Objective To evaluate the level of psychological services available to patients and staff in hospices. Design Questionnaire analysis. Setting Hospices in the UK and Republic of Ireland. Participants 224 hospices. Main outcome measures The availability of professional psychological support for those with advanced disease. Results Responses were received from 166 hospices (74%). Only 50 hospices (30%) have access to a psychiatrist, whilst 68 (41%) have access to a clinical psychologist and 92 (45%) have neither. Only 21 hospices (12%) have service level agreements with local mental health trusts. Counsellors, complementary therapists and spiritual advisors such as chaplains were more plentiful. Conclusions Delivery of the NICE guidelines, especially tier four, may be compromised by limited availability of specialist services. This has implications for the psychological assessment of applicants for voluntary euthanasia under an Assisted Dying Act.
Introduction Increased attention is being paid to the place where people die in order to provide choice and adequate care for terminally ill patients. Secular trends towards institutionalised dying have been reported in Britain and other developed world regions. Aims and Methods
Introduction and aims Palliative care (PC) is an urgent public health issue in Africa, but evidence to inform the spiritual dimension of PC is lacking. Feeling at peace is strongly correlated with spiritual wellbeing (SWB), and occurs in spiritual measures validated cross-culturally in PC populations. We aimed to: Determine levels of SWB among PC patients in South Africa and Uganda. Explore how patients interpret ‘feeling at peace’. Methods Cross-sectional survey using the APCA African Palliative Outcome Scale (POS) item: ‘Over the past 3 days, have you felt at peace?’ (‘0= no, not at all’ – ‘5= yes, all the time’). Semi-structured interviews including cognitive interviewing of the POS, analysed thematically. Results 285 patients surveyed; mean age 40.1; 69.1% women; diagnosis: 80.7% HIV; 17.7% cancer; 1.6% other. Mean peace score 2.92. 27.0% scored 0–1. 72 patients interviewed in 7 languages. Mean age 45.1; 66.7% women; diagnosis: 59.7% HIV; 40.3% cancer. Interpretations of peace fell into four categories: perception of self/ world (peace as a feeling/acceptance/experience); relationship with others; relationship with God; health-related. Barriers to peace included uncontrolled pain, stigma, economic/family worries. Conclusion This is the first study into the SWB of PC patients in sub-Saharan Africa. >25% of patients had not felt at peace in the previous 3 days, or only very rarely. Feeling at peace was interpreted in existential, social, religious and physical terms. Asking whether a patient feels at peace may be effective in eliciting concerns in African PC.
IntroductionPeople are living longer and increasingly die with frailty and complex co-morbidities. Many suffer unnecessarily because of limited recognition of palliative care needs, aggressive management and under treatment. Palliative care is advocated for frail older people with non-malignant conditions to improve assessment and treatment, but with little evidence of effectiveness.Aim(s) and method(s)Aim to determine the preferences for care and palliative outcomes for frail elders by place of death (own home, care home or hospital). Post-bereavement survey (QUALYcare) to carers (n=882) of people aged over 75 years or over via ONS. Survey examines quality of EoLC, preferences and palliative care outcomes for frail elders (malignant and non-malignant conditions). Data analysis using descriptive and inferential statistics to compare by place of death frequency of attainment of preferred place of death, prevalence of palliative outcomes, and formal and informal service use (no. and %, with 95% CI, Chi2 )Results443 (50.2%) participants mainly a son/daughter (68.2%). Majority deceased widowed (53.5%) and lived alone (41.8%). Most resided last months at home (42.9%), or care home (nursing home 22.8%; residential 12%). 35.7% died in hospital, mostly transferring from own home ()n=74/190) or a residential home (n=25/53), but few from nursing homes (15/101). Nearly half who died in hospital resided there for 1–4 weeks (45.6%).Conclusion(s)An opportunity to improve palliative care is responsiveness to timely discharge from hospital for people to die in preferred community settings. Nursing homes care for the majority of people until death, but residential care homes with no onsite nursing require greater support.
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