BMJ supportive & palliative care
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BMJ Support Palliat Care · Dec 2013
Circles of care: should community development redefine the practice of palliative care?
Specialist palliative care, within hospices in particular, has historically led and set the standard for caring for patients at end of life. The focus of this care has been mostly for patients with cancer. More recently, health and social care services have been developing equality of care for all patients approaching end of life. ⋯ Within this article, we propose a model of care which identifies a person with an illness at the centre of a network which includes inner and outer networks, communities and service delivery organisations. All of these are underpinned by policy development, supporting the overall structure. Adoption of this model would allow individuals, communities, service delivery organisations and policy makers to work together to provide end of life care that enhances value and meaning for people at end of life, both patients and communities alike.
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BMJ Support Palliat Care · Dec 2013
ReviewWhat tools are available to identify patients with palliative care needs in primary care: a systematic literature review and survey of European practice.
It can be difficult to identify when a palliative care approach should be started both in malignant, and particularly, in non-malignant disease, ideally to run alongside disease-modifying care. A structured method or tool may be useful to help general practitioners (GPs) identify patients for early palliative care and trigger assessment and care planning. ⋯ Although several identification tools have been developed, none of these have been validated or widely implemented in Europe. Further collaborative international development, implementation and evaluation of such tools are recommended.
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BMJ Support Palliat Care · Dec 2013
Randomized Controlled TrialIs home-based palliative care cost-effective? An economic evaluation of the Palliative Care Extended Packages at Home (PEACH) pilot.
The aim of this study was to evaluate the cost-effectiveness of a home-based palliative care model relative to usual care in expediting discharge or enabling patients to remain at home. ⋯ The results of this small pilot study point to the potential of PEACH as a cost-effective end-of-life care model relative to usual care. Findings support the feasibility of conducting a definitive, fully powered study with longer follow-up and comprehensive economic evaluation.
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BMJ Support Palliat Care · Dec 2013
Discontinuity of care at end of life: a qualitative exploration of OOH end of life care.
This study aimed to understand the experiences of palliative care patients when accessing or making decisions about out of hours (OOH) services. It also aimed to illuminate barriers and enablers to accessing appropriate and timely care following the introduction of the 2004 New General Medical Services Contract. ⋯ Interpersonal or relationship continuity and management continuity are vital to the process of optimising the patient experience of OOH palliative care. While recent service innovations are tackling some of the issues highlighted, this research reinforces the value patients with palliative care needs places on continuity and the need to improve this aspect of care management.
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BMJ Support Palliat Care · Dec 2013
Comparative StudyEffect of a home-based end-of-life nursing service on hospital use at the end of life and place of death: a study using administrative data and matched controls.
To assess the effect of routinely delivered home-based end-of-life care on hospital use at the end of life and place of death. ⋯ Home-based end-of-life care offers the potential to reduce demand for acute hospital care and increase the number of people able to die at home.