bluuebunny/crossref_metadata_2025_split huggingface dataset:
INITIATIVES FOR IMPROVING THE PROVISION OF ASSISTANCE AT MEALTIMES FOR OLDER ADULTS ON HOSPITAL WARDS: A MIXED METHODS SYSTEMATIC REVIEW
Authors: Edwards Deborah , Hopkinson Jane 
Published: February 2014

BackgroundIn the UK, a third of older hospital patients are malnourished. Malnutrition is associated with staying in hospital longer, increased morbidity and mortality, especially for those with chronic conditions. Mealtime assistance may be important to improve nutritional intake, clinical outcomes and patient experience. Two previous quantitative systematic reviews have been undertaken. One explored the use of volunteers and the other feeding assistance in hospitals and care-homes.AimsWe are conducting the first mixed method systematic review about the provision of assistance at mealtimes for older adults on hospital wards to▸i) determine the effectiveness of interventions▸ii) explore the experiences of older adults and those involved with their careMethodsThe design is informed by methods developed by the Evidence for Policy and Practice Information Centre. This ‘mixed-methods’ triangulation approach combines data from i) effectiveness studies, ii) studies which obtain the views of participants and iii) current guidelines and policy. We have conducted a search of electronic databases (CINAHL, MEDLINE, BNI, Cochrane Library, EMBASE, PsychINFO, Open-Grey). Limits were English language; 1996 to present; adults. Abstracts have been assessed against inclusion/exclusion criteria by two researchers to select full-text for quality assessment and data extraction. The key elements of best practice will be extracted from current guidelines and policy documents. This will be used to derive a framework to guide analysis and interpretation of the evidence.ResultsThe findings will be presented as a conceptual map of initiatives for improving the provision of assistance at mealtimes for older adults on hospital wards. We will also present propositions of what might be most effective in assisting oral mealtime nutritional intake and the implications.ConclusionWe are conducting a systematic evaluation of literature to provide recommendations for the supportive nutritional care of older malnourished chronically ill people in hospital.
SPIRITUAL CARE AND KIDNEY DISEASE IN NZ: A QUALITATIVE STUDY WITH NEW ZEALAND RENAL SPECIALISTS
Authors: MacLeod Roderick , Egan Richard , Walker Rob , Wood Sarah , Mountier Jane 
Published: February 2014

BackgroundPeople with chronic kidney disease have a shortened life expectancy and carry a high symptom burden. Research suggests that attending to renal patients' spiritual needs may contribute to an improvement in their quality of life and this combined with the burden of renal disease underscores the need to better understand all domains of patients' well-being, including spirituality. The aim of this qualitative study was to investigate the provision of spiritual care in New Zealand renal units from the perspective of specialists.MethodsThe study was qualitative using semi-structured interviews and thematic analysis. Participants were recruited across New Zealand's ten renal centres. Participants were asked about their understandings of spirituality, patients' spiritual needs, current service provision of spiritual care, pre- and in-service spiritual care training, and suggestions for improvements.ResultsFive specialist doctors and nine specialist nurses were recruited for interviews in 2012. Understandings of spirituality were broad, with most participants having an inclusive understanding. Patients' spiritual needs were generally acknowledged and respected, although not specifically named. Formal spiritual assessments were not done. Consideration of death was discussed as an often-unexamined need. The dominant position was that the specialists did not provide explicit spiritual care of patients but there was some ad hoc provision offered through pre-dialysis educators, family meetings, and Maori liaison staff members. Participants had received no pre-service education or training and very little in-service training in spiritual care. The nurses thought further training “would be useful” but the doctors were less interested. There were many suggestions for improvements.ConclusionMost participants indicated they would attempt to provide some form of spiritual care, but they generally demonstrated a lack of confidence and awareness of how to address a patient's spiritual and end of life needs.
HOW DO PERCEPTIONS OF RISK SHAPE 'CHOICE' IN END-OF-LIFE CARE?
Authors: Wilson Fiona , Ingleton Christine , Gott Merryn , Gardiner Clare 
Published: February 2014

