Quality of care is conceptualised by professionals and in policy documents as: compliance with ‘best practice’ guidelines; improving satisfaction rates; fiscal efficiency; and ethical care. ‘Quality’ in palliative and supportive district nursing care has been conceptualised in all these ways. However, the empirical research in this area draws mostly on professionals’ and carers’ views with little research addressing patients’ views. With political rhetoric pushing for a ‘patient led’ NHS, research into how patients conceptualise quality in this area is necessary to both critique this rhetoric and/or facilitate its aims. Therefore, this research investigates patients’ and carers’ views on the quality of palliative and supportive district nursing care.Participants were recruited to an exploratory qualitative study resulting in a convenience sample of twenty six patients (all of district nursing caseloads) and thirteen carers. All participants were over eighteen, able to consent, lived in their own homes, were under the care of district nurses, and had palliative care needs. Eighteen participants had a cancer diagnosis, six had a non-malignant diagnosis, one had co-morbidities, and one participant did not disclosed their diagnosis. Semi-structured interviews were conducted with all participants, five participants were interviewed twice. Post-structuralist theories were used with discourse analysis techniques for the final analysis.The findings identify three of the most influential discourses in relation to the morality and quality of care: Firstly, ‘busyness’, and how its performance by district nurses masks patients’ and carers’ ability to critique care, instead producing a pseudo-quality which fixes patients and carers subjectivities. Secondly, ‘power/knowledge’ and the ways in which it prevents patients and carers accessing care which they need, and altering care to suit their needs. Thirdly, ‘the home’ and how it (re)forms district nursing care and district nursing care (re)forms the home; meaning that actions by district nurses must also consider the impact on the home as well as the patients and carers. In conclusion quality care may be produced by: ceasing to measure quality; involving patients and carers with commissioning and directing palliative and supportive care; supporting groups other than district nurses such as patients, carers and third parties to produce and distribute knowledge about district nursing care; increasing patients’ and carers’ ability to communicate with one another about their care.Further research may investigate: how patients and carers with palliative and supportive care needs may be involved in commissioning; the most appropriate wording and means to distribute knowledge about palliative and supportive district nursing care; ethnographic work to explore how district nursing and the home interact; more detailed theorisation of how the material and the discursive can be accounted for within post-structuralism.

京都大学 / 0048 / 新制・論文博士 / 博士(社会健康医学) / 乙第13292号 / 論社医博第13号 / 新制||社医||10(附属図書館) / (主査)教授 川上 浩司, 教授 平井 豊博, 教授 伊達 洋至 / 学位規則第4条第2項該当 / Doctor of Public Health / Kyoto University / DFAM

Die Studie evaluiert die Arbeit des Ambulanten Hospiz- und Palliativ-Beratungsdienstes (AHPB) am Hospiz Villa Auguste in Leipzig. Der AHPB betreut Palliativpatienten in der Häuslichkeit. Er versteht sich als Hilfe zur Pflegeüberleitung an Schnittstellen der Versorgung (z.B.: Krankenhaus - Entlassung nach Hause). Ziel der Studie war eine wissenschaftliche Begleitung der Arbeit des AHPB. Seine Struktur-, Prozess und Ergebnisqualität wurden evaluiert. Als ein Schwerpunkt der Studie wurde besonders die Rolle der Angehörigen in der häuslichen Versorgung betrachtet. Es wurde auch untersucht, welche Unterstützung sie von der Brückenschwester erfuhren. Im Rahmen der Interviews wurden sie zur Zufriedenheit mit dem Dienst befragt.

La prise en charge d’un patient atteint d’un cancer impose, au soignant, la recherche du meilleur traitement antinéoplastique possible en association avec un engagement d’accompagnement depuis l’annonce du diagnostic jusqu’à la phase après cancer ou le décès. Au cours de son parcours de soin, le malade et ses proches vont être confrontés à différentes équipes, différentes visions du traitement et différentes approches du soin. Le travail présenté consiste en une analyse nationale française sur l’organisation des soins d’accompagement ainsi que la gestion de la iatrogénie liée à trois grandes familles de thérapeutiques symptomatiques : les érythropoïétines, les biphosphonates et les morphiniques. Basé sur cette photographie du soin d’accompagnement en cancérologie, le développement de ces soins sur un établissement sera alors présenté depuis la gestion ambulatoire en hospitalisation de jour, jusqu’à l’hospitalisation complète dans une unité pilote. Le lien, les différences et les complémentarités entre les équipes aux phases curatives et palliatives seront alors discutés, permettant de définir la place et l’importance du regard global et réunificateur par le biais des soins de support en cancérologie / The management of a cancer patient requires, to the caregivers, finding the best antineoplastic therapy in combination with support involvement from the diagnosis to the stage after cancer or death. During the course of care, patient and family will be confronted with different teams, different visions and different treatment approaches of their care. The work presented starts threw an analysis of French organizations of supportive care and management of iatrogenic effects due to three main types of symptomatic therapeutics: erythropoietins, bisphosphonates and opioids. Based on this photograph of accompanying cancer care, the development in an institution of an health care will be presented for ambulatory management of day hospital for chemotherapy administration, until full hospitalization in a pilot unit. The link, the differences and complementaries between the teams in curative and palliative phases will be discussed to define the role and importance of the overall look and unifying supportive care in oncology

