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Doherty M, Chukwusa E, McQuillan R, Cranfield F, Gao W. The Palliative Care Needs of Patients with Multiple Sclerosis, Parkinson's Related Diseases, and Motor Neurone Disease: A Secondary Analysis of the OPTCARE Neuro Trial Data. J Palliat Med 2024. [PMID: 38597932 DOI: 10.1089/jpm.2023.0437] [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: 04/11/2024] Open
Abstract
Background: Long-term neurological conditions include multiple sclerosis, Parkinson's-related diseases, and motor neurone disease. National and international guidelines recommend a palliative approach for advancing neurological disease, but there is little research describing and comparing the palliative care needs of these patients side by side. Objective: The aim of this study was to describe and compare the symptom burden and psychological distress of patients with multiple sclerosis, Parkinson's-related diseases, and motor neurone disease. Design: A cross-sectional secondary analysis of the OPTCARE Neuro trial data was performed. Setting/Subjects: Recruitment was from seven sites across the United Kingdom. Patients aged 18 years or older, severely affected by advanced stages of multiple sclerosis or Parkinson's-related diseases or any stage of motor neurone disease, with an unresolved symptom, and one other issue despite usual care were eligible. Measurements: Baseline demographics, Integrated Palliative care Outcome Scale (IPOS) Neuro, and Hospital Anxiety and Depression Scale (HADS) results were analyzed. Results: Data from 348 participants were analyzed. The mean IPOS Neuro-S24 score was 27, with no statistical difference found between groups (p = 0.341). The most common symptoms were poor mobility (68.5%), problems using legs (63%), and fatigue (34.8%). The HADS revealed that a quarter of participants met the criteria for a diagnosis of anxiety and depression. Conclusions: Multiple sclerosis, Parkinson's-related disease, and motor neurone disease patients who were eligible for the OPTCARE Neuro trial have unmet needs in the form of distressing physical and psychological symptoms. It is unclear how to address these needs. The answer likely lies in a collaborative approach between neurology, palliative care, psychology, and specialized allied health professionals. Future work should focus on investigating this.
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Affiliation(s)
| | - Emeka Chukwusa
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, United Kingdom
| | | | | | - Wei Gao
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, United Kingdom
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2
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Doherty M, Featherstone HJ, McAleer C, Webb C, O'Reilly M, Twomey M, McQuillan R. Opioid toxicity after oxycodone/naloxone to oxycodone conversion: case series. BMJ Support Palliat Care 2024:spcare-2024-004796. [PMID: 38408794 DOI: 10.1136/spcare-2024-004796] [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] [Received: 01/19/2024] [Accepted: 02/06/2024] [Indexed: 02/28/2024]
Abstract
Combination preparations of oxycodone/naloxone are marketed to aid in the management of opioid induced bowel dysfunction, with caution advised in prescribing in cases of liver dysfunction.This case series demonstrates four cases of patients with normal liver function tests who developed significant opioid toxicity on conversion from combination oxycodone/naloxone to oxycodone at equivalent doses, necessitating significant dose reduction.In each case, a cause for intra-hepatic shunting such as cirrhosis, porto-systemic collaterals or thrombosis were identified, highlighting these as cautionary features when prescribing combination preparations of oxycodone/naloxone and the possible need for dose reduction if converting to oxycodone.
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Affiliation(s)
- Mairead Doherty
- St. Francis Hospice, Raheny, Dublin, Ireland
- Palliative Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Clare McAleer
- St. Francis Hospice, Raheny, Dublin, Ireland
- Palliative Medicine, Beaumont Hospital, Dublin, Ireland
| | - Chloe Webb
- St. Francis Hospice, Raheny, Dublin, Ireland
| | - Maeve O'Reilly
- Specialist Palliative Medicine Service, St Luke's Radiation Oncology Network, Dublin 6, Ireland
| | - Marie Twomey
- Specialist Palliative Medicine Service, St Luke's Radiation Oncology Network, Dublin 6, Ireland
| | - Regina McQuillan
- Palliative Medicine, Beaumont Hospital, Dublin, Ireland
- Palliative Medicine, St Francis Hospice, Dublin 5, Ireland
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3
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Smith S, Brick A, Johnston B, Ryan K, McQuillan R, O'Hara S, May P, Droog E, Daveson B, Morrison RS, Higginson IJ, Normand C. Place of Death for Adults Receiving Specialist Palliative Care in Their Last 3 Months of Life: Factors Associated With Preferred Place, Actual Place, and Place of Death Congruence. J Palliat Care 2024:8258597241231042. [PMID: 38404130 DOI: 10.1177/08258597241231042] [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: 02/27/2024]
Abstract
Objectives: Congruence between the preferred and actual place of death is recognised as an important quality indicator in end-of-life care. However, there may be complexities about preferences that are ignored in summary congruence measures. This article examined factors associated with preferred place of death, actual place of death, and congruence for a sample of patients who had received specialist palliative care in the last three months of life in Ireland. Methods: This article analysed merged data from two previously published mortality follow-back surveys: Economic Evaluation of Palliative Care in Ireland (EEPCI); Irish component of International Access, Rights and Empowerment (IARE I). Logistic regression models examined factors associated with (a) preferences for home death versus institutional setting, (b) home death versus hospital death, and (c) congruent versus non-congruent death. Setting: Four regions with differing levels of specialist palliative care development in Ireland. Participants: Mean age 77, 50% female/male, 19% living alone, 64% main diagnosis cancer. Data collected 2011-2015, regression model sample sizes: n = 342-351. Results: Congruence between preferred and actual place of death in the raw merged dataset was 51%. Patients living alone were significantly less likely to prefer home versus institution death (OR 0.389, 95%CI 0.157-0.961), less likely to die at home (OR 0.383, 95%CI 0.274-0.536), but had no significant association with congruence. Conclusions: The findings highlight the value in examining place of death preferences as well as congruence, because preferences may be influenced by what is feasible rather than what patients would like. The analyses also underline the importance of well-resourced community-based supports, including homecare, facilitating hospital discharge, and management of complex (eg, non-cancer) conditions, to facilitate patients to die in their preferred place.
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Affiliation(s)
- Samantha Smith
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Aoife Brick
- Social Research Division, Economic and Social Research Institute, Dublin, Ireland
- Department of Economics, Trinity College Dublin, Dublin, Ireland
| | - Bridget Johnston
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Karen Ryan
- School of Medicine, University College Dublin, Dublin, Ireland
- St Francis Hospice, Dublin, Ireland
| | - Regina McQuillan
- St Francis Hospice, Dublin, Ireland
- Department of Palliative Care, Beaumont Hospital, Dublin, Ireland
| | - Sinead O'Hara
- Healthcare Pricing Office, Health Service Executive, Dublin, Ireland
| | - Peter May
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - Elsa Droog
- National Office of Quality & Patient Safety, Health Service Executive, Cork, Ireland
| | - Barbara Daveson
- Palliative Care Outcomes Collaboration, University of Wollongong, Wollongong, New South Wales, Australia
| | - R Sean Morrison
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine, New York, USA and James J Peters VA Medical Center, Bronx, USA
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - Charles Normand
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
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4
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McCauley R, Ryan K, McQuillan R, Foley G. Mutual support between patients and family caregivers in palliative care: A qualitative study. Palliat Med 2023; 37:1520-1528. [PMID: 37830745 PMCID: PMC10657498 DOI: 10.1177/02692163231205130] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
BACKGROUND Patients in receipt of palliative care services are often viewed primarily as recipients of support from their family caregiver. There is a dearth of evidence in palliative care on what comprises mutual support between patients and their family caregivers in palliative care. AIM To identify processes of mutual support between patients and family caregivers in palliative care. DESIGN Qualitative study comprising semi-structured interviews. Data were analysed using grounded theory procedures. SETTING/PARTICIPANTS Fifteen patients with advanced illness (cancer n = 14, neurodegenerative n = 1) and 21 family caregivers recruited from a large regional-based hospice. RESULTS Mutual support between patients and family caregivers comprised two primary modes in which support was provided and received. Mutual support involved both patients and family caregivers providing similar types of support to each other, and which typically manifested as emotional support. However, mutual support also occurred when patients reciprocated by providing emotional support to their family caregivers to compensate for other forms of support which they felt no longer able to provide. Patients supported family caregivers by involving them in decision-making for care and both patient and family caregiver preferences were influenced by obligation to their respective other. Mutual support comprised both disclosure and concealment. Involving family caregivers in patient care decision-making was intended by patients to help family caregivers adjust to a caregiving role. CONCLUSIONS The findings inform the development and delivery of psychosocial interventions for patients and family caregivers in palliative care aimed at facilitating supportive relations between them.
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Affiliation(s)
- Rachel McCauley
- Discipline of Occupational Therapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Karen Ryan
- St. Francis Hospice Dublin, Dublin, Ireland
- Mater Misericordiae University Hospital, Dublin, Ireland
- University College Dublin, Dublin, Ireland
| | - Regina McQuillan
- St. Francis Hospice Dublin, Dublin, Ireland
- Beaumont Hospital, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Geraldine Foley
- Discipline of Occupational Therapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
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5
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McCauley R, Ryan K, McQuillan R, Selman LE, Foley G. Supportive relationships between patients and family caregivers in specialist palliative care: a qualitative study of barriers and facilitators. BMJ Support Palliat Care 2023:spcare-2023-004371. [PMID: 38050065 DOI: 10.1136/spcare-2023-004371] [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] [Received: 05/05/2023] [Accepted: 11/18/2023] [Indexed: 12/06/2023]
Abstract
OBJECTIVES Patients with advanced illness and their family caregivers can be mutually supportive. However, what facilitates and/or restricts supportive relationships between patients and family caregivers in palliative care remains unclear. We aimed to identify key barriers to and facilitators of supportive relationships between people with advanced illness and family caregivers in specialist palliative care. METHODS A qualitative study using grounded theory methodology was conducted. Semistructured interviews were undertaken with 15 patients with advanced illness and 21 family caregivers purposively and theoretically sampled from a large regional specialist palliative care service. Verbatim transcripts were analysed in line with grounded theory coding procedures. RESULTS Mutual support was underpinned by mutual concern and understanding. Facilitators of supportive relationships included patients and family caregivers already having a close relationship, caregivers assuming caregiving duties by choice, caregivers feeling competent in a caregiving role, patients valuing caregiver efforts, availability of respite for the caregiver and direct support from healthcare professionals to help both patients and caregivers adjust to advanced illness. Barriers to supportive relationships included absence of support from the wider family, prior mutual conflict between the patient and caregiver, caregivers feeling constrained in their caregiving role and patient and caregiver distress induced by mutual loss. CONCLUSIONS Multiple factors at both a micro (eg, relationship based) and mesolevel (eg, assistance from services) impact patient and family caregiver ability to support one another in specialist palliative care. Supportive relationships between patients and family caregivers are mediated by feelings pertaining to both control and loss.
