Palliative medicine
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Palliative medicine · Mar 2011
ReviewThe outcomes of palliative care day services: a systematic review.
This systematic review evaluates the evidence underpinning the provision of palliative day care services (PDS) to determine whether such services have a measurable effect on attendees' wellbeing. The majority of studies reviewed were qualitative and elicited individual perceptions of the benefits PDS. Although it was difficult to determine the quality of many studies, it would appear that attendance at PDS had a positive impact on attendees' quality of life. ⋯ However little quantitative evidence was offered to prove that PDS had an impact on attendees' quality of life or wellbeing. The review concludes that dying people find attending PDS a valuable experience that allows them to engage with others and to be supported in a restorative environment. However, further well-powered empirical studies are required to provide quality evidence to determine whether or not attendance at PDS does indeed have a positive impact on the wellbeing of attendees.
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Palliative medicine · Mar 2011
Multicenter StudyReturn home at the end of life: Patients' vulnerability and risk factors.
Although most of the people in good health questioned about the subject said they would like to die at home, in the western world between 60 and 80% of deaths occur in hospital. Most authors consider that the indispensable conditions for a return home are the patient's desire and presence of the family and caregivers with the appropriate skills. The assessment of other factors predictive of a return home is inadequate. ⋯ For these patients the caregivers respected their freedom to choose to die at home in over half the cases (56%). Their overall vulnerability (personal, family context and caregivers) had a significant influence on the return home. This overall vulnerability was in fact identified as applying in 40% of the clinical situations, and made the possibility of a return home 50% less likely.
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Palliative medicine · Mar 2011
Comparative StudyInappropriate use of high doses of transdermal fentanyl at admission to a palliative care unit.
A retrospective study was conducted to determine the patterns of strong opioid use in patients admitted to a hospice inpatient unit, with special attention to the use of the transdermal fentanyl patch. This study was conducted to validate or negate the subjective feeling that many patients, treated at admittance with the fentanyl patch, received inappropriately high doses compared to patients treated with oral or parenteral opioids. The case notes of 1154 patients were reviewed and data collected on age, sex, diagnosis, care settings, opioid form and dose on referral, maximal dose during admission and opioid use during the last 24 hours of their life. ⋯ Only 83 kept it until the last 24 hours. We would like to draw attention to the fact that (sometimes inappropriately) high doses of fentanyl were used at admission, probably due to lack of knowledge of the relative strength of the opioid involved and to the failure to recognize the phenomenon of opioid-induced hyperalgesia. In addition, in our experience the long action of the patch can be a disadvantage during the last days and weeks of life, due to the difficulty of dose adjustment and the risk for toxicity.
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Palliative medicine · Mar 2011
Comparative StudyNon-cancer patients in specialized palliative care in Germany: what are the problems?
To determine the role of non-cancer palliative care in inpatient services in Germany, data from the Hospice and Palliative Care Evaluation (HOPE) were analysed. Since 1999, a three-month census has been conducted annually in German palliative care units. Pooled data from 2002-2005 were tested for differences between non-cancer patients (NCs) and cancer patients (Cs). ⋯ There were no differences in social problems. NCs are still rare in specialized inpatient palliative care institutions in Germany. The palliative care needs in patients with non-malignant disease will challenge the health care system as the workload for these services will grow over proportionally.
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Palliative medicine · Mar 2011
Living and coping with Parkinson's disease: perceptions of informal carers.
A review of the literature highlights the important role informal carers play in the provision of palliative care in the community. In order to explore the caring experience of relatives with Parkinson's Disease (PD), interviews were conducted with 26 informal family caregivers. Interviews were taped, transcribed and subjected to content analysis. ⋯ Since diagnosis, carers commented on the lack of continued and coordinated care plans for relatives, resulting in symptoms being mismanaged and care opportunities for relatives and carers missed. Stereotypes of the meaning and timing of palliative care were common with many viewing it as being synonymous with cancer and not applicable to a person with PD. As the well-being of the informal carer directly influences the care of the person with PD, support interventions are required to relieve their burden, maximize outcomes and ensure targeting of services.