Hospital deaths of people aged 90 and over: end-of-life palliative care management.

Hospital deaths of people aged 90 and over: end-of-life palliative care management.
Gerontology, 2008 (epub: 30 May 2008), vol. 54, no. 3,
p. 148-52
Formiga-Francesc, Lopez-Soto-Alfons, Navarro-Margarita et al
Abstract
BACKGROUND: In developed countries, hospital deaths at very advanced age are increasingly common.Few studies have addressed end-of-life care in very elderly patients with non-cancer chronic diseases. OBJECTIVE: To evaluate the circumstances related to end-stage death of non-cancer nonagenarians in an acute care hospital. The results were compared with those from a sample of younger patients. METHODS: We conducted a prospective assessment in two teaching hospitals of the written instructions for the following actions: do not resuscitate (DNR) orders, the graduation of therapeutic decisions, information provided to relatives about prognosis, total withdrawal of normal drug therapy and provision of palliative care. RESULTS: 80 patients over 89 years of age with end-stage congestive heart failure (57.5%) or dementia (42.5%) were included. The control group comprised 52 younger patients (65-74 years). DNR orders were specified in 56% of cases, graduation of therapeutic decisions in 35%, and knowledge of relatives regarding the prognosis in 61%. Drug therapy was withdrawn in 66% of cases and terminal palliative care was initiated in 69%. In the nonagenarians who died, we detected a predominance of females (p = 0.001), a higher percentage of DNR orders (p = 0.02) and a higher percentage of graduation of therapeutic measures (p = 0.02) in comparison with younger patients. CONCLUSION: Our results indicate that there are marked differences according the palliative care provided to oldest-old patients with end-stage non-cancer chronic diseases admitted to an acute care hospital. In any case, care should be improved for both age groups.

Palliative treatment for elderly patients with colon cancer

Palliative treatment for elderly patients with colon cancer in ten Italian medical oncology units.
Anticancer research, May-Jun 2008, vol. 28, no. 3B,
p. 1813-20
Pasetto-Lara-Maria, Falci-Cristina, Rizzo-Elisa, De-Salvo-Gian-Luca, Gasparini-Giampietro et al
Abstract
BACKGROUND: Palliative chemotherapy significantly reduces mortality in patients with stage IV colon cancer, but is less prescribed with rising age. In this paper, we highlight the pattern of palliative treatment and possible effects on survival among elderly patients. PATIENTS AND METHODS: From January to December 2004, 78 files on the management of stage IV colorectal cancer (CRC) patients over 70 years, collected from 10 Italian Centres, were retrospectively examined. Determinants of receipt of palliative chemotherapy and their relation to toxicity and survival were considered. RESULTS: The proportion of elderly patients receiving first-line palliative chemotherapy was 98.7% and it was evaluated according to age, gender, educational level and comorbidities; patients receiving second-line therapy comprised 47.4%, those receiving third-line therapy 14.1% and those treated with a fourth-line therapy totalled 2.6%. Forty-one percent of patients received best supportive care (BSC) alone. CONCLUSION: In Italy, a proportion of elderly patients with metastatic chemonaive CRC are usually treated with a tolerability and overall survival similar to those for the younger population. Among progressive patients after second-line therapy, 45.8% usually undergo third line therapy; the remaining 54.2% undergo BSC.

Indian Journal of Palliative Care 2008 Vol 14 Part 1

The palliative care needs of patients with stage 3 and 4 HIV infection
Jameson
Indian Journal of Palliative Care From EBSCO ( CINAHL with Full Text ) - via Athens
Page: 1-6

Parental concerns in children requiring palliative care
Dighe ; Jadhav ; Muckaden ; Sovani
Indian Journal of Palliative Care From EBSCO ( CINAHL with Full Text ) - via Athens
Page: 16-22

