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David C. Currow - One of the best experts on this subject based on the ideXlab platform.

  • Sleeping-related distress in a Palliative Care Population: A national, prospective, consecutive cohort.
    Palliative medicine, 2021
    Co-Authors: David C. Currow, Walter Davis, Alanna Connolly, Anu Krishnan, Aaron Wong, Andrew Webster, Matilda Mm Barnes-harris, Barb Daveson, Magnus Ekström
    Abstract:

    Sleep, a multi-dimensional experience, is essential for optimal physical and mental wellbeing. Poor sleep is associated with worse wellbeing but data are scarce from multi-site studies on sleeping-related distress in Palliative Care Populations. To evaluate patient-reported distress related to sleep and explore key demographic and symptom distress related to pain, breathing or fatigue. Australian national, consecutive cohort study with prospectively collected point-of-Care data using symptoms from the Symptom Assessment Scale (SAS). People (n = 118,117; 475,298 phases of Care) who died while being seen by specialist Palliative Care services (n = 152) 2013-2019. Settings: inpatient (direct Care, consultative); community (outpatient clinics, home, residential aged Care). Moderate/severe levels of sleeping-related distress were reported in 11.9% of assessments, more frequently by males (12.7% vs 10.9% females); people aged <50 years (16.2% vs 11.5%); and people with cancer (12.3% vs 10.0% for other diagnoses). Sleeping-related distress peaked with mid-range Australia-modified Karnofsky Performance Status scores (40-60).Strong associations existed between pain-, breathing- and fatigue-related distress in people who identified moderate/severe sleeping-related distress, adjusted for age, sex and functional status. Those reporting moderate/severe sleeping-related distress were also more likely to experience severe pain-related distress (adjusted odds ratios [OR] 6.6; 95% confidence interval (CI) 6.3, 6.9); breathing-related distress (OR 6.2; 95% CI 5.8, 6.6); and fatigue-related distress (OR 10.4; 95% CI 9.99-10.8). This large, representative study of Palliative Care patients shows high prevalence of sleeping-related distress, with strong associations shown to distress from other symptoms including pain, breathlessness and fatigue.

  • sleeping related distress in a Palliative Care Population a national prospective consecutive cohort
    Palliative Medicine, 2021
    Co-Authors: David C. Currow, Walter Davis, Anu Krishnan, Aaron Wong, Andrew Webster, Barb Daveson, Alanna M Connolly, Matilda Mm Barnesharris, Magnus Ekström
    Abstract:

    Background:Sleep, a multi-dimensional experience, is essential for optimal physical and mental wellbeing. Poor sleep is associated with worse wellbeing but data are scarce from multi-site studies o...

  • The Level of Distress From Fatigue Reported in the Final Two Months of Life by a Palliative Care Population: An Australian National Prospective, Consecutive Case Series
    Journal of pain and symptom management, 2020
    Co-Authors: Gemma Ingham, Katalin Urban, Samuel F Allingham, Megan B Blanchard, Celia Marston, David C. Currow
    Abstract:

    Abstract Context Fatigue is the most commonly reported symptom in life-limiting illnesses, although not much is known about the distress it causes patients as they approach death. Objectives To map the trajectory of distress from fatigue reported by an Australian Palliative Care Population in the last 60 days leading up to death. Methods A prospective, longitudinal, consecutive cohort study using national data from the Australian Palliative Care Outcomes Collaboration between July 1, 2013, and December 31, 2018. Patients were included if they had at least one measurement of fatigue on a 0–10 numerical rating scale in the 60 days before death. Descriptive statistics were used to analyse patients by diagnostic cohort and functional status. Results A total of 116,604 patients from 203 specialist Palliative Care services were analyzed, providing 501,104 data points. Distress from fatigue affected up to 80% of patients referred to Palliative Care, with the majority experiencing moderate or severe distress. Malignant and nonmalignant diagnoses were equally affected, with the neurological cohort showing the greatest variability. The degree of distress correlated with a patient's functional level; it worsened as a patient's function declined until a patient became bedbound when the reporting of distress reduced. Conclusions Distress from fatigue is high in this cohort of patients. Interventions to reduce this distress need to be a research priority.

