bluuebunny/crossref_metadata_2025_split huggingface dataset:
26 The prognosis in palliative care ii (PIPS2): recruitment data collected during the first year of a multi-centre, prospective, observational cohort study
Authors: Kalpakidou Anastasia K , Todd Chris , Omar Rumana Z , Keeley Vaughan , Griffiths Jane , Vickerstaff Victoria , Stone Patrick 
Published: May 2024

IntroductionMore accurate methods of prognostication are likely to lead to improvements in the quality of care of patients approaching the ends of their lives. The Prognosis in Palliative care Scales (PiPS) predict survival in terms of ‘days’, ‘weeks’ or ‘months’ and have been shown to perform as well as, or better than Clinician Estimates of Survival (CES).1Aimsa) To validate PiPS in a new cohort of patients and b) to evaluate the accuracy of other prognostic tools.2,3MethodsThis is a national, multi-centre, prospective, observational cohort study, aiming to recruit 1780 patients via palliative care services (PCS). Eligible patients have advanced, incurable cancer who have recently been referred to PCS. Patients with or without capacity are included in the study.The primary outcome is the accuracy of PiPS predictions and the difference in accuracy between these predictions and the CES. The secondary outcomes include the accuracy of predictions by the Palliative Prognostic Score, Palliative Prognostic Index, Palliative Performance Scale, and the Feliu Prognostic Nomogram compared with actual patient survival and CES.ResultsWithin 10 months of recruitment, 5699 patients were screened across 27 recruiting sites. Of those, 1608 were approached to participate in the study and 940 were recruited (812 patients with and 128 patients without capacity). Updated recruitment figures and a breakdown of the reasons for ineligibility, inability to approach patients and refusal to consent will be presented.ConclusionThis study demonstrates the feasibility of recruiting large numbers of participants to a prospective palliative care study.References. Gwilliam B, Keeley V, Todd C, Roberts C, Gittins M, Kelly L, Barclay S, Stone P. Prognosticating in patients with advanced cancer-observational study comparing the accuracy of clinicians’ and patients‘ estimates of survival. Ann Oncol2013;24(2):482–488available from: PM:23028038.. Kim ES, Lee JK, Kim MH, Noh HM, Jin YH.Validation of the prognosis in palliative care study predictor models in terminal cancer patients. Korean J Fam Med2014;35(6):283–294available from: PM:25426276. Stone PC, Lund S. Predicting prognosis in patients with advanced cancer. AnnOncol2007;18(6):971–976available from: PM:17043092
3 Conversation analytic study of communication with the relatives and friends of patients in a hospice: study protocol
Authors: Anderson Rebecca , Stone Paddy , Low Joe , Parry Ruth , Tookman Adrian , Lodge Philip , Finlay Dori-Anne , Wood Barbara , Bloch Steven 
Published: May 2024

IntroductionFamily members of patients near the end-of-life value accurate prognostic information that is communicated sensitively by experienced healthcare professionals. This provides opportunities to say goodbye and make decisions about care. Current research is limited and has mostly focused on discussions early in the illness trajectory and with patients and not relatives.Aims and methodsThis study aims to investigate communication about prognosis and end-of-life care between expert healthcare professionals and the relatives and friends of patients who lack capacity and are approaching the end-of-life.We will record conversations between experienced healthcare professionals and relatives of inpatients at a hospice. Recordings will be analysed using conversation analysis to identify practices used by healthcare professionals and relatives to attempt and accomplish communicative tasks. These tasks are likely to include: raising prognosis and care, receipt of information by relatives, communicating uncertainty, and ending these conversations.Healthcare professionals will participate in a focus group on what makes a ‘good’ conversation. Relatives will be invited to take part in one-to-one interviews 3–6 months later to gather their perspectives about experiences of communication about end-of-life care and prognosis.ResultsWe anticipate starting data collection in October 2017.ConclusionNo study to date has directly examined how healthcare professionals communicate prognostic information and discuss care with friends/relatives at the very end-of-life. Findings will therefore provide valuable new information and contribute to developing communication skills interventions for less experienced clinicians working in palliative care settings.
37 With my family i have to think about them… with the girls [friends] i don’t: the role of friendships in advance care planning
Authors: Russell Sarah 
Published: May 2024

