BMJ Supportive & Palliative Care最新文献

Background: Literature on caregiver burden is limited in India and Kerala. We examined the prevalence and factors associated with caregiver burden and its impact on their quality of life.

Methods: We conducted a cross-sectional study among 115 informal caregivers (mean age 70 years, 80% female) of palliative care patients in Kerala. Caregivers were interviewed using the Zarit Burden Interview-22 and the WHOQOL-BREF questionnaires. Factors associated with caregiver burden were analysed using binary logistic regression.

Results: The prevalence of moderate to severe burden was 32.1% (95% CI 23.7% to 41.5%), with 6.2% reporting severe burden (95% CI 2.4% to 12.1%). Caregivers of patients aged ≥73 years (adjusted OR (aOR)=7.19, 95% CI 1.87 to 27.71, p=0.004), children acting as caregivers (aOR=11.09, 95% CI 1.21 to 101.03, p=0.033) and those caring for patients with prolonged disease duration (aOR=3.62, 95% CI 1.04 to 12.67, p=0.044) reported significantly higher burden compared with their counterparts. Moderate to severe burden was associated with lower physical (p<0.001), psychological (p<0.001) and social relations (p=0.002) quality of life scores.

Conclusion: Targeted interventions for caregivers of older patients, children acting as caregivers and those taking care of patients with prolonged disease duration are likely to reduce burden and improve their quality of life.

Objectives: To compare a novel method of methadone rotation used in a specialist palliative care inpatient unit (SPCU) in Cork, Ireland, with rapid titration methods using Perth and Brisbane Protocols as well as the Edmonton method of methadone rotation.

Methods: A retrospective chart review was performed in March-June 2022. All patients who completed rotation to methadone during 2018-2019 in the SPCU were included. 2018-2019 was selected to study a population not affected by the coronavirus pandemic. Oral morphine equivalent (OME) was calculated using the opioid conversion chart. From the OME, the expected daily methadone dose was calculated using the Perth, Brisbane and Edmonton methods. These figures were then compared directly with the actual methadone doses achieved using our dosing schedule.

Results: A comparison of the expected doses using the Perth and Brisbane rapid titration protocols and stable daily dose achieved revealed that the stable methadone dose was significantly lower than both rapid titration protocols (p=<0.0001) and (p=0.0035, respectively). However, a comparison of the expected dose using the Edmonton method and the dose achieved did not determine any significant difference (p=0.7602).

Conclusions: This is the first evaluation of a novel Irish method of methadone rotation and demonstrates a lower overall daily methadone dose compared with established protocols.

Background: The early integration of a specialist palliative care team is demonstrated to have numerous benefits for patients. These extend beyond end-of-life care to include reducing depressive symptoms, improving quality of life and reducing unnecessary interventions.

Aims: This study aims to characterise the patient population referred to the specialist palliative care service with a diagnosis of gynaecological cancer. It also assesses referral frequency and response time in order to understand palliative care utilisation in an acute hospital setting.

Methods: A retrospective chart review and database analysis were performed to extract data on demographics, cancer diagnoses and referral reasons for patients referred to the specialist palliative care service over 3 years. The study focuses on identifying patterns in the characteristics of the referred patient population.

Results: Analysis of 162 patients revealed a distribution across cancer subtypes: 62% ovarian, 22% endometrial, 12% cervical and 4% vulvar. A notable finding was that the outcomes for patients with ovarian cancer were more likely to be discharged home with or without community care (62%) compared with those with endometrial cancer (41%). A rapid response to referrals was observed, with 70% reviewed within 3 days and 98% within a week. This highlights the service's efficiency and the demographic and diagnostic profile of the patient served.

Conclusions: This study gives insight into the demographic and diagnostic profiles of patients with gynaecological cancer referred for palliative care, alongside demonstrating rapid response to such referrals. Despite the rapid assessment times, the research importantly identifies differences in outcomes among different cancer subtypes, with a particular emphasis on the variance in discharge destinations. These findings reflect both patient preferences and medical needs, demonstrating the role of tailoring palliative care approaches to meet the individual needs and desires of this diverse patient population.