154 research outputs found
How outpatient palliative care teleconsultation facilitates empathic patient-professional relationships: a qualitative study
PAF-acether (1-O-hexadecyl/octadecyl-2-acetyl-sn-glycero-3-phosphocholine)-induced fibrinogen binding to platelets depends on metabolic energy
Funding models in palliative care: lessons from international experience
Background:Funding models influence provision and development of palliative care services. As palliative care integrates into mainstream health care provision, opportunities to develop funding mechanisms arise. However, little has been reported on what funding models exist or how we can learn from them.Aim:To assess national models and methods for financing and reimbursing palliative care.Design:Initial literature scoping yielded limited evidence on the subject as national policy documents are difficult to identify, access and interpret. We undertook expert consultations to appraise national models of palliative care financing in England, Germany, Hungary, Republic of Ireland, New Zealand, The Netherlands, Norway, Poland, Spain, Sweden, Switzerland, the United States and Wales. These represent different levels of service development and a variety of funding mechanisms.Results:Funding mechanisms reflect country-specific context and local variations in care provision. Patterns emerging include the following:Provider payment is rarely linked to population need and often perpetuates existing inequitable patterns in service provision.Funding is frequently characterised as a mixed system of charitable, public and private payers.The basis on which providers are paid for services rarely reflects individual care input or patient needs.Conclusion:Funding mechanisms need to be well understood and used with caution to ensure best practice and minimise perverse incentives. Before we can conduct cross-national comparisons of costs and impact of palliative care, we need to understand the funding and policy context for palliative care in each country of interest
Realizing better doctor-patient dialogue about choices in palliative care and early phase clinical trial participation: towards an online value clarification tool (OnVaCT)
Decisional conflict after deciding on potential participation in early phase clinical cancer trials: Dependent on global health status, satisfaction with communication, and timing
Realizing better doctor-patient dialogue about choices in palliative care and early phase clinical trial participation: towards an online value clarification tool (OnVaCT)
Background: Patients with advanced cancer for whom standard systemic treatment is no longer available may be
offered participation in early phase clinical trials. In the decision making process, both medical-technical information
and patient values and preferences are important. Since patients report decisional conflict after deciding on
participation in these trials, improving the decision making process is essential. We aim to develop and evaluate an
Online Value Clarification Tool (OnVaCT) to assist patients in clarifying their values around this end-of-life decision.
This improved sharing of values is hypothesized to support medical oncologists in tailoring their information to
individual patientsâ needs and, consequently, to support patients in taking decisions in line with their values and
reduce decisional conflict.
Methods: In the first part, patientsâ values and preferences and medical oncologistsâ views hereupon will be
explored in interviews and focus groups to build a first prototype OnVaCT using digital communication (serious
gaming). Next, we will test feasibility during think aloud sessions, to deliver a ready-to-implement OnVaCT. In the
second part, the OnVaCT, with accompanied training module, will be evaluated in a pre-test (12â18 months before
implementation) post-test (12â18 months after implementation) study in three major Dutch cancer centres. We will
include 276 patients (> 18 years) with advanced cancer for whom standard systemic therapy is no longer available,
and who are referred for participation in early phase clinical trials. The first consultation will be recorded to analyse
patient-physician communication regarding the discussion of patientsâ values and the decision making process.
Three weeks afterwards, decisional conflict will be measured.
Discussion: This project aims to support the discussion of patient values when considering participation in early
phase clinical trials. By including patients before their first appointment with the medical oncologist and record
Funding models in palliative care: Lessons from international experience
Background: Funding models influence provision and development of palliative care services. As palliative care integrates into mainstream health care provision, opportunities to develop funding mechanisms arise. However, little has been reported on what funding models exist or how we can learn from them. Aim: To assess national models and methods for financing and reimbursing palliative care. Design: Initial literature scoping yielded limited evidence on the subject as national policy documents are difficult to identify, access and interpret. We undertook expert consultations to appraise national models of palliative care financing in England, Germany, Hungary, Republic of Ireland, New Zealand, The Netherlands, Norway, Poland, Spain, Sweden, Switzerland, the United States and Wales. These represent different levels of service development and a variety of funding mechanisms. Results: Funding mechanisms reflect country-specific context and local variations in care provision. Patterns emerging include the following: Provider payment is rarely linked to population need and often perpetuates existing inequitable patterns in service provision. Funding is frequently characterised as a mixed system of charitable, public and private payers. The basis on which providers are paid for services rarely reflects individual care input or patient needs. Conclusion: Funding mechanisms need to be well understood and used with caution to ensure best practice and minimise perverse incentives. Before we can conduct cross-national comparisons of costs and impact of palliative care, we need to understand the funding and policy context for palliative care in each country of interest
Review of European guidelines on palliative sedation: a foundation for the updating of the European Association for Palliative Care framework
in 2009, the European Association for Palliative Care (EAPC) developed a framework on palliative sedation, acknowledging this practice as an important and ethically acceptable intervention of last resort for terminally ill patients experiencing refractory symptoms. Before and after that, other guidelines on palliative sedation have been developed in Europe with variations in terminology and concepts. As part of the Palliative Sedation project (Horizon 2020 Funding No. 825700), a revision of the EAPC framework is planned. The aim of this article is to analyze the most frequently used palliative sedation guidelines as reported by experts from eight European countries to inform the discussion of the new framework. The three most reported documents per country were identified through an online survey among 124 clinical experts in December 2019. Those meeting guideline criteria were selected. Their content was assessed against the EAPC framework on palliative sedation. The quality of their methodology was evaluated with the Appraisal Guideline Research and Evaluation (AGREE) II instrument. Nine guidelines were included. All recognize palliative sedation as a last-resort treatment for refractory symptoms, but the criterion of refractoriness remains a matter of debate. Most guidelines recognize psychological or existential distress as (part of) an indication and some make specific recommendations for such cases. All agree that the assessment should be multiprofessional, but they diverge on the expertise required by the attending physician/team. Regarding decisions on hydration and nutrition, it is proposed that these should be independent of those for palliative sedation, but there is no clear consensus on the decision-making process. Several weaknesses were highlighted, particularly in areas of rigor of development and applicability. The identified points of debate and methodological weaknesses should be considered in any update or revision of the guidelines analyzed to improve the quality of their content and the applicability of their recommendations
Temperature in housing: stratification and contextual factors
Overheating in new and retrofit low carbon dioxide homes is a growing issue in the UK due to climate change and other factors, with 99% of existing housing predicted to be at medium to high risk if summer temperatures become 1·4°C warmer. A year-long field study in two residential developments in the north of England monitored housing at three different scales: two-storey houses and three- and ten-storey blocks of flats. This revealed significant temperature stratification in the staircase zone, which allows a stack effect, as well as temperature differences between dwellings depending on their location in the building, both for summer and winter conditions even in the low-rise housing. Further investigation revealed that albedo and eastâwest orientation also contributed to non-linear overheating. Analyses of inhabitantsâ thermal comfort and security practices as well as occupancy patterns also challenge the regulatory modelling used to predict building performance. It is suggested that these additional physical as well as user factors in residential developments need further investigation and should now be considered in relation to thermal comfort modelling
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