78 results on '"Marvin Omar Delgado Guay"'
Search Results
2. S2-5 Embracing a spiritual and compassionate care for patients living with advanced and terminal illnesses with Existential and Spiritual Distress
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Marvin Omar Delgado Guay
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- 2023
3. Association between Spirituality, Religiosity, Spiritual Pain, Symptom Distress, and Quality of Life among Latin American Patients with Advanced Cancer: A Multicenter Study
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Eduardo Bruera, Alejandra Palma, Monica Grez, Diane D. Liu, Marvin Omar Delgado-Guay, Laura Tupper, and Eva Rosina Duarte
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Male ,Coping (psychology) ,Latin Americans ,Pain ,Religiosity ,03 medical and health sciences ,0302 clinical medicine ,Quality of life (healthcare) ,030502 gerontology ,Neoplasms ,Adaptation, Psychological ,Spirituality ,Humans ,Medicine ,Association (psychology) ,General Nursing ,business.industry ,Original Articles ,General Medicine ,Middle Aged ,humanities ,Latin America ,Anesthesiology and Pain Medicine ,Multicenter study ,030220 oncology & carcinogenesis ,Quality of Life ,Female ,0305 other medical science ,business ,Symptom distress ,Clinical psychology - Abstract
OBJECTIVES: The purpose of this multicenter study was to characterize the association between spirituality, religiosity, spiritual pain, symptom distress, coping, and quality of life (QOL) among Latin American advanced cancer patients. METHODS: Three hundred twenty-five advanced cancer patients from palliative care clinics in Chile, Guatemala, and the United States completed validated assessments: Faith, Importance and Influence, Community, and Address (FICA) (spirituality/religiosity), Edmonton Symptom Assessment Scale-Financial/Spiritual (ESAS-FS), including spiritual pain, Penn State Worry Questionnaire-Abbreviated (PSWQ-A), Center for Epidemiologic Studies Depression Scale (CES-D), Brief-coping strategies (COPE) and Brief religious coping (RCOPE) and RCOPE, respectively, and Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being, Expanded version (FACIT-Sp-Ex). RESULTS: Median age: 58 years (range: 19–85); 60% female; and 62% Catholic and 30% Christian, but not Catholic. Three hundred fifteen patients (97%) considered themselves spiritual and 89% religious, with median intensities of 7 (interquartile range [IQR]: 5–10) and 7 (5–9), respectively (0–10 scale, 10 = “very much”). Median importance of spirituality/religiosity was 10 (IQR: 8–10). The frequency and associations between spirituality/religiosity and various items were as follows: helps to cope with illness (98%; r = 0.66303; p
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- 2021
4. Death Anxiety and Correlates in Cancer Patients Receiving Palliative Care
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Linda L. Emanuel, Sheldon Solomon, Harvey Max Chochinov, Marvin Omar Delgado Guay, George Handzo, Joshua Hauser, Sheri Kittelson, Sean O'Mahony, Tammie E. Quest, Michael W. Rabow, Tasha M. Schoppee, Diana J. Wilkie, Yingwei Yao, and George Fitchett
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Anesthesiology and Pain Medicine ,General Medicine ,General Nursing - Published
- 2022
5. Helpfulness of Question Prompt Sheet for Patient-Physician Communication Among Patients With Advanced Cancer
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Joseph Arthur, Varsha Pawate, Zhanni Lu, Sriram Yennurajalingam, Ahsan Azhar, Akhila Reddy, Daniel Epner, David Hui, Kimberson Tanco, Marvin Omar Delgado Guay, Marieberta Vidal, Minxing Chen, and Eduardo Bruera
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General Medicine - Abstract
ImportanceThere are few robust evaluations of disease-specific question prompt sheets (QPS) in patient-physician communication among patients with advanced cancer.ObjectiveTo compare the patient perception of helpfulness, global evaluation, and preference for the QPS vs a general information sheet (GIS), and to examine the effect of the QPS on participants’ anxiety, participants’ speaking time, number of questions asked, and length of the clinical encounter.Design, Setting, and ParticipantsThis controlled, double-blind randomized clinical trial was conducted at an outpatient palliative and supportive care clinic in a cancer center in the US. Eligible patients were 18 years or older, had a cancer diagnosis, and were undergoing their first outpatient consultation visit with a palliative care physician from September 1, 2017, to May 31, 2019. Data analysis used a modified intention-to-treat design. Data were analyzed from May 18 to June 27, 2022.InterventionQPS, a 25-item list of questions developed by expert palliative care clinicians using a Delphi process and tested among ambulatory advanced cancer patients. The control was GIS, generic information material given routinely to patients seen at the supportive care clinic.Main Outcomes and MeasuresThe main outcome was patient perception of helpfulness. Secondary outcomes included global evaluation and preference of QPS compared with GIS immediately after the encounter.ResultsA total of 130 patients (mean [SD] age, 58.6 [13.3] years; 79 [60.8%] female) were randomized to receive either QPS (67 patients [51.5%]) or GIS (63 patients [48.5%]). Patients considered QPS and GIS equally helpful, with no statistically significant difference (mean [SD] helpfulness score, 7.2 [2.3] points vs 7.1 [2.7] points; P = .79). The QPS group, compared with the GIS group, had a higher global positive view of the material (mean [SD] global perception score, 7.1 [1.3] vs 6.5 [1.7]; P = .03) and felt it prompted them more to generate new questions (mean [SD] rating, 7.0 [2.9] vs 5.3 [3.5]; P = .005). Of 47 patients asked their preference between the items, more participants preferred the QPS to the GIS in communicating with their physicians (24 patients [51.1%] vs 7 patients [14.9%]; P = .01) at the 4-week follow-up. No significant differences between the QPS and GIS groups were observed regarding participant anxiety, speaking time, number of questions asked, or consultation length (eg, mean [SD] anxiety rating, 2.3 [3.7] vs 1.6 [2.7]; P = .19).Conclusions and RelevanceIn this randomized clinical trial, participants perceived both QPS and GIS as equally helpful, but they had a more positive global view of and preferred the QPS. QPS facilitated generation of new questions without increasing patient anxiety nor prolonging the consultation. The findings provide support for increased adoption and integration of QPS into routine oncologic care.Trial RegistrationClinicalTrials.gov Identifier: NCT03287492
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- 2023
6. Emergency Department Use by Terminally Ill Patients: A Systematic Review
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José Amado-Tineo, Roberto Huari-Pastrana, Marvin Omar Delgado-Guay, Teodoro Oscanoa-Espinoza, and Rolando Vásquez-Alva
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Adult ,medicine.medical_specialty ,Palliative care ,Patients ,Concordance ,Terminally ill ,Context (language use) ,CINAHL ,03 medical and health sciences ,0302 clinical medicine ,Neoplasms ,Internal medicine ,medicine ,Humans ,Terminally Ill ,030212 general & internal medicine ,General Nursing ,business.industry ,Palliative Care ,Emergency department ,Confidence interval ,Anesthesiology and Pain Medicine ,030220 oncology & carcinogenesis ,Observational study ,Neurology (clinical) ,Emergency Service, Hospital ,business - Abstract
Context Terminally ill patients (TIP) frequently visit the emergency department (ED), but the prevalence of these visits is unclear. Objective To determine the prevalence of TIP visiting the ED. Methods Systematic review of observational studies published between 1998 and 2018 reporting adults TIP who used the hospital ED, searching in PubMed, CINAHL, SciELO, LILACS, and Cochrane. Three evaluators selected and extracted data (kappa concordance 0.63). The quality of the studies was evaluated with the Newcastle–Ottawa scale and global estimates were made, calculating combined prevalence (95% confidence interval [CI]) and heterogeneity of the studies (I2). Results We identified 2429 publications, ultimately including 31 studies in 14 countries; 79% were from high-income countries, 21% from medium-income countries, and none from low-income countries. Most were from 2015. We found that 45% of patients with cancer visited the ED in the last month of life [95% CI 37–54%] and 75% in the last six months of life [95% CI 62–83%]; I2 = 100%. Overall, 17% of patients who visited the ED had a terminal illness [95% CI 12–23%]; I2 = 98%. Few studies reported terminal nononcologic illness, specific age groups or diseases, hospital admission rates, use of palliative care or nonresuscitation, or other criteria that could be used for grouping. Conclusions Patients with terminal cancer frequently use the ED at the end of life, although use varies among patients and few studies have examined low-income countries or patients with nononcologic terminal illness. The global prevalence of TIP in the ED cannot be calculated from limited reports.
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- 2021
7. Neuroleptic strategies for terminal agitation in patients with cancer and delirium at an acute palliative care unit: a single-centre, double-blind, parallel-group, randomised trial
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William Breitbart, Yvonne Heung, Maxine de la Cruz, Marvin Omar Delgado-Guay, Daniel E. Epner, Joseph Arthur, David Hui, Akhila Reddy, Sapna Amin, Ahsan Azhar, Eduardo Bruera, Janet L. Williams, Ali Haider, Jimin Wu, Thuc Nguyen, Annie Wilson, Terri Armstrong, Shalini Dalal, Kimberson Tanco, and Allison De La Rosa
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medicine.medical_specialty ,Palliative care ,business.industry ,Context (language use) ,Richmond Agitation-Sedation Scale ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Oncology ,Randomized controlled trial ,Refractory ,law ,030220 oncology & carcinogenesis ,Internal medicine ,Haloperidol ,Medicine ,Delirium ,030212 general & internal medicine ,medicine.symptom ,business ,Chlorpromazine ,medicine.drug - Abstract
Summary Background The role of neuroleptics for terminal agitated delirium is controversial. We assessed the effect of three neuroleptic strategies on refractory agitation in patients with cancer with terminal delirium. Methods In this single-centre, double-blind, parallel-group, randomised trial, patients with advanced cancer, aged at least 18 years, admitted to the palliative and supportive care unit at the University of Texas MD Anderson Cancer Center (Houston, TX, USA), with refractory agitation, despite low-dose haloperidol, were randomly assigned to receive intravenous haloperidol dose escalation at 2 mg every 4 h, neuroleptic rotation with chlorpromazine at 25 mg every 4 h, or combined haloperidol at 1 mg and chlorpromazine at 12·5 mg every 4 h, until death or discharge. Rescue doses identical to the scheduled doses were administered at inception, and then hourly as needed. Permuted block randomisation (block size six; 1:1:1) was done, stratified by baseline Richmond Agitation Sedation Scale (RASS) scores. Research staff, clinicians, patients, and caregivers were masked to group assignment. The primary outcome was change in RASS score from time 0 to 24 h. Comparisons among group were done by modified intention-to-treat analysis. This completed study is registered with ClinicalTrials.gov , NCT03021486 . Findings Between July 5, 2017, and July 1, 2019, 998 patients were screened for eligibility, with 68 being enrolled and randomly assigned to treatment; 45 received the masked study interventions (escalation n=15, rotation n=16, combination n=14). RASS score decreased significantly within 30 min and remained low at 24 h in the escalation group (n=10, mean RASS score change between 0 h and 24 h −3·6 [95% CI −5·0 to −2·2]), rotation group (n=11, −3·3 [–4·4 to −2·2]), and combination group (n=10, −3·0 [–4·6 to −1·4]), with no difference among groups (p=0·71). The most common serious toxicity was hypotension (escalation n=6 [40%], rotation n=5 [31%], combination n=3 [21%]); there were no treatment-related deaths. Interpretation Our data provide preliminary evidence that the three strategies of neuroleptics might reduce agitation in patients with terminal agitation. These findings are in the context of the single-centre design, small sample size, and lack of a placebo-only group. Funding National Institute of Nursing Research.
