Palliative medicine
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Palliative medicine · Dec 2010
Individual breathlessness trajectories do not match summary trajectories in advanced cancer and chronic obstructive pulmonary disease: results from a longitudinal study.
Breathlessness is a distressing symptom in advanced disease. Little is known about the trajectories of this symptom over time and towards death. This study aimed to describe and compare the summary and individual trajectories of breathlessness and overall symptom burden over time and towards the end of life following patients with advanced cancer or severe chronic obstructive pulmonary disease (COPD) in inpatient and outpatient health care settings in Germany. ⋯ Twenty-one cancer and 43 COPD patients provided data for individual breathlessness trajectories. These revealed wide individual variations with four different patterns: fluctuation, increasing, stable and decreasing breathlessness. Symptom trajectories on the population level reflecting the whole group mask individual variation, which is reflected in distinct symptom trajectories with different patterns.
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Palliative medicine · Dec 2010
End-of-life practices in palliative care: a cross sectional survey of physician members of the German Society for Palliative Medicine.
To elicit types and frequencies of end-of-life practices by physician members of the German Society for Palliative Medicine. To analyse associations between characteristics of physicians and patients and end-of-life practices with intended hastening of death. ⋯ Physician members of the German Society for Palliative Medicine perform a broad spectrum of end-of-life practices including intended hastening of death. The findings on patients' non-involvement in decision making warrant further empirical-ethical analysis.
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Palliative medicine · Dec 2010
Is it possible to determine use of hospice palliative care services by matching hospice and cancer registry data?
Population-based studies investigating access to palliative care often use death in a hospice as a proxy for service use. We linked data from a large South London hospice to Thames Cancer Registry (TCR) data to determine whether patients who received hospice services differed from those who did not. We matched hospice data for 2474 cancer patients dying between 2000 and 2006, while resident within a restricted catchment area, to TCR data for residents in this area. ⋯ In addition, 5.6% (n= 175) of residents initially defined as not receiving hospice services were recorded as dying in a hospice in the TCR dataset. The problems of overlapping catchment areas and of defining patients receiving services meant we could not adequately determine use of hospice services. This method might be applied more successfully to non-urban hospices, primary care trusts or larger regions.
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Palliative medicine · Oct 2010
ReviewA systematic review of instruments related to family caregivers of palliative care patients.
Support for family caregivers is a core function of palliative care. However, there is a lack of consistency in the way needs are assessed, few longitudinal studies to examine the impact of caregiving, and a dearth of evidence-based interventions. In order to help redress this situation, identification of suitable instruments to examine the caregiving experience and the effectiveness of interventions is required. ⋯ Where psychometric results were reported, validity data were reported in less than half (42%) of these cases. While a considerable variety of instruments have been administered to family caregivers, the validity of some of these requires further consideration. We recommend that others be judicious before developing new instruments for this population.