  • Symptomatic Events in a Community Palliative Care Population: A Prospective Pilot Study.
    Journal of palliative medicine, 2020
    Co-Authors: Aileen Collier, Meera Agar, Debra Rowett, David C. Currow
    Abstract:

    Background: The Palliative Care Population is prescribed a large number of drugs, increasing as patients deteriorate. The cumulative effects of these medications combined with underlying symptom bu...

  • the trajectory of functional decline over the last 4 months of life in a Palliative Care Population a prospective consecutive cohort study
    Palliative Medicine, 2019
    Co-Authors: Deidre D Morgan, David C. Currow, Samuel F Allingham, Magnus Ekström, Alanna M Connolly, Jennifer Tieman
    Abstract:

    Background:Understanding current patterns of functional decline will inform patient Care and has health service and resource implications.Aim:This prospective consecutive cohort study aims to map t...

Matthew Hotopf - One of the best experts on this subject based on the ideXlab platform.

  • I've had a good life, what's left is a bonus: factor analysis of the Mental Adjustment to Cancer Scale in a Palliative Care Population.
    Palliative Medicine, 2013
    Co-Authors: Laura Goodwin, Annabel Price, Lauren Rayner, Stirling Moorey, Barbara Monroe, Nigel Sykes, Penny Hansford, Irene J Higginson, Matthew Hotopf
    Abstract:

    Background:The Mental Adjustment to Cancer Scale is an assessment tool commonly used to measure coping in cancer patients, which characterises adaptive coping under the label of ‘fighting spirit’.A...

  • The factor structure of the PHQ-9 in Palliative Care
    Journal of psychosomatic research, 2013
    Co-Authors: Joseph Chilcot, Annabel Price, Lauren Rayner, Barbara Monroe, Nigel Sykes, Penny Hansford, Laura Goodwin, William Lee, Matthew Hotopf
    Abstract:

    Abstract Objectives The Primary Care Evaluation of Mental Disorders Patient Health Questionnaire (PRIME-MD PHQ-9) is a common screening tool designed to facilitate detection of depression according to DSM-IV criteria. However, the factor structure of the PHQ-9 within the Palliative Care Population has not been evaluated. Methods 300 participants completed the PHQ-9 within one week of referral to a Palliative Care service. Participants completed the PHQ-9 again four weeks later (n = 213). Confirmatory factor analysis (CFA) and multiple-group CFA were undertaken to test the factor structure of the PHQ-9 and evaluate model invariance over time. Results A two-factor model comprising somatic and cognitive–affective latent factors provided the best fit to the data. Multiple-group CFA suggested model invariance over time. Structural equation modelling revealed that follow-up (time 2) cognitive–affective and somatic symptoms were predicted by their baseline (time 1) factors. Conclusions The PHQ-9 measures two stable depression factors (cognitive–affective and somatic) within the Palliative Care Population. Studies are now required to examine the trajectories of these symptoms over time in relation to clinical intervention and events.

  • illness perceptions adjustment to illness and depression in a Palliative Care Population
    Journal of Pain and Symptom Management, 2012
    Co-Authors: Annabel Price, Lauren Rayner, Barbara Monroe, Nigel Sykes, Penny Hansford, Laura Goodwin, Matthew Hotopf, Irene J Higginson, Emma Shaw, William Lee
    Abstract:

