Browsing by Author "Abdul-Razzak, Amane"

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    Description of Continuous Palliative Sedation Practices in a Large Health Region and Comparison with Clinical Practice Guidelines
    (2019-09-03) Abdul-Razzak, Amane; Lemieux, Laurie; Snyman, Maggie; Perez, Grace; Sinnarajah, Aynharan
    Background: Published reports of continuous palliative sedation therapy (CPST) suggest heterogeneity in practice. There is a paucity of reports that compare practice with clinical guidelines. Objectives: To assess adherence of continuous palliative sedation practices with criteria set forth in local clinical guidelines, and to describe other features including prevalence, medication dosing, duration, multidisciplinary team involvement, and concurrent therapies. Design: Retrospective chart review. Settings/Subjects: We included cases in which a midazolam infusion was ordered at the end of life. Study sites included four adult hospitals in the Calgary health region, two hospices, and a tertiary palliative care unit. Measurements: Descriptive data, including proportion of deaths involving palliative sedation therapy, number of criteria documented, midazolam dose/duration, concurrent symptom management therapies, and referrals to spiritual care, psychology, or social work. Results: CPST occurred in 602 out of 14,360 deaths (4.2%). Full adherence to criteria occurred in 7% of cases. The most commonly missed criteria were: a "C2" goals-of-care designation order (comfort care focus in the imminently dying) (84%) and documentation of imminent death in the chart (55%). Concurrent medical therapies included opioids in 98% of cases and intravenous hydration in 85% of cases. Few referrals were made to multidisciplinary care teams. Conclusions: We found low adherence to palliative sedation guidelines. This may reflect the perception that some criteria are redundant or clinically unimportant. Future work could include a study of barriers to guideline uptake, and guideline modification to provide direction on concurrent therapies and multidisciplinary team involvement.
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    Feasibility of a multimodal exercise, nutrition, and palliative care intervention in advanced lung cancer
    (2021-02-13) Ester, Manuel; Culos-Reed, S. N; Abdul-Razzak, Amane; Daun, Julia T; Duchek, Delaney; Francis, George; Bebb, Gwyn; Black, Jennifer; Arlain, Audra; Gillis, Chelsia; Galloway, Lyle; Capozzi, Lauren C
    Abstract Background Advanced lung cancer patients face significant physical and psychological burden leading to reduced physical function and quality of life. Separately, physical activity, nutrition, and palliative symptom management interventions have been shown to improve functioning in this population, however no study has combined all three in a multimodal intervention. Therefore, we assessed the feasibility of a multimodal physical activity, nutrition, and palliative symptom management intervention in advanced lung cancer. Methods Participants received an individually tailored 12-week intervention featuring in-person group-based exercise classes, at-home physical activity prescription, behaviour change education, and nutrition and palliative care consultations. Patients reported symptom burden, energy, and fatigue before and after each class. At baseline and post-intervention, symptom burden, quality of life, fatigue, physical activity, dietary intake, and physical function were assessed. Post-intervention interviews examined participant perspectives. Results The multimodal program was feasible, with 44% (10/23) recruitment, 75% (75/100) class attendance, 89% (8/9) nutrition and palliative consult attendance, and 85% (17/20) assessment completion. Of ten participants, 70% (7/10) completed the post-intervention follow-up. Participants perceived the intervention as feasible and valuable. Physical activity, symptom burden, and quality of life were maintained, while tiredness decreased significantly. Exercise classes prompted acute clinically meaningful reductions in fatigue, tiredness, depression, pain, and increases in energy and well-being. Conclusion A multimodal physical activity, nutrition, and palliative symptom management intervention is feasible and shows potential benefits on quality of life that warrant further investigation in a larger cohort trial. Trial registration NCT04575831 , Registered 05 October 2020 – Retrospectively registered.
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    The Feasibility of a Physical Activity Intervention for Advanced Multiple Myeloma Patients: A Mixed Methods Study.
    (2019-06-04) Albinati, Natalia Kara Renee; Culos-Reed, Susan Nicole; Abdul-Razzak, Amane; McDonough, Meghan H.; Gyurcsik, Nancy C.
    Purpose: The primary aims of the Physical Activity in Advanced Cancer Treatment (PAACT) intervention were to 1) examine the feasibility of a group- and home-based PA program for individuals with advance multiple myeloma (MM) and 2) qualitatively explore the patient’s experience in the program. Secondary aims were to obtain preliminary data on physical fitness and patient-reported outcomes. Methods: In this single-arm study, advanced MM patients (DS stage II-III) participated in a 12-week aerobic and resistance training exercise program, along with the option of a palliative care consultation. Participants attended once-weekly group exercise classes and received individualized home-based exercise booklets. Semi-structured interviews were conducted both midway and at the end of the program with a subset of participants and a thematic analysis approach was utilized. Results: In total, 19 MM patients were enrolled. The program was feasible as demonstrated by recruitment (34.5%), attendance at group classes (72.9%), attrition (15.8%) and safety outcomes (no adverse events). Thematic analysis revealed that the main facilitators were the exercise instructors and the supportive social environment. Barriers included side-effects of cancer treatments and a lack of motivation for home exercise. The main impacts were the perceived benefits to well-being with control over one’s health and exercise behaviour emerging as a core theme. Palliative care consultations were appreciated and helpful, although symptom burden did not always warrant palliative care. Conclusion: Group-and home-based exercise is feasible for advanced MM survivors. Participant experiences indicated that there were numerous perceived physical and mental benefits to participation. These findings may be used to inform the design and implementation of larger PA trials to examine the efficacy of PA interventions and palliative care in this population.