Abstract:
BACKGROUND:Refractory breathlessness in advanced chronic disease leads to high levels of disability, anxiety and social isolation. These result in high health-resource use, although this is not quantified. AIMS:To measure the cost of care for patients with advanced disease and refractory breathlessness and to identify factors associated with high costs. DESIGN:A cross-sectional secondary analysis of data from a randomised controlled trial. SETTING/PARTICIPANTS:Patients with advanced chronic disease and refractory breathlessness recruited from three National Health Service hospitals and via general practitioners in South London. RESULTS:Of 105 patients recruited, the mean cost of formal care was £3253 (standard deviation £3652) for 3 months. The largest contributions to formal-care cost were hospital admissions (>60%), and palliative care contributed <1%. When informal care was included, the total cost increased by >250% to £11,507 (standard deviation £9911). Increased patient disability resulting from breathlessness was associated with high cost (£629 per unit increase in disability score; p = 0.006). Increased breathlessness on exertion and the presence of an informal carer were also significantly associated with high cost. Patients with chronic obstructive pulmonary disease tended to have higher healthcare costs than other patients. CONCLUSION:Informal carers contribute significantly to the care of patients with advanced disease and refractory breathlessness. Disability resulting from breathlessness is an important clinical cost driver. It is important for policy makers to support and acknowledge the contributions of informal carers. Further research is required to assess the clinical- and cost-effectiveness of palliative care interventions in reducing disability resulting from breathlessness in this patient group.
journal_name
Palliat Medjournal_title
Palliative medicineauthors
Dzingina MD,Reilly CC,Bausewein C,Jolley CJ,Moxham J,McCrone P,Higginson IJ,Yi Ddoi
10.1177/0269216317690994subject
Has Abstractpub_date
2017-04-01 00:00:00pages
369-377issue
4eissn
0269-2163issn
1477-030Xjournal_volume
31pub_type
杂志文章abstract:BACKGROUND:There is increasing demand for primary care practitioners to play a key role in palliative care delivery. Given this, it is important to understand their perceptions of the barriers and enablers to optimal palliative care, and how commonly these are experienced. AIM:To explore the type and prevalence of bar...
journal_title:Palliative medicine
pub_type: 杂志文章
doi:10.1177/0269216319865414
更新日期:2019-10-01 00:00:00
abstract::Attitudes toward euthanasia differ between individuals and populations, and in many studies the medical profession is more reluctant than the general public. Our goal was to explore medical students' attitude toward euthanasia. A questionnaire containing open-ended questions was answered anonymously by 165 first- and ...
journal_title:Palliative medicine
pub_type: 杂志文章
doi:10.1177/0269216307081940
更新日期:2007-10-01 00:00:00
abstract::The main focus of palliative care services is to improve patients' quality of life (QOL). The potential value of assessment of QOL in palliative care is being increasingly recognized. The McGill Quality of Life questionnaire (MQOL) is designed specifically for palliative care patients, but its cross-cultural validity ...
journal_title:Palliative medicine
pub_type: 杂志文章
doi:10.1191/026921601680419438
更新日期:2001-09-01 00:00:00
abstract:BACKGROUND: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. AIMS:We aim to review the characte...
journal_title:Palliative medicine
pub_type: 杂志文章,多中心研究
doi:10.1177/0269216314560802
更新日期:2015-04-01 00:00:00
abstract::Medical training teaches physicians to sit when breaking bad news, though there have been no controlled studies to support this advice. We aimed to establish cancer patients' preference for physician posture when physicians break bad news using a randomized controlled crossover trial in a department of palliative care...
journal_title:Palliative medicine
pub_type: 杂志文章,随机对照试验
doi:10.1177/0269216307081184
更新日期:2007-09-01 00:00:00
abstract:BACKGROUND:Constipation affects many patients receiving long-term opioid therapy for cancer pain. Little is known about the nature of psychological distress and the burden associated with this problem. This information may inform the development of effective treatment strategies and ameliorate distress. AIM:The object...
journal_title:Palliative medicine
pub_type: 杂志文章
doi:10.1177/0269216312450358
更新日期:2013-05-01 00:00:00
abstract::Objective of this study is to examine physicians' practices regarding information disclosure to terminally ill patients and to their relatives, without informing the patient. A questionnaire had been sent to a random sample of 3014 Belgian physicians from different specialties frequently involved in end-of-life care. ...
journal_title:Palliative medicine
pub_type: 杂志文章,多中心研究
doi:10.1177/0269216308102043
更新日期:2009-06-01 00:00:00
abstract:BACKGROUND:Early palliative care improves quality of life during life-prolonging treatment for patients with cancer, but the role of nurses in facilitating the early involvement of palliative care is unclear. AIM:To conceptualize the psychosocial processes involved in the introduction and provision of palliative care ...