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Affiliation(s)
- Rachel McCauley
- Discipline of Occupational Therapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Karen Ryan
- St Francis Hospice Dublin, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Regina McQuillan
- St Francis Hospice Dublin, Dublin, Ireland
- Department of Palliative Care, Beaumont Hospital, Dublin, Ireland
| | - Lucy E Selman
- Palliative and End of Life Care Research Group, Population Health Sciences, Bristol Medical School, Bristol, UK
| | - Geraldine Foley
- Discipline of Occupational Therapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
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6
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McCauley R, Ryan K, McQuillan R, Foley G. Patient and Caregiver Reciprocal Support: Impact on Decision Making in Specialist Palliative Care. J Pain Symptom Manage 2023; 66:570-577. [PMID: 37544551 DOI: 10.1016/j.jpainsymman.2023.08.002] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/28/2023] [Accepted: 08/01/2023] [Indexed: 08/08/2023]
Abstract
CONTEXT Patients and informal caregivers in palliative care can reciprocate in supporting one another. However, how reciprocal support among patients and informal caregivers in palliative care impacts on their decision making for care is not well understood. OBJECTIVES To identify how reciprocal support among patients with advanced illness and their informal caregivers in specialist palliative care impacts on their decision making for care. METHODS Between July 2021 and May 2022, 30 qualitative interviews were conducted with 14 patient and caregiver dyads, seven nondyad caregiver participants and one nondyad patient participant (total n = 36), recruited from a large regional specialist palliative care service. Data were analyzed using Corbin and Strauss grounded theory method. RESULTS Reciprocal support among patients and informal caregivers was underpinned by obligation and choice. Caregivers who felt obliged to care had difficulty communicating with the patient about the patient's preferences for care and their own wishes for patient care. Patients who felt obliged to accept support from their caregiver tended to minimize caregiver participation in decision making which made caregivers feel disempowered in discussions about patient care. Caregivers tended to be more involved in decision making when caregivers assumed caregiving duties by choice and when the patient did not feel restricted by their reliance on their caregiver. Open communication between patients and caregivers made patients more trusting of their caregiver. CONCLUSION Patient and caregiver dyadic interventions in specialist palliative care involving decision making need to account for how obligation and choice manifest and function between the patient and caregiver.
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Affiliation(s)
- Rachel McCauley
- Discipline of Occupational Therapy, School of Medicine (R.McC, G.F.), Trinity College Dublin, Dublin, Ireland
| | - Karen Ryan
- St. Francis Hospice (K.R., R.McQ), Dublin, Ireland; Mater Misericordiae University Hospital (K.R.), Dublin, Ireland; University College Dublin (K.R.), Dublin, Ireland
| | - Regina McQuillan
- St. Francis Hospice (K.R., R.McQ), Dublin, Ireland; Beaumont Hospital (R.McQ), Dublin, Ireland; Royal College of Surgeons of Ireland (R.McQ), Dublin, Ireland
| | - Geraldine Foley
- Discipline of Occupational Therapy, School of Medicine (R.McC, G.F.), Trinity College Dublin, Dublin, Ireland.
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7
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McGarry A, Ni Nualláin A, Byrne T, O'Brien J, Rice C, Breathnach O, Grogan W, McAleer C, McQuillan R, McNally, Cowie E. 1277P The role of palliative care in patients with glioblastoma multiforme: A single centre review. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1410] [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: 11/01/2022] Open
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8
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Johnston BM, Daveson B, Normand C, Ryan K, Smith M, McQuillan R, Higginson I, Selman L, Tobin K. Preferences of Older People With a Life-Limiting Illness: A Discrete Choice Experiment. J Pain Symptom Manage 2022; 64:137-145. [PMID: 35490993 DOI: 10.1016/j.jpainsymman.2022.04.180] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 04/08/2022] [Accepted: 04/18/2022] [Indexed: 11/25/2022]
Abstract
CONTEXT There is limited evidence about which elements and characteristics of palliative care service provision improve the experiences of older people living with life-limiting illness. OBJECTIVES To evaluate older patients' (≥65 years) preferences for elements of services and supports and to explore relationships between patient characteristics and the patterns of preferences. METHODS A cross-sectional survey undertaken in Ireland and England using a Discrete Choice Experiment with people accessing specialist palliative care services. A random-effects probit model was used to estimate patient preferences. RESULTS Of the 77 patients were interviewed, 51 participated in the Discrete Choice Experiment component of the interview (response rate = 66%). Participants prioritized support that minimized unpaid caregiver burden (P < 0.001). They also preferred ease of access to services including out-of-hours access (P < 0.001) and free care at home (P < 0.001). Quality of life was prioritized over quantity of life (<0.001). CONCLUSION People living with a life-limiting illness value care that focuses on quality of life, ensures barrier-free access to services and provides sufficient support for relatives. In the context of limited resources and growing demand for care, this study provides evidence about the service elements palliative care delivery models should prioritize and evaluate.
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Affiliation(s)
- Bridget M Johnston
- Centre of Health Policy and Management (B.M.J., C.N., M.S.), School of Medicine, Trinity College Dublin, Ireland.
| | - Barbara Daveson
- Cicely Saunders Institute (B.D., C.N., I.H., L.S.), Faculty Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London UK
| | - Charles Normand
- Centre of Health Policy and Management (B.M.J., C.N., M.S.), School of Medicine, Trinity College Dublin, Ireland; Cicely Saunders Institute (B.D., C.N., I.H., L.S.), Faculty Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London UK
| | - Karen Ryan
- Mater Misericordiae University Hospital (K.R.), Dublin, Ireland
| | - Melinda Smith
- Centre of Health Policy and Management (B.M.J., C.N., M.S.), School of Medicine, Trinity College Dublin, Ireland
| | | | - Irene Higginson
- Cicely Saunders Institute (B.D., C.N., I.H., L.S.), Faculty Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London UK; King's College Hospital NHS Foundation Trust (I.H.), London, UK
| | - Lucy Selman
- Cicely Saunders Institute (B.D., C.N., I.H., L.S.), Faculty Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London UK; Population Health Sciences, Bristol Medical School (L.S.), University of Bristol, Bristol UK
| | - Katy Tobin
- Global Brain Health Institute (K.T.), School of Medicine, Trinity College Dublin, Dublin, Ireland
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Dowling MJ, Molloy U, Payne C, McLean S, McQuillan R, Noonan C, Ryan DJ. Hospital transfer rates and advance care planning following a nursing home-targeted video-conference education series (Project ECHO): a prospective cohort study. Eur Geriatr Med 2022; 13:941-949. [PMID: 35438449 PMCID: PMC9016377 DOI: 10.1007/s41999-022-00624-6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 02/08/2022] [Indexed: 11/17/2022]
Abstract
Purpose Nursing home staff manage increasingly complex patients yet struggle to access education. This study measured the impact of a novel education programme on emergency transfers from nursing homes. Methods In this prospective experimental cohort study, ten interactive sessions were provided to 20 nursing homes, using teleconferencing technology through the “Project ECHO” (Extension for Community Healthcare Outcomes) model. Details of all emergency hospital transfers were submitted by participating nursing homes 6 months before and 6 months from commencement of ECHO. Results Of 20 nursing homes, 13 submitted sufficient data for inclusion. In these 13, there were 260 emergency transfers over a year. There was no significant difference in the number of transfers before and after ECHO (137/260 pre-ECHO vs 123/260 post-ECHO, p = 0.62). Post-ECHO, it was 50% more likely that transfer wishes were discussed in advance of transfer (62 of 137 (45%) transferred pre-ECHO vs 82 of 123 (67%) post-ECHO, p < 0.001). There was a significant increase in compliance with resident wishes post-ECHO in that transferred residents were less likely to have a documented “Not for Transfer” wish (29/137 pre-ECHO (21%) vs 10/123 post-ECHO (8%), p < 0.001). Point prevalence surveys of residents demonstrated significant increases in “Do Not Resuscitate” orders; 286/589 (49%) residents pre-ECHO vs 386/594 (65%) post-ECHO, p < 0.001. Post-ECHO, pain was less frequently the primary cause for transfer (11/137 (8%) pre-ECHO vs 1/123 (0.8%) post-ECHO, p = 0.006). Conclusion ECHO did not affect rates of emergency hospital transfers but did increase advance care planning discussions ahead of hospital transfer by 50% and compliance with the results of those discussions. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-022-00624-6. Aim What effect does a novel education programme have on emergency hospital transfers of, and advance care planning decisions among, nursing home residents? Findings This education programme did not affect overall rates of emergency hospital transfer. It did increase advance care planning discussions, increase compliance with the results of these discussions and increase “DNR” orders among nursing home residents. Message Novel tele-education programmes have the potential to improve advance care planning discussions in nursing homes. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-022-00624-6.
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Affiliation(s)
- Michael J Dowling
- Age-Related Healthcare Department, Tallaght University Hospital, Dublin 24, Ireland.
| | | | - Cathy Payne
- All-Ireland Institute of Hospice and Palliative Care, Dublin, Ireland
| | | | | | - Claire Noonan
- Age-Related Healthcare Department, Tallaght University Hospital, Dublin 24, Ireland
| | - Dan J Ryan
- Age-Related Healthcare Department, Tallaght University Hospital, Dublin 24, Ireland.,Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
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10
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Abstract
BACKGROUND Patients in palliative care are usually conceptualised as recipients of support from family caregivers. Family caregivers in palliative care are typically defined as providers of support to patients. Little is known about reciprocal dimensions of support provision between patients and family caregivers in palliative care. AIM To identify processes of mutual support between patients and family caregivers in palliative care and factors that contribute to or obstruct mutual support between patients and family caregivers in palliative care. DESIGN Systematic review and narrative synthesis of original peer-reviewed research published between January 2000 and March 2020. DATA SOURCES Medline, CINAHL, Embase, AMED, PsycINFO and PsycARTICLES. RESULTS After full-text screening, 10 studies were included. We identified that patients and family caregivers in palliative care can support one another by mutually acknowledging the challenges they face, by remaining positive for one another and by jointly adapting to their changing roles. However, patients and family caregivers may not routinely communicate their distress to each other or reciprocate in distress disclosure. A lack of mutual disclosure pertaining to distress can result in conflict between patients and family caregivers. CONCLUSIONS Few studies have focused in whole or in part, on reciprocal dimensions of support provision between patients with advancing non-curable conditions, and their family caregivers in palliative care. Further research is required to identify key domains of mutual support between patients and family caregivers in palliative care.
