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Ilora Finlay

Publications and source records attributed to Ilora Finlay.

18 recordsLinked to original sources
PubMed2005

The feasibility, reliability and validity of the McGill Quality of Life Questionnaire-Cardiff Short Form (MQOL-CSF) in palliative care population.

In terminally-ill patients, effective measurement of health-related quality of life (HRQoL) needs to be done while imposing minimal burden. In an attempt to ensure that routine HRQoL assessment is simple but capable of eliciting adequate information, the McGill Quality of Life Questionnaire-Cardiff Short Form (MQOL-CSF: 8 items) was developed from its original version, the McGill Quality of Life Questionnaire (MQOL: 17 items). Psychometric properties of the MQOL-CSF were then tested in palliative care patients consisting of 55 out-patients, 48 hospice patients and 86 in-patients: The MQOL-CSF had little respondent burden (mean completion time = 3.3 min) and was evaluated as 'very clear' or 'clear' (98.2%), comprehensive (74.5%) and acceptable (96.4%). The internal consistency reliability was moderate to high (Cronbach's alpha = 0.462-0.858) and test-retest reliability (Spearman's r(s)) ranged from 0.512-0.861. Correlation was moderate to strong (0.478-0.725) between items in the short form and their analogous domains in the MQOL. Most MQOL-CSF items showed strong associations with their own domain (r(s) > or = 0.40). Scores from MQOL-CSF significantly differentiated between patients with differing haemoglobin levels (p < 0.05). Construct validity was overall supported by principal component analysis. It is concluded that the MQOL-CSF is a feasible tool with favourable psychometric properties for routine HRQoL assessment in the palliative care population.

Adult↗
PubMed2004

Cluster randomisation or randomised consent as an appropriate methodology for trials in palliative care: a feasibility study [ISRCTN60243484].

BACKGROUND: Although guidelines for the care of the dying patient exist the evidence base to support the guidelines is poor. Some of the factors contributing to this include failure to recruit to trials, protective healthcare professionals and subsequent attrition from trials due to the death of the patients. Recent studies report favourably on the use of cluster randomisation as an appropriate methodology for use in this patient group. METHODS/DESIGN: A feasibility study, exploring two types of randomisation as appropriate methodology for trials involving dying patients. Cluster randomisation and randomised consent will be utilised following a crossover design at two sites, one oncology ward and one Macmillan unit within the Northwest Wales NHS Trust. All patients commencing on the Integrated Care Pathway (ICP) for the Last Days of Life will be eligible for inclusion in the study. Using the hypothesis that it is not necessary to prescribe an anti-emetic medication when setting up a syringe driver for the dying patient, the study will evaluate different models of research methodology. DISCUSSION: The identification of the most appropriate methodology for use in studies concerning this patient group will inform the development of future clinical studies. Furthermore, the outcomes of this feasibility study will inform the development, of a proposal seeking funding for Wales-wide trials in palliative care. The identification of an appropriate methodology will provide a starting point for the establishment of a robust evidence base for the care of the dying patient.

Journal Article↗
PubMed2003

Is there still a role for open cordotomy in cancer pain management?

For a small number of cancer patients, good pain control remains difficult to achieve despite adequate assessment and medical management. In nine cases, effective control of intractable pain from malignant pelvic disease was achieved by open thoracic cordotomy. The technique was well tolerated, with no major complications. Eight of the nine patients decreased their median daily oral morphine requirement from 560 mg (range 360-2600 mg) to 160 mg (range 40-1000 mg). Maximal survival time post-cordotomy was 830 days, with a median of 107 days. No patient experienced recurrent pain in the initially painful site. For patients with intractable pain associated with advanced pelvic malignancy, the use of an open cordotomy should be considered when satisfactory pain control is not achieved by medical or minimally invasive methods.

Adult↗
PubMed2003

Caring for the dying: how well prepared are general practitioners? A questionnaire study in Wales.

CONTEXT: General practitioners (GPs) and generalist hospital doctors provide the majority of palliative and terminal care in the UK. Studies have revealed problems with symptom control and communication in these settings and inadequate training for clinical students and junior doctors. OBJECTIVES: To investigate the training of GPs in Wales in palliative medicine throughout their careers, with a focus on the Welsh Valleys, an area of social deprivation and high levels of chronic ill health. To compare these data with those previously obtained from a survey of GPs in East Anglia. To develop regression models that enable the prediction of less well trained medical students and GPs. METHODS: A postal questionnaire survey of a random sample of GPs, stratified by practice location (Valleys or elsewhere in Wales). Responders were invited to recall their training in five topics of palliative care (pain control, other symptom control, use of syringe drivers, communication skills and bereavement care) during four career stages (clinical students, junior doctors, GP registrars and GP principals). RESULTS: The response rate was 67.6%. Available data enabled evaluation of generalizability and response bias. Contrary to an initial hypothesis, no significant differences were found between Valleys and non-Valleys responders' reported training, although the study was adequately powered. As medical students, 27% reported receiving no training in any topic, 75% no training in bereavement care and 50% no training in communication skills. Training varied across medical schools and was more common for more recent graduates. As junior doctors, 25% reported no training in any topic, 75% no training in bereavement care and 77% no training in communication skills. The GP registrar year provided significantly more coverage of communication, bereavement and syringe drivers than the combined preceding 6 years of general professional training. As GP principals, a high level of training is reported in all topics. The training experience of GPs in Wales is very similar to that previously reported by GPs in East Anglia: this lends support to the generalizability of these data. Logistic regression analysis indicated that the only predictor of less common training as medical students was having qualified less recently. The main predictors of less common training as GP principals was having become a GP more recently and not being a GP trainer. CONCLUSIONS: There is still some way to go in ensuring that medical students, junior hospital doctors and GPs are all adequately trained for their important role in caring for dying patients.

