Scott Murray

University of Edinburgh | UoE · Usher Institute

Background: The Supportive and Palliative Care Indicators Tool (SPICT) was developed for identifying, in a timely manner, patients who may benefit from supportive and palliative care for better treatment review, care-plan discussion, and end-of-life care. Although the SPICT has been validated in different languages and for patients living in differ...

The Supportive and Palliative Indicators Tool (SPICT) was developed for timely identifying patients who may benefit from supportive and palliative care for a better treatment review, care plan discussion, and end-of-life care. Although the SPICT has been validated in different languages and patients living in different settings, it has not been val...

Objectives The COVID-19 pandemic challenged palliative care (PC) services globally. We studied the ways healthcare professionals (HCPs) working in faith-based hospitals (FBHs) experienced and adapted care through the pandemic, and how this impacted patients with PC needs. Methods In-depth interviews were conducted with HCPs from FBHs serving rural...

Background: There is a need for tools in primary care to support clinicians to identify patients with unmet palliative care needs. The Supportive and Palliative Care Indicators Tool (SPICT) is concise and covers most conditions in primary care settings. However, the SPICT was not available in Japanese. Methods: The translation and cultural adaptati...

Background Unscheduled care is used increasingly during the last year of life by people known to have significant palliative care needs. Aim To document the frequency and patterns of use of unscheduled healthcare by people in their last year of life and understand the experiences and perspectives of patients, families and professionals about acces...

Introduction Death and dying are not 9-5 activities. When a crisis starts out-of-hours (OOH) patients may not be identified as having palliative care needs and are disadvantaged in a frantic system. Whether they die today or another day, they must navigate a complex and confusing process to seek help. Aims To analyse the NHS out-of-hours care syst...

In the majority of high-income settings, palliative care (PC) still relies on hospital care and palliative care specialists, while the involvement of other healthcare professionals, notably general practitioners (GPs), is undefined and incomplete. Moreover, to develop the full potential of palliative care, the participation of the public is needed,...

Objective To estimate the capacity of European countries to integrate palliative care (PC) into their health systems through PC service provision for patients of all ages, with different care needs and diseases, in various settings and by a range of providers. Methods Secondary analysis of survey data from 51 countries with 22 indicators explored...

In palliative care, as in many areas of medicine, there is a considerable amount of research conducted that makes sound recommendations but does not result consistently in improved care. For instance, though palliative care has been shown to benefit all people with a life-threatening illness, its main reach continues to be for those with cancer. Dr...

Objectives: To assess the degree of frailty in older people with different advanced diseases and its relationship with end-of-life illness trajectories and survival. Methods: Prospective, observational study, including all patients admitted to the Acute Geriatric Unit of the University Hospital of Vic (Spain) during 12 consecutive months (2014–2015...

Background: Due to the uncertain disease trajectory and variable rate of progression in chronic obstructive pulmonary disease (COPD), health care professionals (HCPs) are challenged in explaining what the future may hold for patients compared to those with lung cancer (LC). Support and communication of timely information can significantly improve...

Objectives Faith-based organisations (FBOs) in India provide health services particularly to marginalised communities. We studied their preparedness and delivery of palliative care during COVID-19 as part of a mixed-method study. We present the results of an online questionnaire. Methods All FBOs providing palliative care in India were invited to...

Objective To estimate future palliative care need and complexity of need in Scotland, and to identify priorities for future service delivery. Design We estimated the prevalence of palliative care need by analysing the proportion of deaths from defined chronic progressive illnesses. We described linear projections up to 2040 using national death re...

Background Specialist palliative care (SPC) providers tend to use the term ‘complex’ to refer to the needs of patients who require SPC. However, little is known about complex needs on first referral to a SPC service. We examined which needs are present and sought the perspectives of healthcare professionals on the complexity of need on referral to...

Objectives To analyse patterns of use and costs of unscheduled National Health Service (NHS) services for people in the last year of life. Design Retrospective cohort analysis of national datasets with application of standard UK costings. Participants and setting All people who died in Scotland in 2016 aged 18 or older (N=56 407). Main outcome m...

Background: Specialist palliative care (SPC) providers tend to use the term ‘complex need’ to refer to the needs of patients who require SPC. However, little is known about “complex needs” on first referral to a SPC service. We examined which needs are present and sought the perspectives of healthcare professionals on the complexity of need on firs...

Background: Risk prediction after myocardial infarction is often complex in older patients. The Global Registry of Acute Coronary Events (GRACE) model includes clinical parameters and age, but not frailty. We hypothesised that frailty would enhance the prognostic properties of GRACE. Methods: We performed a prospective observational cohort study...

