Biomedical Research ; Capacity Building ; Health Personnel ; education ; Humans ; Palliative Care ; standards ; Quality Improvement ; Singapore ; Terminal Care ; standards

PURPOSE: The purpose of this study was to develop and validate a hospice / palliative care performance measure which would cover more than just physical symptoms or quality of life. METHODS: Through an intensive literature review, the author chose questions that measured aspects of physical, emotional, spiritual, social, or practical domains pertinent to hospice / palliative care for inclusion in the scale. Content validation of the questions was established by 15 hospice / palliative care professionals. A preliminary Hospice Palliative Care Performance Scale (HPCPS) of 20 questions was administered to 134 pairs of terminal cancer patients from 5 hospice palliative care units and their main family caregiver. A validation study was conducted to evaluate construct validity and internal consistency. RESULTS: Factor analysis showed 14 significant questions in five subscales; Physical, Emotional, Spiritual, Social, and Patient' rights. There were no significant differences between the ratings by patients and family members except for three out of the 14 questions. The measure demonstrated construct validity, and Cronbach's alpha of the subscales ranged from .73 to .79. CONCLUSION: The HPCOS demonstrated acceptable validity and reliability. It can be used to assess effectiveness of hospice / palliative care for terminal cancer patients in practice and research.
Aged ; Caregivers/psychology ; Factor Analysis, Statistical ; Female ; Hospice Care/*standards ; Humans ; Male ; Middle Aged ; Outcome Assessment (Health Care)/standards ; Palliative Care/*standards ; Program Development ; Questionnaires

INTRODUCTIONThis paper aimed to ascertain if hospital policy on medical futility helps in conflict resolution, and in ensuring good end-of-life care.

MATERIALS AND METHODSLiterature on the subject published in the last 5 years was identified through Pubmed, and those with empirical data pertaining to the outcomes of interest were examined. A systematic analysis was not possible as papers varied greatly in aims, designs, outcomes and their measures. Instead, the outcomes of representative papers were described and discussed.

RESULTSThere is a widespread use of policies and guidelines based on the concept of medical futility. Conflicts are rare and appear to arise primarily from the manner in which policies are implemented. End-of-life care appears to be improving as evidenced by a significant number of deaths occurring following: (i) discussions involving patient, family, healthcare team members; (ii) cessation of intensive care and (iii) cessation of institution of palliative care. Deaths are increasingly taking place in the presence of family and outside the intensive care wards. Finally, post mortem audit of processes and practices indicate (i) compliance but in a limited manner with policies and recommended guidelines, (ii) family satisfaction and (iii) identify areas where improvement in end-of-life (EOL) care can be effected. Key areas are in improving education of, communication with, and documentation by all stakeholders.

CONCLUSIONHospital policies on medical futility have helped to resolve conflicts and improve end-of-life care. Prospective, multicentre and controlled trials will be useful in determining the value of specific interventions, obtaining generalisable data and facilitating implementation of better end-of-life care models.

Conflict (Psychology) ; Ethics, Medical ; Humans ; Medical Futility ; ethics ; psychology ; Organizational Policy ; Palliative Care ; ethics ; methods ; standards

For advanced stage tumor patients who can not receive radical treatment, quite a part of them require surgical intervention. Surgeons play a important role and are still the main force in palliative treatment for tumors. But in present medical education system, training contents for surgeon involving palliative treatment are few. In fact, surgeons have responsibilities for improving the quality of life, ameliorating pain, preserving the dignity and relieving symptoms of patients in the palliative treatment of tumors. Surgeons should pay attentions to the communication with patients, play a part of clinical multidisciplinary team and apply reasonable surgical intervention approach. Education of palliative treatment for surgeons should also include medical humanistic concern, and the recognition of effects of medical humanity, ethics, dignity and religion on the recovery of tumor patients.
Communication ; Education, Medical ; standards ; Humans ; Interprofessional Relations ; Neoplasms ; surgery ; Pain Management ; methods ; Palliative Care ; methods ; Patient Care Team ; Physician-Patient Relations ; Quality of Life ; Surgeons ; education ; psychology

The Ministry of Health (MOH) has updated the Clinical Practice Guidelines on Chronic Obstructive Pulmonary Disease (COPD) to provide doctors and patients in Singapore with evidence-based treatment for COPD. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH Clinical Practice Guidelines on COPD, for the information of SMJ readers. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website: https://www.moh.gov.sg/content/moh_web/healthprofessionalsportal/doctors/guidelines/cpg_medical.html. The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.
Adult ; Aged ; Evidence-Based Medicine ; Humans ; Middle Aged ; Palliative Care ; Prevalence ; Pulmonary Disease, Chronic Obstructive ; diagnosis ; therapy ; Pulmonary Medicine ; standards ; Quality Improvement ; Radiography, Thoracic ; Risk Factors ; Singapore ; Steroids ; therapeutic use

OBJECTIVEChina began providing antiretroviral therapy to people living with HIV/AIDS (PLWHA) in 2003. This study was to investigate the living conditions, including quality of life and happiness, and need for palliative care of end-of-life PLWHA in rural Henan.

METHODSOne hundred end-of-life AIDS patients were selected from Weishi, Zhenping and Tanghe counties in Henan, using convenience sampling. The World Health Organization Quality of Life for HIV (WHOQOL-HIV) BREF Chinese Version was used to measure the quality of life and the Memorial University of Newfoundland Scale of Happiness (MUNSH) was employed to measure subjective welfare. Qualitative interviews and focus group discussions were undertaken to learn about the palliative care provided and the specific needs of the end-of-life patients.

RESULTSPatients' overall quality of life was moderate (12.62±1.97). Highest scores were in the spirituality/religion/personal beliefs, higher than the average scores in the Chinese population (P<0.01), while psychological (13.58±2.06) and environment (12.50±3.28) domain scores were similar to the latter (P>0.05). Both independence (12.15±2.15) and physiological (14.04±3.16) domain scores were lower than the average of the people living with HIV/AIDS in other studies (P<0.01); however, all were in the moderate range. The average MUNSH score was 21.00±6.20, which was also moderate. The in-depth interviews indicated that the Henan Provincial Government's policy of treatment and care had a beneficial impact on end-of-life AIDS patients, although the care components could be improved.

CONCLUSIONSLiving conditions of the end-of-life AIDS patients were moderate, and the HIV/AIDS palliative care model used was beneficial to them. Care could be improved by assisting the family unit as a whole.

Acquired Immunodeficiency Syndrome ; drug therapy ; epidemiology ; psychology ; therapy ; Adult ; Antiretroviral Therapy, Highly Active ; Blood Donors ; psychology ; China ; Critical Illness ; Female ; HIV Infections ; drug therapy ; epidemiology ; psychology ; therapy ; Humans ; Male ; Palliative Care ; standards ; Plasma Exchange ; statistics & numerical data ; Quality of Health Care ; Quality of Life ; Rural Population ; Surveys and Questionnaires