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Palliative Medicine

Alex Chan, Isabel Chien, Edward Moseley, Saad Salman, Sarah Kaminer Bourland, Daniela Lamas, Anne M Walling, James A Tulsky, Charlotta Lindvall
BACKGROUND: Timely documentation of care preferences is an endorsed quality indicator for seriously ill patients admitted to intensive care units. Clinicians document their conversations about these preferences as unstructured free text in clinical notes from electronic health records. AIM: To apply deep learning algorithms for automated identification of serious illness conversations documented in physician notes during intensive care unit admissions. DESIGN: Using a retrospective dataset of physician notes, clinicians annotated all text documenting patient care preferences (goals of care or code status limitations), communication with family, and full code status...
November 14, 2018: Palliative Medicine
Mie Nordly, Kirstine Skov Benthien, Eva S Vadstrup, Geana P Kurita, Annika B von Heymann-Horan, Hans von der Maase, Christoffer Johansen, Helle Timm, Jakob Kjellberg, Per Sjøgren
BACKGROUND: The focus of specialized palliative care is to improve quality of life for patients with incurable cancer and their relatives including an increased opportunity to make their own choice of place of care and death. AIM: To investigate whether a systematic fast-track transition from oncological treatment to specialized palliative care at home for patients with incurable cancer reinforced with a psychological dyadic intervention could result in more time spent at home and death at home...
November 12, 2018: Palliative Medicine
Szilvia Vas, Rachel Povey, David Clark-Carter
BACKGROUND: Illness adjustment is a widely studied area in the palliative care context. However, research focussing on how altered body image can affect men and women in palliative care is limited and unclear. AIM: To explore the links between palliative care patients' affected sense of self, altered body image and terminal illness adjustment. DESIGN: Semi-structured interviews were conducted, and the Interpretative Phenomenological Analysis approach was used to analyse patients' experiences...
November 12, 2018: Palliative Medicine
Jonathan Hindmarsh, Sharlene Hindmarsh, Mark Lee, Richard Telford
BACKGROUND: This case report describes a patient with known idiopathic Parkinson's disease, being managed with transdermal rotigotine, whose refractory nausea and vomiting was successfully controlled with subcutaneous levomepromazine. No drug-induced extrapyramidal side effects emerged. CASE PRESENTATION: A patient was found to have a locally advanced serous carcinoma, causing secondary bowel obstruction. Furthermore, due to compromised oral access, the patient's oral antiparkinsonian medications for motor control were converted to transdermal rotigotine...
November 8, 2018: Palliative Medicine
Marcus Sellars, Olivia Chung, Linda Nolte, Allison Tong, Dimity Pond, Deirdre Fetherstonhaugh, Fran McInerney, Craig Sinclair, Karen M Detering
BACKGROUND: Advance care planning aims to ensure that care received during serious and chronic illness is consistent with the person's values, preferences and goals. However, less than 40% of people with dementia undertake advance care planning internationally. AIM: This study aims to describe the perspectives of people with dementia and their carers on advance care planning and end-of-life care. DESIGN: Systematic review and thematic synthesis of qualitative studies...
November 8, 2018: Palliative Medicine
Jason W Boland, Victoria Allgar, Elaine G Boland, Stein Kaasa, Marianne J Hjermstad, Miriam J Johnson
BACKGROUND: Performance status, a predictor of cancer survival, and ability to maintain independent living deteriorate in advanced disease. Understanding predictors of performance status trajectory could help identify those at risk of functional deterioration, target support for independent living and reduce service costs. The relationship between symptoms, analgesics and performance status is poorly delineated. AIM: The aim of this study is to determine whether demographics, analgesics, disease characteristics, quality-of-life domains and C-reactive protein predict the trajectory of Karnofsky Performance Status (KPS) in patients with advanced cancer...
November 8, 2018: Palliative Medicine
Penny Franklin, Anne Arber, Liz Reed, Emma Ream
BACKGROUND: Children need to be prepared for the death of a parent and supported afterwards. Parents seek support from health and social care professionals to prepare their children. Support is not always forthcoming. AIM: To systematically identify, analyse and synthesise literature reporting of the experiences of health and social care professionals when supporting parents and children during, and following, the death of a parent. DESIGN: A systematically constructed qualitative review and thematic synthesis...
October 29, 2018: Palliative Medicine
Claud Regnard, Amy Proffitt
No abstract text is available yet for this article.
October 29, 2018: Palliative Medicine
Sigrid Dierickx, Luc Deliens, Joachim Cohen, Kenneth Chambaere
No abstract text is available yet for this article.
October 29, 2018: Palliative Medicine
Naomi T Katz, Bronwyn H Sacks, Brian H Le, Jenny L Hynson
BACKGROUND: Distressing and potentially life-threatening events, such as significant external bleeding, may occur in patients with a known terminal condition. These events are often referred to as catastrophic or crisis events. Pharmacological management varies and there is little evidence to guide practice. AIM: The aim of this study was to explore Australasian palliative medicine doctors' approaches to pre-emptive prescription of medications to manage catastrophic events...
October 29, 2018: Palliative Medicine
Aileen Collier, Michael Hodgins, Gregory Crawford, Alice Every, Kerrie Womsley, Catherine Jeffs, Pat Houthuysen, Srey Kang, Elizabeth Thomas, Valerie Weller, Cindy Van, Caroline Farrow, Ann Dadich
BACKGROUND: Despite the increasing number of people requiring palliative care at home, there is limited evidence on how home-based palliative care is best practised. AIM: The aim of this participatory qualitative study is to determine the characteristics that contribute to brilliant home-based palliative care. DESIGN: This study was inspired by the brilliance project - an initiative to explore how positive organisational scholarship in healthcare can be used to study brilliant health service management from the viewpoint of patients, families, and clinicians...
