To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure firstname.lastname@example.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Early integration of palliative and cancer care improves the quality of life and is facilitated by discussions about the end of life after cessation of active cancer treatment between patients with advanced cancer and their physicians. However, both patients and physicians find end-of-life discussions challenging. The aim of this study was to assess the need for a question prompt list (QPL) that encourages end-of-life discussions between patients with advanced cancer and their physicians.
Focus group interviews (FGIs) were conducted with 18 participants comprising 5 pancreatic cancer patients, 3 family caregivers, 4 bereaved family members, and 6 physicians. Three themes were discussed: question items that should be included in the QPL that encourages end-of-life discussions with patients, family caregivers, and physicians after cessation of active cancer treatment; when the QPL should be provided; and who should provide the QPL. Each interview was audio-recorded, and content analysis was performed.
The following 9 categories, with 57 question items, emerged from the FGIs: (1) preparing for the end of life, (2) treatment decision-making, (3) current and future quality of life, (4) current and future symptom management, (5) information on the transition to palliative care services, (6) coping with cancer, (7) caregivers’ role, (8) psychological care, and (9) continuity of cancer care. Participants felt that the physician in charge of the patient's care and other medical staff should provide the QPL early during active cancer treatment.
Significance of results
Data were collected to develop a QPL that encourages end-of-life discussions between patients with advanced cancer and their physicians.
To examine the association between green tea and coffee intake and cognitive decline in older adults.
A prospective cohort study. The average intake of green tea and coffee in the previous year was assessed through a dietitian interview using a dietary questionnaire. A Mini-Mental State Examination (MMSE) was conducted up to six times biennially. Cognitive decline was screened using the MMSE; its incidence was defined as the first time a score of <27 points was obtained in a biennial test from the baseline. Hazard ratios for incidence of cognitive decline were estimated according to the intake of the two beverages using multivariable Cox proportional hazard regression, controlling for sociodemographic and lifestyle factors.
The National Institute for Longevity Sciences, Longitudinal Study of Aging (NILS-LSA) in Japan.
Men (n 620) and women (n 685), aged 60–85 years, from the NILS-LSA.
During a mean of 5·3 (sd 2·9) years of follow-up, 432 incident cases of cognitive decline were observed. Compared with participants who consumed green tea <once/d, the multivariable hazard ratio (95 % CI) was 0·70 (0·45, 1·06), 0·71 (0·52, 0·97) and 0·72 (0·54, 0·98) among those who consumed green tea once/d, 2–3 times/d and ≥4 times/d, respectively (Ptrend < 0·05). No significant association was found between coffee intake and cognitive decline.
The intake of green tea, but not coffee, was shown to reduce the risk of cognitive decline in older adults.
The purposes of this study were to develop a communication skills training (CST) workshop program based on patient preferences, and to evaluate preliminary feasibility of the CST program on the objective performances of physicians and the subjective ratings of their confidence about the communication with patients at the pre- and post-CST.
The CST program was developed, based on the previous surveys on patient preferences (setting up the supporting environment of the interview, making consideration for how to deliver bad news, discussing about additional information, and provision of reassurance and emotional support) and addressing the patient's emotion with empathic responses, and stressing the oncologists' emotional support. The program was participants' centered approach, consisted a didactic lecture, role plays with simulated patients, discussions and an ice-breaking; a total of 2-days. To evaluate feasibility of the newly developed CST program, oncologists who participated it were assessed their communication performances (behaviors and utterances) during simulated consultation at the pre- and post-CST. Participants also rated their confidence communicating with patients at the pre-, post-, and 3-months after CST, burnout at pre and 3 months after CST, and the helpfulness of the program at post-CST.
Sixteen oncologists attended a newly developed CST. A comparison of pre-post measures showed improvement of oncologists' communication performances, especially skills of emotional support and consideration for how to deliver information. Their confidence in communicating bad news was rated higher score at post-CST than at pre-CST and was persisted at 3-months after the CST. Emotional exhaustion scores decreased at 3-months after CST. In addition, oncologists rated high satisfaction with all components of the program.
Significance of results:
This pilot study suggests that the newly developed CST program based on patient preferences seemed feasible and potentially effective on improving oncologists' communication behaviors what patients prefer and confidence in communicating with patients.
The aim of the study was to clarify the care experience of primary caregivers when caring for a terminal cancer patient in the home with the assistance of a home palliative care service. Participants were asked to provide background data and to evaluate their experience of caregiving and of the patient's response throughout the period of home palliative care, up to the time of death.
One hundred twelve primary family caregivers were a mailed self-report questionnaire, and 74 valid questionnaires were returned (response rate 66%).
Ninety percent felt that the patient's condition of mind and body was reasonably stable, and 75% felt that the death was peaceful. About 90% reported a deepening of their bond with the patient and that the bond of other family members deepened also. Sixty percent reported that the burden of caregiving was not too great or not felt at all. Approximately 90% judged that the patient retained his or her own personal qualities to the end. Ninety percent also felt that they had done their best in their caregiving and judged that home care had been beneficial for the deceased, for the primary caregiver him/herself, and for other family members. These primary caregivers' evaluations of caring for a terminally ill patient at home in conjunction with a home palliative care service were both high and positive.
Significance of results:
Our findings suggest that it is important to maintain the patient's personal qualities up to the time of death through appropriate symptom management, to respect the family bond of the household, and to provide professional support in order to reduce the load on the family. If appropriate care is provided, peaceful home death will be possible, resulting in significant benefits for patients and their families in Japan.
Objective: The aim of this study was to clarify the state of
pain management in Japanese patients with advanced cancer who initiated
opioid therapy in an outpatient setting.
Methods: Interview surveys using questionnaires were
conducted and medical records were reviewed. Pain relief was defined as
>33% decrease in worst pain intensity score, and significance of early
pain relief was investigated in terms of changing self-efficacy for
activities of daily living (ADL). Factors related to early pain relief
were also investigated.
Results: The study was conducted between June and December
2003, on 20 patients (13 women, 7 men; mean age, 59 years). Compared to
score at initiation of opioid administration (Numerical Rating Scale, 8.3
± 1.3), pain relief was generally insufficient at 2 weeks (early
pain relief ratio was only 42%). Patients with sufficient pain relief at 2
weeks displayed significant improvements in numerous ADL functions and
symptom-coping efficacy (p = 0.037), confirming the importance of
early pain relief. Early pain relief was associated with high frequency of
hospital visits before opioid administration and absence of sudden
excavation within the first 2 weeks.
Significance of results: Result of this study indicated
insufficient pain relief at an outpatients setting with advanced cancer
patients. In the meantime, patients had who their pain decrease after 2
weeks also had improved ADL and self-efficacy at the same time. These
findings suggest that to achieve early pain relief in an outpatient
setting, clinical staff must assess pain earlier and inform patients of
possible breakthrough pain following opioid administration and available
treatments for such occurrences.
Email your librarian or administrator to recommend adding this to your organisation's collection.