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Zambrano SC, Chur-Hansen A, Crawford GB. Beyond Right or Wrong: Attitudes and Practices of Physicians, Nurses, Psychologists, and Social Workers Regarding Attendance at Patient Funerals. J Palliat Med 2019; 22:400-407. [DOI: 10.1089/jpm.2018.0234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Wlodarczyk J, Lawn S, Powell K, Crawford GB, McMahon J, Burke J, Woodforde L, Kent M, Howell C, Litt J. Exploring General Practitioners' Views and Experiences of Providing Care to People with Borderline Personality Disorder in Primary Care: A Qualitative Study in Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E2763. [PMID: 30563256 PMCID: PMC6313450 DOI: 10.3390/ijerph15122763] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 12/04/2018] [Accepted: 12/05/2018] [Indexed: 11/17/2022]
Abstract
The prevalence of people seeking care for Borderline Personality Disorder (BPD) in primary care is four to five times higher than in the general population. Therefore, general practitioners (GPs) are important sources of assessment, diagnosis, treatment, and care for these patients, as well as important providers of early intervention and long-term management for mental health and associated comorbidities. A thematic analysis of two focus groups with 12 GPs in South Australia (in discussion with 10 academic, clinical, and lived experience stakeholders) highlighted many challenges faced by GPs providing care to patients with BPD. Major themes were: (1) Challenges Surrounding Diagnosis of BPD; (2) Comorbidities and Clinical Complexity; (3) Difficulties with Patient Behaviour and the GP⁻Patient Relationship; and (4) Finding and Navigating Systems for Support. Health service pathways for this high-risk/high-need patient group are dependent on the quality of care that GPs provide, which is dependent on GPs' capacity to identify and understand BPD. GPs also need to be supported sufficiently in order to develop the skills that are necessary to provide effective care for BPD patients. Systemic barriers and healthcare policy, to the extent that they dictate the organisation of primary care, are prominent structural factors obstructing GPs' attempts to address multiple comorbidities for patients with BPD. Several strategies are suggested to support GPs supporting patients with BPD.
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Digges M, Hussein A, Wilcock A, Crawford GB, Boland JW, Agar MR, Sinnarajah A, Currow DC, Johnson MJ. Pharmacovigilance in Hospice/Palliative Care: Net Effect of Haloperidol for Nausea or Vomiting. J Palliat Med 2017; 21:37-43. [PMID: 28772094 DOI: 10.1089/jpm.2017.0159] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Haloperidol is widely prescribed as an antiemetic in patients receiving palliative care, but there is limited evidence to support and refine its use. OBJECTIVE To explore the immediate and short-term net clinical effects of haloperidol when treating nausea and/or vomiting in palliative care patients. DESIGN A prospective, multicenter, consecutive case series. SETTING/SUBJECTS Twenty-two sites, five countries: consultative, ambulatory, and inpatient services. MEASUREMENTS When haloperidol was started in routine care as an antiemetic, data were collected at three time points: baseline; 48 hours (benefits); day seven (harms). Clinical effects were assessed using the National Cancer Institute's Common Terminology Criteria for Adverse Events (NCI CTCAE). RESULTS Data were collected (May 2014-March 2016) from 150 patients: 61% male; 86% with cancer; mean age 72 (standard deviation 11) years and median Australian-modified Karnofsky Performance Scale 50 (range 10-90). At baseline, nausea was moderate (88; 62%) or severe (11; 8%); 145 patients reported vomiting, with a baseline NCI CTCAE vomiting score of 1.0. The median (range) dose of haloperidol was 1.5 mg/24 hours (0.5-5 mg/24 hours) given orally or parenterally. Five patients (3%) died before further data collection. At 48 hours, 114 patients (79%) had complete resolution of their nausea and vomiting, with greater benefit seen in the resolution of nausea than vomiting. At day seven, 37 (26%) patients had a total of 62 mild/moderate harms including constipation 25 (40%); dry mouth 13 (21%); and somnolence 12 (19%). CONCLUSIONS Haloperidol as an antiemetic provided rapid net clinical benefit with low-grade, short-term harms.