IntroductionThe role of friendships is under-reported in the research literature despite evidence that advance care planning is both a social experience and a health care decision making one.Aim/MethodAs part of a doctoral study, the influences on advance care planning was explored using a qualitative narrative approach to 15 indepth interviews; analysed by a data driven thematic analysis method.ResultsOne finding was the influence of friendships on advance care planning; forums for discussion, entertainment, diversion, practical support, reality checks and ‘safe’ spaces for discussions/decisions about preparing and planning for dying unencumbered by concerns for the emotional well being of informal carers, family or children. Participants retained their identity as a ‘person’ rather than a dying patient supporting them to live with the knowledge of their future death.ConclusionThe importance of friendships at the end of life (Cartwright and Seale 1990) and influence of social networks is described in the literature (Leonard et al 2015), especially in terms of formal and informal support (Lewis et al 2014). However, the role of friendships is often under reported because dying is seen primarily as a family event or difficult to define (de Vries and Johnson 2002). If death is both a health and social experience (Sudnow 1967) then the social elements of dying (e.g friendships) should not be subsumed by the biomedical focus of palliative care (Lewis et al 2013). The findings from this study provides practical insights into the role and definitions of friendships in advance care planning and end of life.References. Cartwright A and Seale C (1990) The natural history of a survey:an account of methodological issues encountered in a study of life before death. King Edwrds Hospital Fund for London.. de Vries B and Johnson C (2002) The death of friends in later life. Advances in life course research7:299–324. Leonard R, Horsfall D, Noonan K (2015) Identifying changes in the support networks of end of life carers using socia network analysis. BMJ Supportive and Palliative Care 5(2):153–159.. Lewis JM, DiGiacomo M Currow DC, Davidson PM (2013) A Social Capital Framework for Palliative Care: Supporting Health and Well Being for People with Life Limiting Illness and their Carers through Social Relations and Networks. Journal of Pain and Symptom Management45(1):92–103. Sudnow D (1967) Passing On. Prentice Hall.
50 A multi-professional educational intervention to improve and sustain respondents’ confidence to deliver palliative care: a mixed methods study
Authors: Reed Elizabeth , Todd Jennifer , Sadler Clair , Berg Jane , Lucas Caroline , Lawton Sally , Grant Robert , Watson Max 
Published: May 2024

BackgroundEducation has been highlighted as fundamental in equipping healthcare professionals with essential knowledge and skills to provide good end of life care. Multiprofessional educational programmes have a positive influence on knowledge, attitude and confidence but few explore the longer term impact on care delivery. The educational intervention we evaluated is an eight week home-study based programme for healthcare professionals and is currently run in nine European centres.AimsTo evaluate the impact the educational intervention has on participants’ confidence in palliative care, to determine if this is sustained over time.DesignA mixed method longitudinal approachSetting/participantsA survey using a self-efficacy scale was emailed to 342 candidates who undertook the educational intervention and semi-structured interviews to a sub-sample of 15 candidates at baseline, 3 and 6 months.ResultsAt three months, candidates had twenty times higher odds of being above any given level of confidence than baseline which was sustained at six months. Confidence was expressed in terms of communication clinical practice and multiprofessional working.ConclusionFindings suggest the ECEPC improves confidence in palliative care that is sustained over time with evidence of confidence in symptom control, communication and a holistic approach in clinical practice.
51 Improving care out of hours by reducing remote prescriptions: a pharmacy-led intervention
Authors: Patel Ronika , Shafqat Abbas , Gishan Faye , Weil Anna 
Published: May 2024

