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Biomedical subjects

M Lloyd-Williams

Publications and source records attributed to M Lloyd-Williams.

At least 19 recordsLinked to original sources
PubMed2003

An analysis of calls to an out-of-hours palliative care advice line.

An advice line was set up by a specialist palliative care hospice to improve the provision of out-of-hours palliative care to primary care teams, i.e. from 17.00 to 09.00 h during the week and at weekends and bank holidays. A senior member of nursing staff or medical staff answered all calls. During the first year of operation, 98 calls were received. The majority of callers were GPs (55%) and community nurses (34%). The advice requested was largely related to management of pain and the use of opiates, e.g. breakthrough dose of opiates and conversion of drugs to syringe drivers. Recommendations from this study include the provision of continuing education on management of terminally ill patients, and improved communication between primary care teams, providers of out-of-hours primary care and specialist palliative care teams.

Holidays↗
PubMed2003

End-of-life decision making--have we got it right?

There are wide-spread misconceptions about palliative care. Various treatments used in palliative care have a potential to shorten, and at times even prolong life. However, such treatments are used with a view to enhance quality of life and/or death. Withholding and withdrawal of life-prolonging treatments are not equivalent to assisting death. It is important that patients who are approaching death are sensitively encouraged to make informed choices about such treatments. At the same time, there is no obligation on part of a health professional to provide a futile treatment. This personal view of two palliative care physicians aims to explore some of the difficulties surrounding end-of-life care.

Decision Making↗
PubMed2002

Senior house officers' experience of a six month post in a hospice.

BACKGROUND: Hospices provide care for patients with a terminal prognosis--a very small number of hospices employ Senior House Officers. METHOD: A survey was carried out to determine the experiences of SHOs working in hospices and their perceptions of the learning opportunities available. Perceived stress was measured by a Visual Analogue scale and psychological distress by the GHQ 12. RESULTS: Of the 38 posts identified 23 SHOs (60%) responded and the majority had qualified during the last five years. Formal teaching was limited, but experiential teaching was very positively described. Many SHOs described their posts as stressful and cited staff conflict and caring for young patients as particularly stressful. Median stress scores as measured on the VAS was 55 mm (range 0-98 mm). Five respondents 22% scored for identifiable psychological distress on the GHQ 12. CONCLUSION: Conclusions include the need to acknowledge the important learning opportunities provided within hospices but also the need for consultant staff to be aware of the sources of stress for SHOs and their need for support.

Attitude of Health Personnel↗
PubMed2001

An analysis of the validity of the Hospital Anxiety and Depression scale as a screening tool in patients with advanced metastatic cancer.

Depression is difficult to diagnose in the terminally ill patient. As a result, it frequently is not treated. This has can have an adverse effect on quality of life and make the palliation of physical symptoms more difficult. In an effort to improve the detection of depression, many palliative care teams are using the Hospital Anxiety and Depression (HAD) scale as a screening tool. The HAD was devised for use in general medical settings and has not been validated for use in palliative care patients. One hundred patients receiving palliative care with an estimated prognosis of 6 months or less were invited to complete the HAD and a semi-structured psychiatric interview, the Present State Examination. The depression and anxiety subscales of the HAD showed poor efficacy for screening when used alone. The optimum threshold was at a combined cut-off of 19, which had a sensitivity of 68% and specificity of 67%. The major construct of the HAD is anhedonia, which may be present at the end of life due to increasing physical illness and may not be pathognomic of a depressive illness in this population. We recommend, therefore, that if the HAD is used as a screening tool in palliative care, it should be as a combined scale, but low sensitivity and specificity may lead to poor efficacy as a screening tool.

Adult↗
PubMed2001

Screening for depression in palliative care patients: a review.

Depression is a significant symptom for 25% of patients admitted to a palliative care unit, but many of these symptoms are not identified and therefore not treated. Reasons for failure to diagnose depression are misconceptions regarding low mood as being a normal part of a terminal illness and also the patients' reluctance to disclose their thoughts and feelings. Medical and nursing staff working within palliative care may also find difficulty in distinguishing between what could be called appropriate sadness and a treatable depressive illness. In an effort to improve the detection of depression, many professionals are using rating scales or tools in order to improve the diagnosis and treatment. This review discusses the complex issues of diagnosis of depression and highlights why certain tools may not be so useful or applicable in the palliative care population.

Depression↗
PubMed2001

Depression in palliative care patients--a prospective study.

Psychological and psychiatric morbidity can be a major source of distress to terminally ill patients and their relatives and friends. A prospective study was carried out to determine the prevalence of undiagnosed depression in palliative care patients and to determine whether factors such as age, previous psychiatric history and perceived social support have any association with the development of depression when patients have advanced metastatic cancer. Patients aged between 18 and 70 years who had a prognosis of < or = 6 months and who were receiving palliative care only for advanced metastatic cancer were interviewed using the Present State examination interview and a semi-structured interview to determine social support, information needs and past psychiatric history. One hundred patients were recruited and the prevalence of depression according to International Classification of Diseases 10 criteria was 22%. Perceived informal social support and past psychiatric history were not associated with being a case of depression but perceived information needs had a weak association. Younger patients and patients with breast cancer were more likely to be identified as being cases of depression. Further research is necessary to explore the aetiology and outcome of depression in palliative care. A high index of suspicion for depression should be maintained for younger patients with advanced metastatic cancer.

Adolescent↗
PubMed2000

Criterion validation of the Edinburgh postnatal depression scale as a screening tool for depression in patients with advanced metastatic cancer.

