51
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McNamara B, Rosenwax LK, Holman CDJ. A method for defining and estimating the palliative care population. J Pain Symptom Manage 2006; 32:5-12. [PMID: 16824980 DOI: 10.1016/j.jpainsymman.2005.12.018] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2005] [Indexed: 11/29/2022]
Abstract
Palliative care research is challenged by a disagreement as to what palliative care is, when it should be offered and what conditions warrant specialized palliative care services. These challenges became evident when we used a population-based data linkage to evaluate the delivery of palliative care services in Western Australia. This paper describes the development of a conceptual framework to provide minimal, mid-range, and maximal estimates of a palliative care population. The estimates include nonmalignant conditions; realistically restrict the number and types of conditions; and propose a time frame over which specialized services can be offered. In defining a palliative care population for the purpose of research, development of an estimation method simultaneously addressed the rhetoric of palliative care with the restrictions inherent in both population-based research and service delivery. When applied to a population, the 10 conditions of the minimal estimate provide an acceptable guide to future research and practice.
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Affiliation(s)
- Beverley McNamara
- School of Social and Cultural Studies, The University of Western Australia, Crawley, Australia.
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Abstract
OBJECTIVES To describe the characteristics of Western Australian (WA) people who received, and did not receive, specialist palliative care (SPC) during their last 12 months of life. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS People who died between 1 July 2000 and 31 December 2002 in WA, and whose cause of death was from cancer or selected non-cancer conditions. MAIN OUTCOME MEASURES Use of SPC in the last 12 months of life. RESULTS There were 27,971 deaths from all causes in WA over the study period. Two-thirds (68%) of people who died of cancer received SPC, but less than one in ten (8%) who died of selected non-cancer conditions received SPC. Those who died of cancer were significantly less likely to receive SPC if they were single or widowed, aged > 85 years or lived in a region other than a major city. Of those who died of selected noncancer conditions, people other than those who were married were significantly less likely to have accessed SPC. Indigenous people were less likely to have accessed SPC, although this was not statistically significant (OR = 0.70, 95% CI: 0.36-1.34). CONCLUSIONS Within a WA context, this study confirms established international evidence for problems of access to SPC by non-cancer patients and other disadvantaged groups. Importantly, this evidence is provided at a population level, thus documenting the extent of inequities in palliative care service provision. By pointing to the areas of most critical need, this study assists in health service policy and planning.
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Affiliation(s)
- L K Rosenwax
- School of Occupational Therapy, Curtin University of Technology, GPO Box U1987, Perth, WA 6845, Australia.
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53
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Rudkins H, Aird T. The importance of early consideration of palliative care in Parkinson's disease. ACTA ACUST UNITED AC 2006. [DOI: 10.12968/bjnn.2006.2.1.20497] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Helen Rudkins
- Brentwood, Billericay and Wickford Primary Care Trust, The Rowans, Highwood Hospital, Geary Drive, Brentwood CM15 9DY, and
| | - Thomas Aird
- , Faculty of Health and Social Care, London South Bank University
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54
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Barnes S, Gott M, Payne S, Parker C, Seamark D, Gariballa S, Small N. Recruiting older people into a large, community-based study of heart failure. Chronic Illn 2005; 1:321-9. [PMID: 17152456 DOI: 10.1177/17423953050010040201] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This paper highlights some of the challenges encountered when recruiting older people with heart failure into longitudinal, community-based research. It draws on the experience gained in a study to provide insights into the palliative care needs of older people with heart failure and the timing and need for service interventions. Five hundred and forty-two people with heart failure (New York Heart Association (NYHA) stages II-IV) and 213 of their informal carers were recruited from primary care practices in four areas of the UK. Ethical issues arising around gate-keeping, terminology and participant burden are discussed along with challenges faced during the recruitment process. Strategies to increase general practitioner and patient recruitment are provided. The paper concludes that prospective longitudinal studies are of particular relevance to chronic illness, and the complexity of setting up such research must be acknowledged and appropriately resourced.
