Our understanding of terminal illness and its consequences has been predominantly based on models derived from expert definition, rather than the patient's perspective. More recently, quality of life tools have been developed to enable patient choice in responses. However, an even broader approach may be needed to help identify goals for care for patients who are terminally ill.The aim of this paper is to report on an exploratory, qualitative study exploring what people living with terminal illness considered were the areas of priority in their lives.Ten people living with terminal cancer were interviewed. Analysis of the interviews incorporated principles of narrative analysis and grounded theory.Over 30 categories were identified and collated into five inter-related themes (personal/intrinsic factors, external/extrinsic factors, future issues, perceptions of normality and taking charge) encompassing the issues of importance to all participants. Each theme focused on 'life and living' in relation to life as it was or would be without illness. Practical issues of daily living and the opportunity to address philosophical issues around the meaning of life emerged as important areas. The central theme, 'taking charge', concerned with people's levels of life engagement, was integrally connected to all other themes.The findings suggest that the way in which health professionals manage patients' involvement in matters such as symptom relief can impact on existential areas of concern. Understanding patients' perspectives in relation to each theme may assist health professionals to develop management strategies appropriate to their needs. The findings challenge some aspects of traditional 'expert-defined' outcome measures. As this was an exploratory study, further work is needed to test and develop the model presented.
Perinatal mood and anxiety disorders (PMADs; a spectrum of emotional and psychological complications that affect expectant or new parents) are among the most common mental health issues affecting working age adults across the globe. Although most people who experience PMADs self-identity as women, PMADs can affect people of all genders. Untreated PMADs have the potential to impact long-term mental and physical health, the health and development of their children, and are among the leading causes of morbidity and mortality worldwide. The negative psychosocial outcomes associated with PMADs, coupled with their significant economic losses, represent significant public health concerns that warrant broader attention and support. In this chapter, we summarize PMADs and one such source of support: employment. We explore how organizational policies, management practices, and inclusive, non-stigmatizing workplace climates can reduce the consequences of PMADs and support workers in seeking and receiving treatment.
Abstract Aims Cancer cachexia is a condition often seen in end stage Non‐Small Cell Lung Cancer (NSCLC) patients. Recent developments include the use of pharmaceutical agents and/or exercise to induce stability/hypertrophy of muscle volume. This requires accurate assessment of the change in both quantity and quality of the muscle during cancer cachexia clinical studies. Magnetic Resonance Imaging (MRI) is appropriately placed to address both of these factors. The present study aimed to investigate total quadriceps muscle volume change by 3T MRI within a cancer cachexia clinical study. Methods and results A uckland's C ancer C achexia e valuating R esistance T raining ( ACCeRT ) study is a randomised controlled feasibility study investigating eicosapentaenoic acid (EPA) and cyclo‐oxygenase‐2 (COX‐2) inhibitor (celecoxib) (Arm A) versus EPA, COX‐2 inhibitor (celecoxib), Progressive Resistance Training (PRT) plus essential amino acids (EAAs) high in leucine (Arm B) in NSCLC cachectic patients. All participants underwent 3T MRI scanning at baseline and at last or end of trial (EOT) visit. Analysis showed a mean total quadriceps muscle volume percentage change from baseline to EOT of +12.5% (Arm A), compared with −3% (Arm B). There was a difference in muscle volume between genders. Arm B participant data showed a percentage change of +4.2% within females (n=2) compared with −10.2% (n=2) within males at EOT visit. All EOT results suggests the use of EPA and celecoxib +/‐ PRT and EAAs could potentially preserve muscle volume loss during refractory cachexia. Conclusions ACCeRT is the first study to utilise 3T MRI total quadriceps muscle volume within a cancer cachexia study, along with the first in an end‐stage/refractory cachexia population. These results can be used for baseline/reference for future cancer cachexia studies targeting the anabolic muscle pathways in end‐stage/refractory cachexia patients.
Men with prostate cancer experience many side effects and symptoms that may be improved by a physically active lifestyle. It was hypothesized that older men with prostate cancer who were physically active would report significantly higher levels of quality of life (QOL) as assessed by the WHOQOL-BREF and the WHOQOL-OLD. Of the 348 prostate cancer survivors who were invited to participate in the present postal survey, 137 men returned the questionnaires. Those who were physically active had significantly lower prostate specific antigen (PSA) scores and higher social participation than those insufficiently active. These findings offer some support for the benefits of physical activity (PA) within the prostate cancer population in managing the adverse side effects of their treatments on aspects of their QOL. Future research should more closely examine what types of PA best promote improvements in varying aspects of QOL and psychological well-being for prostate cancer survivors.
RÉSUMÉ Les navigateurs aident les adultes ruraux âgés avec des maladies avancées, ainsi que leurs familles, de se connecter aux ressources, à l’information, et aux gens qui peuvent améliorer leur qualité de vie. Cet article décrit le processus utilisé pour engager des experts—en vieillissement en milieu rural, les soins palliatifs en milieu rural, et la navigation—ainsi que les intervenants dans les collectivités rurales, d’élaborer une définition conceptuelle d’une telle navigation et de délimiter les compétences pertinentes pour la prise en charge de cette population. Un document de discussion sur les considérations importantes pour la navigation dans cette population a été développé, suivi d’un processus Delphi en quatre étapes avec 30 membres invités experts. Les résultats de l’étude ont abouti à cinq compétences générales de navigation pour les fournisseurs de soins de santé qui prennent soin des personnes âgées rurales et de leurs familles à la fin de vie: la capacité de fournir le dépistage des patients / famille; à préconiser pour le patient / famille; de faciliter les relations avec la communauté; de coordonner l’accès aux services et aux ressources; et de promouvoir l’engagement actif. Les compétences particulières ont également été développées. Ces compétences constituent la base pour la recherche et le développement de programmes d’études en navigation.
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