Palliative medicine
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Palliative medicine · Jun 2006
Predictors associated with the place of death in a country with increasing hospital deaths.
To evaluate the contribution of type of illness, socio-demographic factors, and area of residence to the place of death in a country with increasing hospital deaths. ⋯ Trends in place of death are influenced by available hospital beds, socio-demographic factors and the nature of the terminal disease, in a country with increasing hospital deaths. These associations should be viewed within the context of culture and local health care systems.
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Palliative medicine · Jun 2006
Sodium picosulfate in opioid-induced constipation: results of an open-label, prospective, dose-ranging study.
Identification of a safe and effective dose of the laxative sodium picosulfate was investigated in a single-centre, open-label study of 23 patients (age 40-81 years) receiving > or =60 mg/day morphine sulphate and experiencing constipation. A starting dose of 5, 10 or 15 mg sodium picosulfate (1 mg/mL solution) was administered, based on the patient's clinical status at entry and recent requirements for laxatives. Dose titration was permitted (+/-2.5 or 5 mg increments), to a maximum daily dose of 60 mg. ⋯ A satisfactory response (normal stool consistency, not requiring enemas, suppositories or manual evacuation, no significant adverse event) was achieved in 15/20 evaluable patients. The median daily dose to achieve this was 15 mg (range: 5-30 mg) and the median time to first bowel movement after dosing was 11.75 hours (range: 6-22.5 hours). There was no clear relationship between the opioid dose and the optimum dose of sodium picosulfate, confirming that individual dose titration is necessary.
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Palliative medicine · Jun 2006
Factors predictive of preferred place of death in the general population of South Australia.
In a population survey, 2652 respondents aged 15+ years reported their preferred place of death, if dying of 'a terminal illness such as cancer or emphysema', to be home (70%), a hospital (19%), hospice (10%), or nursing home (<1%). The majority of respondents in all socio-demographic categories reported a preference for dying at home, with the greatest majorities occurring in younger age groups. ⋯ Predictors of preference for death in a hospice rather than hospital include older age, female, single, metropolitan residence, having higher educational and income levels, paid employment, awareness of advanced directives, and interpreting 'dying with dignity' as death without pain or suffering. Investigating the differences between preferred and actual places of death may assist service providers to meet end-of-life wishes.
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Palliative medicine · Jun 2006
Who receives specialist palliative care in Western Australia--and who misses out.
To describe the characteristics of Western Australian (WA) people who received, and did not receive, specialist palliative care (SPC) during their last 12 months of life. ⋯ Within a WA context, this study confirms established international evidence for problems of access to SPC by non-cancer patients and other disadvantaged groups. Importantly, this evidence is provided at a population level, thus documenting the extent of inequities in palliative care service provision. By pointing to the areas of most critical need, this study assists in health service policy and planning.
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Palliative medicine · Apr 2006
Comparative StudyHome care of a child dying of a malignancy and parental awareness of a child's impending death.
In this population-based study, we found that parents who are aware that their child will die from a malignancy are more likely to care for their child at home during the child's last month of life compared to parents who are not aware. End-of-life home care was comparable to hospital care for satisfactory pain relief, access to pain relief and access to medications for other physical symptoms. ⋯ The prevalence of dying at home and being cared for at home during the last month of life was 23.7% when parents realized intellectually more than 1 month in advance that the child would die (versus 12% who did not), 28.7% for parents who sensed that the child was aware of his or her imminent death (versus 7.8% who did not sense this) and 21.9% for those who received information that the child's illness was incurable (versus 9.4% who did not receive the information). Prevalence of children's unrelieved pain was 11.6% for those receiving home care and 15.3% for those receiving care outside the home.