It is estimated that 25% of palliative care patients will have identifiable symptoms of depression. Near the end of life, the distinction between what can be called "appropriate sadness" and depression may be difficult. Many palliative care units use rating scales to help identify patients who may be depressed. It is believed that symptoms such as guilt, worthlessness, and hopelessness may be more discriminating than other symptoms for depression within this population. The Edinburgh postnatal depression scale (EPDS) was devised for use in women in the postnatal period and does not contain any somatic-type symptoms. It consists of 10 items, each rated on a four-point scale, and includes items on guilt, thoughts of self-harm, and hopelessness. It has not previously been used for screening in cancer patients. In a study of 100 inpatients receiving palliative care, a cutoff of 13 on the EPDS had a sensitivity of 81% and a specificity of 79% for detecting cases of depression. There was a low rate of misclassifications. This study suggests that the EPDS may be useful as a screening instrument for palliative care patients.

Adult↗
PubMed2000

General practitioners in North Wales: current experiences of palliative care.

Much work on the role of general practitioners within palliative care has focused on those working in densely populated inner city areas. This study was undertaken to evaluate the provision of palliative care and training needs of general practitioners in North Wales, a predominantly rural area. Questionnaires were sent to all 240 GPs and 94 responded (40%); those GPs responding were younger and mainly worked within partnerships. During the preceding year a median of four terminally ill patients had been cared for by each GP (range 0-21). General practitioners believed that palliative care was an important part of their role and applicable to patients with all end stage diseases. Use was made of community hospital beds as these were perceived as being more convenient for the patients and allowed the GPs to continue their involvement in patient care. Where services--e.g. palliative care consultants, day care and Marie Curie care--is available this was perceived as being very useful and of benefit. General practitioners believed they would benefit from further education and teaching on all aspects of palliative care, and this was supported by just over 50% of doctors knowing the correct breakthrough doses of morphine and many stating they would not prescribe more than a certain dose of opiates. Training in palliative care during vocational training was poor or non-existent and a preference was expressed for experiential teaching.

Bereavement↗
PubMed2000

Difficulties in diagnosing and treating depression in the terminally ill cancer patient.

It is estimated that for a quarter of all patients with advanced metastatic cancer, depression will be significant symptom. However up to 80% of the psychological and psychiatric morbidity which develops in cancer patients goes unrecognised and untreated. One of the main difficulties in establishing a diagnosis of an illness where there are no biological markers, physical signs, or diagnostics tests is deciding what can be called "appropriate sadness" as patients approach the end of life and what is a depressive illness. Criteria for diagnosing depression are discussed together with reasons why established screening tools used in other populations may not be appropriate to screen for depression in terminally ill patients. The use of antidepressants and the role of cognitive therapies are also discussed. For effective treatment of a depressive illness, treatment with antidepressant medication needs to be initiated sooner rather than later and patients may need close supervision to ensure compliance. The awareness of depression, the identification of symptoms, and the initiation of treatment is essential if patients are to be offered optimum palliation of psychological as well as physical symptoms.

Antidepressive Agents↗
PubMed2000

Using bisphosphonates to control the pain of bone metastases: evidence-based guidelines for palliative care.

This work was undertaken by the Science Committee of the Association for Palliative Medicine of Great Britain and Ireland (APM) as a demonstration project in developing clinical guidelines relevant to palliative care from a pragmatic approach to literature review and grading of clinical evidence. CANCERLIT and Embase were searched for relevant papers written in English, published since 1980. Each study identified was rated against agreed criteria for levels of evidence. Most studies were not specifically designed to define speed of response, and were not undertaken in palliative care patients. Thus, careful reading and grading of each study was necessary. Sufficient evidence was identified to make recommendations for clinical practice in a palliative care population of patients, and areas for future research have been identified. Bisphosphonates appear to have a role in managing pain from metastases which has been refractory to conventional analgesic management and where oncological or orthopaedic intervention is delayed or inappropriate.

Bone Neoplasms↗
PubMed1999

Coping with loss

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Journal Article↗
PubMed1999

Assessing depression in palliative care patients using the visual analogue scale: a pilot study.

It is widely recognised that depression is not detected and therefore not treated in patients who are terminally ill. It is difficult to distinguish depression from sadness at the end of life and many of the criteria for diagnosing depression are not appropriate in the terminally ill patient. There has been considerable interest in using screening tools at the time of referral or admission to a hospice, but to date none of these have been validated for use in palliative care patients. This pilot study of 25 patients admitted to a hospice found that a 100-mm linear visual analogue scale (VAS) correlated well with both the depression sub scale and total score of the Hospital Anxiety and Depression Scale (HADS) and was found to be quick and easy to complete by most patients. The finding suggest that the VAS may be useful as a screening tool for depression in patients with advanced metastatic disease and that larger studies comparing VAS to clinical psychiatric interviews should be undertaken.

Adult↗
PubMed1999

A survey of antidepressant prescribing in the terminally ill.

Depression is a symptom in a quarter of patients admitted to a palliative care unit, but little is known of how depression in terminally ill patients is treated. We reviewed 1046 consecutive patient admissions, of whom 106 (10%) were prescribed antidepressant medication while under the care of a palliative care team. Of these patients, 21 were prescribed antidepressants when under the care of the home care team, but 80 patients (76%) were started on medication during the final 2 weeks of life. There was consequently insufficient time for the medication to have any therapeutic effect. Seventeen patients were discharged home on antidepressant medication. Three patients were referred for a psychiatric assessment. Patients prescribed antidepressants were significantly younger (P = 0.002) than those who were not. There were no prescriptions for psychostimulants. Although the numbers of patients prescribed antidepressant medication were low in all disease groups, it was notable that patients with breast cancer were prescribed antidepressant medication more frequently than any other patient group. We conclude that there appears to be a need for a coordinated approach to both the assessment and the treatment of depression in terminally ill patients.

Antidepressive Agents↗