journal_title:Palliative medicine
pub_type: 杂志文章
doi:10.1177/0269216319883980
更新日期:2020-02-01 00:00:00
abstract::Open pulmonary tuberculosis has been increasingly seen in HIV-infected patients in this hospice. Multidrug-resistant tuberculosis is a new and serious threat and two cases have occurred in our hospice in the past two years. This infection poses a health risk to staff, patients, relatives and volunteers. Palliative car...
journal_title:Palliative medicine
pub_type: 杂志文章
doi:10.1177/026921639701100607
更新日期:1997-11-01 00:00:00
abstract::This paper reviews the experience of managing 31 patients with severe dysphagia in motor neurone disease. Thirteen patients were fed nasogastrically and the remaining 18 were managed conservatively without a nasogastric tube. The introduction of nasogastric feeding led to the development of new problems in some patien...
journal_title:Palliative medicine
pub_type: 杂志文章
doi:10.1177/026921639400800108
更新日期:1994-01-01 00:00:00
abstract::This retrospective clinical study reports on the experience of palliative venting gastrostomy (PVG) in an integrated acute teaching hospital and hospice-based palliative care service over a seven-year period (1989-97). PVG was performed for 51 patients with refractory nausea and vomiting resulting from varying degrees...
journal_title:Palliative medicine
pub_type: 杂志文章
doi:10.1191/0269216302pm590oa
更新日期:2002-11-01 00:00:00
abstract::The McGill Quality of Life Questionnaire (MQOL) is a widely used tool that has been specifically developed to measure the quality of life of patients facing a life-threatening illness. Preferably, a self-report instrument has an equal number of items worded positively and negatively. However, all the psychological sca...
journal_title:Palliative medicine
pub_type: 杂志文章,多中心研究
doi:10.1177/0269216308094519
更新日期:2008-09-01 00:00:00
abstract:OBJECTIVES:To explore the experiences of people involved in UK palliative care day services (PCDS) and identify the important outcomes of this service. METHODS:Focus groups were carried out separately with patients, informal carers and volunteers from four purposively selected palliative care day units and with day un...
journal_title:Palliative medicine
pub_type: 杂志文章
doi:10.1191/0269216305pm942oa
更新日期:2005-01-01 00:00:00
abstract::Attitudes to companion animals were surveyed among 50 patients and staff at a day care hospice. Dog visits were welcomed by all but two. Of the 37 patients studied, only seven had a companion animal, often their closest companion. Many more would like to keep an animal, but were prevented by age, frailty or accommodat...
journal_title:Palliative medicine
pub_type: 杂志文章
doi:10.1177/026921639601000410
更新日期:1996-10-01 00:00:00
abstract:BACKGROUND:A normal vitamin D status is required for bones and muscles to maintain their function and structure, but it also contributes to the functional integrity of other multiple physiologic systems in the body. AIM:To assess the relationship of Vitamin D deficiency with health-related quality-of-life issues, fati...
journal_title:Palliative medicine
pub_type: 杂志文章
doi:10.1177/0269216315601954
更新日期:2016-01-01 00:00:00
abstract::Although anecdotal reports suggest nebulized lignocaine may help breathlessness in patients with cancer this has not been examined formally. We report a pilot study comparing nebulized lignocaine 100 mg and 200 mg with saline in six patients with cancer who were breathless at rest. Nebulized lignocaine was well tolera...
journal_title:Palliative medicine
pub_type: 杂志文章
doi:10.1177/026921639400800106
更新日期:1994-01-01 00:00:00
abstract:BACKGROUND:The Delirium Observation Screening Scale (DOS) is designed to detect delirium by nurses' observations and has shown good psychometric properties. Its use in palliative care unit patients has not been studied. AIM:To determine diagnostic and concurrent validity, internal consistency, and user-friendliness of...
journal_title:Palliative medicine
pub_type: 杂志文章
doi:10.1177/0269216313492187
更新日期:2014-01-01 00:00:00
abstract::This study compares terminally ill patients and their family caregivers in terms of the physical and emotional status of the patients, the adequacy of the support provided for the patients and where the patients would be most appropriately placed during the last stage of their lives. Patients and caregivers shared sim...
journal_title:Palliative medicine
pub_type: 杂志文章
doi:10.1177/026921639300700204
更新日期:1993-01-01 00:00:00
abstract::It is important to support general practitioners (GPs) in maintaining and developing their palliative care skills as most of the final year of a patient's life is spent at home under the care of the primary health care team. The training needs and uptake of GPs have been explored, but little is known about how GP educ...