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Crawford GB, Dadich A, Collier A, Hodgins M. P-137 Positive deviance in community palliative care practice. BMJ Support Palliat Care 2017. [DOI: 10.1136/bmjspcare-2017-00133.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Zambrano SC, Chur-Hansen A, Crawford GB. Attending patient funerals: Practices and attitudes of Australian medical practitioners. DEATH STUDIES 2017; 41:78-86. [PMID: 27611349 DOI: 10.1080/07481187.2016.1214631] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The appropriateness of attending a patient's funeral is a medical dilemma. This article focuses on 437 doctors who participated in an online survey. Seventy-one percent of general practitioners, 67% of oncologists, 67% of psychiatrists, 63% of palliative medicine specialists, 52% of surgeons, and 22% of intensive care specialists had attended patient funerals. Significant differences in demographics and between specialties were identified in terms of barriers and benefits associated with attendance. Although attendance is a personal decision, there is a need for open discussions in medical education and professional development concerning death and the role of doctors after a patient dies.
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McMichael LC, Zambrano SC, Crawford GB. The physician as patient in palliative care: A retrospective case-note audit. Palliat Med 2016; 30:889-92. [PMID: 27013531 DOI: 10.1177/0269216316639774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Dying physicians may present unique challenges to palliative care teams. Studies of dying physicians are scarce, but those that exist suggest a potential absence of a coordinating clinician, prolongation of curative treatments, resistance to palliative care input and barriers to discussing psychosocial needs. AIM The aim was to describe and examine the care provided to physician-patients referred to an Australian palliative care service, and to identify issues faced by the physician-patient and by the treating team. DESIGN AND PARTICIPANTS A retrospective case-note audit of the case notes of medical practitioners referred for palliative care and dying between January 2007 and April 2013 was conducted. RESULTS There was evidence of medically qualified friends or family members initiating referrals and directing treatment decisions. There was some evidence of increased consultant-led decision-making and bypassing of usual referral pathways and systems for providing after-hours advice and calling consultants directly. There also appeared to be some reluctance by junior doctors to make decisions, because of the patient's desire for consultant-level advice only. CONCLUSION This study adds to the growing body of literature that identifies the potential difficulties associated with caring for medical practitioners. By understanding some of the complexity of this particular doctor-patient relationship, clinicians can approach the management of physician-patients facing the end of their lives with a more sound understanding of their particular care needs.
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Agar MR, Quinn SJ, Crawford GB, Ritchie CS, Phillips JL, Collier A, Currow DC. Predictors of Mortality for Delirium in Palliative Care. J Palliat Med 2016; 19:1205-1209. [PMID: 27309842 DOI: 10.1089/jpm.2015.0416] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Delirium has a high mortality rate. Understanding predictors of prognosis in patients with delirium will aid treatment decisions and communication. This study aimed to explore variables associated with death during an established episode of delirium in palliative care when haloperidol treatment had been commenced. METHODS A consecutive cohort of palliative care patients, from 14 centers across four countries, is reported. The outcome of interest was death within 14 days from commencement of haloperidol treatment for delirium. Clinicodemographic variables explored were delirium severity, age, gender, primary life limiting illness, body mass index (BMI), total daily haloperidol dose at baseline (mg), functional status, and comorbidities. RESULTS One hundred and sixteen palliative care patients where vital status was known were included in the analysis; 45% (n = 52) died within 10 days, and 56% (n = 65) died within 14 days. In multivariate analyses no clinical or demographic variables predicted death, apart from lower BMI in noncancer patients. CONCLUSION This study has shown a very high mortality rate within two weeks of commencing haloperidol for delirium in palliative care, with no clear clinical predictors for those with a higher chance of dying. Having a higher BMI offered some benefit in survival, but only in noncancer patients. When delirium occurs in advanced illness, discussion should be initiated about the gravity of the clinical situation.
