Abstract:
OBJECTIVES:Report the use of an objective tool, UK Gold Standards Framework (GSF) criteria, to describe the prevalence, recognition and outcomes of patients with palliative care needs in an Australian acute health setting. The rationale for this is to enable hospital doctors to identify patients who should have a patient-centred discussion about goals of care in hospital. DESIGN:Prospective, observational, cohort study. PARTICIPANTS:Adult in-patients during two separate 24 h periods. MAIN OUTCOME MEASURES:Prevalence of in-patients with GSF criteria, documentation of treatment limitations, hospital and 1 year survival, admission and discharge destination and multivariate regression analysis of factors associated with the presence of hospital treatment limitations and 1 year survival. RESULTS:Of 626 in-patients reviewed, 171 (27.3%) had at least one GSF criterion, with documentation of a treatment limitation discussion in 60 (30.5%) of those patients who had GSF criteria. Hospital mortality was 9.9%, 1 year mortality 50.3% and 3-year mortality 70.2% in patients with GSF criteria. One-year mortality was highest in patients with GSF cancer (73%), renal failure (67%) and heart failure (60%) criteria. Multivariate analysis revealed age, hospital length of stay and presence of the GSF chronic obstructive pulmonary disease criteria were independently associated with the likelihood of an in-hospital treatment limitation. Non-survivors at 3 years were more likely to have a GSF cancer (25% vs 6%, p=0.004), neurological (10% vs 3%, p=0.04), or frailty (45% vs 3%, p=0.04) criteria. After multivariate logistic regression GSF cancer criteria, renal failure criteria and the presence of two or more GSF clinical criteria were independently associated with increased risk of death at 3 years. Patients returning home to live reduced from 69% (preadmission) to 27% after discharge. CONCLUSIONS:The use of an objective clinical tool identifies a high prevalence of patients with palliative care needs in the acute tertiary Australian hospital setting, with a high 1 year mortality and poor return to independence in this population. The low rate of documentation of discussions about treatment limitations in this population suggests palliative care needs are not recognised and discussed in the majority of patients. TRIAL REGISTRATION NUMBER:11/121.
journal_name
BMJ Support Palliat Carejournal_title
BMJ supportive & palliative careauthors
Milnes S,Orford NR,Berkeley L,Lambert N,Simpson N,Elderkin T,Corke C,Bailey Mdoi
10.1136/bmjspcare-2015-000864subject
Has Abstractpub_date
2019-03-01 00:00:00pages
92-99issue
1eissn
2045-435Xissn
2045-4368pii
bmjspcare-2015-000864journal_volume
9pub_type
杂志文章abstract:OBJECTIVES:Impending death is poorly recognised. Many undergraduate healthcare professionals will not have experience of meeting or caring for someone who is dying. As death can occur in any setting, at any time, it is vital that all healthcare students, regardless of the setting they go on to work in, have end-of-life...
journal_title:BMJ supportive & palliative care
pub_type: 杂志文章
doi:10.1136/bmjspcare-2019-002025
更新日期:2019-11-20 00:00:00
abstract:OBJECTIVES:The decision to refer a patient to palliative care is complex and often highly variable between medical specialists. In this paper, we examine medical specialists' motivations and triggers underpinning decision-making around referral to palliative care in order to facilitate improvements in referral practice...
journal_title:BMJ supportive & palliative care
pub_type: 杂志文章
doi:10.1136/bmjspcare-2012-000376
更新日期:2014-09-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Meaning in life (MIL) represent a key topic in palliative care. The aims of this study were to explore (1) the differences in perceived MIL and in the meaning-relevant life areas between a representative sample of the Swiss population and palliative care patients, and (2) to what extent MIL ca...
journal_title:BMJ supportive & palliative care
pub_type: 杂志文章
doi:10.1136/bmjspcare-2020-002211
更新日期:2020-07-06 00:00:00
abstract:BACKGROUND:Cancer-related pain is a significant and debilitating problem. Non-pharmacological treatments such as acupuncture may have an adjunctive role in controlling pain without the undesirable side effects of drug regimens and yet the evidence base remains limited. OBJECTIVES:The main objective of this systematic ...
