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Kallel F, Masmoudi S, Kassar O, Mallek R, Medhaffar M, Elloumi M. Prospective observational study of palliative care in hematological malignancies: Report of one year of practice. Transfus Clin Biol 2021; 29:44-48. [PMID: 34411747 DOI: 10.1016/j.tracli.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/03/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Palliative care is an approach that improves the quality of life of patients with advanced disease. OBJECTIVE The aim of this study is to evaluate the process of palliative care in patients with hematologic malignancies. METHODS In this prospective observational study, we included patients with hematologic malignancies who received palliative care over a 12 month period from June 1, 2019, to May 31, 2020 at the day care hospital of the hematology department in University Hospital of Sfax, Tunisia. Blood transfusion was used to relieve symptoms of anemia and bleeding. RESULTS Fifty-five patients were included. The median age was 68 years. Forty-three percent of patients were diagnosed with acute leukemia and 41.8% with myelodysplastic syndrome. Red cell and platelet transfusions were indicated in 94.5% and 36.3% of cases respectively. Patients reported improvement after blood transfusion in 50% of cases. Twenty-five transfusion reactions (45%) were noted. Fever was noted in 33 patients (60%), with documented sites of infection in 84.8% of them. Pulmonary infection was frequently noted (50%). Antimicrobial treatment was prescribed in all febrile cases. Pain was reported in 22 patients and in 77.5% of these cases, it was nociceptive. Patients who received analgesics showed clinical improvement in pain in 81% of cases. Anorexia with malnutrition was reported in 23% of cases which was treated with enteral nutrition in 75% of cases. Sleep disturbance (20 patients), anxiety (7 patients), and depression (4 patients) were mentioned respectively. CONCLUSION Palliative care in hematology should be a multidisciplinary care approach with a global management of the various physical, psychological and sociological complications.
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Affiliation(s)
- Faten Kallel
- Hedi chaker hospital, El Ain road, Km0 5, 3000, Sfax, Tunisia; Faculty medecine of sfax, Avenue Majida BOULILA, 3029 Sfax, Tunisia.
| | - Sonda Masmoudi
- Hedi chaker hospital, El Ain road, Km0 5, 3000, Sfax, Tunisia; Faculty medecine of sfax, Avenue Majida BOULILA, 3029 Sfax, Tunisia
| | - Olfa Kassar
- Hedi chaker hospital, El Ain road, Km0 5, 3000, Sfax, Tunisia; Faculty medecine of sfax, Avenue Majida BOULILA, 3029 Sfax, Tunisia
| | - Rahma Mallek
- Hedi chaker hospital, El Ain road, Km0 5, 3000, Sfax, Tunisia; Faculty medecine of sfax, Avenue Majida BOULILA, 3029 Sfax, Tunisia
| | - Moez Medhaffar
- Hedi chaker hospital, El Ain road, Km0 5, 3000, Sfax, Tunisia; Faculty medecine of sfax, Avenue Majida BOULILA, 3029 Sfax, Tunisia
| | - Moez Elloumi
- Hedi chaker hospital, El Ain road, Km0 5, 3000, Sfax, Tunisia; Faculty medecine of sfax, Avenue Majida BOULILA, 3029 Sfax, Tunisia
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Dowling M, Fahy P, Houghton C, Smalle M. A qualitative evidence synthesis of healthcare professionals' experiences and views of palliative care for patients with a haematological malignancy. Eur J Cancer Care (Engl) 2020; 29:10.1111/ecc.13316. [PMID: 32902114 PMCID: PMC7757223 DOI: 10.1111/ecc.13316] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/30/2020] [Accepted: 08/07/2020] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Patients with haematological malignancies may not be receiving appropriate referrals to palliative care and continuing to have treatments in the end stages of their disease. This systematic review of qualitative research aimed to synthesise healthcare professionals' (HCPs) views and experiences of palliative care for adult patients with a haematologic malignancy. METHODS A systematic search strategy was undertaken across eight databases. Thomas and Harden's approach to thematic analysis guided synthesis on the seventeen included studies. GRADE-GRADEQual guided assessment of confidence in the synthesised findings. RESULTS Three analytic themes were identified: (a) "Maybe we can pull another 'rabbit out of the hat'," represents doctors' therapeutic optimism, (b) "To tell or not to tell?" explores doctors' decision-making around introducing palliative care, and (c) "Hospice, home or hospital?" describes HCPs concerns about challenges faced by haematology patients at end of life in terms of transfusion support and risk of catastrophic bleeds. CONCLUSION Haematologists value the importance of integrated palliative care but prefer the term "supportive care." Early integration of supportive care alongside active curative treatment should be the model of choice in haematology settings in order to achieve the best outcomes and improved quality of life.
