Palliative medicine
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Palliative medicine · Jun 2009
Key stakeholders' experiences and views of the NHS End of Life Care Programme: findings from a national evaluation.
This article reports on the qualitative interview component of a national evaluation of the NHS End of Life Care Programme. It describes and discusses the views and experiences of 37 stakeholders of the Programme in relation to its development and implementation, impact and sustainability. ⋯ The extent of support for the Programme's primary aim to extend and improve end of life care, and the contribution of the hardworking and skilled individuals involved with its implementation, were highlighted as key influences on its successes. The authors conclude that many of the views and experiences highlighted in the stakeholder enquiry are reflected in the development and detail of the recently announced End of Life Care Strategy.
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Palliative medicine · Jun 2009
Does palliative home oxygen improve dyspnoea? A consecutive cohort study.
Palliative oxygen for refractory dyspnoea is frequently prescribed, even when the criteria for long-term home oxygen (based on survival, rather than the symptomatic relief of breathlessness) are not met. Little is known about how palliative home oxygen affects symptomatic breathlessness. A 4-year consecutive cohort from a regional community palliative care service in Western Australia was used to compare baseline breathlessness before oxygen therapy with dyspnoea sub-scales on the symptom assessment scores (SAS; 0-10) 1 and 2 weeks after the introduction of oxygen. ⋯ In multi-factor analysis, neither the underlying diagnosis causing breathlessness nor the demographic factors predicted responders at 1 week. Oxygen prescribed on the basis of breathlessness alone across a large population predominantly with cancer does not improve breathlessness for the majority of people. Prospective randomised trials in people with cancer and non-cancer are needed to determine whether oxygen can reduce the progression of breathlessness compared to a control arm.
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Palliative medicine · Jun 2009
ReviewClassification of pain in cancer patients--a systematic literature review.
One of the aims of the European Palliative Care Research Collaborative (EPCRC) is to achieve consensus on a classification system for cancer pain. We performed a systematic literature review to identify existing classification systems and domains/items used to classify cancer patients with pain. In a systematic search in the databases Medline and Embase, covering 1986-2006, 692 hits were obtained. 92 papers were evaluated to address pain classification. ⋯ The existing approaches to pain classification in cancer patients are different, mostly not thoroughly validated, and none is widely applied. An internationally accepted classification system for cancer pain could improve research and cancer pain management. This systematic review suggests a need for developing an international consensus on how to classify pain in cancer patients.
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Palliative medicine · Jun 2009
Multicenter StudyInformation disclosure to terminally ill patients and their relatives: self-reported practice of Belgian clinical specialists and general practitioners.
Objective of this study is to examine physicians' practices regarding information disclosure to terminally ill patients and to their relatives, without informing the patient. A questionnaire had been sent to a random sample of 3014 Belgian physicians from different specialties frequently involved in end-of-life care. Responses were analysed using weighted percentages, Chi-square, Mann-Whitney U-tests and a multivariate ordinal logistic regression. ⋯ The topics which most physicians always discuss with relatives without informing the patient are the aim of treatment, palliative care and incurability. There is a significant difference between clinical specialists and GPs. Clinical specialists and GPs discuss most end-of-life topics with the patient but omit important issues such as end-of-life hastening options and life-expectancy.
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Palliative medicine · Jun 2009
Treatment of palliative care emergencies by prehospital emergency physicians in Germany: an interview based investigation.
Palliative care medical emergencies as a consequence of advanced cancer account for approximately 3% of all prehospital emergency cases. Therefore, prehospital emergency physicians (EP) are confronted with 'end of life decisions'. No educational content exists concerning palliative medicine in emergency medicine curricula. ⋯ The emergency treatment of palliative care patients can become a particular challenge for any EP. A large percentage of interviewed EPs felt uncertain about aspects of social care and in the assessment of decisions at the end of life. Further information and training are necessary to amenable EPs to provide adequate patient-oriented care to palliative care patients and their relatives in emergency situations.