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Affiliation(s)
- Sarah Barnes
- Sheffield Institute for Studies on Ageing, University of Sheffield, Elmfield, Northumberland Road, Sheffield, S10 2TU, UK.
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55
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Abstract
AIM The aim of this paper is to consider alternative approaches to service delivery for patients with chronic life-limiting illnesses other than cancer. It will also discuss the issues that arise when considering specialist palliative care services within a broader public health context in the United Kingdom. BACKGROUND Contemporary specialist palliative care in the United Kingdom can be said to have two main client groups: the majority are people with a diagnosis of cancer, and a minority are those with a number of other chronic illnesses. From the evidence to date, patients dying from chronic, non-malignant disease experience a considerable number of unmet needs in terms of symptom control and psychosocial support. Although debates in the literature over the last decade have challenged the focus of specialist palliative care services on patients with a cancer diagnosis, only a minority of those with other chronic illnesses receive specialist palliative care services. DISCUSSION Current models of specialist palliative care may not be the most appropriate for addressing the complex problems experienced by the many patients with a non-cancer diagnosis. We suggest that care should be structured around patient problems, viewing specialist palliative care as a service for those with complex end of life symptoms or problems. A role for innovative nurse-led care is proposed. CONCLUSION Reframing the approach to specialist palliative care in the United Kingdom will require great effort on the part of all health and social care professionals, not least nurses. Critical and creative thinking are prerequisites to the development of new models of working. We suggest that a more coherent approach to research and education is required, in particular strategies that explore how patients and nurses can work together in exploring experiences of illness in order to develop more proactive approaches to care.
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Affiliation(s)
- Julie K Skilbeck
- School of Nursing and Midwifery, University of Sheffield, Sheffield, UK.
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Abstract
OBJECTIVES To develop a method for estimating the population who could potentially benefit from receiving palliative care in the last year of their lives, and then apply the estimates to the Western Australian population to ascertain characteristics of these people. METHODS Three estimates of the potential palliative care population, Minimal, Mid-range and Maximal, were developed through focus groups, interviews and the literature. These estimates were applied to the cohort of people who died in Western Australia between 1 July 2000 and 31 December 2002 by linking death records with hospital morbidity data through the Western Australian Data Linkage System. RESULTS Between 0.28% and 0.50% of people in the Western Australian population in any one year could potentially benefit from palliative care, many of whom die from conditions other than neoplasms. While neoplasms accounted for 59.5% of all underlying causes of deaths in the Minimal Estimate, heart failure (21.0%), renal failure (9.8%), chronic obstructive pulmonary disease (9.6%), Alzheimer's disease (4.0%), liver failure (3.2%), Parkinson's disease (1.3%), motor neurone disease (0.9%), HIV/AIDS (<0.01%) and Huntington's disease (<0.01%) accounted for other conditions in this estimate. The study was expanded to include Mid-range and Maximal Estimates. Characteristics of the Western Australian population in these three estimates are described. CONCLUSIONS Unlike traditional palliative care estimates that focus on malignant disease, this study included nonmalignant conditions in a set of three estimates of a potential palliative care population. By using population-based data to describe characteristics of people who compose palliative care populations, these results offer a tool for planning equitable healthcare services.
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Affiliation(s)
- L K Rosenwax
- Faculty of Medicine and Dentistry, The University of Western Australia, Crawley.
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58
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Grbich C, Maddocks I, Parker D, Brown M, Willis E, Piller N, Hofmeyer A. Identification of patients with noncancer diseases for palliative care services. Palliat Support Care 2005; 3:5-14. [PMID: 16594189 DOI: 10.1017/s1478951505050029] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objective: To identify criteria for measuring the eligibility of patients with end-stage noncancer diseases for palliative care services in Australian residential aged care facilities.Methods: No validated set if guidelines were available so five instruments were used: an adaptation of the American National Hospice Association Guidelines; a recent adaptation of the Karnofsky Performance Scale; the Modified Barthel Index; the Abbey Pain Score for assessment of people who are nonverbal and a Verbal Descriptor Scale, also for pain measurement. In addition, nutritional status and the presence of other problematic symptoms and their severity were also sought.Results: The adapted American National Hospice Association Guidelines provided an initial indicative framework and the other instruments were useful in providing confirmatory data for service eligibility and delivery.
