Journal of Palliative Care

This study directly confirms that the degree of congruence between the preferred and actual place death is unsatisfactory. Clinical interventions and health policies need to be developed to assist terminally ill cancer patients who may not be able to achieve their preference for place of end-of-life care and death.

To evaluate the impact of an interactive continuing medical education workshop designed to help physicians in breaking bad news to their patients.

Analysis of post-workshop questionnaires from 539 physicians assessing the retention of the key concepts and the perception of the potential impact of the workshop on their practice immediately after the workshop and six months later.

The most significant concepts retained by the respondents are: the need to take into consideration the whole patient (42.7% post-workshop and 45.6% of follow-up responses), the need to be prepared for the consultation (11.6% and 15%), the importance of better guiding the interview (18.8% and 13.6%), and the value of taking more time during the consultation (5.8% and 8.3%). Analysis of paired responses on the post-workshop and the follow-up questionnaires shows that 35% of the concepts retained are identical.

The majority of physicians retained the key concepts, both immediately following the workshop and in the longer term.

To assess knowledge and associated factors in palliative care.

Self-administered survey of 88 internal medicine house officers in 1996.

Twenty-one interns and 36 residents completed the survey for a response rate of 65%. Most house officers reported 1–5 hours of prior formal training in palliative care, 1–5 hours in pain management, and 6–20 hours in ethics. The mean knowledge score was 75% correct (SD=8); pain management scores were lowest (70%). Overall, interns had a significantly lower mean score than residents (70% vs. 77%; p=0.001). In multivariate analysis, only the year of residency was significantly associated with knowledge score; prior formal training in palliative care, pain management, or ethics was not. One third of house officers rated themselves as “not at all” or “only slightly” at ease in caring for a dying patient. These self-ratings were not associated with prior training or knowledge, but were higher in residents compared to interns.

Palliative care knowledge and ease with dying patients were higher in later years of residency but were not associated with prior formal palliative care training. These data highlight the continued need to evaluate and improve training in palliative care and pain management.

To evaluate whether a short radiation treatment (30 Gy, 3.0 Gy/fraction) had analgesic efficacy in patients with unresectable pancreatic carcinoma.

Twelve patients were included in this analysis. Before starting and at four weeks after radiation therapy, pain intensity was evaluated and analgesic drug therapy was adjusted until a 0–3 pain score was reached (WHO).

No radiotherapy interruptions, no hospitalisation due to toxic reactions, and no severe toxicity were observed. Six patients (50%) had pain control without pharmacological therapy, three patients (25%) reduced their use (35%–72%) of analgesics, while in the remaining three patients (25%) there was no change in analgesic use. Overall, mean reduction in the use of analgesics was 63.1% ± 43.8%. During follow-up (44 months), two patients (16.7%) showed a worsening of pain that required increased analgesia; in one patient, percutaneous splanchnicectomy was necessary.

In patients excluded from standard concomitant chemoradiation, hypofractionated-accelerated radiotherapy is feasible and results in pain relief in most patients, documented as a reduced need for analgesics.

To investigate whether health service input in the last year of life differs between cancer patients who die at home versus those dying in inpatient care.

Post hoc exploratory case-control study of 127 home deaths and 200 inpatient deaths. Retrospective electronic record linkage of patients’ community and inpatient care during the last year of life.

Patients who died at home began their home nursing care closer to death than those who died as inpatients. Their first contact with inpatient hospice care began further from death. Before their final month, home death patients also had more specialist and district nursing than patients who died in inpatient care.

Patients who began their home nursing early were less likely to die at home than those who began such care late. This suggests that it may be difficult to sustain end-of-life care at home for an extended period. Further research incorporating assessment of informal care input and disease trajectory is required to investigate this issue.