Palliative medicine
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Palliative medicine · Sep 2000
ReviewSurvival prediction in terminal cancer patients: a systematic review of the medical literature.
The clinical significance of studies on survival predictors in terminal cancer patients is hindered by both methodological limitations and the difficulty of finding common predictors for all final events in cancer related deaths. To evaluate the published medical literature concerned with the survival of patients with terminal cancer and identify potential prognostic factors, major electronic databases including MEDLINE (1966-), CANCERLIT (1983-) and EMBASE (1988-) were searched up to September 1999. Studies were included in our review if published in English, were cohort studies, addressed the identification of clinical prognostic factors for survival and looked at samples with median survival of < or = 3 months. ⋯ Clinical predictions should be considered as one of many criteria, rather than as a unique criterion by which to choose therapeutic interventions or health care programmes for terminally ill cancer patients. The use of convenient samples as opposed to more representative inception cohorts, the inclusion of different variables in the statistical analyses and inappropriate statistical methods appear to be major limitations of the reviewed literature. Methodological improvements in the design and conduction of future studies may reduce the prognostic uncertainty in this population.
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With the sponsorship of the Spanish Society of Palliative Care (SECPAL), two nation-wide studies from the University of Valladolid were carried out in 1996 and 1998 into the state of palliative care teams in Spain. This report is based on those studies and is the first overall analysis of the current situation of palliative care in Spain. A total of 143 programmes were identified and data were collected from 128 teams (89%): 53 were programmes with hospitalised patients, 75 for home-based patients and 15 were mixed programmes. ⋯ Of the patients who die from cancer each year in our country, 21.2% receive palliative care during the final weeks of life. More than 10 years have passed since the first teams in Spain started their work. The time has now come to recognize the reality of palliative care in our society and to adopt a national policy for terminally ill patients, in line with World Health Organization recommendations formulated in 1989.
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Palliative medicine · Sep 2000
Participation in a creative arts project can foster hope in a hospice day centre.
This study explored the experiences of terminally ill patients taking part in an exhibition of their creative arts work. It took place in St Christopher's Hospice day centre, London, UK, which aims to facilitate an environment in which a range of social and creative opportunities is offered following the theoretical background of Maslow's and Rogers' theories of personal growth and creativity. ⋯ These themes were interpreted as positive expressions of self-esteem, autonomy, social integration and hope. It is suggested that it was possible to identify hope as the essence of the phenomenon, and that this is important in palliative care where traditionally continuation of active medical intervention has been equated with provision of hope.
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Palliative medicine · Sep 2000
Minimum dataset activity for hospice and hospital palliative care services in the UK 1997/98.
This study reports on the third in an annual series of surveys covering England, Wales, Scotland and Northern Ireland on the activity of palliative care services. This report concentrates on inpatient (hospice and hospital) services. All 640 known UK palliative services were sent a standardized questionnaire asking about the characteristics and numbers of patients cared for. ⋯ There are 39,000 new hospice admissions each year and about 100,000 patients have contact with a hospital support service. Overall, the national provision of palliative care is increasing but there are groups who still appear to be missing out on palliative care, especially older people. Increasingly, patients appear to be admitted to a hospice earlier in care and are discharged home.