Palliative Medicine (PALLIATIVE MED)

Publications in this journal

• Article: GERIATRIC PALLIATIVE CARE MODELS BASED ON THE PERCEPTIONS OF - AND ATTITUDES TOWARD END-OF-LIFE NEEDS AND DEMANDS OF TARGET POPULATION

  Kordzaia D, Rukhadze T, Velijanashvili M, Amirejibi D, Durglishvili N, Labadze T
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  ABSTRACT: 24 experts from the fields of Health and Social care, Justice, Economics, Sociology, Gerontology and Geriatrics have identified that: I. Demography, illnesses’ structure, family income, health insurance, legislative and social securities formulate the necessary predictors for creation of Geriatric Palliative Care Model (GPCM) (abstract, EAPC XI Congress, Lisbon, 2011); II. To create such model, the perceptions (P) of- and attitudes (A) toward end-of-life (EL) needs (N) and demands (D) of aged population itself obviously should be taken into account. upposedly these P&A are significantly determined by recognition of the limited lifespan. The similar situation is seen in patients with cancer, who really recognize their limited life terms. Aim: To offer palliative care research teams from different countries to participate in multi-center surveys for “Mapping and Comparative Analysis of P&A toward ELND groups of People with Recognized Limited Lifespan due to Different Causes”. Three groups will be studied: I -”Healthy” elders (80 years and more), continuing social activity, though recognizing the limited terms of remaining life; II - Terminal patients with cancer recognizing their prognosis and the limited terms of remaining life; III - Control group - healthy people of middle age. The research will be based on respondents’ semistructural interviews designed with two main questions: “Tell us about your life” and “What do you think about future?” Supportive questions will be selected according to: Maslow’s pyramid of needs, results of studies by Chochinov et al., TOTE model, model of behavioral analysis on logical levels by G. Bateson. The interviews will be audio-taped, transcripted and coded for further cluster analysis by computer program QSR NVivo9. Study results will support: the correct understanding of the ELND; creation of reasonable background for the development of optimal GPCM; perfection of the palliative care model for cancer patients.
  Palliative Medicine 01/2012; 26(4):657.
• Article: Evaluation of Emergency of Admissions in Palliative Care Unit Patients Suffering with Pain - Causes and Challenges - Georgian Experience

  Rukhadze T, Aladashvili T, Sesiashvili E, Lomidze T, Shanshiashvili I, kordzaia. D
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  ABSTRACT: Aims: Usually patients are referred to the palliative care (PC) unit of National Cancer Centre (NCC) from: home based palliative care services, district outpatient clinics, GPs, Medical Oncologists and by emergency referral. Sometimes, patients suffering with pain are admitted for: opioids prescription or its adequate dose administration. The aim of the research is to identify the most frequent problems of patients suffering with pain and admitted in PC unit of NCC, outline the challenges and the ways of their further improvement. Study population: Were evaluated 716 patients admitted in PC Unit of NCC during the 2010-2011. In the study were involved 427 patients. Methods: Presented study is prospective. Patients were evaluated by medical staff of PC Unit of NCC. Inclusion criteria were: a) Cancer Patients with pain; b) Age >18 years; c) Life expectancy < 6 months; d) Admitted for emergency reasons for pain and symptom control adequateness. Exclusion criteria were: a) patients in the dying phase of their illness evaluated by the admitting physician or nurse; b) mentally ill patients. The method of inferential statistics was used. Results: Study showed that the main problem of emergency admission of those patients were increasing the pain score and from this number of patients in 99% of cases opioids administration were required. In 76% of cases opioids administration were first time and in 24% of cases increasing the dosage were needed. Conclusion: Pain is still the most unresolved symptom for control (p< 0.001). The problems in pain management and related emergency admission at PC unit of NCC should be caused by lacking of: 1) legislative bases - limitation validation of prescription (7 days), 2) list and forms of opioids and their availability, 3) knowledge and experience of health care professionals - stigma and opioidphobia of society and health care professionals. The study was funded from Georgian National Association for Palliative Care.
  Palliative Medicine 01/2012; 26(4):566.
• Article: Using maps and funnel plots to explore variation in place of death from cancer within London, 2002–2007