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Affiliation(s)
- Carol Grbich
- Department of Palliative Care, School of Medicine, Sturt Building, Flinders University, Bedford Park, South Australia 5042, Australia.
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59
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Peretti-Watel P, Bendiane MK, Moatti JP. Attitudes toward palliative care, conceptions of euthanasia and opinions about its legalization among French physicians. Soc Sci Med 2005; 60:1781-93. [PMID: 15686809 DOI: 10.1016/j.socscimed.2004.08.037] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We assume that actors of the professionalization process of palliative care make a special effort to demarcate it from euthanasia, and that such an effort has a significant impact on beliefs and attitudes toward euthanasia among the whole medical profession. We investigated concurrently attitudes toward palliative care, conceptions of euthanasia and opinion toward its legalization among a sample of 883 French general practitioners, oncologists and neurologists. We found four contrasted profiles of attitudes toward palliative care, which were closely correlated with being in touch with palliative care providers. Attitudes toward palliative care were closely correlated with beliefs about which medical practices should be labelled euthanasia, and these beliefs were in turn strongly associated with opinions toward euthanasia legalization. Our results suggest that the relationship between palliative care and euthanasia mixes semantic and strategic aspects, beyond cognitive and conative ones.
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Affiliation(s)
- P Peretti-Watel
- Regional Center for Disease Control of South-Eastern France, Marseille, France.
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60
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Abstract
In the last 14 years, research has identified that patients with heart failure suffer symptoms as severe as people with cancer and would greatly benefit from a palliative care approach. In spite of this fact, it is recognized within the National Service Framework for Heart Failure (Department of Health (DoH), 2000b) and the Cancer Plan (DoH, 2000a) that service provision from a palliative care perspective remains inadequate. In order to address the palliative care needs for patients with heart failure and their families a multidisciplinary team approach between primary and secondary care is needed. This article will review the literature relating to improvement of services from a palliative care perspective. It discusses the quality of life experienced by patients with heart failure and their families and the barriers to providing a palliative care approach from a multidisciplinary team perspective. Finally, it attempts to present future recommendations to develop a structured service provision.
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61
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Grbich C, Maddocks I, Parker D, Brown M, Willis E, Hofmeyer A, Piller N. Palliative care in aged care facilities for residents with a non-cancer disease: results of a survey of aged care facilities in South Australia. Australas J Ageing 2005. [DOI: 10.1111/j.1741-6612.2005.00085.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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62
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Ben Diane MK, Galinier A, Pegliasco H, Lapiana JM, Favre R, Peretti-Watel P, Obadia Y. [Doctors' opinions on palliative care: results from a French survey on physicians attitudes and practices]. SANTE PUBLIQUE 2005; 17:75-85. [PMID: 15835217 DOI: 10.3917/spub.051.0075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To examine practitioners' opinions on palliative care. METHOD Statistical analyses were carried out on data collected from 1000 physicians recruited to participate in a study on knowledge, attitudes and practices with respect to palliative care ("Palliative Care 2002"). A cluster analysis (CAH) was conducted based on responses to nine questions in order to identify homogeneous and contrasting profiles of opinions on palliative care. RESULTS Two distinctly different categories of profiles emerged. The first one had a restrictive approach to palliative care (n = 387; 38.7%), while the second one supported its expansion (n = 613; 61.3%). CONCLUSION A newly revised communication campaign which favoured and recognised palliative care could assist in the dissemination of related practices among physicians.
