Annals of palliative medicine
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Older people with multimorbidities are projected to be the main recipients of palliative care in the coming decades. However, because their specific palliative care needs are poorly understood and service response is underdeveloped, older people with multimorbidity are less likely to receive palliative care. Innovative specialist palliative care services are developing to address this gap, but with little underpinning evidence. Therefore the aim of this paper is to describe the clinical characteristics, symptoms and other concerns of older people with multi-morbidity referred to a new community palliative care service; and to explore possible implications for service delivery by comparing this service population with people receiving standard community-based specialist palliative care. ⋯ The population of older people with multimorbidity has not been routinely recognized as having specialist palliative care needs. However, this evaluation shows that, at first contact, the symptoms and concerns across both service populations was surprisingly similar. Nevertheless, patterns of symptoms may differ between populations over time. Longitudinal prospective data are needed to examine these changes overtime, and the relationship with multimorbidity.
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Communication of prognosis and goals of care between oncologists, community health care providers (HCPs) and patients treated for advanced cancer facilitates optimal care planning. We aimed to review the frequency, content and timing of documented prognosis in written correspondence during the last year of life of advanced cancer patients. ⋯ Documentation of qualitative and quantitative prognosis is infrequent despite multiple clinical encounters prior to patient death. This infers inadequate communication between oncologists and other HCPs which reduces insight into patient clinical trajectory and could result in differing care between providers.
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Renal Supportive/Palliative Care is gaining gradual recognition as a patient-centered care approach that should be integrated to the traditional disease-centered model of care, mainly in elder patients with advanced chronic kidney disease (CKD). The objective of this study was to assess knowledge, perceptions, attitude, experience and interest in palliative care among renal care providers. ⋯ Brazilian nephrologists are often unaware of patient autonomy, more prone to withholding than withdrawing dialysis and deem wishes of the family quasi as important as patient preferences in the shared decision making process. Most Participants answered to evaluate pain and quality of life related to health (HRQoL) routinely and have great interest to learn about renal palliative care.
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More than 70% of patients with advanced cancer experience dyspnea. Dyspnea is predictive of shorter survival and interferes with quality of life (QOL). The present study aimed to identify predictors of the presence and severity of dyspnea in advanced cancer patients. ⋯ Liver, lung and lymph node metastases, a history of respiratory conditions, pulse oximetry <90 and PRFS ≥3 were predictive of the severity of dyspnea and moderate/severe dyspnea. Physicians should be aware of predictive factors that could lead to dyspnea to promote early intervention for improved patient care and the creation of screening tools for clinical practice.
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Review
Outcome measurement in paediatric palliative care: lessons from the past and future developments.
The need for paediatric palliative care (PPC) globally is great yet there is limited evidence of the quality or outcomes of the care provided. The lack of an outcome measure for PPC has been consistently cited as one reason for the lack of robust evidence in the field. Thus recommendations have been made for the development of locally relevant, validated tools to measure outcomes for children. ⋯ The measurement of outcomes in PPC is an imperative. Whilst there are challenges in developing outcome tools and utilizing them in practice, these should not prevent us from advancing the field. The development of the first outcome measure for PPC the African C-POS is a key milestone in the ongoing development and utilization of outcome measures for PPC.