  Peter Madden, Victoria H Coupland, Henrik Møller, Elizabeth A Davies
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  ABSTRACT: London has a high proportion of hospital deaths, which health policy seeks to reduce.We explore variation and trends in place of death from cancer within London between 2002 and 2007. Mortality data based on death certificates were used to define deaths from cancer at home, hospice, hospital and nursing home and examine trends over time for London. Proportions of deaths in each place were presented in maps for 31 London primary care trusts (PCTs). Funnel plots were used to identify consistent performance outside the control limits of three standard deviations. There was little overall change in place of death for London, but consistent variation between PCTs. Outer London PCTs had higher proportions of home deaths and inner London PCTs higher proportions of hospice deaths. Funnel plots identified consistent high outlying performance for home, hospice and hospital deaths. No PCT showed a change of 10% or more in home deaths, but five showed decreasing hospital deaths and three increasing hospice deaths. Maps and funnel plots appear useful for identifying areas with differing performance for home, hospital, nursing home and hospice deaths. These methods may help further investigation of how local services may successfully support deaths outside hospital.
  Palliative Medicine 03/2011; 25(4):323-332.
• Article: An evaluation of the implementation of the GSF and LCP

  Ashton S, McClelland RJ, Roe B, Mazhindu D. Gandy R
  Palliative Medicine 01/2010; vol. 24,:202-252.
• Article: Inappropriateness of using opioids for end-stage palliative sedation: a Dutch study.

  R P B Reuzel, G J Hasselaar, K C P Vissers, G J van der Wilt, J M M Groenewoud, B J P Crul
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  ABSTRACT: To be able to distinguish end-stage palliative sedation from euthanasia without having to refer to intentions that are difficult to verify, physicians must be able to manage palliative sedation appropriately (i.e., see that death is not hastened as a result of disproportionate medication). In the present study, we assessed whether or not this requirement is met in the Netherlands. We sent a retrospective questionnaire to 1,464 medical specialists, general practitioners, and nursing home physicians in the Netherlands. Furthermore, we held two sets of 20 and 22 semi-structured in-depth interviews with general practitioners, internists, lung specialists, and nursing home physicians. Although most guidelines discourage the administration of opioids alone for purposes of palliative sedation, opioids alone were administered for 22% of all the patients reported upon. Those physicians who were more experienced, general practitioners, and physicians who had consulted a palliative care expert administered only opioids significantly less often than the other physicians. The interviewees reported difficulties in assessing the appropriateness of medication, feeling uncertain about the pharmacokinetics of drugs used in moribund patients. Given that no more than 2% of the respondents perceived palliative sedation to be used as a form of euthanasia and that the use of opioids alone was not associated with shorter survival rates, the inappropriate use of opioids can only be attributed to a lack of knowledge or skill and/or a tradition of alleviating refractory dyspnoea with the use of opioids and not as an intentional means of hastening death.
  Palliative Medicine 08/2008; 22(5):641-6.
• Article: Successful control of vomiting, due to malignant upper gastrointestinal obstruction, by 'blind' percutaneous gastrostomy, in a terminally ill patient.

  S M W Hutchison
  Palliative Medicine 08/2008; 22(5):673-4.
• Source

  Available from: eapcnet.org

  Article: The response of a Swiss university hospital's palliative care consult team to assisted suicide within the institution.

  J Pereira, P Laurent, B Cantin, D Petremand, T Currat
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  ABSTRACT: In January 2006 the Centre Hospitalier Universitaire Vaudois (CHUV), a large university hospital in Lausanne, Switzerland, became the first hospital in Switzerland to allow assisted suicide (AS) in exceptional cases within its walls. However, euthanasia is illegal. This decision has posed several ethical and practical dilemmas for the hospital's palliative care consult service. To address these, the team embarked on a formal process of open dialogue amongst its members with the goal of identifying a collective response and position. This process involved meetings every 4 to 6 weeks over the course of 10 months. An iterative process unfolded. One of the principal dilemmas relates to finding a balance between the team's position against AS and the patient's autonomy and the institution's directive. Although all team members expressed opposition to AS, there were mixed opinions as to whether or not the team members should be present during the act if requested so by patients. Some thought this could be misinterpreted as complicity in the act and could send out mixed messages to the public and other health professionals about palliative care. Others felt that the team's commitment to nonabandonment obliged them to be present even if they did not provide the drug or give any advice or assistance. The implications of nonabandonment are explored, as are several other questions such as whether or not the teams are obliged to provide detailed information on AS when requested by patients.
  Palliative Medicine 08/2008; 22(5):659-67.
• Source