journal_title:Palliative medicine
pub_type: 杂志文章
doi:10.1191/026921601678576176
更新日期:2001-05-01 00:00:00
abstract:BACKGROUND:In rural settings, relationships between place and self are often stronger than for urban residents, so one may expect that rural people would view dying at home as a major feature of the 'good death'. AIM:To explore the concept of the 'good death' articulated by rural patients with life-limiting illnesses,...
journal_title:Palliative medicine
pub_type: 杂志文章
doi:10.1177/0269216318800613
更新日期:2018-12-01 00:00:00
abstract:BACKGROUND:Of deaths in high-income countries, 75% are caused by progressive advanced chronic conditions. Palliative care needs to be extended from terminal cancer to these patients. However, direct measurement of the prevalence of people in need of palliative care in the population has not been attempted. AIM:Determi...
journal_title:Palliative medicine
pub_type: 杂志文章
doi:10.1177/0269216313518266
更新日期:2014-04-01 00:00:00
abstract:BACKGROUND:A universal consensus regarding standardized pain outcomes does not exist. The personalized pain goal has been suggested as a clinically relevant outcome measure. AIM:To assess the feasibility of obtaining a personalized pain goal and to compare a clinically based personalized pain goal definition versus a ...
journal_title:Palliative medicine
pub_type: 杂志文章
doi:10.1177/0269216317701891
更新日期:2017-12-01 00:00:00
abstract::This is a review of tools that have been developed to assess pain in children, with a brief evaluation of their practicality and validity. There are some suggestions for the direction of future research in the development and use of the scales. ...
journal_title:Palliative medicine
pub_type: 杂志文章,评审
doi:10.1177/026921639701100503
更新日期:1997-09-01 00:00:00
abstract:BACKGROUND:Hospitalizations in patients with metastatic cancer occur commonly at the end of life but have not been well-described in individuals with metastatic breast cancer. AIM:To describe the reasons for admission and frequency of palliative care and hospice utilization in hospitalized patients with metastatic bre...
journal_title:Palliative medicine
pub_type: 杂志文章
doi:10.1177/0269216316637238
更新日期:2016-10-01 00:00:00
abstract:BACKGROUND:Palliative care requires a multidisciplinary care team. General practitioners often ask specialised palliative home care teams for support. Working with specialised nurses offers learning opportunities, also called workplace learning. This can be enhanced by the presence of a learning facilitator. OBJECTIVE...
journal_title:Palliative medicine
pub_type: 杂志文章,随机对照试验
doi:10.1177/0269216314560391
更新日期:2015-05-01 00:00:00
abstract::The history and development of an extra care sheltered housing complex, specifically designed and built for frail, ambulant, cancer patients is reviewed. Consideration is given to diagnosis, length of stay, place of death, family and social background. Problems are highlighted and the need for future research is discu...
journal_title:Palliative medicine
pub_type: 杂志文章
doi:10.1177/026921639500900309
更新日期:1995-07-01 00:00:00
abstract::A system of 12-hour nursing shifts was adopted at a newly-opened independent hospice. This paper presents the results from an exploratory, descriptive study in which nursing staff reported perceived advantages, disadvantages and satisfaction with the 12-hour shift system. A small sample (n = 11) of both qualified and ...
journal_title:Palliative medicine
pub_type: 杂志文章
doi:10.1177/026921639500900206
更新日期:1995-04-01 00:00:00
abstract:OBJECTIVE:A prospective cohort study evaluated the performance and acceptability of the cognitive based Mood Evaluation Questionnaire (MEQ) in assessing depressive symptoms over time in patients with advanced cancer. The structured clinical interview for DSM-III-R (SCID) and the single-item interview screening question...
journal_title:Palliative medicine
pub_type: 杂志文章
doi:10.1191/0269216303pm812oa
更新日期:2003-10-01 00:00:00
abstract::To be able to distinguish end-stage palliative sedation from euthanasia without having to refer to intentions that are difficult to verify, physicians must be able to manage palliative sedation appropriately (i.e., see that death is not hastened as a result of disproportionate medication). In the present study, we ass...
journal_title:Palliative medicine
pub_type: 杂志文章
doi:10.1177/0269216308091867
更新日期:2008-07-01 00:00:00
abstract::Existential distress has been recognized as a source of suffering for oncology patients. This study focusses on existential issues and coping mechanisms of a unique culturally diverse Jewish/Middle Eastern oncology population. A qualitative assessment of 40 patients with advanced cancer was undertaken through an inter...
journal_title:Palliative medicine
pub_type: 杂志文章
doi:10.1191/0269216305pm1038oa
更新日期:2005-07-01 00:00:00