BackgroundThe National End of Life Care Strategy for England (2008) advocates ‘choice’ as a central tenet of palliative care delivery, however it is not clear how 'choice' is understood nor how choice may be shaped by perceptions of risk.AimA narrative literature review was undertaken with the aim of capturing understandings around choice and perceived risks in end-of-life care.MethodsMedline (Ebsco), PschINFO, Assia (Applied Social Sciences Index and Abstracts), British Nursing Index, High Wire Press, CINAHL (Current Index to Nursing and Allied Health Literature) were searched using the terms decision*, risk*, hospice and palliative care, end of life care. Hand searching of key texts also revealed relevant papers. Inclusion criteria included adult focus (>18 yrs), and UK focus only. Two hundred and forty two papers were examined for relevance and filtered using criteria outlined by Hawker,et al(2002). In total, twenty five papers were analysed for key themes.ResultsNotions of 'choice' are shaped by individual understandings as well as wider structural factors. Individual understandings include perceptions of services, family support, and balancing of self-identity. Structural factors include service provision, professional awareness, and inequalities around ethnicity and class.ConclusionsAcknowledgement by key stakeholders of the structural factors, which constrain choice, may help to inform service development. At the same time, recognition of patient and carer understandings may help to facilitate supportive decision making at end-of-life.
THE ASSESSMENT OF HYDRATION IN ADVANCED CANCER PATIENTS USING BIOELECTRICAL IMPEDANCE ANALYSIS
Authors: Nwosu Amara , Mayland Catriona , Varro Andrea , Ellershaw John 
Published: February 2014

BackgroundCurrent hydration assessments methods are limited in cancer patients approaching death. Bioelectrical impedance analysis (BIA) is an accurate validated method of assessing body composition; however its clinical use in advanced cancer is uncertain.AimsTo measure hydration in advanced cancer patients using BIA, in order to determine the relationship between symptoms, biochemistry and performance status.MethodsA cross-sectional prospective analysis of advanced cancer patients within a specialist palliative care unit in Liverpool, UK. BIA raw measurements, Resistance (R–Ohm), Reactance, (Xc–Ohm), total body water (TBW–through proxy measurement using height/resistance [Ht2/R]), Phase angle (PA) and BIA vector analysis (BIVA) were used to compare for differences in hydration based on WHO performance status (0= asymptomatic, 4=bedbound), symptoms, physical examination and biochemistry.FindingsFrom a possible 97 patients, 78 (80%) provided consent to participate. Ht2/R was lower in patients with a WHO performance status of 4 compared to those with a performance status <4 (mean 42.1 [SD 9.0] vs. 52.3 [14.6], p=0.002), and greater in those with clinically detectable oedema (mean 57 [SD 17.4] vs. 47.7 [12.4], p=0.027). Ht2/R correlated negatively with thirst [r=−0.31, p=0.006], dry mouth [r=−0.294, p=0.009] and fatigue [r=−0.285, p=0.011). BIVA showed significant difference in hydration between groups classified by the presence or absence of oedema (p=0.03) and dry mouth (p=0.04).There was no significant relationship between hydration (Ht2/R and BIVA) vs. biochemical tests or between symptoms vs. biochemistry or performance status.ConclusionsIn advanced cancer, hydration (as measured by Ht2/R and BIVA) relates to clinically measurable signs and symptoms. Further work is needed to determine whether BIA can be used to guide the management of fluid states in advanced cancer.
PERCEPTION OF THE RATE OF CHANGE IN A PATIENT'S CONDITION AS A METHOD OF ESTIMATING PROGNOSIS: A PILOT STUDY
Authors: Grogan Eleanor , Peel Tim , Regnard Claud , Paes Paul 
Published: February 2014

