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BMJ Supportive & Palliative Care

Lillian Krikheli, Lindsay B Carey, Bernice A Mathisen, Shane Erickson, Christa L Carey-Sargeant
BACKGROUND: Given the dearth of literature and no clinical practice guidelines written for speech-language pathologists (SLPs) working in paediatric palliative care (PPC), a need has been identified to explore the scope of clinical practice and strategies used by SLPs. OBJECTIVE: This study aims to undertake an international investigation into the role and scope of practice of SLPs working in PPC to develop consensus-driven 'Recommendations for Speech-Language Pathologists in Paediatric Palliative Care Teams' (ReSP3 CT)...
November 15, 2018: BMJ Supportive & Palliative Care
David Joyce, Michelle Barrett
No abstract text is available yet for this article.
November 15, 2018: BMJ Supportive & Palliative Care
Derek Willis, Rob George
Conscience objection is a proposed way of ensuring that medical practitioners who object to physician-assisted suicide may avoid having to be involved in such a procedure if this is legalised. This right on the part of healthcare professionals already exists in certain circumstances. This paper examines the ethical and legal grounds for conscientious objection for medical professionals and shows how it is heavily criticised in circumstances where it is already used. The paper comes to the conclusion that as the grounds and application of conscience objection are no longer as widely accepted, its future application in any legislation can be called into question...
November 15, 2018: BMJ Supportive & Palliative Care
Bregje A A Huisman, Eric C T Geijteman, Marianne K Dees, Lia van Zuylen, Agnes van der Heide, Roberto S G M Perez
Patients with a limited life expectancy use many medications, some of which may be questionable. OBJECTIVES : To identify possible solutions for difficulties concerning medication management and formulate recommendations to improve medication management at the end of life. METHODS : A two-round Delphi study with experts in the field of medication management and end-of-life care (based on ranking in the citation index in Web of Science and relevant publications). We developed a questionnaire with 58 possible solutions for problems regarding medication management at the end of life that were identified in previously performed studies...
November 15, 2018: BMJ Supportive & Palliative Care
Kate Renton, Anton-Paul Thomas Mayer, Lilias Alison, Daniel Yeomanson
OBJECTIVES: Place of death (POD) is considered a key quality indicator for adult end of-life care, but paediatric evidence is limited. Data from Child Death Overview Panel (CDOP) databases provides an opportunity to describe trends in POD as regional paediatric palliative medicine (PPM) options have increased. Aims were to identify and describe trends in POD for children in South Yorkshire. METHODS: Retrospective cohort study. Anonymised data extracted from five CDOP databases 2008-2015...
November 15, 2018: BMJ Supportive & Palliative Care
Matthew Doré, Derek Willis
BACKGROUND: Evidence regarding out-of-hours (OOH) community palliative care provision is required to inform the need for a 7-day work. AIM: This paper seeks to provide evidence for this discussion by defining general practitioners' (GPs) OOH workload and patients' demographics, symptomology and interventions. By quantifying the challenges faced, we can understand current practice and focus on what provision is required. DESIGN: Using Shropshire Doctors Co-operative's recorded data, the authors have collated a representative picture of the OOH GP palliative care practice over a year from 161 OOH GP-patient interactions...
November 12, 2018: BMJ Supportive & Palliative Care
Choo Hwee Poi, Hwee Sing Khoo, Yong Hwang M Koh, Allyn Hum Yin Mei
OBJECTIVES: Junior doctors learn from the formal and informal curriculum. In a palliative care rotation, the informal curriculum may be useful in teaching attitudes like empathy and compassion. Our study aims to explore how the informal curriculum augments the formal curriculum of a palliative care rotation in shaping the professional development of a doctor. METHODS: We conducted a qualitative study with seven focus group discussions involving 21 junior doctors (medical officers and residents) who spent at least 2 months in a palliative care setting in a tertiary hospital or an inpatient hospice...