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Affiliation(s)
- M K Ben Diane
- Observatoire Régional de la Santé Provence Alpes-Côte-d'Azur, 23, rue Stanislas Torrents, 13006 Marseille, France
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63
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Corner J. Commentary:. J Res Nurs 2005. [DOI: 10.1177/174498710501000207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Jessica Corner
- School of Nursing and Midwifery, University of Southampton
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64
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Aldred H, Gott M, Gariballa S. Advanced heart failure: impact on older patients and informal carers. J Adv Nurs 2005; 49:116-24. [DOI: 10.1111/j.1365-2648.2004.03271.x] [Citation(s) in RCA: 136] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Exley C, Field D, Jones L, Stokes T. Palliative care in the community for cancer and end-stage cardiorespiratory disease: the views of patients, lay-carers and health care professionals. Palliat Med 2005; 19:76-83. [PMID: 15690872 DOI: 10.1191/0269216305pm973oa] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Primary care plays an important role in delivering care to people who are dying. However, providing palliative care to people dying with conditions other than cancer may be more problematic, because it may be more difficult to establish an exact prognosis or to identify their needs. This article draws on qualitative research, which explored the views of health professionals, patients and their carers about care provided at the end of life. Differences between the care of people with cancer and those with end-stage cardiorespiratory disease were found in four main areas: management and progression of disease, communication and information, health care in the community and awareness of dying. The research shows that even in PHCTs (primary health care teams) committed to the delivery of palliative care, people dying with end-stage cardiorespiratory disease are less likely than those with cancer to receive full, and easily understood, information, to be aware that they are dying or to receive district nursing care. There is an increasing call for palliative care to be extended to all, but further work is needed to develop appropriate packages of care for those dying with conditions other than cancer.
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Affiliation(s)
- Catherine Exley
- Centre for Health Services Research, School of Population and Health Sciences, University of Newcastle upon Tyne, Newcastle upon Tyne, UK.
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66
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Baggs JG, Norton SA, Schmitt MH, Sellers CR. The dying patient in the ICU: role of the interdisciplinary team. Crit Care Clin 2004; 20:525-40, xi. [PMID: 15183217 DOI: 10.1016/j.ccc.2004.03.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Expert opinion supports the application of broad interdisciplinary team approaches to the care of the dying patient in the intensive care unit (ICU). Current literature contains many suggestions about how core team members-physicians, nurses, and patients/family members-could systematically enhance interdisciplinary collaboration in the care of the dying patient. In the few studies of ICU interdisciplinary collaborative care of the dying patient, investigator shave demonstrated improvement in care. In addition, ethics consultants and interdisciplinary palliative care teams, working with the core team members, have improved care for the dying. Further studies are needed to document alternative interdisciplinary models for achieving improved and durable patient, family,and provider outcomes in the care of the dying ICU patient.
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Affiliation(s)
- Judith Gedney Baggs
- School of Nursing and School of Medicine and Dentistry, University of Rochester, 601 Elmwood Avenue, Box SON, Rochester, NY 14642, USA.
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67
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Boyd KJ, Murray SA, Kendall M, Worth A, Frederick Benton T, Clausen H. Living with advanced heart failure: a prospective, community based study of patients and their carers. Eur J Heart Fail 2004; 6:585-91. [PMID: 15302006 DOI: 10.1016/j.ejheart.2003.11.018] [Citation(s) in RCA: 136] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2003] [Revised: 10/17/2003] [Accepted: 11/24/2003] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Services for people with heart failure are under-developed. The perspectives of patients, their informal and professional carers should inform development of service models. AIM To describes how patients and carers view health and social care in the last year of life. METHODS Qualitative, serial interviews at three monthly intervals with 20 patients (New York Heart Association Grade IV heart failure), their main informal carer, general practitioner and other key professionals in an urban, community setting in SE Scotland. These were tape-recorded, and analysed with the aid of the qualitative data analysis package NVivo and techniques of narrative analysis. RESULTS 112 interviews comprised; patients (50), informal carers (27), professionals (30), bereavement interviews (5). Patients with heart failure and their carers felt unsupported by services, and had little understanding of their condition, treatment aims or prognosis. Quality of life was severely compromised by physical limitations and psychological morbidity. Psychosocial care, patient and carer education, co-ordination of care between primary and secondary sectors and with social services was generally poor. Many patients had no access to a heart failure nurse specialist. A palliative care approach was rarely apparent. CONCLUSIONS Patients with advanced heart failure may benefit from specific models of care with strategic planning across primary and secondary care, and involvement of health and social care services and specialist palliative care providers. Models of care, which focus on quality of life, symptom control, and psychosocial support for patients and their families while continuing active treatment, should be developed.