October 26, 2018: Palliative Medicine
Cheng-Pei Lin, Catherine J Evans, Jonathan Koffman, Jo Armes, Fliss E M Murtagh, Richard Harding
BACKGROUND: No systematic review has focused on conceptual models underpinning advance care planning for patients with advanced cancer, and the mechanisms of action in relation to the intended outcomes. AIM: To appraise conceptual models and develop a logic model of advance care planning for advanced cancer patients, examining the components, processes, theoretical underpinning, mechanisms of action and linkage with intended outcomes. DESIGN: A systematic review of randomised controlled trials was conducted, and was prospectively registered on PROSPERO...
October 26, 2018: Palliative Medicine
Jen-Kuei Peng, Nilay Hepgul, Irene J Higginson, Wei Gao
BACKGROUND: End-stage liver disease is a common cause of morbidity and mortality worldwide, yet little is known about its symptomatology and impact on health-related quality of life. AIM: To describe symptom prevalence and health-related quality of life of patients with end-stage liver disease to improve care. DESIGN: Systematic review. DATA SOURCES: We searched eight electronic databases from January 1980 to June 2018 for studies investigating symptom prevalence or health-related quality of life of adult patients with end-stage liver disease...
October 22, 2018: Palliative Medicine
Katrina Breaden, Aileen Collier, Caroline Litster, Peter Allcroft, David C Currow, Jane L Phillips
BACKGROUND: Chronic breathlessness syndrome in the context of advancing disease is distressing for all concerned. Oxygen is commonly prescribed in this setting; however, little is known about the perspectives of breathless people who either are on oxygen or are yet to have it prescribed. AIM: To understand and describe the perspectives and experiences of breathless people towards oxygen use at home. DESIGN: This qualitative study utilised an interpretive description approach using semi-structured interviews and thematic analysis...
October 9, 2018: Palliative Medicine
Ravi Taneja, Lisa Y Faden, Valerie Schulz, Asha Rawal, Kristina Miller, Kristen A Bishop, Lorelei Lingard
BACKGROUND: Most laypeople have not engaged in any advance care planning. Yet they are expected to articulate choices for life-sustaining interventions when they need admission to an acute care hospital in Canada. AIM: To describe how laypeople understand and make decisions for life-sustaining interventions when engaging in advance care planning. DESIGN: Semi-structured interviews using constructivist grounded theory methodology and purposive sampling...
October 4, 2018: Palliative Medicine
Lara Pivodic, Tinne Smets, Nele Van den Noortgate, Bregje D Onwuteaka-Philipsen, Yvonne Engels, Katarzyna Szczerbińska, Harriet Finne-Soveri, Katherine Froggatt, Giovanni Gambassi, Luc Deliens, Lieve Van den Block
BACKGROUND: Nursing homes are among the most common places of death in many countries. AIM: To determine the quality of dying and end-of-life care of nursing home residents in six European countries. DESIGN: Epidemiological survey in a proportionally stratified random sample of nursing homes. We identified all deaths of residents of the preceding 3-month period. MAIN OUTCOMES: quality of dying in the last week of life (measured using End-of-Life in Dementia Scales - Comfort Assessment while Dying (EOLD-CAD)); quality of end-of-life care in the last month of life (measured using Quality of Dying in Long-Term Care (QoD-LTC) scale)...
October 1, 2018: Palliative Medicine
Anouk Overbeek, Suzanne Polinder, Juanita Haagsma, Pascalle Billekens, Kim de Nooijer, Bernard J Hammes, Daniel Muliaditan, Agnes van der Heide, Judith Ac Rietjens, Ida J Korfage
BACKGROUND: Advance Care Planning aims at improving alignment of care with patients' preferences. This may affect costs of medical care. AIM: To determine the costs of an Advance Care Planning programme and its effects on the costs of medical care and on concordance of care with patients' preferences. Design/settings/participants: In a cluster randomised trial, 16 residential care homes were randomly allocated to the intervention group, where frail, older participants were offered facilitated Advance Care Planning conversations or to the control group...
October 1, 2018: Palliative Medicine
Miriam J Johnson
No abstract text is available yet for this article.
October 1, 2018: Palliative Medicine
Nikki McCaffrey, Thomas Flint, Billingsley Kaambwa, Belinda Fazekas, Debra Rowett, David C Currow, Janet Hardy, Meera R Agar, Steve Quinn, Simon Eckermann
BACKGROUND: Treating chronic, uncontrolled, cancer pain with subcutaneous ketamine in patients unresponsive to opioids and co-analgesics remains controversial, especially in light of recent evidence demonstrating ketamine does not have net clinical benefit in this setting. AIM: To evaluate the cost-effectiveness of subcutaneous ketamine versus placebo in this patient population. DESIGN AND SETTING: A within-trial cost-effectiveness analysis of the Australian Palliative Care Clinical Studies Collaborative's randomised, double-blind, placebo-controlled trial of ketamine was conducted from a healthcare provider perspective...
October 1, 2018: Palliative Medicine
Hazel Coop, Clare Marlow
No abstract text is available yet for this article.
September 27, 2018: Palliative Medicine
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