bluuebunny/crossref_metadata_2025_split huggingface dataset:
Facilities offered to families and carers of patients at the end of life: audit of current practice
Authors: Zacharias Hannah 
Published: March 2012

BackgroundBetween 2007 and 2009, 49.3% of deaths in Bradford occurred in hospital. Where patients are identified to be in the last days of life, families and carers should be given the opportunity to have unrestricted visiting access, and may want to spend as much as 24 h a day in the hospital. Facilities should be appropriate to support carers' needs. The end of life care strategy has published guidance supporting the King's Fund recommendations for carer facilities at the end of life.AimsTo determine current practice on five acute wards, of the facilities and services provided for relatives of dying patients. To assess if the facilities offered on purpose-built wards with greater numbers of side-rooms differ from more traditional ‘nightingale-style’ wards.ConclusionFacilities vary between wards within the trust regarding what accommodation is available for carers, in terms of access to refreshments, rest areas and sleeping facilities. Purpose built wards with more side rooms and designated quiet rooms offer a greater range of facilities such as sleeping facilities, alternative rest areas and use of a bathroom than the nightingale alternatives. Up to 93% of patients have relatives who wish to stay outside visiting hours. 45% of patients have at least one carer staying overnight; with at least 26% of patients have two or more carers wishing to stay. Drinks were offered on the ward in 93% of cases, however concessionary parking permits were only offered in 23% of cases. No carers were offered concessionary use of the dining room. Following the audit, hospital managers have reviewed hospital facilities for carers and are considering ways in which carer experience could be improved. A leaflet is in production for carers of dying patients, outlining facilities available across the trust.
Is there a role for clock face drawing in palliative care: time will tell?
Authors: Harris Dylan 
Published: March 2012

BackgroundSeveral tools exist to assist screening and diagnosis of cognitive impairment, including the Abbreviated Mental Test; Mini-Mental State Examination; Confusion Assessment Method; and, clock-drawing test (CDT). There are now around 200 publications on the CDT, but largely published in geriatric medicine and psychiatry. Several variations of the CDT exist, but each typically requires the patient to draw the numbers as they would appear on the face of a clock, into a circle, and then add the arms to indicate a specified time. While clock face drawing may appear to be a relatively simple task, it actually requires several perceptual and cognitive functions: auditory comprehension, memory, planning, abstract thinking, perceptual-motor, visual perceptual, visual-motor, visual-spatial and executive functions.AimTo explore the role of the CDT in palliative care. Clock face drawing has been validated in various settings in psychiatry and geriatric medicine for example, screening for Alzheimer's disease in psychiatry and assessment post-stroke in geriatric medicine. The tool may also have a valuable role in palliative care, particularly in patients with complex neuropsychiatric problems. In other settings it has been found to be easy/quick to administer, not threatening to the patient, and useful as a sequential graphical assessment in clinical records. Examples of a useful role in palliative care include (A) a patient with parietal lobe metastases (in assessment of constructional apraxia), (B) delirium in a patient with cancer and hypercalcaemia (in assessment of cognitive function before and after treatment) (C) screening for dementia in a patient known to the palliative care team with advanced Parkinson's disease.ConclusionWhile most research has focused on the use of clock face drawing in psychiatry and geriatric medicine, it has a potentially useful role in palliative care. Further work to explore this area further is now planned.
‘Distress thermometer’ in a hospice – supporting holistic assessment and a possible outcome measure
Authors: Roth Lucy , Jones Sue , Hunt Kimberley , Cochrane Yvonne 
Published: March 2012

BackgroundThe Holistic Assessment of Concerns (HAC) or ‘Distress Thermometer’ is a tool identified by the North of England Cancer Network to support the holistic assessment of patients across the network. It consists of a list of 45 possible concerns. The patient highlights any problems that have troubled them recently. They then identify the three most important concerns scoring each on a distress score from 0–10. Teesside Hospice Audit Group has been exploring ways of measuring patient outcomes for a number of years. This is becoming increasingly important as the Care Quality Commission and Commissioners demand more evidence of a patient centred and effective service.AimsThe HAC Tool was introduced at Teesside Hospice in 2010. The aims of its introduction were to improve our holistic care of patients by identifying what matters most to them and to provide evidence of benefit to patients of our management. Following introduction of the tool we reviewed its implementation in the Inpatient Unit (IPU) and Day Care at the hospice. We analysed 17 sets of Day Care notes and 20 sets of Inpatient notes to assess whether an initial and follow up tool was completed appropriately for each patient. The number and type of concerns elicited were identified and any change in score for each concern was calculated. The average improvement in score across all concerns was 1.5 in Day Care and 2.85 on IPU. Further results will be included in the poster.ConclusionAs a result of this review we demonstrated that our interventions benefit patients at Teesside Hospice. It gives us some good patient centred evidence that our work is effective. We found the HAC was easy to complete. We plan to continue to use the HAC at Teesside Hospice as part of our assessment and planning of each patient's care.
Evaluation of a new education programme for overseas and local doctors
Authors: Watkinson Deborah 
Published: March 2012

