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Cavanagh J, Spiller J, Taylor DR. Assisted dying, moral distress, and conscientious objection. Lancet 2024; 403:1443-1444. [PMID: 38614475 DOI: 10.1016/s0140-6736(23)01910-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/08/2023] [Indexed: 04/15/2024]
Affiliation(s)
- Jonathan Cavanagh
- School of Infection & Immunity, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | | | - D Robin Taylor
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh Medical School, Edinburgh EH8 9AG, UK.
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Glenny L, Nyatanga B, Regnard C, Bisset M, Damaso S, Davis C, Edwards F, Fallon M, George R, Pollock J, Proffitt A, Robinson V, Spiller J, Thavaraj A, Twycross A, Twycross R, Wright G. Assisted dying. Int J Palliat Nurs 2022; 28:55-58. [PMID: 35446671 DOI: 10.12968/ijpn.2022.28.2.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Brian Nyatanga
- Consultant Editor, IJPN; Senior lecturer, University of Worcester
| | - Claud Regnard
- Honorary Consultant in Palliative Care Medicine, St Oswald's Hospice, Newcastle upon Tyne
| | | | - Sergio Damaso
- Clinical Nurse Specialist and Visiting Lecturer in Palliative Care
| | - Carol Davis
- Consultant in Palliative Medicine and Clinical Lead for End-of-Life care, University Hospital Southampton
| | | | - Marie Fallon
- Professor of Palliative Medicine, University of Edinburgh
| | - Rob George
- Professor of Palliative Care, Kings College London; Consultant in Palliative Care, Guys, and St Thomas's Foundation Trust; Independent Clinical and Medicolegal Expert
| | - Jennie Pollock
- Associate Head of Public Policy at the Christian Medical Fellowship
| | - Amy Proffitt
- Consultant in Palliative Medicine; Chair of the Association for Palliative Medicine, London
| | - Vicky Robinson
- Retired Consultant Nurse, Palliative and End-of-Life Care
| | - Juliet Spiller
- Consultant in Palliative Medicine, Marie Curie Hospice, Edinburgh
| | - Angela Thavaraj
- Palliative Care Clinical Nurse Specialist, University Hospital Lewisham, London
| | - Alison Twycross
- Senior Lecturer in Children and Young People's Nursing, The Open University; Editor-in-Chief, Evidence Based Nursing
| | - Robert Twycross
- Emeritus Clinical Reader in Palliative Medicine, Oxford University
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Hulbert-Williams NJ, Norwood SF, Gillanders D, Finucane AM, Spiller J, Strachan J, Millington S, Kreft J, Swash B. Brief Engagement and Acceptance Coaching for Hospice Settings (the BEACHeS study): results from a Phase I study of acceptability and initial effectiveness in people with non-curative cancer. BMC Palliat Care 2021; 20:96. [PMID: 34172029 PMCID: PMC8235846 DOI: 10.1186/s12904-021-00801-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 06/11/2021] [Indexed: 12/04/2022] Open
Abstract
Objectives Transitioning into palliative care is psychologically demanding for people with advanced cancer, and there is a need for acceptable and effective interventions to support this. We aimed to develop and pilot test a brief Acceptance and Commitment Therapy (ACT) based intervention to improve quality of life and distress. Methods Our mixed-method design included: (i) quantitative effectiveness testing using Single Case Experimental Design (SCED), (ii) qualitative interviews with participants, and (iii) focus groups with hospice staff. The five-session, in-person intervention was delivered to 10 participants; five completed at least 80%. Results At baseline, participants reported poor quality of life but low distress. Most experienced substantial physical health deterioration during the study. SCED analysis methods did not show conclusively significant effects, but there was some indication that outcome improvement followed changes in expected intervention processes variables. Quantitative and qualitative data together demonstrates acceptability, perceived effectiveness and safety of the intervention. Qualitative interviews and focus groups were also used to gain feedback on intervention content and to make design recommendations to maximise success of later feasibility trials. Conclusions This study adds to the growing evidence base for ACT in people with advanced cancer. A number of potential intervention mechanisms, for example a distress-buffering hypothesis, are raised by our data and these should be addressed in future research using randomised controlled trial designs. Our methodological recommendations—including recruiting non-cancer diagnoses, and earlier in the treatment trajectory—likely apply more broadly to the delivery of psychological intervention in the palliative care setting. This study was pre-registered on the Open Science Framework (Ref: 46,033) and retrospectively registered on the ISRCTN registry (Ref: ISRCTN12084782).
