BMJ supportive & palliative care
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BMJ Support Palliat Care · Jun 2021
End-of-life discussions in residential care homes improves symptom control: a national register study.
In Europe, residential care homes (RCHs) rather than hospitals are the most common care facilities for the older adult and the place where most deaths occur in this age group. There is a lack of knowledge regarding end-of-life (EOL) discussions and how they correlate with symptoms and symptom relief. ⋯ The results indicate that EOL discussions are correlated with higher prevalence of symptoms, but also with better symptom relief and prescription of symptom drugs PRN when symptomatic. A possible explanation for this is that the EOL discussion can work as an opportunity to discuss symptoms and treatment for symptom relief.
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The COVID-19 pandemic has made unprecedented global demands on healthcare in general and especially the intensive care unit (ICU). the virus is spreading out of control. To this day, there is no clear, published directive for doctors regarding the allocation of ICU beds in times of scarcity. ⋯ Consequently, there has been no transparent discussion among professionals and the public. The thought of being at the mercy of absolute arbitrariness leads to fear among the population, especially the vulnerable groups.
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BMJ Support Palliat Care · Jun 2021
ReviewPhysician attitudes to voluntary assisted dying: a scoping review.
Voluntary assisted dying (VAD) became legal in the Australian state of Victoria on 19 June 2019 and will be legal in Western Australia from 2021. Other Australian states are progressing similar law reform processes. In Australia and internationally, doctors are central to the operation of all legal VAD regimes. It is broadly accepted that doctors, as a profession, are less in favour of VAD law reform than the rest of the community. To date, there has been little analysis of the factors that motivate doctors' support or opposition to legalised VAD in Australia. ⋯ A detailed understanding of medical perspectives about VAD would facilitate the design of legislative models that take better account of doctors' concerns. This may facilitate their greater participation in VAD and help address potential access issues arising from availability of willing doctors.
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BMJ Support Palliat Care · May 2021
Supportive and Palliative Care Indicators Tool prognostic value in older hospitalised patients: a prospective multicentre study.
An increasing number of older patients are hospitalised. Prognostic uncertainty causes hospital doctors to be reluctant to make the switch from cure to care. The Supportive and Palliative Care Indicators Tool (SPICT) has not been validated for prognostication in an older hospitalised population. ⋯ SPICT may be used as a tool to identify older hospitalised patients at risk of dying within 1 year and who may benefit from a palliative care approach including advance care planning. The prognostic accuracy of SPICT is better in older patients admitted at the acute geriatric versus the CU.
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BMJ Support Palliat Care · Apr 2021
Chronic breathlessness in advanced cardiorespiratory disease: patient perceptions of opioid use.
Low-dose oral opioids may improve severe chronic breathlessness in advanced cardiorespiratory diseases. Prescription of opioids for breathlessness occurs infrequently however, with little known about patients' attitudes towards their use in this setting. The aim of this qualitative study was to explore patients' perceptions regarding opioids for the management of severe chronic breathlessness in people with advanced cardiorespiratory disease. ⋯ Lack of knowledge regarding the role of opioids in managing severe chronic breathlessness, opioid misinformation and social stigmas are major barriers to opioid therapy that may be overcome by accurate information from trusted health professionals.