Establishing key criteria to define and compare models of specialist palliative care : a mixed-methods study using qualitative interviews and Delphi survey

Background: Specialist palliative care services have various configurations of staff, processes and interventions, which determine how care is delivered. Currently, there is no consistent way to define and distinguish these different models of care. Aim: To identify the core components that characterise and differentiate existing models of specialist palliative care in the United Kingdom. Design: Mixed-methods study: (1) semi-structured interviews to identify criteria, (2) two-round Delphi study to rank/refine criteria, and (3) structured interviews to test/refine criteria. Setting/participants: Specialist palliative care stakeholders from hospice inpatient, hospital advisory, and community settings. Results: (1) Semi-structured interviews with 14 clinical leads, from eight UK organisations (five hospice inpatient units, two hospital advisory teams, five community teams), provided 34 preliminary criteria. (2) Delphi study: Round 1 (54 participants): thirty-four criteria presented, seven removed and seven added. Round 2 (30 participants): these 34 criteria were ranked with the 15 highest ranked criteria, including setting, type of care, size of service, diagnoses, disciplines, mode of care, types of interventions, ‘out-of-hours’ components (referrals, times, disciplines, mode of care, type of care), external education, use of measures, bereavement follow-up and complex grief provision. (3) Structured interviews with 21 UK service leads (six hospice inpatients, four hospital advisory and nine community teams) refined the criteria from (1) and (2), and provided four further contextual criteria (team purpose, funding, self-referral acceptance and discharge). Conclusion: In this innovative study, we derive 20 criteria to characterise and differentiate models of specialist palliative care – a major paradigm shift to enable accurate reporting and comparison in practice and research

Towards optimal use of antithrombotic therapy of people with cancer at the end of life: a research protocol for the development and implementation of the SERENITY shared decision support tool Thrombosis Research

Background: Even though antithrombotic therapy has probably little or even negative effects on the well-being of people with cancer during their last year of life, deprescribing antithrombotic therapy at the end of life is rare in practice. It is often continued until death, possibly resulting in excess bleeding, an increased disease burden and higher healthcare costs. Methods: The SERENITY consortium comprises researchers and clinicians from eight European countries with specialties in different clinical fields, epidemiology and psychology. SERENITY will use a comprehensive approach combining a realist review, flash mob research, epidemiological studies, and qualitative interviews. The results of these studies will be used in a Delphi process to reach a consensus on the optimal design of the shared decision support tool. Next, the shared decision support tool will be tested in a randomised controlled trial. A targeted implementation and dissemination plan will be developed to enable the use of the SERENITY tool across Europe, as well as its incorporation in clinical guidelines and policies. The entire project is funded by Horizon Europe.Results: SERENITY will develop an information-driven shared decision support tool that will facilitate treatment decisions regarding the appropriate use of antithrombotic therapy in people with cancer at the end of life. Conclusions: We aim to develop an intervention that guides the appropriate use of antithrombotic therapy, prevents bleeding complications, and saves healthcare costs. Hopefully, usage of the tool leads to enhanced empowerment and improved quality of life and treatment satisfaction of people with advanced cancer and their care givers

Die Light/Khanya : 'n ondersoek na lesersbehoeftes

Thesis (MA)--PU vir CHO, 19941. INTRODUCTION: The Light/Khanya is a monthly information paper published by the Pretoria Regional Office of the South African Communication Service and is distributed to blacks in the Pretoria, Northern Transvaal and Eastern Transvaal regions. The function of the paper is to promote, by way of information, economic, social, constitutional and cultural development in line with the national policy in order to realise national aspirations and values. 2. AIM OF THE STUDY: The aim of the study is to determine whether the amount of information published by the Light/Khanya during the period February 1990 to December 1990 was enough to satisfy the needs of the urban readers. 3. RESEARCH METHODOLOGY: The descriptive survey method was chosen as the most applicable research method for this study and the research was done by means of a questionnaire and descriptive statistics. The respondents were chosen from the mailing list of the Mamelodi subscribers by means of the systematic sampling technique. A total of 464 ( 4% of the population of 11 586 which is according to statistical significance) questionnaires were distributed and collected within ten days. A total of 434 fully completed questionnaires were received and statistically analysed. 4. RESULTS OF THE STUDY: The results of the study indicate that the Light/Khanya succeeded in satisfying the majority of readers' needs regarding the amount of information on most of the identified themes and in columns. There was only one theme on which the Light/Khanya published inadequate information, namely the problems in black education. The Light I Khan ya has heterogenious readers regarding sex, age and mother tongue. Factors such as sex and age tend to influence the satisfaction of needs and therefor comparisons were made between two age groups (25 years and younger and 26 years and older), the sexes and the different mother tongue groups. A comparison between the different sexes and two age groups by means of a t-test indicated that there were no practical meaningful differences regarding the amount of information that satisfied their needs. The comparison between the seven different mother tongue groups indicated that several practical meaningful differences exist. The split-half method was used to determine the reliability of the test. The test proved to be reliable as the correlation coefficient (r) was 0,8. The results also clearly show that the Light/Khanya satisfies other needs than just the need for information.Master