BMJ supportive & palliative care
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BMJ Support Palliat Care · Mar 2019
Multicenter StudyA collaborative approach to facilitate professionals to support the breathless patient.
Breathlessness is a major problem for people in their last weeks of life. Breathlessness is considered to be multidimensional with physical, psychological, emotional, social and spiritual factors all playing a part. It has been recognised that specific training to health professionals is beneficial in order to improve the care for patients with breathlessness.Breathlessness courses have tended to focus on senior nurses. A new flexible and collaborative training course was designed to include a wider range of nurses and other health professionals in hospital, hospice, primary care and community settings. The aim of the 'Practical Skills to Support the Breathless Patient' programme was to make patients and carers feel better supported in their breathlessness, for health professionals to develop confidence and skills in using proven interventions, and to adopt a flexible educational design that could be adapted to different contexts. ⋯ The course developed a number of innovative approaches, such as multi-disciplinary learning groups, regular feedback loops, reflexive learning about putting theory into practice and long-term follow-up. Combining these elements increases professionals' confidence and sustains new clinical practice.
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BMJ Support Palliat Care · Mar 2019
Effect of communication skills training on outcomes in critically ill patients with life-limiting illness referred for intensive care management: a before-and-after study.
To describe the effect of a communication skills training programme on patient-centred goals of care documentation and clinical outcomes in critically ill patients with life-limiting illnesses (LLI) referred for intensive care management. ⋯ The intervention was associated with increased PCD documentation and decrease in the choice of critical care as the resuscitation goal. Admissions to ICU did not decrease, and although limited by study design, condition-specific trajectory changes, clinical interventions and outcomes warrant further study.
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BMJ Support Palliat Care · Mar 2019
Paediatric advance care planning survey: a cross-sectional examination of congruence and discordance between adolescents with HIV/AIDS and their families.
To identify patient-reported paediatric advance care planning (pACP) needs of adolescents living with HIV and to examine the congruence with their family's perception of their needs. ⋯ Areas of discordance were associated with life-sustaining choices and when to have the EOL conversation. Targeted, adolescent/family-centred, evidence-based pACP interventions are needed to improve family understanding of youth's EOL wishes.
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The majority of people would prefer to die at home and the stated intentions of both statutory and voluntary healthcare providers aim to support this. This service evaluation compared the preferred and actual place of death of patients known to a specialist community palliative care service. ⋯ Direct enquiry and identification of preferences for end-of-life care is associated with patients achieving their preference for place of death. Patients whose preferred place of death was unknown were more likely to be admitted to hospital for end-of-life care.
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BMJ Support Palliat Care · Mar 2019
Confidence in palliative care issues by medical students and internal medicine residents.
Palliative care (PC) is a relatively new field in Brazil, but this knowledge is of great importance in medical practice. ⋯ Residents were more confident than all of the medical school students except those in their fifth year (P<0.05) because they have more contact with terminally ill patients than other students do; fifth-year medical students are likely overestimating their abilities.