Background: Care home residents are increasingly frail with complex health and social care needs. Their transfer to hospital at the end-of-life can be associated with unwanted interventions and distress. However, hospitals do enable provision of care that some residents wish to receive. We aimed to explore the factors that influence hospital admis...

Background Electronic care coordination systems, known as the Key Information Summary (KIS) in Scotland, enable the creation of shared electronic records available across healthcare settings. A KIS provides clinicians with essential information to guide decision making for people likely to need emergency or out-of-hours care. Aim To estimate the p...

Background: Global annual deaths are rising. It is essential to examine where future deaths may occur to facilitate decisions regarding future service provision and resource allocation. Aims: To project where people will die from 2017 to 2040 in an ageing country with advanced integrated palliative care, and to prioritise recommendations based o...

Background Understanding complex need as the defining characteristic of episodes requiring specialist palliative care (SPC) is key to hospice service development. A single definition of complex need is lacking, however markers of complex need include: presence of multiple needs, needs across different domains, interactions between different needs a...

Background Due to population ageing, serious health related burden is rising. In England and Wales, the number of people requiring palliative care is projected to grow by 42% by 2040 (Etkind et al. 2017). We sought to estimate future palliative care need in Scotland, extending previous work by examining the contribution of multi-mortality (deaths f...

Aim The aim of this position paper is to assist primary health care (PHC) providers, policymakers, and researchers by discussing the current context in which palliative health care functions within PHC in Europe. The position paper gives examples for improvements to palliative care models from studies and international discussions at European Forum...

The discrepancy in the demand for palliative care and distribution of specialist palliative care services will force patients to be eventually cared for by primary care/family physicians in the community. This will necessitate primary care/family physicians to equip themselves with knowledge and skills of primary palliative care. Indian National He...

We describe the findings of a qualitative longitudinal interview study of a group of initially community-dwelling frail older people, and their informal and formal carers. We used a narrative approach to explore the role that narrative may have for people living with frailty. This has been less explored comparative to the experiences of those livin...

Introduction Key Information Summaries (KIS), introduced throughout Scotland in 2013, are shared electronic clinical summaries used to guide urgent care in the community and emergency hospital admission. The percentage of people with a KIS at the time of death can act as an indicator of access to palliative care. Aims • To estimate the extent of...

Background: Approximately 10% of the UK population have an unpaid caring role for a family member or friend. Many of these carers make a significant contribution to supporting patients at the end of life. Carers can experience poor physical and psychosocial wellbeing, yet they remain largely unsupported by health and social care services. Despite i...

Theory/framework: Multimorbidity is increasingly frequent within ageing populations. A better understanding of this phenomenon is pivotal to develop accountable health policies, so that the specifi c needs of the people are met towards the end of life. Methods: We use cause-of-death data for all deaths at ages 20-64, 65-79 and 80+. We allocate unde...

Introduction The percentage of people with a key information summary (KIS) or an anticipatory care plan (ACP) at the time of death can act as an indicator of access to palliative care. Key information summaries (KIS) introduced throughout Scotland in 2013, are shared electronic patient records which contain essential information relevant to a patie...

Background: Communication between professionals, patients and families about palliative and end-of-life care after stroke is complex and there is a need for educational resources in this area. Methods: To explore the key learning needs of healthcare professionals, a multidisciplinary, expert group developed a short electronic survey with open an...

Background: Though the majority of people could benefit from palliative care before they die, most do not receive this approach, especially those with multimorbidity and frailty. GPs find it difficult to identify such patients. Aim: To refine and evaluate the utility of a computer application (AnticiPal) to help primary care teams screen their r...

Background: Liver disease is an increasing cause of death worldwide but palliative care is largely absent for these patients. Aim: We conducted a feasibility trial of a complex intervention delivered by a supportive care liver nurse specialist to improve care coordination, anticipatory care planning and quality of life for people with advanced l...

Background: Case fatality after total anterior circulation stroke is high. Our objective was to describe the experiences and needs of patients and caregivers, and to explore whether, and how, palliative care should be integrated into stroke care. Methods: From 3 stroke services in Scotland, we recruited a purposive sample of people with total an...

Introduction Makerere and Mulago Palliative Care Unit (MPCU) provides quality, evidence-based palliative care (PC) for patients and families through a centre of excellence delivering: an integrated clinical service within the national referral hospitals site; carrying out research, training and capacity-building in collaboration with partners; and...

