BMJ supportive & palliative care
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BMJ Support Palliat Care · Sep 2013
An exploratory study of the knowledge, attitudes and perceptions of advance care planning in family caregivers of patients with advanced illness in Singapore.
The aim of this study was to examine the knowledge, attitudes and perceptions of advance care planning (ACP) in caregivers of patients with advanced illness in Singapore. ⋯ This study highlights the need for public education on the benefits and process of ACP in Singapore. In formulating an approach to ACP, there is a need to take into account cultural sensitivities towards ACP discussions and the importance of closely involving the family unit in the process.
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BMJ Support Palliat Care · Sep 2013
A qualitative analysis of the elements used by palliative care clinicians when formulating a survival estimate.
For patients with advanced and/or incurable disease, clinicians are often called upon to formulate and communicate an estimate of likely survival duration. The objective of this study was to gain a deeper appreciation of this process by identifying and exploring the specific elements that may inform and/or impact a clinician's estimate of survival (CES). ⋯ For any given patient, several elements have the potential to inform and/or impact the process of CES formulation. Study participants were aware of objective clinical factors known to correlate with actual survival duration and likely integrate this information when formulating a CES. Formulation occurs within a larger context comprised of a number of elements that may influence individual estimates. These elements exist against a background of awareness of the overall likelihood of CES inaccuracy. Clinicians are encouraged to develop a personalised and standardised approach to CES formulation whereby an awareness of the menu of potentially impacting elements is consciously integrated into an individual process.
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BMJ Support Palliat Care · Jun 2013
ReviewMoral differences in deep continuous palliative sedation and euthanasia.
In palliative care there is much debate about which end of life treatment strategies are legitimate and which are not. Some writers argue that there is an important moral dividing-line between palliative sedation and euthanasia, making the first acceptable and the latter not. We have questioned this. ⋯ Regarding the first objection, we argue that Materstvedt misses the point: we agree that there is a difference in terms of intentions between continuous deep palliative sedation and euthanasia, but we question whether this conceptual difference makes up for a moral difference. Materstvedt fails to show that it does. Regarding the second objection, we argue that if nothing else is at stake than the value of the patient's life, permanent unconsciousness and death are morally indifferent.
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BMJ Support Palliat Care · Jun 2013
Review Meta AnalysisCongruence between preferred and actual place of death according to the presence of malignant or non-malignant disease: a systematic review and meta-analysis.
Achieving congruence between preferred and actual place of death is increasingly being used as a quantifiable indicator of the effectiveness of palliative care services. Current secular trends indicate a reversal of the institutionalisation of death, but this has been more pronounced in patients with malignant disease. As such, this study was conducted to evaluate whether the preservation of autonomy has been addressed equitably for cancer and non-cancer populations. ⋯ These findings pose a significant challenge, as a 'good' death has been closely matched to achieving patients' wishes, including preferred place of death. Despite increasing awareness that those dying from chronic non-malignant diseases have extensive palliative care needs, much is still to be done to preserve their autonomy and reduce powerlessness in the face of death.
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BMJ Support Palliat Care · Jun 2013
ReviewQuality indicators for palliative and end of life care: a review of Swedish policy documents.
All patients with palliative and end of life care needs should be guaranteed equal and safe treatment and care, regardless of their disease or site of care. The inclusion of quality indicators in national guidelines and other guiding documents supports quality assurance and improvement in provision of care. The aim of this paper was to review existing quality indicators in national Swedish policy documents relevant to palliative and end of life care. ⋯ In the existing Swedish national guidelines for many different diseases, there is still a great need to define clinically relevant and feasible outcome measures of quality of palliative and end of life care.