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Affiliation(s)
- Rachel McCauley
- Discipline of Occupational Therapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Regina McQuillan
- St. Francis Hospice Dublin, Dublin, Ireland.,Royal College of Surgeons of Ireland, Dublin, Ireland.,Beaumont Hospital Dublin, Dublin, Ireland
| | - Karen Ryan
- University College Dublin, Dublin, Ireland.,Mater Hospital Dublin, Dublin, Ireland
| | - Geraldine Foley
- Discipline of Occupational Therapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
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11
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Johnston BM, McCauley R, Rabbitte M, McQuillan R, Honohan C, Mockler D, Thomas S, May P. Evidence on the effectiveness and cost-effectiveness of out-of-hours palliative care. Palliat Med 2021; 35:367-368. [PMID: 33225824 DOI: 10.1177/0269216320969555] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | - Mary Rabbitte
- All Ireland Institute of Hospice and Palliative Care, Dublin, Ireland
| | - Regina McQuillan
- Saint Francis Hospice Centre for Continuing Studies, Dublin, Ireland
| | | | | | | | - Peter May
- Trinity College Dublin, Dublin, Ireland
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12
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Higginson IJ, Yi D, Johnston BM, Ryan K, McQuillan R, Selman L, Pantilat SZ, Daveson BA, Morrison RS, Normand C. Associations between informal care costs, care quality, carer rewards, burden and subsequent grief: the international, access, rights and empowerment mortality follow-back study of the last 3 months of life (IARE I study). BMC Med 2020; 18:344. [PMID: 33138826 PMCID: PMC7606031 DOI: 10.1186/s12916-020-01768-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 08/26/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND At the end of life, formal care costs are high. Informal care (IC) costs, and their effects on outcomes, are not known. This study aimed to determine the IC costs for older adults in the last 3 months of life, and their relationships with outcomes, adjusting for care quality. METHODS Mortality follow-back postal survey. SETTING Palliative care services in England (London), Ireland (Dublin) and the USA (New York, San Francisco). PARTICIPANTS Informal carers (ICrs) of decedents who had received palliative care. DATA ICrs reported hours and activities, care quality, positive aspects and burdens of caregiving, and completed the Texas Revised Inventory of Grief (TRIG). ANALYSIS All costs (formal, informal) were calculated by multiplying reported hours of activities by country-specific costs for that activity. IC costs used country-specific shadow prices, e.g. average hourly wages and unit costs for nursing care. Multivariable logistic regression analysis explored the association of potential explanatory variables, including IC costs and care quality, on three outcomes: positive aspects and burdens of caregiving, and subsequent grief. RESULTS We received 767 completed surveys, 245 from London, 282 Dublin, 131 New York and 109 San Francisco. Most respondents were women (70%); average age was 60 years. On average, patients received 66-76 h per week from ICrs for 'being on call', 52-55 h for ICrs being with them, 19-21 h for personal care, 17-21 h for household tasks, 15-18 h for medical procedures and 7-10 h for appointments. Mean (SD) IC costs were as follows: USA $32,468 (28,578), England $36,170 (31,104) and Ireland $43,760 (36,930). IC costs accounted for 58% of total (formal plus informal) costs. Higher IC costs were associated with less grief and more positive perspectives of caregiving. Poor home care was associated with greater caregiver burden. CONCLUSIONS Costs to informal carers are larger than those to formal care services for people in the last three months of life. If well supported ICrs can play a role in providing care, and this can be done without detriment to them, providing that they are helped. Improving community palliative care and informal carer support should be a focus for future investment.
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Affiliation(s)
- Irene J Higginson
- Department of Palliative Care, Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, Bessemer Road, London, SE5 9PJ, UK. .,King's College Hospital Foundation Trust, Bessemer Road, London, SE5 9PJ, UK.
| | - Deokhee Yi
- Department of Palliative Care, Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, Bessemer Road, London, SE5 9PJ, UK.
| | - Bridget M Johnston
- The Centre of Health Policy and Management, Trinity College Dublin, Room 0.21, 3-4 Foster Place, College Green, Dublin 2, Ireland
| | - Karen Ryan
- Mater Misericordiae Hospital, Eccles Street, Dublin 7, Ireland
| | | | - Lucy Selman
- Department of Palliative Care, Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, Bessemer Road, London, SE5 9PJ, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Stephen Z Pantilat
- Palliative Care Program, Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Barbara A Daveson
- Department of Palliative Care, Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, Bessemer Road, London, SE5 9PJ, UK
| | - R Sean Morrison
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Charles Normand
- Department of Palliative Care, Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, Bessemer Road, London, SE5 9PJ, UK.,The Centre of Health Policy and Management, Trinity College Dublin, Room 0.21, 3-4 Foster Place, College Green, Dublin 2, Ireland
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13
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Guerin S, Kiernan G, Courtney E, McQuillan R, Ryan K. Integration of palliative care in services for children with life-limiting neurodevelopmental disabilities and their families: a Delphi study. BMC Health Serv Res 2020; 20:927. [PMID: 33032605 PMCID: PMC7545942 DOI: 10.1186/s12913-020-05754-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 08/19/2019] [Accepted: 09/22/2020] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this study was to explore expert professionals’ opinions on service provision to children under six with life-limiting neurodevelopmental disabilities (LLNDD), including the goals of care and the integration and coordination of palliative care in general and specialist services. Methods A Delphi design was used with three questionnaire rounds, one open-ended and two closed response rounds. Primary data collected over a six-month period from expert professionals with five years’ (or more) experience in pediatric, intellectual disability and/or palliative care settings. Ratings of agreement and prioritization were provided with agreement expressed as a median (threshold = 80%) and consensus reported as interquartile ranges. Stability was measured using non-parametric tests. Results Primary goals of care were achievement of best possible quality of life, effective communication and symptom management. Service integration and coordination were considered inadequate, and respondents agreed that areas of deficiency included palliative care. Improvement strategies included a single care plan, improved communication and key worker appointments. Conclusions The findings suggest that services do not serve this group well with deficiencies in care compounded by a lack of information on available services and sub-optimal communication between settings. Further research is needed to develop an expert-based consensus regarding the care of children with LLNDD.
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Affiliation(s)
- Suzanne Guerin
- School of Psychology, University College Dublin, Dublin, Ireland.
| | - Gemma Kiernan
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Eileen Courtney
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
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14
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Yi D, Johnston BM, Ryan K, Daveson BA, Meier DE, Smith M, McQuillan R, Selman L, Pantilat SZ, Normand C, Morrison RS, Higginson IJ. Drivers of care costs and quality in the last 3 months of life among older people receiving palliative care: A multinational mortality follow-back survey across England, Ireland and the United States. Palliat Med 2020; 34:513-523. [PMID: 32009542 DOI: 10.1177/0269216319896745] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Care costs rise towards the end of life. International comparison of service use, costs and care experiences can inform quality and improve access. AIM The aim of this study was to compare health and social care costs, quality and their drivers in the last 3 months of life for older adults across countries. Null hypothesis: no difference between countries. DESIGN Mortality follow-back survey. Costs were calculated from carers' reported service use and unit costs. SETTING Palliative care services in England (London), Ireland (Dublin) and the United States (New York, San Francisco). PARTICIPANTS Informal carers of decedents who had received palliative care participated in the study. RESULTS A total of 767 questionnaires were returned: 245 in England, 282 in Ireland and 240 in the United States. Mean care costs per person with cancer/non-cancer were US$37,250/US$37,376 (the United States), US$29,065/US$29,411 (Ireland), US$15,347/US$16,631 (England) and differed significantly (F = 25.79/14.27, p < 0.000). Cost distributions differed and were most homogeneous in England. In all countries, hospital care accounted for > 80% of total care costs; community care 6%-16%, palliative care 1%-15%; 10% of decedents used ~30% of total care costs. Being a high-cost user was associated with older age (>80 years), facing financial difficulties and poor experiences of home care, but not with having cancer or multimorbidity. Palliative care services consistently had the highest satisfaction. CONCLUSION Poverty and poor home care drove high costs, suggesting that improving community palliative care may improve care value, especially as palliative care expenditure was low. Major diagnostic variables were not cost drivers. Care costs in the United States were high and highly variable, suggesting that high-cost low-value care may be prevalent.
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Affiliation(s)
- Deokhee Yi
- Cicely Saunders Institute, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Bridget M Johnston
- The Centre for Health Policy and Management, Trinity College Dublin, Dublin, Ireland
| | - Karen Ryan
- Mater Misericordiae Hospital, Eccles Street, Dublin, Ireland
| | - Barbara A Daveson
- Cicely Saunders Institute, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Diane E Meier
- Department of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Melinda Smith
- Cicely Saunders Institute, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | | | - Lucy Selman
- Cicely Saunders Institute, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Steven Z Pantilat
- Palliative Care Program, Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Charles Normand
- Cicely Saunders Institute, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK.,The Centre for Health Policy and Management, Trinity College Dublin, Dublin, Ireland
| | - R Sean Morrison
- Department of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Irene J Higginson
- Cicely Saunders Institute, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK.,King's College Hospital NHS Foundation Trust, Bessemer Road, London, UK
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15
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Johnston BM, McCauley R, McQuillan R, Rabbitte M, Honohan C, Mockler D, Thomas S, May P. Effectiveness and cost-effectiveness of out-of-hours palliative care: a systematic review. HRB Open Res 2020; 3:9. [PMID: 33585789 PMCID: PMC7845148 DOI: 10.12688/hrbopenres.13006.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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] [Accepted: 03/04/2020] [Indexed: 12/25/2022] Open
Abstract
Background: Out-of-hours palliative care is a priority for patients, caregivers and policymakers. Approximately three quarters of the week occurs outside of typical working hours, and the need for support in care of serious and terminal illness during these times is commonplace. Evidence on relevant interventions is unclear. Aim: To review systematically the evidence on the effect of out-of-hours specialist or generalist palliative care for adults on patient and caregiver outcomes, and costs and cost-effectiveness. Methods: A systematic review of peer-reviewed and grey literature was conducted. We searched Embase, MEDLINE [Ovid], Cochrane Library, CINAHL, Allied and Complementary Medicine [Ovid], PsycINFO, Web of Science, Scopus, EconLit (Ovid), and grey literature published between 1 January 2000 and 12 th November 2019. Studies that comparatively evaluated the effect of out-of-hours specialist or generalist palliative care for adults on patient and caregiver outcomes, and on costs and cost-effectiveness were eligible, irrespective of design. Only English-language studies were eligible. Two reviewers independently examined the returned studies at each stage (title and abstract review, full-text review, and quality assessment). Results: We identified one eligible peer-reviewed study, judged as insufficient quality. Other sources returned no eligible material. The systematic review therefore included no studies. Conclusions: The importance of integrated, 24-hour care for people in line with a palliative care approach is not reflected in the literature, which lacks evidence on the effects of interventions provided outside typical working hours. Registration: PROSPERO CRD42018111041.
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Affiliation(s)
- Bridget M. Johnston
- Centre for Health Policy and Management, Trinity College Dublin, University of Dublin, Dublin, D2, Ireland
| | - Rachel McCauley
- Centre for Health Policy and Management, Trinity College Dublin, University of Dublin, Dublin, D2, Ireland
| | - Regina McQuillan
- Palliative Medicine, St Francis Hospice, Dublin, D05 T9K8, Ireland
- Palliative Medicine, Beaumont Hospital, Dublin, D09 V2N0, Ireland
| | - Mary Rabbitte
- All-Ireland Institute of Hospice and Palliative Medicine, Dublin, D6W, Ireland
| | - Caitriona Honohan
- The Library of Trinity College Dublin, Trinity College Dublin, University of Dublin, Dublin, D2, Ireland
| | - David Mockler
- The Library of Trinity College Dublin, Trinity College Dublin, University of Dublin, Dublin, D2, Ireland
| | - Steve Thomas
- Centre for Health Policy and Management, Trinity College Dublin, University of Dublin, Dublin, D2, Ireland
| | - Peter May
- Centre for Health Policy and Management, Trinity College Dublin, University of Dublin, Dublin, D2, Ireland
- The Irish Longitudinal study on Ageing (TILDA), Trinity College Dublin, University of Dublin, Dublin, D2, Ireland
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16
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Dowling MJ, Molloy U, Payne C, McLean S, McQuillan R, Noonan C, Ryan DJ. 318 Does a Teleconference-Delivered Educational Programme (ECHO) Provided to Nursing Homes Reduce Emergency Hospital Transfers? Age Ageing 2019. [DOI: 10.1093/ageing/afz102.67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Nursing home staff manage increasingly complex patients yet struggle to access education programmes due to geographical logistical barriers. The aim of this study is to measure the impact on emergency hospital transfers a novel teleconference-delivered palliative care education programme (ECHO) has on patient transfers from nursing homes to emergency departments.