Background Heart failure is an emerging challenge for Sub Saharan Africa. However, research on patients’ needs and experiences of care is scarce with little evidence available to support and develop services. We aimed to explore the experiences of patients living and dying with heart failure in Kenya. Methods We purposively recruited 18 patients ad...

Background: The Supportive and Palliative Care Indicators tool (SPICT) supports the identification of patients with potential palliative care (PC) needs. An Austrian-German expert group translated SPICT into German (SPICT-DE) in 2014. The aim of this study was the systematic development, refinement, and testing of SPICT-DE for its application in p...

The illness trajectory for many patients with severe respiratory disease is characterized by steady decline. Yet most healthcare resources are poured into managing acute exacerbations that are only temporarily effective. Further, 'bad deaths' can result from inappropriate medical interventions at times of crisis. In this article, we describe a rang...

Background: The Scottish Government set out its 5-year vision to improve palliative care in its Strategic Framework for Action 2016-2021. This includes a commitment to strengthening research and evidence based knowledge exchange across Scotland. A comprehensive scoping review of Scottish palliative care research was considered an important first s...

Background: Complex need for patients with a terminal illness distinguishes those who would benefit from specialist palliative care from those who could be cared for by non-specialists. However, the nature of this complexity is not well defined or understood. This study describes how health professionals, from three distinct settings in the United...

Objetivo: Apresentar o processo de identificação de pacientes de cuidados paliativos em uma equipe de Estratégia de Saúde da Família no Brasil. Métodos: O processo de identificação ocorreu 1) utilizando o sistema de trabalho de uma Equipe de Estratégia de Saúde da Família e os princípios da atenção primária e 2) aplicando o SPICT, uma ferramenta pa...

Background The Scottish Government set out its five year vision to improve palliative care in its Strategic Framework for Action 2016–2021. This includes a commitment to evidence-based knowledge exchange across Scotland. A comprehensive scoping review of Scottish palliative care research was considered an important first step. Aims • to identify a...

Rapid response to: Davis C, Naci H, Gurpinar E, Poplavska E, Pinto A, Aggarwal A. Availability of evidence of benefits on overall survival and quality of life of cancer drugs approved by European Medicines Agency: retrospective cohort study of drug approvals 2009-13. BMJ. 2017; 359: j4530 (Published 4 October 2017)

Background Patients with heart failure in Uganda present for health care with advanced structural heart disease, have repeated hospitalizations and poorly controlled disease symptoms. The reasons for these are unclear. Literature from other settings shows that patients’ understanding of their illness and their beliefs influence their health related...

Timing of face-to-face and telephone interviews and patient deaths. (ODT)

Background: Three archetypal trajectories of physical decline have been identified: a short period of rapid decline; long-term limitations with intermittent acute periods; and a prolonged gradual decline. An understanding of illness trajectories can help clarify the evolving needs of people with progressive conditions, and inform the development of...

Background The WHO is calling for the integration of palliative care in all health care settings globally. Methods A 3.5–year program was implemented in 12 government hospitals, three each in Kenya, Rwanda, Uganda and Zambia. A four–pillared approach of advocacy, staff training, service delivery strengthening and international and regional partner...

Background The short prognosis of patients with advanced heart failure (HF) and the associated multidimensional distress as illustrated in literature from high income countries necessitates the integration of palliative care into the care of advanced HF patients to address these needs and improve their quality of life. These needs, which are subjec...

Background: Early palliative care may prolong life as well as improve its quality. But it is frequently only started in the last weeks or days of life and largely for people with cancer. Its huge potential to minimise and prevent pain and distress across illnesses is not realised. Aims: To provide a rationale for early palliative care for people wi...

Background: Access to palliative care (generalist or specialist) for most people in need remains a key challenge internationally, even where specialist palliative care is excellent. Providing access is one of the fundamental principles of general practice (alongside with continuity of care and a comprehensive approach). Core competencies in general...

KEY POINTS O The relief of suffering is the main goal of palliative care. O The comprehensive and integrated model of palliative care is based on the needs and characteristics of persons with advanced chronic conditions and limited life prognosis. O Multidimensional needs including physical, emotional, spiritual, family, social, economic, and ethic...

Background: Population ageing will lead to more deaths with an uncertain trajectory. Identifying patients at risk of dying could facilitate more effective care planning. Aim: To determine whether screening for likely death within 12 months is more effective using screening tools or intuition. Design: Randomised controlled trial of screening to...

The number of people in their last years of life with advanced chronic conditions, palliative care needs and limited life prognosis due to different causes including multi-morbidity, organ failure, frailty, dementia, and cancer is rising. Such people represent more than 1% of the population. They are present in all care settings, cause around 75% o...