    Abstract Context Representations of illness have been studied in several Populations, but research is limited in Palliative Care. Objectives To describe illness representations in a Population with advanced disease receiving Palliative Care and to examine the relationship between illness perceptions, adaptive coping, and depression. Methods A cross-sectional survey of 301 consecutive eligible patients recruited from a Palliative Care service in south London, U.K. Measures used included the Brief Illness Perception Questionnaire (Brief IPQ), the Mental Adjustment to Cancer (MAC) Scale, and the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire-9. Results Scores were not normally distributed for most questions on the Brief IPQ. The correlations found between items on the Brief IPQ were understandable in the context of advanced disease. MAC helplessness-hopelessness and fighting spirit were highly correlated with items on the Brief IPQ in opposite directions. The Brief IPQ domains of consequences, identity, concern, personal control, and emotion were associated with depression, a relationship that was not explained by adaptive coping. Seven causal attribution themes were identified: don't know, personal responsibility, exposure, pathological process, intrinsic personal factors, chance, fate or luck, and other. Both lung cancer diagnosis and gender were found to be independently associated with personal responsibility attribution. None of the attribution themes were associated with the presence of depression. Conclusion Assessment of illness perceptions in Palliative Care is likely to yield important information about risk of depression and will help clinicians to personalize management of advanced disease.

  • Predictors of non-remission of depression in a Palliative Care Population:
    Palliative medicine, 2011
    Co-Authors: Laura Goodwin, Annabel Price, Lauren Rayner, Barbara Monroe, Nigel Sykes, Penny Hansford, Irene J Higginson, William Lee, Matthew Hotopf
    Abstract:

    Background:Prospective studies of depression in Palliative Care are rare. Two studies that examine depression prospectively in patients with advanced disease have not looked at predictors of remission.Aims:to explore prospective predictors of non-remission of depression in Palliative Care.Design and participants:The study design comprised two data collections: initial assessment on referral to a Palliative Care service in South London, UK, and a four-week follow-up. Seventy six participants met the criteria for ‘any depressive syndrome’ at the time 1 assessment, using the PRIME-MD, who also participated at time 2. The outcome measure was remission (N = 39) or non-remission (N = 37) of depression by time 2.Results:The findings showed that reporting low social support from family and friends at time of referral was the most powerful risk factor for non-remission. There was also a strong association between improved physical symptoms, from time 1 to 2, and remission of depression.Conclusions:This study in pa...

  • Predictors of non-remission of depression in a Palliative Care Population
    BMJ Supportive & Palliative Care, 2011
    Co-Authors: Laura Goodwin, Annabel Price, Lauren Rayner, Barbara Monroe, Nigel Sykes, Penny Hansford, Irene J Higginson, William Lee, Matthew Hotopf
    Abstract:

    Abstract Introduction and aims Prospective studies of depression in Palliative Care are rare. Two studies which examine depression prospectively in patients with advanced disease have not looked at predictors of remission. This study aims to explore prospective predictors of non-remission of depression in Palliative Care. Methods The study design comprised two data collections: with initial assessment on referral to a Palliative Care service in South London, UK and a 4-week follow-up. 76 participants met the criteria for ‘any depressive syndrome’ at the time 1 assessment using the PRIME-MD, who also participated at time 2. The outcome measure was remission (N=39) or non-remission (N=37) of depression by time 2. Results The findings showed that reporting low social support at time of referral was the most powerful risk factor for non-remission. There was also a strong association between improved physical symptoms, from time 1 to 2, and remission of depression. Conclusion This study in Palliative Care is the first of which we are aware to explore factors associated with non-remission of depression. Depressed patients identified with low social support on referral to Palliative Care might particularly benefit from additional psychosocial Care in the treatment of their depression. This study provides evidence that effective physical symptom management in Palliative Care may be a valuable intervention for depressive symptoms.

Magnus Ekström - One of the best experts on this subject based on the ideXlab platform.