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Affiliation(s)
- Kirsty J Boyd
- Division of Community Health Sciences, General Practice Section, University of Edinburgh, Edinburgh, UK.
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68
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Abstract
This paper draws upon Australian fieldwork to trace the changing notions of a good death held by hospice and palliative care practitioners. Palliative care practitioners search for an ideology to inform their practice within the context of a complex society for which there is no one good death. Social demographics, the multicultural nature of society and institutional constraints frame the experience of dying in complex ways, while contemporary social responses to dying reflect the uncertainties held by many Australians. Despite the fragmentation evident within contemporary Australian society, the hospice movement in Australia and in other Western contexts has sought to reintroduce a ritual for dying. The good death ideology of the original hospice movement proposed a manner of dying in which open communication and acceptance of death were actively encouraged. The hospice model of a good death, however, has become increasingly inappropriate in the current climate of patient autonomy and consumer choice. The practice of palliative care, a holistic form of care for dying people, which follows the individualistic ethic of choice, has emerged from and replaced the original hospice movement. Consequently, the good death of the original hospice movement has been abandoned in favour of a philosophy of a 'good enough' death. However, what may appear a compromise informed by ethical practice masks a return to routine medical practices and a hierarchy of care which prioritises the physical management of symptoms. It appears that while palliative care practitioners may often fail in their facilitation of a good death for their patients, they can be proactive in alleviating their patients' pain and physical discomfort.
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Affiliation(s)
- Beverley McNamara
- The University of Western Australia, 35 Stirling Highway, Crawley 6009, Australia.
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69
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Ewing G, Todd C, Rogers M, Barclay S, McCabe J, Martin A. Validation of a symptom measure suitable for use among palliative care patients in the community: CAMPAS-R. J Pain Symptom Manage 2004; 27:287-99. [PMID: 15050656 DOI: 10.1016/j.jpainsymman.2003.12.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2003] [Indexed: 11/16/2022]
Abstract
The purpose of the study was to investigate psychometric properties of CAMPAS-R, an instrument for prospectively monitoring patients' symptoms and needs during palliative care at home. CAMPAS-R was piloted for face and content validity and then administered alongside criterion measures to a home care sample. Cronbach's alpha was used to test internal consistency and criterion-related validity was tested by non-parametric correlation with Brief Pain Inventory (BPI), Hospital Anxiety and Depression Scale (HADS) and EORTC QLQ-C30. Predictive validity was assessed by relating CAMPAS-R scores to survival. One hundred and nine patients were recruited to the study. Good reliability and high correlations between CAMPAS-R and criterion measures were found. Predictive validity was demonstrated by significant differences in symptom scores between groups differing in length of survival. CAMPAS-R is acceptable to patients, families and primary care professionals and is a valid, reliable instrument, which has the benefit of being easy to score.