Methods
Ten interactive sessions were provided to staff from 20 nursing homes, using teleconferencing technology through the “Project ECHO” model. “Transfer forms” were completed by participating staff 6 months before echo, and 6 months from commencement of echo outlining details of emergency hospital transfers. Participating sites must attend 4 or more of 10 sessions for study inclusion.
Results
Of 20 nursing homes, 15 attended sufficient sessions, and they submitted data regarding 260 emergency transfers over a 12-month period. There was no significant difference in the number of transfers pre vs post ECHO (137 of 260 vs 123 of 260, p=0.62). There was no significant difference in likelihood of hospital admission, length of stay, or number of weekend transfers to hospital (p=0.26, 0.68 and 0.6 respectively). Post-echo, patients were less likely to have pain documented as the primary symptom (11 of 137 vs 1 of 123, p=0.006), and it was more likely that transfer wishes were documented in advance (62 of 137 (45%) vs 82 of 123 (67%), p<0.001). Increase in transfer wishes documentation was explained primarily by an increase in a “for transfer” decision (27 of 62 vs 67 of 82) p=<0.001).
Conclusion
This teleconference, ECHO-delivered palliative education programme did not affect overall rates of emergency hospital transfers from nursing homes. However, it did significantly lower rates of transfers reporting pain as the primary symptom, tentatively suggesting a possible impact on “reversible” hospital transfers. ECHO significantly increased likelihood of transfer status discussion, while most “extra” discussions resulted in a “for transfer” decision.
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Affiliation(s)
- MJ Dowling
- Age-Related Healthcare Department, Tallaght University Hospital, Dublin, Ireland
| | | | - Cathy Payne
- All Ireland Institute of Hospice and Palliative Care, Dublin, Ireland
| | | | | | - Claire Noonan
- Age-Related Healthcare Department, Tallaght University Hospital, Dublin, Ireland
| | - DJ Ryan
- Age-Related Healthcare Department, Tallaght University Hospital, Dublin, Ireland
- Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
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17
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Sigurdardottir KR, Hjermstad MJ, Filbet M, Tricou C, McQuillan R, Costantini M, Autelitano C, Bennett MI, Haugen DF. Pilot testing of the first version of the European Association for Palliative Care basic dataset: A mixed methods study. Palliat Med 2019; 33:832-849. [PMID: 31023149 DOI: 10.1177/0269216319844439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Inadequate description of palliative care cancer patients in research studies often leads to results having limited generalizability. To standardize the description of the sample, the European Association for Palliative Care basic data set was developed, with 31 core demographic and disease-related variables. AIM To pilot test the data set to check acceptability, comprehensibility and feasibility. DESIGN International, multi-centre pilot study at nine study sites in five European countries, using mixed methods. SETTING/PARTICIPANTS Adult cancer patients and staff in palliative care units, hospices and home care. RESULTS In all, 191 patients (544 screened) and 190 health care personnel were included. Median time to fill in the patient form was 5 min and the health care personnel form was 7 min. Ethnicity was the most challenging item for patients and requires decisions at a national level about whether or how to include. Health care personnel found weight loss, principal diagnosis, additional diagnoses and stage of non-cancer diseases most difficult to respond to. Registration of diagnoses will be changed from International Statistical Classification of Diseases and Related Health Problems, 10th version code to a predefined list, while weight loss and stage of non-cancer diseases will be removed. The pilot study has led to rewording of items, improvement in response options and shortening of the data set to 29 items. CONCLUSION Pilot testing of the first version of the European Association for Palliative Care basic data set confirmed that patients and health care personnel understand the questions in a consistent manner and can answer within an acceptable timeframe. The pilot testing has led to improvement, and the new version is now subject to further testing.
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Affiliation(s)
- Katrin Ruth Sigurdardottir
- 1 Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway.,2 European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,3 Sunniva Centre for Palliative Care, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Marianne J Hjermstad
- 2 European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Marilene Filbet
- 4 Department of Palliative Care, Centre Hospitalier de Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Colombe Tricou
- 4 Department of Palliative Care, Centre Hospitalier de Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | | | - Massimo Costantini
- 6 Scientific Directorate, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Cristina Autelitano
- 7 Palliative Care Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Michael I Bennett
- 8 Academic Unit of Palliative Care, Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
| | - Dagny Faksvåg Haugen
- 1 Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway.,9 Department of Clinical Medicine (K1), University of Bergen, Bergen, Norway
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18
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Kiernan G, Courtney E, Ryan K, McQuillan R, Guerin S. Parents’ experiences of services for their child with a life-limiting neurodevelopmental disability. Children's Health Care 2019. [DOI: 10.1080/02739615.2019.1605608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Gemma Kiernan
- School of Nursing and Human Sciences, Dublin City University, Glasnevin, Dublin 9, Ireland
| | - Eileen Courtney
- School of Nursing and Human Sciences, Dublin City University, Glasnevin, Dublin 9, Ireland
| | - Karen Ryan
- St. Francis Hospice, Raheny, Dublin 9, Ireland
| | | | - Suzanne Guerin
- School of Psychology, Newman Building, University College Dublin, Belfield, Dublin 4, Ireland
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19
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Courtney E, Kiernan G, Guerin S, Ryan K, McQuillan R. Mothers' perspectives of the experience and impact of caring for their child with a life-limiting neurodevelopmental disability. Child Care Health Dev 2018; 44:704-710. [PMID: 29938823 DOI: 10.1111/cch.12580] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 05/10/2018] [Accepted: 05/16/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study explored mothers' perspectives of the experiences and impact on themselves and their family when their child has a life-limiting neurodevelopmental disability. METHODS Twelve mothers were interviewed and topics included mothers' experiences of caring, the impact on themselves and their family of care provision, and the management of day-to-day life. Data were analysed using thematic analysis. RESULTS Four themes were identified. "Starting Out" relates to mothers' experiences of the birth of their child and the aftermath. "Keeping the Show on the Road" describes the strategies families employ to manage life day to day and the resources they use. "Shouldering the Burden" describes the range of physical, psychological, and social consequences of the situation for mothers and the family. "The Bigger Picture" relates to the world outside the family and how this is navigated. CONCLUSIONS Findings suggest mothers' overall experiences are characterized by a constant struggle, with evidence of negative impacts on family life, though there is also evidence of resilience and coping. Implications regarding the provision of services are discussed.
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Affiliation(s)
- E Courtney
- School of Nursing and Human Sciences, Dublin City University, Glasnevin, Ireland
| | - G Kiernan
- School of Nursing and Human Sciences, Dublin City University, Glasnevin, Ireland
| | - S Guerin
- UCD School of Psychology, University College Dublin, Belfield, Ireland
| | - K Ryan
- St. Francis Hospice, Raheny, Ireland
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20
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Kane PM, Murtagh FEM, Ryan KR, Brice M, Mahon NG, McAdam B, McQuillan R, O'Gara G, Raleigh C, Tracey C, Howley C, Higginson IJ, Daveson BA. Strategies to address the shortcomings of commonly used advanced chronic heart failure descriptors to improve recruitment in palliative care research: A parallel mixed-methods feasibility study. Palliat Med 2018; 32:517-524. [PMID: 28488925 PMCID: PMC5788074 DOI: 10.1177/0269216317706426] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Recruitment challenges contribute to the paucity of palliative care research with advanced chronic heart failure patients. AIM To describe the challenges and outline strategies of recruiting advanced chronic heart failure patients. DESIGN A feasibility study using a pre-post uncontrolled design. SETTING Advanced chronic heart failure patients were recruited at two nurse-led chronic heart failure disease management clinics in Ireland Results: Of 372 patients screened, 81 were approached, 38 were recruited (46.9% conversion to consent) and 25 completed the intervention. To identify the desired population, a modified version of the European Society of Cardiology definition was used together with modified New York Heart Association inclusion criteria to address inter-study site New York Heart Association classification subjectivity. These modifications substantially increased median monthly numbers of eligible patients approached (from 8 to 20) and median monthly numbers recruited (from 4 to 9). Analysis using a mortality risk calculator demonstrated that recruited patients had a median 1-year mortality risk of 22.7 and confirmed that the modified eligibility criteria successfully identified the population of interest. A statistically significant difference in New York Heart Association classification was found in recruited patients between study sites, but no statistically significant difference was found in selected clinical parameters between these patients. CONCLUSION Clinically relevant modifications to the European Society of Cardiology definition and strategies to address New York Heart Association subjectivity may help to improve advanced chronic heart failure patient recruitment in clinical settings, thereby helping to address the paucity of palliative care research this population.
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Affiliation(s)
- Pauline M Kane
- 1 Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, Cicely Saunders International, King's College London, London, UK
| | - Fliss E M Murtagh
- 1 Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, Cicely Saunders International, King's College London, London, UK
| | - Karen R Ryan
- 2 St Francis Hospice, Dublin, Ireland.,3 Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Niall G Mahon
- 3 Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Regina McQuillan
- 2 St Francis Hospice, Dublin, Ireland.,5 Beaumont Hospital, Dublin, Ireland
| | | | | | - Cecelia Tracey
- 3 Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Irene J Higginson
- 1 Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, Cicely Saunders International, King's College London, London, UK
| | - Barbara A Daveson
- 1 Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, Cicely Saunders International, King's College London, London, UK
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21
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Kane PM, Ellis-Smith CI, Daveson BA, Ryan K, Mahon NG, McAdam B, McQuillan R, Tracey C, Howley C, O'Gara G, Raleigh C, Higginson IJ, Murtagh FE, Koffman J. Understanding how a palliative-specific patient-reported outcome intervention works to facilitate patient-centred care in advanced heart failure: A qualitative study. Palliat Med 2018; 32:143-155. [PMID: 29154724 DOI: 10.1177/0269216317738161] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Palliative care needs of patients with chronic heart failure are poorly recognised. Policy makers advise a patient-centred approach to holistically assess patients' needs and care goals. Patient-reported outcome measures are proposed to facilitate patient-centred care. AIM To explore whether and how a palliative care-specific patient-reported outcome intervention involving the Integrated Palliative care Outcome Scale influences patients' experience of patient-centred care in nurse-led chronic heart failure disease management clinics. DESIGN A feasibility study using a parallel mixed-methods embedded design was undertaken. The qualitative component which examined patients and nurses experience of the intervention is reported here. Semi-structured interviews were conducted and analysed using framework analysis. SETTING/PARTICIPANTS Eligible patients attended nurse-led chronic heart failure disease management clinics in two tertiary referral centres in Ireland with New York Heart Association functional class II-IV. Nurses who led these clinics were eligible for inclusion. RESULTS In all, 18 patients and all 4 nurses involved in the nurse-led clinics were interviewed. Three key themes were identified: identification of unmet needs, holistic assessment and patient empowerment. The intervention impacted on processes of care by enabling a shared understanding of patients' symptoms and concerns, facilitating patient-nurse communication by focusing on these unmet needs and empowering patients to become more involved in clinical discussions. CONCLUSION This Integrated Palliative care Outcome Scale-based intervention empowered patients to become more engaged in the clinical consultation and to highlight their unmet needs. This study adds to the evidence for the mechanism of action of patient-reported outcome measures to improve patient-centred care and will help inform outcome selection for future patient-reported outcome measure research.