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Affiliation(s)
| | - Sabrina F Norwood
- Centre for Contextual Behavioural Science, School of Psychology, University of Chester, Chester, UK
| | - David Gillanders
- School of Health in Social Science, The University of Edinburgh, Edinburgh, UK
| | - Anne M Finucane
- School of Health in Social Science, The University of Edinburgh, Edinburgh, UK.,Marie Curie Hospice, Edinburgh, UK
| | | | | | | | - Joseph Kreft
- Centre for Contextual Behavioural Science, School of Psychology, University of Chester, Chester, UK
| | - Brooke Swash
- Centre for Contextual Behavioural Science, School of Psychology, University of Chester, Chester, UK
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Sampey L, Finucane AM, Spiller J. Shared electronic care coordination systems following referral to hospice. Br J Community Nurs 2021; 26:58-62. [PMID: 33539245 DOI: 10.12968/bjcn.2021.26.2.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In Scotland, the Key Information Summary (KIS) enables health providers to access key patient information to guide decision-making out-of-hours. KISs are generated in primary care and rely on information from other teams, such as community specialist palliative care teams (CSPCTs), to keep them up-to-date. This study involved a service evaluation consisting of case note reviews of new referrals to a CSPCT and semi-structured interviews with palliative care community nurse specialists (CNSs) regarding their perspectives on KISs. Some 44 case notes were examined, and 77% of patients had a KIS on CSPCT referral. One-month post-referral, all those re-examined (n=17) had a KIS, and 59% KISs had been updated following CNS assessments. CNSs cited anticipatory care planning (ACP) as the most useful aspect of KIS, and the majority of CNSs said they would appreciate KIS editing access. A system allowing CNSs to update KISs would be acceptable to CNSs, as it could facilitate care co-ordination and potentially improve comprehensiveness of ACP information held in KISs.
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Affiliation(s)
- Libby Sampey
- Foundation Year 1 Doctor, NHS Lothian, College of Medicine and Veterinary Medicine, University of Edinburgh
| | - Anne M Finucane
- Research Lead and Honorary Research Fellow, Marie Curie Hospice Edinburgh; Usher Institute University of Edinburgh
| | - Juliet Spiller
- Consultant in Palliative Medicine, Marie Curie Hospice Edinburgh
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Harris C, Spiller J, Finucane A. Managing delirium in terminally ill patients: perspective of palliative care nurse specialists. Br J Community Nurs 2020; 25:346-352. [PMID: 32614673 DOI: 10.12968/bjcn.2020.25.7.346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Delirium occurs frequently at end of life. Palliative care clinical nurse specialists (CNSs) are involved in community palliative care provision. Many patients prefer being cared for at home, yet managing delirium in this setting presents unique challenges, potentially resulting in emergency hospital or hospice admission. We examined the experiences and practice of palliative care CNSs managing delirium in the community; 10 interviews were undertaken. Data were analysed using the framework approach. Challenges to delirium management in the community included limited time with patients, reliance on families and access to medications. Assessment tools were not used routinely; time limited visits and inconsistent retesting were perceived barriers. Management approaches differed depending on CNSs' previous delirium education. Strategies to prevent delirium were not used. Community delirium management presents challenges; support surrounding these could be beneficial. Routine assessment tool use and delirium prevention strategies should be included in further education and research.
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Affiliation(s)
- Clare Harris
- Medical student, University of Edinburgh Medical School
| | - Juliet Spiller
- Consultant in Palliative Medicine, Marie Curie Hospice, Edinburgh
| | - Anne Finucane
- Research lead, Marie Curie Hospice Edinburgh and Honorary Research Fellow, University of Edinburgh
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Hawkes CA, Fritz Z, Deas G, Ahmedzai SH, Richardson A, Pitcher D, Spiller J, Perkins GD. Development of the Recommended Summary Plan for eEmergency Care and Treatment (ReSPECT). Resuscitation 2020; 148:98-107. [PMID: 31945422 DOI: 10.1016/j.resuscitation.2020.01.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 12/03/2019] [Accepted: 01/02/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Do-not-attempt-cardiopulmonary-resuscitation (DNACPR) practice has been shown to be variable and sub-optimal. This paper describes the development of the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT). ReSPECT is a process which encourages shared understanding of a patient's condition and what outcomes they value and fear, before recording clinical recommendations about cardiopulmonary-resuscitation (CPR) within a broader plan for emergency care and treatment. METHODS ReSPECT was developed iteratively, with integral stakeholder engagement, informed by the Knowledge-to-Action cycle. Mixed methods included: synthesis of existing literature; a national online consultation exercise; cognitive interviews with users; a patient-public involvement (PPI) workshop and a usability pilot, to ensure acceptability by both patients and professionals. RESULTS The majority (89%) of consultation respondents supported the concept of emergency care and treatment plans. Key features identified in the evaluation and incorporated into ReSPECT were: The importance of discussions between patient and clinician to inform realistic treatment preferences and clarity in the resulting recommendations recorded by the clinician on the form. The process is compliant with UK mental capacity laws. Documentation should be recognised across all health and care settings. There should be opportunity for timely review based on individual need. CONCLUSION ReSPECT is designed to facilitate discussions about a person's preferences to inform emergency care and treatment plans (including CPR) for use across all health and care settings. It has been developed iteratively with a range of stakeholders. Further research will be needed to assess the influence of ReSPECT on patient-centred decisions, experience and health outcomes.