  • Sleeping-related distress in a Palliative Care Population: A national, prospective, consecutive cohort.
    Palliative medicine, 2021
    Co-Authors: David C. Currow, Walter Davis, Alanna Connolly, Anu Krishnan, Aaron Wong, Andrew Webster, Matilda Mm Barnes-harris, Barb Daveson, Magnus Ekström
    Abstract:

    Sleep, a multi-dimensional experience, is essential for optimal physical and mental wellbeing. Poor sleep is associated with worse wellbeing but data are scarce from multi-site studies on sleeping-related distress in Palliative Care Populations. To evaluate patient-reported distress related to sleep and explore key demographic and symptom distress related to pain, breathing or fatigue. Australian national, consecutive cohort study with prospectively collected point-of-Care data using symptoms from the Symptom Assessment Scale (SAS). People (n = 118,117; 475,298 phases of Care) who died while being seen by specialist Palliative Care services (n = 152) 2013-2019. Settings: inpatient (direct Care, consultative); community (outpatient clinics, home, residential aged Care). Moderate/severe levels of sleeping-related distress were reported in 11.9% of assessments, more frequently by males (12.7% vs 10.9% females); people aged <50 years (16.2% vs 11.5%); and people with cancer (12.3% vs 10.0% for other diagnoses). Sleeping-related distress peaked with mid-range Australia-modified Karnofsky Performance Status scores (40-60).Strong associations existed between pain-, breathing- and fatigue-related distress in people who identified moderate/severe sleeping-related distress, adjusted for age, sex and functional status. Those reporting moderate/severe sleeping-related distress were also more likely to experience severe pain-related distress (adjusted odds ratios [OR] 6.6; 95% confidence interval (CI) 6.3, 6.9); breathing-related distress (OR 6.2; 95% CI 5.8, 6.6); and fatigue-related distress (OR 10.4; 95% CI 9.99-10.8). This large, representative study of Palliative Care patients shows high prevalence of sleeping-related distress, with strong associations shown to distress from other symptoms including pain, breathlessness and fatigue.

  • sleeping related distress in a Palliative Care Population a national prospective consecutive cohort
    Palliative Medicine, 2021
    Co-Authors: David C. Currow, Walter Davis, Anu Krishnan, Aaron Wong, Andrew Webster, Barb Daveson, Alanna M Connolly, Matilda Mm Barnesharris, Magnus Ekström
    Abstract:

    Background:Sleep, a multi-dimensional experience, is essential for optimal physical and mental wellbeing. Poor sleep is associated with worse wellbeing but data are scarce from multi-site studies o...

  • the trajectory of functional decline over the last 4 months of life in a Palliative Care Population a prospective consecutive cohort study
    Palliative Medicine, 2019
    Co-Authors: Deidre D Morgan, David C. Currow, Samuel F Allingham, Magnus Ekström, Alanna M Connolly, Jennifer Tieman
    Abstract:

    Background:Understanding current patterns of functional decline will inform patient Care and has health service and resource implications.Aim:This prospective consecutive cohort study aims to map t...

Janet Hardy - One of the best experts on this subject based on the ideXlab platform.

  • Stringent Control of Opioids: Sound Public Health Measures, but a Step Too Far in Palliative Care?
    Current Oncology Reports, 2020
    Co-Authors: Ross Pinkerton, Geoffrey Mitchell, Janet Hardy
    Abstract:

    Purpose of Review Opioids are the only class of drug with the proven ability to control severe pain. The introduction of stringent opioid prescribing restrictions has inevitably impacted upon the ability of those prescribing opioids for advanced life-limited disease to practice as previously and could limit the supply of adequate pain relief to patients with cancer. This review considers the evidence that symptom management of patients with advanced cancer contributes to the “opioid problem” and whether there is adequate recognition of the risks involved. Recent Findings The literature suggests that the risk of opioid abuse is low in the Palliative Care Population as is the risk of legal consequences for doctors prescribing opioids at the end of life. However, as many patients with cancer are living longer or surviving with chronic pain, Palliative Care physicians must be cognisant not only of the risks of long term opioid use but also of the risk of opioid misuse. Summary Adherence to evidence or consensus-based guidelines is necessary to avoid inappropriate prescribing. In Palliative Care, it is appropriate not only to exercise a reasonable degree of opioid control and surveillance, primarily for the good of society, but also to ensure that the ability to treat pain in patients with advanced malignant disease is not compromised.