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Affiliation(s)
- Pauline M Kane
- 1 Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
| | - Clare I Ellis-Smith
- 1 Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
| | - Barbara A Daveson
- 1 Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
| | - Karen Ryan
- 2 Palliative Medicine, St Francis Hospice and Mater Misericordiae University Hospital, Dublin, Ireland
| | - Niall G Mahon
- 3 Department of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Brendan McAdam
- 4 Department of Cardiology, Beaumont Hospital, Dublin, Ireland
| | - Regina McQuillan
- 5 Department of Palliative Medicine, St Francis Hospice and Beaumont Hospital, Dublin, Ireland
| | - Cecelia Tracey
- 3 Department of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Christine Howley
- 3 Department of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | | | | | - Irene J Higginson
- 1 Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
| | - Fliss Em Murtagh
- 1 Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK.,6 Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Jonathan Koffman
- 1 Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
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22
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Higginson IJ, Daveson BA, Morrison RS, Yi D, Meier D, Smith M, Ryan K, McQuillan R, Johnston BM, Normand C. Social and clinical determinants of preferences and their achievement at the end of life: prospective cohort study of older adults receiving palliative care in three countries. BMC Geriatr 2017; 17:271. [PMID: 29169346 PMCID: PMC5701500 DOI: 10.1186/s12877-017-0648-4] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [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: 02/24/2017] [Accepted: 10/19/2017] [Indexed: 11/10/2022] Open
Abstract
Background Achieving choice is proposed as a quality marker. But little is known about what influences preferences especially among older adults. We aimed to determine and compare, across three countries, factors associated with preferences for place of death and treatment, and actual site of death. Methods We recruited adults aged ≥65-years from hospital-based multiprofessional palliative care services in London, Dublin, New York, and followed them for >17 months. All services offered consultation on hospital wards, support for existing clinical teams, outpatient services and received funding from their National Health Service and/or relevant Insurance reimbursements. The New York service additionally had 10 inpatient beds. All worked with and referred patients to local hospices. Face-to-face interviews recorded most and least preferred place of death, treatment goal priorities, demographic and clinical information using validated questionnaires. Multivariable and multilevel analyses assessed associated factors. Results One hundred and thirty eight older adults (64 London, 59 Dublin, 15 New York) were recruited, 110 died during follow-up. Home was the most preferred place of death (77/138, 56%) followed by inpatient palliative care/hospice units (22%). Hospital was least preferred (35/138, 25%), followed by nursing home (20%) and home (16%); hospice/palliative care unit was rarely least preferred (4%). Most respondents prioritised improving quality of life, either alone (54%), or equal with life extension (39%); few (3%) chose only life extension. There were no significant differences between countries. Main associates with home preference were: cancer diagnosis (OR 3.72, 95% CI 1.40–9.90) and living with someone (OR 2.19, 1.33–3.62). Adults with non-cancer diagnoses were more likely to prefer palliative care units (OR 2.39, 1.14–5.03). Conversely, functional independence (OR 1.05, 1.04–1.06) and valuing quality of life (OR 3.11, 2.89–3.36) were associated with dying at home. There was a mismatch between preferences and achievements – of 85 people who preferred home or a palliative care unit, 19 (25%) achieved their first preference. Conclusion Although home is the most common first preference, it is polarising and for 16% it is the least preferred. Inpatient palliative care unit emerges as the second most preferred place, is rarely least preferred, and yet was often not achieved for those who wanted to die there. Factors affecting stated preferences and met preferences differ. Available services, notably community support and palliative care units, require expansion. Contrasting actual place of death with capacity for meeting patient and family needs may be a better quality indicator than simply ‘achieved preferences’. Electronic supplementary material The online version of this article (10.1186/s12877-017-0648-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Irene J Higginson
- Cicely Saunders Institute Of Palliative Care, Policy & Rehabilitation, King's College London, and King's College Hospital, Bessemer Road, London, SE5 9PJ, UK.
| | - Barbara A Daveson
- Cicely Saunders Institute Of Palliative Care, Policy & Rehabilitation, King's College London, and King's College Hospital, Bessemer Road, London, SE5 9PJ, UK
| | - R Sean Morrison
- Department of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029-6574, USA
| | - Deokhee Yi
- Cicely Saunders Institute Of Palliative Care, Policy & Rehabilitation, King's College London, and King's College Hospital, Bessemer Road, London, SE5 9PJ, UK.
| | - Diane Meier
- Department of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029-6574, USA
| | - Melinda Smith
- Cicely Saunders Institute Of Palliative Care, Policy & Rehabilitation, King's College London, and King's College Hospital, Bessemer Road, London, SE5 9PJ, UK
| | - Karen Ryan
- Mater Misericordiae Hospital, Eccles Street, Dublin 7, Ireland
| | | | - Bridget M Johnston
- The Centre of Health Policy and Management, Trinity College Dublin, Room 0.21, 3-4 Foster Place, College Green, Dublin 2, Ireland
| | - Charles Normand
- The Centre of Health Policy and Management, Trinity College Dublin, Room 0.21, 3-4 Foster Place, College Green, Dublin 2, Ireland
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Bourke R, Daly F, Hannon E, Ryan D, Brewer L, Martin A, McQuillan R, Curly G, Greene K, Rufli G, Byrne T, Hayden F, Browne E, White BM, O’Neil P, Curran C. 181Improving Documentation of DNACPR and Treatment Escalation Plans in a Dublin Teaching Hospital. Age Ageing 2017. [DOI: 10.1093/ageing/afx144.183] [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: 11/13/2022] Open
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24
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Selman LE, Daveson BA, Smith M, Johnston B, Ryan K, Morrison RS, Pannell C, McQuillan R, de Wolf-Linder S, Pantilat SZ, Klass L, Meier D, Normand C, Higginson IJ. How empowering is hospital care for older people with advanced disease? Barriers and facilitators from a cross-national ethnography in England, Ireland and the USA. Age Ageing 2017; 46:300-309. [PMID: 27810850 PMCID: PMC5860377 DOI: 10.1093/ageing/afw193] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 08/12/2016] [Indexed: 11/14/2022] Open
Abstract
Background patient empowerment, through which patients become self-determining agents with some control over their health and healthcare, is a common theme across health policies globally. Most care for older people is in the acute setting, but there is little evidence to inform the delivery of empowering hospital care. Objective we aimed to explore challenges to and facilitators of empowerment among older people with advanced disease in hospital, and the impact of palliative care. Methods we conducted an ethnography in six hospitals in England, Ireland and the USA. The ethnography involved: interviews with patients aged ≥65, informal caregivers, specialist palliative care (SPC) staff and other clinicians who cared for older adults with advanced disease, and fieldwork. Data were analysed using directed thematic analysis. Results analysis of 91 interviews and 340 h of observational data revealed substantial challenges to empowerment: poor communication and information provision, combined with routinised and fragmented inpatient care, restricted patients' self-efficacy, self-management, choice and decision-making. Information and knowledge were often necessary for empowerment, but not sufficient: empowerment depended on patient-centredness being enacted at an organisational and staff level. SPC facilitated empowerment by prioritising patient-centred care, tailored communication and information provision, and the support of other clinicians. Conclusions empowering older people in the acute setting requires changes throughout the health system. Facilitators of empowerment include excellent staff-patient communication, patient-centred, relational care, an organisational focus on patient experience rather than throughput, and appropriate access to SPC. Findings have relevance for many high- and middle-income countries with a growing population of older patients with advanced disease.
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Affiliation(s)
- Lucy Ellen Selman
- Department of Palliative Care, Policy and Rehabilitation, King's College London, Cicely Saunders Institute, London SE5 9PJ, UK
- Bristol Randomised Controlled Trials Collaboration, School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK
| | - Barbara A. Daveson
- Department of Palliative Care, Policy and Rehabilitation, King's College London, Cicely Saunders Institute, London SE5 9PJ, UK
| | - Melinda Smith
- Department of Palliative Care, Policy and Rehabilitation, King's College London, Cicely Saunders Institute, London SE5 9PJ, UK
| | - Bridget Johnston
- Centre of Health Policy and Management School of Medicine, Trinity College, University of Dublin, Dublin, Ireland
| | - Karen Ryan
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - R. Sean Morrison
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Caty Pannell
- Department of Palliative Care, Policy and Rehabilitation, King's College London, Cicely Saunders Institute, London SE5 9PJ, UK
| | | | - Suzanne de Wolf-Linder
- Department of Palliative Care, Policy and Rehabilitation, King's College London, Cicely Saunders Institute, London SE5 9PJ, UK
| | - Steven Z. Pantilat
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Lara Klass
- Department of Palliative Care, Policy and Rehabilitation, King's College London, Cicely Saunders Institute, London SE5 9PJ, UK
| | - Diane Meier
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Charles Normand
- Centre of Health Policy and Management School of Medicine, Trinity College, University of Dublin, Dublin, Ireland
| | - Irene J. Higginson
- Department of Palliative Care, Policy and Rehabilitation, King's College London, Cicely Saunders Institute, London SE5 9PJ, UK
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25
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Howes DA, Kerr TA, McQuillan R, Kerr RT, Connell JS. Successful small intestinal resection and anastomosis in a late term broodmare with colic via a standing left flank laparotomy. EQUINE VET EDUC 2017. [DOI: 10.1111/eve.12711] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- D. A. Howes
- Marks Ewen and Associates Equine Hospital; Matamata New Zealand
| | - T. A. Kerr
- Marks Ewen and Associates Equine Hospital; Matamata New Zealand
| | - R. McQuillan
- Marks Ewen and Associates Equine Hospital; Matamata New Zealand
| | - R. T. Kerr
- Marks Ewen and Associates Equine Hospital; Matamata New Zealand
| | - J. S. Connell
- Marks Ewen and Associates Equine Hospital; Matamata New Zealand
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26
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Sussman J, Varela N, Cheung M, Hicks L, Kraftcheck D, Mandel J, Fraser G, Jimenez-Juan L, Boudreau A, Sajkowski S, McQuillan R. Follow-up care for survivors of lymphoma who have received curative-intent treatment. Curr Oncol 2016; 23:e499-e513. [PMID: 27803611 PMCID: PMC5081023 DOI: 10.3747/co.23.3265] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [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: 12/15/2022] Open
Abstract
OBJECTIVE This evidence summary set out to assess the available evidence about the follow-up of asymptomatic survivors of lymphoma who have received curative-intent treatment. METHODS The medline and embase databases and the Cochrane Database of Systematic Reviews were searched for evidence published between 2000 and August 2015 relating to lymphoma survivorship follow-up. The evidence summary was developed by a Working Group at the request of the Cancer Care Ontario Survivorship and Cancer Imaging programs because of the absence of evidence-based practice documents in Ontario for the follow-up and surveillance of asymptomatic patients with lymphoma in complete remission. RESULTS Eleven retrospective studies met the inclusion criteria. The proportion of relapses initially detected by clinical manifestations ranged from 13% to 78%; for relapses initially detected by imaging, the proportion ranged from 8% to 46%. Median time for relapse detection ranged from 8.6 to 19 months for patients initially suspected because of imaging and from 8.6 to 33 months for those initially suspected because of clinical manifestations. Only one study reported significantly earlier relapse detection for patients initially suspected because of clinical manifestations (mean: 4.5 months vs. 6.0 months, p = 0.042). No benefit in terms of overall survival was observed for patients depending on whether their relapse was initially detected because of clinical manifestations or surveillance imaging. SUMMARY Findings in the present study support the importance of improving awareness on the part of survivors and clinicians about the symptoms that might be associated with recurrence. The evidence does not support routine imaging for improving outcomes in this patient population.