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Affiliation(s)
- Maura Dowling
- School of Nursing and MidwiferyNational University of IrelandGalwayIreland
| | - Paul Fahy
- School of Nursing and MidwiferyNational University of IrelandGalwayIreland
| | - Catherine Houghton
- School of Nursing and MidwiferyNational University of IrelandGalwayIreland
| | - Mike Smalle
- James Hardiman LibraryNational University of IrelandGalwayIreland
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Characteristics of palliative home care for patients with hematological tumors compared to those of patients with solid tumors. Int J Hematol 2019; 110:237-243. [DOI: 10.1007/s12185-019-02673-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 05/16/2019] [Accepted: 05/21/2019] [Indexed: 10/26/2022]
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Ramsenthaler C, Gao W, Siegert RJ, Edmonds PM, Schey SA, Higginson IJ. Symptoms and anxiety predict declining health-related quality of life in multiple myeloma: A prospective, multi-centre longitudinal study. Palliat Med 2019; 33:541-551. [PMID: 31060467 DOI: 10.1177/0269216319833588] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Patients with multiple myeloma, an incurable haematological cancer, often receive palliative care only late in their trajectory. Criteria for early referral are lacking. AIM To identify which patients might benefit from early integration, by identifying trajectories of health-related quality of life and the determinants for declining or poor Health related quality of life . DESIGN Prospective, longitudinal cohort study. PARTICIPANTS Multiple myeloma patients at all stages (newly diagnosed, first-line or second-line treatment, early or later treatment-free interval, refractory disease) from in- and outpatient units at 14 hospitals in England were recruited. In addition to clinical information and standardised Health related quality of life and psychological aspects, the Myeloma Patient Outcome Scale (MyPOS) measured palliative care concerns. RESULTS A total of 238 patients were recruited, on average 3.5 years ( SD: 3.4) post-diagnosis. Latent mixture growth models identified four Health related quality of life trajectories. Classes 3 and 4 represent trajectories of stable poor Health related quality of life or declining Health related quality of life over an 8-month period. The strongest predictors of poor outcome at the end of follow-up were general symptom level (odds ratio (OR): 1.3, 95% CI: 1.0-1.6, p = 0.028), presence of clinically relevant anxiety (OR: 1.2, 95% confidence interval (CI): 1.0-1.4, p = 0.019), and presence of pain (OR: 1.02, 95% CI: 1.0-1.1, p = 0.018), all being more predictive than demographic or clinical characteristics. CONCLUSION General symptom level, pain and presence of anxiety predict declining Health related quality of life in multiple myeloma. Identification of patients with palliative care needs should focus on assessing patient-reported symptoms and psychosocial well-being for identifying those at risk of deterioration.
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Affiliation(s)
- Christina Ramsenthaler
- 1 Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK.,2 Department of Palliative Medicine, University Hospital Munich, Munich, Germany
| | - Wei Gao
- 1 Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Richard J Siegert
- 1 Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK.,3 Department of Psychology, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Polly M Edmonds
- 4 Department of Palliative Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Stephen A Schey
- 5 Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Irene J Higginson
- 1 Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
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Busemann C, Jülich A, Buchhold B, Schmidt V, Schneidewind L, Pink D, Schmidt CA, Neumann T, Krüger WH. Clinical course and end-of-life care in patients who have died after allogeneic stem cell transplantation. J Cancer Res Clin Oncol 2017; 143:2067-2076. [PMID: 28551769 PMCID: PMC7101727 DOI: 10.1007/s00432-017-2446-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 05/19/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE Allogeneic stem cell transplantation may cure approximately 50% of patients, however, a significant part of the other half might benefit from a high-quality palliative care medicine at the end of life. Somatic, psychic and spiritual needs of these patients may differ from those of patients suffering from incurable solid tumours and are not comprehensively evaluated so far. METHODS To address this question, data from charts of 123 patients who have died after allogeneic stem cell transplantation were extracted. In detail, the time line of the clinical course, the symptoms, the administered drugs and other applied procedures were analysed. RESULTS Approximately one half of the patients, who have died after stem cell transplantation, did not live more than 5 months. Two-thirds of patients died within 14 months after SCT. 28.5% of the patients could not be discharged after transplantation. However, a significant proportion had a low ECOG-score (0-1) prior to death, indicating a high degree of mobility. Major symptoms were weakness, fatigue and need for aid at daily activities. Severe pain, dyspnoea and obstipation, as known from patients suffering from advanced solid tumours, were rare. In consequence, use of opioids seemed to be less frequent than in patients with solid tumours. Measures of intensive care and i.v.-drug administration were applied to a significant proportion of patients. CONCLUSION The present investigation indicates that the somatic, psychic and spiritual end-of-life-care after allogeneic stem cell transplantation could be optimised. A significant problem for the transplantation team seems to be the realisation of necessity to switch the curative concept into a palliative ambition. Requirements are a subsequent prospectively conducted investigation and an intensification of cooperation between transplant and palliative care teams.