Adverse psychosocial consequences: Compassion fatigue, burnout and vicarious traumatization: Are nurses who provide palliative and hematological cancer care vulnerable&# x003F ;
Sabo
Indian Journal of Palliative Care From EBSCO ( CINAHL with Full Text ) - via Athens
Page: 23-29

Keeping hospice palliative care volunteers on board: Dealing with issues of volunteer attrition, stress, and retention
Claxton - Oldfield ; Claxton - Oldfield
Indian Journal of Palliative Care From EBSCO ( CINAHL with Full Text ) - via Athens
Page: 30-37

Emotion management in childrens palliative care nursing
Maunder
Indian Journal of Palliative Care From EBSCO ( CINAHL with Full Text ) - via Athens
Page: 45-50

Showing the way forward: Pain and Palliative Care Policy of the Government of Kerala
Paleri
Indian Journal of Palliative Care From EBSCO ( CINAHL with Full Text ) - via Athens
Page: 51-54

Canadian Nursing Home 2008 ; VOL 19 ; PART 2

Using active rehabilitation to decrease risk of pneumonia in palliative end-of-life ALS and dementia care-a case study Aggressive nutritional and swallowing interventions can be employed for palliative end-of-life neurological conditions-even in the nursing home
Cleary , S . ; Kizar , S . ; Kalra , S . ; Johnston , W .
Canadian Nursing Home From EBSCO ( CINAHL with Full Text ) - via Athens [Full Text]
Page: 4-10

Establishing palliative care support programs for LTC staff This article addresses the importance of establishing a system of care within LTC homes that supports staff confronted with palliative/end-of-life care on a regular basis
Lusk , C
Canadian Nursing Home From EBSCO ( CINAHL with Full Text ) - via Athens [Full Text]
Page: 11-16

Cancer and disability benefits

Cancer and disability benefits: a synthesis of qualitative findings on advice and support.
Psycho-oncology, May 2008, vol. 17, no. 5,
p. 421-9, 40 refs
Wilson-Kate, Amir-Ziv.
Abstract
Following the Supportive and Palliative Care Guidance, a call was made for a meta-ethnography on social support services for people affected by cancer. We responded by focusing on the topic of financial advice and support. After a scoping exercise revealed little qualitative evidence, we adopted the chief aim of identifying issues for research. Over 50 keywords relating to patient finances, cancer and qualitative research were entered into electronic search databases and combined. Because of the nature of the literature found, we synthesized primary data into themes and discussion, rather than second-order constructs into third-order constructs, as is common in meta-ethnography. Most of the literature found serves pragmatic, campaigning and/or service-development objectives. Also, most relates to disability benefits rather than insurance, tax and other issues. Five themes emerged: patients' struggles to obtain financial advice and benefits; tests/rules for disability benefits; issues relating to 'Special Rules'; intervention by benefit advisers; and intervention by health/social-care professionals. Struggles with the benefit system emerged as the fundamental theme.We conclude that patients need sensitive, proactive services to assist with benefit claims, and a benefit system that seems supportive rather than obstructive. Numerous under-researched topics were identified, including the need for general financial advice, help for carers, and cultural issues.

Airway management in anaplastic thyroid carcinoma

Airway management in anaplastic thyroid carcinoma.
Full text available at OVID for NHS
The Laryngoscope, {Laryngoscope}, Jul 2008, vol. 118, no. 7,
p. 1195-8
Shaha-Ashok-R.
Abstract
OBJECTIVES/HYPOTHESIS: In patients who present with advanced anaplastic thyroid cancer, airway management is difficult because of bilateral vocal cord paralysis or tracheal invasion by the tumor. Airway management can be extremely complex in these patients. STUDY DESIGN: This is the author's 25 year experience with 30 patients who presented with anaplastic thyroid cancer and acute airway problems. METHODS: The patients' airway issues developed soon after presentation or a few months after treatment. Ten patients presented with initial symptoms of acute airway distress. All of these patients were treated with tracheostomy or cricothyrotomy. RESULTS: The 10 patients who presented with initial symptoms of acute airway distress died within 4 months. Eight of the remaining 20 patients developed bilateral vocal cord paralysis. Airway management for these patients depended on the extent of distant disease and the family's understanding of the advanced nature of the disease and the palliative efforts. The remaining patients had a palliative and supportive approach. CONCLUSIONS: Airway management was the most critical issue in patients who presented with anaplastic thyroid cancer and initial airway distress. Cricothyrotomy was helpful in avoiding acute airway catastrophe. It is important to distinguish between poorly differentiated and anaplastic thyroid cancer and lymphoma for appropriate airway management.

