bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors contributing to practitioner choice when declining involvement in legally available care: A scoping protocol
Authors: Brown Janine , Goodridge Donna , Thorpe Lilian , Chipanshi Mary 
Published: August 2018

IntroductionAs legislation addressing medical treatments continues to evolve, there are several circumstances (eg, abortion, assisted dying) in which health practitioners may choose to not provide legally available care options. It is not always clear what underlies practitioner choice, as some research has suggested non-participation in care provision is not always due to an ethical abstention but may represent other factors. This results in tension between a practitioner’s right to refrain from practices deemed morally objectionable by the practitioner, and the care recipient’s right to access legally available treatments. The aim of this systematic scoping review is to identify the current knowledge regarding all the factors influencing practitioner’s choices when declining involvement in legally available healthcare options.Methods and analysisArksey and O’Malley’s scoping framework in concert with Levacet al’s enhancements will guide the systematic scoping review methodological processes. English language documents from 1 January 1998 to current will be sought using Medline, CINAHL, JSTOR, EMBASE, ProQuest Dissertations and Theses Global, PsychINFO and Sociological Abstracts. MeSH headings, keywords and synonyms will be adjusted using an iterative search process. Theses and dissertations will be included in the search protocol; however, other grey literature will be accessed only as required. Two research team members will screen the abstracts and full articles against inclusion criteria. Article information will be extracted via a data collection tool and undergo thematic analysis. Descriptive summary (visual summary and study contextual information) and a presentation of analytical themes will align findings back to the research question.Ethics and disseminationEthics approval is not required. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist will be used to support transparency and guide translation of findings. Findings will be disseminated through professional networks, in peer-reviewed journals and conferences via abstract and presentation.
Clinical and cost-effectiveness of one-session treatment (OST) versus multisession cognitive–behavioural therapy (CBT) for specific phobias in children: protocol for a non-inferiority randomised controlled trial
Authors: Wright Barry D , Cooper Cindy , Scott Alexander J , Tindall Lucy , Ali Shehzad , Bee Penny , Biggs Katie , Breckman Trilby , Davis III Thompson E , Gega Lina , Hargate Rebecca Julie , Lee Ellen , Lovell Karina , Marshall David , McMillan Dean , Teare M Dawn , Wilson Jonathan 
Published: August 2018

IntroductionSpecific phobias (intense, enduring fears of an object or situation that lead to avoidance and severe distress) are highly prevalent among children and young people. Cognitive–behavioural therapy (CBT) is a well-established, effective intervention, but it can be time consuming and costly because it is routinely delivered over multiple sessions during several months. Alternative methods of treating severe and debilitating phobias in children are needed, like one-session treatment (OST), to reduce time and cost, and to prevent therapeutic drift and help children recover quickly. Our study explores whether (1) outcomes with OST are ‘no worse’ than outcomes with multisession CBT, (2) OST is acceptable to children, their parents and the practitioners who use it and (3) OST offers good value for money to the National Health Service (NHS) and to society.MethodA pragmatic, non-inferiority, randomised controlled trial will compare OST with multisession CBT-based therapy on their clinical and cost-effectiveness. The primary clinical outcome is a standardised behavioural task of approaching the feared stimulus at 6 months postrandomisation. The outcomes for the within-trial cost-effectiveness analysis are quality-adjusted life years based on EQ-5D-Y, and individual-level costs based of the intervention and use of health and social service care. A nested qualitative evaluation will explore children’s, parents’ and practitioners’ perceptions and experiences of OST. A total of 286 children, 7–16 years old, with DSM-IV diagnoses of specific phobia will be recruited via gatekeepers in the NHS, schools and voluntary youth services, and via public adverts.Ethics and disseminationThe trial received ethical approval from North East and York Research Ethics Committee (Reference: 17/NE/0012). Dissemination plans include publications in peer-reviewed journals, presentations in relevant research conferences, local research symposia and seminars for children and their families, and for professionals and service managers.Trial registration numberISRCTN19883421;Pre-results.
11 Filling the void: preparing future junior doctors for challenging conversations
Authors: Costelloe Hannah , Copley Alice , Greenhalgh Andrew , Foster Andrew , Solanki Pratik 
Published: August 2018