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Affiliation(s)
- Christoph Busemann
- Department of Internal Medicine C-Haematology, and Oncology, Stem Cell Transplantation, Palliative Care, University Hospital Greifswald, Ernst-Moritz-Arndt University, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Andreas Jülich
- Department of Internal Medicine C-Haematology, and Oncology, Stem Cell Transplantation, Palliative Care, University Hospital Greifswald, Ernst-Moritz-Arndt University, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Britta Buchhold
- Department of Medical Psychology, University Hospital Greifswald, Ernst-Moritz-Arndt University, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Vanessa Schmidt
- Department of Internal Medicine C-Haematology, and Oncology, Stem Cell Transplantation, Palliative Care, University Hospital Greifswald, Ernst-Moritz-Arndt University, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Laila Schneidewind
- Department of Internal Medicine C-Haematology, and Oncology, Stem Cell Transplantation, Palliative Care, University Hospital Greifswald, Ernst-Moritz-Arndt University, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Daniel Pink
- Department of Internal Medicine C-Haematology, and Oncology, Stem Cell Transplantation, Palliative Care, University Hospital Greifswald, Ernst-Moritz-Arndt University, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Christian Andreas Schmidt
- Department of Internal Medicine C-Haematology, and Oncology, Stem Cell Transplantation, Palliative Care, University Hospital Greifswald, Ernst-Moritz-Arndt University, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Thomas Neumann
- Department of Internal Medicine C-Haematology, and Oncology, Stem Cell Transplantation, Palliative Care, University Hospital Greifswald, Ernst-Moritz-Arndt University, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - William H Krüger
- Department of Internal Medicine C-Haematology, and Oncology, Stem Cell Transplantation, Palliative Care, University Hospital Greifswald, Ernst-Moritz-Arndt University, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany.
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Ramsenthaler C, Osborne TR, Gao W, Siegert RJ, Edmonds PM, Schey SA, Higginson IJ. The impact of disease-related symptoms and palliative care concerns on health-related quality of life in multiple myeloma: a multi-centre study. BMC Cancer 2016; 16:427. [PMID: 27387201 PMCID: PMC4937527 DOI: 10.1186/s12885-016-2410-2] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 06/21/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Multiple myeloma, the second most common haematological cancer, remains incurable. Its incidence is rising due to population ageing. Despite the impact of the disease and its treatment, not much is known on who is most in need of supportive and palliative care. This study aimed to (a) assess symptom severity, palliative care concerns and health-related quality of life (HRQOL) in patients with multiple myeloma, and (b) to determine which factors are associated with a lower quality of life. We further wanted to know (c) whether general symptom level has a stronger influence on HRQOL than disease characteristics. METHODS This multi-centre cross-sectional study sampled two cohorts of patients with multiple myeloma from 18 haematological cancer centres in the UK. The Myeloma Patient Outcome Scale (MyPOS) was used to measure symptoms and concerns. Measures of quality of life included the EORTC QLQ-C30, its myeloma module and the EuroQoL EQ-5D. Data were collected on socio-demographic, disease and treatment characteristics and phase of illness. Point prevalence of symptoms and concerns was determined. Multiple regression models quantified relationships between independent factors and the MyPOS, EORTC global quality of life item and EQ5D Index. RESULTS Five-hundred-fifty-seven patients, on average 3.5 years (SD: 3.4) post-diagnosis, were recruited. 18.2 % had newly diagnosed disease, 47.9 % were in a treatment-free interval and 32.7 % had relapsed/progressive disease phase. Patients reported a mean of 7.2 symptoms (SD: 3.3) out of 15 potential symptoms. The most common symptoms were pain (72 %), fatigue (88 %) and breathlessness (61 %). Those with relapsed/progressive disease reported the highest mean number of symptoms and the highest overall palliative care concerns (F = 9.56, p < 0.001). Factors associated with high palliative care concerns were a general high symptom level, presence of pain, anxiety, low physical function, younger age, and being in the advanced stages of disease. CONCLUSION Patients with multiple myeloma have a high symptom burden and low HRQOL, in the advanced and the earlier stages of disease. Identification of patients in need of supportive care should focus on assessing patient-reported outcomes such as symptoms and functioning regularly in clinical practice, complementary to traditional biomedical markers.