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Dixit N, Crawford GB, Lemonde M, Rittenberg CN, Fernández-Ortega P. Left behind: cancer disparities in the developed world. Support Care Cancer 2016; 24:3261-4. [DOI: 10.1007/s00520-016-3192-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 03/21/2016] [Indexed: 12/31/2022]
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Crawford GB, Zambrano SC. Junior doctors' views of how their undergraduate clinical electives in palliative care influenced their current practice of medicine. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2015; 90:338-44. [PMID: 25551858 DOI: 10.1097/acm.0000000000000632] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PURPOSE To explore how junior doctors (doctors in postgraduate training) retrospectively perceived the influence of their undergraduate palliative care attachments (clinical electives) on their current medical practice. METHOD From 2008 to 2013, 100 students participated in palliative care attachments at the University of Adelaide School of Medicine. In 2013, the authors invited 14 of these, now junior doctors, to be in this study. Participants took part in one-on-one, semistructured interviews. Interview data were analyzed for themes. RESULTS Nine junior doctors participated. They were sent a summary of the findings to check whether the themes captured each participant's experiences. Eight replied and agreed. Two main themes were identified: (1) from apprehension to gaining a sense of control, and (2) gaining perspective on the practice of medicine. Participants perceived that the learning experiences from the attachments provided them with a sense of confidence and control over their interactions with dying patients and families. This positive influence not only was present when caring for patients at the end of life but also influenced the participants' identity as medical practitioners. CONCLUSIONS Findings suggest that junior doctors trained earlier in palliative care have enhanced competencies of professionalism, patient-centered medicine, psychosocial and spiritual aspects of palliative care, communication, teamwork, and self-awareness. Learning a palliative approach can help them make a difference in treating dying patients, but also in general patient care. Therefore, physicians trained in palliative care may be better prepared to contribute to a health care system that is person-centered, ethically conscientious, and personally fulfilling.
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Ng F, Crawford GB, Chur-Hansen A. Treatment approaches of palliative medicine specialists for depression in the palliative care setting: findings from a qualitative, in-depth interview study. BMJ Support Palliat Care 2015; 6:186-93. [PMID: 25573668 DOI: 10.1136/bmjspcare-2014-000719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 12/19/2014] [Indexed: 11/04/2022]
Abstract
BACKGROUND Treatment of depression in the palliative care setting is complicated by varied treatment preferences, a small body of research, and unique challenges associated with the end-of-life. Little is known about the treatment practices of medical practitioners in this setting. OBJECTIVE This study aimed to investigate and characterise the treatment approaches of palliative medicine specialists for depression. DESIGN Semistructured, in-depth interviews were conducted to explore explanatory models of depression from palliative medicine specialists, including a focus on treatment. Verbatim interview transcripts were analysed for themes. SETTING/PARTICIPANTS Palliative medicine specialists practising in Australia were recruited and purposively sampled. Nine participants were interviewed to reach data saturation. RESULTS Five themes were identified in relation to treatment of depression: (1) guiding principles of treatment; (2) treatment approaches; (3) factors underpinning treatment decisions; (4) difficulties arising in treatment; and (5) interdisciplinary roles. Participants described five distinct treatment approaches, consisting of biological orientation, psychosocial orientation, combination approach, undifferentiated approach and ambivalence. Treatment decisions were contingent on patient, depression, clinician and sociocultural factors. Difficulties included discomfort with treating depression, being inadequately equipped and confronting therapeutic limitations. Treating depression was considered to require multidisciplinary team effort. CONCLUSIONS Palliative medicine specialists' treatment approaches are linked to their concepts of and causal explanations for depression. Future treatment guidelines could aim to consider specific varieties of depression, be more differentiated in treatment modality and type, and consider decision-shaping factors. Continuing mental health education and the incorporation of psychiatry and psychology into palliative care services may have enduring benefits.
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Ng F, Crawford GB, Chur-Hansen A. Palliative medicine specialists' causal explanations for depression in the palliative care setting: a qualitative in-depth interview study. BMJ Support Palliat Care 2014; 6:178-85. [PMID: 24776779 DOI: 10.1136/bmjspcare-2013-000626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 04/06/2014] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Medical practitioners have different causal explanations for depression, and may have greater difficulty in explaining causality of depression in the palliative care setting. The objective of this study was to investigate and describe the causal explanations of depression in the palliative care setting, from the perspective of palliative medicine specialists. METHODS Palliative medicine specialists practising in Australia were recruited and purposively sampled. Individual semistructured, in-depth interviews were conducted to explore their explanatory models of depression, including a focus on causal explanations. Nine participants were interviewed to reach data saturation. Interview transcripts were analysed for themes. RESULTS Six themes for causal explanations of depression were identified: (1) Depression is inexplicable; (2) Biological explanations-primarily neurotransmitter depletion; (3) Psychological explanations-including reaction to circumstances, inability to accept illness and dying, diminished self, and coping mechanisms; (4) Social explanations-including inadequate social support, and contribution from modern medicine and societal norms; (5) Interrelationships between causal factors-mainly multifactoriality; (6) Different explanation for de novo and pre-existing depressions. Participants also articulated a link between causal explanations and clinical interventions. CONCLUSIONS Palliative medicine specialists hold causal explanations of depression that align with the biopsychosocial and vulnerability-stress models. They use multiple individual explanations with diverse theoretical underpinnings, and largely view depression as multifactorial in causality. Given that causal explanations are linked to clinical interventions, these findings have implications for clinical practice and medical education.
