Palliative medicine
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Palliative medicine · Sep 2010
Multicenter Study Comparative StudyAttitudes towards weight and weight assessment in oncology patients: survey of hospice staff and patients with advanced cancer.
The objective of this study was to compare attitudes of hospice staff towards weight loss and weight assessment in the hospice setting with those of patients with advanced malignancy in the hospital outpatient setting. Two paper-based questionnaires (one for staff and one for patients) were designed. The staff survey was circulated to all hospices in the UK and Ireland, and the patient questionnaire was given to patients attending three oncological care clinics in Belfast, Northern Ireland; Wolverhampton, England; and Auckland, New Zealand. ⋯ However, 124/129 (96%) of patients with advanced cancer reported that they had never found the experience of being weighed in a healthcare facility upsetting. Some 95/129 (74%) of patients weighed themselves at home and 89% would want to know if their weight was changing. While there is reluctance on the part of many hospice staff to weigh patients, most patients with advanced malignancy in the hospital setting do not report weight measurement to be upsetting.
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Palliative medicine · Sep 2010
Multicenter StudyEquity of use of specialist palliative care by age: cross-sectional study of lung cancer patients.
The equitable provision of care is a core principle of the National Health Service. Previous research has suggested that older cancer patients may be less likely to use specialist palliative care, but such research has been limited by retrospective design and the failure to measure clinical need. The objective of this study was to examine the extent to which the use of specialist palliative care in lung cancer patients varies by age, after accounting for need. ⋯ Metastatic disease, global quality of life and the clinic where treatment was provided were associated with use of specialist palliative care. Age, gender, deprivation, living alone, current or most recent line of treatment, number of co-morbidities and carer stress were not associated with receipt of such services. This suggests that, for patients within the specialist cancer care system, access to specialist palliative care is offered on the basis of need.
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Palliative medicine · Sep 2010
Multicenter StudyPalliative care discharge from paediatric intensive care units in Great Britain.
We aim to describe the demographics and clinical characteristics of children discharged to palliative care from 31 paediatric intensive care units in Great Britain, using a cohort of admissions and discharges from the database of paediatric intensive care units (Paediatric Intensive Care Audit Network (PICANet)). The patients included in this study were children discharged alive from paediatric intensive care units (n = 68882) between 1 January 2004 and 31 December 2008. The main outcome measure was Odds Ratios for discharge of children from paediatric intensive care units to palliative care and their referral destination. ⋯ South Asian children referred to palliative care were less likely to receive this care in a hospice (OR 0.18, 95% CI 0.04,0.83) and more likely to receive it in a hospital setting (OR 2.57, 95% CI 1.16,5.71). We conclude that children admitted to paediatric intensive care units have a very low rate of discharge to palliative care. Specific demographic and clinical variables are associated with referral to palliative care.
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Palliative medicine · Sep 2010
Comparative StudySingle Question in Delirium (SQiD): testing its efficacy against psychiatrist interview, the Confusion Assessment Method and the Memorial Delirium Assessment Scale.
In this study we address the research question; How sensitive is a single question in delirium case finding? Of 33 'target' admissions, consent was obtained from 21 patients. The single question: 'Do you think [name of patient] has been more confused lately?' was put to friend or family. Results of the Single Question in Delirium (SQiD) were compared to psychiatrist interview (ΨI) which was the reference standard. The Confusion Assessment Method (CAM) and two other tools were also applied. Compared with ΨI, the SQiD achieved a sensitivity and specificity of 80% (95% CI 28.3-99.49%) and 71% (41.90-91.61%) respectively. The CAM demonstrated a negative predictive value (NPV) of 80% (51.91-95.67%) and the SQiD showed a NPV of 91% (58.72-99.77%). Kappa correlation of SQiD with the ΨI was 0.431 (p = 0.023). The CAM had a kappa value of 0.37 (p = 0.050). A further important finding in our study was that the CAM had only 40% sensitivity in the hands of minimally trained clinical users. ⋯ The SQiD demonstrates potential as a simple clinical tool worthy or further investigation.
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Palliative medicine · Sep 2010
An exploration of the experience, confidence and attitudes of staff to the provision of palliative care to people with intellectual disabilities.
Research suggests that shortcomings exist in the provision of palliative care to people with intellectual disabilities. This mixed-methods study aimed to describe the experience, confidence and attitudes of staff to the provision of palliative care to people with intellectual disabilities. The sample was drawn from the population of one Health Service Executive area in Ireland. ⋯ Both palliative care and intellectual disability services staff lacked confidence in their ability to provide palliative care. Staff were challenged by perceived 'differences' and 'difficulties' in the provision of care. They endorsed a partnership approach to care but focus group discussions revealed that a shared desire to cooperate was insufficient to guarantee effective collaboration.