There is much interest in whether the needs of ethnic minority patients are being met by palliative care services. Bradford has a population that includes people from several different ethnic minorities, the largest number of whom originate from Pakistan. In May 2000 a bilingual health-care worker (BHCW) was appointed to work with the local palliative care teams to improve service provision for patients from South Asia. An audit of referrals to Bradford teaching hospitals palliative care team from October 2001 to September 2002 looked at the role of the BHCW. It was found that the BHCW was involved in 41% of referrals from ethnic minorities. In addition to aiding communication, the BHCW also provided an important link between the community and the hospital for patients and had a role in bereavement and family support. This audit indicates the BHCW role can be successful and may be useful for other population groups.
Most patients wanted to be resuscitated despite being given the likely poor survival rates from CPR. They also wanted to be involved in the decision-making process, and wanted their next of kin involved, even when, medically, the procedure was unlikely to be successful. The findings that patient and next of kin views correlated well shows that relatives' views are a good representation of patient views. In contrast, consultant's decisions were strongly correlated with the patient's performance status and clinical state. No patients were upset by the study, although nine patients declined to participate.
There is increasing evidence of the benefits of having a mentor during the early years as a consultant. Mentoring encourages and provides support to an individual in their professional development. Although there are different forms of mentoring there is recognition that developing a formal mentoring scheme can provide a consistent approach and support within a framework. The Royal College of Physicians of Edinburgh has introduced a mentoring scheme for new consultants that provides a forum for supporting them in their ongoing professional wellbeing. There is potential that the process of mentoring can improve an individual's development, and motivate and encourage them to develop the skills needed to achieve their goals, thus having an impact on ultimately improving their ability to deliver an effective patient-centred service.
There are many assessment tools available to measure emesis. This Association for Palliative Medicine Science Committee Task Group undertook a review of the validity and suitability of the assessment tools available to measure nausea, vomiting and retching within a palliative care population. Electronic databases were searched from 1970 to 2004. Both specific and global tools were identified and reviewed for their validity, reliability and suitability for our patient population where coexisting cognitive impairment and significant co-morbidities may make accurate assessment of symptoms difficult. Within specific palliative care scenarios namely daily clinical assessment, prevalence surveys and randomized controlled trial settings, the team reached a consensus on which tools had the greatest evidence to recommend them, either for immediate use or for further validation studies. An ideal measurement tool for the assessment of nausea, vomiting and retching has not yet been developed.
Spinal cord stimulation (SCS) is a useful option in selected patients with chronic neuropathic pain. The aim of this questionnaire-based survey was to determine what assessment methods are used for patients being considered for SCS in pain management centres in the United Kingdom. This was in relation to the recommendations produced by the Task Force of the European Federation of IASP chapters (1998) on neuromodulation. Questionnaires were sent out to previously identified individual SCS implanters. The response rate was 64% (n=44). The results of the survey were generally encouraging. Just over half of respondents use some form of guideline to assess patients for SCS, most trying opioid and co-analgesia before proceeding to SCS insertion. There was significant variation concerning absolute contraindications. The majority of respondents worked in a multi-disciplinary team and 61% stated their patients received a psychological assessment but although 96% of individuals worked with a specialist nurse only 25% reported that the nurse had an active role in the pre-assessment of patients for SCS. The development of national guidelines may provide a more standardised approach but further research into the role of the specialist nurse and the benefits of psychological assessment would also be useful.
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