November 12, 2018: BMJ Supportive & Palliative Care
Cara Bailey, Philip Kinghorn, Alistair Hewison, Christina Radcliffe, Terry Nicholas Flynn, Elizabeth Huynh, Joanna Coast
BACKGROUND: Values used in economic evaluation are typically obtained from the general public, which is problematic when measures are to be used with people experiencing a life-course stage such as the end of life. OBJECTIVE: To assess the feasibility of obtaining values for the ICECAP-Supportive Care Measure (SCM) from patients receiving advanced supportive care through a hospice. METHODS: Participants completed eight best-worst scaling questions in a think-aloud interview to explain choices in different hypothetical end-of-life scenarios...
November 12, 2018: BMJ Supportive & Palliative Care
Hassan Assareh, Joanne M Stubbs, Lieu T T Trinh, Sally Greenaway, Meera Agar, Helen M Achat
OBJECTIVE: Use of palliative care in hospitals for people at end of life varies. We examined rate and time of in-hospital palliative care use and associated interhospital variations. METHODS: We used admissions from all hospitals in New South Wales, Australia, within a 12-month period, for a cohort of adults who died in 73 public acute care hospitals between July 2010 and June 2014. Receiving palliative care and its timing were based on recorded use. RESULTS: Among 90 696 adults who died, 27% received palliative care, and the care was initiated 7...
November 8, 2018: BMJ Supportive & Palliative Care
Daniel Munday, Vandana Kanth, Shadrach Khristi, Liz Grant
Palliative care is recognised as a fundamental component of Universal Health Coverage (UHC), which individual countries, led by the United Nations and the WHO, are committed to achieving worldwide by 2030-Sustainable Development Goal (SDG) 3.8. As the incidence of non-communicable diseases (NCD) in low-income and middle-income countries (LMICs) increases, their prevention and control are the central aspects of UHC in these areas. While the main focus is on reducing premature mortality from NCDs (SDG 3.4), palliative care is becoming increasingly important in LMICs, in which 80% of the need is found...
November 1, 2018: BMJ Supportive & Palliative Care
Joel J Rhee, Patrick C K Teo, Geoffrey K Mitchell, Hugh E Senior, Aaron J H Tan, Josephine M Clayton
OBJECTIVES: General practitioners (GPs) are well placed to be involved in end-of-life care for patients with life-limiting illnesses. However, differing views exist regarding their role. This study aims to explore the views of GPs and specialist palliative care clinicians (SPCCs) on the role that GPs should play in the planning and provision of end-of-life care and important barriers and facilitators to GPs' involvement in end-of-life care including suggestions for improvement. METHODS: Qualitative description methodology using semistructured interviews of 11 GPs and 10 SPCCs...
November 1, 2018: BMJ Supportive & Palliative Care
Paul Taylor, Miriam J Johnson, Dawn Wendy Dowding
OBJECTIVES: To improve the ability of clinical staff to recognise end of life in hospital inpatients dying as a result of cancer and heart failure, and to generate new hypotheses for further research. METHODS: This mixed-methods study used decision theory as a theoretical basis. It involved a parallel databases-convergent design, incorporating findings from previously published research, with equal priority to study groups and synthesis by triangulation. The individual arms were (1) a retrospective cohort study of 102 patients with cancer and 81 patients with heart failure in an acute trust in the North of England, and(2) a semistructured interview study of 19 healthcare professionals caring for the same patient groups...
October 18, 2018: BMJ Supportive & Palliative Care
Tayler Kiss-Lane, Odette Spruijt, Thomas Day, Vivian Lam, Kavitha J Ramchandran, Sandy Chan, Gary Hsin, Nandini Vallath, Sushma Bhatnagar, M R Rajagopal, Karl A Lorenz
BACKGROUND: Whether online resources can facilitate spread of palliative care knowledge and skills in India is an urgent question given few providers and a large, ageing population. OBJECTIVES: We surveyed needs and feasibility regarding e-learning. METHODS: Indian, Australian and North American palliative care experts developed an electronic survey using Qualtrics, emailed to all registrants of the 2017 Indian Association of Palliative Care (IAPC) conference and distributed during the conference...
