BackgroundComplex need for patients with a terminal illness distinguishes those who would benefit from specialist palliative care from those who could be cared for by non-specialists. However, the nature of this complexity is not well defined or understood. This study describes how health professionals, from three distinct settings in the United Kingdom, understand complex need in palliative care.MethodsSemi-structured qualitative interviews were conducted with professionals in primary care, hospital and hospice settings. Thirty-four professionals including doctors, nurses and allied health professionals were recruited in total. Data collected in each setting were thematically analysed and a workshop was convened to compare and contrast findings across settings.ResultsThe interaction between diverse multi-dimensional aspects of need, existing co-morbidities, intractable symptoms and complicated social and psychological issues increased perceived complexity. Poor communication between patients and their clinicians contributed to complexity. Professionals in primary and acute care described themselves as ‘generalists’ and felt they lacked confidence and skill in identifying and caring for complex patients and time for professional development in palliative care.ConclusionsComplexity in the context of palliative care can be inherent to the patient or perceived by health professionals. Lack of confidence, time constraints and bed pressures contribute to perceived complexity, but are amenable to change by training in identifying, prognosticating for, and communicating with patients approaching the end of life.Electronic supplementary materialThe online version of this article (10.1186/s12904-017-0259-z) contains supplementary material, which is available to authorized users.
We report 2 fatal cases of the acetaminophen-alcohol syndrome and review 51 reported cases in the medical literature. The MEDLINE database from January 1966 to December 1995 and bibliographies of selected articles were used to obtain the case reports. Inclusion criteria were a clear history of alcohol use, a history of acetaminophen use and/or an elevated serum acetaminophen level, peak aspartate aminotransferase (AST) greater than 800 U/L, and exclusion of other causes of hepatotoxicity by negative hepatitis serologies and/or a liver biopsy showing typical findings of acetaminophen toxicity. Demographic characteristics, clinical features, treatment, and outcome were extracted from reports meeting inclusion criteria and our own 2 cases. This syndrome affected relatively young, frequently healthy patients. Acetaminophen was invariably taken for nonsuicidal intent. The mortality rate was 32%. A typical laboratory picture was defined, characterized by an extraordinarily high AST level. Treatment with N-acetylcysteine was not effective due to delayed presentation and diagnosis. Patients who use alcohol and health care providers should be educated about this potentially fatal syndrome. Prevention is the key to reducing its occurrence.
the End-of-Life Study GroupThis study is a cross-sectional descriptive survey of randomly selected primary care patients and physicians regarding patient, physician, and family roles in end-of-life decision making. The subjects included 329 adult outpatients and 272 practicing physicians. Physicians were more likely than patients to believe the patient alone was responsible for making end-of-life decisions. Patients were more likely than physicians to believe the physician should provide a recommendation in addition to facts to help the patient make end-of-life decisions. We conclude that patients prefer a more active role for physicians in both decision making and discussion of end-of-life care than do physicians themselves. The recently published results from the SUPPORT trial demonstrated serious shortcomings in end-oflife decision making and medical care. 1 End-of-life decision making did not improve following the intervention, in which skilled nurses provided physicians with information about their patients' preferences for end-of-life care. Commentaries on the SUPPORT trial have noted that endof-life decision making is a process that must occur within the context of the individual patient-physician relationship, and that nurses and computers may not help meet patients' goals. 2 If interventions outside the patientphysician relationship fail, characteristics of direct discussion and decisions between patients and their doctors must be improved. In this context, several questions need to be better answered. How do patients and physicians view their roles in end-of-life decision making? How should they share the decision-making process? What is the role of the family in end-of-life decision making? We performed a multicentered study of ambulatory patients and primary care physicians designed to address these questions. METHODSWe conducted a cross-sectional descriptive survey of primary care patients and physicians in eight communities in the United States from January through April 1992. The study sites were those of the participants in the End-of-Life Study Group, including Tampa, Florida; Peoria and Rockford, Illinois; Wichita, Kansas; Louisville, Kentucky; Greensboro, North Carolina; Danville, Pennsylvania; and Morgantown, West Virginia. The methods were reported previously. 3 PatientsPatients were adult outpatients who had appointments in primary care offices. Exclusion criteria included active psychiatric illness, and health or emotional states that might be jeopardized by participation. Forty patients were randomly selected from appointment schedules at each site. All gave informed consent. Demographic data on patients refusing to participate were collected. PhysiciansPhysicians were primary care practitioners in general internal medicine, family medicine, and general practice. Fifty practicing primary care physicians were randomly selected from lists of primary care physicians in each community. Study Instrument and Data CollectionA qualitative study by our group, using structured interviews with pati...
We defined a discrepancy between the preferences of primary care patients and physicians regarding the timing of the discussion about advance directives. We propose physician education regarding patient preferences as the most effective way to accomplish the goal of improving the frequency and quality of discussions about advance directives.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.