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- 2020
8. Efficacy and safety of fentanyl buccal for cancer pain management by administration through a soluble film: an update
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Marvin Omar Delgado-Guay
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Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Marvin Omar Delgado-GuayDivision of Geriatrics and Palliative Medicine, The University of Texas, Medical School at Houston, Houston, TX, USAAbstract: More than half of patients receiving prescription medicine for cancer pain have been reported to experience inadequate pain relief or breakthrough pain. Buccal administration can deliver lipophilic opioids rapidly to the systemic circulation through the buccal mucosa, limiting gastrointestinal motility and first-pass metabolism. This review updates the safety and efficacy of fentanyl buccal soluble film (FBSF) in patients with cancer pain. Literature was identified through searches of Medline (PubMed). Search terms included combinations of the following: cancer pain, fentanyl, fentanyl buccal soluble film, pharmacology, kinetics, safety, efficacy and toxicity. FBSF is an oral transmucosal form of fentanyl citrate developed as a treatment of breakthrough pain in opioid-tolerant patients with cancer. Studies have shown that it is well tolerated in the oral cavity, with adequate bioavailability and safety in cancer patients. Further studies are warranted to evaluate, in comparison with other short-acting opioids, its efficacy in the management of breakthrough cancer pain, its addictive potential and its economic impact in cancer patients.Keywords: fentanyl buccal soluble film, cancer pain
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- 2010
9. Financial Toxicity in People Living with Advanced Cancer: A New, Deadly, and Poorly Addressed Effect of Cancer and Necessary Treatment
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Maxine de la Cruz and Marvin Omar Delgado-Guay
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Finance ,Palliative care ,Social work ,Referral ,Oncology (nursing) ,business.industry ,Quality of life (healthcare) ,Harm ,Intervention (counseling) ,Neoplasms ,Health care ,Adaptation, Psychological ,Quality of Life ,Medicine ,Humans ,business ,Health policy - Abstract
Objectives Advances in cancer treatments have allowed improved outcomes, even with advanced disease. However, this progress has resulted in a new toxic effect termed ‘financial toxicity.’ Financial toxicity severely impacts quality of life, even among those insured. The purpose of this article is to gain better understanding of this relatively new concept to better care for our patients, presented primarily from a US perspective. Data Sources These include medical databases (PubMed, Scopus) and researcher experience. Conclusion Financial toxicity is highly prevalent in patients with advanced cancer, and it is associated with multiple worsened outcomes. Those with advancing cancer are at accumulating risk of financial toxicity, exacerbated by other known risk factors. The effects of financial toxicity are debilitating, resulting in deleterious physical, psychological, spiritual, and social effects drastically affecting quality of life. Coping strategies such as taking less than prescribed therapy, delays seeking care, and poorly managed comorbid conditions potentially cause increased symptoms and worse outcomes. Implications for Nursing Practice Careful assessments by multidisciplinary health care teams could allow early intervention, timely referral to health professionals including social work or financial navigators, and provision of emotional support. Further studies are needed to explore solutions on an institutional and national level that can guide health policy and the creation of practice models that can reduce the harm of financial toxicity.
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- 2021
10. Multidimensional Patient Assessment
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Alexander Harding and Marvin Omar Delgado-Guay
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medicine.medical_specialty ,business.industry ,Medicine ,Medical physics ,Patient assessment ,business - Published
- 2021
11. The End of Therapy: Building the Psychosocial and Spiritual Bridges to Survivorship
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Marvin Omar Delgado-Guay and Paige Farinholt
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Gerontology ,End of therapy ,business.industry ,Survivorship curve ,Medicine ,business ,Psychosocial - Published
- 2021
12. Spiritual Care
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Marvin Omar Delgado- Guay and Alexander Harding
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- 2021
13. The desire to hasten death in advanced cancer patients at a Mexican palliative care service
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Marvin Omar Delgado-Guay, Oscar Rodríguez-Mayoral, Leticia Ascencio-Huertas, Emma Verastegui, and Silvia Allende-Pérez
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medicine.medical_specialty ,Palliative care ,business.industry ,Psychiatric assessment ,Panic disorder ,medicine.disease ,03 medical and health sciences ,Psychiatry and Mental health ,Clinical Psychology ,0302 clinical medicine ,030220 oncology & carcinogenesis ,medicine ,Delirium ,Major depressive disorder ,030212 general & internal medicine ,medicine.symptom ,Assisted suicide ,Psychiatry ,business ,Suicidal ideation ,Depression (differential diagnoses) - Abstract
Introduction. The desire to hasten death (DHD) might be present in patients with advanced cancer. Multiple distressing physical and psychosocial symptoms may be related to it. There is limited literature about the characteristics of these patients in Mexico. Objective. To describe the prevalence and factors associated with DHD in advanced cancer patients evaluated by a palliative care psychiatrist. Method. We conducted a cross-sectional study, including all patients referred to psychiatric assessment at the Servicio de Cuidados Paliativos of the Instituto Nacional de Cancerologia in Mexico City, from January to December 2016. DHD was defined as the presence of death ideas, suicidal ideation, and/or request for euthanasia or medically assisted suicide. Patients with delirium, dementia, psychosis, or uncontrolled physical symptoms were excluded. Results. Sixty-four patients were included in the study. Most of them were women (59%); the mean age was 49 years old ( SD = 16). Of them, 64% met criteria for a major depressive disorder, 64% for generalized anxiety disorder and/or panic disorder, and 11% for substance use disorders. 44% expressed DHD. In a multivariate regression analysis predicting DHD, only one factor emerged: clinical depression ( OR = 13.5, p = .002, 95% CI [02.562, 71.726]). Discussion and conclusion. The desire to hasten death is a frequent issue for the patients evaluated at the psychiatric palliative care clinic. Depression and other distressing psychiatric pathologies were associated with DHD. Interdisciplinary interventions are needed to treat DHD. More research is warranted in order to understand the factors associated with the expression of DHD.
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- 2019
14. Inequalities in Financial Distress, Symptoms, and Quality of Life Among Patients with Advanced Cancer in France and the U.S
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Patrick Michaud, Murielle Ruer, Cécile Barbaret, Stéphane Sanchez, Anne-Marie Schott, Marilène Filbet, Marvin Omar Delgado-Guay, Wadih Rhondali, Léa Monsarrat, Christelle Brosse, and Eduardo Bruera
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Cross-Cultural Comparison ,Male ,Cancer Research ,medicine.medical_specialty ,Palliative care ,Population ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Cost of Illness ,Quality of life ,Neoplasms ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,education ,Aged ,Neoplasm Staging ,education.field_of_study ,business.industry ,Cognitive disorder ,Cancer ,Health Status Disparities ,Middle Aged ,medicine.disease ,United States ,Distress ,Cross-Sectional Studies ,Socioeconomic Factors ,Oncology ,Symptom Management and Supportive Care ,030220 oncology & carcinogenesis ,Quality of Life ,Anxiety ,Female ,France ,Self Report ,medicine.symptom ,business ,Psychosocial - Abstract
BACKGROUND. Financial distress (FD) is common among patients with advanced cancer. Our purpose was to compare the frequency and intensity of FD and its associations with symptom distress and quality of life (QOL) in these patients in France and the U.S. MATERIALS AND METHODS. In this secondary analysis of two cross‐sectional studies, we assessed data on 292 patients who received cancer care at a public hospital or a comprehensive cancer center in France (143 patients) or the U.S. (149 patients). Outpatients and hospitalized patients over 18 years of age with advanced lung or breast or colorectal or prostate cancer were included. Diagnosed cognitive disorder was considered a noninclusion criterion. Advanced cancer included relapse or metastasis or locally advanced cancer or at least a second‐line chemotherapy regimen. Patients self‐rated FD and assessed symptoms, psychosocial distress, and QOL on validated questionnaires. RESULTS. The average patient age was 59 years, and 144 (49%) were female. FD and high intensity were reported more frequently in U.S. patients than in French (respectively 129 [88%] vs. 74 [52%], p
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- 2019
15. Expression of existential suffering in two patients with advanced cancer in an acute palliative care unit
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Nhu-Nhu Nguyen, Michael Tang, Eduardo Bruera, Kimberson Tanco, and Marvin Omar Delgado-Guay
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Male ,Psychotherapist ,Palliative care ,Existentialism ,Pain ,Spiritual distress ,03 medical and health sciences ,0302 clinical medicine ,Neoplasms ,Patients' Rooms ,Medicine ,Humans ,030212 general & internal medicine ,General Nursing ,Aged ,business.industry ,Palliative Care ,General Medicine ,Psychiatry and Mental health ,Clinical Psychology ,Distress ,Supportive psychotherapy ,030220 oncology & carcinogenesis ,Quality of Life ,Female ,Integrative medicine ,Spiritual care ,business ,Lying - Abstract
BackgroundRecognizing and managing existential suffering remains challenging. We present two cases demonstrating how existential suffering manifests in patients and how to manage it to alleviate suffering.Case descriptionCase 1: A 69-year-old man with renal cell carcinoma receiving end-of-life care expressed fear of lying down “as he may not wake up.” He also expressed concerns of not being a good Christian. Supportive psychotherapy and chaplain support were provided, with anxiolytic medications as needed. He was able to express his fear of dying and concern about his family, and Edmonton Symptom Assessment System scores improved. He died peacefully with family at bedside. Case 2: A 71-year-old woman presented with follicular lymphoma and colonic obstruction requiring nasogastric drain of fecaloid matter. Initially, she felt that focusing on comfort rather than cure symbolized giving up but eventually felt at peace. Physical symptoms were well-controlled but emotionally she became more distressed, repeatedly asking angrily, “Why is it taking so long to die?.” She was supported by her family through Bible readings and prayers, but she was distressed about being a burden to them. An interdisciplinary approach involving expressive supportive counseling, spiritual care, and integrative medicine resulted in limited distress relief. Owing to increasing agitation, the patient and family agreed to titrate chlorpromazine to sedation. Her family was appreciative that she was restful until her death.ConclusionExistential suffering manifests through multiple domains in each patient. A combination of pharmacologic and non-pharmacologic techniques may be needed to relieve end-of-life suffering.
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- 2020
16. The Influence of Spirituality and Religiosity on US Oncologists’ Personal Use of and Clinical Practices Regarding Complementary and Alternative Medicine
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Katherine Daunov, Lorenzo Cohen, Catherine Powers-James, Kathrin Milbury, Adriana Alvarez, Richard T. Lee, Andrea G. Barbo, Marvin Omar Delgado-Guay, Olufunmilayo I. Olopade, and Gabriel Lopez
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Complementary Therapies ,Male ,integrative medicine ,medicine.medical_specialty ,Alternative medicine ,lcsh:RC254-282 ,dietary supplements ,Religiosity ,03 medical and health sciences ,0302 clinical medicine ,Physicians ,Surveys and Questionnaires ,Spirituality ,medicine ,Humans ,Oncologists ,business.industry ,Religion and Medicine ,herbs ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,spirituality ,medical oncology ,United States ,030205 complementary & alternative medicine ,Religion ,Complementary and alternative medicine ,Oncology ,030220 oncology & carcinogenesis ,Family medicine ,Integrative medicine ,business ,Research Article - Abstract
Background: Cancer patients frequently use complementary and alternative medicine (CAM), and spirituality has been associated with CAM use among patients. We evaluated how oncologists’ spirituality and religiosity are associated with personal use and patient recommendations for CAM. Methods: A survey was mailed to 1000 medical oncologists in the United States. The questionnaire asked about oncologists’ approaches to CAM use by patients, focusing on the use of herbs and supplement (HS), and about religiosity and spirituality. Results: Of 937 deliverable questionnaires, 392 were returned (response rate 42%). Respondents were mostly men (71%) and Caucasian (76%), with a median age of 48. Approximately 16% reported no religion, 19% Jewish, 24% Catholic, 28% Christian, and 13% other religions. Eighteen percent reported attending religious services at least once a week, including 15% who attend several times per week. Twenty-eight percent reported high theological pluralism (skepticism regarding whether one religion is comprehensively and uniquely true); 58% described themselves as moderately or very spiritual. Self-reported spirituality and religious service attendance were associated with using CAM personally and recommending HS to patients. In multivariate analyses, moderate-high spirituality and attending religious services less than monthly was positively associated with personal use of CAM: odds ratio (OR) = 3.10 (confidence interval [CI] = 1.5-6.5) and OR = 3.04 (CI = 1.5-6.6), respectively. Physicians with moderate to high spirituality were more likely to report recommending CAM in general (OR = 3.07, CI = 1.3-7.1), but less likely to report recommending HS (OR = 0.33, CI = 0.14-0.75). Conclusion: Self-reported spirituality is a significant factor among US oncologists’ decision to use CAM and recommend CAM to patients.