Evidence demonstrates that medical students have limited experience in developing ‘higher-order communication skills’ (Kaufmanet al.2000). Anecdotally many do not feel confident in their ability to conduct difficult conversations often due to a lack of exposure to such scenarios in practice or a pervasive notion that these scenarios are inappropriate for students and beyond the scope of a junior doctor’s role and thus not a focus of curriculums (Nobleet al.2007). There is however a correlation between level of clinical experience and improved confidence for medical students (Morgan and Cleave-Hogg 2002).We surveyed a group of final year medical students to assess their confidence using a 10-point Likert scale in tackling common palliative and end of life care scenarios. Our intervention comprised a study day of 10 practical small-group teaching simulation and OSCE-style stations designed to provide exposure to common experiences in a controlled setting. We reassessed the confidence of students after delivery and objectively explored the impact of the day by asking participants to complete a validated assessment before and after the course. All results showed significant improvement on t-testing: confidence in end of life communication in an OSCE setting improved by 42.2% and assessment marks improved by 24.7% (p=0.039).Palliative care is an area in which students approaching the end of undergraduate training feel underprepared. Our findings demonstrate that small group sessions improve confidence by facilitating communication practice in a controlled environment and providing crucial exposure to common palliative care scenarios they will face as doctors.References. Kaufman D, Laidlaw T, Macleod H. Communication skills in medical school: Exposure confidence and performance.Academic Medicine[online] 2000;75(10):S90–S92. Available at https://journals.lww.com/academicmedicine/Fulltext/2000/10001/Communication_Skills_in_Medical_School__Exposure.29.aspx [Accessed: 30 May 2018]. Morgan P, Cleave-Hogg D. Comparison between medical students’ experience confidence and competence. Medical Education [online] 2002;36(6):534–539. Available at https://doi.org/10.1046/j.1365-2923.2002.01228.x [Accessed: 30 May 2018]. Noble L, Kubacki A, Martin J, Lloyd M. The effect of professional skills training on patient-centredness and confidence in communicating with patients. Medical Education [online] 2007;41(5):432–440. Available at https://doi.org/10.1111/j.1365-2929.2007.02704.x [Accessed: 30 May 2018]
12 Feasibility of an online implementation toolkit for palliative care services seeking to implement a carer-centred process of assessment and support
Authors: Diffin Janet , Ewing Gail , Rowland Christine , Grande Gunn 
Published: August 2018

IntroductionThe Carer Support Needs Assessment Tool (CSNAT) intervention requires a change in practice to a carer-centred process of assessment and support.1-3An online toolkit was developed to guide palliative services through the process of implementing the CSNAT intervention.AimsExplore the feasibility and acceptability of delivering implementation training through an online toolkit format.MethodsThe online toolkit has two learning components: (1) Individual: knowledge for practitioners to use the intervention; (2) Organisational: to assist a project team to plan pilot and sustain implementation. Five UK palliative care services participated; 2–4 practitioners from each completed the toolkit. Online survey administered upon completion of each learning component for feedback on content followed by telephone interview.Results15 practitioners completed ‘Learning component 1’ survey 14 completed ‘Learning component 2’ survey and 13 were interviewed. Feedback on content was positive. Online learning suitability was influenced by resource availability the nature/size of the team and individual learning styles. Variation in location of completion (work/home or both) was partly explained by availability of IT equipment space and time within the organisation. Whilst the majority of participants saw the value of online learning some had a preference for face-to-face delivery and so blended learning to include group discussions was deemed appropriate.ConclusionsWhilst online learning is welcomed by practitioners organisations need to ensure sufficient resources are available to enable completion and that it is given the same priority as attendance at face-to-face workshops. Blended learning may help accommodate different learning preferences.FunderNIHR CLARHC Greater ManchesterReferences. Ewing G, Grande G. Development of a Carer Support Needs Assessment Tool (CSNAT) for end-of-life care practice at home: A qualitative study. Palliative Medicine2013;27(3):244–56.. Ewing G, Brundle C, Payne S, Grande G. The Carer Support Needs Assessment Tool (CSNAT) for use in palliative and end-of-life care at home: A validation study. Journal of Pain and Symptom Management2013;46(3):395–405.. Ewing G, Austin L, Diffin J, Grande G. Developing a person-centred approach to carer assessment and support. British Journal of Community Nursing2015;20(12):580–4.
15 Triggers for the pharmacological management of delirium in palliative care: a mixed methods study
Authors: Fairfield Catherine L , Finucane Anne M , Spiller Juliet A 
Published: August 2018