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Affiliation(s)
- Gail Ewing
- Center for Family Research, University of Cambridge, United Kingdom
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70
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Nordgren L, Olsson H. Palliative care in a coronary care unit: a qualitative study of physicians' and nurses' perceptions. J Clin Nurs 2004; 13:185-93. [PMID: 14723670 DOI: 10.1111/j.1365-2702.2004.00816.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Earlier research has shown that physicians and nurses are motivated to provide good palliative care, but several factors prevail that prevent the best care for dying patients. To provide good palliative care it is vital that the relationship between nurses and physicians is one based on trust, respect and sound communication. However, in settings such as a coronary care unit, disagreement sometimes occurs between different professional groups regarding care of dying patients. AIM AND OBJECTIVES The aim of this study was to describe and understand physicians' and nurses' perceptions on their working relationship with one another and on palliative care in a coronary care unit setting. DESIGN Using a convenience sample, professional caregivers were interviewed at their work in a coronary care unit in Sweden. METHODS Data collection and analysis were done concurrently using a qualitative approach. RESULTS From the interviews, a specific pattern of concepts was identified. The concepts were associated with a dignified death, prerequisites for providing good palliative care and obstacles that prevented such care. CONCLUSIONS Caregivers who work in a coronary care unit are highly motivated to provide the best possible care and to ensure a dignified death for their patients. Nevertheless, they sometimes fail in their intentions because of several obstacles that prevent good quality care from being fully realized. RELEVANCE TO CLINICAL PRACTICE To improve practice, more attention should be paid to increasing dying patients' well-being and participation in care, improving strategic decision-making processes, offering support to patients and their relatives, and improving communication and interaction among caregivers working in a coronary care unit. Caregivers will be able to support patients and relatives better if there are good working relations in the work team and through better communication among the various professional caregivers.
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Affiliation(s)
- Lena Nordgren
- Department of Caring and Public Health Sciences, Mälardalen University, Västerås, Sweden.
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71
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Cochrane J. The experience of uncertainty for individuals with HIV/AIDS and the palliative care paradigm. Int J Palliat Nurs 2003; 9:382-8. [PMID: 14593274 DOI: 10.12968/ijpn.2003.9.9.11767] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This small qualitative study investigated the lived experience of individuals with HIV/AIDS, exploring the uncertainty related to episodes of life-threatening illness followed by recovery, 'revival'. The themes that emerged related to the unpredictability of when death would occur. The participants described the dilemma of living with a chronic illness with a totally unpredictable disease trajectory. Following periods of being extremely unwell, individuals would then recover and experience periods of relative well-being, only to succumb to another infection later. The findings highlighted the uncertainty that pervades all aspects of HIV-positive individuals' lives as they face death. An awareness of this may be important in those offering palliative care to those with HIV/AIDS.
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Affiliation(s)
- Jackie Cochrane
- Ipswich Hospital NHS Trust, Pinewood Surgery, Shepherds Drive, Ipswich, IP8 3SL, UK
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72
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73
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Seymour J, Clark D, Marples R. Palliative care and policy in England: a review of health improvement plans for 1999-2003. Palliat Med 2002; 16:5-11. [PMID: 11963451 DOI: 10.1191/0269216302pm521oa] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Since 1987 health authorities in England have been required to make plans for palliative care provision, but their record in doing so has been patchy. The production of health improvement plans (HlmPs), in which each health authority must set out its priorities and actions designed to improve the health and well-being of its local population, provides an opportunity to examine the extent to which palliative care provision in the NHS is regarded as a priority by policy makers in England. This paper reports on a structured documentary review of the HlmPs published by the 99 health authorities in England. The review indicates that at the moment, in spite of the longstanding duty placed on health authorities to develop strategic plans for palliative care and to assess the level of local palliative care needs, not all have made significant progress in this direction. Among those that do have plans for palliative care, the vast majority of these plans are for people with cancer. What emerges most clearly is a sense in which specialist palliative care, especially for non-cancer patients, is perceived as an 'optional extra' by many health authorities rather than an integral and essential part of the overall supportive care strategy which they clearly are at pains to develop.
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Affiliation(s)
- J Seymour
- Sheffield Palliative Care Studies Group, University of Sheffield, Trent Palliative Care Centre, Sheffield, UK.