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- 2020
17. Developing a Healing Environment for Broken Souls of Patients With Life-Threatening Illnesses and Their Caregivers
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Marvin Omar Delgado-Guay
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Palliative care ,Critical Illness ,media_common.quotation_subject ,Environment ,Existentialism ,03 medical and health sciences ,Dignity ,0302 clinical medicine ,Nursing ,Spirituality ,Humans ,Medicine ,cardiovascular diseases ,030212 general & internal medicine ,General Nursing ,media_common ,Patient Care Team ,Terminal Care ,business.industry ,Palliative Care ,Religion and Medicine ,Spiritual concerns ,Anesthesiology and Pain Medicine ,Caregivers ,030220 oncology & carcinogenesis ,Neurology (clinical) ,Spiritual care ,Soul ,business ,Privilege (social inequality) - Abstract
What a privilege it is to be able to touch those sacred spaces in the soul of each person that we encounter everyday. Patients with life-threatening illnesses can struggle with physical, emotional, and existential and spiritual concerns and the suffering of caregivers. A key goal of our supportive and palliative care teams is to alleviate patient and caregiver suffering. When caring for patients with advanced and terminal illness, the spirituality of each member of the palliative care team becomes a single collective spirituality or soul with common goals, values, and belonging, with a main goal of providing the best care for patients and caregivers in the alleviation of suffering. Embracing the spiritual care into our daily practice is a common effort and a service provided by each member of the team. Our role as members of the collective soul is to preserve human dignity and raise up the broken souls of patients living with life-threatening illness by creating healing environments.
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- 2018
18. Adaptive and maladaptive coping strategies among patients with advanced cancer
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Marvin Omar Delgado-Guay, Akhila Reddy, Eduardo Bruera, Ali S Haider, Rony Dev, Cindy L. Carmack, Ishwaria Mohan Subbiah, Joseph Arthur, and David Hui
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Cancer Research ,Palliative care ,Oncology ,Maladaptive coping ,business.industry ,Medicine ,business ,Advanced cancer ,Clinical psychology - Abstract
e24129 Background: Few studies have examined the coping mechanisms among patients with advanced cancer seen by palliative care. The objective of the study was to evaluate coping strategies in advanced cancer patients and identity risk factors for maladaptive coping. Methods: The authors conducted a secondary analysis of a cross-sectional survey on chemical coping. We prospectively enrolled patients with advanced cancer from a Supportive Care Clinic and documented the patient demographics, symptom expression (Edmonton Symptom Assessment System), Zubrod performance status, substance use history including tobacco, and coping strategies (the Brief COPE Questionnaire). Univariate and multivariate analyses were performed to identify risk factors for the use of maladaptive coping strategies. Results: Among 399 patients, the most common malignancies were gastrointestinal (21%) and breast (19%). Cancer patients frequently incorporated adaptive coping strategies including acceptance (86.7%), emotional support (79.9%), religion (69.4%), active coping (62.4%), instrumental support (48.4%), positive reframing (48.6%), planning (49.6%), and infrequently, humor (18.5%). Common maladaptive strategies included self-distraction (36.6%) and venting (14.5%), while self-blame (6.3%), denial (4.5%), behavioral disengagement (1.8%), and substance use (1.0%) were infrequently reported. On univariate analysis, venting was significantly associated with anxiety and depression, female gender, and tobacco use; and self-distraction was significantly associated with younger age, gender, depression, dyspnea, and a post-secondary education (P
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- 2021
19. Advanced cancer patients’ reported wishes at the end of life: a randomized controlled trial
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Vera J De la Cruz, Jimin Wu, Michael J. Fisch, Susan Frisbee-Hume, Eduardo Bruera, Janet L. Williams, Marvin Omar Delgado-Guay, Diane Liu, and Alfredo Rodriguez-Nunez
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Adult ,Male ,medicine.medical_specialty ,Ethnic group ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Interquartile range ,law ,Neoplasms ,medicine ,Humans ,Spirituality ,030212 general & internal medicine ,Aged ,Aged, 80 and over ,Terminal Care ,business.industry ,Communication ,Nursing research ,Patient Preference ,Middle Aged ,humanities ,Checklist ,Test (assessment) ,Oncology ,030220 oncology & carcinogenesis ,Family medicine ,Anxiety ,Marital status ,Female ,medicine.symptom ,business - Abstract
Conversations about end-of-life (EOL) wishes are challenging for many clinicians. The Go Wish card game (GWG) was developed to facilitate these conversations. Little is known about the type and consistency of EOL wishes using the GWG in advanced cancer patients. We conducted a randomized controlled trial to assess the EOL wishes of 100 patients with advanced cancer treated at The University of Texas MD Anderson Cancer Center. The purpose of this study was to determine the EOL wishes of patients with advanced cancer and to compare patients’ preference between the GWG and List of wishes/statements (LOS) containing the same number of items. Patients were randomized into four groups and completed either the GWG or a checklist of 35 LOS and one opened statement found on the GWG cards; patients were asked to categorize these wishes as very, somewhat, or not important. After 4–24 h, the patients were asked to complete the same or other test. Group A (n = 25) received LOS-LOS, group B (n = 25) received GWG-GWG, group C (n = 26) received GWG-LOS, and group D (n = 24) received LOS-GWG. All patients completed the State-Trait Anxiety Inventory (STAI) for adults before and after the first test. Median age (interquartile range = IQR): 56 (27–83) years. Age, sex, ethnicity, marital status, religion, education, and cancer diagnosis did not differ significantly among the four groups. All patients were able to complete the GWG and/or LOS. The ten most common wishes identified as very important by patients in the first and second test were to be at peace with God (74 vs. 71 %); to pray (62 vs. 61 %); and to have family present (57 vs. 61 %). to be free from pain (54 vs. 60 %); not being a burden to my family (48 vs. 49 %); to trust my doctor (44 vs. 45 %); to keep my sense of humor (41 vs. 45 %); to say goodbye to important people in my life (41 vs. 37 %); to have my family prepared for my death (40 vs. 49 %); and to be able to help others (36 vs. 31 %). There was significant association among the frequency of responses of the study groups. Of the 50 patients exposed to both tests, 43 (86 %) agreed that the GWG instructions were clear, 45 (90 %) agreed that the GWG was easy to understand, 31 (62 %) preferred the GWG, 39 (78 %) agreed that the GWG did not increase their anxiety and 31 (62 %) agreed that having conversations about EOL priorities was beneficial. The median STAI score after GWG was 48 (interquartile range, 39–59) vs. 47 (interquartile range, 27–63) after LOS (p = 0.2952). Patients with advanced cancer assigned high importance to spirituality and the presence/relationships of family, and these wishes were consistent over the two tests. The GWG did not worsen anxiety.
- Published
- 2016
20. Geriatric Issues in Palliative Care
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Marvin Omar Delgado Guay and Sriram Yennurajalingam
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Palliative care ,Nursing ,business.industry ,Medicine ,business - Abstract
The proportion of patients aged 65 years or older is steadily increasing within United States. Older patients reaching end of life frequently have multiple chronic debilitating diseases. The approach to managing palliative care issues in the geriatric population is similar to that for younger adults except that assessment and management is more complex due to the presence of a higher frequency of comorbid illness, prolonged course of illness, and functional impairment. Management of palliative care issues in patients with advanced dementia is complex and often involves comprehensive geriatric assessment and interdisciplinary care. This chapter reviews various geriatric issues in palliative care.
- Published
- 2018
21. Management of Psychological Symptoms Including Anxiety and Depression
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Marvin Omar Delgado Guay
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business.industry ,Medicine ,Anxiety ,medicine.symptom ,business ,Depression (differential diagnoses) ,Clinical psychology - Abstract
Most advanced cancer patients develop psychological symptoms, either alone or in combination with physical symptoms. Frequently psychological symptoms complicate management of physical symptoms such as pain. Routine screening is essential for diagnosis. Among the many possible psychological symptoms, the most common are adjustment disorders, anxiety disorders, depressive disorders, and cognitive disorders, which can be major sources of distress for patients and can pose significant management problems. Treatment may include combination of psychotherapy as well as pharmacotherapy. In this chapter we will review the diagnosis, and management of the most common psychological symptoms such as anxiety and depression experienced by the patients receiving palliative care.
- Published
- 2018
22. Symptom Assessment
- Author
-
Marvin Omar Delgado Guay
- Abstract
Patients with advanced disease experience severe physical and psychological symptoms which are often underdiagnosed and often addressed only when severe and debilitating. Recent studies have shown that routine assessment of symptoms is significantly associated with improvement of quality of life and extending survival. The optimal delivery of quality palliative care involves improving quality of life by impeccable assessment of physical and psychosocial symptoms. Routine screening of symptoms using validated tools often results in thorough assessment of the significant symptoms and prompt and optimal management of symptom distress. This chapter reviews the key aspects involved in screening and assessment of symptoms.
- Published
- 2018
23. Psychosocial and Spiritual Issues in Palliative Care
- Author
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Sriram Yennurajalingam and Marvin Omar Delgado Guay
- Subjects
Palliative care ,Nursing ,business.industry ,Medicine ,business ,Psychosocial - Abstract
In patients with serious life-limiting illness, there is a complex interplay of psychosocial, cultural, and spiritual issues. Increasing evidence demonstrates that psychosocial as well as spiritual distress play a significant role in the overall distress in palliative care patients. These also negatively factor in the patient’s well-being and control of symptoms. However, the differentiation between psychosocial and spiritual is often difficult. An interdisciplinary approach is critical so as to alleviate this distress among patients receiving Palliative Care. This chapter reviews the assessment and management of key issues related to psychosocial, cultural, and spiritual issues in patients with serious life-limiting illness.
- Published
- 2018
24. Association between Spirituality/Religiosity and Quality of End-of-Life Care (DRAFT)
- Author
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Marvin Omar Delgado-Guay
- Subjects
Religiosity ,Gerontology ,media_common.quotation_subject ,Spirituality ,Quality (business) ,Association (psychology) ,Psychology ,End-of-life care ,media_common - Abstract
The Coping with Cancer Study is a multicenter, prospective, longitudinal observational study that examines the association between religious coping strategies and end-of-life care outcomes in patients with advanced cancer. Baseline interviews were performed to assess religious coping and other related variables. Patients were followed until death, a median of 122 days after baseline assessment. Logistic regression analyses showed a significant association between higher positive religious coping with increased preference of aggressive care at the end-of-life. Subsequent analyses from the same study showed that patients who expressed high spiritual support only from religious communities were less likely to receive hospice and more likely to receive aggressive end-of-life measures including dying in an intensive care unit. This effect was reverse in spiritual/religious care and was provided by the medical team.
