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BMJ Supportive & Palliative Care

Bill Lukin, Jaimi Greenslade, Alison Mary Kearney, Carol Douglas, Tegwen Howell, Michael Barras, Phillip Good
CONTEXT: A rapid method of methadone conversion known as the Perth Protocol is commonly used in Australian palliative care units. There has been no follow-up or validation of this method and no comparison between different methods of conversion. OBJECTIVES: The primary objective of this study was to test the hypothesis that the achieved doses of methadone are independent of the conversion method (rapid vs slower). The secondary objectives included examining the relationship between calculated target doses, actual achieved doses and duration of conversions...
February 16, 2019: BMJ Supportive & Palliative Care
Alessandra Buja, Michele Rivera, Vincenzo Baldo, Marta Soattin, Ylenia Rizzolo, Giuseppe Zamengo, Sarah Boscolo, Maria Cristina Ghiotto, Gianfranco Damiani
OBJECTIVES: The aim of this study was to investigate how palliative care service structures and processes correlate with their outputs and outcomes, measuring the latter respectively in terms of intensity of care and death at home. METHODS: The Veneto Regional Health Authorities collected a set of 37 quality indicators for the year 2016, covering the following five dimensions: service integration, service structure, accessibility, professional processes and organisational processes...
February 14, 2019: BMJ Supportive & Palliative Care
Barret Rush, Clark Fruhstofer, Keith R Walley, Leo Anthony Celi, Mayur Brahmania
BACKGROUND: Patients with end-stage liver disease (ESLD) have a reduced life expectancy and a significant symptom burden. Our aim is to determine if inpatient palliative care (PC) referral for patients with ESLD is associated with decreased hospital readmission rates. METHODS: The 2013 US Nationwide Readmission Database (NRD) was used for the current analysis. The NRD allows for longitudinal analysis of all patient hospital admissions across 22 states. Patients ≥18 years of age with a diagnosis of ESLD with at least two decompensating events were included in the analysis...
February 13, 2019: BMJ Supportive & Palliative Care
Stephen Barclay, Emily Moran, Sue Boase, Margaret Johnson, Roberta Lovick, Jonathan Graffy, Patrick L White, Brenda Deboys, Katy Harrison, Brooke Swash
INTRODUCTION: Primary care has a central role in palliative and end of life care: 45.6% of deaths in England and Wales occur under the care of primary care teams at home or in care homes. The Community Care Pathways at the End of Life (CAPE) study investigated primary care provided for patients in the final 6 months of life. This paper highlights the opportunities and challenges associated with primary palliative care research in the UK, describing the methodological, ethical, logistical and gatekeeping challenges encountered in the CAPE study and how these were addressed...
February 12, 2019: BMJ Supportive & Palliative Care
Karen Harrison Dening, Emma Castle, Caroline Scates, Kay De Vries
OBJECTIVES: Historically, dementia has not been recognised as a life-limiting condition or one that may benefit from a palliative approach to its care. There are many challenges in providing palliative and end-of-life care to this group of people, some of which may be reduced through advance care planning (ACP) to support people with dementia to have a greater influence on their care at end of life. ACP has been defined as a process of discussing and recording of wishes, values and preferences for future care and treatment held between an individual, family members and their care provider(s) that takes effect when the person loses capacity...
February 8, 2019: BMJ Supportive & Palliative Care
John J You, Peter Allatt, Michelle Howard, Carole A Robinson, Jessica Simon, Rebecca Sudore, Amy Tan, Carrie Bernard, Marilyn Swinton, Xuran Jiang, Doug Klein, Michael McKenzie, Gillian Fyles, Daren Keith Heyland
OBJECTIVES: To develop and validate a values clarification tool, the Short Graphic Values History Tool (GVHT), designed to support person-centred decision making during serious illness. METHODS: The development phase included input from experts and laypersons and assessed acceptability with patients/family members. In the validation phase, we recruited additional participants into a before-after study. Our primary validation hypothesis was that the tool would reduce scores on the Decisional Conflict Scale (DCS) at 1-2 weeks of follow-up...
