Palliative medicine
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Palliative medicine · Oct 2018
Ambulance staff and end-of-life hospital admissions: A qualitative interview study.
Hospital admissions for end-of-life patients, particularly those who die shortly after being admitted, are recognised to be an international policy problem. How patients come to be transferred to hospital for care, and the central role of decisions made by ambulance staff in facilitating transfer, are under-explored. ⋯ Ambulance interviewees fulfilled an important role in the admission of end-of-life patients to hospital, frequently having to decide whether to leave a patient at home or to instigate transfer to hospital. Their difficulty in facilitating non-hospital care at the end of life challenges the negative view of near end-of-life hospital admissions as failures. Hospital provision was sought for dying patients in need of care which was inaccessible in the community.
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Palliative medicine · Oct 2018
Is end-of-life care a priority for policymakers? Qualitative documentary analysis of health care strategies.
Prioritisation of end-of-life care by policymakers has been the subject of extensive rhetoric, but little scrutiny. In England, responsibility for improving health and care lies with 152 regional Health and Wellbeing Boards. ⋯ Half of Health and Wellbeing Strategies mention end-of-life care, few prioritise it and none cite evidence for effective interventions. The absence of connection between need, aim and intervention is concerning. Future research should explore whether and how strategies have impacted on local populations.
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Palliative medicine · Oct 2018
Comparative StudyDifferences in primary palliative care between people with organ failure and people with cancer: An international mortality follow-back study using quality indicators.
Measuring the quality of palliative care in a systematic way using quality indicators can illuminate differences between patient groups. ⋯ People who died of organ failure are at risk of receiving lower quality palliative care than people who died of cancer, but the differences vary per country. Initiatives to improve palliative care should have different priorities depending on the healthcare and cultural context.
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Palliative medicine · Oct 2018
Is specialized palliative cancer care associated with use of antineoplastic treatment at the end of life? A population-based cohort study.
The use of chemotherapy in the last 14 days of life should be as low as possible. ⋯ Overall, the incidence of antineoplastic treatment in the last 14 days of life was low compared to other studies. Patients in specialized palliative care had a reduced risk of receiving chemotherapy at the end of life.
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Palliative medicine · Oct 2018
Use of mirtazapine in patients with chronic breathlessness: A case series.
Breathlessness remains a common and distressing symptom in people with advanced disease with few effective treatment options. Repurposing of existing medicines has been effective in other areas of palliative care, for example, antidepressants to treat pain, and offers an opportunity to deliver improved symptom control in a timely manner. Previous case series have shown reduced breathlessness following the use of sertraline (a selective serotonin reuptake inhibitor) in people with chronic obstructive pulmonary disease. ⋯ Patients with chronic breathlessness in this case series reported benefits during mirtazapine treatment. To determine the effectiveness of mirtazapine in alleviating breathlessness and improving quality of life in chronic lung disease, blinded randomised trials are warranted.