Communication model for encouraging optimal care at the end of life for hospitalized patients

A communication model for encouraging optimal care at the end of life for hospitalized patients.
QJM : monthly journal of the Association of Physicians, Dec 2007, vol. 100, no. 12
p. 791-7
Workman-S.
Abstract
Multiple studies have demonstrated that treatment at or near the end of life is rarely optimal. Unwanted death-prolonging treatments are frequently provided and open communication about death and dying is often lacking. Early effective communication about goals, prognosis and options would improve patient care at or near the end of life by enhancing choice and facilitating palliative care. A five-step sequential approach to communicating with patients at risk of dying in hospital about treatment goals and outcomes (and/or their family members) is presented. The five steps are founded upon the recognition that trials of life-sustaining treatments are also, by definition, trials of palliative care. A narrative review of currently available qualitative and quantitative research is used to support the recommendations.
Journal-Article, Review.

Current opinion in oncology Jul 2008 vol. 20 no. 4

Delirium in cancer patients: a focus on treatment-induced psychopathology.
p. 360-6, 66 refs
Agar-Meera, Lawlor-Peter.
Abstract
PURPOSE OF REVIEW: Delirium is a neuropsychiatric syndrome that occurs frequently in cancer patients, especially in those with advanced disease. Recognition and effective management of delirium is particularly important in supportive and palliative care, especially in view of the projected increase in the elderly population and the consequent potential for the number of patients both diagnosed and living longer with cancer to increase substantively. RECENT FINDINGS: Studies of delirium in a variety of settings have generated new insights into phenomenology, assessment tools, the psychomotor subtypes, potential patho-physiological markers, pathogenesis, reversibility, and the role of sedation in symptom control. SUMMARY: Validated tools exist to assist in the assessment of delirium. Although our understanding of the pathogenesis of delirium has improved somewhat, there remains a compelling need to further elucidate the underlying pathophysiology, especially in relation to opioids and the other psychoactive medications that are used in supportive care. Further trials are needed, especially in patients with advanced disease to determine predictive models of reversibility, preventive strategies, outcomes, and to assess the role of antipsychotic and other medications in symptomatic management.

Depression and cancer: recent data on clinical issues, research challenges and treatment approaches.
p. 353-9
Reich-Michel
Abstract
PURPOSE OF REVIEW: Clinical guidelines for depression screening, assessment and management in the oncologic field and palliative care are becoming paramount in routine cancer care. This psychiatric comorbidity has several impacts on quality of life, anticancer treatment compliance, hospital stay duration, health-care costs, morbidity and possibly mortality even if discordant reports exist. RECENT FINDINGS: Recent development of brain imaging techniques (MRI, positron emission tomography), neurobiological and genetic tools allow new understanding of the pathophysiology process of depressive disorders in cancer populations besides the usual endocrinologic and psychoneuroimmunologic hypothesis. Broader indications besides depressive or anxiety disorders appear or must be investigated for the new generation of antidepressants (selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, noradrenergic specific serotonergic antidepressants) in oncology, such as hot flashes, neuropathic pain, fatigue, anorexia/cachexia. Psychosocial interventions seem to have a slight impact on well- being, quality of life and depressive symptomatology but not on survival. SUMMARY: The present article reviews recent literature on depression and cancer and highlights practical assessment and detection of depression, biological and physiopathological correlates and its pharmacologic and psychosocial treatment. Implementation of these several techniques must be supported by ongoing research about the complex relation between depressive disorders and generally mental health and oncology.