- Published
- 2018
25. Dignity Therapy for Patients Near the End of Life (DRAFT)
- Author
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Marvin Omar Delgado-Guay
- Subjects
Dignity ,Political science ,media_common.quotation_subject ,Law ,media_common - Abstract
The objective of this study was to establish the feasibility of dignity therapy and determine its impact on psychosocial and existential distress in 100 patients near the end of life. Dignity therapy helped patients to discuss issues that matter most or that they would mostly want to be remembered. Sessions were transcribed and edited, with a returned final version to the patient. This psychological therapy was well accepted, and it did help patients at the end-of-life in many psychosocial and existential issues and increased will to live. This chapter describes the basics of the study, briefly reviews other relevant studies and information, gives a summary and discusses implications, and concludes with a relevant clinical case
- Published
- 2018
26. Characteristics and Outcomes of Advanced Cancer Patients Who Received Palliative Care at a Public Hospital Compared with Those at a Comprehensive Cancer Center
- Author
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Eduardo Bruera, Janet L. Williams, Jewel Ochoa, Minjeong Park, Hilda Cantu, Jeannette Ferrer, and Marvin Omar Delgado-Guay
- Subjects
Adult ,Male ,medicine.medical_specialty ,Palliative care ,Patient characteristics ,Cancer Care Facilities ,Spiritual distress ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Internal medicine ,Neoplasms ,Health insurance ,Medicine ,Humans ,030212 general & internal medicine ,General Nursing ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Hospitals, Public ,Palliative Care ,Cancer ,General Medicine ,Middle Aged ,medicine.disease ,Advanced cancer ,United States ,Anesthesiology and Pain Medicine ,030220 oncology & carcinogenesis ,Public hospital ,Hospice and Palliative Care Nursing ,Female ,Brief Reports ,business ,Psychosocial - Abstract
Background: Patients with advanced cancer experience severe physical, psychosocial, and spiritual distress requiring palliative care (PC). There are limited literature regarding characteristics and outcomes of patients evaluated by PC services at public hospitals (PHs). Objective, Design, Setting/Subjects, and Measurements: To compare the outcomes of advanced cancer patients undergoing PC at a PH and those at a comprehensive cancer center (CCC). We reviewed 359 consecutive advanced cancer patients (PH, 180; CCC, 179) undergoing PC. Symptoms and outcomes at consultation and first follow-up visit were assessed. Summary statistics were used to describe patient characteristics and outcomes. Results: The PH and CCC patients differed significantly according to race: 23% white, 39% black, and 36% Hispanic patients at the PH versus 66% white, 17% black, and 11% Hispanic patients at the CCC (p
- Published
- 2018
27. Frequency, intensity, and correlates of spiritual pain in advanced cancer patients assessed in a supportive/palliative care clinic
- Author
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Gary B. Chisholm, Susan Frisbee-Hume, Eduardo Bruera, Janet L. Williams, Marvin Omar Delgado-Guay, and Andrea Octavia Ferguson
- Subjects
Adult ,Male ,medicine.medical_specialty ,Attitude to Death ,Palliative care ,Patients ,Nausea ,Pain ,Spiritual distress ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Neoplasms ,Internal medicine ,medicine ,Humans ,Spirituality ,030212 general & internal medicine ,General Nursing ,Depression (differential diagnoses) ,Aged ,Aged, 80 and over ,business.industry ,Palliative Care ,General Medicine ,Middle Aged ,Texas ,Advanced cancer ,Intensity (physics) ,Surgery ,Psychiatry and Mental health ,Clinical Psychology ,030220 oncology & carcinogenesis ,Anxiety ,Female ,Financial distress ,medicine.symptom ,business - Abstract
Objective:Regular assessments of spiritual distress/spiritual pain among patients in a supportive/palliative care clinic (SCPC) are limited or unavailable. We modified the Edmonton Symptom Assessment Scale (ESAS) by adding spiritual pain (SP) to the scale (0 = best, 10 = worst) to determine the frequency, intensity, and correlates of self-reported SP (≥1/10) (pain deep in your soul/being that is not physical) among these advanced cancer patients.Method:We reviewed 292 consecutive consults of advanced cancer patients (ACPs) who were evaluated at our SCPC between October of 2012 and January of 2013. Symptoms were assessed using the new instrument (termed the ESAS–FS).Results:The median age of patients was 61 (range = 22–92). Some 53% were male; 189 (65%) were white, 45 (15%) African American, and 34 (12%) Hispanic. Some 123 of 282 (44%) of ACPs had SP (mean (95% CI) = 4(3.5–4.4). Advanced cancer patients with SP had worse pain [mean (95% CI) = 5.3(4.8, 5.8) vs. 4.5(4.0, 5.0)] (p = 0.02); depression [4.2(3.7, 4.7) vs. 2.1(1.7, 2.6), p < 0.0001]; anxiety [4.2(3.6, 4.7) vs. 2.5(2.0, 3.0), p < 0.0001]; drowsiness [4.2(3.7, 4.7) vs. 2.8(2.3, 3.2), p < 0.0001]; well-being [5.4(4.9, 5.8) vs. 4.5(4.1, 4.9), p = 0.0136]; and financial distress (FD) [4.4(3.9, 5.0) vs. 2.2(1.8, 2.7), p < 0.0001]. Spiritual pain correlated (Spearman) with depression (r = 0.45, p < 0.0001), anxiety (r = 0.34, p < 0.0001), drowsiness (r = 0.26, p < 0.0001), and FD (r = 0.44, p < 0.0001). Multivariate analysis showed an association with FD [OR (95% Wald CI) = 1.204(1.104–1.313), p < 0.0001] and depression [1.218(1.110–1.336), p < 0.0001]. The odds that patients who had SP at baseline would also have SP at follow-up were 182% higher (OR = 2.82) than for patients who were SP-negative at baseline (p = 0.0029). SP at follow-up correlated with depression (r = 0.35, p < 0.0001), anxiety (r = 0.25, p = 0.001), well-being (r = 0.27, p = 0.0006), nausea (r = 0.29, p = 0.0002), and financial distress (r = 0.42, p < 0.0001).Significance of results:Spiritual pain, which is correlated with physical and psychological distress, was reported in more than 40% of ACPs. Employment of the ESAS–FS allows ACPs with SP to be identified and evaluated in an SCPC. More research is needed.
- Published
- 2015
28. Financial Distress and Its Associations With Physical and Emotional Symptoms and Quality of Life Among Advanced Cancer Patients
- Author
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Marvin Omar Delgado-Guay, Eduardo Bruera, Jeanette Ferrer, Jewel Ochoa, Gary B. Chisholm, Wadih Rhondali, Supakarn Tayjasanant, Susan Frisbee-Hume, Janet L. Williams, Hilda Cantu, and Alyssa G. Rieber
- Subjects
Cancer Research ,medicine.medical_specialty ,Cross-sectional study ,business.industry ,Cancer ,Hospital Anxiety and Depression Scale ,medicine.disease ,Confidence interval ,Very frequent ,Distress ,Oncology ,Quality of life ,Symptom Management and Supportive Care ,Internal medicine ,Medicine ,business ,Psychiatry ,Psychosocial - Abstract
Objective. There are limited data on the effects of financial distress (FD) on overall suffering and quality of life (QOL) of patients with advanced cancer (AdCa). In this cross-sectional study, we examined the frequency of FD and its correlates in AdCa. Patients and Methods. We interviewed 149 patients, 77 at a comprehensive cancer center (CCC) and 72 at a general public hospital (GPH). AdCa completed a self-rated FD (subjective experience of distress attributed to financial problems) numeric rating scale (0 = best, 10 = worst) and validated questionnaires assessing symptoms (Edmonton Symptom Assessment System [ESAS]), psychosocial distress (Hospital Anxiety and Depression Scale [HADS]), and QOL (Functional Assessment of Cancer Therapy-General [FACT-G]). Results. The patients’ median age was 60 years (95% confidence interval [CI]: 58.6–61.5 years); 74 (50%) were female; 48 of 77 at CCC (62%) versus 13 of 72 at GPH (18%) were white; 21 of 77 (27%) versus 32 of 72 (38%) at CCC and GPH, respectively, were black; and 7 of 77 (9%) versus 27 of 72 (38%) at CCC and GPH, respectively, were Hispanic (p < .0001). FD was present in 65 of 75 at CCC (86%; 95% CI: 76%–93%) versus 65 of 72 at GPH (90%; 95% CI: 81%–96%; p = .45). The median intensity of FD at CCC and GPH was 4 (interquartile range [IQR]: 1–7) versus 8 (IQR: 3–10), respectively (p = .0003). FD was reported as more severe than physical distress, distress about physical functioning, social/family distress, and emotional distress by 45 (30%), 46 (31%), 64 (43%), and 55 (37%) AdCa, respectively (all significantly worse for patients at GPH) (p < .05). AdCa reported that FD was affecting their general well-being (0 = not at all, 10 = very much) with a median score of 5 (IQR: 1–8). FD correlated (Spearman correlation) with FACT-G (r = −0.23, p = .0057); HADS-anxiety (r = .27, p = .0014), ESAS-anxiety (r = .2, p = .0151), and ESAS-depression (r = .18, p = .0336). Conclusion. FD was very frequent in both groups, but median intensity was double among GPH patients. More than 30% of AdCa rated FD to be more severe than physical, family, and emotional distress. More research is needed to better characterize FD and its correlates in AdCa and possible interventions. Implications for Practice: Financial distress is an important and common factor contributing to the suffering of advanced cancer patients and their caregivers. It should be suspected in patients with persistent, refractory symptom expression. Early identification, measurement, and documentation will allow clinical teams to develop interventions to improve financial distress and its impact on quality of life of advanced cancer patients.
- Published
- 2015
29. The association between religiosity and resuscitation status preference among patients with advanced cancer
- Author
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Gary B. Chisholm, Marvin Omar Delgado-Guay, Eduardo Bruera, and Janet L. Williams
- Subjects
Adult ,Male ,medicine.medical_specialty ,Resuscitation ,Adolescent ,Decision Making ,law.invention ,Religiosity ,Young Adult ,Randomized controlled trial ,law ,Neoplasms ,Secondary analysis ,medicine ,Humans ,Terminally Ill ,Psychiatry ,Association (psychology) ,General Nursing ,Aged ,Randomized Controlled Trials as Topic ,Resuscitation Orders ,Physician-Patient Relations ,Communication ,Religion and Medicine ,Patient Preference ,General Medicine ,Middle Aged ,Advanced cancer ,Preference ,Resuscitation status ,Psychiatry and Mental health ,Clinical Psychology ,Family medicine ,Female ,Advance Directives ,Psychology - Abstract
Objective:The potential influence of patient religious and spiritual beliefs on the approach to end-of-life care and resuscitation status preferences is not well understood. The aim of this study was to assess the association between religiosity and resuscitation preferences in advanced-cancer patients.Method:We performed a secondary analysis of a randomized controlled trial that evaluated the influence of physician communication style on patient resuscitation preferences. All patients completed the Santa Clara Strength of Religious Faith Questionnaire–Short Form (SCSRFQ–SF) and expressed their resuscitation preferences. We determined the frequency of resuscitation preferences and its association with intensity of religiosity.Results:A total of 78 patients completed the study. The median age was 54 years, with a range of 18–78. Some 46 (59%) were women; 57 patients (73%) were Caucasian, 15 (19%) African American, and 5 (7%) Hispanic. A total of 46 patients (56%) were Protestant and 13 (17%) Catholic. Some 53 of 60 patients who chose Do Not Resuscitate status (DNR) (88%) and 16 of 18 patients who refused DNR (89%) for a video-simulated patient were highly religious (p = 0.64). When asked about a DNR for themselves after watching the videos, 43 of 48 who refused DNR (90%) and 26 of 30 patients who chose DNR (87%) were highly religious (p = 0.08). The Spearman correlation coefficient for patients choosing DNR for themselves and intensity of religiosity was r = –0.16 (p = 0.16). Some 30 patients (38%) who chose DNR for the video patient refused DNR for themselves, and 42 who chose DNR for both the video patient and themselves (54%) were highly religious (p = NS).Significance of Results:There was no significant association between intensity of patient religiosity and DNR preference for either the video patient or the patients themselves. Other beliefs and demographic factors likely impact end-of-life discussions and resuscitation status preferences.
- Published
- 2015
30. Hypermetabolism and symptom burden in advanced cancer patients evaluated in a cachexia clinic
- Author
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David Hui, Rony Dev, Marvin Omar Delgado-Guay, Egidio Del Fabbro, Gary B. Chisholm, Shalini Dalal, and Eduardo Bruera
- Subjects
medicine.medical_specialty ,Palliative care ,business.industry ,Proportional hazards model ,Cancer ,medicine.disease ,Confidence interval ,Surgery ,Cachexia ,Weight loss ,Physiology (medical) ,Internal medicine ,Hypermetabolism ,Medicine ,Orthopedics and Sports Medicine ,Resting energy expenditure ,medicine.symptom ,business - Abstract
Background Elevated resting energy expenditure (REE) may contribute to weight loss and symptom burden in cancer patients. Aims The aim of this study was to compare the velocity of weight loss, symptom burden (fatigue, insomnia, anxiety, and anorexia—combined score as measured by the Edmonton Symptom Assessment Score), high-sensitivity C-reactive protein, and survival among cancer patients referred to a cachexia clinic with hypermetabolism, elevated REE > 110% of predicted, with normal REE. Methods A retrospective analysis of 60 advanced cancer patients evaluated in a cachexia clinic for either >5% weight loss or anorexia who underwent indirect calorimetry to measure REE. Patients were dichotomized to either elevated or normal REE. Descriptive statistics were generated, and a two-sample Student's t-tests were used to compare the outcomes between the groups. Kaplan–Meier and Cox regression methodology were used to examine the survival times between groups. Results Thirty-seven patients (62%) were men, 41 (68%) were White, 59 (98%) solid tumours, predominantly 23 gastrointestinal cancers (38%), with a median age of 60 (95% confidence interval 57.0–62.9). Thirty-five patients (58%) were hypermetabolic. Non-Caucasian patients were more likely to have high REE [odds ratio = 6.17 (1.56, 24.8), P = 0.01]. No statistical difference regarding age, cancer type, gender, active treatment with chemotherapy, and/or radiation between hypermetabolic and normal REE was noted. The velocity of weight loss over a 3 month period (−8.5 kg vs. −7.2 kg, P = 0.68), C-reactive protein (37.3 vs. 55.6 mg/L, P = 0.70), symptom burden (4.2 vs. 4.5, P = 0.54), and survival (288 vs. 276 days, P = 0.68) was not significantly different between high vs. normal REE, respectively. Conclusion Hypermetabolism is common in cancer patients with weight loss and noted to be more frequent in non-Caucasian patients. No association among velocity of weight loss, symptom burden, C-reactive protein, and survival was noted in advanced cancer patients with elevated REE.