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Affiliation(s)
- Claire A Hawkes
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, UK
| | - Zoe Fritz
- THIS (The Healthcare Improvement Studies) Institute, University of Cambridge, UK; Cambridge University Hospitals, UK
| | - Gavin Deas
- University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Hills Road, Cambridge, UK
| | - Sam H Ahmedzai
- National Institute for Health Research Clinical Research Network - Cancer Cluster, University of Leeds, UK
| | - Alison Richardson
- School of Health Sciences, University of Southampton & University Hospital Southampton NHS Foundation Trust, UK
| | - David Pitcher
- Resuscitation Council UK, 5th Floor, Tavistock House North, Tavistock Square, London, WC1H 9HR, UK
| | | | - Gavin D Perkins
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, UK; University Hospitals Birmingham, NHS Foundation Trust, Birmingham, UK.
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Hulbert-Williams NJ, Norwood S, Gillanders D, Finucane A, Spiller J, Strachan J, Millington S, Swash B. Brief Engagement and Acceptance Coaching for Community and Hospice Settings (the BEACHeS Study): Protocol for the development and pilot testing of an evidence-based psychological intervention to enhance wellbeing and aid transition into palliative care. Pilot Feasibility Stud 2019; 5:104. [PMID: 31452926 PMCID: PMC6702709 DOI: 10.1186/s40814-019-0488-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 08/12/2019] [Indexed: 11/17/2022] Open
Abstract
Background Cancer affects millions of individuals globally, with a mortality rate of over eight million people annually. Although palliative care is often provided outside of specialist services, many people require, at some point in their illness journey, support from specialist palliative care services, for example, those provided in hospice settings. This transition can be a time of uncertainty and fear, and there is a need for effective interventions to meet the psychological and supportive care needs of people with cancer that cannot be cured. Whilst Acceptance and Commitment Therapy (ACT) has been shown to be effective across diverse health problems, robust evidence for its effectiveness in palliative cancer populations is not extensive. Method This mixed-methods study uses a single-case experimental design with embedded qualitative interviews to pilot test a novel intervention for this patient group. Between 14 and 20 patients will be recruited from two hospices in England and Scotland. Participants will receive five face-to-face manualised sessions with a psychological therapist. Sessions are structured around teaching core ACT skills (openness, awareness and engagement) as a way to deal effectively with challenges of transition into specialist palliative care services. Outcome measures include cancer-specific quality of life (primary outcome) and distress (secondary outcome), which are assessed alongside measures of psychological flexibility. Daily diary outcome assessments will be taken for key measures, alongside more detailed weekly self-report, through baseline, intervention and 1-month follow-up phases. After follow-up, participants will be invited to take part in a qualitative interview to understand their experience of taking part and acceptability and perceived effectiveness of the intervention and its components. Discussion This study is the first investigation of using ACT with terminally ill patients at the beginning of their transition into palliative treatment. Using in-depth single-case approaches, we will refine and manualise intervention content by the close of the study for use in follow-up research trials. Our long-term goal is then to test the intervention as delivered by non-psychologist specialist palliative care practitioners thus broadening the potential relevance of the approach. Trial registration Open Science Framework, 46033. Registered 19 April 2018.
