Palliative medicine
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Palliative medicine · Jan 2011
Review Meta AnalysisAntidepressants for the treatment of depression in palliative care: systematic review and meta-analysis.
Depression can exacerbate symptoms associated with life-threatening illness and increase disability and distress. In palliative care, depression occurs in a context of multiple symptoms, which complicates detection and treatment. While systematic reviews of antidepressants have been conducted in specific life-threatening diseases, no previous study has synthesized the evidence in palliative care. ⋯ Their superiority over placebo is apparent within 4-5 weeks and increases with continued use. It is probable that the effect sizes yielded in this review overestimate the efficacy of antidepressants due to biases such as selective reporting and publication. Nevertheless, the magnitude and consistency of the effect suggests genuine benefit.
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Palliative medicine · Jan 2011
ReviewA comparison of palliative care outcome measures used to assess the quality of palliative care provided in long-term care facilities: a systematic review.
Provision of palliative care in long-term care (LTC) facilities is important, but limited research has been undertaken to investigate the most appropriate outcome measure for use in this setting. In this systematic review we aimed to measure the psychometric properties (reliability/validity) and feasibility of palliative outcome measures used to assess the quality of palliative care provided in LTC. For identification of outcome measures we undertook systematic searches of electronic databases from 1 January 2000 to 12 September 2008. ⋯ The Family Perceptions of Care Scale is considered by the authors as the most suitable outcome measure for use in LTC facilities. Of the remaining nine measures, a further two were also considered suitable for measuring the quality of palliative care in residential aged care facilities. These are the Quality of Dying in Long-term Care scale and the Toolkit Interview.
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Palliative medicine · Jan 2011
'Heated political dynamics exist ...': examining the politics of palliative care in rural British Columbia, Canada.
Palliative care is delivered by a number of professional groups and informal providers across a range of settings. This arrangement works well in that it maximizes avenues for providing care, but may also bring about complicated 'politics' due to struggles over control and decision-making power. Thirty-one interviews conducted with formal and informal palliative care providers in a rural region of British Columbia, Canada, are drawn upon as a case study. ⋯ Three themes crosscut these politics: ownership, entitlement, and administration. The politics revealed by the interviews, and heretofore underexplored in the palliative literature, have implications for the delivery of palliative care. For example, the outcomes of the politics simultaneously facilitate (e.g. by promoting advocacy for local services) and serve as a barrier to (e.g. by privileging certain communities/care sites/provider) palliative care provision.
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Palliative medicine · Jan 2011
Are patients' preferences for information and participation in medical decision-making being met? Interview study with lung cancer patients.
We examined the degree to which newly diagnosed patients with advanced lung cancer wanted to be informed and involved in medical decision-making, and whether the patients felt their preferences were met. Patients from 13 hospitals in Flanders were interviewed with a standard questionnaire. ⋯ With regard to participation in medical decision-making (in general, about treatment, transfer or end-of-life), patients who preferred the doctor to make decisions or those who preferred to make the decision themselves often achieved this (in their perception), while patients who wanted an in-between position with some involvement, often did not. To conclude, preferences of patients with lung cancer for information concerning delicate topics and for shared decision-making with the physician were not well met.