BMJ supportive & palliative care
-
BMJ Support Palliat Care · Sep 2011
Prevalence, course and associations of desire for hastened death in a UK palliative population: a cross-sectional study.
To determine the prevalence, severity and remission of desire for hastened death (DHD) in a UK representative sample of patients with advanced disease receiving palliative care and to examine the associations of desire for death. ⋯ The prevalence of DHD was at the lower end of that seen in previous studies using similar samples. More severe DHD was uncommon and for most part remitted to some extent during the study. The provision of symptom control and timely detection and intervention for depression coupled with a focus on optimising function, instilling hope and preserving dignity are likely to contribute to alleviation of DHD in patients with advanced illness.
-
BMJ Support Palliat Care · Sep 2011
Living and dying with severe chronic obstructive pulmonary disease: multi-perspective longitudinal qualitative study.
To understand the perspectives of people with severe chronic obstructive pulmonary disease (COPD) as their illness progresses, and of their informal and professional carers, to inform provision of care for people living and dying with COPD. ⋯ Our findings challenge current assumptions underpinning provision of end of life care for people with COPD. The policy focus on identifying a time point for transition to palliative care has little resonance for people with COPD or their clinicians and is counter productive if it distracts from early phased introduction of supportive care. Careful assessment of possible supportive and palliative care needs should be triggered at key disease milestones along a lifetime journey with COPD, in particular after hospital admission for an exacerbation.
-
BMJ Support Palliat Care · Sep 2011
ReviewPalliative care in Africa since 2005: good progress, but much further to go.
There has been rapid progress in palliative care in Africa since the World Health Assembly in 2005 which identified palliative care as an urgent humanitarian need. Palliative care is now recognised as a basic human right, and momentum has gathered to translate this into action. From being significantly present in only five countries in 2004, palliative care is now delivered in nearly 50% of African countries. ⋯ Current challenges are to increase coverage while maintaining quality, to develop dynamic and flexible responses to the changing illness patterns in Africa, and to counter false beliefs. Resourcefulness and harnessing new technologies such as mobile phones while respecting cultural traditions, may be the way forward. The authors review recent progress in policy, service provision and training initiatives in Africa, illustrate the current situation at grass roots level from a recent evaluation of programmes in Kenya, Malawi and Uganda, analyse the current urgent challenges and suggest some ways ahead.
-
BMJ Support Palliat Care · Sep 2011
How common are palliative care needs among older people who die in the emergency department?
To determine the prevalence and nature of palliative care needs in people aged 65 years or more (65+) who die in emergency departments (EDs). ⋯ There is considerable palliative care need among older people who ultimately died in the ED, of whom only a minority were known to palliative care services in this study. Previous ED and hospital admission suggest opportunities for referral and forward planning. More older people in need of palliative care must be identified and managed earlier to avoid future undesired admissions and deaths in hospital.
-
BMJ Support Palliat Care · Sep 2011
Exploring health professionals' views regarding the optimum physical environment for palliative and end of life care in the acute hospital setting: a qualitative study.
Limited evidence exists relating to key elements of the optimum physical hospital environment for patients receiving palliative and end of life care in acute hospitals. The aim of this study was to explore the perspectives of health professionals regarding the optimum physical environment for palliative and end of life care in the acute hospital setting. ⋯ Many deficiencies exist in physical hospital environments for patients at the end of life. However, changes to the hospital environment are limited by resource restrictions, increasing rules and regulations, and a focus on clinical aspects of care. Further research is needed to establish patient and family views about the optimum physical hospital environment, to explore ways in which an appropriate environment can be most effectively achieved and to ensure engagement with planners, designers and stakeholders when commissioning new hospitals or renovating existing facilities.