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74
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Affiliation(s)
- J Corner
- The Royal Marsden NHS Trust, Centre for Cancer and Palliative Care Studies, London, UK
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75
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Luddington L, Cox S, Higginson I, Livesley B. The need for palliative care for patients with non-cancer diseases: a review of the evidence. Int J Palliat Nurs 2001; 7:221-6. [PMID: 12148972 DOI: 10.12968/ijpn.2001.7.5.12635] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The palliative care needs of patients with cancer are understood and managed well by specialist palliative care services. Patients dying of non-cancer diseases are rarely offered these services. A literature review was conducted to determine the physical and psychosocial problems of patients dying from non-cancer diseases. Studies were identified using a systematic keyword search of six electronic databases. Fourteen studies were identified and assessed according to rigour of design. Findings suggest that some patients dying of non-cancer have needs comparable with those dying of cancer. Low response rates, subject bias, and measurement bias mean that findings should be viewed with caution. More prospective, rigorously designed research is necessary to identify which patients with non-cancer diagnoses may benefit from specialist palliative care.
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Affiliation(s)
- L Luddington
- Palliative Care, Chelsea and Westminster Hospital, London, UK
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76
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Shipman C, Addington-Hall J, Barclay S, Briggs J, Cox I, Daniels L, Millar D. Educational opportunities in palliative care: what do general practitioners want? Palliat Med 2001; 15:191-6. [PMID: 11407190 DOI: 10.1191/026921601678576176] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
It is important to support general practitioners (GPs) in maintaining and developing their palliative care skills as most of the final year of a patient's life is spent at home under the care of the primary health care team. The training needs and uptake of GPs have been explored, but little is known about how GP educational preferences vary. The aim of this study was to explore the current educational preferences of GPs in different geographical locations as part of an evaluation of an educational intervention. The methods used included postal questionnaires sent to 1061 GPs. Results from 640 (60%) of GPs revealed that half (51%) wanted education in symptom control for non-cancer patients. More inner-city GPs wanted education in opiate prescribing (43%), controlling nausea and vomiting (45%), and using a syringe driver (38%) than their urban and rural colleagues (26%, 29% and 21%, respectively). Increased educational preference and increased difficulty in accessing information was associated with reduced confidence in symptom control. To maximize educational uptake it will be important for educational strategies to be developed and targeted according to variations in demand, and in particular to respond to the need for palliative care education in symptom control for patients suffering from advanced non-malignant disease.
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Affiliation(s)
- C Shipman
- Department of Palliative Care and Policy, Guy's, King's & St. Thomas' School of Medicine, Bessemer Road, London SE5 9PJ, UK.
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77
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Abstract
Traditionally, medical oncology and palliative care have been considered two distinct and separate disciplines, both as regards treatment objectives and delivery times. Palliative care in terminal stages, aimed exclusively at evaluating and improving quality of life, followed antitumor therapies, which concentrated solely on quantitative results (cure, prolongation of life, tumoral mass shrinkage). Over the years, more modern concepts have developed on the subject. Medical oncology, dealing with the skills and strategic co-ordination of oncologic interventions from primary prevention to terminal phases, should also include assessment and treatment of patients' subjective needs. Anticancer therapies should be evaluated in terms of both the quantitative and qualititative impact on patients' lives. Hence, the traditional view of palliative care has to be modified: it constitutes a philosophical and methodological approach to be adopted from the early phases of illness. It is not the evident cultural necessity of integrating medical oncology with palliative medicine that may be a matter of argument, but rather the organizational models needed to put this combined care into practice: should continuous care be guaranteed by a single figure, the medical oncologist, or rather by an interdisciplinary providers' team, including full-time doctors well-equipped for palliative care? In this paper the needs of cancer patients and the part that a complete oncologist should play to deal with such difficult and far-reaching problems are firstly described. Then, as mild provocation, data and critical considerations on the ever increasing needs of palliative care, the present shortcomings in quality of life and pain assessment and management by medical oncologists, and the uncertain efficacy of interventional programmes to change clinical practice are described. Finally, a model of therapeutic continuity is presented. which in our view is realistic and feasible: an Oncologic Programme as the unifying process, and the Comprehensive Cancer Centre, or the Oncologic Department, the delivering structure.
