Evidence for Improving Palliative Care at the End of Life: A Systematic Review

Lorenz, Karl; Lynn, Joanne; Dy, Sydney M.; Shugarman, Lisa R.; Wilkinson, Anne; Mularski, Richard A.; Morton, Sally C.; Hughes, Ronda G.; Hilton, Lara; Maglione, Margaret; Rhodes, Shannon; Rolón, Cony; Sun, Virginia; Shekelle, Paul G

doi:10.7326/0003-4819-148-2-200801150-00010

Cited by 518 publications

(355 citation statements)

References 139 publications

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“…The absence of a shared understanding of how end of life is recognised, or at what point end of life is defined for people with dementia, means that research that focused on improving symptom assessment for people with advanced dementia, on needs assessment in care homes, and on communication and the involvement of people with dementia in decision making were not included in the review (Fossey et al, 2006;Hancock et al, 2006;Zwakhalen et al, 2006). Data extraction ceased in 2006, however a rapid review of research and reviews published up till 2008 (Birch and Draper, 2008;Di Giulio et al, 2008;Lorenz and Lynn, 2008) indicate that the research focus and methods and findings discussed in this paper have not dramatically changed, and that there are still very few intervention studies that include people with dementia who are living at home or in a care home.…”

Section: Discussionmentioning

confidence: 99%

End of life care for community dwelling older people with dementia: an integrated review

Goodman

Evans

Wilcock

et al. 2009

Int J Geriat Psychiatry

106

102

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Objective: To review the evidence for end-of-life care for community dwelling older people with dementia (including those resident in care homes). Design: An integrated review synthesised the qualitative and quantitative evidence on end-of-life care for community dwelling older people with dementia. English language studies that focused on prognostic indicators for end-of-life care, assessment, support/relief, respite and educational interventions for community dwelling older people with dementia were included. A user representative group informed decisions on the breadth of literature used. Each study selected was screened independently by two reviewers using a standardised check list. Results: Sixty eight papers were included. Only 17% (12) exclusively concerned living and dying with dementia at home. Six studies included direct evidence from people with dementia. The studies grouped into four broad categories: Dementia care towards the end of life, palliative symptom management for people with dementia, predicting the approach of death for people with dementia and decision-making. The majority of studies were descriptive. The few studies that developed dementia specific tools to guide end of life care and outcome measures specific to improve comfort and communication, demonstrated what could be achieved, and how much more needs to be done. Conclusions: Research on end-of-life care for people with dementia has yet to develop interventions that address the particular challenges that dying with dementia poses. There is a need for investigation of interventions and outcome measures for providing end-of-life care in the settings where the majority of this population live and die.

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Section: Discussionmentioning

confidence: 99%

End of life care for community dwelling older people with dementia: an integrated review

Goodman

Evans

Wilcock

et al. 2009

Int J Geriat Psychiatry

106

102

View full text Add to dashboard Cite

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“…Opioids are effective for the management of dyspnea, but are underused by physicians because of concerns about respiratory depression [62]. The American College of Physicians (ACP) recommends treatment with short-acting opioids, because several randomized controlled trials have shown the beneficial effects of systemic opioids in the control of dyspnea [63,64]. Although small series describe relief of dyspnea with the administration of nebulized opioids [65], randomized controlled trials and a Cochrane review did not show that nebulized opioids are effective for dyspnea [66].…”

Section: Dyspneamentioning

confidence: 99%

Symptom Management in Metastatic Breast Cancer

2011

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Approximately 40,000 women die as a result of breast cancer each year and many more live with advanced disease. When breast cancer recurs, the goals of treatment often shift from one of cure to controlling the disease for as long as possible while palliating symptoms interfering with the patient's functional status and quality of life. This requires ongoing discussions with the patient and family about the goals of care. Many symptoms depend on the site of metastasis, with bone being the most frequent, and commonly occur with fatigue, depression, insomnia, and pain. The purpose of this paper is to identify and provide an overview of the management of the most common symptoms in patients with breast cancer metastases.

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“…[15][16][17][18] During this time, palliative care treatment plans can be implemented, in place of or in addition to existing care plans, to reduce suffering and improve end-of-life care. 12,19,20 Despite the benefits of palliative care [18][19][20][21][22][23][24][25] and its growth in recent years, 20,25,27 it is not always available for inpatients, partly because the subspecialty palliative care workforce is not currently sufficient to reach all patients dying in hospital settings and partly because practitioners do not recognize shifts in patient trajectory indicating the need for palliative care consultation. [26][27][28][29][30][31][32] In an environment focusing on "cure," transition away from disease-modifying treatments to symptom control can seem counterintuitive.…”

Section: Introductionmentioning

confidence: 99%

Intervention to Improve Care at Life’s End in Inpatient Settings: The BEACON Trial

et al. 2014

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BACKGROUND: Widespread implementation of palliative care treatment plans could reduce suffering in the last days of life by adopting best practices of traditionally home-based hospice care in inpatient settings. OBJECTIVE: To evaluate the effectiveness of a multimodal intervention strategy to improve processes of end-of-life care in inpatient settings. DESIGN: Implementation trial with an intervention staggered across hospitals using a multiple-baseline, stepped wedge design. PARTICIPANTS: Six Veterans Affairs Medical Centers (VAMCs). INTERVENTION: Staff training was targeted to all hospital providers and focused on identifying actively dying patients and implementing best practices from home-based hospice care, supported with an electronic order set and paper-based educational tools. MAIN MEASURES: Several processes of care were identified as quality endpoints for end-of-life care (last 7 days) and abstracted from electronic medical records of veterans who died before or after intervention (n= 6,066). Primary endpoints were proportion with an order for opioid pain medication at time of death, donot-resuscitate order, location of death, nasogastric tube, intravenous line infusing, and physical restraints. Secondary endpoints were administration of opioids, order/administration of antipsychotics, benzodiazepines, and scopolamine (for death rattle); sublingual administration; advance directives; palliative care consultations; and pastoral care services. Generalized estimating equations were conducted adjusting for longitudinal trends. KEY RESULTS: Significant intervention effects were observed for orders for opioid pain medication (OR:

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Evidence for Improving Palliative Care at the End of Life: A Systematic Review

Cited by 518 publications

References 139 publications

End of life care for community dwelling older people with dementia: an integrated review

End of life care for community dwelling older people with dementia: an integrated review

Symptom Management in Metastatic Breast Cancer

Intervention to Improve Care at Life’s End in Inpatient Settings: The BEACON Trial

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