Palliative medicine
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Palliative medicine · Oct 2017
Review Meta AnalysisWhat do we know about different models of providing palliative care? Findings from a systematic review of reviews.
A wide range of organisational models of palliative care exist. However, decision makers need more information about which models are likely to be most effective in different settings and for different patient groups. ⋯ Irrespective of setting or patient characteristics, models of palliative care appear to show benefits and some models of palliative care may reduce total healthcare costs. However, much more detailed and systematic reporting of components and agreement about outcome measures is essential in order to understand the key components and successfully replicate effective organisational models.
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Palliative medicine · Oct 2017
ReviewUnderstanding meaning in life interventions in patients with advanced disease: A systematic review and realist synthesis.
Among patients with advanced disease, meaning in life is thought to enhance well-being, promote coping and improve the tolerance of physical symptoms. It may also act as a buffer against depression and hopelessness. As yet, there has been no synthesis of meaning in life interventions in which contextual factors, procedures and outcomes are described and evaluated. ⋯ This review provides an explanatory model of the contextual factors and mechanisms that may be involved in promoting meaning in life. These approaches could provide useful tools for relieving existential suffering at the end of life.
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Palliative medicine · Oct 2017
Randomized Controlled Trial Comparative StudyRandomised clinical trial of early specialist palliative care plus standard care versus standard care alone in patients with advanced cancer: The Danish Palliative Care Trial.
Beneficial effects of early palliative care have been found in advanced cancer, but the evidence is not unequivocal. ⋯ We did not observe beneficial or harmful effects of early specialist palliative care, but important beneficial effects cannot be excluded.
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Palliative medicine · Oct 2017
Initial perceptions of palliative care: An exploratory qualitative study of patients with advanced cancer and their family caregivers.
Despite evidence for early integration of palliative care for people with advanced cancer and their families, patterns of late engagement continue. Prior research has focused on health professionals' attitudes to palliative care with few studies exploring the views of patients and their carers. ⋯ While there is an increasing move towards early integration of palliative care, this study suggests that patient and caregiver understandings have not equally progressed. A targeted public health campaign is warranted to disentangle understandings of palliative care as the 'institutional death' and to reframe community rhetoric surrounding palliative care from that of disempowered dying to messages of choice, accomplishment and possibility.
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Palliative medicine · Oct 2017
Using social exchange theory to understand non-terminal palliative care referral practices for Parkinson's disease patients.
A palliative approach is recommended in the care of Parkinson's disease patients; however, many patients only receive this care in the form of hospice at the end of life. Physician attitudes about palliative care have been shown to influence referrals for patients with chronic disease, and negative physician perceptions may affect early palliative referrals for Parkinson's disease patients. ⋯ Physicians may be more likely to refer patients to non-terminal palliative care if (1) they work in interdisciplinary settings and/or (2) previous personal or patient experience with palliative care was positive. They may be less likely to refer if (1) they fear a loss of autonomy in patient care, (2) they are unaware of available programs, and/or (3) they believe they address palliative needs. Initiatives to educate neurologists on the benefits and availability of non-terminal palliative services could improve patient access to this care.