Aim: To investigate the symptom experience, access to supportive care services and rehabilitation of patients with a primary malignant brain tumour (PMBT) and their carers. Methods: A case review of 70 patients with a diagnosis of PMBT who received palliative care in fi ve specialist palliative care units between July 2005 and June 2006. The review examined patients' symptom experience, care issues, access to rehabilitation and access to supportive care services. Results: The two most signifi cant issues experienced by patients and identifi ed in the case review were hemiparesis (17%) and cognitive problems (16%). There were a number of care problems concerning safety related to mobility and falls (9%). Symptoms related to fatigue and tiredness were reported infrequently. There was an absence of information relating to the needs of informal carers; however, 18% of carers accessed bereavement counselling services following the death of the person they cared for. Conclusion: The needs of carers were not found to be routinely documented within the case notes. For some patients, referral to specialist palliative care services occur late in the illness trajectory, which means that patients and carers may not be able to access the full range of supportive care services available. Initial assessment of patients should identify the range of support services that both carers and patients are offered; and the uptake and response to services should be documented throughout the illness trajectory.
Objective: Palliative sedation is a method of symptom management frequently used in hospices to treat uncontrolled symptoms at the end of life. There is a substantial body of literature on this subject; however, there has been little research into the experiences of hospice nurses when administering palliative sedation in an attempt to manage the terminal restlessness experienced by cancer patients.Method: Semistructured interviews were conducted with a purposive sample of seven hospice nurses who had cared for at least one patient who had undergone palliative sedation within the past year in a hospice in the south of England in the United Kingdom. A phenomenological approach and Colaizzi's stages of analysis were employed to develop themes from the data.Results: Facilitating a "peaceful death" was the primary goal of the nurses, where through the administration of palliative sedation they sought to enable and support patients to be "comfortable," "relaxed," and "calm" at the terminal stage of their illness. Ethical dilemmas related to decision making were a factor in achieving this. These were: medication decisions, "juggling the drugs," "causing the death," sedating young people, the family "requesting" sedation, and believing that hospice is a place where death is hastened.Significance of results: Hospice nurses in the U.K. frequently encounter ethical and emotional dilemmas when administering palliative sedation. Making such decisions about using palliative sedation causes general discomfort for them. Undertaking this aspect of care requires confidence and competence on the part of nurses, and working within a supportive hospice team is of fundamental importance in supporting this practice.
This pilot study aimed to assess the benefits of hypnotherapy in the management of anxiety and other symptoms, including depression and sleep disturbance, in palliative care patients with cancer. Eleven hospice patients received four sessions of hypnotherapy and completed the Hospital Anxiety and Depression Scale, the Edmonton Symptom Assessment System, and the Verran and Snyder-Halpern Scale at set time points. Wrist actigraphy also provided an objective assessment of sleep quality. After the second hypnotherapy session there was a statistically significant reduction in mean anxiety and symptom severity, but not in depression or sleep disturbance. After the fourth session there was a statistically significant reduction in all four patient-reported measures but not in actigraphy. These results offer evidence that hypnotherapy can reduce anxiety in palliative care patients, as well as improving sleep and the severity of psychological and physical symptoms. Further studies are needed to explore whether the observed benefits were a direct result of the hypnotherapy and how the intervention could most benefit this patient population.
This paper reports on a system of managing admissions and discharges from a specialist palliative day hospice (SPDH) in the south of England. SPDH is a well established component of palliative care provision in the UK, but studies have rarely addressed issues around admission and discharge. Case study methodology was used to evaluate the programme. Interviews were conducted with five patients who had attended the day hospice, taken a break or been discharged and returned; their carer(s); the key worker from the day hospice; and any other health professional who was involved in the patient's care during the admission. Communication issues were found within the team regarding referral and discharge processes, documentation of care, decision making, and information giving. Family members did not feel involved in decision making in relation to the programme. The most significant finding was the emotional and psychological impact on the patients of taking the break. Discharge from SPDH is known to be a difficult and sensitive issue, especially when patients are living with life-limiting illnesses that can change quickly. The patients in this study all had some form of dependency on the service and four of the five would have chosen to continue attending if they could. They experienced deterioration in psychological and physical wellbeing during the period in which they did not attend.
IntroductionIn palliative care patients, anxiety is usually attributed to a reaction to diagnosis, treatment and its possible outcomes. Despite the support for hypnotherapy as a resource for the alleviation of psychological and emotional distress, there is a paucity of evidences to support the use of hypnotherapy for symptom relief.AimsAims of this study were to assess the benefits of hypnotherapy in the management of anxiety in palliative care patients and to ascertain if hypnotherapy could affect other symptoms including depression and sleep disturbance.MethodsParticipants received four sessions of hypnotherapy and completed the Hospital Anxiety and Depression Scale, Edmonton Symptom Assessment Scale, Verran and Snyder-Halpern Scale, and wrist actigraphy. Out of 21 patients recruited, eleven successfully completed the study.ResultsAfter the second hypnotherapy session there was a statistically significant reduction in patient-reported anxiety (p=0.0066) and symptoms (p=0.0094), but not in depression (p=0.2910) or sleep disturbance (p=0.0868). After the fourth hypnotherapy session, there was a statistically significant reduction in patient-reported anxiety (p=0.0016), depression (p=0.0466), symptoms (p=0.0329) and sleep disturbance (p=0.0081). Actigraphy did not show a statistically significant improvement in sleep quality.DiscussionHypnotherapy intervention appears to have a more immediate impact on anxiety and symptom severity whereas the improvement in depression and sleep quality is more slowly acquired. Actigraphy is a new tool to measure the quality of sleep. Its validation is still in progress and thus the sleep indicators chosen for this study are still a subject of debate. This could explain the result inconsistency.ConclusionThis study suggests that hypnotherapy can contribute to reduction in anxiety in palliative care patients with the added benefit of improving sleep and severity of psychological and physical symptoms.
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