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Burgess T, Braunack-Mayer A, Crawford GB, Beilby J. Australian health policy and end of life care for people with chronic disease: An analysis. Health Policy 2014; 115:60-7. [DOI: 10.1016/j.healthpol.2013.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 07/22/2013] [Accepted: 08/05/2013] [Indexed: 11/30/2022]
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Burgess T, Young M, Crawford GB, Brooksbank MA, Brown M. Best-practice care for people with advanced chronic obstructive pulmonary disease: the potential role of a chronic obstructive pulmonary disease care co-ordinator. AUST HEALTH REV 2014; 37:474-81. [PMID: 23972084 DOI: 10.1071/ah12044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2012] [Accepted: 06/20/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To explore service availability and accessibility for people with advanced chronic obstructive pulmonary disease (COPD) and their carers and strategies for improvement, including the potential role of a COPD care co-ordinator in ensuring best-practice care in the Australian context. METHODS This qualitative study used focus groups and interviews with health professionals, carers and consumers to explore gaps and restrictions in services, barriers to access and the functioning of services. Data were analysed deductively. RESULTS Key themes arising from the data included difficulties around access to care, lack of continuity of care, poor care co-ordination, the need for active disease management as well as supportive care, and poor communication. A COPD care co-ordinator was suggested as an effective strategy for ensuring best-practice care. CONCLUSIONS People with advanced COPD often have difficulty navigating the acute, primary and community care systems to deal with the multiple services that they may require. Lack of communication between health professionals and services is frequently a significant issue. A COPD care co-ordinator, encompassing advanced nursing skills, could ensure that care is centred on the needs of the person and their carer and that they receive continuing, appropriate and accessible care as they approach the end of their life.
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Ng F, Crawford GB, Chur-Hansen A. How do palliative medicine specialists conceptualize depression? Findings from a qualitative in-depth interview study. J Palliat Med 2014; 17:318-24. [PMID: 24410323 DOI: 10.1089/jpm.2013.0378] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Different professional conceptualizations of depression may complicate the clinical approach to depression in the palliative care setting. This study aimed to explore and characterize how palliative medicine specialists conceptualize depression. METHODS Palliative medicine specialists (i.e., consultants/attending physicians in palliative medicine) practicing in Australia were recruited. Participants were purposively sampled. Individual semi-structured, in-depth interviews were conducted to explore their conceptualizations of depression. Nine participants were interviewed to reach data saturation. Interview transcripts were analyzed for themes. RESULTS Four main themes were identified in relation to the conceptualization of depression: (1) depression is a varied concept--it was variously considered as abnormal, a medical problem, an emotional experience, a social product, and an action-oriented construct; (2) depression has unclear boundaries, with differentiation between depression and sadness being especially challenging; (3) depression is different in the palliative care setting--it was seen as more understandable, and distinct from depression that predates life-limiting illnesses; and (4) depression is a challenging issue. CONCLUSIONS Depression is conceptualized by palliative medicine specialists in divergent, ontologically heterogeneous and ill-defined ways. A unitary concept of depression was not evident in this study. The concepts of depression need to be actively debated and refined in clinical practice, medical education, and research in order for more sophisticated and consistent models to be developed. The distinction of de novo depression from recurrent or persistent forms of depression also warrants further study.
