- Email: [email protected]
27 Quality of life assessment in palliative care
Abstracts and Learning Outcomes / European Journal of Oncology Nursing 18S1 (2014) S1–S22
and management of cancer- and chemotherapy-related neutropenia. Oncology nurses play critical roles in each of the areas and are charged with becoming familiar with the state of the knowledge of neutropenia and maintaining their understanding of the evidence and guidelines. In doing so, oncology nurses can be confident that sound rationale and clinical evidence are driving their decision-making processes to ensure quality cancer care and provide patients with the best opportunity for favourable long-term outcomes. No conflict of interest. 24 Nursing evidence and controversies in infection prevention No abstract received. No conflict of interest information specified.
Parallel Session: Palliative Care 25 What competencies are required for basic and specialised palliative care? No abstract received. No conflict of interest information specified. 26 Challenges related to symptoms that impact on eating B.M. Bernhardson1 . 1 Karolinska Institute, Dept. of Learning Informatics Management and Ethics, Stockholm, Sweden This presentation is built on the literature and my experiences from research on chemosensory alterations and malnutrition over the last 10 years from a nursing perspective. I will discuss factors such as the impact of symptoms on eating during the cancer trajectory from diagnosis to the end of life and new data on malnutrition. The presentation will discuss the meaning that affected persons attach to symptoms, which can differ, in part depending on where in the cancer trajectory the symptoms occur. Symptoms that are related to problems with eating can include anorexia, early satiety, chemosensory disorders, mouth problems, nausea, and pain but fatigue, depressed mood and diarrhea have also been related to eating difficulties. These symptoms are seldom experienced in isolation which makes their assessment challenging. It is highly important to assess multiple symptoms since some may be “silent symptoms”. Such silent symptoms, e.g. chemosensory disorders, are not always discussed openly with the healthcare staff. An array of measurement tools can be found, and several symptom-specific tools have been developed for research purposes. Which tools should we choose? I will also discuss in this presentation that the label of the symptom should be considered. Words can be open to different interpretations, and making sure that the words used to describe the symptoms, e.g. nausea or anorexia, are interpreted as intended is crucial for the correct assessment and interpretation of symptoms. Health care staff needs to make sure that the patient and the staff are talking about the same phenomena. One outcome of not eating enough is weight loss. There is an ongoing discussion about what information parameters like weight and BMI provide, without further information on other factors such as hydration status, tumor site and the existence of liver disease. Today research is expanding on body composition as an improved indicator for malnutrition, since imbalance between fat and muscle mass can mislead interpretations of the nutritional status of an obese person. These and other challenges for the health care staff in assessing and dealing with symptoms that impact on eating to enhance patients’ health-related quality of life will be discussed. No conflict of interest.
S7
27 Quality of life assessment in palliative care G. Catania1 , M. Beccaro2 , M. Costantini3 , D. Ugolini4 , A. De Silvestri5 , A. Bagnasco6 , L. Sasso6 . 1 IRCCS Azienda Ospedaliera Universitaria San Martino-IST-Istituto Nazionale per la Ricerca sul Cancro, Regional Palliative Care Network, Genoa, Italy; 2 Academy of Sciences of Palliative Medicine, Education Unit, Bologna, Italy; 3 IRCCS Arcispedale S Maria Nuova, Palliative Care Unit, Reggio Emilia, Italy; 4 IRCCS Azienda Ospedaliera Universitaria San Martino-IST-Istituto Nazionale per la Ricerca sul Cancro, Unit of Clinical Epidemiology, Genoa, Italy; 5 IRCCS Policlinico San Matteo Foundation, Biometry Unit, Pavia, Italy; 6 University of Genoa, Department of Health Sciences, Genoa, Italy Background: One of the most crucial palliative care challenge is in determining how patients’ needs are defined and assessed. Assessing quality of life has been defined as a priority in palliative care and it has become a central concept in palliative clinical practice. Aim: To determine to what extent interventions focused on measuring quality of life in palliative care practice are effective in improving outcomes in palliative care patients. Material and Methods: Systematic review according to the recommendations of the PRISMA statement and hand searches. Medline, CINAHL, EMBASE, PsycINFO and the Cochrane library were searched for papers published until June 2012, and through hand searching from references lists of included articles. Only studies that included adult palliative care patients, in any palliative care clinical practice setting of care, and with an experimental, quasiexperimental or observational analytical study design were eligible for inclusion. All studies were independently reviewed by two investigators who scored them for methodological quality by using the Edwards Method Score. Results: Eleven papers (of 8579) incorporating information from 10 studies were included. Only three were RCTs. The quality of the evidence was found from moderate to low. Given a wide variability among patients outcomes, individual effect size was possible for six out of ten studies, three of which found a moderate Effect Size (ES) on symptoms (ES = 0.68), and psychological (ES = 0.60) and social (ES = 0.55) dimensions. Conclusions: Effectiveness of interventions focused on quality of life assessment is moderate. Further rigorous research is needed considering such interventions as complex. No conflict of interest.
