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Biomedical subjects

Ian Maddocks

Publications and source records attributed to Ian Maddocks.

11 recordsLinked to original sources
PubMed2005

Identification of patients with noncancer diseases for palliative care services.

OBJECTIVE: To identify criteria for measuring the eligibility of patients with end-stage noncancer diseases for palliative care services in Australian residential aged care facilities. METHODS: No validated set if guidelines were available so five instruments were used: an adaptation of the American National Hospice Association Guidelines; a recent adaptation of the Karnofsky Performance Scale; the Modified Barthel Index; the Abbey Pain Score for assessment of people who are nonverbal and a Verbal Descriptor Scale, also for pain measurement. In addition, nutritional status and the presence of other problematic symptoms and their severity were also sought. RESULTS: The adapted American National Hospice Association Guidelines provided an initial indicative framework and the other instruments were useful in providing confirmatory data for service eligibility and delivery.

Australia↗
PubMed2005

Documenting end of life decisions in residential aged care facilities in South Australia.

OBJECTIVE: This research examined the provision of palliative care for residents with a non-cancer diagnosis including the use of advance directives and advance care planning as part of palliative care policies in residential aged care facilities in South Australia. There are no guidelines for recording residents' wishes if they are no longer competent. METHODS: Stage 1 involved a survey of 90 randomly selected aged care facilities. Stage 2 involved case studies of 69 residents, appropriate for palliative care, from 17 facilities and interviews with 15 directors of care. RESULTS: Most residential aged care facilities used forms to record residents' wishes about end of life care, but there was little consistency. Some had no palliative care policy and few facilities required a formal advance directive. Not all residents had formally appointed a proxy. CONCLUSIONS: Residential aged care facilities should be required to develop and implement a palliative care policy acknowledging the Accreditation Standards and State legislation and including a simple tool for advance care planning. Case conferencing could assist in discussing and documenting the resident's wishes. Public education is essential to increase community and professional awareness in order to promote empowerment for the increasing number of older people who will die in residential aged care facilities.

Advance Care Planning↗
PubMed2005

A palliative approach or specialist palliative care? What happens in aged care facilities for residents with a noncancer diagnosis?

This article presents results of the second stage of a research project which explored the palliative care needs of 69 residents with a noncancer diagnosis in South Australia. Extensive data were collected prospectively from case notes, and resident and staff interviews over a 10-week period. Residents were suffering multiple conditions and were highly dependent for activities of daily living. Most residents' care was consistent with a palliative approach, with only three residents in the study referred to a specialist palliative care service. However, for some residents, pain and symptom management were not always adequate, and referral to a specialist palliative care service would have been appropriate. This research indicates that, with additional education, it could be possible to extend the principles and philosophy of palliative care by adopting a palliative care approach within aged care facilities.

Aged↗
PubMed2003

Grief and bereavement.

Bereavement support is an integral part of palliative care. Grieving after loss is a normal process; however, some grief reactions become complicated and may seriously compromise the health of an individual. Routine bereavement care helps identify people at risk of complicated grieving. The burden of grief can last for years, sometimes indefinitely. People caring for the bereaved need to pay special attention to cultural differences, the burden of caring for dying children, and the special support needs of bereaved children and adolescents. Excellent resources to assist in grief management, including the expertise of palliative care teams, are readily available.

Bereavement↗
PubMed2003

Issues in palliative care for Indigenous communities.

All Indigenous communities in Australia have a common heritage of loss. Indigenous death rates are much higher than those for white Australians. Indigenous people use healthcare services reluctantly, and palliative care services rarely. Cultural considerations that need to be respected include Indigenous understandings of disease causation, attributions of blame for sickness, the performance of ceremonies after death and the importance of dying on traditional lands. The involvement of Indigenous health workers in clinical care increases confidence in the healthcare system as a whole.

Attitude to Death↗
PubMed2003

Palliative care education in the developing countries.

Individuals who have experience in palliative care in wealthier countries with well-structured health systems see the palliative care needs of developing countries as forbiddingly huge. They are aware of an increasing incidence of cancer, but health delivery systems are often patchy and deficient, medications for pain management are not widely available, and cultural considerations limit opportunities to face advanced illness and focus on symptom control in terminal illness. An increasing prevalence of HIV infection compounds palliative care needs. Medical practice focuses on interventions that promise cure and earn a good reward, while nursing standards are variable and often unsatisfactory. There is a need for demonstrations of good care and effective symptom control, even if these reach only a small fraction of the needy population. On such demonstrations can be built education programs that take account of local realities, and promote attitudes, knowledge and skills capable of gradually introducing a greater professional concern and a better prospect of effective care for the dying.

Acquired Immunodeficiency Syndrome↗
PubMed2002

Issues in the conduct of therapeutic trials in palliative care: an Australian perspective.

Palliative care has been slow to demonstrate that its common interventions are supported by high levels of evidence. There are multiple reasons for this--historical and cultural, as well as the recognised difficulties of conducting studies in dying persons. There are problems in isolating the effect of a single intervention from the many other changing dimensions which attend the progress of terminal illness, and problems also in defining particular outcomes free from the contaminating effect of other simultaneous changes in a patient's situation. Sickness is an interaction between disease and patient, and science sits more comfortably with the study of disease than with the understanding of the patient. Nevertheless, the therapies commonly employed for symptom management in individuals with advanced and terminal illness deserve more rigorous investigation to establish their efficacy. In Australia, new levels of government support for research have stimulated a closer examination of principles and practical guidelines for the conduct of research in this area of healthcare.

Aged↗