Palliative medicine
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Palliative medicine · Mar 2018
Randomized Controlled TrialEffects of two feedback interventions on end-of-life outcomes in nursing home residents with dementia: A cluster-randomized controlled three-armed trial.
Despite increased attention for palliative care in dementia, recent studies found burdensome symptoms and unmet family caregiver needs in the last phase of life. Feedback is being used to improve the quality of palliative care, but we do not know how effective it is. ⋯ Neither feedback strategy improved end-of-life outcome. Perhaps, skills to translate the feedback into care improvement actions were insufficient. Feedback with favorable family ratings might even have triggered opposite effects. Trial number: NTR3942.
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Palliative medicine · Mar 2018
Randomized Controlled Trial Comparative StudyEffectiveness of advance care planning with family carers in dementia nursing homes: A paired cluster randomized controlled trial.
In dementia care, a large number of treatment decisions are made by family carers on behalf of their family member who lacks decisional capacity; advance care planning can support such carers in the decision-making of care goals. However, given the relative importance of advance care planning in dementia care, the prevalence of advance care planning in dementia care is poor. ⋯ Advance care planning was effective in reducing family carer uncertainty in decision-making concerning the care of their family member and improving perceptions of quality of care in nursing homes. Given the global significance of dementia, the implications for clinicians and policy makers include them recognizing the importance of family carer education and improving communication between family carers and formal care providers.
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Palliative medicine · Feb 2018
Randomized Controlled TrialUsing intuition or a formal palliative care needs assessment screening process in general practice to predict death within 12 months: A randomised controlled trial.
Population ageing will lead to more deaths with an uncertain trajectory. Identifying patients at risk of dying could facilitate more effective care planning. ⋯ Screening tool was better at predicting actual death than intuition, but with a higher false positive rate. Both were similarly effective at screening the whole cohort for death. Screening for possible death is not the best option for initiating end-of-life planning: recognising increased burden of illness might be a better trigger.
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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 · Jun 2017
Randomized Controlled TrialFeasibility of assessing patients' acceptable pain in a randomized controlled trial on a patient pain education program.
For patients with cancer-related pain, the numeric rating scale is the most frequently used instrument to measure pain intensity. In the literature, it has been suggested to interpret patient-reported ratings of pain in relation to the pain intensity which is acceptable to the individual patient. ⋯ Measurement of acceptable pain intensity is feasible. Patients with additional pain treatment became more critical and accepted less pain. More research is needed before we can use acceptable pain intensity as a reference for the interpretation of pain ratings.