February 6, 2019: BMJ Supportive & Palliative Care
David See, Brian Le, Alexandra Gorelik, Peter Eastman
BACKGROUND: There is increasing recognition that patients with non-malignant diseases have comparable physical and psychosocial symptom burden to patients with cancer. There is currently limited data directly comparing symptom burden between these patient groups. OBJECTIVE: To investigate differences in symptom burden between patients with malignant and non-malignant conditions admitted to a palliative care unit (PCU). METHOD: A cross-sectional study involving 186 patients admitted to a PCU was undertaken...
February 4, 2019: BMJ Supportive & Palliative Care
Susan DeSanto-Madeya, Dan Willis, Julie McLaughlin, Aristotle Boslet
OBJECTIVES: Family caregivers suffer a high burden of emotional and psychological distress following the death of a loved one in the intensive care unit and often struggle to heal in the weeks following their loss. The purpose of this hermeneutic phenomenological study was to describe and interpret the experience of healing for family caregivers six weeks following the death of a loved one in the ICU. METHODS: Semi-structured telephone interviews were conducted with a purposive sample of twenty-four family caregivers six weeks following the death of their loved ones in the ICU...
February 4, 2019: BMJ Supportive & Palliative Care
Aoife Gleeson, Faye Johnson
OBJECTIVES: An increasing number of patients with motor neuron disease (MND) in the UK and Ireland use assisted ventilation, and a small proportion of these use long-term tracheostomy ventilation (TV).1 2 NICE guidelines recommend that patients with MND should routinely receive specialist palliative care input.3 The aim was to establish the extent to which hospices and specialist palliative care units (SPCUs) in the UK and Ireland currently manage patients with MND using assisted ventilation especially TV and to identify any associated barriers...
February 2, 2019: BMJ Supportive & Palliative Care
Tanja Krones, Ana Budilivschi, Isabelle Karzig, Theodore Otto, Fabio Valeri, Nikola Biller-Andorno, Christine Mitchell, Barbara Loupatatzis
OBJECTIVES: To investigate the impact of advance care planning (ACP) including decision aids for severely ill medical inpatients. METHODS: Single-centre randomised controlled trial at a Swiss university hospital. Patients were randomly assigned (1:1) to receive an extra consultation with the hospital social service or a consultation with in-house facilitators trained according to an internationally established ACP programme. Trial participants with the exception of the observers were fully blinded...
January 21, 2019: BMJ Supportive & Palliative Care
Nicholas Jennings, Kenneth Chambaere, Luc Deliens, Joachim Cohen
OBJECTIVES: Low/middle-income countries, particularly Small Island Developing States, face many challenges including providing good palliative care and choice in place of care and death, but evidence of the circumstances of dying to inform policy is often lacking. This study explores where people die in Trinidad and Tobago and examines and describes the factors associated with place of death. METHODS: A population-level analysis of routinely collected death certificate and supplementary health data where the unit of analysis was the recorded death...
January 18, 2019: BMJ Supportive & Palliative Care
Paulo Luz, Beatriz Gosalbez
No abstract text is available yet for this article.
January 18, 2019: BMJ Supportive & Palliative Care
Jean-Philippe Laroche
Sudden cessation of baclofen can produce a withdrawal syndrome even if it was previously orally administered. We present the case of a man who exhibited signs of baclofen withdrawal syndrome during palliative sedation. Attempts were made to induce muscle relaxation with ever-increasing doses of benzodiazepine. Ultimately, control over the withdrawal syndrome was regained by using a continuous subcutaneous infusion (CSCI) of dexmedetomidine, a highly selective α2 adrenergic agonist. Very limited published reports concerning CSCI of dexmedetomidine exist...
