Palliative medicine
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Palliative medicine · Oct 2015
Multicenter StudyA quasi-experimental controlled evaluation of the impact of a hospice rapid response community service for end-of-life care on achievement of preferred place of death.
Rapid response services operating 24 h a day have been advocated in UK health policy to support dying patients at home, though there is limited evidence of their effectiveness. ⋯ The addition of a rapid response hospice at home service did not have a significant impact on helping patients to die where they wanted in an area already well served by community palliative care. Recording preferences, and changes over time, is difficult and presented challenges for this study.
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Palliative medicine · Sep 2015
Multicenter StudyThe desire to hasten death: Using Grounded Theory for a better understanding "When perception of time tends to be a slippery slope".
Some patients with advanced and progressive diseases express a desire to hasten death. ⋯ The desire to hasten death may be used as an extreme coping strategy to maintain control against anticipated agony. Patients expected health professionals to listen to and respect their experiences. Emerging hypotheses included the following: (a) patients try to balance life time and anticipated agony, and the perception of time is distressing in this balancing act; (b) anticipated images of agony and suffering in the dying process occur frequently and are experienced by patients as intrusive; (c) patients expressing a desire to hasten death are in need of more information about the dying process; and (d) patients wanted their caregivers to listen to and respect their wish to hasten death, and they did not expect the caregivers to understand this as an order to actually hasten their death.
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Palliative medicine · Jul 2015
Multicenter StudyBurnout, psychological morbidity and use of coping mechanisms among palliative care practitioners: A multi-centre cross-sectional study.
The prevalence of burnout, psychological morbidity and the use of coping mechanisms among palliative care practitioners in Singapore have not been studied. ⋯ Our results reveal that burnout and psychological morbidity are significant in the palliative care community and demonstrate a need to look at managing long working hours and promoting the use of coping mechanisms to reduce burnout and psychological morbidity.
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Palliative medicine · Apr 2015
Multicenter StudyAdmission of the very elderly to the intensive care unit: family members' perspectives on clinical decision-making from a multicenter cohort study.
Little is known about the perspectives and experiences of family members of very elderly patients who are admitted to the intensive care unit. ⋯ There is incongruity between family values and preferences for end-of-life care and actual care received for very elderly patients who are admitted to the intensive care unit. Deficiencies in communication and decision-making may be associated with prolonged use of life-sustaining treatments in very elderly critically ill patients, many of whom ultimately die.
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Palliative medicine · Apr 2015
Multicenter StudyHospital rapid response team and patients with life-limiting illness: a multicentre retrospective cohort study.
Approximately one-third of rapid response team consultations involve issues of end-of-life care. We postulate a greater occurrence in patients with a life-limiting illness, in whom the opportunity for advance care planning and palliative care involvement should be offered. ⋯ Patients with a life-limiting illness had worse outcomes post-rapid response team consultation. Our findings suggest that a routine clarification of goals of care for this cohort, within 3 days of hospital admission, may be advantageous. These discussions may provide clarity of purpose to treating teams, reduce the burden of unnecessary interventions and promote patient-centred care agreed upon in advance of any deterioration.