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Affiliation(s)
- J. Sussman
- Division of Radiation Oncology, Juravinski Cancer Centre, Hamilton
| | - N.P. Varela
- Cancer Care Ontario, Program in Evidence-Based Care, McMaster University, Hamilton
| | - M. Cheung
- Odette Cancer Centre, Sunny-brook Health Sciences Centre, Toronto
| | - L. Hicks
- Division of Hematology/Oncology, St. Michael’s Hospital, Toronto
| | - D. Kraftcheck
- Provincial Primary Care and Cancer Network, Hamilton Niagara Haldimand Brant, Grimsby
| | - J. Mandel
- Department of Diagnostic Imaging and Nuclear Medicine, Oakville Trafalgar Memorial Hospital, Oakville
| | - G. Fraser
- Division of Malignant Hematology, Juravinski Cancer Centre, Hamilton
| | | | - A. Boudreau
- Sunnybrook Health Sciences Centre, Toronto and
| | - S. Sajkowski
- Cancer Care Ontario Patient and Family Advisor, Toronto, ON
| | - R. McQuillan
- Cancer Care Ontario Patient and Family Advisor, Toronto, ON
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27
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Galvin M, Corr B, Madden C, Mays I, McQuillan R, Timonen V, Staines A, Hardiman O. Caregiving in ALS - a mixed methods approach to the study of Burden. BMC Palliat Care 2016; 15:81. [PMID: 27596749 PMCID: PMC5011853 DOI: 10.1186/s12904-016-0153-0] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [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: 01/23/2016] [Accepted: 08/26/2016] [Indexed: 12/13/2022] Open
Abstract
Background Caregiver burden affects the physical, psychological and emotional well-being of the caregiver. The purpose of this analysis was to describe an informal caregiver cohort (n = 81), their subjective assessment of burden and difficulties experienced as a result of providing care to people with Amyotrophic Lateral Sclerosis (ALS). Methods Using mixed methods of data collection and analysis, we undertook a comprehensive assessment of burden and difficulties associated with informal caregiving in ALS. As part of a semi-structured interview a series of standardised measures were used to assess quality of life, psychological distress and subjective burden, and in an open-ended question caregivers were asked to identify difficult aspects of their caregiving experience. Results The quantitative data show that psychological distress, hours of care provided and lower quality of life, were significant predictors of caregiver burden. From the qualitative data, the caregiving difficulties were thematised around managing the practicalities of the ALS condition, the emotional and psychosocial impact; limitation and restriction, and impact on relationships. Conclusions The collection and analysis of quantitative and qualitative data better explores the complexity of caregiver burden in ALS. Understanding the components of burden and the difficulties experienced as a result of caring for someone with ALS allows for better supporting the caregiver, and assessing the impact of burden on the care recipient. Electronic supplementary material The online version of this article (doi:10.1186/s12904-016-0153-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Miriam Galvin
- School of Nursing and Human Sciences, Dublin City University, Dublin 9, Ireland. .,Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland.
| | - Bernie Corr
- Department of Neurology, National Neuroscience Centre, Beaumont Hospital, Dublin 9, Ireland
| | - Caoifa Madden
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland
| | - Iain Mays
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland
| | - Regina McQuillan
- Beaumont Hospital, Dublin 9, Ireland.,St Francis Hospice, Raheny, Dublin 5, Ireland
| | - Virpi Timonen
- School of Social Work and Social Policy, Trinity College Dublin, Dublin 2, Ireland
| | - Anthony Staines
- School of Nursing and Human Sciences, Dublin City University, Dublin 9, Ireland
| | - Orla Hardiman
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland.,Department of Neurology, National Neuroscience Centre, Beaumont Hospital, Dublin 9, Ireland
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28
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Kane PM, Murtagh FEM, Ryan K, Mahon NG, McAdam B, McQuillan R, Ellis-Smith C, Tracey C, Howley C, Raleigh C, O'Gara G, Higginson IJ, Daveson BA. The gap between policy and practice: a systematic review of patient-centred care interventions in chronic heart failure. Heart Fail Rev 2016; 20:673-87. [PMID: 26435042 PMCID: PMC4608978 DOI: 10.1007/s10741-015-9508-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Patient-centred care (PCC) is recommended in policy documents for chronic heart failure (CHF) service provision, yet it lacks an agreed definition. A systematic review was conducted to identify PCC interventions in CHF and to describe the PCC domains and outcomes. Medline, Embase, CINAHL, PsycINFO, ASSIA, the Cochrane database, clinicaltrials.gov, key journals and citations were searched for original studies on patients with CHF staged II–IV using the New York Heart Association (NYHA) classification. Included interventions actively supported patients to play informed, active roles in decision-making about their goals of care. Search terms included ‘patient-centred care’, ‘quality of life’ and ‘shared decision making’. Of 13,944 screened citations, 15 articles regarding 10 studies were included involving 2540 CHF patients. Three studies were randomised controlled trials, and seven were non-randomised studies. PCC interventions focused on collaborative goal setting between patients and healthcare professionals regarding immediate clinical choices and future care. Core domains included healthcare professional-patient collaboration, identification of patient preferences, patient-identified goals and patient motivation. While the strength of evidence is poor, PCC has been shown to reduce symptom burden, improve health-related quality of life, reduce readmission rates and enhance patient engagement for patients with CHF. There is a small but growing body of evidence, which demonstrates the benefits of a PCC approach to care for CHF patients. Research is needed to identify the key components of effective PCC interventions before being able to deliver on policy recommendations.
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Affiliation(s)
- P M Kane
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ, UK.
| | - F E M Murtagh
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ, UK
| | - K Ryan
- St. Francis Hospice, Dublin, Ireland.,Mater Misericordiae University Hospital, Dublin, Ireland
| | - N G Mahon
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - B McAdam
- Beaumont Hospital, Dublin, Ireland
| | - R McQuillan
- St. Francis Hospice, Dublin, Ireland.,Beaumont Hospital, Dublin, Ireland
| | - C Ellis-Smith
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ, UK
| | - C Tracey
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - C Howley
- Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - G O'Gara
- Beaumont Hospital, Dublin, Ireland
| | - I J Higginson
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ, UK
| | - B A Daveson
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ, UK
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29
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Sexton DJ, Lowney AC, O'Seaghdha CM, Murphy M, O'Brien T, Casserly LF, McQuillan R, Plant WD, Eustace JA, Kinsella SM, Conlon PJ. Do patient-reported measures of symptoms and health status predict mortality in hemodialysis? An assessment of POS-S Renal and EQ-5D. Hemodial Int 2016; 20:618-630. [DOI: 10.1111/hdi.12415] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Donal J. Sexton
- Health Research Board of Ireland Clinical Research Facility; National University of Ireland Galway; Galway Ireland
| | - Aoife C. Lowney
- Department of Palliative Medicine; Marymount University Hospital & Hospice; Cork Ireland
| | | | - Marie Murphy
- Department of Palliative Medicine; Marymount University Hospital & Hospice; Cork Ireland
| | - Tony O'Brien
- Department of Palliative Medicine; Marymount University Hospital & Hospice; Cork Ireland
| | - Liam F. Casserly
- Department of Nephrology; University Hospital Limerick; Limerick Ireland
| | - Regina McQuillan
- Department of Palliative Medicine; Beaumont Hospital; Dublin Ireland
| | - William D. Plant
- Department of Renal Medicine; Cork University Hospital; Cork Ireland
| | - Joseph A. Eustace
- Department of Renal Medicine; Cork University Hospital; Cork Ireland
- Health Research Board of Ireland Clinical Research Facility; University College Cork; Cork Ireland
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30
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Lowney AC, Myles HT, Bristowe K, Lowney EL, Shepherd K, Murphy M, O'Brien T, Casserly L, McQuillan R, Plant WD, Conlon PJ, Vinen C, Eustace JA, Murtagh FEM. Understanding What Influences the Health-Related Quality of Life of Hemodialysis Patients: A Collaborative Study in England and Ireland. J Pain Symptom Manage 2015; 50:778-85. [PMID: 26300026 DOI: 10.1016/j.jpainsymman.2015.07.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Revised: 07/12/2015] [Accepted: 07/15/2015] [Indexed: 11/16/2022]
Abstract
CONTEXT The international cohort of hemodialysis patients is aging and increasing in number. Nephrologists have a therapeutic relationship with their patients that may span decades. Often overlooked components of chronic disease management include symptom control and assessment of health-related quality of life (HRQoL). OBJECTIVES This study describes the symptom profile of a large cohort of patients with end-stage renal disease on hemodialysis in England and Ireland and evaluates how symptom burden and other factors influence quality-of-life scores. METHODS A prospective cross-sectional observational study of hemodialysis patients was conducted in Ireland and England during 2011 and 2012. Two validated clinical tools were used to determine HRQoL and symptom burden. Demographic and clinical data were examined, and regression analysis was used to determine associations with HRQoL scores. RESULTS A total of 893 patients on hemodialysis (mean [SD] age 64 [16] years) had a high symptom burden and poor HRQoL compared with population norms. Specifically, 64% of patients reported pain (95% confidence interval 61%-67%) and 79% reported weakness (95% confidence interval 75%-81%). A total of 43 percent of patients reported between six and 10 symptoms in the week preceding the survey. HRQoL was significantly and independently associated with poor mobility and pain and remained significant after adjusting for variations in clinical characteristics. Being listed on a transplant wait-list register was positively associated with HRQoL. CONCLUSION These findings illustrate the high symptom burden and poor HRQoL of the hemodialysis population. Emphasis during clinical reviews on pain assessment and on assessing mobility plus interventions, such as pain management and physiotherapy/occupational therapy, are practical ways for renal teams to help improve patients' quality of life.
