Applied Sciences

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Dear Colleagues,

Patients' quality of life has become one of the most important purposes of medical practice and scientific research.

With the increasing life expectancy and remarkable achievements in the medical field, finding out and offering better solutions has become an outstanding aim for improving life quality in patients with different chronic, progressive diseases, as well as for supporting and preventing the burden of care in their families.

This Special Issue aims to address the current concern in identifying the most appropriate supportive and palliative interventions of health professionals in order to provide better quality of life for their patients.

Topics may include studies on palliative medicine, on cancer and non-cancer diseases, and supportive treatment for patients facing serious illnesses.

Prof. Dr. Vladimir Poroch
Guest Editor

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Keywords

quality of life
palliative medicine
supportive interventions
multidisciplinarity and holistic approach
symptom control
chronic progressive diseases
burden of care prevention

Published Papers (2 papers)

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Research

10 pages, 539 KiB

Open AccessArticle

Health Care Resource Use at End of Life in Patients with Advanced Lung Cancer

by Kersti Oselin, Heti Pisarev, Keit Ilau and Raul-Allan Kiivet

Appl. Sci. 2021, 11(19), 9301; https://doi.org/10.3390/app11199301 - 7 Oct 2021

Viewed by 1261

Abstract

We aimed to study differences in the use of health care resources in relation to time before death in patients with advanced lung cancer who either received systemic anti-cancer treatment (SACT) or were ineligible for SACT. A retrospective cohort of lung cancer patients (N = 778) diagnosed with advanced disease at North Estonia Medical Centre from 2015–2017 was linked to population-based health care data. We calculated a composite measure of cumulative resource use, comprised from the following: outpatient care, emergency department (ED) visit, inpatient care, admission to intensive care unit, nursing care and prescriptions. Costs were highest in patients who received SACT in the last month before death and decreased in parallel with the time elapsed from the last SACT. Only 20% of SACT patients received nursing care in the final month of life. The no-SACT patients had less time covered by health care services per month, and large differences were seen in the type of service received by the study groups. The largest contributor of health care costs at end of life was acute inpatient care, including approximately 10% of patients who died on the same day as or day following the emergency department visit. These results demonstrate the low nursing care and hospice utilization rates in Estonia. Full article

(This article belongs to the Special Issue Supportive Care and Palliative Medicine Interventions in Improving Quality of Life)

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11 pages, 962 KiB

Open AccessArticle

Comparison of Palliative Care Models in Idiopathic Pulmonary Fibrosis

by Sarah Younus, Jeffrey A. Bakal, Janice Richman-Eisenstat, Ghadah Alrehaili, Sharina Aldhaheri, Michelle Morales, Naomi Rippon, Elisabeth Bendstrup, Ingrid Harle, Onofre Moran-Mendoza, Shaney L. Barratt, Huzaifa Adamali and Meena Kalluri

Appl. Sci. 2021, 11(19), 9028; https://doi.org/10.3390/app11199028 - 28 Sep 2021

Cited by 2 | Viewed by 2170

Abstract

Introduction: Palliative care (PC) is recommended in idiopathic pulmonary fibrosis (IPF) patients but poorly implemented. Integration of PC into routine management by pulmonologists may improve overall and end-of-life (EOL) care, but the optimal model of PC delivery is unknown. Objective: To describe three PC care delivery models and their impact on EOL; the Multidisciplinary Collaborative ILD clinic, Edmonton, Canada (EC) and the Bristol ILD Service, UK (BC) that provide primary level PC; and the Queen’s University ILD Clinic, Kingston, Canada (QC), which refers IPF patients to a specialist PC Clinic using specific referral criteria. Methods: A multicenter retrospective observational study of IPF patients receiving care in the identified clinics (2012–2018) was designed. Demographics; PC delivery, including symptom management; advance care planning (ACP); and location of death data were examined. Results: 298 IPF patients were included (EC 95, BC 84, and QC 119). Median age was 71 years with 74% males. Overall, 63% (188) patients received PC. Primary PC approach in EC and BC led to more patients receiving PC (98% EC, 94% BC and 13% QC (p < 0.001/<0.001)) with earlier initiation compared to QC. Associated higher rates of non-pharmacologic dyspnea management [98% EC, 94% BC, and 2% QC (p < 0.001/<0.001); opioids (45% EC and BC, and 23% QC (p < 0.001/<0.001)); and ACP (100% EC and BC, and 13% QC patients (p < 0.001/<0.001))] were observed. Median follow up (IQR) was 16 months (5–28) with 122 deaths (41%). Primary PC model in EC and BC decedents was associated with more PC delivery (91% EC, 92% BC and 19% QC (p < 0.001)) with more symptoms management, oxygen, and opiate use than QC (p < 0.001; p = 0.04; p = 0.01). EOL discussions occurred in 73% EC, 63% BC, and 4% QC decedents (p = 0.001). Fifty-nine% (57) died at home or hospice and 38% (36) in hospitals. Concordance rate between preferred and actual location of death was 58% in EC (0.29 (−0.02–0.51)) and 37% in BC models (−0.11 (−0.20–0.15)). Conclusions: Primary PC approach for IPF is feasible in ILD clinics with concurrent disease management and can improve access to symptom management, ACP, PC and EOL care. Reliance on PC specialist referral for PC initiation outside of the ILD clinic can result in delayed care. Full article

(This article belongs to the Special Issue Supportive Care and Palliative Medicine Interventions in Improving Quality of Life)

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