scholarly journals Specialist palliative medicine physicians and nurses accuracy at predicting imminent death (within 72 hours): a short report

2020 ◽  
Vol 10 (2) ◽  
pp. 209-212
Author(s):  
Nicola White ◽  
Fiona Reid ◽  
Victoria Vickerstaff ◽  
Priscilla Harries ◽  
Patrick Stone
Keyword(s):  
Palliative Care ◽  
Palliative Medicine ◽  
Prospective Observational Study ◽  
Secondary Data ◽  
Palliative Care Team ◽  
Terminal Phase ◽  
Short Report ◽  
Specialist Palliative Care ◽  
Imminent Death ◽  
The Difference

ObjectivesResearch suggests that clinicians are not very accurate at prognosticating in palliative care. The ‘horizon effect’ suggests that accuracy ought to be better when the survival of patients is shorter. The aim of this study was to determine the accuracy of specialist palliative care clinicians at identifying which patients are likely to die within 72 hours.DesignIn a secondary data analysis of a prospective observational study, specialist palliative care doctors and nurses (in a hospice and a hospital palliative care team) provided survival predictions (yes/no/uncertain) about which patients would die within 72 hours.ResultsSurvival predictions were obtained for 49 patients. A prediction from a nurse was obtained for 37/49 patients. A prediction from a doctor was obtained for 46/49 patients. In total, 23 (47%)/49 patients actually died within 72 hours of assessment. Nurses accurately predicted the outcome in 27 (73%)/37 cases. Doctors accurately predicted the outcome in 30 (65%)/46 cases. When comparing predictions given on the same patients (27 [55%]/49), nurses were slightly better at recognising imminent death than doctors (positive predictive value (the proportion of patients who died when the clinician predicted death)=79% vs 60%, respectively). The difference in c-statistics (nurses 0.82 vs doctors 0.63) was not significant (p=0.13).ConclusionEven when patients are in the terminal phase and close to death, clinicians are not very good at predicting how much longer they will survive. Further research is warranted to improve prognostication in this population.

Palliative care in the intensive cardiac care unit

2015 ◽  
Author(s):  
Jayne Wood ◽  
Maureen Carruthers
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Symptom Control ◽  
World Health ◽  
Terminal Phase ◽  
Cardiac Care ◽  
Life Care ◽  
Specialist Palliative Care ◽  
Cardiac Care Unit

Specialist palliative care services originally focused on improving the quality of life for patients with a diagnosis of cancer in the terminal phase of their illness. However, organizations, such as the World Health Organization, supported by recent national strategies, such as the End of Life Care Strategy (United Kingdom, 2008), promote the early integration of specialist palliative care into the management of patients with incurable disease, irrespective of the diagnosis. The primary goal of the intensive cardiac care unit is to help patients survive acute threats to their lives. However, the suddenness and severity of illness, particularly when associated with an underlying cardiological diagnosis, often means that the provision of optimal specialist palliative care is challenging. This chapter addresses key issues relating to the provision of specialist palliative care in the challenging and complex environment of the intensive cardiac care unit, including symptom control, end of life care, decision making, and communication. The benefits of multidisciplinary working for effective quality improvement in patient care and best support for patients, families/carers, and staff are also addressed. The importance of interdisciplinary working is highlighted, and, by embedding the principles of holistic care into daily practice, the intensive cardiac care unit can ensure that patients and their families/carers receive the support they need in a timely manner from individuals who are well supported in what is often considered to be one of the most challenging medical environments.

Hospices and palliative care for children: converging stories

2019 ◽  
Vol 130 (1) ◽  
pp. 81-88 ◽  
Author(s):  
Richard D W Hain
Keyword(s):  
Palliative Care ◽  
Palliative Medicine ◽  
Healthcare Providers ◽  
Specialist Palliative Care ◽  
Funding Formula ◽  
Published Research ◽  
Local Healthcare

Abstract Introduction Children’s hospices offer support to children and their families according to a model that is quite different from adult hospices and has evolved in parallel with specialist paediatric palliative medicine services. Sources of data Published research, Together for Short Lives. Areas of agreement The services hospices offer are highly valued by families. Areas of controversy It is not always clear that hospices can be described as ‘specialist’, which can make it difficult for hospices to negotiate appropriate commissioning arrangements with the statutory sector. Growing points Children’s palliative care generally is poorly developed compared with the adult specialty, and local providers should work with hospices to help redress the inequity that children face in accessing specialist palliative care. Areas timely for developing research If hospices are to continue to be important providers of palliative care in children they must develop robust and fair relationships with local healthcare providers. That would be facilitated by development of a funding formula for children that properly acknowledges the part hospices already play in palliative care.

scholarly journals Palliative medicine in the intensive care unit: needs, delivery, quality

2021 ◽  
pp. bmjspcare-2020-002795
Author(s):  
Stephanie A Hill ◽  
Abdul Dawood ◽  
Elaine Boland ◽  
Hannah E Leahy ◽  
Fliss EM Murtagh
Keyword(s):  
Palliative Care ◽  
Intensive Care ◽  
Length Of Stay ◽  
Care Delivery ◽  
Multiorgan Failure ◽  
Symptom Control ◽  
Palliative Care Team ◽  
Care Team ◽  
Specialist Palliative Care ◽  
Treatment Limitation

