Palliative medicine
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Palliative medicine · May 2016
Observational StudyThe importance of the feasibility study: Lessons from a study of the hand-held fan used to relieve dyspnea in people who are breathless at rest.
The dyspnea accompanying advanced cardiorespiratory disease is often refractory to palliation. It is disabling, distressing and associated with the diseases most common everywhere in the world. The hand-held fan, used to generate a draught across the face, is a simple, cost-effective, safe, and universally applicable palliative breathlessness intervention, consistently described as valuable in qualitative research. A previous crossover trial confirmed its benefit in patients breathless at rest, but the washout period was uncertain. ⋯ Feasibility work is essential, even for simple widely employed interventions.
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Palliative medicine · May 2016
Multicenter StudyPalliative Care Problem Severity Score: Reliability and acceptability in a national study.
The Palliative Care Problem Severity Score is a clinician-rated tool to assess problem severity in four palliative care domains (pain, other symptoms, psychological/spiritual, family/carer problems) using a 4-point categorical scale (absent, mild, moderate, severe). ⋯ The Palliative Care Problem Severity Score is an acceptable measure, with moderate reliability across three domains. Variability in inter-rater reliability across sites and participant feedback indicate that ongoing education is required to ensure that clinicians understand the purpose of the tool and each of its domains. Raters familiar with the patient they were assessing found it easier to assign problem severity, but this did not improve inter-rater reliability.
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Palliative medicine · May 2016
ReviewDoes the use of specialist palliative care services modify the effect of socioeconomic status on place of death? A systematic review.
Cancer patients in lower socioeconomic groups are significantly less likely to die at home and experience more barriers to access to palliative care. It is unclear whether receiving palliative care may mediate the effect of socioeconomic status on place of death. ⋯ There is some evidence to suggest that use of specialist palliative care may modify the effect of socioeconomic status on place of death.
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Palliative medicine · May 2016
ReviewDoes facilitated Advance Care Planning reduce the costs of care near the end of life? Systematic review and ethical considerations.
While there is increasing evidence that Advance Care Planning has the potential to strengthen patient autonomy and improve quality of care near the end of life, it remains unclear whether it could also reduce net costs of care. ⋯ The limited data indicate net cost savings may be realised with Advance Care Planning. Methodologically robust trials with clearly defined Advance Care Planning interventions are needed to make the costs and returns of Advance Care Planning transparent.