Search

Kennedy B Nkhoma,1 Lindsay Farrant,2 Olona Mzimkulu,2 Joy Hunter,2 Irene Higginson,1 Wei Gao,2 Matthew Maddocks,1 Liz Gwyther,2 Richard Harding1 1Cicely Saunders Institute of Palliative Care Policy and Rehabilitation, King’s College London, London, UK; 2Division of Interdisciplinary Palliative Care & Medicine, Department of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South AfricaCorrespondence: Kennedy B Nkhoma, Email kennedy.nkhoma@kcl.ac.ukBackground: Many deaths globally are attributable to non-communicable disease, and four-fifths of these deaths are in low- and middle-income countries. Globally, COPD is currently the third leading cause of mortality.Research Question: 1) To determine the prevalence and burden of symptoms and concerns, and 2) determine predicting factors of symptom burden among patients with COPD.Methods: A cross-sectional survey was conducted at eight primary care sites in Western Cape. We collected socio-demographic data (age, gender, smoking status, number of missed doses of prescribed medication in the last seven days) and clinical data (PEF and KPS). The Memorial Symptom Assessment Scale (MSAS), the Medical Outcomes Study, Social Support Survey (MOS-SSS), the London Chest Activity of Daily Living Scale (LCADLS) and the COPD Assessment Test (CAT) (impairment on person’s life) were administered to patients. We conducted ordered logistic regression analysis to assess factors associated with the burden of symptoms. MSAS subscales: 1) Global symptom distress index, 2) physical symptom distress and 3) psychological symptom distress were dependent outcomes. We constructed three ordinal logistic regression models for each of the three subscales. Covariates were MOS-SSS, LCADLS, CAT, demographic and clinical variables.Results: We recruited n=387 patients, mean age 59.5 years, 53.0% female. In multivariate analysis, each of the three models (ie, global, psychological and physical symptom distress) was positively associated with impairment on person’s life p< 0.001, difficulty to perform activities of daily living p< 0.001, and low social support p< 0.001. Old age was associated with lower global symptom distress (p=0.004), psychological and (0.014) physical distress (0.005). Missing 1 or more doses of medication was associated with higher levels of global (0.004) and physical (0.005) symptom distress.Interpretation: The high prevalence and burden of physical and psychological symptoms provides strong evidence of the need for integrating person-centred assessment and management of symptoms in primary care settings.Keywords: chronic lung disease, chronic obstructive pulmonary disease, symptom burden, symptom distress, symptom prevalence

Background: Breast cancer is the leading cause of cancer morbidity and mortality among women in developing countries. Advanced stage disease with limited treatment options implies a significant symptom burden, which poses a challenge to attending health care providers. Objectives: To determine prevalence and the severity of symptoms among breast cancer patients. Design of the Study: Descriptive cross-sectional hospital-based study. Study Area and Population: Breast cancer patients attending the University of Ilorin Teaching hospital. Materials and Methods: Breast cancer patients attending surgical outpatient clinics and those on admission during the study period were recruited. The patients completed an interviewer administered symptom assessment tool consisting of 32 physical and psychological symptoms. Demographics, cancer stages, treatments and referrals for palliative care interventions were obtained from the case notes. Results: Sixty breast cancer patients were studied, and eighty percent (80%) of the patients had advanced cancer. The number of symptoms ranged from 0-18, and the overall mean number of symptoms was 5.5 + 4.4. The top 5 symptoms were; pain (63.3%), worrying (45%), feeling sad (41.7%), weight loss (46.7%) and insomnia (35%). Pain, poor body image, breast swellings were the most distressing symptoms. Five percent (5%) of the patients had referral to palliative care team. Conclusion. This study showed that breast cancer patients manifest significant physical and psychological symptoms. Pain was the most prevalent and distressing symptom. Systematic symptom assessment and palliative care service provision are recommended for breast cancer patients with advanced disease. [ABSTRACT FROM AUTHOR]