IntroductionDelirium is a serious neurocognitive disorder with a high prevalence in palliative care and debate regarding its management is ongoing.AimsTo describe how delirium and its symptoms is documented in patient recordsTo determine the use of delirium screening tools and how these are viewed by staffTo identify triggers for pharmacological intervention in delirium management in a terminally ill population.MethodsA retrospective case-note review concerning all patients admitted to a hospice inpatient setting between 1–17th August 2017 and semi-structured interviews with 7 hospice doctors and nurses.Results21 patients were reviewed. 62% were screened for delirium using the 4AT on admission. 76% had documented symptoms of delirium and of these 81% died without delirium resolution. There were inconsistencies in the documentation of delirium and the term itself was used infrequently. Non-pharmacological measures were poorly documented. Midazolam was the most commonly used medication. Triggers for pharmacological intervention included failure of non-pharmacological measures distress agitation and risk of patient harm. Nursing staff recognised delirium in its severe form but were less likely to do so in milder cases.ConclusionsTriggers for pharmacological intervention are in-keeping with guidelines however the level of understanding of delirium’s presentation varied between participants. This along with the high prevalence of delirium frequent use of midazolam and limited awareness and documentation of non-pharmacological measures (e.g. structured family support) highlights the need for further training and research.
16 Delirium care of hospice patients: a qualitative interview study with staff and volunteers
Authors: Featherstone Imogen , Johnson Miriam , Jones Lesley , Coppo Eleonora , Hosie Annmarie , Bush Shirley H , Siddiqi Najma , Taylor Johanna , Teodorczuk Andrew 
Published: August 2018

IntroductionDelirium is a distressing condition which is commonly experienced by hospice patients. Although delirium can be prevented by around one-third in hospital inpatients (Siddiqiet al.2016) there has been little research into effective strategies to prevent and manage delirium in hospices. Greater insight into the current practice attitudes and understanding of hospice staff and volunteers would inform the development of interventions that are tailored to improve delirium care in hospices.AimTo explore the understanding attitudes and practice of hospice staff and volunteers regarding the care of patients with delirium.Methods36 qualitative semi-structured interviews were conducted at two hospices. Participants were purposively sampled to include different disciplines (9 health care assistants, 8 nurses, 5 doctors, 4 volunteers, 3 board members, 2 allied health professionals, 2 managers, 2 domestic workers and 2 fundraisers). A topic guide and case vignettes prompted participants to describe their experiences in relation to delirium prevention recognition assessment and management. Three researchers are conducting thematic analysis to identify analyse and interpret themes from the interview data.ResultsProvisional results include themes of: ‘Supporting the distressing experience of delirium’; ‘Management strategies’ and ‘The burden of delirium care.’ Gaps in current practice relate to delirium prevention recognition and screening. Potential facilitators for developing interventions in hospices include education flexibility in staffing the role of volunteers and a supportive staff culture.ConclusionThis study will provide important insights into staff and volunteers’ current practice which will inform the development of a targeted intervention to improve delirium care in hospices.Reference. Siddiqi N, Harrison J, Clegg A, Teale E, Young J, Taylor J, Simpkins S. Interventions for preventing delirium in hospitalised non-ICU patients. Cochrane Database of Systematic Reviews2016;(3). Art. No.: CD005563. doi:10.1002/14651858.CD005563.pub3
20 Validation of the support needs approach for patients (SNAP) tool to enable patients with advanced copd to identify and express their support needs to healthcare professionals
Authors: Gardener Carole , Ewing Gail , Farquhar Morag 
Published: August 2018

