Palliative medicine
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Palliative medicine · Mar 2017
Implementing a patient-centred outcome measure in daily routine in a specialist palliative care inpatient hospital unit: An observational study.
Gathering clinical evidence data on patients' palliative care needs is paramount to identify changes in outcomes over time and maintaining on-going quality improvement. Implementation of patient-centred outcome measures has been widely recommended. The routine use of these instruments in daily practice is challenging and not widespread. ⋯ Implementing a patient-centred outcome measure in a hospital palliative care service is feasible and improves quality of care. Controlling high pain at T0 improved (>80%) by T1. Results became more consistent and symptom control was improved overall. Patients are evaluated based on holistic domains by an interdisciplinary team and we have added a much needed measure to help guide improvement of the quality of care provided.
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Palliative medicine · Mar 2017
Comparative StudyProcess and impact of an advance care planning intervention evaluated by bereaved surrogate decision-makers of dialysis patients.
Few studies have examined the process and impact of an advance care planning intervention experienced by surrogate decision-makers of dialysis patients. ⋯ Our data may help explain the beneficial effects of SPIRIT on surrogates, but future trials should include data on control surrogates' perspectives.
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Palliative medicine · Feb 2017
Bereavement outcomes: A quantitative survey identifying risk factors in informal carers bereaved through cancer.
Enabling patients to die in their preferred place is important but achieving preferred place of death may increase the informal carer's risk into bereavement. ⋯ Participants were individuals who registered the death of a person between 1 December 2011 and 31 May 2012; where cancer (defined by ICD10 codes C00-D48) was the primary cause; where the deceased was over 18 years of age and death occurred at home, hospice, nursing home or hospital in Northern Ireland. Participants were approached in confidence by the Demography and Methodology Branch of the Northern Ireland Statistics and Research Agency. Those wishing to decline participation were invited to return the reply slip. Non-responders received a second questionnaire 6 weeks after initial invitation. Results indicated that risk factors positively influencing bereavement outcomes included patients having no preference for place of death and carers remaining in employment pre- or post-bereavement. In contrast, patients dying in hospital, carers stopping work, being of lower socio-economic status and close kinship to the deceased negatively affected bereavement scores. Family carers should be adequately supported to continue in employment; priority should be given to assessing the financial needs of families from lower socio-economic areas; and bereavement support should focus on close relatives of the deceased.
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Palliative medicine · Feb 2017
Review Meta AnalysisAdvance care planning, palliative care, and end-of-life care interventions for homeless people: A systematic review.
Homeless individuals have a high prevalence of multiple chronic comorbidities and early mortality compared to the general population. They also experience significant barriers to access and stigmatization in the healthcare system. Providing advance care planning, palliative care, and end-of-life care for this underserved population is an important health issue. ⋯ The effectiveness of advance care planning, palliative care, and end-of-life care interventions for homeless individuals is uncertain. High-quality studies of interventions that reflect the unique and complex circumstances of homeless populations and investigate patient-related outcomes, caregiver burden, and cost-effectiveness are needed.