  Available from: ceco.org.uk

  Article: Developing narrative research in supportive and palliative care: the focus on illness narratives.

  A F Bingley, C Thomas, J Brown, J Reeve, S Payne
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  ABSTRACT: The phenomenon of the 'illness narrative' is well-documented, in the last 25 years, of increasing interest to researchers in health and social sciences. Personal stories about the experience of facing the end of life also have an established history of particular relevance for palliative care clinicians. In this article, we review and describe a range of narrative analysis approaches that may be of use in palliative care. In particular, we distinguish between qualitative analysis applied to narratives and narrative analysis as a method. We discuss the potential benefits and challenges in the use of narrative research methods as a means to deepen our understanding of patient, carer and health professionals' experience, and to support improvements in end of life care policy and practice.
  Palliative Medicine 08/2008; 22(5):653-8.
• Article: How strictly should advance decisions be followed? The patients' opinion.

  R J Jox, M Krebs, J Bickhardt, K Hessdörfer, S Roller, G D Borasio
  Palliative Medicine 08/2008; 22(5):675-6.
• Article: Differing management of people with advanced cancer and delirium by four sub-specialties.

  M Agar, Dc Currow, J Plummer, R Chye, B Draper
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  ABSTRACT: Delirium in advanced cancer is prevalent, with limited prospective data to guide management. The aim was to survey current practice of specialists using two contrasting cases of delirium in cancer. A questionnaire was designed to identify investigations and treatment used, in relation to two cases. Overall response rate (n = 270) was 30%. Place of care: Only 35% of medical oncologists would consider care at home for a patient with reversible delirium compared with 66% of other specialists. Investigations: 85% specialists would order basic bloods, however, medical oncologists were more likely to use oxygen saturation and head computed tomography, psychogeriatricians more likely to order thyroid function and palliative medicine specialists less likely to order chest X-ray and urine culture. Greater than 40% of specialists would do no investigations for terminal delirium. Treatment: Medical oncologists use more pre-emptive therapies and more likely to use a benzodiazepine as agent of choice, and Palliative medicine specialists used significantly more neuroleptics to treat hypoactive symptoms of delirium. The survey emphasise significant areas of variability in the management of delirium in advanced cancer. Furthermore, evidence to guide management in ways that draw on the strengths and knowledge of each specialty is urgently needed.
  Palliative Medicine 08/2008; 22(5):633-40.
• Article: The acceptability of an information leaflet explaining cardiopulmonary resuscitation policy in the hospice setting: a qualitative study exploring patients' views.

  H M Johnson, A Nelson
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  ABSTRACT: Guidelines advise that patients receiving palliative care should be given realistic information about cardiopulmonary resuscitation (CPR) and encouraged to participate in decisions about this. For many patients attending a hospice, CPR is unlikely to be successful because of advanced disease. It is difficult to predict which patients would like to discuss CPR and whether such discussion might cause distress. This research set out to determine the acceptability and understanding of a patient information leaflet about CPR given to inpatients and day-unit patients in one hospice, and to seek patients' views on communication about resuscitation. Semi-structured interviews were carried out with five hospice inpatients and one day-unit patient and analysed using interpretative phenomenological analysis for emergent themes. The leaflet was acceptable to the participants but was interpreted in the context of their understanding of their illness and prognosis. The leaflet alone is not a reliable method of communicating resuscitation policy and should be followed up by the opportunity to ask questions, if the patient wishes. Many factors influence patient choices about CPR. Realistic information about prognosis and about the risks and harms of CPR would allow patients to make a better-informed decision. However, if a patient prefers not to talk about their prognosis and end-of-life issues, then this should be respected.
  Palliative Medicine 08/2008; 22(5):647-52.
• Article: Death during transfer of a palliative care patient.

