Palliative medicine
-
Restructuring health care in Canada has emphasized the provision of ambulatory and home-based palliative care. Acquiring economic evidence is critical given this trend and its tremendous demands on family caregivers. The purposes of this study were: 1) to comprehensively assess the societal costs of home-based palliative care; and 2) to examine the socio-demographic and clinical factors that account for variations in costs over the course of the palliative trajectory. ⋯ Multivariable linear regression indicated that costs were greater for patients who: had lower physical functioning (p < 0.001); lived with someone (p = 0.007); and when the patients approached death (p = 0.021). Information highlighting the variation in costs across individuals may aid policy makers and mangers in deciding how to allocate resources. Greater clarity regarding costs over the course of the palliative trajectory may improve access to care.
-
Using a decision-making and treatment checklist developed to facilitate the at-home palliative sedation process, we assessed the incidence and efficacy of palliative sedation for end-of-life cancer patients with intractable symptoms who died at home. We retrospectively reviewed the medical records of 370 patients who were followed by a palliative home care team. Twenty-nine of 245 patients (12%) who died at home had received palliative sedation. ⋯ The mean time between palliative sedation initiation and time of death was 2.6 days. In 13 of the cases (45%), the palliative sedation decision was made with the patient and his or her family members, and in another 13 patients (45%), the palliative sedation decision was made only with the patient's family members. We concluded that palliative sedation may be used safely and efficaciously to treat dying cancer patients with refractory symptoms at home.
-
Palliative medicine · Jul 2010
Multicenter StudyAssessing and improving out-of-hours palliative care in a deprived community: a rapid appraisal study.
Recent changes to out-of-hours primary care in the UK have generated concerns about care for palliative care patients. The aim of this study was to identify key challenges and improvements to out-of-hours palliative care in a mixed urban and rural deprived area. ⋯ We recommend provision to out-of-hours services of an enhanced 'special note' for palliative care patients, to be completed early in the course of the illness and updated regularly. The provision for certain complex patients to bypass NHS24 should be considered if routine care is not satisfactory.
-
Palliative medicine · Jul 2010
Comparative StudyThe place of supportive, palliative and end-of-life care research in the United Kingdom Research Assessment Exercise, 2001 and 2008.
We report on a study of the place of research on supportive, palliative and end-of-life care within the United Kingdom Research Assessment Exercise of 2001 and 2008. Sixty-seven Higher Education Institutions in 2001 and 66 in 2008 contributed work to the Research Assessment Exercise relevant to supportive, palliative and end-of-life care. This comprised 16 subject areas in 2001 and 25 in 2008, and was generated by 178 authors in 2001 and 176 authors in 2008. ⋯ Between the years little growth occurred in contributions to the Research Assessment Exercise relating to supportive, palliative and end-of-life care, and the 'high-intensity groups' remain relatively fragile. With one exception, there is no concentration of effort in clinical studies relating to the medical aspects of supportive, palliative and end-of-life care. By 2008 there were still less than 40 university academics in the UK with major commitments to research in supportive, palliative and end-of-life care, as measured by their Research Assessment Exercise participation.
-
Palliative medicine · Jul 2010
Multicenter Study Comparative StudyCurrent and planned palliative care service provision for chronic obstructive pulmonary disease patients in 239 UK hospital units: comparison with the gold standards framework.
Patients with chronic obstructive pulmonary disease report a symptom burden similar in magnitude to terminal cancer patients yet service provision and access has been reported as poor. In the absence of a specific national chronic obstructive pulmonary disease service framework the gold standards framework might support service developments. We surveyed 239 UK acute hospital units admitting chronic obstructive pulmonary disease patients, comprising 98% of all acute trusts, about their current and planned provision for palliative care services. ⋯ Whilst 66% of units had plans to develop palliative care services, when mapped against the gold standards framework few were directly relevant and only three of the seven key standards were covered to any significant degree. We conclude that service provision remains poor and access is hindered by a lack of proactive initiation of discussion. Planned developments in chronic obstructive pulmonary disease palliative care services also lack a strategic framework that risks holistic design.