IntroductionThe Marie Curie Medicines Management Policy1states that remote prescriptions may be used under certain circumstances. General Medical Council prescribing guidance for doctors (2) and national guidance for nurses and nurse prescribers3,4allow for remote prescribing. This normally requires written confirmation using secure email, following a verbal order from a doctor to a nurse. In an inpatient hospice setting without resident medical cover this process may delay administration of medication.AImsTo understand which medications are remotely prescribed and investigate whether the administration by nurses of ‘homely remedies’(an approved lists of non-prescription or over the counter (OTC) medicines) can reduce the burden on on-call medical staff, enabling more timely delivery of medication .MethodThe hospice pharmacy team undertook an audit of inpatient remote prescriptions issued over twelve months and categorised them into prescription and non-prescription medications. Following an educational intervention for nurses and junior doctors and displaying information posters on the wards, we re-audited remote prescriptions after three months.ResultsNinety-three remote prescriptions were issued over twelve months, approximately two prescriptions each week. The majority of these prescriptions were for OTC medications, usually for symptom management. The re-audit showed a reduction in the number of remote prescriptions issued, to less than one per week.Conclusion and discussionEducation and training by pharmacists resulted in a reduction in remote prescriptions. Formulating an approved list of ‘homely remedies’ could further reduce this, which may result in more timely administration of medications to patients thereby improving patient care.References. Marie Curie Medicines management in Hospices policy (2016) https://mariecurie365.sharepoint.com/PPG/Shared%20Documents/Medicines%20Management%20in%20Hospcies%20policy.pdf#search=medicines%20management. http://www.gmc-uk.org/guidance/ethical_guidance/14326.asp. NMC Standards of proficiency for nurse and midwife prescribers (2015) http://www.nmc-uk.org/Documents/NMC-Publications/NMC-Standards-for-medicines-management.pdf. National Institute for Clinical Excellence. Managing Medicines in Care Homes, 2014https://www.nice.org.uk/guidance/sc1/chapter/1-recommendations#care-home-staff-giving-non-prescription-and-over-the-counter-products-to-residents-homely
53 Compassionate communities in north wales: a service evaluation
Authors: Watt Bethany , Hiscock Julia , Poolman Marlise , Livingstone Tracy 
Published: May 2024

AimTo evaluate hospice-supported, volunteer-led community befriending services in North Wales operating within the Compassionate Communities model.MethodsFive semi-structured, qualitative interviews lasting 1–2 hours were conducted with facilitators of current hospice-supported community befriending services in North Wales. These comprised the four volunteer coordinators, two at each site, in addition to the hospice lead for the facilitation of these services.Ten (out of a total of nineteen) volunteers involved with the befriending services completed an online (or paper if preferred) survey about their current activities within, and views on, the befriending services.Data from the qualitative interviews was fully transcribed verbatim, and subsequently combined with qualitative data from the volunteer survey and analysed using the Framework approach. Descriptive statistics were used to provide frequency data (counts, percentages) from the volunteer survey where the answer format provided pre-determined responses.ResultsInitial analysis of the results has provided an understanding of the development and operation of these community-led services, and has given insight into perceived barriers to and facilitators of their optimal functioning. It has revealed duality of opinion about the role of the hospice and the role of the community within the befriending services, most notable in the coexistence of views expressed regarding the need to be protected and guided by the hospice, and the desire to be free from the confines of hospice-imposed regulations and the medical model of care.We will present the results of the full analysis and consider implications for hospices nationwide in facilitating the development of Compassionate Communities.
58 Assessing and managing constipation for patients receiving palliative care in a hospice setting: a systematic review of the literature
Authors: McIlfatrick Sonja , Preshaw Deborah , Hasson Felicity , Carduff Emma , Clarke Mike , Coast Jo , Ferguson Claire , Finucane Anne , Graham Lisa , Larkin Philip , McCorry Noleen , Slater Paul , Watson Max , Wright Eileen 
Published: May 2024