BackgroundPalliative care has been established for about 12 years in Singapore but is much less developed elsewhere in the Asia-Pacific region. The Department at the National Cancer Centre runs a busy hospital support service; seeing over 1400 new patients in 2010. It has always hosted a large number of visiting foreign doctors often returning to establish palliative care in their own countries. Local doctors also rotate through. No formal training programme or evaluation of the experience has been undertaken.AimsEighteen months ago, in an attempt to formalise and evaluate the training, a series of standard ‘core tutorials’ were developed on foundational palliative care topics. MCQs were written based on these using various guidelines. 20 doctors were tested with the same MCQ preposting and after the tutorial completion; the typical interval was 6–8 weeks. Findings: Overseas doctors (n=6): mean preposting 51.4% (+/-12.9); mean post-tutorials 75% (+/-5.3) mean improvement 45% Local MOs (core trainees) (n=9): mean preposting 65.2 (+/-14.9); mean post-tutorials 82.1% (+/-8.81); mean improvement 26% Local ASTs (spRs) (n=5): mean preposting 79.8 (+/-8); mean post-tutorials 82.5% (+/-8.81); mean improvement 3%.ConclusionThe results suggest all doctors benefited from the training but the overseas doctors improved most and results overall were more uniform. Clearly the tutorial learning was also supplemented by on-going clinical exposure. The learning points have been: MCQs were refined to eliminate ambiguity and to consider language difficulties for overseas doctors. Testing allowed struggling doctors to be identified and remedial support given. A more advanced MCQ has been added for end of posting testing. Progress is being made to use an IT system for online tutorials and MCQ testing to cut down on tutor time MCQs mainly test knowledge but they are helpful as part of a multifaceted evaluation to determine development during the posting.
Raising awareness of the Macmillan Durham cachexia pack (MDCP) within a local cancer network
Authors: Hawkins Colette , Andrew Inga 
Published: March 2012

BackgroundThe Macmillan Durham Cachexia Pack (MDCP) was launched in 2007. In 2010, in response to sporadic awareness and use of MDCP within The North of England Cancer Network (NECN), a series of workshops were commissioned to raise awareness.AimTo raise awareness of MDCP, ascertain barriers to its use and establish its role in practice.MethodThree workshops took place at different venues within NECN. The structure of each workshop was; sharing views on participants' experience of caring for patients with ACS, case presentation to highlight common issues, review of the MDCP and discussion around opportunities and barriers to use of the MDCP.ResultsOf the 46 participants, most were nursing staff with a wide range of healthcare professionals and allied staff represented. Views from participants' experience of patients with ACS largely corresponded with the literature; a feeling of helplessness/hopelessness when approaching patients, finding ACS difficult/hard/challenging, patients reporting powerlessness/desperation but appreciating support to cope with symptoms and to change expectations. Opportunities from use of MDCP included; ensures a consistent approach for generalist staff, resource to use in education sessions including for carers, can be adapted to local policy and need, useful tool for immediately after diagnosis. Barriers to use of MDCP included; changing patients attitudes that something can be done about ACS, lack of flexibility with hospital catering, time constraints, responsibility for assessing patients, number of other assessment tools requiring completion.ConclusionThe workshops were reported to be useful and achieved the aim of raising awareness of MDCP. It appears that the future of MDCP lies as an educational tool to enable specialists to improve awareness and management of ACS and as a practical tool for generalists from all related professions, to dip in and out of.
Experience of a trainee in palliative medicine in a resource limited hospital PC setting
Authors: Dunn Joanna , Leng Mhoira 
Published: March 2012