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Affiliation(s)
- Christina Ramsenthaler
- />Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King’s College London, School of Medicine, Bessemer Road, London, SE5 9PJ UK
| | - Thomas R. Osborne
- />Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King’s College London, School of Medicine, Bessemer Road, London, SE5 9PJ UK
| | - Wei Gao
- />Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King’s College London, School of Medicine, Bessemer Road, London, SE5 9PJ UK
| | - Richard J. Siegert
- />Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King’s College London, School of Medicine, Bessemer Road, London, SE5 9PJ UK
- />Auckland University of Technology, Auckland, New Zealand
| | - Polly M. Edmonds
- />Department of Palliative Care, King’s College Hospital NHS Foundation Trust, London, UK
| | - Stephen A. Schey
- />Department of Haematological Medicine, King’s College Hospital NHS Foundation Trust, London, UK
| | - Irene J. Higginson
- />Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King’s College London, School of Medicine, Bessemer Road, London, SE5 9PJ UK
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Cormican O, Dowling M. Managing relapsed myeloma: The views of patients, nurses and doctors. Eur J Oncol Nurs 2016; 23:51-8. [PMID: 27456375 DOI: 10.1016/j.ejon.2016.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 04/19/2016] [Accepted: 04/20/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE The study aim was to explore whether there were differing opinions on the current management of relapsed myeloma between patients and health care professionals, a topic which has never been explored previously in the literature. METHODS This qualitative study was undertaken at a regional specialist haematology centre in Ireland. Individual interviews were undertaken with multiple myeloma patients with relapsed disease (n = 8). Three focus groups were also undertaken with haematology nurse specialists, haematology doctors and staff nurses working in a haematology day unit (n = 17). The analysis of interview data was guided by thematic analysis. RESULTS Two central themes were interpreted from the interview data: 'shared decision making with the expert patient' and 'an unpredictable disease journey'. Patients felt well informed regarding their illness but faced difficult decisions at times. Nurses and doctors stressed the importance of the early introduction of palliative care but acknowledged difficulties due to myeloma being unpredictable. CONCLUSION Managing relapsed myeloma was fraught with complex issues. Patients developed alternative ways of coping with their disease including adopting the role of the 'expert patient', continuing to battle their disease and living with a chronic illness. Health care professionals struggle to manage the realities of a disease where the prognosis is improving. Uncertainty around patients' care and difficulties such as when 'enough is enough', continue to cause challenges. The transition to a chronic disease offers hope to patients and an opportunity for health care professionals to implement holistic care plans encouraging patients to be self proactive.
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Affiliation(s)
- Orlaith Cormican
- The Cancer Clinical Trials Unit, Room 1.68, Clinical Research Facility, National University of Ireland Galway, Galway University Hospital, Newcastle Rd., Galway, Ireland.
| | - Maura Dowling
- School of Nursing and Midwifery, National University of Ireland, Galway, University Road, Galway, Ireland.
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Caring for terminal patients in haematology: the urgent need of a new research agenda. Support Care Cancer 2014; 23:5-7. [DOI: 10.1007/s00520-014-2489-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 10/17/2014] [Indexed: 10/24/2022]
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McGrath P, Kearsley J. Caring for dying patients can be a satisfying experience. CMAJ 2011; 183:169-70. [PMID: 21135080 DOI: 10.1503/cmaj.101627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Pam McGrath
- International Program of Psycho-Social Health Research, Central Queensland University, Brisbane, Queensland, Australia.
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Howell DA, Roman E, Cox H, Smith AG, Patmore R, Garry AC, Howard MR. Destined to die in hospital? Systematic review and meta-analysis of place of death in haematological malignancy. BMC Palliat Care 2010; 9:9. [PMID: 20515452 PMCID: PMC2892433 DOI: 10.1186/1472-684x-9-9] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Accepted: 06/01/2010] [Indexed: 11/10/2022] Open
Abstract
Background Haematological malignancies are a common, heterogeneous and complex group of diseases that are often associated with poor outcomes despite intensive treatment. Research surrounding end-of-life issues, and particularly place of death, is therefore of paramount importance, yet place of death has not been formally reviewed in these patients. Methods A systematic literature review and meta-analysis was undertaken using PubMed to identify all studies published between 1966 and 2010. Studies examining place of death in adult haematology patients, using routinely compiled morbidity and mortality data and providing results specific to this disease were included. 21 studies were identified with descriptive and/or risk-estimate data; 17 were included in a meta-analysis. Results Compared to other cancer deaths, haematology patients were more than twice as likely to die in hospital (Odds Ratio 2.25 [95% Confidence Intervals, 2.07-2.44]). Conclusion Home is generally considered the preferred place of death but haematology patients usually die in hospital. This has implications for patients who may not be dying where they wish, and also health commissioners who may be funding costly end-of-life care in inappropriate acute hospital settings. More research is needed about preferred place of care for haematology patients, reasons for hospital deaths, and how these can be avoided if home death is preferred.
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Affiliation(s)
- Debra A Howell
- Epidemiology and Genetics Unit, Department of Health Sciences, Seebohm Rowntree Building, University of York, YO10 5DD, UK.
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