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Affiliation(s)
- M Maltoni
- Department of Oncology, City Hospital L. Pierantoni, Forlì, Italy.
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78
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Abstract
Specialist palliative care providers are seeking to transfer the principles of palliative care to more general care settings in order to meet the needs of people with diseases other than cancer. To prepare nursing home staff to provide palliative care increasing numbers of educational initiatives are now being offered. This paper explores some of the assumptions that underpin these initiatives. Recommendations are made that recognize the expertise already held within nursing homes and propose a collaborative approach to promote the appropriate integration of palliative care with nursing home practice.
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Affiliation(s)
- K A Froggatt
- Macmillan Practice Development Unit, Centre for Cancer and Palliative Care Studies, Institute of Cancer Research, c/o Royal Marsden NHS Trust, Fulham Road, London SW3 6JJ, UK.
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79
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Abstract
This paper reviews changing patterns of mortality worldwide, paying particular attention to differences between developed and developing countries and the consequences of demographic and epidemiological transitions. These involve gains in life expectancy and a shift from infectious to degenerative conditions as causes of death. Reversals to these transitions in certain Eastern European and African countries, due respectively to the social disorganisation accompanying the collapse of communism and to AIDS is described. The implications of changing population structures for the experience of old age and dying are explored and gender and socio-economic differences within countries is highlighted. The current state of knowledge about differences in the dying trajectories of different causes of death is summarised and gaps in this knowledge identified. The availability of lay health care in the community at different points in the demographic transition is described, and the problems and dilemmas of formal health care provision for dying people in both developed and developing countries outlined, including an analysis of the reasons for public support for euthanasia in some Western countries. In particular, the appropriateness of models of specialist palliative care outside the cultures in which such care originally developed is questioned. Finally, there is discussion of the extent to which medical and scientific measures erode traditional religious consolations for the problems involved in dying and bereavement.
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Affiliation(s)
- C Seale
- Department of Sociology, Goldsmiths College, University of London, UK.
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80
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Abstract
With increasing requests for palliative care provision for all patients regardless of diagnosis, professionals within specialist palliative care services and palliative care nurse specialists need to consider how they will respond. Current palliative care is considered inequitable as the majority of palliative care services do not include those with non-malignant disease. This article examines a number of issues concerning the extension of palliative care to this patient population. It considers the needs of non-cancer patients, palliative care responsibilities, resource implications, professional knowledge and responsibilities, and possible action. Recommendations include the need for further research to explore these patients' needs and the role of specialist palliative care services. Suggestions regarding how Macmillan nurses could respond to the increased demand for palliative care services are offered. Within the current financial climate, the only realistic response for the Macmillan nurse is to act as a consultant working in collaboration with other health professionals outside the palliative care specialty.
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Affiliation(s)
- L Wallwork
- Macmillan Service Office, Newark Hospital, Newark, UK
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81
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Abstract
This article presents some of the findings from a large national multi-method study on the management of death and dying in residential and nursing homes for older people. The study included all types of registered homes and interviews were conducted with staff, residents and visitors to the homes. Stage 1 used a survey questionnaire to provide background demographic data. Stages 2 and 3 included 100 interviews with the heads of homes and 12 case studies. Particular consideration was given to internal and external influences on care provision in the interviews and observations were made in the case study homes. Clearly, home staff are committed to the provision of good quality terminal care for residents. This article focuses on some of the reasons why that commitment is difficult to translate into practice.
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Affiliation(s)
- C Komaromy
- School of Health and Social Welfare, Open University, Milton Keynes, UK
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