Palliative Care Approach to End of Life

Extract

[...] immediately after announcing his decision to stop chemotherapy. Can the patient benefit from alternative treatments that are more beneficial? [...]

[...] In an editorial in the journal Annals of Oncology 2345-2348, 2011), the author S. Braga revisits this practice, which he also adopts in his oncology department in Portugal, and emphasizes that there is little contradictory scientific data to guide medical treatment decisions in this context. According to his initial analysis, it appears that about one in five patients with cancer is under chemotherapy in the last month of their life, without clear benefit, for example, on the lengthening of life, and sometimes with significant negative consequences, such as increased toxicity of treatments, impaired quality of life, and significant costs. [...]

[...] However, these devices seem to have improved hospital survival expectancy compared to other procedures. The authors conclude that there are not yet enough studies to provide evidence of the improvement of the health status and quality of life of patients through the use of NGT, in patients receiving palliative care. They recommend in this matter personalized decision-making, on a case-by-case basis, evaluating as precisely as possible the benefits and drawbacks of such devices for the patient's quality of life. [...]

[...] The clarity and quality of the information provided to the patient, which corresponds to his request and takes into account his psychological state, seem, according to published studies, to be a key element to consider in the doctor's communication with his patient. It appears that the closer proximity between the healthcare staff and the patient interferes with the ability to communicate unpleasant news. These data may explain the discomfort I felt with my referring nurse to re-establish communication with Mr. [...]

[...] Regarding the question of maintaining or not maintaining the nasogastric tube (NGT) in patients receiving palliative care, recent studies allow for the evaluation of the benefits and drawbacks of this device, compared also to the use of a percutaneous endoscopic gastrostomy (PEG) articles were reviewed, to select for a more precise examination. The use of nasogastric tube in palliative care seems to have led to fewer episodes of diarrhea and more restrictions than patients who did not use these tubes. In addition, the use of the tube increased hospital admissions. No statistical difference was found between the use of tubes (NGT and PEG) or not, in terms of symptom treatment, comfort level, and end-of-life satisfaction in patients. [...]