- Published
- 2015
31. Spirituality and religiosity in supportive and palliative care
- Author
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Marvin Omar Delgado-Guay
- Subjects
Psychotherapist ,Palliative care ,Interprofessional Relations ,media_common.quotation_subject ,MEDLINE ,Critical Care and Intensive Care Medicine ,Religiosity ,Nursing ,Adaptation, Psychological ,Spirituality ,Humans ,Medicine ,Cultural Competency ,media_common ,Patient Care Team ,Terminal Care ,Teamwork ,Patient care team ,Oncology (nursing) ,business.industry ,Palliative Care ,General Medicine ,Religion ,Caregivers ,Oncology ,Spiritual care ,business ,Cultural competence - Abstract
To provide an updated overview about the role of spirituality and religiosity in the way patients with life-threatening illnesses cope, and the importance of providing a comprehensive spiritual assessment and spiritual care in an interdisciplinary team work setting, such as supportive and palliative care.Spirituality is a lifelong developmental task, lasting until death. Spirituality and religion continue to play an important role across cultures globally. Spirituality is seen as a vital element connected to seeking meaning, purpose, and transcendence in life. Many individuals recognize their life-threatening illness as an opportunity for spiritual growth; therefore, these individuals who have access to spirituality through meaning, purpose, connections with others, or connections with a higher power will have the spiritual resources necessary to adjust to adverse circumstances. It is extremely important to pay attention to patients' and caregivers' cultural and spiritual identity and spiritual needs.The interdisciplinary supportive and palliative care model of spiritual care proposes inclusion of the spiritual domain in the overall screening and history-taking process and spiritual care by all members of the team, including a full spiritual assessment by a professional chaplain. Research in this extremely important field needs to continue growing.
- Published
- 2014
32. Association between hypogonadism, symptom burden, and survival in male patients with advanced cancer
- Author
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Eduardo Bruera, Nikhil Sobti, Shalini Dalal, Rony Dev, Egidio Del Fabbro, Marvin Omar Delgado-Guay, and David Hui
- Subjects
Cancer Research ,medicine.medical_specialty ,Palliative care ,biology ,business.industry ,C-reactive protein ,Hazard ratio ,Cancer ,medicine.disease ,Gastroenterology ,Cachexia ,Endocrinology ,Oncology ,Weight loss ,Internal medicine ,medicine ,Vitamin D and neurology ,biology.protein ,medicine.symptom ,business ,Testosterone - Abstract
BACKGROUND A high frequency of hypogonadism has been reported in male patients with advanced cancer. The current study was performed to evaluate the association between low testosterone levels, symptom burden, and survival in male patients with cancer. METHODS Of 131 consecutive male patients with cancer, 119 (91%) had an endocrine evaluation of total (TT), free (FT), and bioavailable testosterone (BT); high-sensitivity C-reactive protein (CRP); vitamin B12; thyroid-stimulating hormone; 25-hydroxy vitamin D; and cortisol levels when presenting with symptoms of fatigue and/or anorexia-cachexia. Symptoms were evaluated by the Edmonton Symptom Assessment Scale. The authors examined the correlation using the Spearman test and survival with the log-rank test and Cox regression analysis. RESULTS The median age of the patients was 64 years; the majority of patients were white (85 patients; 71%). The median TT level was 209 ng/dL (normal: ≥ 200 ng/dL), the median FT was 4.4 ng/dL (normal: ≥ 9 ng/dL), and the median BT was 22.0 ng/dL (normal: ≥ 61 ng/dL). Low TT, FT, and BT values were all associated with worse fatigue (P ≤ .04), poor Eastern Cooperative Oncology Group performance status (P ≤ .05), weight loss (P ≤ .01), and opioid use (P ≤ .005). Low TT and FT were associated with increased anxiety (P ≤ .04), a decreased feeling of well-being (P ≤ .04), and increased dyspnea (P ≤ .05), whereas low BT was only found to be associated with anorexia (P = .05). Decreased TT, FT, and BT values were all found to be significantly associated with elevated CRP and low albumin and hemoglobin. On multivariate analysis, decreased survival was associated with low TT (hazards ratio [HR], 1.66; P = .034), declining Eastern Cooperative Oncology Group performance status (HR, 1.55; P = .004), high CRP (HR, 3.28; P
- Published
- 2014
33. Spiritual and psychological distress in older and the oldest-old living with advanced cancer patients (O-OOAdCa) in a comprehensive cancer center
- Author
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Linda Pang, Marvin Omar Delgado-Guay, Eduardo Bruera, Janet L. Williams, and Maxine de la Cruz
- Subjects
Gerontology ,Cancer Research ,business.industry ,Psychological distress ,Cancer ,Oldest old ,medicine.disease ,Advanced cancer ,03 medical and health sciences ,0302 clinical medicine ,Oncology ,030220 oncology & carcinogenesis ,Medicine ,Center (algebra and category theory) ,business ,030215 immunology - Abstract
e23041 Background: Older adults living with cancer may experience multiple physical, emotional and spiritual symptoms. Limited literature describing the frequency of psychological and spiritual distress in O-OOAdCa. Methods: Retrospective chart review of patients seen by the Palliative Care team from January 2013 to December 2016. We randomly sampled 200 patients aged < 65, 200 patients aged 65 - < 85) and 41 consecutive patients ≥85). Using the ESAS-FS, determined the frequency, and correlates of self-reported Spiritual Pain (SP) and Anxiety (Anx) and Depression (Dep) among these patients. Psycho-spiritual distress was defined as the presence of SP ≥1/10, Anx ≥2/10, and Dep ≥2/10. Results: 52% were female, 61% white, and 48% with ECOG of 2 in the group < 65, 48% were female, 61% white, and 43% an ECOG of 2 from group 65 to 84, and 49% were female, and 83% white, and 49% an ECOG of 3 from the group > 85 years. Spiritual Pain was present in 101/200 (51%) in the group < 65 vs. 61/187 (36%) in group 65-84 vs. 15/54 (29%) in ≥85, p = 0.004. Anxiety was present in 130/200 (65%), vs. 120/187 (65%), vs. 35/54(65%) per group respectively, p = NS. Depression was present in 109/200 (55%), vs. 100/187 (54%), vs. 29/54 (54%), respectively per group, p = NS. Psycho-spiritual distress was present in 65/200 (33%), vs. 44/187 (24%), vs. 11/54 (20%) per group respectively, P = NS. Logistic regression showed gender female correlated with higher psycho-spiritual distress (OR:2.08, p = 0.012), fatigue OR:1.32, p = 0.01, Well-Being OR:1.32, p = 0.02, Financial Distress OR:1.63, p = 0.00, age group < 65, OR:9.24, p = 0.03. Conclusions: High prevalence of Anxiety, Depression and Spiritual Pain in O-OOAdCa. Less frequency of Spiritual Pain in the Oldest-Old when compared with the rest of the population. Highlights the importance of an integrative Psycho-spiritual care to this population. More research is needed.
- Published
- 2019
34. Spirituality, religiosity, and burnout in Latin American palliative care health care professionals (LAPC)
- Author
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Maria Margarita Reyes Donoso, Ismariel I Espín Gónzalez, Norma Colautti, Miriam Elisa Riveros Rios, Tania Pastrana, Mario Lopez Saca, and Marvin Omar Delgado-Guay
- Subjects
Cancer Research ,medicine.medical_specialty ,Palliative care ,Latin Americans ,Demographics ,business.industry ,Burnout ,Religiosity ,Oncology ,Median time ,Family medicine ,Health care ,Spirituality ,medicine ,business - Abstract
164 Background: Spirituality (S) and religiosity (R) are essential in delivering Quality Palliative Care(PC). There's limited literature regarding Latin American clinicians’ spiritual and religious characteristics, or how these shape their clinical engagement and presence of burnout. Methods: To describe the frequency, intensity and importance of S and R and burnout on the LAPC's practice. From 6/1-12/31, 2017, a crossectional study using an anonymous/voluntary Online Survey was provided to active members of ALCP. We collected and analyzed data regarding demographics, role of S, R, and burnout. Results: 221/353 members from 20 Latin American Countries participated, RR:63%. Median age 47(SD+/-12), 75% were women. 40% Catholic. 58% were physicians, 19% nurses, 12% psychology, and other 12%. The median time of working in PC was 9 years (+/-7). LAPC considered themselves spiritual(median:8/10, range 0-10) and religious (5, 0-10). LAPC considered S/R very important in their lives (9/10, 0-10 and 6/10, 0-10), respectively. LAPC reported that S/R was a source of strength/comfort (9/10, SD+/-2), helped them to cope with their problems (8/10,+/-3), and helped them to keep their quality of life in a stressful work environment (8/10,+/-4). 60% LAPC felt energized and 86% reported not feeling exhausted after taking care of patients who are dying. This is associated with being spiritual (p=0.003) and its importance in life (p=0.025). 86% reported strongly/somewhat agreed with: "I feel called to take care of patients who are dying", this was associated with being spiritual (p=0.044). 31/221(14%) reported being burned out. No significant difference among gender, profession, age, years in PC, or importance of S/R. Having higher (34%) versus not (11%) experience emotional exhaustion after caring of the dying were more likely to report burnout (p
- Published
- 2018
35. Do-Not-Resuscitate (DNR) Orders and Consultants' Willingness to Perform Invasive Procedures
- Author
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Eduardo Bruera, Marvin Omar Delgado-Guay, and Ahmed Elsayem
- Subjects
Anesthesiology and Pain Medicine ,DNR orders ,business.industry ,Do not resuscitate ,medicine ,Neurology (clinical) ,Medical emergency ,medicine.disease ,business ,General Nursing - Published
- 2015
36. Decisional Control Preferences of Hispanic Patients With Advanced Cancer From the United States and Latin America
- Author
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Marvin Omar Delgado-Guay, Eva Rossina Duarte, Henrique A. Parsons, Eduardo Bruera, Julio Allo, Sofia Bunge, Alejandra Palma, J. Lynn Palmer, and Sriram Yennurajalingam
- Subjects
Male ,Gerontology ,Latin Americans ,Palliative care ,Decision Making ,Population ,Context (language use) ,Age Distribution ,Patient satisfaction ,Neoplasms ,Prevalence ,Humans ,Medicine ,Sex Distribution ,education ,General Nursing ,Aged ,Physician-Patient Relations ,Terminal Care ,education.field_of_study ,Marital Status ,business.industry ,Palliative Care ,Patient Preference ,Hispanic or Latino ,Middle Aged ,United States ,Acculturation ,Latin America ,Anesthesiology and Pain Medicine ,Social Class ,Scale (social sciences) ,Test score ,Female ,Neurology (clinical) ,Patient Participation ,business ,Demography - Abstract
Understanding cancer patients' preferences in decisional roles is important in providing quality care and ensuring patient satisfaction. There is a lack of evidence on decisional control preferences (DCPs) of Hispanic Americans, the fastest growing population in the U.S.The primary aims of this study were to describe DCPs of Hispanics with advanced cancer in the U.S. (HUSs) and compare the frequency of passive DCPs in this population with that of Hispanics with advanced cancer in Latin America (HLAs).We conducted a prospective survey of patients with advanced cancer referred to outpatient palliative care clinics in the U.S., Chile, Argentina, and Guatemala. Information was collected on sociodemographic variables, Karnofsky Performance Scale scores, acculturation (Marin Acculturation Assessment Tool), and DCP (Control Preference Scale). Chi-square tests were used to determine the differences in DCPs between HUSs and HLAs.A total of 387 patients were surveyed: 91 in the U.S., 100 in Chile, 94 in Guatemala, and 99 in Argentina. The median age of HUSs was 56 years, 59% were female, and the median Karnofsky Performance Scale score was 60; the corresponding values for HLAs were 60 years, 60%, and 80. HLAs used passive DCP strategies significantly more frequently than HUSs did with regard to the involvement of the family (24% vs. 10%; P=0.009) or the physician (35% vs. 16%; P0.001), even after age and education were controlled for. Eighty-three percent of HUSs and 82% of HLAs preferred family involvement in decision making (P=non-significant). No significant differences were found in DCPs between poorly and highly acculturated HUSs (P=0.91).HUSs had more active DCPs than HLAs did. Among HUSs, acculturation did not seem to play a role in DCP determination. Our findings confirm the importance of family participation for both HUSs and HLAs. However, HUSs were less likely to want family members to make decisions on their behalf.