January 12, 2019: BMJ Supportive & Palliative Care
Marina Maffoni, Piergiorgio Argentero, Ines Giorgi, Julia Hynes, Anna Giardini
OBJECTIVES: Palliative care providers may be exposed to numerous detrimental psychological and existential challenges. Ethical issues in the healthcare arena are subject to continual debate, being fuelled with ongoing medical, technological and legal advancements. This work aims to systematically review studies addressing the moral distress experienced by healthcare professionals who provide adult palliative care. METHODS: A literature search was performed on PubMed, Scopus, Web of Science and PsycINFO databases, searching for the terms 'moral distress' AND 'palliative care'...
January 12, 2019: BMJ Supportive & Palliative Care
Marie Joseph
'Opioid induced hyper-algesia' is a paradoxical phenomenon known to occur with high-dose opioid therapy when attempting to control severe pain. The high opioid load leads to exacerbation of existing 'central sensitization' process in the spinal cord dorsal horn and parts of the brain. This situation usually occurs in the clinical context of uncontrolled complex pain with a predominant neuropathic pain component. There is resistance to the analgesic effect of the opioid which worsens with increasing doses. It was not commonly known that in this situation there is often a resistance to the respiratory depression effect of the opioid too caused by similar mechanisms...
January 12, 2019: BMJ Supportive & Palliative Care
Caris E Grimes, Belinda Stringer, Linda Roberts-Jones
BACKGROUND: Following bereavement, families can be left with unanswered questions or issues of concern. We piloted a bereavement service model which was consultant and governance-led with the aim to reduce complaints, reduce litigation, reduce coroners inquests and support families. METHODS: Following the death of a patient, the next of kin was sent an invitation. Those that responded were offered a 1-hour appointment with a consultant, senior sister and a member of the governance team...
January 10, 2019: BMJ Supportive & Palliative Care
Deborah Lam, Samantha Kay, Jennie Pickard, Sophie Harrison
Fentanyl has a low molecular weight and is lipophilic making it suitable for transdermal administration. However, multiple factors appear to lead to interindividual variation in absorption via this route. Here we describe an unusual case where a patient was found to have twelve 100 μg/hour fentanyl patches in situ which she was using as background analgesia.
January 5, 2019: BMJ Supportive & Palliative Care
Deborah H L Muldrew, Sharon Kaasalainen, Dorry McLaughlin, Kevin Brazil
OBJECTIVES: With an increased dependency on nursing homes to provide care to the ageing population, it is likely that ethical issues will also increase. This study aimed to identify the type of ethical issues and level of associated distress experienced by nurses providing palliative care in nursing homes in the UK and Canada, and pilot the Ethical issues in Palliative Care for Nursing Homes (EPiCNH) instrument in Canada. METHODS: A cross-sectional survey design was used...
December 18, 2018: BMJ Supportive & Palliative Care
Steven Vanderstichelen, Joachim Cohen, Yanna Van Wesemael, Luc Deliens, Kenneth Chambaere
OBJECTIVES: Volunteers have an important place in palliative care (PC), positively influencing quality of care for seriously ill people and those close to them and providing a link to the community. However, it is not well understood where volunteers fit into PC provision or how to support them adequately. We therefore chose to describe volunteer roles across care settings through the perspective of those closely involved in the care of terminally ill people. METHODS: A qualitative study was conducted using both focus groups with volunteers, nurses, psychologists and family physicians and individual semistructured interviews with patients and family caregivers...
December 7, 2018: BMJ Supportive & Palliative Care
Mark Howard, Christina Ramsenthaler
BACKGROUND: Driving is a complex activity that requires physical abilities and adequate executive and cognitive functioning. There is concern among specialist palliative care services about patients continuing to drive despite having progressive incurable illnesses, comorbidities and medications to manage their symptoms. OBJECTIVES: To determine the quality of literature available about driving that would apply to palliative care patients, specifically in relation to road test or simulated driving scores and neurocognitive testing...
December 6, 2018: BMJ Supportive & Palliative Care
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