IntroductionPalliative Care was introduced to Uganda in 1993, with the development of Hospice Africa Uganda providing a clinical service together with education and research. Palliative medicine Specialist Registrars have been undergoing placements at Hospice Africa Uganda for many years, gaining experience in palliative medicine in a resource-limited setting as well as contributing to clinical care, education and research. With the development of the hospital palliative care team at Makerere University and Mulago hospital in 2008, there was an opportunity for healthcare professionals, specialist registrars in particular, to gain experience in hospital based palliative care in a resource-limited setting.DescriptionAn opportunity arose for a year's out of programme (Specialist Palliative Medicine Registrar) experience in the palliative care unit, part of the department of medicine, in the main government teaching hospital in Kampala. This provided opportunities for clinical experience in a resource-limited setting as well as experience in palliative care education, including teaching undergraduate and postgraduate medical and nursing students as well as some curriculum development. There was also an opportunity for contributing to the unit's research portfolio.Lessons LearntThere is a need to be very organised and plan things well in advance, especially if the experience is to be recognised for training.ConclusionThis placement provides a great opportunity for trainees in palliative medicine to gain experience in many different areas of the curriculum, particularly in research, training and management. It also provides significant learning opportunities in developing a hospital-based palliative care service. Some of the experience can be used towards fulfilling the requirements of the specialist registrar training, but it is more of an opportunity to contribute to the development of palliative care services locally, nationally and internationally in a resource-limited setting.
Practical palliative care course for doctors in specialist training
Authors: Nicholson Alex , French Ann 
Published: March 2012

BackgroundNational directives (Supportive and Palliative Care: NICE 2004, End of life strategy: DoH 2008), National Service Frameworks for long-term conditions and Medical Specialty Training curricula have created demand for education of the medical workforce in palliative and end of life care. Traditional methods include seconded attachments spent with palliative care services including hospices, but expanding demands/expectations require alternative methods to deliver education and experience.AimsBuilding on success of an initiative for GPs, a course designed and run through Teesside University seeks to meet training needs of hospital doctors throughout the North East aspiring to become consultants in any discipline. Four palliative medicine consultants act as tutors albeit without formal funding. Several Deanery specialty training committees recognise the course as fulfilling necessary requirements. The course is rated Level 5 (Diploma) and provides 30 credits. Success awards a Certificate in Professional Development. Delivered partly through the virtual learning environment and partly through clinical placement the course comprises: 10 weekly on-line ‘lessons’ addressing key topics including objectives, reference material and a formatively reviewed assignment. 10 clinical sessions matching identified learning needs, arranged by the learner and linked to a reflective diary A group ethics tutorial The final summative assessment is a 4000 word reflective piece of writing demonstrating integration of learning from all course components into personal professional development.ConclusionEighty-seven training grade doctors have enrolled since 2005. Formal evaluation (of 2005 and 2006 cohorts) and informal evaluation annually is positive. Graduates report high levels of satisfaction and impact. Modifications have been made in response to comments. A recurring concern is the difficulty in securing clinical placements due to competing pressure on palliative care services from other professional visitors. This is frustrating given that the underlying ambition is to enhance the skills in the ‘generalist’ workforce.
Art as tool and reflection of PC professionals' own espirituality
Authors: Merino Teresa García-Baquero , Cruz Belen Martinez 
Published: March 2012

BackgroundFrida Kahlo was able to showcase her suffering through her work, oil paints, many of which self-portraits. Her pain allowed her to express her emotions too. Unhappiness, suffering, as well as joy and life's natural discourse strengthens artists' spirit giving way to their best works (Van Gogh, Beethoven, Frida Kahlo, Cervantes, etc). Does unhappiness generate art? Art therapy uses artistic expression as a vehicle to improve social, physical, emotional and personal dimensions.AimTo establish whether palliative care professionals feel the need to express emotions surfacing from professional activities, To establish the means used To know how they were helped by them.MethodA questionnaire was designed and sent to different care levels PC teams. Descriptive study to analyse results PC professionals need a way to express their feelings and emotions and if so, how they go about it. Permission was sought from all respondents to use their responses.ResultsA total of 44 professionals responded (out of) 81.8% females and18.2 males, 79.5% chose their current job and 20.5% did not 93% had experienced the need to express their emotions brought about by professionals experiences. 75% expressed them verbally at work, 54% outside work and l 27% through art including painting, poetry, narrative and music. Of those who used art to express themselves: 19.5% were able to enter a creative process, 9.8% to reflect, 4.9% and 100% to Explore and pay better attention to own ideas and feelings.Conclusions(1) It is worth therefore to help PC professionals to express their inner me/self. (2) Organise workshops directed to gain insight into relationships with their own emotions. (3) Art can help PC professionals express their own spirituality and find solace.
The role of specialist palliative care services in stroke – views from an acute stroke unit
Authors: Jeffries Clare , Cathy Shipman , Wee Bee 
Published: March 2012