Initial findings from a longitudinal study of an individualized family educational program (IFE) are reported. The IFE intervention was undertaken to assess the impact of timing and dosage of information on caregiver's utilization of other support services and caregiver outcomes. A sample of 244 caregivers located in 5 states was randomly assigned to a control group or one of two treatment groups. Trained caregiver specialists created a tailored package of materials for each family assigned to the IFE intervention. Over a period of 12 months, critical information about Alzheimer's disease and its process, coping skills, and available services and resources was provided to caregivers in a format that was tailored to meet the specific needs of the caregiver at each point of contact. Caregivers assigned to the 'information only group' received a single package of information about similar issues at the time of enrollment in the study. Caregivers in the control group received no special information or care management services. Repeated measures ANOVA were conducted using data collected at the time of admission, and 6 and 12 months after admission. Findings indicate that the caregivers who received a single package of information at the time of admission to the project ('information only group') experienced higher levels of depression than those assigned to either the control group or the individualized treatment. The authors conclude that that too much information can be more deleterious for caregivers than no information. The paper concludes with a discussion of implications of this finding for traditional caregiver educational programs.

The need for palliative care education remains vital to contribute to the quality of life of patients, both adults and children, with cancer in Africa. The number of patients with cancer continues to rise, and with them the burden of palliative care needs. Palliative care has been present in Africa for nearly four decades, and a number of services are developing in response to the HIV/AIDS epidemic. However, the needs of cancer patients remain a challenge. Education and training initiatives have developed throughout this time, using a combination of educational methods, including, more recently, e-learning initiatives. The role of international and national organisations in supporting education has been pivotal in developing models of education and training that are robust, sustainable, and affordable. Developing a material for education and professional development needs to continue in close collaboration with that already in production in order to optimise available resources. Seeking ways to evaluate programmes in terms of their impact on patient care remains an important part of programme delivery. This article reviews the current situation. [ABSTRACT FROM AUTHOR]

OBJECTIVES: The purpose of this study was to describe ethnic differences in physician-patient communication about alternative therapies, using a data set comprised of audiotapes and transcripts of primary care medical visits. METHODS: The data set was collected during 1995 at the family practice and general medicine clinics at the University of New Mexico Health Sciences Center, Albuquerque, NM. Twenty-seven (27) resident physicians and 205 of their Hispanic and non-Hispanic white patients age 50 and over participated. RESULTS: Almost 18 percent of patients reported using one or more alternative therapies during the preceding month. Herbal medicine was the most widely used therapy. Eighty-three percent (83%) of patients who reported using an alternative therapy in the previous month did not tell their physicians. Physicians asked one or more questions about alternative therapies during only 3.4% of encounters. Only 2% of patients asked their physicians one or more questions about alternative therapies. There were no ethnic differences in physician-older patient communication about alternative therapies. DISCUSSION: Physician-patient communication could be improved to enhance physician understanding of the spectrum of interventions patients pursue to improve their health. [ABSTRACT FROM AUTHOR]

Families caring for a person with Alzheimer's disease (AD) soon discover that it is unlike any other illness. Coping with a degenerative brain disease is much different than dealing with a physical disability. AD is more disruptive to, and has greater impact on, the family than other chronic diseases. AD caregiving carries with it a high financial, social, and emotional price. Families must work toward effectively coping with the disease, decreasing the harmful effects on the family, and keeping family conflicts to a minimum. Support groups can provide families with much-needed information on the disease, emotional and practical support, and an expressive or advocacy outlet. Formal services can help relieve some of the burden of caring for an AD patient. Family members must remember that there is no "right" way to care for a person with AD, and each family must determine, with the help of the appropriate professionals and services, how to best meet its own needs. Given the burdens of care, however, even small interventions may translate into improvements in the quality of life or confidence of the caregiver. [ABSTRACT FROM AUTHOR]

Family members of Alzheimer's patients need information on how to facilitate daily care and reduce their own stress. The advice you convey can not only improve the quality of the caregiving but also prevent burnout. [ABSTRACT FROM AUTHOR]