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R Hillier

Publications and source records attributed to R Hillier.

15 recordsLinked to original sources
PubMed2006

The sound of death rattle I: are relatives distressed by hearing this sound?

BACKGROUND: Death rattle is the noisy, rattling breathing that occurs in many dying patients. Health professionals intervene because the sound is said to distress attendant relatives. We found no formal study to confirm or refute relatives' distress, so we decided to ask the relatives. METHOD: Face-to-face semi-structured interviews with 27 bereaved relatives to investigate their experience of terminal care and what their response had been to the sound of death rattle if this had occurred. Interview transcripts were subjected to thematic content analysis. RESULTS: We found that almost half of the 12 relatives who had heard the sound of death rattle had been distressed by it. The others were either neutral about the sound or found it a helpful signal of impending death. CONCLUSION: We confirmed that some relatives do find it distressing to hear the sound of death rattle. However, our expectation that relatives are universally disturbed by this sound was unfounded. There is no justification for a 'blanket' approach to therapeutic intervention when death rattle occurs. A better understanding is required of how relatives make sense of the sound of death rattle.

Attitude to Death↗
PubMed2006

The sound of death rattle II: how do relatives interpret the sound?

BACKGROUND: In an earlier study, we found that some bereaved relatives (five out of 12 interviewed) found it distressing to hear the sound of death rattle, but the remainder did not. In this paper, we report a second study in which we explored how a different group of relatives interpreted the sound of death rattle when they heard it. METHOD: We conducted face-to-face semi-structured interviews with 25 bereaved relatives using the principles of grounded theory. RESULTS: Seventeen of the 25 bereaved relatives interviewed had heard the sound of death rattle. Ten relatives were distressed by the sound, but seven were not. Some relatives regarded the sound of death rattle as a useful warning sign that death was imminent. Their interpretation of the sound was influenced by the patient's appearance, being less concerned if the patient was not obviously disturbed. Relatives were distressed when they thought that the sound of death rattle indicated that the patient might be drowning or choking. These concerns were reinforced by seeing fluid dribble from the dying patient's mouth. CONCLUSION: This study confirms the previous finding that not all relatives are distressed by the sound of death rattle. It also demonstrates that relatives interpret the sound in a variety of ways, some matter of fact and some distressing. We suggest that effective communication is helpful in uncovering relatives' interpretation of death rattle and dispelling unwarranted fears.

Attitude to Death↗
PubMed2001

Palliative care: a suitable setting for undergraduate interprofessional education.

Effective delivery of high-quality palliative care requires effective interprofessional teamworking by skilled health and social care professionals. Palliative care is therefore highly suitable for sowing the seeds of interprofessional teamworking in early professional education. This paper describes experiences of running undergraduate interprofessional workshops in palliative care for medical, nursing, social work, physiotherapy and occupational therapy students. These workshops are unusual in three respects: first, the involvement of family carers mean that these learning experiences are rooted in clinical reality; secondly, there is no attempt to 'tidy up' the story for the students; thirdly, unlike many undergraduate interprofessional programmes, these workshops have been sustained over several years. Evaluation of these workshops demonstrate that students value and enjoy the opportunity to work together; they find the experience moving, informative and interesting. Feedback from carers showed that they appreciated the opportunity to present their real-life experiences to students. Our evidence suggests that palliative care is a suitable subject for undergraduate interprofessional education.

Attitude of Health Personnel↗
PubMed1999

'Someone to talk to' and 'pain control': what people expect from a specialist palliative care team.

This paper presents a qualitative analysis of a subsample of data from a larger investigation into general practitioner referrals to specialist palliative care services (SPCS). The aim was to identify the expectations and perceptions of patients with advanced cancer and their relatives. Twenty-nine individuals were interviewed (18 patients, 11 relatives). Qualitative analysis of the interview transcripts was undertaken using an approach based on interpretative phenomenological analysis. The results indicated that SPCS were perceived as providing psychosocial services, characterized as 'support' and 'someone to talk to'. SPCS were expected to have 'expertise in symptom control', particularly in relation to pain management. The study demonstrated that patients' and relatives' expectations of a referral to SPCS were of psychosocial support and symptom control. It is argued that the implications of this restricted view of SPCS may mean that other salient concerns are not raised by patients and relatives.

Caregivers↗
PubMed1996

Impact of witnessing death on hospice patients.

