Access to palliative care for patients with advanced cancer: A longitudinal population analysis

Background The UK National Health Service is striving to improve access to palliative care for patients with advanced cancer however limited information exists on the level of palliative care support currently provided in the UK. We aimed to establish the duration and intensity of palliative care received by patients with advanced cancer and identify which cancer patients are missing out. Methods Retrospective cancer registry, primary care and secondary care data were obtained and linked for 2474 patients who died of cancer between 2010 and 2012 within a large metropolitan UK city. Associations between the type, duration, and amount of palliative care by demographic characteristics, cancer type, and therapies received were assessed using Chi-squared, Mann-Whitney or Kruskal-Wallis tests. Multinomial multivariate logistic regression was used to assess the odds of receiving community and/or hospital palliative care compared to no palliative care by demographic characteristics, cancer type, and therapies received. Results Overall 64.6% of patients received palliative care. The average palliative care input was two contacts over six weeks. Community palliative care was associated with more palliative care events (p<0.001) for a longer duration (p<0.001). Patients were less likely to receive palliative care if they were: male (p = 0.002), aged 80 years or over (p<0.05), diagnosed with lung cancer (p<0.05), had not received an opioid prescription (p<0.001), or had not received chemotherapy (p<0.001). Patients given radiotherapy were more likely to receive community only palliative care compared to no palliative care (Odds Ratio = 1.49, 95% Confidence Interval = 1.16–1.90). Conclusion Timely supportive care for cancer patients is advocated but these results suggest that older patients and those who do not receive anti-cancer treatment or opioid analgesics miss out. These patients should be targeted for assessment to identify unmet needs which could benefit from palliative care input

A systematic review of patient reported factors associated with uptake and completion of cardiovascular lifestyle behaviour change

Background: Healthy lifestyles are an important facet of cardiovascular risk management. Unfortunately many individuals fail to engage with lifestyle change programmes. There are many factors that patients report as influencing their decisions about initiating lifestyle change. This is challenging for health care professionals who may lack the skills and time to address a broad range of barriers to lifestyle behaviour. Guidance on which factors to focus on during lifestyle consultations may assist healthcare professionals to hone their skills and knowledge leading to more productive patient interactions with ultimately better uptake of lifestyle behaviour change support. The aim of our study was to clarify which influences reported by patients predict uptake and completion of formal lifestyle change programmes. Methods: A systematic narrative review of quantitative observational studies reporting factors (influences) associated with uptake and completion of lifestyle behaviour change programmes. Quantitative observational studies involving patients at high risk of cardiovascular events were identified through electronic searching and screened against pre-defined selection criteria. Factors were extracted and organised into an existing qualitative framework. Results: 374 factors were extracted from 32 studies. Factors most consistently associated with uptake of lifestyle change related to support from family and friends, transport and other costs, and beliefs about the causes of illness and lifestyle change. Depression and anxiety also appear to influence uptake as well as completion. Many factors show inconsistent patterns with respect to uptake and completion of lifestyle change programmes. Conclusion: There are a small number of factors that consistently appear to influence uptake and completion of cardiovascular lifestyle behaviour change. These factors could be considered during patient consultations to promote a tailored approach to decision making about the most suitable type and level lifestyle behaviour change support

UK student alcohol consumption: A cluster analysis of drinking behaviour typologies

Objective: To assess the extent to which university students are following UK Government advice regarding appropriate consumption of alcohol, and to investigate if students can be placed into distinct clusters based on their drinking behaviour. Design: A descriptive questionnaire study. Setting: One hundred and nineteen undergraduate students from Leeds Metropolitan University, UK. Method: An online survey, which included a diary to record daily alcohol consumption over the previous week, was completed during the winter of 2007/08. Cluster analysis was used to classify students into subgroups based on comparable alcohol-drinking characteristics. National recommended sensible drinking behaviour guidelines in terms of total weekly alcohol intake, maximum daily alcohol intake, number of alcohol-free days and estimated blood alcohol levels were used to compare drinking behaviour the previous week by age, sex and cluster group. Results: Consuming weekly alcohol levels considered hazardous was common (58%) with nearly 70% of responders binge drinking at least once over that period; most students (80%) were, however, following the government’s recommendation for two consecutive alcohol-free days per week. No significant differences in drinking behaviour by sex were found, but binge drinkers tended to be younger. Four distinct alcohol-drinking behaviour clusters were identified based on alcohol consumption frequency and quantity. Only students in the non or light drinkers group all remained within national recommended guidelines for weekly intake and alcohol-free days. Conclusion: Students who consume alcohol are commonly drinking daily and weekly alcohol levels in excess of national sensible drinking guidelines; most students, however, abstain from alcohol on at least two consecutive days. The four distinct drinking clusters suggest that students would benefit from targeted interventions. In particular, personalization of interventions to reflect the distinct patterns of drinking behaviour could increase intervention effectiveness

Odds ratios (95% confidence intervals) from multinomial multivariable logistic regression comparing sources of palliative care, compared with no palliative care, by patient characteristics.

<p>Odds ratios (95% confidence intervals) from multinomial multivariable logistic regression comparing sources of palliative care, compared with no palliative care, by patient characteristics.</p

Therapies received by palliative care provision.

<p>Therapies received by palliative care provision.</p

Demographic characteristics by palliative care provision.

<p>Demographic characteristics by palliative care provision.</p