Abstract
Kehl KA, Gartner CM: Can you hear me now? The experience of a deaf family member surrounding the death of loved ones. Palliat Med 2010;24:88–93.
Deaf individuals face unique challenges when a family member is dying. Good communication is important when dealing with family members, with miscommunication creating misunderstanding and conflict. In this qualitative study, the authors interviewed a college-educated older deaf man (using death history questions) about the challenges he faced interacting with the healthcare system as three of his loved ones were dying. Results demonstrated there are physical barriers, financial barriers to obtaining interpreters, and problems with the cultural competence of others (e.g., lack of the use of American Sign Language). The authors conclude that these findings provide a framework for future research concerning the needs of deaf individuals facing the end of life and provide guidance for clinicians.
Murray RP: Spiritual care beliefs and practices of special care and oncology RNs at patients' end of life. J Hospice Palliat Nurs 2010;12:51–58.
The need for nurses to address patients' spiritual needs at the end of life is well known and a critical component of care. In this descriptive comparative study, the author evaluated the personal spiritual beliefs and practices of 33 intensive care and oncology RNs caring for patients at the end of life. The RNs from these two units completed the Demographic and Spiritual Beliefs and Practices survey. Results demonstrated a nonsignificant difference between nurses who worked on the two units; RNs from both units strong believed in the necessity of assessing spiritual care needs at the end of life. Nevertheless, data revealed a great inconsistency in nurses addressing these needs as well as a desire for education in addressing spiritual needs with patients and families. The author concludes that this study supports previous research identifying the need for greater support of the RN in identifying and assessing spiritual needs of patients.
Temel JS, Greer JA, Admane S, et al.: Code status documentation in the outpatient electronic medical records of patients with metastatic cancer. J Gen Intern Med 2010;25:150–153.
Advance care planning (ACP) is considered an essential and increasingly necessary component of medical care in the United States. ACP typically entails advanced directives that either describe patients' wishes for care in the event of a specific medical scenario (“living will”) or assign another party to express patients' wishes in the event they are unable to do so (“health care proxy”). In this retrospective of 2498 patients with metastatic solid tumors (metastatic prostate, breast, ovarian, bladder/kidney, colorectal, noncolorectal gastrointestinal, and lung cancers) at an academic cancer center, an electronic patient database and the longitudinal medical record (LMR) were queried to identify demographic information, cancer type, number of clinic visits, and documentation of code status. Primary outcome was the percentage documented code status in the LMR. Results demonstrated 20.3% had a documented code status, with code status most commonly designated in patients with noncolorectal gastrointestinal (31.7%) and lung (30.7%) cancers, and less frequently in patients with genitourinary (4.5%), ovarian (4.3%), and prostate (1.9%) cancers. Independent predictors of having documented code status included religious affiliation, cancer type, and a greater number of visits to the cancer center. Younger patients and black patients were less likely to be designated as do-not-resuscitate and do-not-intubate. The authors conclude that despite the incurable nature of metastatic cancer, only a minority of patients had a code status documented in the electronic medical record.
Granda-Cameron C, DeMille D, Lynch MP, et al. An interdisciplinary approach to manage cancer cachexia. Clin J Oncol Nurs 2010;14:72–81.
Cancer cachexia is defined as a decrease in baseline weight by 5%–10% or more in 6 months or 5% in 1 month, and occurs in 50%–75% of patients with cancer. In addition, cachexia may lead to delayed, missed, or decreased treatments. This article describes how a palliative care program of an urban community cancer center developed an interdisciplinary Clinic (Cancer Appetite and Rehabilitation [CARE] Clinic) to treat cancer cachexia with the goal of using an interdisciplinary approach to improve symptom management, nutrition, function, and quality of life for patients with cancer at high risk for malnutrition. Trends for improvement were noted in patients visiting the clinic. The authors conclude that the process of developing and implementing this type of clinic may help oncology nurses and other healthcare professionals to improve management of cancer cachexia and overall cancer care.
Kierner KA, Hladschik-Kermer B, Gartner V, Watzke HH. Attitudes of patients with malignancies towards completion of advance directives. Support Care Cancer 2010;18:367–372.
Advance directives (ADs) serve to preserve and honor a patient's autonomy at the end of life when their capacity to make decisions becomes impaired. Several studies in healthy individuals and geriatric patients have reported meager use of ADs, so the authors of this cohort study investigated attitudes towards AD in hospitalized patients with a malignant disease. One hundred eight patients completed the study, with results demonstrating that 5% of patients had an AD, while 85% did not wish to complete an AD. “Full confidence in physicians” (22%) and “not important for me at the moment” (15%) were the most frequently stated reasons for not completing an AD. Only 10% (11/108) of patients decided to complete an AD. Patients who decided in favor of an AD had significantly higher Hospital Anxiety and Depression Scale (HADS-D) scores than those who decided against an AD (HADS-D, 8.3 ± 5.0 vs. 5.8 ± 4.1, p = 0.035). The patients' HADS depression score was negatively associated with their Karnofsky index (r = −0.232, p = 0.017). The authors conclude that their data reveal a scarce demand for AD completion in their population of hospitalized patients with cancer, but that patients who wanted to complete an AD had a high HADS-D, which was associated with a low performance status.