IntroductionPatient identified need is key to delivering a person-centred approach in supportive and palliative care. The support needs approach for patients (SNAP) tool aims to enable patients with advanced COPD to identify and express their support needs to healthcare professionals (HCPs) but its validity is unknown.AimTo establish the face content and criterion validity of the SNAP tool in advanced COPD.MethodsTwo-stage mixed method primary care study involving patients with advanced COPD and their carers. Stage 1: Face and content validity assessed though focus groups involving patients and carers (n=12) considering appropriateness relevance and completeness of the SNAP tool. Thematic data analysis within a Framework Approach. Stage 2: Content and criterion validity assessed in a postal survey through patient self-completion of the SNAP tool and disease impact measures (chronic respiratory questionnaire COPD assessment test and hospital anxiety and depression scale). Content validity assessed using summary statistics; criterion validity via correlations between tool items and impact measures.ResultsThe SNAP tool has good face content and criterion validity. Patients and carers found the tool patient-friendly with potential clinical utility. No tool items were redundant. Clear correlations were found between tool items and the majority of items/sub-scales of the impact measures.DiscussionThe SNAP tool has good face content and criterion validity. It has the potential to support the delivery of supportive and palliative care in advanced COPD by enabling patients to identify and express their support needs to HCPs. Future work will pilot SNAP in clinical practice.
21 Identification and management of delirium in the palliative inpatient unit
Authors: Gill Andrew , Rayment Clare , Kane Chris 
Published: August 2018

IntroductionDelirium is an acute confusional state. The incidence of delirium in palliative care units is estimated between 13% and 42% (Hosie 2014). Delirium is associated with an increase in mortality and length of hospice stay yet it is poorly identified. Up to 50% of cases of delirium are reversible (Lawlor 2000) as such early identification and impeccable assessment and treatment could relieve the suffering.AimTo assess identification and management of delirium in two hospices.MethodsRetrospective notes analysis to identify patients with delirium whether they were coded with a delirium diagnosis and whether the management of delirium followed best practice.Results77 inpatients across two hospices were assessed in one month in 2018. There were 37 episodes of possible delirium only five were coded as delirium none had assessment with a recognised delirium tool. Reversibility was considered for 48 episodes; it was not clear from the documentation that this was all possible reversible causes. Family were kept informed 94% of the time. A management plan was documented for five patients.ConclusionDelirium was being considered but not documented a common problem in medical notes. Documentation of a management plan was poor but when there was a plan best practice was followed with non-pharmacological management then low dose antipsychotic with stronger sedation reserved for terminal agitation. An education feedback loop formal training on delirium and design of an electronic medical record template to prompt the management of delirium is ongoing. Practice will be reassessed three months after this intervention.References. Hosie A, Davidson P, Agar M, et al. Delirium prevalence incidence and implications for screening in specialist palliative care inpatient settings: A systematic review. Palliative Medicine2013;27(6):486–498.. Lawlor P, Gagnon B, Mancini I, et al. Occurrence causes and outcome of delirium in patients with advanced cancer: A prospective study. Archives of Internal Medicine2000;160(6):786–794.
23 Findings from a pilot and feasibility trial of a music therapy intervention in specialist palliative care
Authors: Graham-Wisener Lisa , Reid Joanne , McConnell Tracy , McGrillen Kerry , Kirkwood Jenny , McKeown Miriam , Clarke Mike , Regan Joan , Hughes Naomi , Porter Sam 
Published: August 2018

