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BMJ Supportive & Palliative Care

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https://www.readbyqxmd.com/read/28270396/affording-opportunities-to-discuss-deterioration-in-paediatric-palliative-care-consultations-a-conversation-analytic-study
#1
Stuart Ekberg, Susan Danby, Anthony Herbert, Natalie K Bradford, Patsy Yates
OBJECTIVE: Discussing the potential deterioration of a child who has a life-limiting condition has recognised benefits for future care, but can be challenging in a clinical context where uncertain illness trajectories are common. Existing research is restricted to indirect forms of evidence such as self-report data from clinicians and families. This study directly explores how discussions about deterioration are managed within actual paediatric palliative care consultations. METHODS: 9 consultations were video recorded in an Australian paediatric palliative care service...
March 7, 2017: BMJ Supportive & Palliative Care
https://www.readbyqxmd.com/read/28270395/leaky-pipeline-gender-bias-self-selection-or-all-three-a-quantitative-analysis-of-gender-balance-at-an-international-palliative-care-research-conference
#2
Katherine E Sleeman, Jonathan Koffman, Irene J Higginson
OBJECTIVES: The 'leaky pipeline' in academia is a clearly described phenomenon, but has not been examined in palliative care. We analysed the gender balance of speakers at the 9th World Research Congress of the European Association of Palliative Care (EAPC) to test the null hypothesis that there is no difference in the proportion of women and men with senior academic visibility in palliative care conference programmes. METHODS: The final programme of the 2016 EAPC World Congress was examined, and the gender of each speaker was recorded...
March 7, 2017: BMJ Supportive & Palliative Care
https://www.readbyqxmd.com/read/28258162/developing-a-model-for-embedded-palliative-care-in-a-cancer-clinic
#3
Susan DeSanto-Madeya, David McDermott, Jessica A Zerillo, Nancy Weinstein, Mary K Buss
OBJECTIVES: Describe the development and key features of a model for embedded palliative care (PC) for patients with advanced kidney cancer or melanoma seen in a cancer clinic. METHODS: Retrospective chart review of patients following an initial phase and then a prospective review following the implementation of a model for embedded PC. RESULTS: In the initial phase, 18 patients were seen for a total of 53 visits; 78% were seen more than once, with a mean of three visits per patient...
March 3, 2017: BMJ Supportive & Palliative Care
https://www.readbyqxmd.com/read/28255070/patient-values-informing-medical-treatment-a-pilot-community-and-advance-care-planning-survey
#4
S Milnes, C Corke, N R Orford, M Bailey, J Savulescu, D Wilkinson
Medicine regards the prevention of death as an important priority. Yet patients may have a range of priorities of equal or greater importance. These other priorities are often not discussed or appreciated by treating doctors. OBJECTIVES: We sought to identify priorities of care for patients attending an advance care planning (ACP) clinic and among the general population, and to identify factors associated with priorities other than prolonging life. METHODS: We used a locally developed survey tool 'What Matters Most' to identify values...
March 2, 2017: BMJ Supportive & Palliative Care
https://www.readbyqxmd.com/read/28255069/sexual-well-being-in-cancer-and-palliative-care-an-assessment-of-healthcare-professionals-current-practice-and-training-needs
#5
Aoife Gleeson, Emily Hazell
: Sexual well-being is often significantly affected by cancer and its treatments. Previous research shows that a patient's sexual well-being is often overlooked in clinical practice. OBJECTIVES: The aims of this study were twofold. First, to determine the current practice of healthcare professionals (HCPs) working with cancer and palliative care patients in primary and secondary care settings in relation to sexual well-being. Second, to determine the education requirements of HCPs regarding the management of sexual well-being concerns of cancer/palliative care patients...
March 2, 2017: BMJ Supportive & Palliative Care
https://www.readbyqxmd.com/read/28246083/commissioning-of-specialist-palliative-care-services-in-england
#6
Harriet Lancaster, Ilora Finlay, Maxwell Downman, James Dumas
OBJECTIVES: Some failures in end-of-life care have been attributed to inconsistent provision of palliative care across England. We aimed to explore the variation in commissioning of services by Clinical Commissioning Groups (CCGs) using a data collection exercise. METHODS: We sent a Freedom of Information request in the form of an open questionnaire to all 209 CCGs in England to assess their commissioning of palliative and end-of-life care services, mainly focused on the provision of specialist palliative care services...
February 28, 2017: BMJ Supportive & Palliative Care
https://www.readbyqxmd.com/read/28246082/survivorship-of-severe-medically-unexplained-symptoms-in-palliative-care
#7
Justin Dwyer, Keryn Taylor, Mark Boughey
OBJECTIVES: Patients who articulate their psychological distress primarily through physical symptoms (referred to as medically unexplained symptoms (MUS)) pose a challenge to the skills of most clinicians, including palliative care physicians. The philosophical underpinnings of palliative care with a stated focus on symptom management and care of the person in their psychosociospiritual context lend itself to the care of these patients. The aim of this study was to investigate the characteristics to improve identification of this patient group within palliative care...
