39 research outputs found

    'Burden to others' as a public concern in advanced cancer:a comparative survey in seven European countries

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    Background: Europe faces an enormous public health challenge with aging populations and rising cancer incidence. Little is known about what concerns the public across European countries regarding cancer care towards the end of life. We aimed to compare the level of public concern with different symptoms and problems in advanced cancer across Europe and examine factors influencing this. Methods: Telephone survey with 9,344 individuals aged >= 16 in England, Flanders, Germany, Italy, Netherlands, Portugal and Spain. Participants were asked about nine symptoms and problems, imagining a situation of advanced cancer with less than one year to live. These were ranked and the three top concerns examined in detail. As 'burden to others' showed most variation within and between countries, we determined the relative influence of factors on this concern using GEE and logistic regression. Results: Overall response rate was 21%. Pain was the top concern in all countries, from 34% participants (Italy) to 49% (Flanders). Burden was second in England, Germany, Italy, Portugal, and Spain. Breathlessness was second in Flanders and the Netherlands. Concern with burden was independently associated with age (70+ years, OR 1.50; 95%CI 1.24-1.82), living alone (OR 0.82, 95%CI 0.73-0.93) and preferring quality rather than quantity of life (OR 1.43, 95%CI 1.14-1.80). Conclusions: When imagining a last year of life with cancer, the public is not only concerned about medical problems but also about being a burden. Public education about palliative care and symptom control is needed. Cancer care should include a routine assessment and management of social concerns, particularly for older patients with poor prognosis

    Radio Interferometric Detection of TiO and TiO_2 in VY Canis Majoris: "seeds" of Inorganic Dust Formation

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    Circumstellar envelopes around late-type stars harbour a rich variety of molecular gas and copious amounts of dust, originating from the mass-loss of the central star during the asymptotic giant branch (AGB) or the red supergiant phase. The formation of dust in these objects, in particular the first nucleation stages out of gas phase molecules, is still poorly understood. Here we report the first detection of pure rotational transitions of the two simplest titanium oxides, TiO and TiO_2, towards the oxygen-rich red supergiant VY Canis Majoris (VY CMa). This actually represents the first secure identification of TiO_2 in space. Observations of several rotational emission lines of both species with the Submillimeter Array (SMA) in the 345 GHz-band and with the IRAM Plateau de Bure Interferometer (PdBI) around 220 GHz confirm the presence of these refractory species in the cool (<1000 K) circumstellar envelope in a region several times the size of the dust formation zone. The role of Ti oxides as "seeds" of inorganic dust formation in oxygen-rich circumstellar envelopes will be discussed in view of the present observations.status: publishe

    After you: conversations between patients and healthcare professionals in planning for end of life care

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    Background This study explores with patients, carers and health care professionals if, when and how Advance Care Planning conversations about patients' preferences for place of care (and death) were facilitated and documented. Methods The study adopted an exploratory case study design using qualitative interviews, across five services delivering palliative care to cancer and non-cancer patients within an urban and rural English region. The study recruited 18 cases made up of patients (N = 18; 10 men; 8 women; median age 75); nominated relatives (N = 11; 7 women; 4 men; median age 65) and healthcare professionals (N = 15) caring for the patient. Data collection included: 18 initial interviews (nine separate interviews with patients and 9 joint interviews with patients and relatives) and follow up interviews in 6 cases (involving a total of 5 patients and 5 relatives) within one year of the first interview. Five group interviews were conducted with 15 healthcare professionals; 8 of whom also participated in follow up interviews to review their involvement with patients in our study. Results Patients demonstrated varying degrees of reticence, evasion or reluctance to initiate any conversations about end of life care preferences. Most assumed that staff would initiate such conversations, while staff were often hesitant to do so. Staff-identified barriers included the perceived risks of taking away hope and issues of timing. Staff were often guided by cues from the patient or by intuition about when to initiate these discussions. Conclusions This study provides insights into the complexities surrounding the initiation of Advance Care Planning involving conversations about end of life care preferences with patients who are identified as having palliative care needs, in particular in relation to the risks inherent in the process of having conversations where mortality must be acknowledged. Future research is needed to examine how to develop interventions to help initiate conversations to develop person centred plans to manage the end of life
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