Adult↗
PubMed2002

Do hospital-based palliative teams improve care for patients or families at the end of life?

To determine whether hospital-based palliative care teams improve the process or outcomes of care for patients and families at the end of life, a systematic literature review was performed employing a qualitative meta-synthesis and quantitative meta-analysis. Ten databases were searched. This was augmented by hand searching specific journals, contacting authors, and examining the reference lists of all papers retrieved. Studies were included if they evaluated palliative care teams working in hospitals. Data were extracted by two independent reviewers. Studies were graded using two independent hierarchies of evidence. A Signal score was used to assess the relevance of publications. Two analyses were conducted. In a qualitative meta-synthesis data were extracted into standardized tables to compare relevant features and findings. In quantitative meta-analysis we calculated the effect size of each outcome (dividing the estimated mean difference or difference in proportions by the sample's standard deviation). Nine studies specifically examined the intervention of a hospital-based palliative care team or studies. A further four studies considered interventions that included a component of a hospital or support team, although the total intervention was broader. The nature of the interventions varied. The studies were usually in large teaching hospitals, in cities, and mainly in the United Kingdom. Outcomes considered symptoms, quality of life, time in hospital, total length of time in palliative care, or professional changes, such as prescribing practices. Only one of the studies was a randomized controlled trial and this considered a hospital team as part of other services. Most method scores indicated limited research quality. Comparison groups were subject to bias and the analyses were not adjusted for confounding variables. In addition, there were problems of attrition and small sample sizes. Nevertheless, all studies indicated a small positive effect of the hospital team, except for one study in Italy, which documented deterioration in patient symptoms. The Signal scores indicated that the studies were relevant. No study compared different models of hospital team. This review suggests that hospital-based palliative care teams offer some benefits, although this finding should be interpreted with caution. The study designs need to be improved and different models of providing support at the end of life in hospital need comparison. Standardized outcome measures should be used in such research and in practice.

Family↗
PubMed2002

Not another questionnaire! Maximizing the response rate, predicting non-response and assessing non-response bias in postal questionnaire studies of GPs.

BACKGROUND: Non-response is an important potential source of bias in survey research. With evidence of falling response rates from GPs, it is of increasing importance when undertaking postal questionnaire surveys of GPs to seek to maximize response rates and evaluate the potential for non-response bias. OBJECTIVES: Our aim was to investigate the effectiveness of follow-up procedures when undertaking a postal questionnaire study of GPs, the use of publicly available data in assessing non-response bias and the development of regression models predicting responder behaviour. METHOD: A postal questionnaire study was carried out of a random sample of 600 GPs in Wales concerning their training and knowledge in palliative care. RESULTS: A cumulative response rate graph permitted optimal timing of follow-up mailings: a final response rate of 67.6% was achieved. Differences were found between responders and non-responders on several parameters and between sample and population on some parameters: some of these may bias the sample data. Logistic regression analysis indicated medical school of qualification and current membership of the Royal College of General Practitioners to be the only significant predictors of responders. Late responders were significantly more likely to have been qualified for longer. CONCLUSIONS: This study has several implications for future postal questionnaire studies of GPs. The optimal timing of reminders may be judged from plotting the cumulative response rate: it is worth sending at least three reminders. There are few parameters that significantly predict GPs who are unlikely to respond; more of these may be included in the sample, or they may be targeted for special attention. Publicly available data may be used readily in the analysis of non-response bias and generalizability.

Adult↗
PubMed2002

An integrated care pathway for the last two days of life: Wales-wide benchmarking in palliative care.

Functional benchmarking assesses performance and practice across a broad range of settings and carries the potential to effect change in practice. An integrated care pathway (ICP) can assist in the benchmarking process, defining desired outcomes for specific patient groups over a designated time frame. Any variations to the agreed course of care are documented using the 'variance sheet'. This article describes the Wales-wide implementation of an ICP for the last two days of life. The project has enabled an ongoing centralized collection and analysis of variance sheets, which reflect the care of the dying patient in four different care settings crossing the voluntary and statutory sectors. Initial analysis of the first 500 variance sheets to be generated by the ICP for the last two days of life indicates that the management of pain, agitation, excess respiratory secretions and mouth care may be problematic. The same problems were experienced across acute, hospice, specialist inpatient units and community care. Closing the audit cycle involves incorporating the information from the variance analysis into clinical practice.

Analysis of Variance↗
PubMedDate not supplied

Dying with dignity.

Explore the source record for details and available documents.

Delivery of Health Care↗
PubMedDate not supplied

Crossing the 'bright line'--difficult decisions at the end of life.

Patients tell us stories about their lives, their symptoms and their interpretation of them. As physicians we try to make sense of the stories, piecing together the fragments that come our way to discern a diagnosis which we then confirm or refute by examination and investigation. Thus was Samuel Gee's life as a physician: with little in the way of diagnostic tools his 'clinical skills' had to be honed finely and his diagnostic nose well attuned. Perhaps we have today lost some of that clinical intuition. We seek the evidence base for all we do, failing to observe subtleties in our quest for hard science. Following Gee's esteemed lead--for he was celebrated for his clinical descriptions--I will unashamedly use doctor-patient experiences to illustrate my points, particularly around end-of-life decisions.

Attitude to Death↗