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Crawford GB, Burgess TA, Young M, Brooksbank MA, Brown M. A patient-centred model of care incorporating a palliative approach: A framework to meet the needs of people with advanced COPD? PROGRESS IN PALLIATIVE CARE 2013. [DOI: 10.1179/1743291x13y.0000000053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Crawford GB, Agar M M, Quinn SJ, Phillips J, Litster C, Michael N, Doogue M, Rowett D, Currow DC. Pharmacovigilance in hospice/palliative care: net effect of haloperidol for delirium. J Palliat Med 2013; 16:1335-41. [PMID: 24138282 DOI: 10.1089/jpm.2013.0230] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Prescribing practice in hospice/palliative care is largely extrapolated from other areas of clinical practice, with few studies of net medication effects (benefits and harms) in hospice/palliative care to guide prescribing decisions. Hospice/palliative care patients differ in multiple ways from better studied participant groups, hence the applicability of studies in other participant groups is uncertain. Haloperidol, a butyrophenone derivative and dopamine antagonist, is commonly prescribed for nausea, vomiting, and delirium in hospice/palliative care. Its frequent use in delirium occurs despite little evidence of the effect of antipsychotics on the untreated course of delirium. The aim of this study was to examine the immediate and short-term clinical benefits and harms of haloperidol for delirium in hospice/palliative care patients. METHOD A consecutive cohort of participants from 14 centers across four countries who had haloperidol commenced for delirium were recruited. Data were collected at three time points: baseline, 48 hours (clinical benefits), and day 10 (clinical harms). Investigators were also able to report clinical harms at any time up to 14 days after it was commenced. RESULTS Of the 119 participants included, the average dose was 2.1 mg per 24 hours; 42 of 106 (35.2%) reported benefit at 48 hours. Harm was reported in 14 of 119 (12%) at 10 days, the most frequent being somnolence (n=11) and urinary retention (n=6). Seven participants had their medication ceased due to harms (2 for somnolence and 2 for rigidity). Approximately half (55/119) were still being treated with haloperidol after 10 days. CONCLUSION Overall, 1 in 3 participants gained net clinical benefit at 10 days.
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Ng F, Crawford GB, Chur-Hansen A. Palliative Medicine Practitioners' Views on the Concept of Depression in the Palliative Care Setting. J Palliat Med 2013; 16:922-8. [DOI: 10.1089/jpm.2012.0502] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Chur-Hansen A, Zambrano SC, Crawford GB. Furry and feathered family members--a critical review of their role in palliative care. Am J Hosp Palliat Care 2013; 31:672-7. [PMID: 23892336 DOI: 10.1177/1049909113497084] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This article presents a comprehensive critical review of the peer-reviewed literature on palliative care and companion animals (CAs), reporting on the evidence and knowledge base regarding CAs and their role for people at end of life. PubMed, PsycINFO, Medline, Scopus, and Google Scholar were searched for studies pertaining to CAs, end of life, and hospice palliative care. Six studies dealt specifically with empirical research. The remaining literature addressed the topic peripherally or anecdotally. The evidence for efficacy and the knowledge base about the role of CAs at end of life in hospice and palliative care is weak. Further efforts are required to study the conditions under which CAs may be beneficial for patient care, including acceptability to staff, family, and other patients, and with consideration of welfare for the animals involved.
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Crawford GB, Robinson JA, Baker AEZ, Crail SM. End-stage kidney disease: a survey of recent research to support a palliative approach. Am J Hosp Palliat Care 2013; 31:331-7. [PMID: 23585549 DOI: 10.1177/1049909113484383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This survey examines the quantity, quality, and accessibility of recent research that contributes to the evidence-based implementation of a palliative approach to end-stage kidney disease (ESKD). An electronic search identified published articles (between September 2009 and August 2011) relevant to adults with ESKD (n = 1628). Few articles (n = 136) referred to key themes in a palliative approach to care: life-limiting illness, holistic care, and unit of care. Most of the relevant empirical articles used designs that did not allow a causal variable to be identified, and evaluations of interventions were rare. The literature was dispersed and often in journals unlikely to be regularly accessed by renal clinicians. Literature supporting the implementation of a full evidence-based palliative approach to ESKD is expanding but remains limited and is difficult to identify and access.
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Burgess TA, Braunack Mayer AJ, Crawford GB, Beilby JJ. Meeting end‐of‐life care needs for people with chronic disease: palliative care is not enough. Med J Aust 2013; 198:186-7. [DOI: 10.5694/mja12.11058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 01/24/2013] [Indexed: 11/17/2022]
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Zambrano SC, Chur-Hansen A, Crawford GB. How Do Surgeons Experience and Cope with the Death and Dying of Their Patients? A Qualitative Study in the Context of Life-limiting Illnesses. World J Surg 2013; 37:935-44. [DOI: 10.1007/s00268-013-1948-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Brown M, Brooksbank MA, Burgess TA, Young M, Crawford GB. The experience of patients with advanced chronic obstructive pulmonary disease and advance care-planning: A South Australian perspective. JOURNAL OF LAW AND MEDICINE 2012; 20:400-409. [PMID: 23431856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Advance care-planning conversations with people who have chronic obstructive pulmonary disease (COPD) are important because of the severity of the disease and the unpredictable timing of death. Advance care-planning is a process involving conversations about future wishes, including end-of-life care and the appointment of a substitute decision-maker. This qualitative research explored issues relating to end-of-life decisions with 15 individuals and their carers living in the community who had severe COPD. Findings indicated that, although patients and carers would welcome the opportunity to discuss end-of-life decisions, almost no conversation about care-planning had been initiated by health professionals with any of the participants. It also demonstrated that professional support is required to assist with advance care-planning and the completion of the legal advance directive documents.
