This paper aims to reconcile the use of Palliative Performance Scale (PPSv2) for survival prediction in palliative care through an international collaborative study by five research groups. The study involves an individual patient data meta-analysis on 1,808 patients from four original datasets to reanalyze their survival patterns by age, gender, cancer status, and initial PPS score. Our findings reveal a strong association between PPS and survival across the four datasets. The Kaplan-Meier survival curves show each PPS level as distinct, with a strong ordering effect in which higher PPS levels are associated with increased length of survival. Using a stratified Cox proportional hazard model to adjust for study differences, we found females lived significantly longer than males, with a further decrease in hazard for females not diagnosed with cancer. Further work is needed to refine the reporting of survival times/probabilities and to improve prediction accuracy with the inclusion of other variables in the models. Resume / Cet article vise a reconcilier !'usage de l'echelle de performance en soins palliatifs [EPSP] comme facteur predlctlf de survie grace aun projet international commun auquel ont particlpe cinq groupes de recherche. Cette etude comporte une meta-analyse des donnees recueillies aupres des 1,808 patients provenant de quatre cohortes differentes. On a done refait I'analyse du pronostic de survie selon I'age, Ie genre, Ie stade de la maladie et Ie score initial de I'EPSP. Nos resultats revelent qu'il y a une relation importante entre I'EPSP et Ie facteur predictif de survie atravers I'ensemble des donnees des quatre groupes. Les courbes de survie Kaplan-Meier demontrent que chaque niveau de I'EPSP est distinct et que les plus hauts scores de I'EPSP sont assocles aune plus longue periods de survie. A I'aide du modele de hasard proportionnel de Cox, nous avons realuste les differences qui existaient entre les etudes et nous avons decouvert que les femmes, de tacon significative, vivent plus longtemps que les hommes. De plus, ces probabilites sont encore plus elevees chez les femmes n'ayant pas ete diagnostiquees du cancer. II nous faudra d'autres etudes pour perfectionner nos previsions sur Ie temps de survie/probabilite et pour ameliorer "exactitude des predictions tout en y ajoutant d'autres variables.
Patients undergoing treatment for head and neck cancers have a myriad of distressing symptoms and treatment side effects which significantly alter communication and lower quality of life. Telehealth technology has demonstrated promise in improving patient-provider communication by delivering supportive educational content and guidance to patients in their homes. A telehealth intervention using a simple telemessaging device was developed to provide daily education, guidance, and encouragement for patients undergoing initial treatment of head and neck cancer. The goal of this article is to report the feasibility and acceptance of the intervention using both quantitative and qualitative measures. No eligible patients declined participation based on technology issues. Participants completed the intervention over 86% of the expected days of use. Direct nursing contact was seldom needed during the study period. Satisfaction with the technology and the intervention was very high. In this study a telehealth intervention was shown to be feasible, well accepted, and regularly used by patients experiencing extreme symptom burden and declining quality of life as a result of aggressive treatment for head and neck cancer.
The PPS scores are associated with patient length of survival in a hospice program and can be used in evaluating hospice appropriateness.
Long and complicated grief is a relevant factor contributing to the deterioration of the older adults' later life quality. In China, the unintentional consequence of the one-child policy has emerged. There, the group of older adults who lost their only child is called shiduers. The current study compared 42 older adults who lost their only child to 33 older adults who have a child, in term of their physical and mental health, and social support. The results confirmed the general deteriorating trend in those aspects of the bereaved Chinese parents' life after their only child's death. The results also revealed the impairments on the shiduers' physical, mental, and social aspects were significant, compared to the clinical diagnosis cutoff points used in Western countries. Unique policy and cultural characteristics are the main factors contributing to the severe impairment of shiduers. Results have implications for policy advocacy and practice intervention in specific cultural environments.
The needs of an aging population and advancements in the treatment of both chronic and life-threatening diseases have resulted in increased demand for quality palliative care. The doctors of the future will need to be well prepared to provide expert symptom management and address the holistic needs (physical, psychosocial, and spiritual) of patients dealing with serious illness and the end of life. Such preparation begins with general medical education. It has been recommended that teaching and clinical experiences in palliative care be integrated throughout the medical school curriculum, yet such education has not become the norm in medical schools across the world. This article explores the current status of undergraduate medical education in palliative care as published in the English literature and makes recommendations for educational improvements which will prepare doctors to address the needs of seriously ill and dying patients.
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