  N J Pease, I F Finlay
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  ABSTRACT: This short report illustrates the potential confusion that exists when terminally ill patients die during transfer between places of care. The report documents the legal requirements necessary if a terminally ill patient dies during transfer and raises the debate regarding what policies and practice currently exist, within the UK, for transfer of terminally ill patients.
  Palliative Medicine 08/2008; 22(5):671-2.
• Article: Palliative care research in the community: it is time to progress this emerging field.

  S Murray, S Barclay, M I Bennett, M Kendall, Z Amir, M Lloyd-Williams
  Palliative Medicine 08/2008; 22(5):609-11.
• Article: To replace or not to replace? - Partial coning and a sixth nerve palsy secondary due to displacement of a tunnelled intrathecal catheter for pain control.

  J Gibbins, C Steeds, G L Greenslade, S R Tunstall, N K Patel, C F Stannard
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  ABSTRACT: We report the displacement of a tunnelled intrathecal catheter causing significant cerebrospinal fluid (CSF) leak, resulting in partial coning and a sixth nerve palsy. The patient had advanced malignant mesothelioma and all other methods of pain control had been unsuccessful. As far as we are aware, there are no published reports of early replacement of an intrathecal catheter in patients with neurological sequelae. Surgical re-siting of the intrathecal catheter produced good pain relief for many months. Doctors involved in the use of indwelling intrathecal catheters for pain control must be aware of the risk of significant neurological sequelae but should not dismiss re-establishment of intrathecal therapy in the presence of significant neurological complications.
  Palliative Medicine 08/2008; 22(5):668-70.
• Source

  Available from: eapcnet.org

  Article: Opioids in context: relieving the pain of cancer. The role of comprehensive cancer management.

  P J Hoskin
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  ABSTRACT: Optimal pain control requires detailed appraisal of each symptom; in many cases definitive treatment of the underlying cause will be the most effective means of pain control. As an example back pain may be due not only to bone metastases but also enlarging lymph nodes, renal pain or retroperitoneal tumour. Benign causes including degenerative joint disease should also be considered and each cause treated specifically alongside the use of analgesics.
  Palliative Medicine 07/2008; 22(4):303-9.
• Article: A Delphi study to develop the Association for Palliative Medicine consensus syllabus for undergraduate palliative medicine in Great Britain and Ireland.

  P Paes, B Wee
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  ABSTRACT: The Association for Palliative Medicine (APM) produced a previous undergraduate palliative medicine syllabus in 1992. This study describes the process of developing the new APM consensus syllabus against the background of changes in medical education and palliative medicine since 1992. The syllabus was derived by means of a Delphi study carried out amongst experts in palliative medicine across Britain and Ireland. Forty-three participants agreed to take part. Three rounds of the Delphi study took place. Consensus (75% agreement) was achieved in over 90% of the outcomes. The new syllabus is broken down into the following sections: basic principles, physical care, psychosocial care, culture, language, religious and spiritual issues, ethics and legal frameworks. Learning outcomes are categorised as essential or desirable. Using a Delphi study, we have developed a consensus syllabus for undergraduate palliative medicine. This is sufficiently flexible to allow all medical schools to ensure that their students achieve the essential learning outcomes by the time they graduate, whereas those with more generous curricular space will additionally be able to deliver selected desirable learning outcomes.
  Palliative Medicine 07/2008; 22(4):360-4.
• Article: Revisiting depression in palliative care settings: the need to focus on clinical utility over validity.