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Affiliation(s)
- Nicholas J Hulbert-Williams
- 1Centre for Contextual Behavioural Science, School of Psychology, University of Chester, Parkgate Road, Chester, CH1 4BJ UK
| | - Sabrina Norwood
- 1Centre for Contextual Behavioural Science, School of Psychology, University of Chester, Parkgate Road, Chester, CH1 4BJ UK
| | - David Gillanders
- 2School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | | | | | | | - Sue Millington
- 1Centre for Contextual Behavioural Science, School of Psychology, University of Chester, Parkgate Road, Chester, CH1 4BJ UK
| | - Brooke Swash
- 1Centre for Contextual Behavioural Science, School of Psychology, University of Chester, Parkgate Road, Chester, CH1 4BJ UK
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Coyle S, Elverson J, Harlow T, Jordan A, McNamara P, O'Neill C, Quibell R, Regnard C, Spiller J, Stephenson J. The myth that shames us all. Lancet 2018; 392:1196. [PMID: 30319108 DOI: 10.1016/s0140-6736(18)31876-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 08/07/2018] [Indexed: 11/23/2022]
Affiliation(s)
- Séamus Coyle
- Palliative Care Institute, University of Liverpool and Saint Helens and Knowsley Hospitals Trust, Liverpool, UK
| | - Jo Elverson
- Saint Oswald's Hospice, Newcastle upon Tyne NE31EE, UK
| | - Tim Harlow
- Saint Oswald's Hospice, Newcastle upon Tyne NE31EE, UK
| | | | - Paul McNamara
- Saint Oswald's Hospice, Newcastle upon Tyne NE31EE, UK
| | - Catherine O'Neill
- Saint Oswald's Hospice, Newcastle upon Tyne NE31EE, UK; Hospiscare, Exeter, UK
| | - Rachel Quibell
- Newcastle Upon Tyne NHS Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Claud Regnard
- Saint Oswald's Hospice, Newcastle upon Tyne NE31EE, UK.
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Finucane AM, Davydaitis D, Carduff E, Horseman Z, Baughan P, Meade R, Warren T, Tapsfield J, Spiller J, Campbell S, Murray SA. 17 Key information summary (KIS) generation for people who died in scotland in 2017: a mixed methods study. BMJ Support Palliat Care 2018. [DOI: 10.1136/bmjspcare-2018-mariecurie.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
IntroductionThe percentage of people with a key information summary (KIS) or an anticipatory care plan (ACP) at the time of death can act as an indicator of access to palliative care. Key information summaries (KIS) introduced throughout Scotland in 2013, are shared electronic patient records which contain essential information relevant to a patient’s care including palliative care. There is now a need to examine current levels of KIS generation and ACP documentation in the last months of life to assess progress and review barriers and facilitators to sharing patient information across settings and to inform out-of-hours care.AimsTo estimate the extent and timing of KIS and ACP generation for people who die with an advanced progressive condition and to compare with our previous study (Tapsfield et al. 2016).To explore GP experiences of commencing and updating a KIS; and their perspectives on what works well and what can be improved in supporting this process.MethodsA mixed methods study consisting of a retrospective review of the electronic records of all patients who died in 16 Scottish general practices in 2017 and semi-structured interviews with 16 GPs.ResultsQuantitative and qualitative data collection is in progress.ConclusionFindings will describe current levels of KIS and ACP documentation for people who die in Scotland. We will synthesize GP experiences of KIS use and describe the essential components of an ACP that need to be documented to enable good palliative care across settings including emergency and out-of-hours care.Reference. Tapsfield J, Hall C, Lunan C, McCutheon H, McLoughlin P, Rhee J, Rus A, Spiller J, Finucane AM, Murray SA. Many people in Scotland now benefit from anticipatory care before they die: An after death analysis and interviews with general practitioners. BMJ Supportive and Palliative Care2016. doi:10.1136/bmjspcare-2015-001014
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Irvine J, Spiller J, Finucane A. 26 ‘What matters to me?’ staff perspectives on the identification and documentation of ‘what matters’ and the role of values-clarification in palliative care settings. BMJ Support Palliat Care 2018. [DOI: 10.1136/bmjspcare-2018-mariecurie.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
IntroductionValues-clarification has an important role in palliative care for clinical staff and their patients (Edwards 2014). The question ‘What matters to me?’ seeks to support patients in voicing their values and forms part of the daily assessment of each patient at the Marie Curie Hospice Edinburgh.AimsExplore staff perspectives on the role of understanding patient values and their interaction with clinical practice in a palliative care setting.MethodThe current study was a service evaluation investigating the practical application of ‘What matters to me?’ as a proxy question for values identification using a retrospective casenotes review and focus group discussion with 12 clinical staff. Data was analysed using a qualitative method thematic analysis.ResultsDoctors recorded ‘What matters to me?’ information most frequently (52%) and nurses second (36%). Focus group results indicated widespread understanding of the importance of values to staff personally and person-centred care but revealed varying approaches to electronic documentation. Multidisciplinary team meeting electronic records were found to be less useful than intended. Quality of evidence of community documentation of ‘What matters’ being transitioned to the inpatient setting was overall positive. Casenotes analysis gave rise to patient values core themes including family being at home and general health.DiscussionThis evaluation found extensive agreement regarding the positive impact of using the ‘What matters to me?’ question to elicit patient values. Implications for hospice practice will be discussed including clarifying electronic documentation practices increased healthcare assistant access to electronic records and regular updating of the nursing handover sheets.Reference. Edwards AW. Therapeutic values clarification and values development for end-of-life patients: A conceptual model. American Journal of Hospice and Palliative Medicine®2014;31(4):414–419.
