Palliative medicine
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Palliative medicine · Oct 2009
Multicenter StudyPhysician factors associated with outpatient palliative care referral.
Outpatient palliative care can provide significant benefits to seriously ill patients, but several barriers to appropriate referrals remain. No study has examined the physician factors associated with referral to outpatient palliative care. To determine physician factors, with a focus on physician beliefs, associated with referral to palliative care. ⋯ Physician characteristics other than their beliefs about palliative care played a significant role in determining referral. Palliative care programs should aim to increase their visibility in the outpatient setting to increase referrals by primary care physicians. Tools that help physicians identify seriously ill patients who could benefit from palliative care may also serve to increase appropriate referrals.
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Palliative medicine · Oct 2009
Barriers to advance care planning in chronic obstructive pulmonary disease.
The English End of Life Care Strategy promises that all patients with advanced, life limiting illness will have the opportunity to participate in Advance Care Planning (ACP). For patients with Chronic Obstructive Pulmonary Disease (COPD), the barriers to this being achieved in practice are under-explored. Five focus groups were held with a total of 39 health care professionals involved in the care of patients with COPD. ⋯ The findings from this study indicate that, for patients with COPD, significant service improvement is needed before the objective of the End of Life Care Strategy regarding patient participation in end of life decision-making is to be achieved. Whilst the findings support the Strategy's recommendations regarding an urgent for both professional education and increased public education about end of life issues, they also indicate that these alone will not be enough to effect the level of change required. Consideration also needs to be given to the integration of chronic disease management and end of life care and to developing definitions of end of life care that fit with concepts of 'continuous palliation'.
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Palliative medicine · Oct 2009
Case ReportsCan ketamine prescribed for pain cause damage to the urinary tract?
Presentation of three palliative care patients who were given ketamine as an analgesic and subsequently developed significant and debilitating urological symptoms. In one patient there was resolution of symptoms following cessation of ketamine, but some symptoms persisted until death in the other two. Possible mechanisms for damage to the urothelium by ketamine are suggested.