  • What do Palliative Care patients and their relatives think about research in Palliative Care?—a systematic review
    Supportive Care in Cancer, 2010
    Co-Authors: Clare White, Janet Hardy
    Abstract:

    Introduction Research in Palliative Care patients has been controversial and is often challenging. It is important to know the views of potentially eligible patients themselves in order to determine the appropriateness of research in the Palliative Care Population and to develop realistic studies that are practical and achievable in this Population. This systematic review aims to identify the views of Palliative Care patients and their families towards research, the factors that are important when considering participation, and the types of research trial they would support or reject. Methods A systematic literature review was undertaken to identify what is known to date regarding the views of Palliative Care patients and their relatives towards research participation. Eight relevant studies were identified. Discussion There is an increasing body of evidence considering the views of Palliative Care patients towards research in Palliative Care. However, only three studies have considered the views of their relatives/Caregivers. Several common themes emerged from the literature including the potential for personal gain, altruism, the wish to avoid complex studies and a desire to retain autonomy. Trial-related factors were also important determinants of willingness of patients and relatives to participate in research. The views expressed by Palliative Care patients towards research are similar to those of other patient Populations. Conclusion Research to date in the Palliative Care setting has suggested that patients are interested in participating in research and may actually benefit from doing so.

  • What do Palliative Care patients and their relatives think about research in Palliative Care?-a systematic review.
    Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 2009
    Co-Authors: Clare White, Janet Hardy
    Abstract:

    Introduction Research in Palliative Care patients has been controversial and is often challenging. It is important to know the views of potentially eligible patients themselves in order to determine the appropriateness of research in the Palliative Care Population and to develop realistic studies that are practical and achievable in this Population. This systematic review aims to identify the views of Palliative Care patients and their families towards research, the factors that are important when considering participation, and the types of research trial they would support or reject.

Laura Goodwin - One of the best experts on this subject based on the ideXlab platform.

  • I've had a good life, what's left is a bonus: factor analysis of the Mental Adjustment to Cancer Scale in a Palliative Care Population.
    Palliative Medicine, 2013
    Co-Authors: Laura Goodwin, Annabel Price, Lauren Rayner, Stirling Moorey, Barbara Monroe, Nigel Sykes, Penny Hansford, Irene J Higginson, Matthew Hotopf
    Abstract:

    Background:The Mental Adjustment to Cancer Scale is an assessment tool commonly used to measure coping in cancer patients, which characterises adaptive coping under the label of ‘fighting spirit’.A...

  • The factor structure of the PHQ-9 in Palliative Care
    Journal of psychosomatic research, 2013
    Co-Authors: Joseph Chilcot, Annabel Price, Lauren Rayner, Barbara Monroe, Nigel Sykes, Penny Hansford, Laura Goodwin, William Lee, Matthew Hotopf
    Abstract:

    Abstract Objectives The Primary Care Evaluation of Mental Disorders Patient Health Questionnaire (PRIME-MD PHQ-9) is a common screening tool designed to facilitate detection of depression according to DSM-IV criteria. However, the factor structure of the PHQ-9 within the Palliative Care Population has not been evaluated. Methods 300 participants completed the PHQ-9 within one week of referral to a Palliative Care service. Participants completed the PHQ-9 again four weeks later (n = 213). Confirmatory factor analysis (CFA) and multiple-group CFA were undertaken to test the factor structure of the PHQ-9 and evaluate model invariance over time. Results A two-factor model comprising somatic and cognitive–affective latent factors provided the best fit to the data. Multiple-group CFA suggested model invariance over time. Structural equation modelling revealed that follow-up (time 2) cognitive–affective and somatic symptoms were predicted by their baseline (time 1) factors. Conclusions The PHQ-9 measures two stable depression factors (cognitive–affective and somatic) within the Palliative Care Population. Studies are now required to examine the trajectories of these symptoms over time in relation to clinical intervention and events.

