Abstract
Dear Editor:
Clinician performed ultrasound (CPU) or “bedside ultrasound” has been increasingly adopted by a variety of medical disciplines to answer specific focused questions. It has the potential to be an adjunct to clinical examination in the palliative setting. Ultrasound may assist in clarification of the cause of abdominal distension, by identifying ascites or urinary retention. Thoracic ultrasound can diagnose pleural and cardiac effusions, pneumonia, or a pneumothorax. 1 Ultrasound may facilitate clearer decisions when disease progression is found. 2
Bedside scanning can be contemporaneous. When a clinical question is raised, CPU can provide images that may be viewed together by clinicians, patients, and their families. It may allow informed discussion, improved and timely joint decision making, and reduce transport for imaging. It has the potential to reduce the burden of uncertainty. Portable ultrasound devices can allow imaging in the patient's own home.2,3
Although there have been case series reporting bedside ultrasound use internationally,2,3,4 there has been no published study of the use of bedside ultrasound in an Australian palliative care context. Accordingly, we undertook a survey of members of ANZSPM (Australia and New Zealand Society of Palliative Medicine) to evaluate their opinions regarding perceived utility, current use, training, and potential barriers to the use of CPU. A total of 83 doctors in a wide variety of palliative medicine contexts responded to the survey. Seventy-five percent of these doctors had positive perceptions of the potential utility of CPU. Respondents thought that ultrasound may reduce patient transfer, assist community care, and contribute timely answers to clinical questions. Although only 27% of respondents had experience of CPU, 84% were interested in further training. The main limitations to the use of CPU were lack of confidence and lack of palliative-specific training. Other barriers included the lack and cost of available equipment, and concerns regarding clinical issues such as challenging anatomy. Fear of litigation was a concern to <20%.
This survey has revealed an interest in the possibilities of bedside ultrasound in the palliative setting in Australia and highlighted the lack of suitable training for palliative physicians. CPU has the potential to be a useful adjunct in the care of palliative patients. By clarification of the diagnosis at the bedside, CPU may provide a bridge between active investigation and treatment, provide direction for intervention for improved symptoms, or help in considering prognosis and best treatment.