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Hulbert-Williams N, Gillanders D, Finucane A, Millington S, Norwood S, Spiller J, Strachan J, Swash B. 18 Brief engagement and acceptance coaching in community and hospice settings (the beaches study): protocol for developing and pilot testing an evidence-based intervention to enhance wellbeing at transition into palliative care. BMJ Support Palliat Care 2018. [DOI: 10.1136/bmjspcare-2018-mariecurie.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
IntroductionThe transition into palliative care can cause uncertainty fear and distress. Quality of life can be detrimentally affected and advance planning for end-of-life is often avoided. Acceptance and Commitment Therapy (ACT) is a promising intervention for supporting palliative patients; the focus on values may be especially relevant to restoring meaningful living. We present a protocol for development and piloting of a brief ACT-based intervention for delivery at the palliative care transition point.Aims and methodsA multiple-baseline single-case non-controlled design is used. This enables exploration of effectiveness and processes causing outcome improvement. Integrated qualitative interviews provide acceptability data. The five-session intervention is delivered by psychologists to 14 participants in two hospices. Participants with an incurable cancer diagnosis but life expectancy of four months or more are eligible. Weekly self-report questionnaires assess study outcomes (quality of life distress) and changes in therapeutic processes. A smartphone app facilitates daily assessment of brief measures to enable sensitive measurement of process change.ResultsQuantitative data will be analysed using visual plots and statistical change indices across study phases: this enables calculation of indicative effect sizes for future trial planning. Recruitment attrition and engagement will be analysed descriptively as feasibility indicators. Framework analysis is used to for qualitative data.ConclusionsSingle-case designs are not commonly used in psychosocial oncology however they offer a scientific data-driven approach to intervention development. By the end of this study we aim to manualise our intervention for non-psychologist delivery to plan a randomised trial with maximised implementation potential.References. Hayes SC, Strosahl KD, Wilson KG. Acceptance and commitment therapy: The process and practice of mindful change2011. Guilford Press.. Murray, et al. Patterns of social psychological and spiritual decline toward the end of life in lung cancer and heart failure. Journal of Pain and Symptom Management2007;34(4):393–402.. Ost L. The efficacy of acceptance and commitment therapy: An updated systematic review and meta-analysis. Behaviour Research and Therapy2014;61:105–12.
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Carduff E, Johnston S, Winstanley C, Morrish J, Murray SA, Spiller J, Finucane A. What does 'complex' mean in palliative care? Triangulating qualitative findings from 3 settings. BMC Palliat Care 2018; 17:12. [PMID: 29301524 PMCID: PMC5753489 DOI: 10.1186/s12904-017-0259-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 12/04/2017] [Indexed: 11/16/2022] Open
Abstract
Background Complex need for patients with a terminal illness distinguishes those who would benefit from specialist palliative care from those who could be cared for by non-specialists. However, the nature of this complexity is not well defined or understood. This study describes how health professionals, from three distinct settings in the United Kingdom, understand complex need in palliative care. Methods Semi-structured qualitative interviews were conducted with professionals in primary care, hospital and hospice settings. Thirty-four professionals including doctors, nurses and allied health professionals were recruited in total. Data collected in each setting were thematically analysed and a workshop was convened to compare and contrast findings across settings. Results The interaction between diverse multi-dimensional aspects of need, existing co-morbidities, intractable symptoms and complicated social and psychological issues increased perceived complexity. Poor communication between patients and their clinicians contributed to complexity. Professionals in primary and acute care described themselves as ‘generalists’ and felt they lacked confidence and skill in identifying and caring for complex patients and time for professional development in palliative care. Conclusions Complexity in the context of palliative care can be inherent to the patient or perceived by health professionals. Lack of confidence, time constraints and bed pressures contribute to perceived complexity, but are amenable to change by training in identifying, prognosticating for, and communicating with patients approaching the end of life. Electronic supplementary material The online version of this article (10.1186/s12904-017-0259-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Emma Carduff
- Marie Curie Hospice, 133 Balornock Road, Glasgow, G21 3US, UK. .,School of School of Medicine, Nursing and Healthcare, University of Glasgow, 59 Oakfield Avenue, Glasgow, G12 8LL, UK.
