BMJ supportive & palliative care
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BMJ Support Palliat Care · Sep 2014
Evaluation of screening criteria for palliative care consultation in the MICU: a multihospital analysis.
There are currently no comprehensive studies in critical care settings that have set out to examine the association of palliative care screening criteria with multiple, adverse patient outcomes. ⋯ Decisions on the appropriateness for palliative care consultation in the MICU can be aided using a trigger screen. We recommend the use of this screen be considered in the MICU with the suggested revisions. Additional studies are needed to determine if the use of the trigger screen is associated with improved clinical outcomes.
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BMJ Support Palliat Care · Jun 2014
Development and initial validation of a new outcome measure for hospice and palliative care: the St Christopher's Index of Patient Priorities (SKIPP).
To develop and conduct a preliminary psychometric analysis of a hospice and palliative care patient-reported outcome measure to detect patients' perceptions of change in quality of life (QoL) and issues of concern, and views of service benefit. ⋯ SKIPP can detect patients' perception of change in QoL and main concerns, and the difference patients think the service has made to them. Its design with current and retrospective components addresses response shift and means it can be used for quality improvement or clinical purposes with only one administration, an advantage in frail populations. It is therefore a useful addition to hospice and palliative care patient-reported outcome measures.
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BMJ Support Palliat Care · Jun 2014
Left ventricular assist device withdrawal: an ethical discussion.
Specialist palliative care (SPC) services are increasingly integrated with chronic heart failure (CHF) services. Left ventricular assist devices (LVADs) represent an advance in the management of advanced CHF, but may pose ethical challenges for SPC services providing care to this population. The patient received an LVAD as 'bridge-to-heart-transplant,' but subsequently experienced multiple cerebral haemorrhages, resulting in neurological deficits, and severe functional impairment. ⋯ Following discussion within the multi-disciplinary team and with the patient's family, LVAD support was withdrawn, and the patient died peacefully. This piece reviews the ethical considerations that informed decision-making, in particular, autonomy, informed consent and futility. In addition, the question of the nature of LVADs is debated and how the perceptions of the patient, and others, of the device may influence decision-making around withdrawal of treatment.
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BMJ Support Palliat Care · Jun 2014
Doctors' attitudes towards prescribing opioids for refractory dyspnoea: a single-centred study.
Dyspnoea is a distressing and common symptom in palliative care. There is evidence that opioids can improve the experience of dyspnoea. Limited data suggest that doctors' attitudes may be a barrier to prescribing opioids for the relief of refractory dyspnoea. This study explored UK hospital doctors' experience of, and attitudes towards, prescribing opioids for refractory dyspnoea in advanced disease. ⋯ This group of doctors was aware of the use of opioids for refractory dyspnoea and reported a willingness to prescribe opioids for this symptom. However, confidence varied considerably depending on clinical context. Fears about side effects were prevalent and should be addressed. Doctors would benefit from clearer guidance on prescribing regimes, specifically in circumstances other than the dying patient.