[Show abstract][Hide abstract] 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.
[Show abstract][Hide abstract] 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 01/2011; 1(1). · 13.66 Impact Factor
[Show abstract][Hide abstract] 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
[Show abstract][Hide abstract] 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.
[Show abstract][Hide abstract] 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. · 1.31 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Services for people with heart failure are under-developed. The perspectives of patients, their informal and professional carers should inform development of service models.
To describes how patients and carers view health and social care in the last year of life.
Qualitative, serial interviews at three monthly intervals with 20 patients (New York Heart Association Grade IV heart failure), their main informal carer, general practitioner and other key professionals in an urban, community setting in SE Scotland. These were tape-recorded, and analysed with the aid of the qualitative data analysis package NVivo and techniques of narrative analysis.
112 interviews comprised; patients (50), informal carers (27), professionals (30), bereavement interviews (5). Patients with heart failure and their carers felt unsupported by services, and had little understanding of their condition, treatment aims or prognosis. Quality of life was severely compromised by physical limitations and psychological morbidity. Psychosocial care, patient and carer education, co-ordination of care between primary and secondary sectors and with social services was generally poor. Many patients had no access to a heart failure nurse specialist. A palliative care approach was rarely apparent.
Patients with advanced heart failure may benefit from specific models of care with strategic planning across primary and secondary care, and involvement of health and social care services and specialist palliative care providers. Models of care, which focus on quality of life, symptom control, and psychosocial support for patients and their families while continuing active treatment, should be developed.
European Journal of Heart Failure 09/2004; 6(5):585-91. · 5.25 Impact Factor