Anderson

Burgess

Echteld

Fliss E. M. Murtagh

Irene J. Higginson

Julia Addington-Hall

Murtagh

Neil S. Sheerin

Noble

Murtagh, F.E.M.

Sheerin, N.S.

Addington-Hall, J.

Higginson, I.J.

Southampton (e-Prints Soton)

Trajectories of illness in Stage 5 chronic kidney disease: a longitudinal study of patient symptoms and concerns in the last year of life

Crossref

Clinical Journal of the American Society of Nephrology

Trajectories of Illness in Stage 5 Chronic Kidney Disease

Background and objectives: The illness trajectory in the last year of life in advanced (stage 5) chronic kidney disease is poorly understood. Mapping the trajectory of patient-centered outcomes could facilitate better care. The objectives of this study were to determine trajectories of symptoms and wider health-related concerns in the last year of life in stage 5 chronic kidney disease, managed without dialysis.Design, setting, participants, &amp; measurements: A longitudinal symptom survey in three UK renal units was used, using the Memorial Symptom Assessment Scale–Short Form and core Palliative Care Outcome Scale. Average (using mean scores over time) and individual (using individual scores over time, with visual graphical analysis) trajectories were mapped.Results: Seventy-four patients (mean age, 81 ± 6.8 years) were recruited; 49 died during follow-up. Average trajectories showed moderate symptom distress and health-related concerns, with marked increase in the last 2 months of life. Visual graphical analysis enabled stable, increasing, or fluctuant individual trajectories to be identified. The proportion following these trajectories varied between outcome measures; regarding symptoms, 50% followed a stable pattern, 24% increased, and 21% fluctuated compared with 26%, 57%, and 21%, respectively, for health-related concerns. Inter-rater agreement in grouping trajectories was high (κ statistic, 0.80 and 0.86, respectively).Conclusions: In the 2 months before death, patients reported a sharp increase in symptom distress and health-related concerns. Health care should anticipate and address this increase, which may indicate the patients is approaching death. Considerable individual variation and flexibility/responsiveness of care is important: one size of service does not fit all

Murtagh, Fliss E M

Sheerin, Neil S

Addington-Hall, Julia

Higginson, Irene J

King's Research Portal

Trajectories of Illness in Stage 5 Chronic Kidney Disease: A Longitudinal Study of Patient Symptoms and Concerns in the Last Year of Life

Flinders Academic Commons

Archived at the Flinders Academic Commons:http://hdl.handle.net/2328/27231This is a scan of a document number DUN/Speeches/1606in the Dunstan Collection, Special Collections, Flinders University Library.http://www.flinders.edu.au/library/info/collections/special/dunstan/Title:Speech notes - Welcome to members of the Japan Natural Gas Survey TeamPlease acknowledge the source as:Dunstan Collection, Flinders University Library.Identifier: DUN/Speeches/1606© Copyright Estate Donald Allan Dunstan-/eoe SPEECH NOTES FOR THE P R E M I E R . WELCOME TO MEMBERS OF THE J A P A N NATURAL GAS SURVEY TEAM . 3 0 / 6 / 7 1 . M I SS DE YONGER, MR. K E L L Y , L A D I E S AND GENTLEMENt I T G I V E S ME P A R T I C U L A R PLEASURE TODAY TO WELCOME THE J A P A N E S E NATURAL GAS SURVEY M I S S I O N TO A D E L A I D E . YOUR V I S I T PROV IDES FURTHER EV IDENCE OF THE GROWING TRADING L I N K S AND T I E S DEVELOP ING BETWEEN OUR TWO COUNTRIES -L I N K S WHICH MUST CONTINUE TO GRDW I N THE F U T U R E . THE SOUTH A U S T R A L I A N GOVERNMENT I S P A R T I C U L A R L Y ANXIOUS TO FOSTER CLOSER TRADING AND INVESTMENT L I N K S AND WE HAVE EMBARKED ON AN A C T I V E P O L I C Y TO A C H I E V E T H I S . Dunstan Collection, Special Collections, Flinders University Library.MY GOVERNMENT HAS E S T A B L I S H E D CLOSE R E L A T I O N S H I P S WITH THE J A P A N E S E GOVERNMENT AND A NUMBER OF THE LARGER COMPANIES REPRESENTED HERE TODAY . I HOPE TO BU I LD ON TH05E CONTACTS WHEN I V I S I T TOKYO AGAIN NEXT MONTH FOR FURTHER D I S C U S S I 0 N 5 ON TRADE AND DEVELOPMENT . YOUR V I S I T NOW COMES AT A P A R T I C U L A R L Y OPPORTUNE T I M E . IN ADDIT ION TO THE ESTABL ISHMENT OF P I P E D S U P P L I E S OF NATURAL GAS FROM OUR FAR NORTH TO THE A D E L A I D E MARKET , WE HAVE RECENTLY CONCLUDED A CONTRACT FOR THE S U P P L Y OF GAS TO THE NEW SOUTH WALES MARKET . THE CONSORTIUM OF E IGHT COMPANIES , INCLUDING THE S A N T O S - D E L H I P R I N C I P A L S , WHO ARE R E S P O N S I B L E FOR T H I S ARE TO BE CONGRATULATED ON THEIR ENERGY AND PERSERVERANCE IN DEVELOPING AND ACQUIR ING T H I S V A L U A B L E O U T L E T . Dunstan Collection, Special Collections, Flinders University Library.3. I T HA5 OPENED THE WAY FOR A MAJOR EXPLORAT ION EFFORT IN THE NORTH EA5T OF OUR STATE TO CONFIRM THE RESERVES REQUIRED AND I HOPE , TOO, THAT T H I S WILL PROVE NOT ONLY THE GAS RESERVES BUT MORE V A L U A B L E RESOURCES SUCH AS O I L . U T I L I S A T I O N OF NATURAL GAS RESOURCES TO SUPPLY THOSE TWO MARKETS WILL LEAD TO THE A V A I L A B I L I T Y OF V A L U A B L E BY -PRODUCTS AND WE LOOK FORWARD ALSO TO THE EARLY DEVELOPMENT OF A L I Q U I D S PROJECT IN THE FAR NORTH. DEVELOPMENTS IN THE NATURAL GAS AREA COULD WELL LEAD TO THE ESTABL ISHMENT OF ANOTHER LARGE INDUSTRY IN T H I S STATE - P O S S I B L Y IN PARTNERSH IP WITH J A P A N E S E I N T E R E S T S . Dunstan Collection, Special Collections, Flinders University Library.I TRUST YOUR D I S C U S S I O N S WITH DELHI SANTOS TODAY ARE WORTH WHILE AND IF THERE I S ANY WAY IN WHICH MY GOVERNMENT CAN BE OF A S S I S T A N C E , P L E A S E DO NOT H E S I T A T E TO CONTACT MY DEPARTMENT. Dunstan Collection, Special Collections, Flinders University Library.