journal_title:BMJ supportive & palliative care
pub_type: 杂志文章,评审
doi:10.1136/bmjspcare-2011-000022
更新日期:2011-06-01 00:00:00
abstract:OBJECTIVES:To review literature regarding online educational initiatives in palliative care which are targeted to update health professionals and prepare distance courses suitable for a Brazilian context. METHODS:7 databases (PubMed, Cochrane Library, LILACS, SCIELO, CINAHL, Science Direct and Scopus) were reviewed fo...
journal_title:BMJ supportive & palliative care
pub_type: 杂志文章,评审
doi:10.1136/bmjspcare-2015-001042
更新日期:2017-06-01 00:00:00
abstract:OBJECTIVES:This paper reports on qualitative data exploring the experiences and coping mechanisms of medical specialists from the specialties of intensive care, surgery, oncology and palliative care, when dealing with death and dying and their emotional connection with dying patients in the context of a life-threatenin...
journal_title:BMJ supportive & palliative care
pub_type: 杂志文章
doi:10.1136/bmjspcare-2012-000208
更新日期:2012-09-01 00:00:00
abstract:OBJECTIVES:Education and training are seen as 'absolutely essential parts of providing palliative care'. As part of a larger study to explore the extent of palliative care need in two acute hospital settings, we report the perceptions of healthcare professionals regarding their training and educational needs. METHODS:...
journal_title:BMJ supportive & palliative care
pub_type: 杂志文章
doi:10.1136/bmjspcare-2012-000233
更新日期:2013-06-01 00:00:00
abstract:OBJECTIVE:To assess the involvement of volunteers with direct patient/family contact in UK palliative care services for children and young people. METHOD:Cross-sectional survey using a web-based questionnaire. SETTING:UK specialist paediatric palliative care services. PARTICIPANTS:Volunteer managers/coordinators fro...
journal_title:BMJ supportive & palliative care
pub_type: 杂志文章
doi:10.1136/bmjspcare-2012-000355
更新日期:2015-09-01 00:00:00
abstract:BACKGROUND:A diagnosis of cancer and anticipated death of a loved one has a significant impact on the whole family. Research has mainly focused on carers, with little emphasis on the wider, long-term implications. AIM:To explore the cancer beliefs of patients with advanced cancer and their relatives. The focus was on ...
journal_title:BMJ supportive & palliative care
pub_type: 杂志文章
doi:10.1136/bmjspcare-2015-000906.74
更新日期:2015-04-01 00:00:00
abstract:OBJECTIVES:Evidence-based communication skills training for health and social care professionals is essential to improve the care of seriously ill patients and their families. We aimed to evaluate the self-reported impact of 'Difficult Conversations', a multidisciplinary half-day interactive workshop, and gain feedback...
journal_title:BMJ supportive & palliative care
pub_type: 杂志文章
doi:10.1136/bmjspcare-2017-001447
更新日期:2018-03-01 00:00:00
abstract:OBJECTIVES:To identify those factors which adversely affected recruitment to a large multicentre palliative care study. METHODS:Patient accrual to a multicentre, observational, palliative care study was monitored at three critical junctures in the research process. (1) Eligibility-did the patient fulfil the study entr...
journal_title:BMJ supportive & palliative care
pub_type: 杂志文章,多中心研究
doi:10.1136/bmjspcare-2012-000396
更新日期:2013-09-01 00:00:00
abstract:OBJECTIVE:Evidence is mixed regarding the impact of advance care planning (ACP) on place of death. This cohort study investigated the effect of ACP programmes on place of death and utilisation of life-sustaining treatments for patients during end-of-life (EOL) care. METHODS:This prospective cohort study identified dec...
journal_title:BMJ supportive & palliative care
pub_type: 杂志文章
doi:10.1136/bmjspcare-2020-002520
更新日期:2020-10-28 00:00:00
abstract:OBJECTIVES:Mechanical ventilation (MV) has been shown to improve survival and quality of life in motor neuron disease (MND). However, during the progression of MND, there may come a point when MV is no longer felt appropriate. Association of Palliative Medicine Guidelines have been recently published to help clinicians...
