Palliative medicine
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Social support is important in the bereavement period. In this study, the respondents were family members and friends to a patient who had died at a palliative care unit. The aim was to explore wishes and needs for, access to and effects of social support in the bereaved. ⋯ The network consisted of the close family, the origin family, relatives and friend. Support from the professional staff was required when the network was dysfunctional or when the grieving person did not want to burden members of his/her own network. The need for social support from professional staff was most needed close to the death and some time after.
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Palliative medicine · Mar 2009
Professionals delivering palliative care to people with COPD: qualitative study.
This article describes health and social care professionals' perceptions of palliative care and facilitators and barriers to the delivery of such care for patients with advanced chronic obstructive pulmonary disease. Health professionals participated in semi structured interviews and focus groups which were analysed using content analysis. ⋯ Consequently the delivery of palliative care was viewed as a specialist role rather than an integral component of care. There is a need for education and training for health and social care professions to plan and provide high quality end-of-life care.
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Palliative medicine · Jan 2009
ReviewEvaluation of hospital palliative care teams: strengths and weaknesses of the before-after study design and strategies to improve it.
Hospital palliative care teams (HPCTs) are well established as multi-professional services to provide palliative care in an acute hospital setting and are increasing in number. However, there is still limited evaluation of them, in terms of efficacy and effectiveness. The gold standard method of evaluation is a randomised control trial, but because of methodological (e.g., randomisation), ethical and practical difficulties such trials are often not possible. ⋯ As for every study design, avoidance and minimisation of bias is important to improve validity. Therefore, strategies of selecting an appropriate control group or time series and applying valid outcomes and measurement tools help reducing bias and strengthen the methods. Special attention is needed to plan and define the design and applied method.
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Palliative medicine · Jan 2009
ReviewAdvanced cancer patients' prognostic information preferences: a review.
Open communication in cancer care has gained increasing importance in recent years and diagnostic disclosure is now common place. However, there is a significant variability in the sharing of prognostic information. Information needs may vary significantly over the disease trajectory, and there has been relatively little work done focussing on late illness. ⋯ However, for a proportion of patients, hope and realism were irreconcilable when presented with detailed or unequivocal information. Professionals have a responsibility to provide information to patients, but also to respect the need to maintain some ambiguity about the future, if that is a patient's wish. Therefore, prognostic discussions necessitate careful, individualised assessment, a process which can facilitate enhanced palliative care for patients with advanced cancer.
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Palliative medicine · Jan 2009
Validation of the confusion assessment method in the palliative care setting.
The Confusion Assessment Method (CAM) is widely used in the palliative care setting despite the fact that its performance in this population has not been validated. The aim of the study was to determine the sensitivity and specificity of the CAM when used by Non-Consultant Hospital Doctors (NCHDs) working in a specialist palliative care unit. A pilot phase was performed in which NCHDs received a 1-hour training session based on the original CAM training manual. 32 patients underwent 33 assessments in the pilot phase but the sensitivity of the CAM was only 0.5 (0.22-0.78) and specificity was 1.0 (0.81-1.0). ⋯ Sensitivity was 0.88 (0.62-0.98) and specificity was 1.0 (0.88-1.0). The results suggest that the CAM is a valid screening tool for delirium in the palliative care setting but its performance is dependent on the skill of the operator. NCHDs require a certain standard of training before becoming proficient in its use.