February 28, 2017: BMJ Supportive & Palliative Care
https://www.readbyqxmd.com/read/28232515/home-palliative-care-works-but-how-a-meta-ethnography-of-the-experiences-of-patients-and-family-caregivers
#8
REVIEW
Vera P Sarmento, Marjolein Gysels, Irene J Higginson, Barbara Gomes
OBJECTIVE: To understand patients and family caregivers' experiences with home palliative care services, in order to identify, explore and integrate the key components of care that shape the experiences of service users. METHODS: We performed a meta-ethnography of qualitative evidence following PRISMA recommendations for reporting systematic reviews. The studies were retrieved in 5 electronic databases (MEDLINE, EMBASE, PsycInfo, BNI, CINAHL) using 3 terms and its equivalents ('Palliative', 'Home care', 'Qualitative research') combined with 'AND', complemented with other search strategies...
February 23, 2017: BMJ Supportive & Palliative Care
https://www.readbyqxmd.com/read/28232514/bridge-the-deep-chasm-between-patients-with-cancer-and-palliative-care-in-japan
#9
LETTER
Kazuhiro Kosugi, Kenji Tsuda, Asaka Higuchi, Jinichi Mori, Tetsuya Tanimoto
No abstract text is available yet for this article.
February 23, 2017: BMJ Supportive & Palliative Care
https://www.readbyqxmd.com/read/28213346/costs-of-family-caregiving-in-palliative-care-cofac-questionnaire-development-and-piloting-of-a-new-survey-tool
#10
Clare Gardiner, Chris McDermott, Claire Hulme
BACKGROUND: Family caregivers play an important role in the care of patients receiving palliative care, yet little is known about the financial impact of family caregiving in this context. A lack of existing validated tools for collecting data on the costs of family caregiving in palliative care has resulted in a weak and limited evidence base. The aim of the study was to describe the development and initial piloting of a new survey tool which captures data on the costs of family caregiving in palliative care: the Costs of Family Caregiving (COFAC) questionnaire...
February 17, 2017: BMJ Supportive & Palliative Care
https://www.readbyqxmd.com/read/28209568/experience-based-design-co-design-and-experience-based-co-design-in-palliative-and-end-of-life-care
#11
Erica Borgstrom, Stephen Barclay
Experience-based design, co-design, and experience-based co-design can be used within healthcare to design services that improve the patient, carer and staff experience of the services. As palliative and end-of-life care centrally value person-centred care, we believe that service designers, commissioners and those tasked with making quality improvements will be interested in this growing field. This paper outlines these approaches-with a particular emphasis on experience-based co-design-and describes how they are and can be used within palliative and end-of-life care...
February 16, 2017: BMJ Supportive & Palliative Care
https://www.readbyqxmd.com/read/28196828/systematic-review-of-the-effectiveness-barriers-and-facilitators-to-general-practitioner-engagement-with-specialist-secondary-services-in-integrated-palliative-care
#12
REVIEW
Sue-Ann Carmont, Geoffrey Mitchell, Hugh Senior, Michele Foster
The general practitioner (GP) has a critical role in an integrated model of palliative care as they often know the patient and carer well, are experts in generalist care and have knowledge of health and social services in the community. Specialist palliative services have insufficient capacity to meet demand and those with non-cancer terminal conditions and those from rural and remote areas are underserved. Research has focused on improving access to palliative care by engaging the GP with specialist secondary services in integrated palliative care...
February 14, 2017: BMJ Supportive & Palliative Care
https://www.readbyqxmd.com/read/28174164/improving-malodour-management-in-advanced-cancer-a-10-year-retrospective-study-of-topical-oral-and-maintenance-metronidazole
#13
Reena George, Thotampuri Shanthi Prasoona, Ramu Kandasamy, Renitha Cherian, Thangarathi Celine, Jenifer Jeba, Shakila Murali, David Mathew
OBJECTIVES: To explore the relative effectiveness of topical or oral metronidazole used for malodour in necrotic cancers and to propose a protocol for metronidazole usage in managing malodour. METHODS: A retrospective case note review of the management of malodour over 10 years comparing outcomes with topical, intermittent and maintenance oral metronidazole. RESULTS: Among 179 patients treated for malodour, the commonest primaries were cervical (45%), and head and neck cancers (40%)...
February 6, 2017: BMJ Supportive & Palliative Care
https://www.readbyqxmd.com/read/28167657/from-concept-to-practice-is-multidimensional-care-the-leading-principle-in-hospice-care-an-exploratory-mixed-method-study
#14
Everlien de Graaf, Merel van Klinken, Danielle Zweers, Saskia Teunissen
BACKGROUND: Hospice care (HC) aims to optimise the quality of life of patients and their families by relief and prevention of multidimensional suffering. The aim of this study is to gain insight into multidimensional care (MC) provided to hospice inpatients by a multiprofessional team (MT) and identify facilitators, to ameliorate multidimensional HC. METHODS: This exploratory mixed-method study with a sequential quantitative-qualitative design was conducted from January to December 2015...