October 9, 2018: BMJ Supportive & Palliative Care
Hannah O'Brien, Fiona Kiely, Aileen Barry, Sarah Meaney
OBJECTIVES: Extrapyramidal side effects (EPSEs) are serious potentially reversible side effects of antipsychotic and other medications that can cause distress for patients. A core principle of palliative care involves optimising quality of life. If side effects of medications are burdensome, it is imperative that we address this issue. The aim of the study was to determine and describe the burden of EPSEs in a specialist inpatient unit. METHODS: Consenting patients who met inclusion criteria were assessed for EPSE with two validated screening tests, the Modified Simpson-Angus Scale (MSAS) and Barnes Akathisia Rating Scale (BARS)...
October 9, 2018: BMJ Supportive & Palliative Care
Laura Parry
Dementia is an increasingly recognised medical condition which, towards its later stages, leads to the manifestation of symptoms that often require palliation. Hospice admission for patients with dementia has been shown to increase caregiver satisfaction. Yet, admission can be harmful for the patient. This feature follows the case of one patient, Mr Smith, who was admitted to Royal Trinity Hospice (RTH) for symptom control, along with providing respite for his carers. Shortly into Mr Smith's admission, he became increasingly agitated and was ultimately discharged home...
October 5, 2018: BMJ Supportive & Palliative Care
Charlotte Russell, Averil Fountain
OBJECTIVE: The National Institute of Clinical Excellence (NICE) (2004) guidance recommends a tiered approach to psychological care within cancer care. This includes the provision of Clinical Psychologists to support other professionals to deliver high-quality psychological care at levels 1 and 2 and to provide direct input to patients experiencing high levels of distress at level 4. However, little is known about the role of Clinical Psychology within UK Hospices currently. A survey of Clinical Psychologists working in this area was undertaken to address this gap in knowledge...
October 3, 2018: BMJ Supportive & Palliative Care
Sasha Murdoch
Quality improvement can be difficult to assess and monitor in palliative care due to the nature of the specialty. This essay investigates ways in which this is currently carried out by assessing the benefits of patient-centred outcome measures. Potential technological improvements which could be implemented in the future are also discussed. This is an award-winning essay which subsequently complemented a separate project which analysed the use of the Integrated Palliative Care Outcome Scale in an inpatient palliative care unit...
October 3, 2018: BMJ Supportive & Palliative Care
Alba Gabriela Picco Brunetto
A patient receiving maintenance treatment with methadone (MTM) was treated with parenteral methadone for intense pain crises in cancer of the tongue with severe mucositis and dysphagia. Authors like Manfredi et al describe good results in the use of methadone as an analgesic in patients with MTM. The difficulties which arise with parenteral use derive from the drug itself and from those to whom the treatment is administered: serious side effects like malignant arrhythmias and respiratory depression and the complex nature of these patients, addicted to opiates with a terminal illness and pain which is difficult to treat...
October 1, 2018: BMJ Supportive & Palliative Care
Eleanor Anderson Reid, Olga Kovalerchik, Karen Jubanyik, Stuart Brown, Denise Hersey, Liz Grant
INTRODUCTION: Of the 40 million people globally in need of palliative care (PC), just 14% receive it, predominantly in high-income countries. Within fragile health systems that lack PC, incurable illness is often marked by pain and suffering, as well as burdensome costs. In high-income settings, PC decreases healthcare utilisation, thus enhancing value. Similar cost-effectiveness models are lacking in low-income and middle-income countries and with them, the impetus and funding to expand PC delivery...
October 1, 2018: BMJ Supportive & Palliative Care
Elizabeth J Cathcart-Rake, Deanne Smith, David Zahrieh, Charles L Loprinzi
OBJECTIVES: As a rose geranium in sesame oil spray product has been anecdotally noted to improve nasal vestibulitis symptoms, this study was designed to assess whether patients with nasal vestibulitis associated with cancer-directed therapy experienced symptomatic improvements from it. METHODS: Patients with breast cancer, prescribed rose geranium nasal spray, were identified by looking at pharmacy records and patient diagnosis at Mayo Clinic Rochester. Patient medical information, as well as documentation of symptoms, were gleaned from medical charts...
September 26, 2018: BMJ Supportive & Palliative Care
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