BackgroundStroke is the third commonest cause of death and causes significant symptoms and disability. In the UK, acute stroke care occurs in hospital. National Stroke Strategy guidelines recommend that patients should be cared for in stroke units to improve survival and disability. Previous research suggests that most patients dying from stroke are not referred to specialist palliative care services (SPCS) and some have unmet palliative care needs.1AimsTo determine what healthcare professionals (HCP) on a stroke unit believe constitutes good end of life care (EOLC) and if barriers exist to its implementation.Method15 HCP from an acute stroke unit were purposively sampled. Semistructured interviews were undertaken to examine specific care domains. Participants were also asked their views on the role of SPCS in stroke and when they would refer to SPCS. Interviews were recorded, transcribed and analysed using framework analysis.ResultsParticipants would consider referral if a patient has complex physical or psychological symptoms, discharge needs, family needing psychological support, cancer, been known to SPCS or for help with ethical decisions. Participants believed the EOLC they provided generally did not require SPCS input. Some believed that the expertise of SPCS lay elsewhere. It was proposed that symptoms due to stroke were either easier to control compared to other conditions or under-recognised.ConclusionHCP believe they provide good EOLC for stroke patients. The role of SPCS was not clear to all staff. HCP said they were more likely to refer for assistance with complex symptoms, psychological support, ethical dilemmas, if patients are known to the SPCS or have cancer. Expertise of SPCS is still perceived to be associated with malignancy. Education and improved links between stroke and SPCS teams could improve EOLC.
Pre-emptive prescribing for palliative care patients in primary care
Authors: Kemp Laurence , Holland Richard , Barclay Stephen , Swift Louise 
Published: March 2012

BackgroundOne of the challenges of palliative care at home is ensuring good symptom control, including access to medication out of hours. One potential solution is ‘pre-emptive prescribing’ (PEP) of medicines in advance of need.AimsTo evaluate pre-emptive prescribing with respect to: (1) Prevalence in GP end of life care (2) Factors influencing its use (3) Association with likelihood of home death (4) Impact on utilisation of healthcare in the last month of life.MethodsRetrospective examination of the records of all deaths occurring during 2009 in twelve diverse Cambridgeshire GP practices.ResultsPEP was used in 16% of predictable deaths: levels of usage varied widely between practices. Receiving a PEP was associated with having a recorded preferred place of death (OR 2.14, 95% CI 1.46 to 3.12) and being on the practice palliative care register (OR 2.23, 95% CI 1.24 to 4.00). Those living at home were less likely than those in care homes to receive a PEP (OR 0.53, 95% CI 0.31 to 0.89). The use of PEP was associated with increased chance of death at home in all groups, an effect modulated by the patient's usual place of residence (own home or care home) and history of previous hospital admissions (OR 6.02, 95% CI 1.70 to 21.2 for subgroup living in own home with previous hospital admissions). PEP use was also associated with decreased risk of hospitalisation in last month of life, and increased GP contact in both care home and community residents: it did not appear to affect hospice admissions of GP out-of-hours service contacts.ConclusionsThis is the first study to evaluate the use of PEP in primary care. There was a strong association with home death and decreased hospital admissions: however, a causal association is not demonstrated, and the active component of the intervention remains unclear.
Experiences and support needs of older care givers caring for family members (or friends) with cancer
Authors: Bailey Chris , Seymour Kim Chivers , Duke Sue , Moore Mike 
Published: March 2012

Background77% of cancer deaths occur in people aged 65 years and over. However, research has largely focused on younger adults, leading to a lack of understanding of the complex needs of older adults with cancer and their family care givers.AimsTo explore the experience and support needs of older family care givers in end of life care.MethodsA longitudinal study using indepth interviews and structured measure of service use (OMFAQ). 25 pairs were recruited via specialist palliative care nurses, comprising one person with cancer and their lay care giver, all aged 65 years and over. Mean age was 78 years. Mean length of relationships was 44 years. 25 indepth interviews were conducted; 19 second interviews two to four weeks later and 11 final interviews 6 months after the first. Data analysis was based on the process of microanalysis, constant comparison and theory development described by Strauss and Corbin (1998, 2008).ResultsA theoretical model of family caregiving was developed which suggests that the experience of family caregiving is characterised by a sense of anticipated loss in the context of which ties of duty and loyalty exert a strong influence. Arising from this central experience are a range of caregiving strategies, notably care management, maintaining the household and negotiating relationships with health and social care professionals, that focus on achieving a sense of equilibrium or containment across physical, functional and emotional domains.ConclusionsThe pressure to keep up with the responsibilities of caregiving leads to a strict scheduling of day-to-day life. Maintaining a sense of good governance within this concentrated and condensed physical and metaphysical space can be difficult. Supportive interventions are needed for care givers and should focus on providing relief from the difficulty of accommodating caregiving demands, and the tendency towards an increasingly tightly boundaried day-to-day life.