K Boyd

The University of Edinburgh, Edinburgh, Scotland, United Kingdom

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Publications (16)62.38 Total impact

  • M A Denvir, S A Murray, K J Boyd
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    ABSTRACT: Palliative care is recommended for patients with end-stage heart failure with several recent, randomised trials showing improvements in symptoms and quality of life and more studies underway. Future care planning provides a framework for discussing a range of palliative care problems with patients and their families. This approach can be introduced at any time during the patient's journey of care and ideally well in advance of end-of-life care. Future care planning is applicable to a wide range of patients with advanced heart disease and could be delivered systematically by cardiology teams at the time of an unplanned hospital admission, akin to cardiac rehabilitation for myocardial infarction. Integrating cardiology care and palliative care can benefit many patients with advanced heart disease at increased risk of death or hospitalisation. Larger, randomised trials are needed to assess the impact on patient outcomes and experiences. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
    Heart (British Cardiac Society) 04/2015; 101(13). DOI:10.1136/heartjnl-2014-306724 · 6.02 Impact Factor
  • Journal of Hepatology 04/2015; 62:S836-S837. DOI:10.1016/S0168-8278(15)31469-0 · 10.40 Impact Factor
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    ABSTRACT: Patients with advanced heart disease typically have a poor prognosis despite optimal cardiac therapy. These patients and families rarely receive coordinated holistic assessment and future care planning (FCP). This Marie Curie funded phase 2 trial seeks to explore whether a FCP intervention is acceptable, feasible and deliverable to patients (and families) with advanced heart disease following a recent unscheduled hospital admission. Patients with an unscheduled admission for acute coronary syndrome (ACS) or heart failure (HF) were screened using a prognostic scoring tool. Patients with a 12 month estimated mortality risk of 20% or greater were randomly allocated to either early (upon discharge) or delayed (after 12 weeks) FCP for 12 weeks. The FCP intervention combines holistic needs-assessment by a cardiologist with creation of a written/shared FCP and nurse-led care in the community. Primary outcome is quality of life of patients and carers assessed using questionnaires. We recruited 50 patients (32 carers) - 22% with ACS, 68% HF and 10% valvular heart disease. There were 5 deaths and 5 withdrawals. For the whole cohort mean age is 81.1 years (SD=8.6), 60% male, mean Charlson comorbidity index was 4.2 (SD=1.7), median Canadian frailty scale=5 (Mildly frail). Intervention and follow up is currently on-going. Findings demonstrate that the intervention and outcome measures were feasible and deliverable. Further analysis will provide invaluable information on the nature and feasibility of a larger clinical trial sufficiently powered to address hard clinical end-points. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
    Supportive and Palliative Care 03/2015; 5(1):104. DOI:10.1136/bmjspcare-2014-000838.7
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    ABSTRACT: Objective: To establish whether Foundation Year 1 (FY1) doctors in Edinburgh are sufficiently prepared to deliver generalist palliative care, with a view to informing developments in undergraduate and postgraduate medical education. Methods: Questionnaires were sent to FY1 doctors and to supervising consultants. Semi-structured interviews were conducted with five FY1 doctors. Results: A total of 60 FY1 doctors and 31 consultants replied. The majority of FY1 doctors did not feel well-prepared to deliver basic palliative care, especially when managing distress and social issues. Consultants agreed that FY1 doctors were underprepared. Junior doctors reported high levels of distress themselves, with few seeking support from senior colleagues. Both sets of respondents made suggestions for curricular improvements. Conclusions: Newly qualified doctors were not adequately prepared to deliver generalist palliative care and lacked first-hand experience of end-of-life issues. Current reviews of palliative care education should address the learning and supportive needs of our most junior doctors more effectively.
    The journal of the Royal College of Physicians of Edinburgh 03/2013; 43(1):24-8. DOI:10.4997/JRCPE.2013.105
  • The journal of the Royal College of Physicians of Edinburgh 01/2013; 43(2):187.
  • Supportive and Palliative Care 03/2012; 2(Suppl_1):A43-A43. DOI:10.1136/bmjspcare-2012-000196.124
  • S. A. Murray, K. Boyd
    Palliative Medicine 06/2011; 25(4):382. DOI:10.1177/0269216311401949 · 2.85 Impact Factor