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Affiliation(s)
- Aoife C Lowney
- Department of Palliative Medicine, Marymount University Hospital & Hospice, Cork, Ireland; Department of Palliative Medicine, Cork University Hospital, Cork, Ireland.
| | - Helena T Myles
- Department of Palliative Medicine, Beaumont Hospital, Dublin, Ireland
| | - Katherine Bristowe
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, United Kingdom
| | - Eanna L Lowney
- College of Medicine and Health at University College Cork, Cork, Ireland
| | - Katie Shepherd
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, United Kingdom
| | - Marie Murphy
- Department of Palliative Medicine, Marymount University Hospital & Hospice, Cork, Ireland
| | - Tony O'Brien
- Department of Palliative Medicine, Marymount University Hospital & Hospice, Cork, Ireland; Department of Palliative Medicine, Cork University Hospital, Cork, Ireland; College of Medicine and Health at University College Cork, Cork, Ireland
| | - Liam Casserly
- Department of Renal Medicine, Limerick University Hospital, Limerick, Ireland
| | - Regina McQuillan
- Department of Palliative Medicine, St Francis Hospice, Raheny, Dublin, Ireland
| | - William D Plant
- College of Medicine and Health at University College Cork, Cork, Ireland; Department of Renal Medicine, Cork University Hospital, Cork, Ireland
| | - Peter J Conlon
- Department of Renal Medicine, Beaumont Hospital Dublin, Dublin, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Catherine Vinen
- Department of Renal Medicine, Kings College Hospital NHS Foundation Trust, London, United Kingdom
| | - Joseph A Eustace
- College of Medicine and Health at University College Cork, Cork, Ireland; Department of Renal Medicine, Cork University Hospital, Cork, Ireland; HRB Clinical Research Facility at University College Cork, Cork, Ireland
| | - Fliss E M Murtagh
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, United Kingdom
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31
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Affiliation(s)
| | | | | | - Aoife Lowney
- St Luke's Hospital and Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
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32
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Kane PM, Daveson BA, Ryan K, McQuillan R, Higginson IJ, Murtagh FEM. The need for palliative care in Ireland: a population-based estimate of palliative care using routine mortality data, inclusive of nonmalignant conditions. J Pain Symptom Manage 2015; 49:726-733.e1. [PMID: 25461670 DOI: 10.1016/j.jpainsymman.2014.09.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 09/21/2014] [Accepted: 09/22/2014] [Indexed: 11/24/2022]
Abstract
CONTEXT Over the history of palliative care provision in Ireland, services have predominantly provided care to those with cancer. Previous estimates of palliative care need focused primarily on specialist palliative care and included only a limited number of nonmalignant diseases. OBJECTIVES The primary aim of this study was to estimate the potential population with generalist and/or specialist palliative care needs in Ireland using routine mortality data inclusive of nonmalignant conditions. The secondary aim was to consider the quality of Irish data available for this population-based estimate. METHODS Irish routine mortality data (2007-2011) were analyzed for malignant and nonmalignant conditions recognized as potentially requiring palliative care input, using specific International Statistical Classification of Diseases and Related Health Problems-10th Revision codes. The method developed by Murtagh et al. was used to give a population-based palliative care needs estimate, encompassing generalist and specialist palliative care need. RESULTS During the period 2007-2011, there were 141,807 deaths. Eighty percent were from conditions recognized as having associated palliative care needs, with 41,253 (30%) deaths from cancer and 71,226 (50%) deaths from noncancer conditions. The majority of deaths, 81% (91,914), were among those ≥65 years. There was a 13.9% (901) increase in deaths of those ≥85 years. Deaths from dementia increased by 51.3%, with an increase in deaths from neurodegenerative disease (42.8%) and cancer (9.5%). CONCLUSION Future palliative care policy decisions in Ireland must consider the rapidly aging Irish population with the accompanying increase in deaths from cancer, dementia, and neurodegenerative disease and associated palliative care need. New models of palliative care may be required to address this.
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Affiliation(s)
- Pauline M Kane
- Department of Palliative Care, Policy & Rehabilitation, King's College London, Cicely Saunders Institute, London, United Kingdom.
| | - Barbara A Daveson
- Department of Palliative Care, Policy & Rehabilitation, King's College London, Cicely Saunders Institute, London, United Kingdom
| | - Karen Ryan
- St. Francis Hospice and Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Irene J Higginson
- Department of Palliative Care, Policy & Rehabilitation, King's College London, Cicely Saunders Institute, London, United Kingdom
| | - Fliss E M Murtagh
- Department of Palliative Care, Policy & Rehabilitation, King's College London, Cicely Saunders Institute, London, United Kingdom
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McLean S, Dhonnchu TN, Mahon N, McQuillan R, Gordijn B, Ryan K. Left ventricular assist device withdrawal: an ethical discussion. BMJ Support Palliat Care 2013; 4:193-195. [PMID: 24644168 DOI: 10.1136/bmjspcare-2012-000347] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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: 08/14/2012] [Revised: 11/27/2012] [Accepted: 12/06/2012] [Indexed: 11/04/2022]
Abstract
Specialist palliative care (SPC) services are increasingly integrated with chronic heart failure (CHF) services. Left ventricular assist devices (LVADs) represent an advance in the management of advanced CHF, but may pose ethical challenges for SPC services providing care to this population. The patient received an LVAD as 'bridge-to-heart-transplant,' but subsequently experienced multiple cerebral haemorrhages, resulting in neurological deficits, and severe functional impairment. The risk of further cerebral events precluded ongoing anticoagulation, and she was transferred to an SPC inpatient unit for symptom control and end-of-life care. Following discussion within the multi-disciplinary team and with the patient's family, LVAD support was withdrawn, and the patient died peacefully. This piece reviews the ethical considerations that informed decision-making, in particular, autonomy, informed consent and futility. In addition, the question of the nature of LVADs is debated and how the perceptions of the patient, and others, of the device may influence decision-making around withdrawal of treatment.
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Affiliation(s)
- Sarah McLean
- Palliative Care Service, St Francis Hospice, Dublin, Ireland.,Milford Care Centre, Castletroy, Limerick, Ireland
| | - Tara Ni Dhonnchu
- Department of Cardiothoracic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Niall Mahon
- Department of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Bert Gordijn
- Institute of Ethics, Dublin City University, Dublin, Ireland
| | - Karen Ryan
- Palliative Care Service, St Francis Hospice, Dublin, Ireland.,Department of Cardiothoracic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
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Rowley D, McLean S, O'Gorman A, Ryan K, McQuillan R. Review of cancer pain management in patients receiving maintenance methadone therapy. Am J Hosp Palliat Care 2010; 28:183-7. [PMID: 20826493 DOI: 10.1177/1049909110380897] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Methadone is commonly used in the treatment of heroin addiction. Patients with a history of opioid misuse or on methadone maintenance therapy (MMT) with cancer often have difficult to manage pain. We studied 12 patients referred to the palliative care service with cancer pain who were on MMT. All had difficult to control pain, and a third required 5 or more analgesic agents. Two patients had documented ''drug-seeking'' behavior. Methadone was used subcutaneously as an analgesic agent in 1 patient. We explore why patients on MMT have difficult to manage pain, the optimal management of their pain, and the increasing role of methadone as an analgesic agent in cancer pain.
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O'Seaghdha CM, McQuillan R, Moran AM, Lavin P, Dorman A, O'Kelly P, Mohan DM, Little P, Hickey DP, Conlon PJ. Higher tacrolimus trough levels on days 2-5 post-renal transplant are associated with reduced rates of acute rejection. Clin Transplant 2009; 23:462-8. [PMID: 19681975 DOI: 10.1111/j.1399-0012.2009.01021.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We analyzed the association between whole-blood trough tacrolimus (TAC) levels in the first days post-kidney transplant and acute cellular rejection (ACR) rates. Four hundred and sixty-four consecutive, deceased-donor kidney transplant recipients were included. All were treated with a combination of TAC, mycophenolate mofetil and prednisolone. Patients were analyzed in four groups based on quartiles of the mean TAC on days 2 and 5 post-transplant: Group 1: median TAC 11 ng/mL (n = 122, range 2-13.5 ng/mL), Group 2: median 17 ng/mL (n = 123, range 14-20 ng/mL), Group 3: median 24 ng/mL (n = 108, range 20.5-27 ng/mL) and Group 4: median 33.5 ng/mL (n = 116, range 27.5-77.5 ng/mL). A graded reduction in the rates of ACR was observed for each incremental days 2-5 TAC. The one-yr ACR rate was 24.03% (95% CI 17.26-32.88), 22.20% (95% CI 15.78-30.70), 13.41% (95% CI 8.15-21.63) and 8.69% (95% CI 4.77-15.55) for Groups 1-4, respectively (p = 0.003). This study suggests that higher early TACs are associated with reduced rates of ACR at one yr.
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Affiliation(s)
- C M O'Seaghdha
- Department of Nephrology and Transplantation, Beaumont Hospital, Dublin, Ireland
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Carson RWR, Jacob P, McQuillan R. Towards safer use of opioids. Ir Med J 2009; 102:257-259. [PMID: 19873867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The main aim of our work was to improve the safety of opioid use in our institution, an acute generalhospital with 620 beds. Initially, all reported opioid errors from 2001 - 2006 were audited. The findings directed a range of multidisciplinary staff educational inputs to improve opioid prescribing and administration practice, and encourage drug error reporting. 448 drug errors were reported, of which 54 (12%) involved opioids; of these, 43 (79%) involved codeine, morphine or oxycodone. 31 of the errors (57%) were associated with administration, followed by 12 (22%) with dispensing and 11 (20%) with prescribing. There were 2 reports of definite patient harm. A subsequent audit examined a 17-month period following the introduction of the above teaching: 17 errors were noted, of which 14 (83%) involved codeine, morphine or oxycodone. Again, drug administration was most error-prone, comprising 11 (65%) of reports. However, just 2 (12%) of the reported errors now involved prescribing, which was a reduction.
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Affiliation(s)
- R W R Carson
- Department of Palliative Care Medicine, Beaumont Hospital, Beaumont, Dublin 9.
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Lucey M, McQuillan R, MacCallion A, Corrigan M, Flynn J, Connaire K. Access to medications in the community by patients in a palliative setting. A systems analysis. Palliat Med 2008; 22:185-9. [PMID: 18372383 DOI: 10.1177/0269216307085722] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study performed a systems analysis of the process by which patients under the care of a specialist palliative home care obtained medications, and highlighted factors that delay this process. Systems analysis is the science dealing with analysis of complex, large-scale systems and the interactions within those systems. This study used a mixed-methods approach of questionnaires of general practitioners, pharmacists and patients, and a prospective observational study of delays experienced by patients referred to the home care team over a three-month period. This study found the main factors causing delay to be: medications not being in stock in pharmacies, medications not being available on state reimbursed schemes and inability of patients and carers to courier medications.
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Affiliation(s)
- M Lucey
- St Francis Hospice, Raheny, Dublin, Ireland.
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Abstract
Indigenous people are among the ethnic minorities who encounter palliative care services. This research shows that Irish Travellers have little experience of specialist palliative care and that specialist palliative care providers have little knowledge or experience of Irish Travellers. Characteristics of Irish Travellers culture including the importance of hope, avoidance of open acknowledgment of death, the importance of family and the avoidance of the place of death (including moving away or burning caravans where death has occurred) challenge the provision of specialist palliative care. Individualisation of patient care, a feature of specialist palliative care can help staff provide appropriate care.