- Published
- 2013
37. A multicenter survey of Hispanic caregiver preferences for patient decision control in the United States and Latin America
- Author
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Eva Rosina Duarte, Sriram Yennurajalingam, J. Lynn Palmer, Henrique A. Parsons, Alejandra Palma, Antonio Noguera, Marvin Omar Delgado-Guay, Isabel Torres-Vigil, Sofia Bunge, and Eduardo Bruera
- Subjects
Male ,Gerontology ,medicine.medical_specialty ,Latin Americans ,Palliative care ,Decision Making ,Argentina ,White People ,Article ,medicine ,Humans ,Chile ,Decision control ,business.industry ,Family caregivers ,Palliative Care ,Hispanic or Latino ,General Medicine ,Middle Aged ,Guatemala ,United States ,Preference ,Acculturation ,Latin America ,Anesthesiology and Pain Medicine ,Caregivers ,Scale (social sciences) ,Family medicine ,Multicenter survey ,Female ,business - Abstract
Background: Understanding family caregivers’ decisional role preferences is important for communication, quality of care, and patient and family satisfaction. The family caregiver has an important role in a patient’s decisional role preferences. There are limited studies on family caregivers’ preferences of the patient’s decision control at the end of life among Hispanics. Aims: To identify Hispanic caregivers’ preferences of the decision control of patients with advanced cancer and to compare the preferences of caregivers in Hispanic Latin American and Hispanic American caregivers. Design: We surveyed patients and their family caregivers referred to outpatient palliative care clinics in the United States, Chile, Argentina, and Guatemala. Caregiver preferences of patient’s decision control were evaluated using the Control Preference Scale. Caregivers’ and patients’ sociodemographic variables, patient performance status, and Hispanic American patient acculturation level were also collected. Participants: A total of 387 caregivers were surveyed: 100 (26%) in Chile, 99 (26%) in Argentina, 97 (25%) in Guatemala, and 91 (24%) in the United States. The median age was 56 years, and 59% were female. Results: Caregiver preference of patient’s decision control was passive, shared, and active for 10 (11%), 45 (52%), and 32 (37%) Hispanic American caregivers and 54 (19%), 178 (62%), and 55 (19%) Hispanic Latin American caregivers ( p = 0.0023), respectively. Caregiver acculturation level did not affect the preferences of the Hispanic American sample ( p = 0.60). Conclusions: Most Hispanic family caregivers preferred the patient to make shared decisions. Hispanic Latin American caregivers more frequently preferred patients to assume a passive decisional role. Acculturation did not influence the preferences of Hispanic American caregivers.
- Published
- 2013
38. Spirituality, Religiosity, and Spiritual Pain in Advanced Cancer Patients
- Author
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David Hui, Eduardo Bruera, Marvin Omar Delgado-Guay, Steven Thorney, Kathy Govan, Maxine de la Cruz, and Henrique A. Parsons
- Subjects
Adult ,Male ,medicine.medical_specialty ,Coping (psychology) ,Palliative care ,Pain ,Comorbidity ,Hospital Anxiety and Depression Scale ,Religiosity ,Young Adult ,Rating scale ,Neoplasms ,Humans ,Medicine ,Outpatient clinic ,Spirituality ,Young adult ,Psychiatry ,General Nursing ,Aged ,Aged, 80 and over ,business.industry ,Palliative Care ,Middle Aged ,medicine.disease ,Texas ,Religion ,Anesthesiology and Pain Medicine ,Quality of Life ,Female ,Neurology (clinical) ,business ,Attitude to Health ,Clinical psychology - Abstract
Spirituality, religiosity, and spiritual pain may affect advanced cancer patients' symptom expression, coping strategies, and quality of life.To examine the prevalence and intensity of spirituality, religiosity, and spiritual pain, and how spiritual pain was associated with symptom expression, coping, and spiritual quality of life.We interviewed 100 advanced cancer patients at the M.D. Anderson palliative care outpatient clinic in Houston, TX. Self-rated spirituality, religiosity, and spiritual pain were assessed using numeric rating scales (0=lowest, 10=highest). Patients also completed validated questionnaires assessing symptoms (Edmonton Symptom Assessment Scale [ESAS] and Hospital Anxiety and Depression Scale), coping (Brief COPE and Brief R-COPE), the value attributed by the patient to spirituality/religiosity in coping with cancer (Systems of Belief Inventory-15R), and spiritual quality of life (Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being-Expanded [FACIT-Sp-Ex]).The median age was 53 years (range 21-85) and 88% were Christians. Almost all patients considered themselves spiritual (98%) and religious (98%), with a median intensity of 9 (interquartile range 7-10) of 10 and 9 (range 5-10) of 10, respectively. Spiritual pain was reported in 40 (44%) of 91 patients, with a median score of 3 (1-6) among those with spiritual pain. Spiritual pain was significantly associated with lower self-perceived religiosity (7 vs. 10, P=0.002) and spiritual quality of life (FACIT-Sp-Ex 68 vs. 81, P=0.001). Patients with spiritual pain reported that it contributed adversely to their physical/emotional symptoms (P0.001). There was a trend toward increased depression, anxiety, anorexia, and drowsiness, as measured by the ESAS, among patients with spiritual pain (P0.05), although this was not significant after Bonferroni correction.A vast majority of advanced cancer patients receiving palliative care considered themselves spiritual and religious. Spiritual pain was common and was associated with lower self-perceived religiosity and spiritual quality of life.
- Published
- 2011
39. Characteristics of patients who refuse do-not-resuscitate orders upon admission to an acute palliative care unit in a comprehensive cancer center
- Author
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Donna S. Zhukovsky, Henrique A. Parsons, Badi El Osta, Lynn Palmer, David Hui, Maxine J. De La Cruz, Eduardo Bruera, Marvin Omar Delgado-Guay, Shana L. Palla, and Adenike E Akitoye
- Subjects
Adult ,Male ,Cancer Research ,medicine.medical_specialty ,Palliative care ,Nausea ,medicine.medical_treatment ,Pain ,Cancer Care Facilities ,Interquartile range ,Neoplasms ,Internal medicine ,medicine ,Humans ,Cardiopulmonary resuscitation ,Intensive care medicine ,health care economics and organizations ,Survival analysis ,Resuscitation Orders ,Retrospective Studies ,business.industry ,Palliative Care ,Retrospective cohort study ,Odds ratio ,Middle Aged ,Patient Acceptance of Health Care ,Survival Analysis ,humanities ,Black or African American ,Oncology ,Case-Control Studies ,Female ,medicine.symptom ,business - Abstract
BACKGROUND: Refusal of appropriately indicated do-not-resuscitate (DNR) orders may cause harm and distress for patients, families, and the medical team. We conducted a retrospective study to determine the frequency and predictors of refusals of DNR in advanced cancer patients admitted to an acute palliative care unit. METHODS: A total of 2538 consecutive admissions were reviewed. Demographic and clinical characteristics from 200 consecutive patients with DNR orders and 100 consecutive patients who refused DNR were collected, and differences between the groups were determined by multivariate regression and recursive partitioning analysis. RESULTS: Of 2538 admissions, 2530 (99%) were appropriate for DNR discussion. Of the 2530 admissions, 2374 were unique patients, and 100 (4%) of 2374 refused DNR. Refusers had median (interquartile range, IQR) pain of 7 (4-9) versus 5 (3-8, P = .0005), nausea of 2 (0-7) versus 1 (0-4, P = .05), and dyspnea of 1 (0-5) versus 4 (0-7, P = .002) as compared with DNR nonrefusers, respectively. Patients with hematological malignancies and advance directives had a lower DNR refusal risk (odds ratio [OR], 0.38; P = .02, and OR, 0.36; P < .0001, respectively). Multivariate regression analysis revealed that patients with moderate-severe pain (OR, 3.19; P = .002) and with no advance directives (OR, 2.94; P ≤ .001) had higher DNR refusal risk. There were more inpatient deaths among DNR nonrefusers (87 of 200 vs 1 of 100, P < .0001). Median (IQR) time from discharge to death was 18 (8-35) days for those with DNR orders and 85 (25-206) days for DNR refusers (P ≤ .0001). CONCLUSIONS: DNR refusal in patients admitted to the acute palliative care unit is low, more frequent in patients with more pain and nausea and no advance directives, and associated with longer survival. This study demonstrates possible predictors of complicated DNR discussions. Cancer 2010. © 2010 American Cancer Society.
- Published
- 2010
40. Inclusion of spiritual pain in patient reported outcome assessments as part of an integrative medicine physician consultation
- Author
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Wenli Liu, Minxing Chen, Marvin Omar Delgado-Guay, Gabriel Lopez, Alejandro Chaoul, Lorenzo Cohen, Yisheng Li, and Eduardo Bruera
- Subjects
Cancer Research ,Health services ,medicine.medical_specialty ,Oncology ,Nursing ,business.industry ,Family medicine ,medicine ,In patient ,Integrative medicine ,business ,Inclusion (education) ,Outcome (game theory) - Abstract
190 Background: Complementary and integrative health services are increasingly available to patients at cancer centers to help address physical and psychological needs. We review inclusion of spiritual pain (SP) as part of patient reported outcome (PRO) assessments in patients presenting for an outpatient integrative medicine consultation at a comprehensive cancer center. Methods: PRO data were collected as part of outpatient physician consultations at an integrative medicine clinic; we reviewed data between January 2013 and April 2017. Patients completed the Edmonton Symptom Assessment Scale (ESAS-FS, 12 symptoms, scale 0-10, 10 worst possible) immediately prior to the clinical encounter. ESAS distress subscales analyzed included psychological, physical, and global. Statistical analyses included summary statistics, two sample t-tests, correlations, and logistic regression. Results: We analyzed data from 4348 unique participants. Demographics included 65% women, average age 55.5, 78% Caucasian, 72% married or with significant other, majority Christian non-Catholic (49%) followed by non-specified (23%), and Catholic (20%). Overall, 41% of patients reported SP at baseline. Patients reporting a SP score of ≥ 1 (n = 1549) reported significantly higher levels of global, physical, and psychological distress than patients with SP scores of 0 (n = 2275) (all p’s < 0.001). Older patients and men were less likely to report SP. SP clustered with psychological symptoms of depression and anxiety (reliability coefficient 0.76). Conclusions: A significant number of cancer patients presenting for integrative medicine consultations reported having SP, with SP clustering with psychological versus physical symptoms. More research is needed to better understand how routine screening for SP contributes to assessments of overall psychological health.