Parallel Session: Increased Complexity in Ambulatory Care 28 Bone marrow transplant in ambulatory care C. Gallego Miralles1 , A. Hernando1 , C. Moreno1 , S. Segura1 , P. Ayora1 , M. Carreno ˜ 1 , N. Arab1 , J. Guell1 , A. Gaya1 , F. Fernandez1 . 1 Hospital Clinic, Hematology and Oncology department, Barcelona, Spain Background: The use of filgrastim-mobilized peripheral blood progenitor cells and the use of prophylactic antibiotics and hematopoietic growth factors after transplant (SCT) reduce the risk for develop serious infections, facilitating the transfer of care to the outpatient setting. In the last decades, different models of outpatient-SCT are implemented but most published studies report high rates of readmissions (20–80%). The aims of this study were to know the current landscape of outpatient-SCT models, to identify areas for development and key points to optimize these programs and to know how Home Care Units (HCU) facilitates the empowerment of the patient and family. Material and Methods: A retrospective analysis of our experience and a revision of the medical literature in reference of outpatientSCT models (total outpatient, delayed admission and early dis-
and management of cancer- and chemotherapy-related neutropenia. Oncology nurses play critical roles in each of the areas and are charged with becoming familiar with the state of the knowledge of neutropenia and maintaining their understanding of the evidence and guidelines. In doing so, oncology nurses can be confident that sound rationale and clinical evidence are driving their decision-making processes to ensure quality cancer care and provide patients with the best opportunity for favourable long-term outcomes. No conflict of interest. 24 Nursing evidence and controversies in infection prevention No abstract received. No conflict of interest information specified.
Parallel Session: Palliative Care 25 What competencies are required for basic and specialised palliative care? No abstract received. No conflict of interest information specified. 26 Challenges related to symptoms that impact on eating B.M. Bernhardson1 . 1 Karolinska Institute, Dept. of Learning Informatics Management and Ethics, Stockholm, Sweden This presentation is built on the literature and my experiences from research on chemosensory alterations and malnutrition over the last 10 years from a nursing perspective. I will discuss factors such as the impact of symptoms on eating during the cancer trajectory from diagnosis to the end of life and new data on malnutrition. The presentation will discuss the meaning that affected persons attach to symptoms, which can differ, in part depending on where in the cancer trajectory the symptoms occur. Symptoms that are related to problems with eating can include anorexia, early satiety, chemosensory disorders, mouth problems, nausea, and pain but fatigue, depressed mood and diarrhea have also been related to eating difficulties. These symptoms are seldom experienced in isolation which makes their assessment challenging. It is highly important to assess multiple symptoms since some may be “silent symptoms”. Such silent symptoms, e.g. chemosensory disorders, are not always discussed openly with the healthcare staff. An array of measurement tools can be found, and several symptom-specific tools have been developed for research purposes. Which tools should we choose? I will also discuss in this presentation that the label of the symptom should be considered. Words can be open to different interpretations, and making sure that the words used to describe the symptoms, e.g. nausea or anorexia, are interpreted as intended is crucial for the correct assessment and interpretation of symptoms. Health care staff needs to make sure that the patient and the staff are talking about the same phenomena. One outcome of not eating enough is weight loss. There is an ongoing discussion about what information parameters like weight and BMI provide, without further information on other factors such as hydration status, tumor site and the existence of liver disease. Today research is expanding on body composition as an improved indicator for malnutrition, since imbalance between fat and muscle mass can mislead interpretations of the nutritional status of an obese person. These and other challenges for the health care staff in assessing and dealing with symptoms that impact on eating to enhance patients’ health-related quality of life will be discussed. No conflict of interest.
