Palliative medicine
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Palliative medicine · Dec 2004
Multicenter Study Clinical TrialOral transmucosal fentanyl citrate in the management of breakthrough pain in cancer: an open, multicentre, dose-titration and long-term use study.
Sixty-six patients with cancer-related pain entered an open multicentre study to examine the safety and efficacy of oral transmucosal fentanyl citrate (OTFC) in the treatment of breakthrough pain. Patients were eligible for the study if they were stabilized on a long-acting opioid but were experiencing up to four episodes of breakthrough pain a day and achieving at least partial relief from breakthrough pain using conventional medication (normal release oral morphine in the majority of patients). The efficacy of the conventional medication was documented in a run-in phase and patients then changed to OTFC. ⋯ Most drop-outs in this phase were associated with progression of the underlying disease. No patient stopped using OTFC because of dissatisfaction with the drug. OTFC appears to be a safe and effective treatment for breakthrough pain in cancer patients and may have advantages over currently available opioid formulations.
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Palliative medicine · Dec 2004
Attitudes and experiences of Oregon hospice nurses and social workers regarding assisted suicide.
When the Oregon Death with Dignity Act (ODDA) legalizing physician-assisted suicide was enacted into law in 1997, Oregon hospice clinicians were uncertain how involved they would be with patients who wanted this option. However, 86% of the 171 persons in Oregon who have died by lethal prescription were enrolled in hospice programmes. ⋯ Nurses and social workers in hospices and other settings can expect to encounter patient questions about physician-assisted suicide, whether legalized or not, and must be prepared to have these discussions. Most hospice professionals in Oregon do not believe that assisted suicide and hospice enrollment are mutually exclusive alternatives.
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Palliative medicine · Dec 2004
A survey of the perspectives of specialist palliative care providers in the UK of inpatient respite.
One of the major reasons for admission of patients to hospital in late stage disease is the inability of carers to continue to provide care at home. Specialist palliative care services have typically admitted patients for acute symptom control, terminal care and respite care to benefit them and their carers. This paper reports the results of a cross-sectional survey of inpatient respite care provision provided by specialist palliative care services and hospices in the UK. ⋯ There was some evidence that respite provision was regarded as a lower priority than admissions for symptom control and terminal care, and that patients' needs were prioritized over those of carers. Only 10% of services conducted regular, routine audit, with very few seeking the views of service users. Findings suggest that carers' needs and wishes are not prioritized by specialist palliative care services offering inpatient respite, which may mean that they find it difficult to maintain their caregiving roles over longer disease trajectories or in the face of overwhelming demands.
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Palliative medicine · Dec 2004
A study into the educational needs of children's hospice doctors: a descriptive quantitative and qualitative survey.
To identify and explore the educational needs of children's hospice doctors in England. ⋯ There is a disparity between educational needs as derived from self-rated competencies and from educational diary keeping; suggesting that children's hospice doctors may not be fully aware of their own educational, support and training needs. Self-rated competencies emphasise the value of education in craft or clinical skills; whereas personal diary keeping emphasises the value of education in intrapersonal and interpersonal skills such as communication, team-working and personal coping skills. The current curricula and educational resources need to acknowledge that interpersonal and intrapersonal competencies are as important as clinical competencies. While the study looks particularly at the educational needs of children's hospice doctors, readers may feel that the findings are of relevance to all specialities and disciplines.
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Palliative medicine · Dec 2004
Physical symptom profiles of depressed and nondepressed patients with cancer.
Depression and symptom severity are predictive of survival in cancer patients, but are often correlated with each other. This paper compares the physical symptom profiles of depressed and nondepressed cancer patients and further examines the predictive ability of multiple symptoms on depressive status. Data were collected from 121 hospitalized patients with breast, oesophageal and head and neck cancer. ⋯ Significantly more symptoms were observed in depressed than in nondepressed patients (mean = 3.77 versus 2.52). Both groups showed similar rankings of symptom occurrence rates. Patients simultaneously experiencing insomnia, pain, anorexia and fatigue had a higher risk of depression (odds ratio = 5.03).