- Published
- 2017
41. Spirituality among Latino caregivers of patients with advanced cancer: A qualitative study
- Author
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Marvin Omar Delgado-Guay, Eva Rossina Duarte, Eduardo Bruera, Laura Tupper, Alejandra Vega Palma, Monica Grez, and Susana McCollom
- Subjects
Cancer Research ,medicine.medical_specialty ,Palliative care ,Interpretative phenomenological analysis ,business.industry ,Face (sociological concept) ,humanities ,Religiosity ,Oncology ,Spirituality ,Medicine ,Meaning (existential) ,business ,Psychiatry ,Association (psychology) ,Qualitative research ,Clinical psychology - Abstract
180 Background: Caregivers of cancer patients often face significant physical, social, and emotional distress. There has been limited research on the association between Latino Caregivers’ spirituality/religiosity, meaning, and spiritual pain. Methods: We interviewed 336 Latino Caregivers of patients at Palliative Care clinics in Chile, Guatemala, and the US. Five open-ended questions were asked about spirituality, religion, meaning, and spiritual pain. Answers were transcribed and data analyzed. The analytic framework was based on an interpretive phenomenological analysis. Initial themes were grouped into themes, connections between themes were developed until a thematic rationale was achieved. Results: Latino caregivers’spirituality and religious beliefs were described as an anchor during the painful witnessing of a loved-ones’suffering. Main themes emerged about relationships, inner strength, hope, and acceptance/reconciliation. It was reported as an integrative force to help them to cultivate hope and love walking through their love one’s illness and their journey as caregivers. They expressed meaning as a manifestation of spirituality together with their love to others(spouse, family, others). The presence of Spiritual Pain was common and manifested as suffering and potential loss of loved ones, and broken relationship with Higher Power, that triggered a profound experience of their own pain(both spiritual and emotional) and their own quality of life. This was expressed in physical terms such as “heartache” and “soul ache.” Through discernment, prayer, and relationships with loved-ones, spirituality was integrated as a healing force during the caregiver journey. Spirituality was reported as a substance of hope weaved into an integrative process, as caregivers reconciled the tension of faith with sorrow. Conclusions: Spirituality and religious beliefs are reported as fundamental for Latino Caregivers. Despite these elements, Spiritual Pain is common and affects all aspects of their humanity. Most of them experienced a reconciliation experience with the broken relationships with themselves, with others or with Higher Power.
- Published
- 2017
42. Intermittent Subcutaneous Opioids for the Management of Cancer Pain
- Author
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Abdul Shukkoor, Robin L. Fainsinger, Hue Quan, Eduardo Bruera, J. Lynn Palmer, Marvin Omar Delgado-Guay, and Henrique A. Parsons
- Subjects
Adult ,Male ,Palliative care ,Nausea ,Injections, Subcutaneous ,Sedation ,Analgesic ,Pain ,Young Adult ,Neoplasms ,medicine ,Humans ,General Nursing ,Aged ,Pain Measurement ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Health Care Costs ,Original Articles ,General Medicine ,Middle Aged ,medicine.disease ,Analgesics, Opioid ,Bowel obstruction ,Anesthesiology and Pain Medicine ,Opioid ,Anesthesia ,Vomiting ,Female ,medicine.symptom ,business ,Cancer pain ,medicine.drug - Abstract
Pain is a very common symptom in patients with advanced cancer, with a prevalence as high as 80%. The vast majority of patients with cancer pain require opioids for its treatment.1,2 Most patients will require alternatives to the oral route for analgesic administration during the course of their disease, due to a variety of factors such as nausea, vomiting, sedation, delirium, bowel obstruction, and swallowing impairment.3 Patients who need parenteral opioids for severe cancer pain usually are managed with intravenous (IV) continuous infusions to maintain stable blood levels due to the short half life of the drugs.4 In order to maintain a continuous opioid infusion, patients managed by palliative care and hospice teams in acute care hospitals, inpatient hospices or at home need to use expensive portable or nonportable pumps, with the added costs of maintenance of a central or peripheral intravenous line and the management of rescue analgesic boluses.2,4 Intermittent IV opioid delivery results in significant sedation and short duration of effect, due to the short half-life of these drugs.4 One alternative is the subcutaneous (SC) route, which offers the possibility of maintaining efficacious pain control with intermittent injections, due to the slower rate of absorption of opioid analgesics.5–7 Intermittent subcutaneous opioid administration with an indwelling subcutaneous butterfly needle is a painless and inexpensive way of achieving pain control in those patients.7–10 The Edmonton Injector is a portable, simple, safe, and inexpensive mechanical device for delivering subcutaneous drugs.11 The purpose of this study is to review the results of intermittent SC opioids in a consecutive series of patients with cancer.
- Published
- 2008
43. Symptom distress in advanced cancer patients with anxiety and depression in the palliative care setting
- Author
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J. Lynn Palmer, Marvin Omar Delgado-Guay, Eduardo Bruera, Henrique A. Parsons, and Zhijun Li
- Subjects
Adult ,Male ,medicine.medical_specialty ,Palliative care ,Psychometrics ,Nausea ,Anxiety ,Hospital Anxiety and Depression Scale ,Severity of Illness Index ,Statistics, Nonparametric ,Young Adult ,Neoplasms ,Internal medicine ,medicine ,Humans ,Psychiatry ,Depression (differential diagnoses) ,Aged ,Retrospective Studies ,Aged, 80 and over ,Clinical Trials as Topic ,Depression ,business.industry ,Palliative Care ,Middle Aged ,medicine.disease ,Advanced cancer ,Clinical trial ,Oncology ,Mood disorders ,Female ,medicine.symptom ,business - Abstract
Mood disorders are among the most distressing psychiatric conditions experienced by patients with advanced cancer; however, studies have not shown a direct association of physical symptoms with depression and anxiety. The purpose of this study is to determine the relationship between the frequency and intensity of patients’ physical symptoms and their expressions of depression and anxiety. We retrospectively reviewed the records of 216 patients who had participated in three previous clinical trials conducted by our group. We assessed patients’ demographic data using descriptive statistics. We analyzed physical symptom frequency and intensity using the Edmonton Symptom Assessment System (ESAS) and anxiety and depression using the respective subscales of the Hospital Anxiety and Depression Scale (HADS-A and HADS-D). Sixty-two percent were male; the median age was 59 years (range 20–91 years). Seventy nine (37%) of the patients had depressive mood (HADS-D ≥ 8), and 94 (44%) had anxiety (HADS-A ≥ 8). Patients with depressive mood expressed higher frequency of drowsiness (68/78, 64%; p = 0.0002), nausea (52/79, 66%; p = 0.0003), pain (74/79, 94%; p = 0.0101), dyspnea (68/79, 86%; p = 0.0196), worse appetite (72/79, 91%; p = 0.0051), and worse well-being (78/79, 99%; p = 0.0014) and expressed higher intensity of symptoms (ESAS ≥ 1) [median (Q1–Q3)] including drowsiness [4 (3–7), p = 0.0174], fatigue [7 (5–8), p
- Published
- 2008
44. Characteristics and outcomes of patients with advanced cancer evaluated by a palliative care team at an emergency center. A retrospective study
- Author
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Gary B. Chisholm, Eduardo Bruera, Janet L. Williams, Alfredo Rodriguez-Nunez, Marvin Omar Delgado-Guay, Seong Hoon Shin, and Susan Frisbee-Hume
- Subjects
Adult ,Male ,medicine.medical_specialty ,Constipation ,Palliative care ,Nausea ,03 medical and health sciences ,0302 clinical medicine ,Interquartile range ,Internal medicine ,Neoplasms ,medicine ,Humans ,030212 general & internal medicine ,Depression (differential diagnoses) ,Aged ,Retrospective Studies ,business.industry ,Palliative Care ,Retrospective cohort study ,Middle Aged ,Treatment Outcome ,Oncology ,030220 oncology & carcinogenesis ,Emergency medicine ,Vomiting ,Female ,medicine.symptom ,business ,Home Hospice - Abstract
Patients with advanced cancer may be referred for a palliative care consultation (PC) from a hospital emergency center (EC) or as inpatients. However, research about symptoms and outcomes in patients with advanced cancer who receive PC at the EC is limited. We reviewed demographic variables, frequency and intensity of symptoms (using the Edmonton Symptom Assessment Scale (ESAS)), PC interventions, time from admission to PC consultation, hospitalization duration, and discharge destination of 200 advanced cancer patients referred to PC services from the EC (“EC patients”) and 200 matched advanced cancer inpatients referred to PC services (“inpatients”) from January 1, 2010, through December 31, 2011. The median age for all patients was 56 years (range, 48–64 years); 222 (56 %) patients were female, and 243 (61 %) were white. There were no significant demographic differences between the EC patients and inpatients. The median time from admission to PC was 12 h (range, 7–23 h) for the EC patients and 24 h (24–96 h) for the inpatients (p
- Published
- 2015
45. The Frequency, Characteristics, and Outcomes Among Cancer Patients With Delirium Admitted to an Acute Palliative Care Unit
- Author
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Sriram Yennu, Akhila Reddy, Eduardo Bruera, Maxine de la Cruz, Jimin Wu, Viraj Ransing, Marvin Omar Delgado-Guay, and Diane Liu
- Subjects
Advance care planning ,Adult ,Cancer Research ,medicine.medical_specialty ,Palliative care ,Cancer Care Facilities ,behavioral disciplines and activities ,Young Adult ,Neoplasms ,mental disorders ,medicine ,Humans ,Young adult ,Intensive care medicine ,Aged ,Aged, 80 and over ,business.industry ,Medical record ,Palliative Care ,Delirium ,Middle Aged ,Survival Analysis ,Texas ,nervous system diseases ,Hospitalization ,Distress ,Oncology ,Symptom Management and Supportive Care ,Emergency medicine ,Etiology ,medicine.symptom ,business - Abstract
Background. Delirium is a common neuropsychiatric condition seen in patients with severe illness, such as advanced cancer. Few published studies are available of the frequency, course, and outcomes of standardized management of delirium in advanced cancer patients admitted to acute palliative care unit (APCU). In this study, we examined the frequency,characteristics,andoutcomesofdeliriuminpatients with advanced canceradmitted to an APCU. Methods. Medical records of 609 consecutive patients admitted to the APCU from January 2011 through December 2011 were reviewed. Data on patients’ demographics; Memorial Delirium Assessment Scale (MDAS) score; palliative care specialist (PCS) diagnosis of delirium; delirium etiology, subtype, and reversibility; late development of delirium; and discharge outcome were collected. Delirium was diagnosed with MDAS score $7 and by a PCS using Diagnostic and Statistical Manual, 4th edition, Text Revision criteria. All patients admitted to the APCU received standardized assessments and management of delirium per best practice guidelines in delirium management. Results. Of556patientsintheAPCU,323(58%)hadadiagnosis of delirium. Of these, 229 (71%) had a delirium diagnosis on admissionand94(29%)developeddeliriumafteradmissionto the APCU.Delirium reversedin 85 of 323episodes (26%). Half of patients with delirium (n 5 162) died. Patients with the diagnosisofdeliriumhada lowermedianoverallsurvival than thosewithoutdelirium.Patientswhodevelopeddeliriumafter admission to the APCU had poorer survival (p # .0001) and alowerrateofdeliriumreversal(p5.03)comparedwiththose admitted with delirium. Conclusion. More than half of the patients admitted to the APCU had delirium. Reversibility occurred in almost one-third of cases. Diagnosis of delirium was associated with poorer survival.The Oncologist 2015;20:1425–1431 ImplicationsforPractice:Deliriumisthemostcommonneuropsychiatricconditioninpatientswithseveremedicalillnessandthose at the end of life. It can be a source of distress for patients, their families, and the medical team.When missed, or if symptoms are misinterpreted, delirium may also lead to unnecessary interventions.This underlines the importance of diagnosis and detection of deliriumin populationsthatare atincreasedrisk.This study hasimportantimplications inpractice,asitcan assistclinicians inmaking decisions regarding other medical interventions, advance care planning, and communicating with families relating to end-of-life issues.