| | - Sarah Johnston
- Faculty of Medicine, University of Edinburgh, Edinburgh, UK
| | | | - Jamie Morrish
- Faculty of Medicine, University of Aberdeen, Aberdeen, UK
| | - Scott A Murray
- Primary Palliative Care Research Group, Centre for Population Health Sciences, The Usher Institute, The University of Edinburgh, Medical School, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Juliet Spiller
- Marie Curie Hospice Edinburgh, Frogston Road West, Edinburgh, EH10 7DR, UK
| | - Anne Finucane
- Marie Curie Hospice Edinburgh, Frogston Road West, Edinburgh, EH10 7DR, UK
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Affiliation(s)
- Zoe Fritz
- ReSPECT expert working group, Resuscitation Council (UK), 5th Floor, Tavistock House North, London WC1H 9HR, UK
| | - David Pitcher
- ReSPECT expert working group, Resuscitation Council (UK), 5th Floor, Tavistock House North, London WC1H 9HR, UK
| | - Claud Regnard
- ReSPECT expert working group, Resuscitation Council (UK), 5th Floor, Tavistock House North, London WC1H 9HR, UK
| | - Juliet Spiller
- ReSPECT expert working group, Resuscitation Council (UK), 5th Floor, Tavistock House North, London WC1H 9HR, UK
| | - Madeleine Wang
- ReSPECT expert working group, Resuscitation Council (UK), 5th Floor, Tavistock House North, London WC1H 9HR, UK
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McGregor E, Vermont L, Yong XY, Spiller J. P-93 Standards for documentation of dnacpr decisions and discussions in a hospice inpatient unit & community team. BMJ Support Palliat Care 2017. [DOI: 10.1136/bmjspcare-2017-00133.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Carduff E, Lugton J, Spiller J, Hall C. P-98 Patient and caregiver experiences of do not attempt cardiopulmonary resuscitation (DNACPR) conversations: an integrative review of the literature. BMJ Support Palliat Care 2017. [DOI: 10.1136/bmjspcare-2017-00133.97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Baird L, Spiller J. P-47 A quality improvement approach to cognitive assessment on hospice admission: could we use the 4at or short cam? BMJ Support Palliat Care 2017. [DOI: 10.1136/bmjspcare-2017-00133.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Tapsfield J, Hall C, Lunan C, McCutcheon H, McLoughlin P, Rhee J, Leiva A, Spiller J, Finucane A, Murray SA. Many people in Scotland now benefit from anticipatory care before they die: an after death analysis and interviews with general practitioners. BMJ Support Palliat Care 2016; 9:e28. [PMID: 27075983 PMCID: PMC6923937 DOI: 10.1136/bmjspcare-2015-001014] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 01/11/2016] [Accepted: 01/18/2016] [Indexed: 12/05/2022]
Abstract
Background Key Information Summaries (KIS) were introduced throughout Scotland in 2013 so that anticipatory care plans written by general practitioners (GPs) could be routinely shared electronically and updated in real time, between GPs and providers of unscheduled and secondary care. Aims We aimed to describe the current reach of anticipatory and palliative care, and to explore GPs’ views on using KIS. Methods We studied the primary care records of all patients who died in 2014 in 9 diverse Lothian practices. We identified if anticipatory or palliative care had been started, and if so how many weeks before death and which aspects of care had been documented. We interviewed 10 GPs to understand barriers and facilitating factors. Results Overall, 60% of patients were identified for a KIS, a median of 18 weeks before death. The numbers identified were highest for patients with cancer, with 75% identified compared with 66% of those dying with dementia/frailty and only 41% dying from organ failure. Patients were more likely to die outside hospital if they had a KIS. GPs identified professional, patient and societal challenges in identifying patients for palliative care, especially those with non-cancer diagnoses. Conclusions GPs are identifying patients for anticipatory and palliative care more equitably across the different disease trajectories and earlier in the disease process than they were previously identifying patients specifically for palliative care. However, many patients still lack care planning, particularly those dying with organ failure.