  J L Reeve, M Lloyd-Williams, C Dowrick
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  ABSTRACT: To review the literature on depression in palliative care patients to identify implications for development of clinical practice and individual patient care. A qualitative review of depression prevalence studies in palliative care settings. We explore the utility of existing prevalence studies for clinical practice through testing two hypotheses: that high prevalence rates are associated with increased risk factors in study samples, and that poor methodological quality of the studies artefactually inflate prevalence estimates. Eighteen studies were identified in the search and included in this review. Risk factors may contribute to depression prevalence but through a complex interaction of factors making individual risk levels hard to determine. Measurement artefact cannot, alone, account for elevated levels of depression in this population but may contribute to imprecision. The importance of organic decline as a potential confounding variable is highlighted. Future research into the causes and prevalence of depression should adopt longitudinal approaches using large samples, and consider the impact of organic disorder as an important confounding factor. Clinical practice and care of individual patients may be better supported by development of a prognostic index considering the predictive power of depressive symptoms and risk factors on well-being.
  Palliative Medicine 07/2008; 22(4):383-91.
• Source

  Available from: ntu.edu.tw

  Article: Good death study of elderly patients with terminal cancer in Taiwan.

  S Y Cheng, W Y Hu, W J Liu, C A Yao, C Y Chen, T Y Chiu
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  ABSTRACT: Over half of all terminal cancer patients in Taiwan are 65 or older, thus demonstrating the importance of terminal care for elderly people. This study investigates the good death status of elderly patients with terminal cancer, comparing the differences in the degree of good death among elderly and younger groups, and exploring the factors related to the good death score. Three hundred and sixty-six patients with terminal cancer admitted to a palliative care unit were enrolled. Two structured measurements, the good death scale and the audit scale for good death services, were used as the instruments in the study. The scores of individual items and of the good death scale were increased significantly in both elderly (n = 206, 56.3%) and younger (n = 160, 43.7%) groups from the time of admission to just prior to death. However, the elderly group had significantly lower scores in 'awareness' (t = -3.76, P < 0.001), 'propriety' (t = -2.92, P < 0.01) and 'timeliness' (t = -2.91, P < 0.01) than the younger group prior to death. Furthermore, because of a lack of truth-telling, the elderly group also had significantly lower scores than the younger group in both 'respect for autonomy' and 'decision-making participation' (t = -2.17, P < 0.05; t = -2.21, P < 0.05, respectively). Multiple regression analysis revealed that 'respect for autonomy' (OR = 1.22, 95% CI = 0.76-1.67) and 'verbal support '(OR = 0.93, 95% CI = 0.34-1.51) were two independent correlates of the good death score in the elderly group. The dilemma of truth-telling compromises the autonomy of the elderly patients with terminal cancer and consequently affects their good death scores. The palliative care team should emphasize the issue of truth-telling in the process of caring for terminally ill cancer patients, especially elderly patients.
  Palliative Medicine 07/2008; 22(5):626-32.
• Article: Gabapentin for breakthrough pain due to bone metastases.

  A Caraceni, E Zecca, C Martini, A Pigni, P Bracchi
  Palliative Medicine 07/2008; 22(4):392-3.
• Article: Effect of a population-based educational intervention focusing on end-of-life home care, life-prolonging treatment and knowledge about palliative care.

  M Miyashita, K Sato, T Morita, M Suzuki
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  ABSTRACT: The effectiveness of population-based educational interventions in palliative care is unclear. We conducted an educational intervention study for the general public focusing on end-of-life home care, life-prolonging treatment and knowledge about palliative care and measured the change in perception about these issues. Participants were recruited from the 11 districts of Fukushima City, Japan. One-hour educational lectures were conducted in each district from April 2006 to March 2007. Meetings were held in a community centre or hall in each district. We asked participants to fill in a questionnaire before and after the educational lecture. Of 607 participants, 595 (98%) answered both pre- and post-intervention questionnaires. The feasibility of a home death changed from 9% before to 34% after the intervention (P < 0.001). In addition, preference for life-prolonging treatment and attitudes toward end-of-life care including symptom management at home, misconceptions about opioids, artificial hydration and communication issues between patient and medical practitioners were significantly improved after the intervention. Factors that were significantly associated with changing perceptions about the feasibility of a home death were male gender, change in beliefs regarding burden to family caregivers, anxiety regarding admission to the hospital with worsening physical condition and fear that pain would not be relieved at home. This population-based educational intervention was effective in changing beliefs regarding the feasibility of home care, preference for life-prolonging treatment and attitudes toward end-of-life care.
  Palliative Medicine 07/2008; 22(4):376-82.