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Palliative Medicine

Glenn Phair, Ashley Agus, Charles Normand, Kevin Brazil, Aine Burns, Paul Roderick, Alexander P Maxwell, Colin Thompson, Magdi Yaqoob, Helen Noble
BACKGROUND: Previous research has explored the cost of providing renal replacement therapies in patients with end-stage kidney disease and their quality of life. This is the first study to examine the healthcare costs of patients receiving conservative care without dialysis for end-stage kidney disease. This alternative to dialysis is an option for patients who prefer a supportive and palliative care approach. AIM: Descriptive cost and quality of life analyses alongside a UK-based multi-centre observational study in patients receiving conservative management for end-stage kidney disease...
May 1, 2018: Palliative Medicine
Anna Green, Natalia Jerzmanowska, Marguerite Green, Elizabeth A Lobb
BACKGROUND: Ethnic minority patients have unique challenges in accessing health services. These include language difficulties, unfamiliarity with the health system, lower rates of cancer screening and survival, higher rates of reported side effects from cancer treatment and poorer quality of life. Little is known about this patient group when transitioning to palliative care. AIM: To elicit the experiences of palliative care health professionals when providing care for patients from culturally and linguistically diverse backgrounds which differ from mainstream Australian language and culture...
May 1, 2018: Palliative Medicine
Samar M Aoun, Lauren J Breen, Ishta White, Bruce Rumbold, Allan Kellehear
AIMS: To determine who provides bereavement support in the community, what sources are perceived to be the most or least helpful and for what reason, and to identify the empirical elements for optimal support in developing any future compassionate communities approach in palliative care. DESIGN: A population-based cross-sectional investigation of bereavement experiences. Sources of support (informal, community and professional) were categorised according to the Public Health Model of Bereavement Support; most helpful reasons were categorised using the Social Provisions Scale, and least helpful were analysed using inductive content analysis...
May 1, 2018: Palliative Medicine
Sue Healy, Fiona Israel, Margaret Charles, Liz Reymond
BACKGROUND: Palliative care patients consistently nominate home as their preferred care environment. This is challenging without support from laycarers, especially if patients require subcutaneously administered symptom relief. Laycarers typically lack confidence with this task and request professional guidance. AIM: To explore differences in laycarers' confidence in administering subcutaneous injections depending upon whether a laycarer, registered nurse or pharmacist prepared injections for subsequent administration by laycarers...
May 1, 2018: Palliative Medicine
Naomi Dhollander, Luc Deliens, Simon Van Belle, Aline De Vleminck, Koen Pardon
BACKGROUND: To date, no randomised controlled trials on the integration of specialised palliative home care into oncology care have been identified. Information on whether existing models of integrated care are applicable to the home care system and how working procedures and skills of the palliative care teams might require adaptation is missing. AIM: To gain insight into differences between early and late involvement and the effect on existing working procedures and skills as perceived by palliative home care teams...
May 1, 2018: Palliative Medicine
Steven Vanderstichelen, Dirk Houttekier, Joachim Cohen, Yanna Van Wesemael, Luc Deliens, Kenneth Chambaere
BACKGROUND: Volunteers fulfil several roles in supporting terminally ill people and their relatives and can positively influence quality of care. Healthcare in many countries faces resource constraints and some governments now expect communities to provide an increasing proportion of palliative care. However, systematic insights into volunteer presence, tasks and training and organisational challenges for volunteerism are lacking. AIM: Describe organised volunteerism in palliative direct patient care across the Flemish healthcare system (Belgium)...
May 1, 2018: Palliative Medicine
Hsien Seow, Daryl Bainbridge
BACKGROUND: Interprofessional specialized palliative care teams at home improve patient outcomes, reduce healthcare costs, and support many patients to die at home. However, practical details about how to develop home-based teams in different regions and health systems are scarce. AIM: To examine how a variety of home-based specialized palliative care teams created and grew their team over time and to identify critical steps in their evolution. DESIGN: A qualitative study was designed based on a grounded theory approach, using semi-structured interviews and other documentation...
May 1, 2018: Palliative Medicine
Benoît F Leheup, Stéphanie Ducousso, Stéphane Picard, Raphaël Alluin, Christophe Goetz
BACKGROUND: The subcutaneous route is widely used in both palliative care and geriatrics. Numerous compounds are administered by this route, including paracetamol. However, there is no recommendation on which to base this latter practice and, in the absence of published evidence, nothing is known regarding its local tolerability in palliative care patients. AIM: The main objective of this study was to assess the local tolerability of paracetamol when administered subcutaneously for analgesic or antipyretic purposes in patients hospitalized in the palliative care unit...
May 1, 2018: Palliative Medicine
Jason W Boland, Miriam Johnson, Diana Ferreira, David J Berry
BACKGROUND: Morphine can cause central nervous system side effects which impair driving skills. The legal blood morphine concentration limit for driving is 20 µg/L in France/Poland/Netherlands and 80 µg/L in England/Wales. There is no guidance as to the morphine dose leading to this concentration. AIM: The in silico (computed) relationship of oral morphine dose and plasma concentration was modelled to provide dose estimates for a morphine plasma concentration above 20 and 80 µg/L in different patient groups...
May 1, 2018: Palliative Medicine
Sarah Russell
Since the latter part of the twentith century, international research, education and practice of advance care planning has experienced a diversity of developments and defintions. Whilst this variety may seem bewildering, a continued commitment to accurate, focussed research enables better care through better understanding and better evidence.
