When to intervene is key for end-of-life care
When to intervene is key for end-of-life care
Nursing institute seeks more study
The National Institute of Nursing Research is seeking grant applications for advanced research on end-of-life treatment issues.
The call for applications came with the release of a report citing the lack of research on end-of-life issues and noting that the question is not just a matter of whether to intervene but when intervention should take place. The report is based on a workshop held last year that featured leading experts on palliative care and death and dying. (For information on other end-of-life initiatives, see story, p. 56.)
Patricia A. Grady, director of the National Institute of Nursing Research, says the report signals a commitment to investing resources in the development of new tools to assess symptoms and evaluate treatments. "These tools will enable us to clarify the extent of the problem and to set national priorities to improve quality of life for those facing terminal illness," she says.
The report's major conclusion is that end-of-life symptoms occur in combination and are interconnected, but more study must be done on those relationships. For example, cachexia affects dyspnea because the chest muscles become weaker. Opioids, a class of drugs used to treat pain, also may lessen dyspnea but worsen cognitive function.
The report calls for more epidemiologic research and basic and clinical studies of common symptoms in terminal illness. It also recommends examining the following:
· ethical issues, such as community and individual preferences about symptom management of dying patients;
· barriers to end-of-life research for vulnerable populations, including economic issues such as the direct and indirect costs and burdens of symptoms.
The institute also issued a call for grant applications to study end-of-life symptoms.
Co-sponsors include these divisions of the National Institutes of Health (NIH) in Bethesda, MD: the National Cancer Institute, the National Institute of Allergy and Infectious Diseases, the National Institute of Mental Health, and the Office of Alternative Medicine. While the studies will address pain, they also will focus on symptoms such as dyspnea, cognitive disturbances, and cachexia, which have lagged far behind in research funding.
June Lunney, MD, a scientific program admin istrator in the institute's Division of Extramural Activities, says a major issue is "intervening at the appropriate point in the trajectory of dying to max imize quality of life right up until death occurs."
The research project, she says, achieved three principal goals: It summarized the current state of knowledge about the most common symptoms associated with terminal illness, identified important needs and opportunities for research appropriate for NIH funding, and began a process for enhancing interdisciplinary and interagency collaboration in research on palliative care.
Previously, the symptoms of dying have been regarded as an inevitable part of the process. But the report states there is evidence that these symptoms can be alleviated. Many experts in palliative care believe the real question is not one of inevitability but rather when and how to intervene. For example, cachexia may be somewhat acceptable to patients and families, especially in the final days before death. However, it can interfere with functioning in the weeks and months before death when intervention might prolong independence.
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.