007-2008 in our ward (controls), and 27 consecutive cancer patients cared for with the EOL-care protocol between May 2009 and February 2010 (cases). Results Patients in the case group received fewer interventions than controls (catheterization rate: 0% vs 19.4%; invasive procedure rate: 0% vs 8.5%; parenteral nutrition: 0% vs 3.6%), but they obtained almost complete relief of symptoms (pain, dyspnea, respiratory tract obstruction by secretions, agitation, nausea/vomiting). The most prominent result was pain relief: systematic checks revealed persistent pain in only 2.9% of the EOL-care group versus 59.7% of the controls during the last 48 hours of life. Discussion This observational study provides evidence that the quality of EOL-care for cancer patients can be improved, even in non-specialized departments, through organizational rather than technological interventions. |
topic |
End-of-life care Cancer Pain control |
url |
http://www.italjmed.org/index.php/ijm/article/view/68 |
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