Background15%–20% of critical care patients die during their hospital admission. This service evaluation assesses quality of palliative care in intensive care units (ICUs) compared with national standards.MethodsRetrospective review of records for all patients who died in four ICUs (irrespective of treatment limitation) between 1 June and 31 July 2019. Descriptive statistics reported for patient characteristics, length of stay, admission route, identification triggers and palliative care delivery.ResultsForty-five patients died, two records were untraced, thus N=43. The dying process was recognised in 88% (n=38). Among those where dying was recognised (N=35), 97% (34) had documented family discussion before death, 9% (3) were offered religious/spiritual support, 11% (4) had review of hydration/nutrition and 6% (2) had documented preferred place of death. Prescription of symptom control medications was complete in 71% (25) opioids, 34% (12) haloperidol, 54% (19) midazolam and 43% (15) hyoscine. Combining five triggers—length of stay >10 days prior to ICU admission 7% (3), multiorgan failure ≥3 systems 33% (14), stage IV malignancy 5% (2), post-cardiac arrest 23% (10) and intracerebral haemorrhage requiring mechanical ventilation 12% (5)—identified 60% (26) of patients. Referral to the palliative care team was seen in 14% (5), and 8% (3) had specialist palliative care team review.ConclusionsRecognition of dying was high but occurred close to death. Family discussions were frequent, but religious/spiritual needs, hydration/nutrition and anticipatory medications were less often considered. The ICUs delivered their own palliative care in conjunction with specialist palliative care input. Combining five triggers could increase identification of palliative care needs, but a larger study is needed.

scholarly journals Coordination of Care Within a Mobile Palliative Care Team and Organization of a Continuing Education Program for Health Professionals in Palliative Care

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 62s-62s
Author(s):  
A. Mubeneshayi Kananga
Keyword(s):  
Palliative Care ◽  
Best Practices ◽  
Continuing Education ◽  
Health Professionals ◽  
National Policy ◽  
Palliative Care Team ◽  
Care Team ◽  
Terminal Phase ◽  
Dr Congo ◽  
Mobile Team

Background: In DR Congo (DRC), many cancer patients in the terminal phase of their condition have minimal access to palliative care. There is a combined effect of poverty, the deterioration of the health system and the absence of a well-defined national policy on palliative care. Patients are for the most part abandoned to the care of inexperienced family members. Founded in 2009, Palliafamilli aims to improve the quality of life of patients requiring palliative care in the DRC by providing visits and care for patients, by striving to increase access to palliative care in the region and by informing, raising awareness and mobilizing key national stakeholders. In September 2018, Palliafamilli will launch a mobile palliative care team (MPCT) in partnership with the general hospital of Ndjili in Kinshasa. The MPCT is an interdisciplinary team consisting of physicians, nurses, a psychologist and a project manager; all experienced in accompaniment, symptom management and palliative emergency. It has a consultancy role for professionals, patients and their caregivers. Aim: Through a African Cancer Fellowship award, I will visit a mobile team of palliative care from CHRU Besançon, France, for one month in May 2018 to gain experience in designing and implementing best practices for a mobile palliative care team. Methods: I will work closely with the mobile palliative care team of the Besançon Regional Hospital Center to gain experience regarding the coordination and care administration of palliative care within a mobile team. I will also learn about the different programs of continuing education for health professionals, make comparisons and adapt the programs to the reality of DR Congo. Results: With a view to promoting access to palliative care patients, I intend to learn from the host organization the best practices that they apply to overcome communication difficulties with the patient and their relatives which can constitute delays to access to adequate care. This delay is more marked for patients suffering from cancer because the evolution of their pathology is unpredictable. The main barriers are the insufficient knowledge of patients' needs and the opportunities offered by palliative care. Upon my return, I will adapt the best practices learned in France to the DRC context during the launch of the new mobile palliative care team. Conclusion: In Congo, a cross-cutting approach is required to provide patients with palliative care and pain relief, as resources are limited, many people are in need of care, and there are few nurses and doctors empowered to provide care. An effective approach is to involve community or volunteer caregivers supervised by health professionals, and Palliafamilli is successful due in its multidisciplinary and multisectoral approach, with adaptation to cultural, social and economic specificities and its integration with existing health systems, focusing on primary health care and community and home care.

Palliative care emergencies

2016 ◽  
Author(s):  
Richard D.W. Hain ◽  
Satbir Singh Jassal
Keyword(s):  
Palliative Care ◽  
Intestinal Obstruction ◽  
Palliative Medicine ◽  
Superior Vena ◽  
Vena Cava ◽  
Cord Compression ◽  
Patient Experiences ◽  
Palliative Care Team ◽  
Superior Vena Cava Obstruction ◽  
Paediatric Palliative Care

A palliative care emergency describes a symptom situation that is serious and demands immediate and skilled specialist attention, but is also unusual enough for there to be a possibility that the specialist has not often encountered it. In a palliative care emergency, the patient experiences sudden and severe distress that can only be relieved by prompt and confident intervention by the palliative care team. There is little time to prepare for it, and, to the specialist in paediatric palliative medicine, an emergency is defined by the importance of already having a clear strategy for dealing with it. That can be challenging for those working in paediatric palliative care, because most are rare. This chapter covers the six main emergencies encountered in paediatric palliative medicine: cord compression, catastrophic haemorrhage, severe uncontrolled pain, superior vena cava obstruction, intestinal obstruction, and hypercalcaemia.

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