- Published
- 2015
46. Effect of Lorazepam With Haloperidol vs Haloperidol Alone on Agitated Delirium in Patients With Advanced Cancer Receiving Palliative Care
- Author
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David Hui, Donna S. Zhukovsky, Paul Walker, Kenneth R. Hess, William Breitbart, Maxine de la Cruz, Thuc Nguyen, Diane Liu, Akhila Reddy, Daniel E. Epner, Eduardo Bruera, Janet L. Williams, Sapna Amin, Kimerson Tanco, Marieberta Vidal, Susan Frisbee-Hume, Annie Wilson, Stacy Hall, Seyedeh Dibaj, and Marvin Omar Delgado-Guay
- Subjects
Adult ,Male ,Palliative care ,Lorazepam ,Placebo ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Pharmacotherapy ,Double-Blind Method ,Randomized controlled trial ,law ,Neoplasms ,mental disorders ,Haloperidol ,medicine ,Humans ,030212 general & internal medicine ,Adverse effect ,Aged ,Aged, 80 and over ,business.industry ,Palliative Care ,Delirium ,General Medicine ,Middle Aged ,Hospitalization ,Anti-Anxiety Agents ,030220 oncology & carcinogenesis ,Anesthesia ,Drug Therapy, Combination ,Female ,medicine.symptom ,business ,Antipsychotic Agents ,medicine.drug - Abstract
The use of benzodiazepines to control agitation in delirium in the last days of life is controversial.To compare the effect of lorazepam vs placebo as an adjuvant to haloperidol for persistent agitation in patients with delirium in the setting of advanced cancer.Single-center, double-blind, parallel-group, randomized clinical trial conducted at an acute palliative care unit at MD Anderson Cancer Center, Texas, enrolling 93 patients with advanced cancer and agitated delirium despite scheduled haloperidol from February 11, 2014, to June 30, 2016, with data collection completed in October 2016.Lorazepam (3 mg) intravenously (n = 47) or placebo (n = 43) in addition to haloperidol (2 mg) intravenously upon the onset of an agitation episode.The primary outcome was change in Richmond Agitation-Sedation Scale (RASS) score (range, -5 [unarousable] to 4 [very agitated or combative]) from baseline to 8 hours after treatment administration. Secondary end points were rescue neuroleptic use, delirium recall, comfort (perceived by caregivers and nurses), communication capacity, delirium severity, adverse effects, discharge outcomes, and overall survival.Among 90 randomized patients (mean age, 62 years; women, 42 [47%]), 58 (64%) received the study medication and 52 (90%) completed the trial. Lorazepam + haloperidol resulted in a significantly greater reduction of RASS score at 8 hours (-4.1 points) than placebo + haloperidol (-2.3 points) (mean difference, -1.9 points [95% CI, -2.8 to -0.9]; P .001). The lorazepam + haloperidol group required less median rescue neuroleptics (2.0 mg) than the placebo + haloperidol group (4.0 mg) (median difference, -1.0 mg [95% CI, -2.0 to 0]; P = .009) and was perceived to be more comfortable by both blinded caregivers and nurses (caregivers: 84% for the lorazepam + haloperidol group vs 37% for the placebo + haloperidol group; mean difference, 47% [95% CI, 14% to 73%], P = .007; nurses: 77% for the lorazepam + haloperidol group vs 30% for the placebo + haloperidol group; mean difference, 47% [95% CI, 17% to 71%], P = .005). No significant between-group differences were found in delirium-related distress and survival. The most common adverse effect was hypokinesia (3 patients in the lorazepam + haloperidol group [19%] and 4 patients in the placebo + haloperidol group [27%]).In this preliminary trial of hospitalized patients with agitated delirium in the setting of advanced cancer, the addition of lorazepam to haloperidol compared with haloperidol alone resulted in a significantly greater reduction in agitation at 8 hours. Further research is needed to assess generalizability and adverse effects.clinicaltrials.gov Identifier: NCT01949662.
- Published
- 2017
47. Lorazepam as an adjuvant to haloperidol for agitated delirium at the end of life: A double-blind randomized controlled trial
- Author
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Maxine de la Cruz, William Breitbart, Diane D. Liu, David Hui, Susan Frisbee-Hume, Akhila Reddy, Eduardo Bruera, Janet L. Williams, Kenneth R. Hess, Donna S. Zhukovsky, Annie Wilson, Seyedeh Dibaj, Paul Walker, Marieberta Vidal, Kimberson Tanco, Daniel E. Epner, Sapna Amin, Stacy Hall, Marvin Omar Delgado-Guay, and Thuc Nguyen
- Subjects
Cancer Research ,business.industry ,medicine.medical_treatment ,Lorazepam ,law.invention ,Double blind ,03 medical and health sciences ,0302 clinical medicine ,Agitated delirium ,Oncology ,Randomized controlled trial ,030502 gerontology ,law ,030220 oncology & carcinogenesis ,Anesthesia ,mental disorders ,Haloperidol ,Medicine ,0305 other medical science ,business ,Adjuvant ,medicine.drug - Abstract
10003 Background: Agitated delirium is a highly distressing neuropsychiatric syndrome common in the last days of life. The use of benzodiazepines for agitated delirium is highly controversial. We compared the effect of lorazepam versus placebo as an adjuvant to haloperidol for persistent agitated delirium. Methods: In this double-blind trial, we randomly assigned patients with advanced cancer admitted to an acute palliative care unit with agitated delirium despite scheduled haloperidol to either lorazepam 3 mg IV or placebo, in addition to haloperidol 2 mg IV upon the onset of agitation. The primary outcome was the Richmond Agitation Sedation Scale (RASS) over the first 8 hours, ranging from -5 (unarousable) to +4 (combative). Secondary endpoints were rescue neuroleptic use, perceived comfort, delirium-related distress, adverse effects and overall survival. 26 patients per arm provided 80% power to detect a between arm difference of 0.5 effect size in mean RASS with a=5%. We used the Wilcoxon Rank Sum test for primary comparison. Results: 52 of 58 (90%) patients who received the medications completed 8 h of observation. RASS decreased significantly within 30 min of treatment in both arms (Table). The lorazepam arm was associated with significantly greater reduction of RASS (Table), less rescue neuroleptics (mean haloperidol equivalent dose 1 mg v. 3 mg, P=0.02), and greater comfort as perceived by blinded caregivers (84% v. 37%, P=0.007) and nurses (77% v. 30%, P=0.005) compared to placebo. We found no significant between-group differences in delirium-related distress, adverse effects and overall survival (median 68 v. 73 h, P=0.56). Conclusions: The combination of lorazepam/haloperidol resulted in rapid and significant reduction of agitation compared to haloperidol alone. Our study supports the judicious use of single dose lorazepam/haloperidol for persistent agitated delirium. Clinical trial information: NCT01670097. [Table: see text]
- Published
- 2017
48. Financial distress in patients with advanced cancer
- Author
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Marvin Omar Delgado-Guay, Christelle Brosse, Murielle Ruer, Anne-Marie Schott, Léa Monsarrat, Patrick Michaud, Eduardo Bruera, Cécile Barbaret, Stéphane Sanchez, Wadih Rhondali, and Marilène Filbet
- Subjects
Male ,Economics ,Cross-sectional study ,Emotions ,Cancer Treatment ,lcsh:Medicine ,Social Sciences ,Anxiety ,Hospital Anxiety and Depression Scale ,Geographical Locations ,0302 clinical medicine ,Cost of Illness ,Quality of life ,Neoplasms ,Surveys and Questionnaires ,Breast Tumors ,Medicine and Health Sciences ,Psychology ,Ethnicities ,Medicine ,French People ,030212 general & internal medicine ,lcsh:Science ,education.field_of_study ,Multidisciplinary ,Middle Aged ,Europe ,Oncology ,030220 oncology & carcinogenesis ,Female ,France ,medicine.symptom ,Research Article ,medicine.medical_specialty ,Population ,03 medical and health sciences ,Health Economics ,Breast cancer ,Internal medicine ,Breast Cancer ,Humans ,education ,business.industry ,lcsh:R ,Biology and Life Sciences ,Cancers and Neoplasms ,Cancer ,medicine.disease ,Advanced cancer ,Health Care ,Cross-Sectional Studies ,People and Places ,Quality of Life ,lcsh:Q ,Population Groupings ,business ,Finance ,Health Insurance - Abstract
Purpose We examined the frequency and severity of financial distress (FD) and its association with quality of life (QOL) and symptoms among patients with advanced cancer in France. Design In this cross-sectional study, 143 patients with advanced cancer were enrolled. QOL was assessed using the Functional Assessment of Cancer General (FACT-G) and symptoms assessed using Edmonton Assessment System (ESAS) and Hospital Anxiety and Depression Scale (HADS). FD was assessed using a self-rated numeric scale from 0 to 10. Results Seventy-three (51%) patients reported having FD. Patients reported having FD were most likely to be younger (53.8 (16,7SD) versus 62 (10.5SD), p
- Published
- 2017
49. Avoidable and unavoidable visits to the emergency department among patients with advanced cancer receiving outpatient palliative care
- Author
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Eduardo Bruera, Janet L. Williams, Yu Jung Kim, Marvin Omar Delgado-Guay, Gary B. Chisholm, Seong Hoon Shin, and Julio Allo
- Subjects
Male ,medicine.medical_specialty ,Constipation ,Palliative care ,Context (language use) ,Tertiary Care Centers ,Neoplasms ,Outpatients ,medicine ,Ambulatory Care ,Outpatient clinic ,Humans ,General Nursing ,business.industry ,Palliative Care ,Cancer ,Emergency department ,Middle Aged ,medicine.disease ,Advanced cancer ,Anesthesiology and Pain Medicine ,Logistic Models ,Emergency medicine ,Multivariate Analysis ,Female ,Neurology (clinical) ,Medical emergency ,medicine.symptom ,business ,Emergency Service, Hospital - Abstract
Admissions to the emergency department (ED) can be distressing to patients with advanced cancer receiving palliative care. There is limited research about the clinical characteristics of these patients and whether these ED visits can be categorized as avoidable or unavoidable.To determine the frequency of potentially avoidable ED visits (AvEDs) for patients with advanced cancer receiving outpatient palliative care in a large tertiary cancer center, identify the clinical characteristics of the patients receiving palliative care who visited the ED, and analyze the factors associated with AvEDs and unavoidable ED visits (UnAvEDs).We randomly selected 200 advanced cancer patients receiving treatment in the outpatient palliative care clinic of a tertiary cancer center who visited the ED between January 2010 and December 2011. Visits were classified as AvED (if the problem could have been managed in the outpatient clinic or by telephone) or UnAvED.Forty-six (23%) of 200 ED visits were classified as AvED, and 154 (77%) of 200 ED visits were classified as UnAvED. Pain (71/200, 36%) was the most common chief complaint in both groups. Altered mental status, dyspnea, fever, and bleeding were present in the UnAvED group only. Infection, neurologic events, and cancer-related dyspnea were significantly more frequent in the UnAvED group, whereas constipation and running out of pain medications were significantly more frequent in the AvED group (P0.001). In a multivariate analysis, AvED was associated with nonwhite ethnicity (odds ratio [OR] 2.66; 95% CI 1.26, 5.59) and constipation (OR 17.08; 95% CI 3.76, 77.67), whereas UnAvED was associated with ED referral from the outpatient oncology or palliative care clinic (OR 0.24; 95% CI 0.06, 0.88) and the presence of baseline dyspnea (OR 0.46; 95% CI 0.21, 0.99).Nearly one-fourth of ED visits by patients with advanced cancer receiving palliative care were potentially avoidable. Proactive efforts to improve communication and support between scheduled appointments are needed.
- Published
- 2014
50. 'I don't want to burden my family': handling communication challenges in geriatric oncology
- Author
-
M. De la Cruz, Marvin Omar Delgado-Guay, and Daniel E. Epner
- Subjects
Aged, 80 and over ,Aging ,Physician-Patient Relations ,Terminal Care ,Palliative care ,business.industry ,media_common.quotation_subject ,Palliative Care ,Empathy ,Hematology ,Silence ,Dignity ,Jargon ,Oncology ,Geriatric oncology ,Nursing ,Neoplasms ,Medicine ,Humans ,Active listening ,Conversation ,Female ,business ,media_common - Abstract
Oncologists need excellent communication skills to effectively handle challenging conversations regarding prognosis, transition to palliative care, code status, and other sensitive topics. Foundational skills include: 1) posing open-ended, exploratory questions, 2) allowing for appropriate silence in the conversation, 3) listening actively, 4) recognizing emotions, 5) responding to emotions with empathy rather than biomedical information, and 6) speaking with clarity by avoiding technical jargon and offering small chunks of information. Conversations about sensitive topics can be particularly challenging with geriatric patients, who experience functional and sensory limitations. The risk-benefit ratio of diagnostic and therapeutic interventions tips precariously in older patients as many develop geriatric syndromes. Older cancer patients have the unique perspective of looking back on a long life and looking forward to impending death. Higher order skills can be very powerful in helping geriatric cancer patients find meaning and dignity at the end of life. These skills include exploring spirituality and coping strategies and engaging the patient in conversation and reflection about their legacy.
- Published
- 2013
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