In the three decades since the concept of "awareness" was introduced to describe the nature of communication between dying people and their carers, there has been a radical change in hospital policies and medical practice. It is now common for the majority of cancer patients to be given full information about their disease and prognosis. Hospices provide a model of care in which death and dying are dealt with in an open manner. While this approach has been welcomed by the majority of people, a minority might still prefer a more limited awareness. An inevitable part of hospice care is the exposure to, and awareness of, people who are dying. There is little empirical data that considers the impact of death on fellow patients. This pilot investigation compared psychological morbidity, perceptions of comfort and/or distress, and descriptions of a "good death" in hospice cancer patients who reported witnessing a fellow patient's death (n = 34) with patients who did not have this experience (n = 33). Patients were assessed using the Hospital Anxiety and Depression scale, an Events Checklist and a semi-structured interview. The results indicate that patients witnessing a death were significantly less depressed than those who did not. Awareness of dying was found to be both comforting and distressing, although overall patients reported more comforting than distressing events. A "good death" was defined by patients in terms of symptom control, including dying in their sleep, being pain free, quietness and dignity. Narratives were used to describe the meaning of a "good death". Quantitative and qualitative analyses have been undertaken to provide a complex interpretation of these issues.

Adaptation, Psychological↗
PubMed1996

Perceptions of a 'good' death: a comparative study of the views of hospice staff and patients.

The literature suggests that health professionals working in palliative care have developed an idealised concept of dying which has been labelled the 'good' death. This paper reports the results of a preliminary qualitative study which compared the concepts of a 'good' death used by patients and staff in a palliative care unit. Semistructured interviews designed to elicit perceptions of 'good' and 'bad' deaths were conducted with 18 patients and 20 health professionals. The transcribed interviews were content analysed. There were major differences between the views of patients and staff. The patients' descriptions of a "good' death were diverse and included: dying in one's sleep, dying quietly, with dignity, being pain free and dying suddenly. In comparison, staff characterised a "good' death in terms of adequate symptom control, family involvement, peacefulness and lack of distress, while a "bad' death was described as involving uncontrolled symptoms, lack of acceptance and being young. The findings suggest that patients and staff differ in their conceptualisations of a "good' death.

Attitude of Health Personnel↗
PubMed1990

Control of pain in terminal cancer.

Many elderly patients with cancer neither expect nor seek good pain control. This stoicism often follows the experience of poor symptom control among relatives and friends in the past and may explain why the severity of pain may be underestimated by the clinician. In addition, when pain is identified, physicians may be apprehensive about the use of strong analgesic drugs and their side effects, so that pain control is poor. This paper describes the diagnosis, assessment, and management of cancer pain in the elderly and deals specifically with analgesic and other drugs for the control of pain. The methods described are effective in up to 87% of patients. Although side effects occur, they can be minimized by skillful prescribing, explanation and reassurance.

Aged↗
PubMed1988

Palliative medicine.

Explore the source record for details and available documents.

Education, Medical, Graduate↗
PubMed1981

Pregnancy-specific beta 1-glycoprotein as a screening test for at-risk pregnancies.

A serum assay was performed on 605 women for pregnancy-specific beta 1-glycoprotein (SP-1) between 31 and 34 weeks' gestation. SP-1 was also estimated for 255 of these women between 15 and 20 weeks' gestation, coincidental with maternal serum alpha-fetoprotein (AFP) screening. A clinical classification of pregnancy outcome was constructed for ech group. SP-1 values at 31 to 34 weeks' gestation in pregnancies that resulted in the birth of a small-for-dates (SFD) infant were statistically different from those in normal pregnancies (p less than 0.001). A value of 100 mg per liter was chosen as a suitable discriminatory level at 31 to 34 weeks, below which SP-1 had a sensitivity of 64%, a predictive value of 24%, and defined a relative risk of 5.3 for SFD infants. These parameters compare favorably with published data on the use of human placental lactogen as a screening test. No statistical relationship was found between SP-1 values at 31 to 34 weeks and birth weight, placental weight, parity, or other abnormal pregnancy outcomes. SP-1 screening at 15 to 20 weeks' gestation showed no correlation with serum AFP or with other parameters studied.

Female↗
PubMed1981

Terminal care: present services and future priorities.

Since 1975 hospices and other specialist services for terminal cancer have expanded rapidly. In December 1980 this survey found 72 such services in Britain providing 58 inpatient units, 32 home care teams, and eight hospital support teams. Many were outside the NHS. Inpatient units provided 1297 beds (modal size 21-25 beds) and dealt with under 7% of deaths from cancer. Home care teams provided 76.5 full-time equivalent nurses (modal size two nurses). Regional variations were considerable: from 10.9 beds/million population in Trent to 48.5 beds/million in South-west Thames; no home care nurses in Mersey and Wales, and 5.1 nurses/million in Wessex. Of 58 more services being planned, the 17 starting in 1981 will not substantially alter these regional imbalances. Respondents' opinions suggest a target of 40-50 inpatient unit beds/million population. This might be reduced if hospitals were better equipped to deal with these patients. Suggested priorities are to redress regional inequalities, develop home care and hospital support teams rather than inpatient units, and improve teaching and training. Co-ordination of plans between the NHS and the voluntary sector is needed.

Education, Medical, Undergraduate↗