Journal of pain and symptom management, May 2008, vol. 35, no. 5

Factors correlated with fatigue in terminally ill cancer patients: a longitudinal study.
Okuyama-Toru, Akechi-Tatsuo, Shima-Yasuo, Sugahara-Yuriko et al
Abstract
Fatigue is among the most distressing symptoms experienced by terminally ill cancer patients. It is necessary to clarify factors correlated with fatigue to develop effective management strategies. A consecutive sample of cancer patients newly registered in the Palliative Care Unit (PCU) was assessed on three occasions: at the second visit to the outpatient clinic of the PCU (Time 1), three weeks after the Time 1 session over the telephone (Time 2), and at admission to the PCU (Time 3). The patients' fatigue and a broad range of biopsychosocial factors were assessed using the validated questionnaires, structured interviews, and medical record reviews at Time 1 and Time 3. Fatigue was the only factor assessed at Time 2. Two hundred patients participated in the Time 1 session, and 129 and 73 were followed at Time 2 and Time 3, respectively. Greater fatigue at Time 1 was significantly correlated with psychological distress, lower Karnofsky Performance Status score, dyspnea, and appetite loss (adjusted coefficients of determination (R(2))=0.49). Greater fatigue at Time 2 was significantly correlated with psychological distress, lower Karnofsky Performance Status and fatigue at Time 1 (adjusted R (2)=0.51). Greater fatigue at Time 3 was significantly correlated with changes for the worse in psychological distress, Karnofsky Performance Status, and dyspnea severity during the period between Time 1 and Time 3, after adjusting for Time 1 fatigue (adjusted R(2) =0.54). The results indicate that fatigue in terminally ill cancer patients is determined by both physical and psychological factors. It may be important to include psychological intervention in the multidimensional management of fatigue in this population, in addition to physical and nursing interventions.

Potential drug interactions in cancer patients receiving supportive care exclusively.
p. 535-43
Riechelmann-Rachel-P, Zimmermann-Camilla, Chin-Sheray-N, Wang-Lisa et al
Abstract
Cancer patients at the end of life often take many medications and are at risk for drug interactions. The purpose of this study was to describe the epidemiology of potential drug interactions in cancer patients receiving supportive care exclusively. We retrospectively reviewed the charts of consecutive adult cancer outpatients attending palliative care clinics at the Princess Margaret Hospital, Toronto, Canada. Drugs were screened for interactions by the Drug Interaction Facts software, which classifies interactions by levels of severity (major, moderate, and minor) and scientific evidence (1-5, with 1=the strongest level of evidence). Among 372 eligible patients, 250 potential drug interactions were identified in 115 patients (31%, 95% confidence interval 26%-36%). The most common involved warfarin and phenytoin. Most interactions were classified as being of moderate severity (59%) and 42% of them were supported by Levels 1-3 of evidence. In multivariable analysis, increasing age (P<0.001), presence of comorbidity (P=0.001), cancer type (brain tumors, P<0.001), and increasing number of drugs (P<0.001) were associated with risk of drug interactions. Potential drug interactions are common in palliative care and mostly involve warfarin and anticonvulsants. Older patients, those with comorbid conditions, brain tumor patients, and those taking many medications are at greater risk of drug interactions.