BackgroundEstimation of prognosis is a common request. Many methods have been considered but are often complex or unreliable. Some palliative medicine physicians feel the best guide may be the recent rate of change in physical condition. For example, if a patient perceives their condition has been changing weekly they may have a prognosis of weeks; if day by day the prognosis is likely to be days. No research has been done to show whether this is an accurate guide, despite it being widely used.PatientPatient perceived rate of changeDoctor estimated prognosisActual survival1Daysweeks32 days2Weeksweeks35 days3Weeksweeks33 days4Weeksshort months44 days5Monthsmonths40 days6Monthsmonths40 days7Daysmonths70 days8stablemonths154 daysThe study needs repeating with greater numbers of patients to further research this area.MethodsAdults with cancer admitted to an NHS inpatient specialist palliative care unit were recruited (exclusion criteria: 1. lacking capacity; 2. if it was thought the study may cause unnecessary distress). Patients were asked “how has your condition changed recently?" (plus a further probe of "do you think things have been changing daily/weekly/monthly?" if required) but were not asked directly about prognosis. Ethics approval was obtained. Data was collected on patient's perception of rate of change, consultant's estimate of prognosis and actual survival time.AimTo determine whether the proposed research question was a reliable indicator of survival time.ResultsEight patients were recruited. There was similarity between patient perceived rate of change, doctor prognosis estimate and actual survival time in most cases. Numbers were smaller than anticipated due to concerns about causing distress in patients, although this did not occur in participating patients.
OUT-OF-HOURS PALLIATIVE CARE: WHAT ARE THE EDUCATIONAL NEEDS AND PREFERENCES OF GENERAL PRACTITIONERS?
Authors: Magee Claire , Koffman Jonathan 
Published: February 2014

BackgroundGeneral practitioners (GPs) provide most out-of-hours medical care, but overall see few palliative patients. Keeping their knowledge and skills up-to-date is challenging. UK national policy has highlighted the importance of improving training for out-of-hours clinicians in order to reduce unnecessary admissions and support patients to die at home. However, little is known about the educational preferences of GPs working in this setting.AimsTo explore the confidence of out-of-hours GPs in symptom control, and to identify their educational needs and preferences in order to inform recommendations for future educational programmes.MethodsA structured postal survey was designed and sent to 1005 GPs employed by an independent provider of out-of-hours services across England. Quantitative data was analysed using descriptive statistics and non-parametric tests.Results203 (20.3%) GPs responded to the survey questionnaire. 13.3% (n=27) worked exclusively out-of-hours; they were typically older and more experienced. Confidence in assessing palliative care emergencies (42.8%, n=87: ‘not so confident’ or ‘not at all confident’), managing symptoms in non-cancer patients (39.4%, n=80) and prescribing a new syringe driver (39.0%, n=79) was lowest. Low confidence was associated with infrequent exposure (p<0.05) and lack of training (p<0.05). 12.8% (n=26) had never received formal palliative care training. Educational preferences were closely associated with confidence (p<0.0005); the above topics were most requested. E-learning was the preferred method (67.5%, n=137). GPs were more likely to prefer education with other GPs than with other professionals (p=0.001). 82.1% (n=165) felt training focused on out-of-hours work would be beneficial.ConclusionsConfidence in key palliative care competences is lacking. Educational strategies must be targeted at GPs needs, both in terms of content and delivery, with regular updates. E-learning is favoured, but should be combined with other approaches such as out-of-hours themed workshops. Specialist palliative care services should engage with out-of-hours providers to support education.
DEATH ANXIETY AMONG MEDICAL STUDENTS: PREVALENCE AND IMPLICATIONS
Authors: Thiemann Pia , Quince Thelma , Benson John , Wood Diana , Barclay Stephen 
Published: February 2014

