BMJ supportive & palliative care
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BMJ Support Palliat Care · Sep 2011
How common are palliative care needs among older people who die in the emergency department?
To determine the prevalence and nature of palliative care needs in people aged 65 years or more (65+) who die in emergency departments (EDs). ⋯ There is considerable palliative care need among older people who ultimately died in the ED, of whom only a minority were known to palliative care services in this study. Previous ED and hospital admission suggest opportunities for referral and forward planning. More older people in need of palliative care must be identified and managed earlier to avoid future undesired admissions and deaths in hospital.
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BMJ Support Palliat Care · Sep 2011
Exploring health professionals' views regarding the optimum physical environment for palliative and end of life care in the acute hospital setting: a qualitative study.
Limited evidence exists relating to key elements of the optimum physical hospital environment for patients receiving palliative and end of life care in acute hospitals. The aim of this study was to explore the perspectives of health professionals regarding the optimum physical environment for palliative and end of life care in the acute hospital setting. ⋯ Many deficiencies exist in physical hospital environments for patients at the end of life. However, changes to the hospital environment are limited by resource restrictions, increasing rules and regulations, and a focus on clinical aspects of care. Further research is needed to establish patient and family views about the optimum physical hospital environment, to explore ways in which an appropriate environment can be most effectively achieved and to ensure engagement with planners, designers and stakeholders when commissioning new hospitals or renovating existing facilities.
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BMJ Support Palliat Care · Sep 2011
'Do Not Attempt Cardiopulmonary Resuscitation' discussions at the point of discharge: a case note review of hospice practice following local integrated policy implementation.
An integrated 'Do Not Attempt Cardiopulmonary Resuscitation' (DNACPR) policy was implemented across Lothian in 2006 (for ease of reading the terminology 'DNACPR' has been used throughout the paper where the original Lothian Policy used 'DNAR'). Patients were, for the first time, able to be discharged home with their DNACPR form after discussion about cardiopulmonary resuscitation (CPR). ⋯ It is possible to discuss CPR with a high proportion of hospice patients prior to discharge from a hospice. Following the introduction of an integrated policy, more patients have DNACPR forms prior to admission. Most patients receiving specialist palliative care find DNACPR discussions acceptable and understand the benefits of having a DNACPR form.
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BMJ Support Palliat Care · Jun 2011
Transitions to palliative care in acute hospitals in England: qualitative study.
To explore how transitions to a palliative care approach are perceived to be managed in acute hospital settings in England. ⋯ Significant barriers to implementing a policy of structured transitions to palliative care in acute hospitals were identified by health professionals in both primary and secondary care. These need to be addressed if current UK policy on management of palliative care in acute hospitals is to be established.
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BMJ Support Palliat Care · Jun 2011
ReviewExploring the transition from curative care to palliative care: a systematic review of the literature.
UK policy guidance on treatment and care towards the end of life identifies a need to better recognise patients who are likely to be in the last 12 months of life. Health and social care professionals have a key role in initiating and managing a patient's transition from 'curative care' to palliative care. The aim of this paper is to provide a systematic review of evidence relating to the transition from curative care to palliative care within UK settings. ⋯ The literature suggests that little is known about the potentially complex transition to palliative care. Evidence suggests that continuity of care and multidisciplinary collaboration are crucial in order to improve the experience of patients making the transition. An important role is outlined for generalist providers of palliative care. Incorporating palliative care earlier in the disease trajectory and implementing a phased transition appear key components of optimum care.