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Zambrano SC, Chur-Hansen A, Crawford GB. On the emotional connection of medical specialists dealing with death and dying: a qualitative study of oncologists, surgeons, intensive care specialists and palliative medicine specialists. BMJ Support Palliat Care 2012; 2:270-5. [PMID: 24654200 DOI: 10.1136/bmjspcare-2012-000208] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This paper reports on qualitative data exploring the experiences and coping mechanisms of medical specialists from the specialties of intensive care, surgery, oncology and palliative care, when dealing with death and dying and their emotional connection with dying patients in the context of a life-threatening illness. METHODS Thirty-three semi-structured individual interviews were analysed using thematic analysis. RESULTS One of the key themes of medical specialists' experiences with death and dying was their ambivalence about developing emotional connections with patients and families. Advantages of not engaging emotionally with patients were related to preserving objectivity in the decision making process, while a perceived disadvantage was the loss of the opportunity to engage in meaningful relationships that could positively influence patients, families and the medical specialist. Finding a balance in the face of ambivalence was a preferred approach and participants employed a variety of coping strategies. CONCLUSIONS Participants took different positions about the emotional connection that should develop with their dying patients and their families. Although there was agreement about finding a balance between objectivity and connection, their strategies for achieving this seem to be subjective and prescribed by individual notions. By sharing perspectives and learning how other colleagues deal with similar issues, there is an opportunity for medical practitioners to develop a well-rounded approach to dealing with death and dying, which may enhance personal and professional relationships and may ultimately influence future generations of medical practitioners.
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Currow DC, Farquhar M, Ward AM, Crawford GB, Abernethy AP. Caregivers' perceived adequacy of support in end-stage lung disease: results of a population survey. BMC Pulm Med 2011; 11:55. [PMID: 22117836 PMCID: PMC3262756 DOI: 10.1186/1471-2466-11-55] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Accepted: 11/25/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND End-stage lung disease (ESLD) is a frequent cause of death. What are the differences in the supports needed by caregivers of individuals with ESLD at end of life versus other life-limiting diagnoses? METHODS The South Australian Health Omnibus is an annual, random, face-to-face, cross-sectional survey. In 2002, 2003 and 2005-2007, respondents were asked a range of questions about end-of-life care; there were approximately 3000 survey participants annually (participation rate 77.9%). Responses were standardised for the whole population. The families and friends who cared for someone with ESLD were the focus of this analysis. In addition to describing caring, respondents reported additional support that would have been helpful. RESULTS Of 1504 deaths reported, 145 (9.6%) were due to ESLD. The ESLD cohort were older than those with other 'expected' causes of death (> 65 years of age; 92.6% versus 70.6%; p < 0.0001) and were less likely to access specialised palliative care services (38.4% versus 61.9%; p < 0.0001). For those with ESLD, the mean caring period was significantly longer at 25 months (standard deviation (SD) 24) than for 'other diagnoses' (15 months; SD 18; p < 0.0001). Domains where additional support would have been useful included physical care, information provision, and emotional and spiritual support. CONCLUSIONS Caregiver needs were similar regardless of the underlying diagnosis although access to palliative care specialist services occurred less often for ESLD patients. This was despite significantly longer periods of time for which care was provided.
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Abstract
Intrathecal analgesia is an interventional form of pain relief with definite advantages and multiple complications. Administration of intrathecal analgesia needs a good resource setting and expertise. Early complications of intrathecal analgesia can be very distressing and managing these complications will need a high degree of knowledge, technical expertise and level of experience. Pain control alone cannot be the marker of quality in palliative care. A holistic approach may need to be employed that is more person and family oriented.
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