BackgroundDeath Anxiety is related to an awareness of the reality of dying and death. There is some evidence that physicians' fear of death has a negative impact on their own wellbeing and influences their care of terminal ill patients. The first time that physicians face death in a professional context is at medical school. The nature, development and implications of death anxiety in medical students are currently poorly understood.AimsTo examine medical students' death anxiety: (1) prevalence, gender differences and change over time; (2) associations with attitudes towards end of life care (EOLC) and psychological wellbeing.MethodsFour cohorts of core science students and 4 cohorts of clinical students at the University of Cambridge Medical School participated for up to 3 consecutive years (N=953). Questionnaires concerning death anxiety (Collett-Lester Fear of Death Scale), psychological wellbeing (Hospital Anxiety and Depression Scale, Interpersonal Reactivity Index) and attitudes towards EOLC (Sullivan's statements) were administered each year.ResultsDeath Anxiety was moderate among students of all training levels and remained stable over time. No gender differences were found except for the subscale ‘death of others’, where men scored significantly lower than women in 5 of the 6 years. In core science and clinical years weak negative correlations (r=–.18 −–.42) were present between death anxiety and wellbeing. Consistent weak to moderate correlations (r=.27–.50) between death anxiety and attitudes towards EOLC revealed that students with higher death anxiety were more afraid of negative personal impact of EOLC.ConclusionWhile death anxiety was not high among most medical students, its association with low wellbeing and negative attitudes towards EOLC are concerning. Addressing death anxiety during medical education appears to be important to enhance the quality of EOLC and the student's psychological health.
TISSUE DONATION AND END OF LIFE CARE
Authors: Sedgwick Rosemary , Gibson Natasha , Williams Charles , Kreeger Lulu , Holmes Grant 
Published: February 2014

BackgroundNICE organ donation guidance makes it explicit in its first recommendation that ‘organ donation should be considered as a usual part of “end-of-life care” planning.’ The Liverpool Care Pathway (LCP) incorporated a prompt for clinicians to discuss tissue and organ donation with the patient, and if appropriate their relatives. A recent audit found that of 20 Kingston Hospital LCP proformas completed, only 1 had documented that this information had been ascertained.AimsTo explore junior doctors' attitudes surrounding discussion of tissue donation in the context of end of life care.MethodsWe surveyed 33 junior doctors about their knowledge and attitudes towards tissue donation and end of life care, seeking to elucidate why the proforma question- “Does the patient have an expressed wish for tissue donation” was not being asked.ResultsFifty-two percent were not aware that there was a question about expressed wishes for tissue donation. Common reasons for not completing the question on the proforma included: “timing not feeling appropriate”, “lack of familiarity with tissue donation procedure” and "unsure if patients on the LCP will be suitable". Views on the most appropriate time to discuss tissue donation were mixed: 45% said “A&E registration” and 42% “as part of end of life discussions”. Only 56% of junior doctors reported having received any training on tissue donation.ConclusionsJunior doctors are undertrained and not comfortable discussing tissue donation as part of providing end of life care. Knowledge and communication skills pertaining to tissue donation should be incorporated into the foundation doctors' curriculum. Locally we plan to guarantee the implementation of teaching for all doctors about tissue donation and to add comprehensive information about the subject, including eligibility criteria and contact details for further guidance and support to the Kingston Hospital “junior doctor handbook”.
EMPOWERING CARE HOME STAFF TO DELIVER QUALITY END OF LIFE CARE: THE IMPACT OF THE SIX STEPS TO SUCCESS PROGRAMME ON END OF LIFE CARE IN CARE HOMES IN NORTH WEST ENGLAND
Authors: O'Brien Mary , Kirton Jennifer , Knighting Katherine , Gandy Rob , Jack Barbara , Roe Brenda , Flynn Caroline , Horgan Elaine 
Published: February 2014

BackgroundInappropriate admissions to hospital from care homes at the end-of-life (EoL), identified within the UK Department of Health's End-of-Life Care (EoLC) Strategy resulted in the call for improved education surrounding EoLC for care home staff. In response, theSix Steps to Success, an organisational change programme, was developed for use with care home staff. The aim of the programme is to ensure all residents receive high quality EoLC provided by a care home that encompasses the philosophy of palliative care and that allows people to die where they choose.AimsTo explore the impact of theSix Steps to Successprogramme on EoLC in care homes in Northwest England.MethodsThe mixed-method evaluation consisted of three phases; i) examination of audit data collected on care homes from cohort 1 that had completed the programme by November 2012 (quality markers and measures; post death information; knowledge skills and confidence audit); ii) questionnaires (n=16) and interviews (n=9) with Six Steps Facilitators (N=18) and iii) case studies on care homes (n=6), randomly chosen from a selection matrix of homes that had completed the programme and volunteered to take part taking account of geographical spread (urban/rural) and type of care home. Analysis involved descriptive statistical comparisons and frequencies; qualitative data were subject to content analysis to identify themes.ResultsAll care homes demonstrated improvements in Advance Care Planning (ACP). Knowledge skills and confidence around EoLC improved markedly amongst care home staff, with 92% improvement for Spirituality skills and 79% improvement for ACP knowledge. Residents dying in their preferred place of death increased from 81.5% to 83.1%.ConclusionsEoLC in care homes has undoubtedly improved. TheSix Steps to Successprogramme has helped care home staff deliver better end-of-life care for their residents ensuring their wishes and preferences at end-of-life are met.
ADVANCE CARE PLANNING TRAINING IN NURSING HOMES: A SUCCESS STORY?
Authors: Baron Kirsten , Walshe Catherine 
Published: February 2014