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Affiliation(s)
- Julia Tapsfield
- Primary Palliative Care Research Group, Centre for Population Health Sciences, The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | | | | | | | - Peter McLoughlin
- Department in Strategic Planning and Modernisation, Lothian NHS Board, Edinburgh, UK
| | - Joel Rhee
- School of Public Health & Community Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Alfonso Leiva
- Primary Care Research Unit of Mallorca, Baleares Health Services-IbSalut, Palma, Spain.,Instituto de Investigación Sanitaria de Palma, Palma, Spain
| | | | | | - Scott A Murray
- Primary Palliative Care Research Group, Centre for Population Health Sciences, The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
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Hall CC, Carduff E, Lugton J, Spiller J. PATIENT AND FAMILY EXPERIENCES OF DNACPR DISCUSSIONS: AN INTEGRATIVE REVIEW OF THE LITERATURE. BMJ Support Palliat Care 2015. [DOI: 10.1136/bmjspcare-2014-000838.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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19
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Lugton J, Finucane AM, Kennedy C, Spiller J. THE EXPERIENCES OF CAREGIVERS OF PATIENTS WITH DELIRIUM AND THEIR ROLE IN ITS MANAGEMENT IN A PALLIATIVE CARE SETTING. BMJ Support Palliat Care 2015. [DOI: 10.1136/bmjspcare-2014-000838.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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20
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Low C, Finucane A, Mason B, Spiller J. Palliative care staff's perceptions of do not attempt cardiopulmonary resuscitation discussions. Int J Palliat Nurs 2014; 20:327-33. [DOI: 10.12968/ijpn.2014.20.7.327] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Catherine Low
- fifth-year medical student, University of Edinburgh, Scotland
| | - Anne Finucane
- Research Lead, Marie Curie Hospice Edinburgh, Frogston Road West, Edinburgh, EH10 7DR, Scotland
| | - Bruce Mason
- Research Associate in Palliative Care, University of Edinburgh
| | - Juliet Spiller
- Consultant in Palliative Medicine, Marie Curie Hospice Edinburgh
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22
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Spiller J, Kiehlmann P, Davison H, Murphy D, Wilkie R. NHS Scotland DNACPR and CYPADM integrated policies – development of quality measures. BMJ Support Palliat Care 2012. [DOI: 10.1136/bmjspcare-2012-000196.33] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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23
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Murphy D, Wilkie R, Davison H, Spiller J. The NHS Scotland unified approach to paediatric resuscitation using the children and young peoples acute deterioration management (CYPADM) policy: development and implementation of quality measures. BMJ Support Palliat Care 2012. [DOI: 10.1136/bmjspcare-2012-000196.308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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24
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Whigham J, Spiller J, Finucane A, Adam J. Supporting healthcare professionals in three clinical settings to engage in advance care planning. BMJ Support Palliat Care 2012. [DOI: 10.1136/bmjspcare-2012-000196.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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25
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Murray C, Short S, Spiller J, Kiehlmann P. The development and introduction of a national integrated DNACPR policy in Scotland. Resuscitation 2010. [DOI: 10.1016/j.resuscitation.2010.09.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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26
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Leonard M, Spiller J, Keen J, MacLullich A, Kamholtz B, Meagher D. Symptoms of depression and delirium assessed serially in palliative-care inpatients. Psychosomatics 2010; 50:506-14. [PMID: 19855037 DOI: 10.1176/appi.psy.50.5.506] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Delirium occurs in approximately 1 in 5 general hospital admissions and up to 85% of patients with terminal illness, but can be difficult to differentiation from other disorders, such as depression. OBJECTIVE The authors assessed and compared mood states as they relate to onset of delirium. METHOD Symptoms of depression and delirium were assessed in 100 consecutive palliative-care admissions immediately after admission and 1 week later. RESULTS Overall, 51% experienced either major depression or delirium. Most patients with syndromal delirium also met criteria for major depressive illness, and 50% of those with depression had delirium or subsyndromal delirium (SSD). Delirium symptoms were less common in patients with major depression than depressive symptoms in patients with delirium or SSD. DISCUSSION Delirium should be considered in patients with altered mood states, and screening for depression should initially rule out delirium. Sustained alterations in mood may be more frequent in delirium than previously recognized.
