Andrew Thorns

Accuracy of prognosis prediction by PPI in hospice inpatients with cancer: a multi-centre prospective study

The Palliative Prognostic Index (PPI) is a prognostication tool for palliative care patients based on clinical indices developed in Japan and further validated by one study in the UK. The aim of this study was to test its prediction accuracy in a large inpatient hospice sample. The admitting doctor in three inpatient hospices calculated the PPI score on admission. Two hundred and sixty-two patients were included in this study. Based on the PPI score, three subgroups were identified. Group 1 corresponded to patients with PPI ≤4 and the median survival of 53 days (95% CI 40 to 80 days). Group 2 corresponded to those with PPI >4 and ≤6 and the median survival 15 days (95% CI 12 to 26 days) and Group 3 corresponded to patients with PPI >6 and the median survival of 5 days (95% CI 3 to 7 days). In this study, PPI was able to identify patients’ likelihood of dying within 3 weeks with a sensitivity of 64% and specificity of 83%. It was able to identify a 6-week survival chance with a sensitivity of 62% and specificity of 86%. A one-unit increase in PPI score was estimated to increase the hazard for death by a factor of 1.33 (95% CI 1.26 to 1.40), based on fitting a stratified Cox proportional hazards model. The authors conclude that PPI can be used to predict prognosis for patients with advanced cancer.

Palliative care in people with chronic obstructive pulmonary disease

Passive acceptance of the illness has implications for end of life care and delivery of services

What is the best way to manage the last stages of COPD

Janssen and colleagues write powerfully about the decision to perform euthanasia in a patient with chronic obstructive pulmonary disease (COPD).1 The needs of such patients are not well met when they reach …

1 Evaluation of a nurse directed beds model of care in a stand-alone hospice inpatient unit (IPU)

Introduction Patient complexity needs to be understood to match resources to need in palliative care (Pask et al. 2018). A future increase in need for these services means alternative models of care should be considered (Etkind et al. 2017). Pilgrims Hospice is unique in having three IPUs run by a single organisation covering a distinct geographical area. This set up enabled the implementation of a stand-alone nurse directed unit taking less medically complex patients alongside traditionally staffed IPUs. Aims The project aimed to answer the following: Can we identify medical complexity prior to admission? Do nurse directed beds in a stand–alone unit improve use of resources produce similar outcome and satisfaction. Methods Data were collected from routine activity figures surveys of staff and service users’ thematic analysis of operational meetings and a focus group of staff at a strategic level. Tools were utilised to measure complexity and level of need (Gannon 2017). Results The findings supported using resources more efficiently and for the nursing team to be empowered and developed. Concerns related to: Travel time when patients not admitted to the closest unit. Inefficient use of beds A perceived need for a full multidisciplinary team including medicine Delay in death certificate completion The medical complexity tool appeared unreliable as a triage tool Conclusions The concept received support from participants. However we were unable to effectively answer the questions posed for a mixture of system data collection and methodological reasons. For nurse directed beds to be successful a different approach is required. References . Pask S, Pinto C, Bristowe K, van Vliet L, Nicholson C, Evans C, George R, Bailey K, Davies J, Guo P, Daveson B, Higginson IJ, Murtagh FEM. A framework for complexity in palliative care: A qualitative study with patients family carers and professionals. Palliative Medicine2018;32(6):1078–1090. . Etkind SN, Bone AE, Gomes B, Lovell N, Evans CJ, Higginson IJ. How many people will need palliative care in 2040? Past trends future projections and implications for services. BMC Medicine2017;15:102. Available at https://doi.org/10.1186/s12916-017-0860-2 . Gannon C. P-82 what level of medical input do hospice inpatients need and does this correspond to their need for specialist nursing input? A service evaluation in a UK hospice. BMJ Supportive and Palliative Care2017;7(Suppl 1). Available at https://www.pah.org.uk/wp-content/uploads/2018/04/pah_jm_A0_medical_input_poster.pdf (Accessed: 25 May 2018)

Time for a public health campaign encouraging people to talk about death

I am glad that our medical colleagues listened to Black and her mother and came to a decision driven by patient wishes and not the seemingly constant drive to do things …

Communication and a public campaign needed for expectations in frailty to become realistic

Overexpectation in frailty by relatives and patients1 can be tackled only by two actions: improved communication by all …