ObjectiveThere is limited research exploring the experiences of people living with advanced cancer in the Gaza Strip (GS), Palestine. Thus, this study aimed to determine the level of psychological distress, anxiety, and depression among advanced cancer patients in the GS and identify factors associated with a high level of distress.Materials and methodsA secondary analysis was performed using primary data from a larger study focusing on supportive care needs in advanced cancer patients in GS. Three hundred sixty-one patients agreed to participate and filled out the Distress Thermometer (DT) and the Hospital Anxiety and Depression Scale (HADS). Multivariate logistic regression was conducted to identify factors associated with high distress levels.ResultsOver two-thirds of advanced cancer patients (70.6%) reported a high level of distress. They also reported a significantly higher distress level than patients with early cancer (96.5 vs. 3.5%; p = 0.001). About 92.8% of participants reported depression and anxiety symptoms. Physical, emotional, and practical problems were the primary sources of distress. Breast cancer patients were more likely to have psychological distress than colon and stomach cancer patients. Newly diagnosed patients had a higher level of anxiety, depression, and distress than those who had a cancer diagnosis for an extended period.ConclusionPatients with advanced cancer in the GS exhibited a significantly higher level of psychological distress, depression and anxiety than patients with advanced cancer elsewhere. Efforts should be made to identify psychological distress as a routine part of oncology practice. Future research should further explore the causes of psychological distress in cancer patients in conflict zones and feasible mitigation strategies.
Methods Views of hospital physicians caring for people with conditions causing chronic breathlessness were explored in a South Indian hospital as part of a service improvement project. Three semi-structured focus groups were conducted in English, audio-recorded, transcribed and subjected to thematic analysis. Results Fifteen clinicians participated, representing oncology, palliative care, cardiology and respiratory specialties. Three major themes (Impact, Invisibility and Purpose) and 12 subthemes were generated by the data.Chronic breathlessness as defined, was seen as prevalent with a huge impact on patients, their families, carers and clinicians. In non-palliative care clinicians, a sense of therapeutic helplessness with a lack of awareness or ability to manage chronic breathlessness was observed in association with active avoidance. This, a perceived lack of assessment tools and lack of clear clinical pathways allowing access to palliative care contributed to the invisibility of people with this symptom.Most participants were in agreement about the name of chronic breathlessness syndrome. All agreed that focussed systematic identification would foster education regarding assessment, management and monitoring and would support service development and research. Conclusions Chronic breathlessness syndrome is recognised in clinical practice in Southern India but risks being invisible due to lack of awareness, particularly of interventions to manage the breathlessness itself. A named and defined syndrome was seen as a way to improve identification and management of chronic breathlessness.
Feedback from patients and carers at our hospice-based MND support group highlighted that although the tertiary hospital clinic was important to them, it lacked access to local support, and pre-bereavement care. Often crises and issues arise in between hospital appointments; therefore local services are important in hospital admission avoidance where possible. Aim To develop a satellite MND MDT clinic at our hospice incorporating the regional and local MND expertise. Method The novel hospice-based clinic includes the hospital MND specialist nurse, an MND Association representative, and the hospice therapy team. New referrals are seen in the next monthly clinic.The pilot will run for 12 months and be reviewed at six and 12 months.During the year, clinic activity data, patient and carer feedback and a patient reported outcome scale (IPOS) will be collected as part of the service evaluation. This service is being set up within existing hospice budgets. Results Preliminary analysis of IPOS and qualitative feedback data indicates that patients and carers prefer not having the burden of travelling to the tertiary hospital and value the opportunity to have more time to discuss their care and access the local services available to them. Frequent reviews and expedited access to hospice services has allowed more timely management of arising issues, preventing interval hospital admissions. Conclusions By implementing the 2016 NICE Guidelines in MND care through our novel hospice-based clinic, we have a new service which rates very highly in satisfaction with patients and carers. It is also preventing crises in MND care falling upon tertiary centres by diversion to palliative care within local services. Background Constipation is a common problem in palliative care, affecting approximately 50% of patients admitted to hospices and causing a wide range of symptoms. It is important to identify, treat and document constipation systematically in order to provide immediate symptomatic relief and to prevent complication occurrence. Aims To identify if there is documented evidence that constipated hospice inpatients are being adequately assessed, monitored and managed, and to implement improvements where necessary. Methods Retrospective audit of constipation assessment and management in twenty consecutive patients admitted to a hospice inpatient unit, against local and national standards. Data collected included documentation of bowel habits, oral laxative prescribing and administration, and rectal interventions. Results A number of areas for improvement were identified in both medical and nursing documentation and clinical practice. Particular areas for improvement included standardisation of documentation, the creation and implementation of appropriate care plans, review and upward titration of oral laxatives, rectal medication administration, and obtaining verbal consent and offering a chaperone prior to bowel examination or intervention. Conclusions Lack of optimal assessment, management and documentation of constipation in hos...
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