IntroductionConstipation causes considerable suffering, either as a direct result of physical symptoms or due to related social and psychological problems. Despite this, uncertainty persists about the best management within hospice settings.AimTo synthesise the current evidence base on the assessment and management of constipation for palliative care patients within a hospice setting.MethodsA systematic search of MEDLINE, Embase, Cinahl, Scopus, and Cochrane databases was undertaken in April 2017 for empirical studies, written in English, on the assessment and management of constipation in the hospice, between 2007 and 2017. Two researchers independently reviewed and critically appraised all studies, conducted data extraction and undertook a thematic analysis.ResultsFourteen studies were included in the review including randomised trials (n=3), observational (n=5), and descriptive studies (n=6). The majority of the research was conducted in palliative care units and targeted either healthcare professionals or patients. The analysis highlighted a lack of standard definition of constipation. Clinicians experienced challenges in constipation assessment, with a need to combine patient reports with physical examination. Clinicians focused on pharmacological management, however, consideration around non-pharmacological aspects is also essential. Finally, the need to assess current practice for the management of constipation in light of changing priorities of care at end of life was emphasised.DiscussionSupporting clinicians to more effectively assess and manage the complexities of constipation in this setting is essential in improving overall symptom management. Gaps in the evidence base included defining constipation, constipation prevention, non-pharmacological management, and management in the dying patient.
6 Caregivers’ difficulty rating scale: development and initial validation of a tool to identify unmet needs of indian caregivers
Authors: Bhardwaj Tushti 
Published: May 2024

BackgroundCaring for a cancer patient is debilitating for caregivers especially among Indian population as culturally people prefer to care at home than nursing home. Unavailability of palliative care services and professional caregivers add to the family burden.ObjectivesCaregiving difficulties need assessment but cancer specific burden instruments are rare in Indian context. This paper presents development and initial validation of Caregiver’s Difficulty Rating scale and highlights the nature of caregiving burden on primary caregivers.Methods108 items were prepared in English after case-interviews and reviewing existing scales for face validity. Experts judged the items for content validity, 54 items with 100% agreement were retained. Forward-backward policy was used for Hindi translation. Reliability analysis was performed with 30 respondents. Final scale was administered to 100 caregivers of head and neck cancer patients for internal consistency and item-scale statistics. For construct validity know-group comparison was made using EORTCQOL instrument with caregiver-patients dyads.ResultsHigh correlation among 3 translated versions (r>0.76, p<0.01), chronbach’s alpha (0.948), and spilt-half coefficient (0.965) suggested translation reliability and scale consistency. Caregiver’s burden had significant negative correlation with global quality of life of patients (−0.514**) supporting theory base. Help for food arrangement, managing work- life and treatment cost were highly rated difficulty.ConclusionCDRS had 50 items under four dimensions viz- physical, emotional, social and financial hardships. Scale requires further work on convergent and divergent validity and testing sensitivity to change which are underway. Study has implications to educate caregivers and making provisions of respite care. Community engagements and caregivers’ support group may work as sources of emotional and social support.
9 The opinions of hospice staff and patients towards routine weighing upon admission to an inpatient hospice setting
Authors: Byrne Niall , Codling Jan , Phippen Alison , Pickard Jennie , Kay Samantha 
Published: May 2024