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Abstract
Acute renal failure (ARF) can complicate up to 60% of orthotopic liver transplants (OLT). The RIFLE criteria were developed to provide a consensus definition for acute renal disease in critically ill patients. Using the RIFLE criteria, we aimed to determine the incidence and risk factors for ARF and acute renal injury (ARI), and to evaluate the link with the outcomes, patient survival and length of hospital stay. Three hundred patients, who received 359 OLTs, were retrospectively analyzed. ARI and ARF occurred post 11.1 and 25.7% of OLTs, respectively. By multivariate analysis, ARI was associated with pre-OLT hypertension and alcoholic liver disease and ARF with higher pre-OLT creatinine, inotrope and aminoglycoside use. ARF, but not ARI, had an impact on 30-day and 1-year patient survival and longer length of hospital stay. ARI and ARF, as defined by the RIFLE criteria, are common complications of OLT, with distinct risk factors and ARF has serious clinical consequences. The development of a consensus definition is a welcome advance, however these criteria do need to be validated in large studies in a wide variety of patient populations.
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Affiliation(s)
- A O'Riordan
- Department of Nephrology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
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Bhatia N, Shah RK, Villacorta M, McQuillan R, Annino DJ, Rebeiz EE. Effect of rehabilitation facility location on outcomes in head and neck surgical patients. Eur J Cancer Care (Engl) 2006; 15:458-62. [PMID: 17177903 DOI: 10.1111/j.1365-2354.2006.00678.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The objective of this study was to determine the significance of in-hospital rehabilitation facility vs. distant rehabilitation facilities in the outcomes and complications of post-operative head and neck surgical patients. Retrospective review of head and neck surgical patients was conducted over a 5-year period at a tertiary care medical centre. Fifty patients met criteria for this study (35 males, 15 females). Forty-two patients had a primary squamous cell carcinoma and eight patients had other primary malignancies of the head and neck. Thirty-two patients were placed in an in-hospital rehabilitation facility and 18 patients were placed in distant rehabilitation facilities (average distance 40.9 miles). Seventeen patients (34%) had complications including infection/drainage (seven patients), fistula (six patients), pneumonia (two patients), wound dehiscence (two patients) and other minor complications. The difference complication rate among the two groups was not statistically significant (37.5% in-hospital rehabilitation, 27.8% distant rehabilitation; P=0.496). The rate of hospital re-admission was not statistically significant (25% in-hospital rehabilitation patients, 16.7% distant rehabilitation patients; P=0.505). The average length of stay of patients without complications was 18.5 days (SD=5.8) for in-hospital rehabilitation and 12.9 days (SD=17) for distant rehabilitation. This difference was not statistically significant (P=0.346). In summary, one-third of post-operative head and neck surgical patients developed complications while in a rehabilitation facility. The length of stay, hospital re-admission rate and frequency of complications does not correlate with the proximity of the rehabilitation facility to the hospital where the patients received their surgery.
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Affiliation(s)
- N Bhatia
- Tufts University School of Medicine, Boston, MA, USA.
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McQuillan R, Campbell H. Gender differences in adolescent injury characteristics: A population-based study of hospital A&E data. Public Health 2006; 120:732-41. [PMID: 16815504 DOI: 10.1016/j.puhe.2006.02.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2005] [Revised: 02/01/2006] [Accepted: 02/15/2006] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To investigate patterns of adolescent home/leisure injury serious enough to require hospital attendance. STUDY DESIGN Population-based analysis of data collected by the Home and Leisure Accident Surveillance System (HASS/LASS). METHODS Study subjects were 0-17 year old residents of Airdrie and Coatbridge, Lanarkshire, Scotland, who attended Monklands Hospital Accident and Emergency (A&E) Department with a home/leisure injury during calendar years 1996-1999. Male to female relative risk ratios (M:F RRRs) for A&E attendance, fracture and hospital admission, stratified into sports and non-sports injuries, were calculated. Sports injuries were further analysed by specific sports and by whether the sports activity was organized or informal. Data were analysed in age groups corresponding to children's stage of schooling. RESULTS The M:F RRR for non-sports A&E attendances remained constant throughout childhood (1.35, 95% CI 1.30-1.39 in 0-17 year olds), whilst that for sports attendances increased sharply with age (2.50, 95% CI 0.89-7.02 in 0-4 year olds, increasing to 8.11, 95% CI 6.27-10.51 in 16-17 year olds). Of sports injury attendances, 50.3% were football-related. Football was overwhelmingly the main cause of boys' sports injury in both the organized and informal sports injury categories. When football injuries were excluded from the analysis, the widening teenage gender gap in injury risk disappeared. There was no significant gender difference in teenagers' rates of A&E attendance for injuries sustained during compulsory school physical education (PE), suggesting a dose-response relationship between sports participation and injury risk. CONCLUSIONS This study found significant gender inequalities in adolescent injury risk, which were largely attributable to boys' football injuries. Focusing prevention efforts on making football safer would, then, be a sensible strategy for reducing the overall burden of adolescent injury and for reducing sex inequalities in injury risk; however further research is needed to understand how the risks differ between organized and informal football. These findings are also interesting because of what they suggest about teenage girls' lack of participation in sport and habitual physical activity. This is clearly of public health concern because of the links between physical inactivity and a range of health problems.
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Affiliation(s)
- R McQuillan
- Public Health Sciences, University of Edinburgh, Medical School, Teviot Place, Edinburgh EH8 9AG, UK
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Abstract
BACKGROUND In recent years, the discipline of paediatric palliative care has emerged in response to the awareness of the distinct needs of dying children. To date, in Ireland there is no paediatrician trained in palliative medicine, and specialist paediatric palliative care is generally delivered by adult trained teams. AIMS We wished to examine the experience of an adult palliative care service providing palliative care to children. METHODS The study entailed three stages: (1) a retrospective chart review of all children referred to the service; (2) a questionnaire survey; and (3) a focus group to explore the views of staff in caring for children. RESULTS The main themes highlighted were staff competence, staff stress, uncertainty of prognosis, resource implications and co-operation with other teams. CONCLUSION This study highlights some of the challenges for an adult palliative care team providing paediatric palliative care. Many skills developed for adult patients can be used in paediatric palliative care. Adult palliative care teams and paediatric teams have complementary skills. The challenge is to integrate services to meet the needs of terminally ill children.
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Lucey JV, Thompson C, Green AJ, McDonnell CO, McQuillan R, Fitzgerald R. Book reviews. Ir J Med Sci 2000. [DOI: 10.1007/bf03170495] [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: 10/20/2022]
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McLoughlin R, McQuillan R. Transdermal fentanyl and respiratory depression. Palliat Med 1997; 11:419. [PMID: 9472602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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McLoughlin R, McQuillan R. Using nifedipine to treat tenesmus. Palliat Med 1997; 11:419-20. [PMID: 9472603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Hanlon P, Beck S, Robertson G, Henderson M, McQuillan R, Capewell S, Dorward A. Coping with the inexorable rise in medical admissions: evaluating a radical reorganisation of acute medical care in a Scottish district general hospital. Health Bull (Edinb) 1997; 55:176-84. [PMID: 9364106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To describe radical changes in acute medical care in a district general hospital and assess their impact on staff and patients. DESIGN A before and after comparison of structure, process and outcome indicators in the year preceding and following reorganisation. SETTING The Adult Medicine Clinical Directorate of the Royal Alexandra Hospital in Paisley, Scotland. SUBJECTS Staff in the Medical Directorate and a random sample of 400 patients. INTERVENTIONS The main stimulus for reorganisation was the pressure caused by a relatively steep rise in admissions. In response, the six existing general medical wards were converted into a 38-bed Medical Admissions Unit and five more specialised wards. A new acute receiving rota allowed each consultant to concentrate almost exclusively on acute receiving for one week at a time. RESULTS The boarding of patients in non-medical wards was eliminated through improved bed management. The needs of patients became better matched to the specialism of their consultant. The cardiologist's share of in-patients with cardiological problems rose from 34% of 2,877 cases to 58% of 3,085 cases (p < 0.001) and the respiratory physicians' share of respiratory in-patients grew from 53% of 1,281 cases to 67% of 1,287 cases (p < 0.001). After the reorganisation, medical staff had significantly fewer concerns about losing track of patients (p < 0.01) or about boarding (p < 0.01), however, concern about 'blocked beds' became greater (p < 0.05). Nurses reported more time for health promotion (p < 0.01) but also a rise in stress (p < 0.05). More patients reported that staff had time to explain their treatment (85/109 (79%) before, 93/105 (89%) after, p < 0.05) and a higher proportion felt ready for discharge (91/108 (84%) before, 99/106 (93%) after, p < 0.05). CONCLUSIONS Radical reorganisation of medical care in response to rising acute medical admissions is achievable and may lead to improvements in care.
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Affiliation(s)
- P Hanlon
- Royal Alexandria Hospital, Paisley
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Owen MD, Fibuch EE, McQuillan R, Millington WR. Postoperative analgesia using a low-dose, oral-transdermal clonidine combination: lack of clinical efficacy. J Clin Anesth 1997; 9:8-14. [PMID: 9051539 DOI: 10.1016/s0952-8180(96)00218-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
STUDY OBJECTIVE To determine if a lower than previously reported oral-transdermal clonidine regimen could reduce postoperative morphine requirements without producing systemic side effects. DESIGN Double-blind, randomized, placebo-controlled study. SETTING University-affiliated hospital. PATIENTS 29 healthy, ASA physical status I and II females undergoing elective abdominal hysterectomy. INTERVENTIONS Patients received preoperative oral clonidine 4 to 5 mu/kg and a 7 cm2 transdermal clonidine patch (0.2 mg/24 hours) or a placebo tablet and patch. MEASUREMENTS AND MAIN RESULTS Postoperative patient-controlled analgesia pumps provided morphine during the 48-hour study period. Morphine use, hemodynamic changes, and nonhemodynamic side effects were recorded. Additionally, visual analog pain scales (VAPS) and plasma concentrations of morphine and clonidine were measured. We found that low-dose clonidine had no potentiating effect on morphine analgesia. Postoperative morphine use, VAPS, and morphine plasma levels were similar between the control and clonidine-treated groups. Nevertheless, patients in the clonidine group experienced a significantly greater incidence of intraoperative and postoperative hypotension and bradycardia than did the control group. No differences were noted in the incidence of nonhemodynamic side effects. CONCLUSIONS The low-dose oral-transdermal clonidine regimen evaluated failed to reduce postoperative morphine requirements, although patients who received clonidine were still at risk for developing hypotension.
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Affiliation(s)
- M D Owen
- Department of Anesthesiology, Saint Luke's Hospital of Kansas City, MO, USA
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Abstract
Life-threatening illness is fortunately rare in children. Some children, however, will need palliative care for symptom control; psychological support may be needed by the child and the child's family; and families may require help with decisions about life-prolonging treatment. Providing consistent high-quality care for a relatively uncommon problem is difficult. Adult palliative care services, liaison with pediatricians can help provide this care.
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Affiliation(s)
- R McQuillan
- Holme Tower Marie Curie Centre, Penarth, South Glamorgan, United Kingdom
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