Search

Aim To explore the views of general practitioners (GPs) regarding the involvement of the practice nurse (PN) in supporting older people with heart failure (HF) throughout the disease trajectory and identify specific implications for initiating advance care planning and improving end-of-life care. Methods Thirty GPs in a large urban area of New Zealand (NZ) participated in in-depth qualitative interviews. The interviews were recorded and transcribed verbatim. Data were entered into Nvivo software and were analysed thematically. Results While the GPs' experiences of working with the PN as contributor to the management of older patients with HF were positive overall, very minimal involvement of the PN in palliative and end-of-life care management was identified. However, significant potential for expansion was identified, particularly in the areas PNs are currently involved in, namely communication, education, and coordinating services, all of which are considered essential to effective palliative and end-of-life care. Conclusion The views of GPs are important as they employ PNs in NZ and are central to the ways in which the PN role can be developed in the future to improve services for older people with HF throughout the disease trajectory. Our study indicates that there is significant potential to expand the role of the PN throughout the HF disease trajectory, a development which could address some of the current gaps in palliative and end-of-life care management for these patients. Further research is required to develop and evaluate a model which optimizes the PN role throughout the disease trajectory of people with HF. [ABSTRACT FROM AUTHOR]

Background There is a paucity of studies which explore palliative care patients' involvement in research. The involvement of patients with a life-limiting illness in research raises numerous ethical concerns for researchers keen to take account of their views and experiences of service provision. Assumptions are readily made about whether participation is appropriate for this patient group due to their perceived vulnerability. Aim To explore the views of hospice users regarding their motivations for taking part in a study, designed to inform the delivery of care, and ensure ongoing service improvement. Methods Based on a larger pilot study to examine patients' satisfaction with hospice care, and using a qualitative interview approach, twenty-one patients under the care of three hospices in the Auckland region of New Zealand took part. Interviews were recorded and transcribed verbatim. Data were analysed using a thematic analysis technique. Results The involvement of hospice users in research is important and has the capacity to produce a diverse, but significant impact on those involved. Not only does their involvement demonstrate the potential to shape service provision, it also reveals the therapeutic benefits to individuals with a life-limiting illness of simply taking part. Of particular importance is the view that participation enables a sense of personhood to be maintained circumventing the potential of a 'social death'. Unless they are unable to consent, palliative care patients should be regarded as autonomous individuals and given the opportunity to participate in research. [ABSTRACT FROM AUTHOR]

Options for the careful use of benzodiazepines in end-of-life care may be limited by several factors, including local availability and experience. Fifty-seven patients treated with midazolam for palliative sedation therapy (PST) in end-of-life care were matched by diagnosis, sex, and age with 57 patients treated with flunitrazepam. Comparisons included the number of PST interventions required, maintenance of consciousness, length of life remaining, and responses for a range of symptoms, using the patient's perspective where possible. Both benzodiazepines improved symptoms in all categories considered, with flunitrazepam appearing to be more effective. Patients on flunitrazepam survived longer after the initiation of PST (P = 0.01), remained conscious for longer (P = 0.019), and required fewer adjuvant treatment interventions (P = 0.008). There is a potential concern that patients may feel trapped by midazolam and not be able to communicate this. [ABSTRACT FROM AUTHOR]