IntroductionThe role of inpatient hospice care is gradually changing from overwhelmingly providing care at the end of life, to focusing more on symptom management which facilitates discharge home. However, some hospice clinical practices have not adapted to reflect that change, as seen by infrequent bodyweight assessment at admission. This leads to an inability to conform to best practice in medication management and nutritional assessment.Aims and methodsTo facilitate altering our clinical guidelines to achieve best clinical standards of care we needed to understand the rationale for the reluctance among hospice staff to weigh patients and understand if those fears are justified by consulting with patients. Two paper-based surveys were designed and completed with staff and patients at our hospice. Outcome measures were descriptive information about staff and patient opinions that were grouped into themes for quantitative analysis.ResultsResults among patients mirrored previous research and showed that the majority of patients 37/38 (97.3%) surveyed did not find being weighed distressing, and in fact, 36/38 (94.7%) would prefer to know their bodyweight if measured. We found that staff members, however, were broadly opposed to routine weighing on admission (50.63%).ConclusionRationale for opposition included fear of causing upset and a belief that it is inappropriate for the holistic environment of the hospice. Weight loss can be distressing and preventing unnecessary procedures is important. However, to ensure optimal clinical care we have recommended that weighing patients should be the default position unless reasons for exclusion exist.References. Watson M, Coulter S, McLoughlin C, Kelt S, Wilkinson P, McPherson A, Wilson, R, Eatock M. Attitudes towards weight and weight assessment in oncology patients: survey of hospice staff and patients with advanced cancer. Palliative Medicine2010;24(6):623–629.. National institute for health and clinical excellence (NICE). Nutrition support in adults 2006, [CG32]. London: NICE.. Charani E, Gharbi M, Hickson M, Othman S, Alfituri A, Frost G, Holmes A. Lack of weight recording in patients being administered narrow therapeutic index antibiotics: a prospective cross-sectional study. BMJ Open2015;5(4);e006092–e006092.. Khan A, Flavin K, Tsang J. Weight a minute - iatrogenic paracetamol toxicity is preventable by utilisation of well-designed drug charts.BMJ Quality Improvement Reports2014;3(1):u203956.w1721.
Abstract P155: Identifying Inpatient and Outpatient Factors That Reduce Heart Failure Exacerbation Readmissions
Authors: Aujla Sumeet , Tabbaa Kutiba , Affas Ziad , Dubaisi Samer , Joseph Alan , Najor Amanda , Onofrey Erin , Hussain Ali , Arnautovic Jelena 
Published: May 2024

Acute heart failure 30-day readmissions are associated with increased patient morbidity and mortality. Our aim is to identify systemic factors that can reduce heart failure readmissions, including the implementation of a heart failure care coordination team. We assessed the hypothesis that individualized post-discharge education and summary from the heart failure care coordination team will reduce 30-day heart failure readmissions.This retrospective study included 213 patients, 18 years and older admitted with NYHA Class II-IV and ACC/AHA Stage B-D heart failure exacerbations from July 2021- March 2022, at a community hospital. Collected variables included demographics, medical comorbidities, labs, echocardiographic findings, inpatient orders, LACE index score, discharge follow-up, receipt of an after-visit summary, length of stay, and 30-day readmission. Descriptive data was summarized as counts and percentages for categorical data, and mean or median for continuous data. Between-group parametric data means were compared by calculating the t-test for independent variables, or medians using the Mann-Whitney U test for data that were nonparametric. Categorical variables were compared by calculating the chi-square test for association or Fisher’s exact test, as appropriate. The primary study objective was tested using Logistic regression modeling. Throughout this study, a p-value ≤0.05 (two-tail) was considered statistically significant. The medical records of all available reduced treatment plan patients were compared to preserved treatment plan patients in approximately equal numbers. Pair-wise t-tests required the greatest number of subjects. Using the conventional power level of 80%, a two-tailed alpha of 0.05, and assuming a medium effect size, it was estimated that this comparison will require at least 114 subjects.
In this study, 189 of 213 patients were reached by the heart failure care coordination team. 49/189 were readmitted in 30 days and 140/189 were not. For the readmission group, the percentage of patients who were CKD Stage 3 or 4 (39.4%, 28 of 71) was higher than those who were not (21.1%, 30 of 142) with a p-value of 0.005. The percentage of patients who had discharge BNP checked (39.1%, 18 of 46) was higher than those who were not (24.1%, 40 of 166) with a p-value of 0.043. A higher LACE index score was associated with readmission as compared to a lower score, with a p-value of < 0.001.
In conclusion, presence of CKD stage 3 or 4, discharge BNP, and a higher LACE-index score were associated with 30-day heart failure readmission. Counterintuitively, the heart failure care coordination team did not have an impact on this endpoint, contrary to our hypothesis. Future studies with a larger sample size and focus on the outpatient care team efforts may be helpful in elucidating the team's potential in preventing heart failure readmission.