journal_title:BMJ supportive & palliative care
pub_type: 杂志文章
doi:10.1136/bmjspcare-2017-001464
更新日期:2020-03-01 00:00:00
abstract:CONTEXT:Patients with chronic cancer pain frequently suffer severe exacerbations of pain intensity which are difficult to control adequately via pharmaceutical management. Management of these episodes of breakthrough pain (BTP) presents a challenge both to the physician and the patient, and supplemental 'rescue' doses ...
journal_title:BMJ supportive & palliative care
pub_type: 杂志文章,评审
doi:10.1136/bmjspcare-2011-000066
更新日期:2011-12-01 00:00:00
abstract:OBJECTIVES:This study explores the narrative accounts of chronic obstructive pulmonary disease (COPD) to identify events that potentially could act as triggers for provision of supportive and palliative care. Trigger events must have meaning for the patient/carer, be visible to professionals, and have value in provokin...
journal_title:BMJ supportive & palliative care
pub_type: 杂志文章
doi:10.1136/bmjspcare-2013-000629
更新日期:2014-06-01 00:00:00
abstract::Adrenocortical carcinoma (ACC) comprises approximately 0.02% of all malignant tumours, which are a very small fraction of a group of cancers that affect in 0.7 to 2 in 1 000 000 people per year. Recurrence is very common even after complete resection and prognosis is poor. We report a case of a sporadic form of ACC fo...
journal_title:BMJ supportive & palliative care
pub_type: 杂志文章
doi:10.1136/bmjspcare-2018-001568
更新日期:2019-03-01 00:00:00
abstract:OBJECTIVE:This study examined whether the choice of pain-related outcome to represent opioid efficacy influenced findings in a genetic association study. Data from the European Pharmacogenetic Opioid Study, which used opioid dose as the outcome, were analysed in respect of six alternative outcomes: average pain intensi...
journal_title:BMJ supportive & palliative care
pub_type: 杂志文章,随机对照试验
doi:10.1136/bmjspcare-2012-000212
更新日期:2012-12-01 00:00:00
abstract:BACKGROUND:Health promoting palliative care began in Victoria, Australia and has been included in Victorian palliative care policy for over a decade. AIM:To review the way Victorian palliative care services have responded to government policies and strategic directions that are based upon health promoting palliative c...
journal_title:BMJ supportive & palliative care
pub_type: 杂志文章
doi:10.1136/bmjspcare-2015-000906.48
更新日期:2015-04-01 00:00:00
abstract:BACKGROUND:Resistance training (RT) is an effective way to increase muscle mass but little is known about its role to prevent sarcopenia in advanced cancer. Furthermore, the preferred setting for this training is not known. Considering home is frequently the place of care and death preferred by cancer patients, it is i...
journal_title:BMJ supportive & palliative care
pub_type: 杂志文章
doi:10.1136/bmjspcare-2020-002230
更新日期:2020-08-13 00:00:00
abstract:BACKGROUND:Compared with the current inpatient consultation model, a novel corounding model of care whereby palliative specialists round with oncology teams, increases healthcare collaboration and may improve quality of care for inpatients. Whether this translates to better pain control for patients is unexplored. OBJ...
journal_title:BMJ supportive & palliative care
pub_type: 杂志文章
doi:10.1136/bmjspcare-2020-002540
更新日期:2020-12-18 00:00:00
abstract:OBJECTIVES:As a rose geranium in sesame oil spray product has been anecdotally noted to improve nasal vestibulitis symptoms, this study was designed to assess whether patients with nasal vestibulitis associated with cancer-directed therapy experienced symptomatic improvements from it. METHODS:Patients with breast canc...