  • illness perceptions adjustment to illness and depression in a Palliative Care Population
    Journal of Pain and Symptom Management, 2012
    Co-Authors: Annabel Price, Lauren Rayner, Barbara Monroe, Nigel Sykes, Penny Hansford, Laura Goodwin, Matthew Hotopf, Irene J Higginson, Emma Shaw, William Lee
    Abstract:

    Abstract Context Representations of illness have been studied in several Populations, but research is limited in Palliative Care. Objectives To describe illness representations in a Population with advanced disease receiving Palliative Care and to examine the relationship between illness perceptions, adaptive coping, and depression. Methods A cross-sectional survey of 301 consecutive eligible patients recruited from a Palliative Care service in south London, U.K. Measures used included the Brief Illness Perception Questionnaire (Brief IPQ), the Mental Adjustment to Cancer (MAC) Scale, and the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire-9. Results Scores were not normally distributed for most questions on the Brief IPQ. The correlations found between items on the Brief IPQ were understandable in the context of advanced disease. MAC helplessness-hopelessness and fighting spirit were highly correlated with items on the Brief IPQ in opposite directions. The Brief IPQ domains of consequences, identity, concern, personal control, and emotion were associated with depression, a relationship that was not explained by adaptive coping. Seven causal attribution themes were identified: don't know, personal responsibility, exposure, pathological process, intrinsic personal factors, chance, fate or luck, and other. Both lung cancer diagnosis and gender were found to be independently associated with personal responsibility attribution. None of the attribution themes were associated with the presence of depression. Conclusion Assessment of illness perceptions in Palliative Care is likely to yield important information about risk of depression and will help clinicians to personalize management of advanced disease.

  • Predictors of non-remission of depression in a Palliative Care Population:
    Palliative medicine, 2011
    Co-Authors: Laura Goodwin, Annabel Price, Lauren Rayner, Barbara Monroe, Nigel Sykes, Penny Hansford, Irene J Higginson, William Lee, Matthew Hotopf
    Abstract:

    Background:Prospective studies of depression in Palliative Care are rare. Two studies that examine depression prospectively in patients with advanced disease have not looked at predictors of remission.Aims:to explore prospective predictors of non-remission of depression in Palliative Care.Design and participants:The study design comprised two data collections: initial assessment on referral to a Palliative Care service in South London, UK, and a four-week follow-up. Seventy six participants met the criteria for ‘any depressive syndrome’ at the time 1 assessment, using the PRIME-MD, who also participated at time 2. The outcome measure was remission (N = 39) or non-remission (N = 37) of depression by time 2.Results:The findings showed that reporting low social support from family and friends at time of referral was the most powerful risk factor for non-remission. There was also a strong association between improved physical symptoms, from time 1 to 2, and remission of depression.Conclusions:This study in pa...

  • Predictors of non-remission of depression in a Palliative Care Population
    BMJ Supportive & Palliative Care, 2011
    Co-Authors: Laura Goodwin, Annabel Price, Lauren Rayner, Barbara Monroe, Nigel Sykes, Penny Hansford, Irene J Higginson, William Lee, Matthew Hotopf
    Abstract:

    Abstract Introduction and aims Prospective studies of depression in Palliative Care are rare. Two studies which examine depression prospectively in patients with advanced disease have not looked at predictors of remission. This study aims to explore prospective predictors of non-remission of depression in Palliative Care. Methods The study design comprised two data collections: with initial assessment on referral to a Palliative Care service in South London, UK and a 4-week follow-up. 76 participants met the criteria for ‘any depressive syndrome’ at the time 1 assessment using the PRIME-MD, who also participated at time 2. The outcome measure was remission (N=39) or non-remission (N=37) of depression by time 2. Results The findings showed that reporting low social support at time of referral was the most powerful risk factor for non-remission. There was also a strong association between improved physical symptoms, from time 1 to 2, and remission of depression. Conclusion This study in Palliative Care is the first of which we are aware to explore factors associated with non-remission of depression. Depressed patients identified with low social support on referral to Palliative Care might particularly benefit from additional psychosocial Care in the treatment of their depression. This study provides evidence that effective physical symptom management in Palliative Care may be a valuable intervention for depressive symptoms.