Palliative medicine
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The main objective of this study is to validate a Consciousness Scale for palliative care. The scale was named Consciousness Scale for palliative care (CSPC). The validation had two phases: 1) face validity--the scale was assessed by seven healthcare professionals, both doctors and nurses, experienced in palliative care; 2) reliability and construct validity--performed by four investigators, two nurses and two doctors. ⋯ The CSPC can be a very useful tool for assessing consciousness in palliative care patients. It is very ease to use, not time consuming and can be used with minimal training. Communication between professionals can be improved in the clinical setting and in the research environment.
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Palliative medicine · Sep 2008
Multicenter StudyImplementation and impact of the Gold Standards Framework in community palliative care: a qualitative study of three primary care trusts.
The Gold Standards Framework (GSF) has been widely adopted within UK general practices, yet there is little understanding of its impact on the provision of community palliative care services. This study presents data on the anticipation and adoption of the GSF within three Primary Care Trusts in North West England. Forty-seven interviews were conducted with generalist and specialist palliative and primary care professionals. ⋯ Many respondents believed that the GSF needed local champions to be sustainable. Slow or incomplete adoption was reported. The GSF was recognised as important because it facilitated changes to previously difficult aspects of work between professionals, but few respondents reported direct benefits to patient care.
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Palliative medicine · Sep 2008
Multicenter StudyPopulation-based study of dying in hospital in six European countries.
This study examined the proportion of deaths taking place in hospitals in six European countries in relation to demographic, epidemiologic and healthcare factors. Retrospective analyses were performed on a database integrating death certificate data of all deaths in 2002 in Sweden and 2003 in Belgium, England, Scotland, the Netherlands and Wales (N = 891,780). Data were linked with regional healthcare statistics. ⋯ Cancer patients often died in hospitals in Sweden but less frequently so in the Netherlands and England. Country differences in the proportion of patients dying in hospital are only partly the result of differences in health care provision, and are in particular larger for certain patient categories, suggesting country-specific end-of-life practices in these categories. These findings can contribute to rational public health policies aimed at reducing hospital deaths.
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Palliative medicine · Sep 2008
Multicenter StudyDevelopment and validation of a prognostic scale for use in patients with advanced cancer.
The aim of this study was to develop a new prognostic indicator to help predict survival in advanced cancer patients more accurately. Data on 329 patients obtained from a multi-centre study in London were analysed. A multifactorial Cox regression model was applied and validated using bootstrapping techniques. ⋯ Four variables were found to be associated with worse survival: primary lung cancer, secondary liver cancer, raised C-Reactive protein and poor performance status (ECOG 4). Survival curves showed that patients designated as 'high' risk by the resulting index had significantly shorter survival than those designated as 'low' risk. A high score on the newly derived prognostic index is associated with poorer survival, but its clinical utility is limited by the relatively low predictive probability of the score.
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Palliative medicine · Sep 2008
ReviewNon-pharmacological interventions for breathlessness management in patients with lung cancer: a systematic review.
The aim is to review the published scientific literature for studies evaluating non-pharmacological interventions for breathlessness management in patients with lung cancer. The following selection criteria were used to systematically search the literature: studies were to be published research or systematic reviews; they were to be published in English and from 1990 to 2007; the targeted populations were adult patients with dyspnoea/breathlessness associated with lung cancer; and the study reported on the outcomes from use of non-pharmacological strategies for breathlessness. This review retrieved five studies that met all inclusion criteria. ⋯ Analysis of the available evidence suggests that tailored instructions delivered by nurses with sufficient training and supervision may have some benefits over other delivery approaches. Based on the results, non-pharmacological interventions are recommended as effective adjunctive strategies in managing breathlessness for patients with lung cancer. In order to refine such interventions, future research should seek to explore the core components of such approaches that are critical to achieving optimal outcomes, the contexts in which the interventions are most effective, and to evaluate the relative benefits of different methods for delivering such interventions.