S7
27 Quality of life assessment in palliative care G. Catania1 , M. Beccaro2 , M. Costantini3 , D. Ugolini4 , A. De Silvestri5 , A. Bagnasco6 , L. Sasso6 . 1 IRCCS Azienda Ospedaliera Universitaria San Martino-IST-Istituto Nazionale per la Ricerca sul Cancro, Regional Palliative Care Network, Genoa, Italy; 2 Academy of Sciences of Palliative Medicine, Education Unit, Bologna, Italy; 3 IRCCS Arcispedale S Maria Nuova, Palliative Care Unit, Reggio Emilia, Italy; 4 IRCCS Azienda Ospedaliera Universitaria San Martino-IST-Istituto Nazionale per la Ricerca sul Cancro, Unit of Clinical Epidemiology, Genoa, Italy; 5 IRCCS Policlinico San Matteo Foundation, Biometry Unit, Pavia, Italy; 6 University of Genoa, Department of Health Sciences, Genoa, Italy Background: One of the most crucial palliative care challenge is in determining how patients’ needs are defined and assessed. Assessing quality of life has been defined as a priority in palliative care and it has become a central concept in palliative clinical practice. Aim: To determine to what extent interventions focused on measuring quality of life in palliative care practice are effective in improving outcomes in palliative care patients. Material and Methods: Systematic review according to the recommendations of the PRISMA statement and hand searches. Medline, CINAHL, EMBASE, PsycINFO and the Cochrane library were searched for papers published until June 2012, and through hand searching from references lists of included articles. Only studies that included adult palliative care patients, in any palliative care clinical practice setting of care, and with an experimental, quasiexperimental or observational analytical study design were eligible for inclusion. All studies were independently reviewed by two investigators who scored them for methodological quality by using the Edwards Method Score. Results: Eleven papers (of 8579) incorporating information from 10 studies were included. Only three were RCTs. The quality of the evidence was found from moderate to low. Given a wide variability among patients outcomes, individual effect size was possible for six out of ten studies, three of which found a moderate Effect Size (ES) on symptoms (ES = 0.68), and psychological (ES = 0.60) and social (ES = 0.55) dimensions. Conclusions: Effectiveness of interventions focused on quality of life assessment is moderate. Further rigorous research is needed considering such interventions as complex. No conflict of interest.
Parallel Session: Increased Complexity in Ambulatory Care 28 Bone marrow transplant in ambulatory care C. Gallego Miralles1 , A. Hernando1 , C. Moreno1 , S. Segura1 , P. Ayora1 , M. Carreno ˜ 1 , N. Arab1 , J. Guell1 , A. Gaya1 , F. Fernandez1 . 1 Hospital Clinic, Hematology and Oncology department, Barcelona, Spain Background: The use of filgrastim-mobilized peripheral blood progenitor cells and the use of prophylactic antibiotics and hematopoietic growth factors after transplant (SCT) reduce the risk for develop serious infections, facilitating the transfer of care to the outpatient setting. In the last decades, different models of outpatient-SCT are implemented but most published studies report high rates of readmissions (20–80%). The aims of this study were to know the current landscape of outpatient-SCT models, to identify areas for development and key points to optimize these programs and to know how Home Care Units (HCU) facilitates the empowerment of the patient and family. Material and Methods: A retrospective analysis of our experience and a revision of the medical literature in reference of outpatientSCT models (total outpatient, delayed admission and early dis-