Mapping levels of palliative care development: a global view.
p. 469-85
Wright-Michael, Wood-Justin, Lynch-Thomas, Clark-David.
Abstract
Palliative care is coming to be regarded as a human right. Yet globally, palliative care development appears patchy and comparative data about the distribution of services are generally unavailable. Our purpose is to categorize hospice-palliative care development, country by country, throughout the world, and then depict this development in a series of world and regional maps. We adopt a multimethod approach, which involves the synthesis of evidence from published and grey literature, regional experts, and a task force of the European Association of Palliative Care. Development is categorized using a four-part typology constructed during a previous review of palliative care in Africa. The four categories are (1) no identified hospice-palliative care activity, (2) capacity building activity but no service, (3) localized palliative care provision, and (4) countries where palliative care activities are approaching integration with mainstream service providers. We found palliative care services in 115/234 countries. Total countries in each category are as follows: (1) no identified activity 78 (33%), (2) capacity building 41 (18%), (3) localized provision 80 (34%), and (4) approaching integration 35 (15%). The ratio of services to population among Group 4 countries ranges from 1:43,000 (in the UK) to 1:4.28 million (in Kenya); among Group 3 countries it ranges from 1:14,000 (in Gibraltar) to 1:158 million (in Pakistan). The typology differentiates levels of palliative care development across the four hemispheres and in rich and poor settings. Although half of the world's countries have a palliative care service, far more are needed before such services are generally accessible worldwide.

Nerve blocks in palliative care.

Nerve blocks in palliative care.
British journal of anaesthesia, Jul 2008 (epub: 20 May 2008), vol. 101, no. 1,
p. 95-100
Chambers-W-A.
Abstract
Although between 85% and 90% of patients with advanced cancer can have their pain well controlled with the use of analgesic drugs and adjuvants, there are some patients who will benefit from an interventional procedure. This includes a variety of nerve blocks and also some neurosurgical procedures. Approximately 8-10% of patients may benefit from a peripheral nerve block and around 2% from a central neuraxial block. The most common indication is because opioid dose escalation is limited by signs of opioid toxicity but some patients will benefit from one component of their pain being relieved by a simple peripheral block. Most patients about to undergo these procedures are already taking high doses of opiods and obtaining valid consent may pose problems. The use of peripheral nerve blocks, epidural and intrathecal infusions, and plexus blocks is discussed.

Awake palliative thoracic surgery

Awake palliative thoracic surgery in a high-risk patient: one-lung, non-invasive ventilation combined with epidural blockade.
Anaesthesia, Jul 2008 (epub: 12 Feb 2008), vol. 63, no. 7
p. 761-3
Guarracino-F, Gemignani-R, Pratesi-G, Melfi-F, Ambrosino-N.
Abstract
We report the case of a terminally ill cancer patient with recurrent pericardial and bilateral pleural effusions who was scheduled for video-assisted thoracoscopic surgery. The operation was performed with the patient awake under epidural anaesthesia. The patient's cough reflex in response to lung manipulation was successfully minimised by the inhalation of aerosolised lidocaine. Video-assisted thoracic surgery requires the exclusion of a lung from ventilation. In order to support one-lung spontaneous ventilation in this high- risk patient, we successfully used non-invasive bilevel positive airway pressure ventilation via a facemask. Based on this preliminary experience, we think that critically ill patients scheduled for palliative surgery can be successfully managed with the combination of minimally invasive surgical techniques and neuraxial block with non-invasive lung ventilation.

Views of nurse prescribing among Macmillan nurses

Exploring the views of nurse prescribing among Macmillan nurses.
Full text available at Ebsco CINAHL Athens
British journal of community nursing, Apr 2008, vol. 13, no. 4, p. 171-2, 174-7
Ryan-Woolley-Bernadette, McHugh-Gretl, Luker-Karen.
Abstract
Nurse prescribing is a key government initiative which aims to enhance patient care. The aim of this study was to investigate the prescribing practice of specialist nurses working in cancer and palliative care and to explore the benefits of and barriers to uptake of nurse prescribing training. A national postal survey of 2252 Macmillan nurses was undertaken using a structured questionnaire with open-ended questions. Data were analyzed using thematic content analysis for 1575 respondents (70% response rate). Only 13% (203) had undergone prescribing training and of these 105 provided responses to the open questions concerning training and of the 87% (1372) who had not undergone the training, 423 provided details on barriers to nurse prescribing training. The data presented in this paper draw from this data. The findings indicate that those who prescribed gave the prospect of improving care as the main reason for undertaking nurse prescribing training. The main reasons why these specialist nurses did not undertake training were: resource issues particularly with respect to backfill while training, lack of medical support and mentorship, concerns about the relevance of prescribing as a nursing role and prioritizing other courses. If nurse prescribing is to be more widely available for cancer and palliative care patients it is important in both primary and secondary care to address the resource and support issues.