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Affiliation(s)
- Maeve Leonard
- Department of Adult Psychiatry, Midwestern Regional Hospital, Limerick, Ireland
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27
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Leonard M, Spiller J, Keen J, MacLullich A, Kamholtz B, Meagher D. Symptoms of Depression and Delirium Assessed Serially in Palliative-Care Inpatients. Psychosomatics 2009. [DOI: 10.1016/s0033-3182(09)70844-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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28
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Homayounfar K, Spiller J, von Stillfried F, Raible M. [Mobile and digital documentation of inpatient treatments : use of personal digital assistants in addition with the ClinicCoach(c) software]. Unfallchirurg 2009; 110:1076-81. [PMID: 18034223 DOI: 10.1007/s00113-007-1343-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Documentation of the individual treatment course is essential from medical as well as economic and forensic aspects. With increasing hospital computerization the conventional hardcopy form of record keeping is seen to be associated with high outlays and restrictiveness. METHODS Clinicians engaged consistently in the development of a personal digital assistant (PDA)-based electronic record system (Clinic Coach(c)), which maps the entire course of inpatient treatments. The system's effectiveness was reviewed by means of a standardized questionnaire and analysis of 8,595 data sets relating to PPR and wound findings. RESULTS In patients undergoing surgery wound findings and PPR were documented in 83.6% and in 94.3% respectively. The ClinicCoach(c) System was rated more effective than paper-based documentation by 78.4% of the testing healthcare workers. CONCLUSION The combination of PDAs and ClinicCoach(c) is a reliable and to clinical routine well adapted system that allows digital documentation at the bedside.
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Affiliation(s)
- K Homayounfar
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Klinikum Kassel GmbH, Kassel, Deutschland
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Abstract
This case history gives the unusual presentation of piriformis syndrome as the immediate cause of symptoms for a patient with spinal stenosis and non Hodgkin's lymphoma in a palliative care setting. It also details the relief and subsequent resolution of symptoms with acupuncture where strong opioids and neuropathic agents such as gabapentin and ketamine were providing only minimal relief.
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30
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Spiller J. Book Review: The Journey to Pain Relief. Acupunct Med 2004. [DOI: 10.1136/aim.22.3.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
Depression is a significant symptom for many palliative care patients, but is difficult to diagnose and therefore treat. In an effort to improve detection, there has been increasing interest in the use of screening tools. Many tools, however, have been developed for physically well patients and it is important that tools are validated for the populations in which they are used. The present study was carried out on behalf of the Association of Palliative Medicine, Science Committee, to assess the available evidence for using screening tools in palliative care. The single question 'Are you depressed?' was the tool with the highest sensitivity and specificity and positive predictive value. Where the Hospital Anxiety and Depression Scale and the Edinburgh Depression Scale are used, the validated cut-off thresholds for palliative care patients should be employed. Patients who report thoughts of self-harm or suicide need prompt assessment and evaluation.
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Affiliation(s)
- Mari Lloyd-Williams
- Community Studies Unit, University of Liverpool Medical School, Liverpool, UK.
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Abstract
Chest pain accounts for much of the rising numbers of emergency admissions, but in-patient assessment is not necessarily the best way of dealing with these patients. We ran a 'rapid-assessment chest pain clinic' to provide an alternative route of assessment, and audited its outcome. General practitioners referred patients with recent-onset chest pain, increasing chest pain, chest pain at rest, or other chest pain of concern, on the understanding that they would be seen within 24 h. During 8 1/2 months, 334 patients were referred and 317 patients were seen, most of whom had exercise electrocardiography. A median of 6 months later, 278 patients were personally contacted to determine outcome. Of these, 18% had been admitted immediately with acute coronary syndromes, and 49% had been diagnosed as non-coronary chest pain (none of whom subsequently infarcted or died). Continuing symptoms were infrequent, and satisfaction was high, although 13% of patients had been revascularized. A significant number of patients required immediate admission and/or ultimate revascularization, but many more did not. The majority of these patients had non-coronary chest pain, and this diagnosis was substantiated by their excellent outcome and (in some cases) by further investigation.
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Affiliation(s)
- A P Davie
- MRC Clinical Research Initiative in Heart Failure, University of Glasgow, UK
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Spiller J. For whose sake--patient or nurse? Ritual practices in patient washing. Prof Nurse 1992; 7:431-4. [PMID: 1574502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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