February 6, 2017: BMJ Supportive & Palliative Care
https://www.readbyqxmd.com/read/28167656/key-issues-affecting-quality-of-life-and-patient-reported-outcomes-in-prostate-cancer-an-analysis-conducted-in-2128-patients-with-initial-psychometric-assessment-of-the-prostate-cancer-symptom-scale-pcss
#15
Pavlos Msaouel, Richard J Gralla, Randy A Jones, Patricia J Hollen
OBJECTIVE: Evidence-based quality of life (QL) questionnaires require the identification of issues of importance to patients. The primary aim of this study was to inform providers on patient-expressed issues while enhancing the content validity of instruments assessing QL and patient-reported outcomes (PROs) in prostate cancer. The study provided additional psychometric properties for the new PRO and QL instrument, the Prostate Cancer Symptom Scale (PCSS). METHODS: An anonymous web-based survey of 2128 patients with prostate cancer was conducted with patients rating 18 QL items on a five-point scale...
February 6, 2017: BMJ Supportive & Palliative Care
https://www.readbyqxmd.com/read/28167655/improving-community-access-to-terminal-phase-medicines-through-the-implementation-of-a-core-medicines-list-in-south-australian-community-pharmacies
#16
Paul Tait, Chris Horwood, Paul Hakendorf, Timothy To
OBJECTIVES: Difficulties accessing medicines in the terminal phase hamper the ability of patients to die at home. The aim of this study was to identify changes in community access to medicines for managing symptoms in the terminal phase throughout South Australia (SA), following the development of a 'Core Medicines List' (the List) while exploring factors predictive of pharmacies carrying a broad range of useful medicines. METHODS: In 2015, SA community pharmacies were invited to participate in a repeat survey exploring the availability of specific medicines...
February 6, 2017: BMJ Supportive & Palliative Care
https://www.readbyqxmd.com/read/28159802/ranitidine-forgotten-drug-of-delayed-gastric-emptying
#17
Abbie E Veevers, Stephen G Oxberry
Delayed gastric emptying in the presence or absence of mechanical bowel obstruction can cause distressing symptoms in palliative care patients. We present two patients, both with vomiting due to delayed gastric emptying and gastric outlet obstruction secondary to pancreatic cancer, treated with subcutaneous ranitidine resulting in a symptomatic response. We hypothesise that ranitidine is a useful adjunct to standard treatment with prokinetic agents or octreotide in such patients and potentially those with proximal mechanical bowel obstruction from other malignancies with associated delayed gastric emptying...
February 3, 2017: BMJ Supportive & Palliative Care
https://www.readbyqxmd.com/read/28153857/development-validity-and-reliability-testing-of-the-east-midlands-evaluation-tool-emet-for-measuring-impacts-on-trainees-confidence-and-competence-following-end-of-life-care-training
#18
B Whittaker, R Parry, L Bird, S Watson, C Faull
OBJECTIVES: To develop, test and validate a versatile questionnaire, the East Midlands Evaluation Tool (EMET), for measuring effects of end of life care training events on trainees' self-reported confidence and competence. METHODS: A paper-based questionnaire was designed on the basis of the English Department of Health's core competences for end of life care, with sections for completion pretraining, immediately post-training and also for longer term follow-up...
February 2, 2017: BMJ Supportive & Palliative Care
https://www.readbyqxmd.com/read/28153856/death-of-outrage-over-talking-about-dying
#19
Nrupen A Bhavsar, Sara Constand, Matthew Harker, Donald H Taylor
OBJECTIVES: We examined public reaction to the proposed Center for Medicare and Medicaid Services rule reimbursing physicians for advanced care planning (ACP) discussions with patients. METHODS: Public comments made on regulations.gov were reviewed for relevance to ACP policy and their perceived position on ACP (ie, positive, negative and neutral). Descriptive statistics were used to quantify the results. RESULTS: A total of 2225 comments were submitted to regulations...
February 2, 2017: BMJ Supportive & Palliative Care
https://www.readbyqxmd.com/read/28143976/calvarial-metastasis-of-renal-cell-carcinoma
#20
Tabrez Suffee, Mohamed Derder, Julien Quilichini, Edouard Dezamis, Laurent Lantieri
The calvarium is an extremely unusual site of metastasis of renal cell carcinoma. We report a 62-year-old man who was enrolled for palliative medical management for an exophytic calvarial metastasis. His quality of life was greatly compromised with everyday local care and bandages due to recurrent events of infection and bleeding, limiting his social life. Surgical palliative surgery was carried out to improve the patient's quality of life. After tumour resection, the resultant defects of the calvarium and the scalp were covered by a muscular latissimus dorsi free flap and a fascia lata graft as dural substitute...
January 31, 2017: BMJ Supportive & Palliative Care
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