BMC health services research

A method to determine spatial access to specialized palliative care services using GIS.
BMC health services research, 2008 (epub), vol. 8, p. 140
Cinnamon-Jonathan, Schuurman-Nadine, Crooks-Valorie-A.
Abstract
BACKGROUND: Providing palliative care is a growing priority for health service administrators worldwide as the populations of many nations continue to age rapidly. In many countries, palliative care services are presently inadequate and this problem will be exacerbated in the coming years. The provision of palliative care, moreover, has been piecemeal in many jurisdictions and there is little distinction made at present between levels of service provision. There is a pressing need to determine which populations do not enjoy access to specialized palliative care services in particular. METHODS: Catchments around existing specialized palliative care services in the Canadian province of British Columbia were calculated based on real road travel time. Census block face population counts were linked to postal codes associated with road segments in order to determine the percentage of the total population more than one hour road travel time from specialized palliative care. RESULTS: Whilst 81% of the province's population resides within one hour from at least one specialized palliative care service, spatial access varies greatly by regional health authority. Based on the definition of specialized palliative care adopted for the study, the Northern Health Authority has, for instance, just two such service locations, and well over half of its population do not have reasonable spatial access to such care. CONCLUSION: Strategic location analysis methods must be developed and used to accurately locate future palliative services in order to provide spatial access to the greatest number of people, and to ensure that limited health resources are allocated wisely. Improved spatial access has the potential to reduce travel-times for patients, for palliative care workers making home visits, and for travelling practitioners. These methods are particularly useful for health service planners - and provide a means to rationalize their decision-making. Moreover, they are extendable to a number of health service allocation problems.

BMC Palliative Care

Palliative care in advanced dementia; a mixed methods approach for the development of a complex intervention
Elizabeth L Sampson ; Ingela Thune - Boyle ; Riitta Kukkastenvehmas ; Louise Jones ; Adrian Tookman ; Michael King and Martin R Blanchard
ISSUE: 2008 ; VOL 7
[PDF] [Abstract]
Page: 8

International Journal of Palliative Nursing 2008 Vol 14 Part 6

Discussions at the end of life
Mula , C
Page: 263

What do community nurse specialists do? An activity analysis
Newbury , J . ; de Leeuw , W . ; Newton , C .
Page: 264-273

Spirituality in palliative care: what language do we need ?
Byrne , M
Page: 274-280

Saying it in song: music therapy as a carer support intervention
O Kelly , J
Page: 281-286

Families' transition to a Canadian paediatric hospice. Part two: results of a pilot study
Author(s): Steele , R . ; Derman , S . ; Cadell , S . ; Davies , B . ; Siden , H . ; Straatman , L
Page: 287-296

The grief experience of same-sex couples within an Irish context
Author(s): Glackin , M . ; Higgins , A .
Page: 297-302

Transferring knowledge: evaluating the use of a telephone advice line
Author(s): Carr , S . M . ; Lhussier , M . ; Wilcockson , J .
Page: 303-308

Paediatric palliative care.

Paediatric palliative care.
Lancet, 28 Jun 2008, vol. 371, no. 9631,
p. 2169
Darlington-Anne-Sophie-E, van-den-Heuvel-Eibrink-Marry-M, Passchier- Jan.
Publication type
Comment, Letter.
Comment on: Lancet. 2008 Mar 8; 371(9615):852-64.

