Palliative medicine
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Palliative medicine · Apr 2009
Comparative StudyA comparison of the quality of care provided to cancer patients in the UK in the last three months of life in in-patient hospices compared with hospitals, from the perspective of bereaved relatives: results from a survey using the VOICES questionnaire.
The importance of evaluating systematically the effectiveness of hospice care has been noted for at least 20 years. There is, however, limited evidence about whether and how the care provided to terminally ill patients by in-patient hospices in the UK differs from that provided in NHS hospitals. In this article, we, therefore, present a comparison of hospice in-patient care and hospital care for cancer patients in the UK, from the perspective of bereaved relatives who had experienced both types of care during the last 3 months of the patient's life. ⋯ In comparison to hospital care, from the perspective of bereaved relatives, hospice in-patient care provided better pain control, better communication with patients and families, and better medical, nursing and personal care, which treated the patient with more dignity. Further research is needed to confirm these findings using a wider sample of in-patient hospices in the UK and including the perspectives of patients. Providing high quality care for terminally ill patients in acute hospitals remains an important challenge.
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Palliative medicine · Apr 2009
Informal carer bereavement outcome: relation to quality of end of life support and achievement of preferred place of death.
This study investigated (a) whether carer bereavement outcome is affected by the achievement of the patient's and/or carers' preferred place of death and (b) the relationship between carer satisfaction with end of life care and bereavement outcome. Participants were 216 carers of patients referred to hospice at home (H@H). Prospective recording of preferred and actual place of death were obtained from H@H records. ⋯ Fulfilment of carer preference for place of death only related to post-bereavement mental health at P < 0.1. Adequacy of psychological support showed the clearest relationship with bereavement outcome both in univariate and multivariate analyses. The level of support, particularly psychological, may be more important for carers' bereavement outcome than achievement of the preferred place of death for the patient.
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This study estimates the frequency of different medical end-of-life decisions (ELDs) made in the United Kingdom (UK) in 2007-2008, comparing these with 2004. Postal survey was carried out with 8857 medical practitioners, of whom 3733 (42%) practitioners replied, with 2869 having attended a person who died in the previous year. The proportion of UK deaths involving (1) voluntary euthanasia (0.21%; CI: 0-0.52), (2) physician-assisted suicide (0.00%) and (3) ending of life without an explicit request from the patient (0.30%; CI: 0-0.60) is low. ⋯ Further findings about the distribution of ELDs across subgroups are also reported. Survey research in this area requires careful control over question wording if valid estimates and comparisons of the prevalence of ELDs are to be made. The high rate of sedation compared with other countries may be a cause for concern.
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Palliative medicine · Apr 2009
Practice GuidelineResearching breathlessness in palliative care: consensus statement of the National Cancer Research Institute Palliative Care Breathlessness Subgroup.
Breathlessness is common in advanced disease and can have a devastating impact on patients and carers. Research on the management of breathlessness is challenging. ⋯ The aims of this paper are to facilitate the design of adequately powered multi-centre interventional studies in breathlessness, to suggest a standardised, rational approach to breathlessness research and to aid future 'between study' comparisons. Discussion of the physiology of breathlessness is included.
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Palliative medicine · Apr 2009
Legalisation of euthanasia or physician-assisted suicide: survey of doctors' attitudes.
This study reports UK doctors' opinions about legalisation of medically assisted dying (euthanasia and physician-assisted suicide), comparing this with the UK general public. A postal survey of 3733 UK medical practitioners was done. The majority of UK doctors are opposed to legalisation, contrasting with the UK general public. ⋯ Frequency of treating patients who die is not independently associated with attitudes. Many doctors supporting legalisation also express reservations and advocate safeguards; many doctors opposing legalisation believe and accept that treatment and nontreatment decisions may shorten life. It is hoped that future debates about legalisation can proceed with this evidence in mind.