Palliative medicine
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Palliative medicine · Sep 2019
Video consultations in palliative care: A systematic integrative review.
There is extensive need for palliative care worldwide, but access to care remains inadequate, especially for non-cancer patients. Video consultations are a promising tool in the provision of home-based palliative care, but an overview of evidence solely on video consultations in palliative care is lacking. ⋯ Using video technology in palliative care has both advantages and disadvantages. However, evidence beyond the focus on specialized palliative care and patients with cancer is limited. Future research should focus on how and when video consultations might replace in-person specialized palliative care and video consultations in general palliative care, in low and middle income countries; and involve patients with a non-cancer diagnosis.
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Palliative medicine · Sep 2019
ReviewPatient and carer involvement in palliative care research: An integrative qualitative evidence synthesis review.
Patient/carer involvement in palliative care research has been reported as complex, difficult and less advanced compared to other areas of health and social care research. There is seemingly limited evidence on impact and effectiveness. ⋯ Evidence identified suggests that involvement in palliative care research is challenging, but not dissimilar to that elsewhere. The facilitators and barriers identified relate mainly to the conduct of researchers at an individual level; in particular, there exists a reluctance among professionals to undertake involvement, and myths still perpetuate that patients/carers do not want to be involved. A developed infrastructure, more involvement-friendly organisational cultures and a strengthening of the evidence base would also be beneficial.
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Palliative medicine · Sep 2019
How many older adults receive drugs of questionable clinical benefit near the end of life? A cohort study.
The high burden of disease-oriented drugs among older adults with limited life expectancy raises important questions about the potential futility of care. ⋯ A substantial share of older persons with life-limiting diseases receive drugs of questionable clinical benefit during their last months of life. Adequate training, guidance and resources are needed to rationalize and deprescribe drug treatments for older adults near the end of life.
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Palliative medicine · Sep 2019
Family members' experiences of assisted dying: A systematic literature review with thematic synthesis.
Families' experiences of assisted dying are under-investigated and families are rarely considered in clinical guidelines concerning assisted dying. ⋯ Our data confirm that families across all jurisdictions are involved in assisted suicide decision and enactment. Family needs are under-researched, and clinical guidelines should incorporate recommendations about how to consider family needs and how to provide them with evidence-based tailored interventions.
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Palliative medicine · Sep 2019
Do published patient decision aids for end-of-life care address patients' decision-making needs? A systematic review and critical appraisal.
Many decisions are made by patients in their last months of life, creating complex decision-making needs for these individuals. Identifying whether currently existing patient decision aids address the full range of these patient decision-making needs will better inform end-of-life decision support in clinical practice. ⋯ Patient decision-making needs are broad and varied. Currently developed patient decision aids are insufficiently addressing patient decision-making needs. Improving future end-of-life patient decision aid content through five key suggestions could improve patient-focused decision-making support at the end of life.