Palliative medicine
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Palliative medicine · Sep 2021
Virtual models of care for people with palliative care needs living in their own home: A systematic meta-review and narrative synthesis.
Access to palliative care in the community enables people to live in their preferred place of care, which is often home. Community palliative care services struggle to provide timely 24-h services to patients and family. This has resulted in calls for 'accessible and flexible' models of care that are 'responsive' to peoples' changing palliative care needs. Digital health technologies provide opportunities to meet these requirements 24-h a day. ⋯ Prospero CRD42020200266.
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Palliative medicine · Sep 2021
Exploring expanded interdisciplinary roles in goals of care conversations in a national goals of care initiative: A qualitative approach.
The United States Veterans Health Administration National Center for Ethics in Health Care implemented the Life-Sustaining Treatment Decisions Initiative throughout the Veterans Health Administration health care system in 2017. This policy encourages goals of care conversations, referring to conversations about patient's treatment and end-of-life wishes for life-sustaining treatments, among Veterans with serious illnesses. A key component of the initiative is expanding interdisciplinary provider roles in having goals of care conversations. ⋯ Organizational role theory is a helpful framework for exploring interdisciplinary roles in a goals of care initiative. Support and recognition of provider role expansion in goals of care conversations was important for the adoption of a goals of care initiative. Actionable strategies, including multi-level leadership support and the use of interdisciplinary champions, facilitate role change and have potential to strengthen uptake of a goals of care initiative.
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Palliative medicine · Sep 2021
What does effective end-of-life care at home for children look like? A qualitative interview study exploring the perspectives of bereaved parents.
End-of-life care for children with life-shortening conditions is provided in a range of settings including hospital, hospice and home. What home-based, end-of-life care should entail or what best practice might look like is not widely reported, particularly from the perspective of parents who experienced the death of a child at home. ⋯ Parents with experience of caring for a dying child at home offer valuable input to future the policy and practice surrounding effective home-based, end-of-life care for children. New models of care or service developments should consider the key components and attributes for effective home-based end-of-life identified by bereaved parents in this study.
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Palliative medicine · Sep 2021
Case ReportsIntranasal dexmedetomidine: Procedural sedation in palliative care: A case report.
This report describes the use of intranasal dexmedetomidine to control incident pain and facilitate daily change of dressing in a patient with cutaneous breast cancer. ⋯ Intranasal dexmedetomidine is a potentially useful medication for procedural sedation in the management of complex wound dressings. It provides rousable short-term sedation, anxiolysis and analgesia. Further research into the role of intranasal dexmedetomidine to facilitate challenging dressing changes in a community setting is warranted.
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Palliative medicine · Sep 2021
Increased number of deaths within 24 h of admission during a period of social restriction related to the COVID-19 pandemic: A retrospective service evaluation in a metropolitan palliative care unit.
COVID-19 has led to implementation of wide-ranging social restriction measures with consequent impact on health care utilisation in many domains. There is little published data on the experience of palliative care services catering to a population with low case numbers of COVID-19. ⋯ Increased numbers of deaths within 24 h of admission occurred on the palliative care unit despite low COVID-19 case numbers in the wider community, and in the setting of widespread social restriction measures. More research is needed examining the health-related consequences of such restrictions for individuals not infected with COVID-19.