IntroductionMusic therapy aligns to the holistic approach to palliative and end-of-life care (PEOLC) with increased prevalence in PEOLC settings (Graham-Wiseneret al.2018). Despite this there is a dearth of high-quality evidence examining the impact of music therapy towards end of life on quality of life (McConnellet al.2016).AimsThe aim of this pilot and feasibility study was to: test procedures; outcomes and validated tools; estimate recruitment and attrition rates; and calculate the sample size required for a phase III randomised controlled trial.MethodsA single-centre pilot and feasibility trial with patients admitted to a specialist palliative care inpatient unit within the United Kingdom. Participants were randomised (1:1) to either a music therapy intervention of two 30–45 min sessions of music therapy per week for three consecutive weeks or usual care. The primary outcome measure was to evaualte the feasibility of administering the McGill Quality of Life Questionnaire (MQoL) baseline with follow-up measures at one, three and five weeks.Results51 participants were recruited to the trial over a 12 month period. Feasibility of administering music therapy intervention and attrition rates identified one-week follow-up as an appropriate primary outcome. Results suggest a likely effect on MQoL total score between intervention and control arms in particular the existential subscale.ConclusionThe current study resolved a number of issues towards informing robust procedures for a phase III RCT. This data is urgently needed to ensure an evidence-based decision on inclusion of music therapy in palliative care services.References. Graham-Wisener L, Watts G, Kirkwood J, Harrison C, McEwan J, Porter S, Reid J, McConnell TH. Music therapy in UK palliative and end-of-life care: A service evaluation. BMJ supportive & palliative care2018.. McConnell T, Scott D, Porter S. Music therapy for end-of-life care: An updated systematic review. Palliative Medicine2016;30(9):877–883.
29 Multi-disciplinary palliative care for men living with duchenne: a qualitative interview study
Authors: Laidlaw Sheonad , Carduff Emma 
Published: August 2018

BackgroundDuchenne muscular dystrophy (DMD) is an x-linked ultra-rare neuromuscular condition affecting 1 in 3600–6000 live male births.1Individuals live with an exceptional illness trajectory of prolonged dwindling frailty and high symptom burden.2While it is recognised that a co-ordinated multidisciplinary team approach may increase the survival of those with DMD and improve their quality of life (QoL)3adults are receiving less comprehensive and co-ordinated care compared with those in the paediatric service.4AimTo investigate QoL in adults with DMD living in the West of Scotland (WoS).MethodsThe SEIQoL-DW tool was used to assess the five most important elements that contribute to an individual’s QoL – these were then used to guide qualitative interviews with six men in the WoS. A thematic analysis was undertaken.ResultsMen living with DMD in the WoS described living good lives but feel ‘forgotten’ due to perceived gaps in their care: poorly co-ordinated and infrequent health care; lack of multi-disciplinary team input and holistic care; and poor or no access to allied health care professionals for example physiotherapy and psychological support.ConclusionsExisting guidelines rarely seem materialise as person-centred care. There are numerous opportunities to introduce palliative care gently as part of the MDT early in the illness trajectory and continue in a dynamic manner as time elapses and when trigger points arise. Better co-ordinated multi-disciplinary care with the inclusion of a palliative care specialist may be a solution allowing for an early introduction to palliative care and proactive advance care planning.References. Bushby K, et al. Diagnosis and management of duchenne muscular dystrophy part 1: Diagnosis and pharmacological and psychosocial managment. Lancet Neurol2010;9:77–93.. Landfeldt E, et al. The burden of duchenne muscular dystrophy. Neurology2014;83:529–36.. Bushby K, et al. Diagnosis and management of duchenne muscular dystrophy part 2: Implementation of multidisciplinary care. Lancet Neurol2010;9:177–89.. Rodger S, et al. Adult care for duchenne muscular dystrophy in the UK. J Neuro2015;262:629–41.