journal_title:BMJ supportive & palliative care
pub_type: 杂志文章
doi:10.1136/bmjspcare-2018-001569
更新日期:2020-12-01 00:00:00
abstract:BACKGROUND:In Switzerland, helping with assisted suicide under certain conditions is not prosecuted. With approximately 300 cases annually, this leaves behind a large group of bereaved people where its consequences are mostly unknown. The study aimed to explore family involvement in decision making prior to assisted su...
journal_title:BMJ supportive & palliative care
pub_type: 杂志文章
doi:10.1136/bmjspcare-2013-000483
更新日期:2015-06-01 00:00:00
abstract:CONTEXT:Patients living with cystic fibrosis (CF) report impaired quality of life. Little is known about unmet supportive care needs among adults living with CF and how they are associated with demographic characteristics. OBJECTIVES:The primary objective of this study was to identify associations between demographic ...
journal_title:BMJ supportive & palliative care
pub_type: 杂志文章
doi:10.1136/bmjspcare-2019-001819
更新日期:2019-08-31 00:00:00
abstract:BACKGROUND:Values used in economic evaluation are typically obtained from the general public, which is problematic when measures are to be used with people experiencing a life-course stage such as the end of life. OBJECTIVE:To assess the feasibility of obtaining values for the ICECAP-Supportive Care Measure (SCM) from...
journal_title:BMJ supportive & palliative care
pub_type: 杂志文章
doi:10.1136/bmjspcare-2018-001582
更新日期:2019-12-01 00:00:00
abstract:OBJECTIVE:This study investigated the preferences of patients, family and staff for single or shared rooms in a UK hospice. METHOD:Semistructured interviews were conducted with patients, informal carers and staff at a hospice, focusing on room type preference. RESULTS:14 current and former hospice inpatients, 15 pati...
journal_title:BMJ supportive & palliative care
pub_type: 杂志文章
doi:10.1136/bmjspcare-2013-000514
更新日期:2015-06-01 00:00:00
abstract:BACKGROUND:The unprecedented scale of contemporary migration across countries over the last decade means that ageing and dying occur in a more globalised, multicultural context. It is therefore essential to explore the end-of-life experiences of older people from migrant backgrounds. METHODS:A scoping review of peer-r...
journal_title:BMJ supportive & palliative care
pub_type: 杂志文章,评审
doi:10.1136/bmjspcare-2020-002617
更新日期:2020-12-09 00:00:00
abstract:OBJECTIVES:Patients with advanced cancer do not report all symptoms, so assessment is best done systematically. However, for such patients, completion rates of some symptom instruments are <50%. Symptoms can be quantified by various scales including the Categorical Response Scale (CRS), Numerical Rating Scale (NRS) and...
journal_title:BMJ supportive & palliative care
pub_type: 杂志文章
doi:10.1136/bmjspcare-2015-001018
更新日期:2018-06-01 00:00:00
abstract:OBJECTIVE:In Singapore, more elderly are living in nursing homes (NHs), with a resultant increase in deaths occurring in NHs. However, palliative care training is limited in Singapore's core nursing curriculum, and many NHs rely on foreign-trained staff who may not have previous palliative care training. Our study aime...
journal_title:BMJ supportive & palliative care
pub_type: 杂志文章
doi:10.1136/bmjspcare-2020-002690
更新日期:2020-11-09 00:00:00
abstract:BACKGROUND:Non-invasive ventilation (NIV) is beneficial for respiratory failure in motor neurone disease (MND) but some patients may wish to stop the intervention. Guidance from the National Institute for Health and Care Excellence recommends that research is needed on NIV withdrawal. There is little in the literature ...
journal_title:BMJ supportive & palliative care
pub_type: 杂志文章
doi:10.1136/bmjspcare-2013-000470
更新日期:2014-03-01 00:00:00
abstract:OBJECTIVES:This paper examined the potential of a new classification framework, The Spectrum of Children's Palliative Care Needs, to facilitate identification of children with palliative care needs for the purposes of minimum data set collection and population needs assessment. METHODS:Health and social care professio...
journal_title:BMJ supportive & palliative care
pub_type: 杂志文章
doi:10.1136/bmjspcare-2012-000407
更新日期:2015-09-01 00:00:00