May 1, 2018: Palliative Medicine
Ben Hughes, Mary R O'Brien, Anita Flynn, Katherine Knighting
BACKGROUND: An increasing number of young people are living with life-limiting conditions. Current research about advance care planning for young people indicates differing experiences for those involved. Understanding how far young people are engaged in their own advance care plan is important to shape future practice and facilitate young people's wishes. AIM: To identify and assess the current evidence to determine the barriers and facilitators to the engagement of young people in their own advance care planning process...
May 1, 2018: Palliative Medicine
Tabitha Thomas, Gemma Clarke, Stephen Barclay
BACKGROUND: Discharge from inpatient palliative care units to long-term care can be challenging. In the United Kingdom, hospice inpatients move to a care home if they no longer require specialist palliative care and cannot be discharged home. There is evidence to suggest that patients and families find the prospect of such a move distressing. AIM: To investigate the issues that arise when patients are transferred from hospice to care home at the end of life, from the perspective of the hospice multidisciplinary team...
April 1, 2018: Palliative Medicine
Jingyi Chen, Yazhu Lin, Jie Yan, Yong Wu, Rong Hu
BACKGROUND: Terminal illness not only causes physical suffering but also spiritual distress. Spiritual care has been widely implemented by healthcare professionals to assist patients coping with spiritual distress. However, the effects of spiritual care need to be clear. AIM: To evaluate the effects of spiritual care on quality of life and spiritual well-being among patients with terminal illness. DESIGN: Systematic review according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance...
April 1, 2018: Palliative Medicine
Miriam J Johnson, Paula McSkimming, Alex McConnachie, Claudia Geue, Yvonne Millerick, Andrew Briggs, Karen Hogg
BACKGROUND: The effectiveness of cardiology-led palliative care is unknown; we have insufficient information to conduct a full trial. AIM: To assess the feasibility (recruitment/retention, data quality, variability/sample size estimation, safety) of a clinical trial of palliative cardiology effectiveness. DESIGN: Non-randomised feasibility. SETTING/PARTICIPANTS: Unmatched symptomatic heart failure patients on optimal cardiac treatment from (1) cardiology-led palliative service (caring together group) and (2) heart failure liaison service (usual care group)...
April 1, 2018: Palliative Medicine
Lenzo Robijn, Jane Seymour, Luc Deliens, Ida Korfage, Jayne Brown, Peter Pype, Agnes Van Der Heide, Kenneth Chambaere, Judith Rietjens
BACKGROUND: Involving patients in decision-making is considered to be particularly appropriate towards the end of life. Professional guidelines emphasize that the decision to initiate continuous sedation should be made in accordance with the wishes of the dying person and be preceded by their consent. AIM: To describe the decision-making process preceding continuous sedation until death with particular attention to the involvement of the person who is dying. DESIGN: Qualitative case studies using interviews...
April 1, 2018: Palliative Medicine
Lisa Ann Williams, Tess Moeke-Maxwell, Janine Wiles, Stella Black, Gabriella Trussardi, Ngaire Kerse, Merryn Gott
BACKGROUND: A key challenge in meeting the palliative care needs of people in advanced age is the multiple healthcare and social service agencies typically involved in their care. The 'patient navigator' model, originally developed in cancer care, is the professional solution most often recommended to address this challenge. However, little attention has been paid, or is known, about the role that family carers play in enabling their dying relatives to negotiate service gaps. AIM: To explore the role family caregivers play in helping people dying in advanced old age navigate health services at the end of life...
April 1, 2018: Palliative Medicine
Anne-Lore Scherrens, Kim Beernaert, Lenzo Robijn, Luc Deliens, Nele S Pauwels, Joachim Cohen, Benedicte Deforche
BACKGROUND: It is necessary to understand behaviours that contribute to improvement in the quality of end-of-life care; use of behavioural theories allows identification of factors underlying end-of-life care behaviour, but little is known about the extent to which, and in what manner, these theories are used in an end-of-life care research context. AIM: To assess the number of end-of-life care studies that have used behavioural theories, which theories were used, to what extent main constructs were explored/measured and which behavioural outcomes were examined...
March 1, 2018: Palliative Medicine
Jenny Kitzinger, Celia Kitzinger
BACKGROUND: Families of patients in vegetative or minimally conscious states are often horrified by the suggestion of withdrawing a feeding tube, even when they believe that their relative would not have wanted to be maintained in their current condition. Very little is known about what it is like to witness such a death. AIM: To understand these families' experience of their relatives' deaths. DESIGN: Qualitative study using in-depth narrative interviews analyzed inductively with thematic analysis...
March 1, 2018: Palliative Medicine
Eva Schildmann, Sebastian Pörnbacher, Helen Kalies, Claudia Bausewein
BACKGROUND: Sedatives are frequently used towards the end of life. However, there is scarce information when their use is labelled as 'palliative sedation'. AIM: To assess the use and labelling of 'continuous administration of sedatives within the last 7 days of life', based on objective operational criteria, on a palliative care unit. DESIGN: Retrospective cohort study, using medical records. Explorative statistical analysis (SPSS 23). SETTING/PARTICIPANTS: Patients who died on a palliative care unit from August 2014 to July 2015...
March 1, 2018: Palliative Medicine
Judith Ac Rietjens, Johannes Jm van Delden, Agnes van der Heide
No abstract text is available yet for this article.
March 1, 2018: Palliative Medicine
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