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    ABSTRACT: Introduction and aimsDue to the variable illness trajectory and uncertain prognosis, most patients with advanced heart disease fail to receive adequate end-of-life care. The Gold Standards Framework (GSF) has been used in primary care to identify such patients. We assessed its utility in patients presenting in the acute hospital setting with acute coronary syndrome (ACS).Methods Consecutive patients with ACS admitted to an acute cardiology unit, over two separate 4 week periods, were included. Data were collected from patient notes and interviews with doctors. Patients were assessed using GSF and a clinical prognostic score (Global Registry of Acute Coronary Events, GRACE). All patients were followed-up for 1 year.Results168 patients were included. 40 (24%) patients were identified under the GSF as being in the last year of life due to their heart disease. Compared with GSF negative patients, GSF positive patients had a significantly higher GRACE score (13.9 vs 8.3, p=0.002). The GRACE score of patients who died within 6 months was significantly higher than those who survived (20.2 vs 9.27, p=0.008). GSF poorly predicted 6 month mortality (sensitivity 17%) but was strongly predictive of all-cause readmission during follow-up (p=0.000001).ConclusionGSF may be useful in predicting readmissions in ACS patients but is poor at predicting mortality. Combining GSF criteria with GRACE may guide secondary care clinicians in identifying ACS patients who may benefit from end of life care.
    BMJ British medical journal 04/2011; 1(1). DOI:10.1136/bmjspcare-2011-000020.43 · 16.30 Impact Factor
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    ABSTRACT: IntroductionPatients with chronic heart failure (CHF) suffer significant mortality and morbidity. New patient-centred methods of assessing quality of life are needed that focus on supportive and palliative care needs. We aimed to assess a previously validated palliative care outcome scale (POS) questionnaire in patients with CHF.Methods Patients seen by Specialist Heart Failure Nurses in outpatient clinics and on home visits were recruited. POS questionnaires were completed by patients at three time points over an 8 week period. Specialist Heart Failure Nurses completed a POS at baseline for each patient. Patients completed the Euroqol EQ5D at the end of the study.ResultsAverage age was 73, and all patients had left ventricular failure. 32 patients completed the baseline questionnaire; 25 completed questionnaires at all 3 time points. Patient POS scores were significantly consistent between time points (p
    Supportive and Palliative Care 04/2011; 1(1). DOI:10.1136/bmjspcare-2011-000020.48
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    ABSTRACT: Introduction and aimsIdentifying patients with non-malignant disease in the hospital setting who might benefit from palliative and supportive care is challenging. There is little research in this area. A screening tool, the Scottish Palliative Care Indicator Tool (SPICT) was developed to help identify acute cardiac patients who might benefit from supportive/palliative care. We aimed to compare this new tool with the Gold Standards Framework Prognostic Indicator Guide (GSF-PIG)and two clinical prognostic scores currently used in hospital practice (GRACE and Seattle).Methods Consecutive patients admitted to a cardiology ward with acute coronary syndrome (ACS) and acute heart failure (AHF) over a 4 week period were identified. Data for SPICT, GSF-PIG, GRACE (estimated 6 month% mortality) and Seattle scores (estimated 12 month% mortality) were obtained from patient records and by interviews with hospital staff.ResultsACS (78)AHF (16)% meeting criteriaMean GRACE score(% (SD))% meeting criteriaMean Seattle score (% (SD))SPICT negative92.310.0 (9.9)75.013.2 (8.2)SPICT positive7.720.0 (12.4)25.013.3 (7.3)p value(t test)p=0.022p=0.985GSF negative84.49.5 (9.8)37.512.3 (11.6)GSF positive15.617.0 (11.3)62.513.7 (4.9)p value(t test)p=0.019p=0.745ConclusionsSPICT and GSF identified ACS patients with significantly higher risk of death within 6 months of discharge. Neither prognostic tool appeared to predict Seattle score mortality in patients with AHF. SPICT and GSF have equivalent predictive utility in identifying acute cardiac patients nearing end-of life.
    Supportive and Palliative Care 04/2011; 1(1). DOI:10.1136/bmjspcare-2011-000020.60
  • BMJ British medical journal 01/2011; · 16.30 Impact Factor
  • BMJ British medical journal 01/2011; · 16.30 Impact Factor
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    ABSTRACT: The objectives of this review were to assess the methods and approaches applied to end-of-life cancer research based on papers focusing on approaches or methodological issues related to seeking the views of people affected by terminal cancer. A comprehensive search of 10 databases (January 1980-February 2004) was undertaken. References were screened, quality assessed and data extracted by two reviewers. Analysis followed a meta-narrative approach. Fifteen papers were included. They discussed 'traditional' approaches, such as focus groups, interviews, surveys, as well as innovative approaches allied to the arts. They reveal that mixed methods are gaining popularity. The emotional demands placed on researchers and the ethical issues involved in this research area were also discussed. We concluded that researchers should embrace innovative approaches from other areas of social science, such as the use of arts-based techniques. This may facilitate recruitment of the hard-to-reach groups and engage with experiences that may be otherwise difficult to verbalize. Although researching the needs of the dying carries challenges, these are not the exclusive domain of the cancer field. This study reveals that diverse methods, from research-based drama to postal questionnaires, can enhance end-of-life research. However, this review reveals the need for more methodological work to be undertaken and disseminated.
    European Journal of Cancer Care 08/2008; 17(4):377-86. DOI:10.1111/j.1365-2354.2007.00880.x · 1.76 Impact Factor
  • Palliative Medicine 05/2008; 22(3):291-2. DOI:10.1177/0269216307087143 · 2.85 Impact Factor
  • European Journal of Palliative Care 01/2008; 15(6):272-275.
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