BackgroundThe number of older frail nursing home residents is increasing in the UK. Advance Care Planning (ACP) for this population provides an opportunity to empower older people by discussing and documenting their wishes and preferences for their future care. The nursing home workforce is well placed to carry out ACP but lack confidence and training.AimTo evaluate the success of a programme of ACP training for nursing home employees.MethodsThree longitudinal questionnaire surveys completed before and after the initiation of the ACP training programme by both nursing homes that had completed the training and those yet to undergo the training and the results compared to identify changes. A knowledge based questionnaire on ACP administered to staff before completing the training at baseline and repeated a number of weeks after the training. A survey of ACP practice within the nursing home completed by managers at baseline before initiation of the training programme and then again a number of weeks later.A survey of place of death of nursing home residents in a twelve month period before the initiation of the training programme and a twelve month period after commencement of the programme.Results16 nursing homes were included in the study, 12 that had undergone the training programme and 4 that had not. Superior Advance Care Planning knowledge was evident in those staff that had completed the training. There was an increase of 85% in the number of Advance Care Plans completed in the training homes and an overall reduction in hospital deaths of 25% for residents from training homes.ConclusionsA programme of Advance Care Planning training for nursing homes is successful in improving nursing home staff knowledge, increasing ACP practice and reducing hospital deaths.
WOULD INTEGRATING HIGH-FIDELITY SIMULATION AS A LEARNING—TEACHING STRATEGY ENHANCE END OF LIFE CARE SKILLS FOR PRE-REGISTRATION NURSING STUDENTS? A QUALITATIVE ENQUIRY
Authors: Venkatasalu Munikumar Ramasamy 
Published: February 2014

BackgroundIn UK, palliative and end of life care services are under significant strain due increased number of dying population and aging palliative care nursing workforce combined with staff shortages and a recruitment crisis. Conversely, current nurse education do not prepare students with positive attitude and necessary end of life care skills to meet this critical workforce crisis. Comparing to traditional teaching methods, simulation is proven to enhance clinical skills and positive attitudes, yet little is known about its effectiveness on End of Life care Education.AimTo design, use and assess the effectiveness of high-fidelity simulation teaching session for first year nursing students on dealing with first death experiences in their clinical placement.MethodsUsing qualitative approach, this study conducted with two stages. At first, two groups (n=48) of total eight first year students groups (n=167) randomly selected and received two high-fidelity simulation scenarios on end of life care topics; rest received traditional methods a seminar led discussion. In the second stage, when all return from their first clinical placement, we conducted in total of 12 individual in-depth interviews with both students who attended simulation based teaching (n=7) and also with traditional teaching methods (n=5). Data were analysed using Framework design.FindingsDespite both teaching-learning strategies improved students' knowledge on end of life care, in contrast traditional methods students who received simulation based End of Life care Education were better prepared in terms of emotional experience and enhanced hands on practical skills in their first clinical placement. Limitations of using simulation as teaching-learning strategy for teaching end of life care topics were identified.ConclusionsUsing simulation based end of life care teaching-learning strategies perceived to produce positive clinical outcomes. Further research needed to explore wider application of simulation in diverse end of life care topics in preregistration nursing education and clinical practice.