Current opinion in supportive and palliative care
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The aim of this review is to summarize the current state of the science in physical symptoms and other end-of-life care domains and/or illness-specific outcomes in palliative care. The review includes progress in outcome measure development and interpretation, with specific reference to the clinical trial context. ⋯ Clinical trials of palliative care interventions need to consider a range of outcomes, however, the choice and timing of measurement of the primary outcome need to be guided by the domain most likely to be influenced by the intervention.
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Curr Opin Support Palliat Care · Dec 2012
ReviewChallenges in defining 'palliative care' for the purposes of clinical trials.
Palliative care has become part of mainstream medicine with increasing evidence about the effectiveness of specialist palliative care (SPC) on patient and family outcomes. Comparison of studies testing SPC interventions is challenging as types of interventions and reporting of components of the intervention vary. In consequence, study results are difficult to interpret. ⋯ Due to the lack of an agreed definition of palliative care and heterogeneity in reporting of components of an SPC intervention comparison of studies remains challenging. Key aspects of palliative care interventions are incurable disease, multidisciplinary approach, focus on symptom management including standardized assessment, psychosocial and family support, and (advance) care planning. Detailed information about all aspects of the intervention should be provided.
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Curr Opin Support Palliat Care · Dec 2012
Advancing the science of hospice care: Coalition of Hospices Organized to Investigate Comparative Effectiveness.
There is very little high-quality evidence to guide clinical practice in hospice care. In the areas of medical therapy, patient-centered and family-centered outcomes, and patient safety, there are numerous high-impact questions for which answers are needed. Although randomized controlled trials are the gold standard for research, such trials are difficult, time consuming, and expensive to conduct in a hospice population. Moreover, they cannot examine the implementation of therapies in real-world settings. Therefore, there is a need for novel, complementary approaches to research in this unique population. ⋯ CHOICE is a growing research network that has the potential to make a contribution to the science of palliative care in a hospice population.
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Awareness of palliative care, including knowledge and skills regarding symptom alleviation via pharmacological and non-pharmacological interventions, is limited in many settings. Lists have been published of recommended drugs for palliative care that include medications for different disease stages, using different modes of administration. ⋯ Recommendations for the most appropriate drugs which should be available for the care of dying patients in all settings is suggested to have potential to improve quality of care through increasing the confidence of physicians and nurses, being costeffective, decreasing the need for hospital admissions, and most of all - reducing suffering. Education and training at all levels, as well as further policy work through expert recommendations, care pathways, and media attention, are needed.
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Curr Opin Support Palliat Care · Sep 2012
ReviewIs there a role for parenteral nutrition or hydration at the end of life?
This review aims to update healthcare providers on the role of parenteral nutrition/hydration in terminal patients and highlight recent research. ⋯ Hydration and nutrition are essential for the maintenance of life. In patients at the end of life, artificial hydration and nutrition pose clinical, ethical, and logistical dilemmas. No strong evidence exists supporting the use of parenteral hydration/nutrition for the majority of terminally ill patients; however, a subset of patients may derive some benefit. Uncertainty about determining prognosis, psychosocial factors, and perceptions of perceived benefits results in artificial nutrition/hydration being initiated in terminally ill patients. Discontinuation of artificial support can result in distress for patients, family members, and healthcare providers.