Palliative medicine
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Palliative medicine · Mar 1998
An evaluation of palliative care services for cancer patients in the Southern Health and Social Services Board of Northern Ireland.
An interview study of 55 lay carers of people who died from cancer in the Southern Board of Northern Ireland was undertaken using a combination of closed-format and open-ended questions. The aim of the study was to evaluate palliative care services delivered in the last six months of their lives to cancer patients who died either at home or in hospital. Two-thirds of the deaths (36) occurred in the domestic home, 45 of the deceased were admitted as hospital inpatients, and the great majority were in receipt of community nursing (53) and general practitioner (54) services. ⋯ While they were generally satisfied with services specific areas of difficulty were identified in each aspect of care addressed by the study. The most favourable assessments were made of community nursing with the greatest number of negative comments being made about inpatient hospital care. Differing interests between some of those who were dying and their lay carers were found in two areas: the receipt of help from nonfamily members and the information that the deceased received about their terminal status.
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Palliative medicine · Mar 1998
The use of the Edmonton Symptom Assessment Scale (ESAS) within a palliative care unit in the UK.
The Edmonton Symptom Assessment scale (ESAS) was used on 1004 occasions to assess 71 patients with advanced malignant disease admitted to a palliative care unit in the UK over a six-week period. The median length of inpatient stay was eight days (range 1-36) and the median survival from start of ESAS to death was 16 days (range 2-202). ⋯ When scores were analysed retrospectively over five days according to outcome (death--group 1, or discharge--group 2) there was a significant improvement in pain scores in group 2 but no change in overall score, and a significant deterioration in activity, drowsiness and appetite in group 1 with no change in overall score. ESAS did not seem an appropriate tool in this group of patients as the total symptom scores were so often biased by the inevitable increase in individual symptom scores immediately prior to death.
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In the palliative care of patients with motor neurone disease (MND) symptoms are encountered that can be helped by the use of strong opioid medication. A retrospective survey of the 32 patients dying of MND at the Wisdom Hospice who required opioids showed that 75% received oral opioids, 94% received parenteral opioids and 72% received both oral and parenteral opioids. The median oral morphine dose was 60 mg/24 h, with a median duration of 51 days and the median parenteral dose was 180 mg/24 h with a median duration of use of three days. The results show that strong opioids can be used safely and effectively in the palliative care of patients with MND.