Paediatric palliative care.
Lancet 28 Jun 2008, vol. 371, no. 9631, p. 2169
Vissers-Kris-C-P, Engels-Yvonne, Verhagen-Constans.
Comment, Letter.
Comment on: Lancet. 2008 Mar 8; 371(9615):852-64.

Impact of specialty on attitudes of Australian medical practitioners to end-of-life decisions.

Impact of specialty on attitudes of Australian medical practitioners to end-of-life decisions.
Full text available at ProQuest
The Medical journal of Australia 21 Apr 2008, vol. 188, no. 8
p. 450-6
Parker-Malcolm-H, Cartwright-Colleen-M, Williams-Gail-M.
Abstract
OBJECTIVE: To compare attitudes and practices of Australian medical practitioners, by specialty, to a range of medical decisions at the end of life. DESIGN, SETTING AND PARTICIPANTS: As part of an international study, in 2003, a structured questionnaire was mailed to 2964 medical practitioners drawn from membership registers of Australian and Australasian professional colleges. Data from 1478 questionnaires were statistically analysed using validated instruments. MAIN OUTCOME MEASURES: Practitioners' willingness to comply with requests from patients and/or their relatives for symptom relief which might also hasten death; provision of terminal sedation and euthanasia, or willingness to provide these on their own initiative. RESULTS: Respondents reported being much more willing to comply with a patient's request for increasing symptom relief, even at risk of hastening death, than for terminal sedation. Over a quarter of respondents would provide terminal sedation to competent patients on their own initiative. A small number of respondents would intentionally hasten death. There were significant differences by specialty for all three actions. Oncologists, palliative care physicians and geriatricians were least likely to actively hasten death, and more likely to act unilaterally to relieve symptoms as a medical necessity. CONCLUSIONS: Perceptions about the causation of death and aspects of medical culture appear to influence physicians' attitudes towards medical decisions at the end of life. Our findings have implications for medical education, interprofessional communication and discussion between the medical profession and the community.

End-of-life care in the trauma intensive care unit

Changing the culture around end-of-life care in the trauma intensive care unit.
The Journal of trauma Jun 2008, vol. 64, no. 6
p. 1587-93
Abstract
BACKGROUND: Ten percent to 20% of trauma patients admitted to the intensive care unit (ICU) will die from their injuries. Providing appropriate end-of-life care in this setting is difficult and often late in the patients' course. Patients are young, prognosis uncertain, and conflict common around goals of care. We hypothesized that early, structured communication in the trauma ICU would improve end-of-life care practice. METHODS: Prospective, observational, prepost study on consecutive trauma patients admitted to the ICU before and after a structured palliative care intervention was integrated into standard ICU care. The program included part I, early (at admission) family bereavement support, assessment of prognosis, and patient preferences, and part II (within 72 hours) interdisciplinary family meeting. Data on goals of care discussions, do-not-resuscitate (DNR) orders and withdrawal of life support (W/D) were collected from physician rounds, family meetings, and medical records. RESULTS: Eighty-three percent of patients received part I and 69% part II intervention. Discussion of goals of care by physicians on rounds increased from 4% to 36% of patient-days. During intervention, rates of mortality (14%), DNR (43%), and W/D (24%) were unchanged, but DNR orders and W/D were instituted earlier in hospital course. ICU length of stay was decreased in patients who died. CONCLUSIONS: Structured communication between physician and families resulted in earlier consensus around goals of care for dying trauma patients. Integration of early palliative care alongside aggressive trauma care can be accomplished without change in mortality and has the ability to change the culture of care in the trauma ICU.

Palliative care - Annals of Oncology

Palliative care
Annals of Oncology July 2008 ; VOL 19 ; PART suppl_5
Page: v160 - v160

New Library book

In the Health Sciences Library:
Royal College of Physicians
Palliative care services : meeting the needs of patients Nov 2007
Shelved at 616.994 ROY