Clara Granda-Cameron

Concept analysis of good death in terminally ill patients.

The purpose of this concept analysis of good death was to examine the attributes of a good death and explore the changes of the concept over time and its impact on terminally ill patients. The method used for this analysis was the Rodgers’ evolutionary method. A literature search was completed using Medline Ovid and Journal Storage (JSTOR).The findings describe the evolution of the good death concept over time from the prehistoric era followed by premodern, modern, and postmodern times. In addition, information is presented about surrogate terms, attributes, antecedents, and consequences associated with good death followed by analysis and discussion of the findings. General attributes of a good death include pain and symptom management, awareness of death, patient’s dignity, family presence, family support, and communication among patient, family, and health care providers.

Measuring patient-oriented outcomes in palliative care: functionality and quality of life.

Outcomes measurement is necessary to evaluate quality of care, increase knowledge about experiences with cancer and therapies, and determine the effectiveness of interventions directed toward improving symptoms and quality of life (QOL) in research and clinical care. Recent attention on outcomes measurement and research in palliative care settings has emphasized the need to incorporate patient-reported outcomes. Unlike other areas of research in oncology, palliative care research is comprised largely of descriptive studies elucidating the process involved with palliative care, with a notable void in well-designed patient-oriented studies employing standard instruments for measuring functional status, QOL, symptoms, and psychosocial well-being. Outcomes programs in practice settings where palliative care is an integral part of clinical services can offer important information about patient experiences across the continuum of care and help to identify patients most likely to benefit from palliative care interventions. Therefore, oncology nurses must be informed about outcome-measurement issues, including ways to select reliable and valid instruments and determine which ones are appropriate for palliative care populations. Content related to the measurement of patient-oriented outcomes is presented to assist nurses in developing outcomes programs in palliative care settings.

International Association for Hospice and Palliative Care (IAHPC) List of Essential Practices in Palliative Care

ABSTRACT The objective of this study was to identify, through a consensus process, the essential practices in primary palliative care. A three-phase study was designed. Phase 1 methods included development of a working group; a literature review; development of a baseline list of practices; and identification of levels of intervention. In Phase 2, physicians, nurses, and nurse aides (n = 425) from 63 countries were asked in three Delphi rounds to rate the baseline practices as essential or nonessential and select the appropriate levels of intervention for each. In Phase 3, representatives of 45 palliative care organizations were asked to select and rank the 10 most important practices resulting from Phase 2. Scores (1–10) were assigned to each, based on the selected level of importance. Results of Phase 1 were a baseline list of 140 practices. Three levels of intervention were identified: Identification/Evaluation; Diagnosis; and Treatment/Solution measures. In Phase 2, the response rates (RR) for the Delphi rounds were 96.5%, 73.6%, and 71.8%, respectively. A consensus point (≥80% agreement) was applied, resulting in 62 practices. In Phase 3, RR was 100%. Forty-nine practices were selected and ranked. “Evaluation, Diagnosis and Treatment of Pain” scored the highest (352 points). The working group (WG) arranged the resulting practices in four categories: Physical care needs, Psychological/Emotional/Spiritual care needs, Care Planning and Coordination, and Communication. The IAHPC List of Essential Practices in Palliative care may help define appropriate primary palliative care and improve the quality of care delivered globally. Further studies are needed to evaluate their uptake and impact.

The experience of having cancer in Latin America.

When the human experience is reduced to basic feelings, it becomes evident that the impact of cancer produces similar responses in people around the world. These responses are affected by the individuals culture, myths, and beliefs. Latin America includes several countries, each with different traditions and backgrounds. This article illuminates common cultural health beliefs in Latin America that play a significant role in the way Latin Americans perceive the experience of cancer. Nurses providing care to cancer patients should be aware of cultural differences and familiar with the lifeways of the major cultural groups in order to meet the needs of the patients under their care.

Risk Factors Associated With Unplanned Hospital Readmissions in Adults With Cancer

PURPOSE/OBJECTIVES To identify risk factors associated with 30-day unplanned hospital readmissions in adults with cancer. DESIGN Case-control study. SETTING A teaching hospital in an urban center in the Mid-Atlantic region of the United States. SAMPLE 302 adults with solid tumors. METHODS The Conceptual Model of Re-Hospitalization was used as a theoretic framework. Univariate logistic regression and multivariate logistic regression were conducted to identify risk factors for hospital readmission. MAIN RESEARCH VARIABLES Risk factors included patient, clinical, hospitalization, and discharge-planning characteristics. FINDINGS From November 2011 to November 2012, 29% of patients were readmitted within 30 days after discharge, and a higher percentage of those readmissions occurred within the first week of discharge. Several predictors for hospital readmission were identified in the univariate logistic analysis, but the most relevant in the final multivariate logistic model were moderate to high risk for falls and advanced stage disease (metastatic). CONCLUSIONS Hospital readmission is an indicator of quality care. Learning about risk factors allows opportunities to prevent hospital readmission by identifying those at high risk and implementing optimal discharge-planning systems and early referrals to palliative care. IMPLICATIONS FOR NURSING Oncology nurses are best positioned to develop strategic plans aimed at improving discharge planning and transitions of care that will decrease unplanned hospital readmissions.

Experience of Newly Diagnosed Patients With Sarcoma Receiving Chemotherapy

PURPOSE/OBJECTIVES To examine symptom distress and quality of life (QOL) in newly diagnosed patients with sarcoma receiving chemotherapy. DESIGN Pilot study; descriptive, quantitative. SETTING Urban community cancer center in the northeastern United States. SAMPLE 11 newly diagnosed patients with sarcoma. METHODS Participants completed the Edmonton Symptom Assessment Scale and the Functional Assessment of Cancer Therapy-General at baseline and on days 1, 15, and 21 of their chemotherapy treatment. MAIN RESEARCH VARIABLES Symptom distress and QOL. FINDINGS Fatigue was the most prevalent and pervasive symptom. Anxiety, well-being, lack of appetite, drowsiness, and depression were the most commonly reported symptoms during chemotherapy. QOL was negatively affected. The lowest mean score reported was for functional well-being. Outcome profiles for symptom distress increased over time, whereas QOL profiles decreased over time. Exploratory analyses of age, race, sex, and diagnosis group suggested differences that warrant further study. CONCLUSIONS Overall, increasing symptom distress and reduced QOL over time were reported by patients with sarcoma during chemotherapy. Exploratory analysis by demographic variables and treatment group suggested the need for further research of predictors for symptom distress and QOL. IMPLICATIONS FOR NURSING Clinical and research implications included the need for better understanding about symptom distress and QOL predictors in patients with sarcoma, as well as the evaluation of interventions directed to address this populations specific needs.

Bringing an Inpatient Palliative Care Program to a Teaching Hospital: Lessons in Leadership

This feature provides a platform for oncology nurses to illustrate the many ways that leadership may be realized and professional practice may transform cancer care. Possible submissions include but are not limited to overviews of projects, interviews with nurse leaders, and accounts of the application of leadership principles or theories to practice. Descriptions of activities, projects, or action plans that are ongoing or completed are welcome. Manuscripts should clearly link the content to the impact on cancer care. Manuscripts should be six to eight doublespaced pages, exclusive of references and tables, and accompanied by a cover letter requesting consideration for this feature. For more information, contact Associate Editor Paula Klemm, PhD, RN, OCN, at klemmpa@udel.edu or Associate Editor Judith K. Payne, PhD, RN, AOCN, at payne031@mc.duke.edu Paula T. Rieger, RN, MSN, AOCN®, FAAN Associate Editor