Palliative medicine
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Palliative medicine · Jun 2007
An evaluation of a physiotherapy led non-pharmacological breathlessness programme for patients with intrathoracic malignancy.
The outcomes of the first 4 years of a physiotherapy led non-pharmacological breathlessness management programme for patients with intrathoracic malignancy are described. Of the 169 patients enrolling, only 14 completed the full 4-week programme. All reported improvements in some parameters measured though these did not reach statistical significance. ⋯ Objective post intervention scores could not be made in this group, but anecdotal quotes suggested benefit. In a group whose natural history is a relentless deterioration over a period of months, pre- and post-intervention symptom scoring is difficult to achieve. It is suggested that a qualitative approach might be more sensitive at identifying which aspects of the service are most appropriate.
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Palliative medicine · Apr 2007
ReviewWhich measurement scales should we use to measure breathlessness in palliative care? A systematic review.
There is no universally accepted measurement scale to assess breathlessness in adult palliative care patients. This significantly hampers clinical practice and research into effective interventions. The aim is to systematically identify and appraise breathlessness measurement scales, which are validated for use in palliative care or which show potential for use. ⋯ The NRS, modified Borg, CRQ-D and CDS appear most suitable for use in palliative care, but further evaluation is required before adopting any scale as standard. This review has been registered with the Cochrane collaboration and will be published and updated as a Cochrane review.
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The Dutch health care system is characterized by a strong emphasis on primary care. To get insight into the strengths and gaps in end-of-life care in the Netherlands, data are needed about use and patient evaluation of end-of-life care. We assessed the experiences of patients with end-of-life care during the last months of life. ⋯ Most patients indicated to be satisfied with the care offered by their caregivers. Problems in end-of-life care concerned communication, difficulties in coordination, accessibility of end-of-life care and responding quickly to acute problems. We conclude that comprehensive and interdisciplinary end-of-life care may address patients' needs, but that it simultaneously is a challenge to optimal communication among disciplines and between caregivers and the patient.
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Palliative medicine · Apr 2007
Shifting to conscious control: psychosocial and dietary management of anorexia by patients with advanced cancer.
The psychosocial strategies used by advanced cancer patients to manage anorexia are poorly described. A greater understanding of them may guide clinicians to provide appropriate interventions to patients and caregivers. ⋯ Participants retained the motivation and ability to eat without appetite, providing the intake of food did not provoke nausea or the anticipation of emesis. Nutritional interventions must be tailored around patients' eating capabilities. Counselling and education programmes that assist family members in understanding the shift to conscious control over eating are required.
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Palliative medicine · Apr 2007
ReviewDo religious or spiritual beliefs influence bereavement? A systematic review.
Responses to bereavement may be influenced by characteristics such as age or gender, but also by factors like culture and religion. ⋯ Available data do not allow for a definite answer on whether religious/spiritual beliefs effectively influence bereavement as most studies suffer from weaknesses in design and methodological flaws. Further research is needed. Recommendations for further research are given.