Although provision of palliative care on the United States is growing, referrals to the service are often late or non-existent. The simultaneous care model provides a blueprint for the most progressive form of palliative care, which is palliation and disease-oriented treatments delivered concurrently. Research indicates the existence of a widespread misconception that associates palliative care with imminent death, and some organizations have chosen to re-brand their palliative care services to influence this perception. The goal of this study was to assess the effects of a name change from palliative care to supportive care on the communicative process during referrals to the service.

Most patients with pancreatic cancer will present with metastatic or locally advanced disease. Unfortunately, most patients with localized disease will experience recurrence even after multimodality therapy. As such, pancreatic cancer patients arrive at a common endpoint where decisions pertaining to palliative care come to the forefront. This article summarizes surgical, endoscopic, and other palliative techniques for relief of obstructive jaundice, relief of duodenal or gastric outlet obstruction, and relief of pain due to invasion of the celiac plexus. It also introduces the utility of the palliative care triangle in clarifying a patient's and family's goals to guide decision making.

The aim of this study was to describe non-surgical treatment options for the diseases mucositis and peri-implantitis found in present literature. The literature review also illustrates the effect of the treatment opptions on soft tissue with mucositis and peri-implantitis surrounding dental implants. The study reviews twelve scientific articles that have been processed from the aim of the study. The result shows six therapy options, Er:YAG laser, air abrasive, ultrasonic device, hand instruments, hand instruments in combination with antibiotics and hand instruments in combination with clorhexidin. The following methods are described according to how they are used and how they affect the soft tissue surrounding dental implants. The therapy options showed some improvements with reduced pocket depth, bleeding on probing (BOP) and gain in clinical attachment level (CAL). Several studies accentuate the importance of good self-care and regular visits for supportive care which have an impact on the survival of the implants and in avoiding progress of disease. All of the therapy options have positive effects but to different extent and it is not concluded how long the positive effect remains in the soft tissue. / Syftet var att redogöra för icke-kirurgiska behandlingsmetoder vid mukosit och periimplantitsom beskrivs i litteraturen. Litteraturstudien belyser ävenbehandlingsalternativens påverkan på vävnaden vid sjukdomstillstånden mukosit ochperi-implantit. Studien är utförd som en allmän litteraturstudie och innefattar 12vetenskapliga artiklar som bearbetats utefter studiens syfte. Resultatet redovisar sexbehandlingsalternativ, Er:YAG laser, air abrasive, ultraljud, handinstrument,handinstrument i kombination med antibiotika och handinstrument i kombination medklorhexidin. Metoderna är beskrivna både hur de används och vilken klinisk påverkan dehar på vävnaden runt tandimplantat. De förbättringar som visats är viss reduktion avfickdjup, blödning vid sondering (BOP) och vinst av klinisk fästenivå (CAL). Samtligametoder ger positiv effekt, men i olika grad. Ett flertal studier påvisar betydelsen av godegenvård och regelbundna besök för stödbehandling vilket är av betydelse förimplantatens överlevnad och för att undvika progression av sjukdom. Däremot kan detses en begränsning i hur länge resultatet bibehålls i vävnaden.

PURPOSE: (1) Investigate supportive care needs and preferences of parents of children with cancer (2) Assess the feasibility and preliminary outcomes of a Parent Support Group Intervention (PSGI). METHODS: One-hundred and eight parents completed the Parent Support Survey (PSS). Data were utilized in the creation of a PSGI. The PSGI consisted of eight 1.5-hour sessions encompassing guided group discussion. As part of feasibility, acceptability, recruitment/retention and preliminary outcomes were assessed. Parents completed outcome measures assessing knowledge of disease/treatment management, community/hospital/family resources, perception of social support and feelings of distress/anxiety. RESULTS: From the PSS, 86/108 (80%) of parents expressed interest in a PSGI. Fourteen parents attended the PSGI only once and 14 parents attended the PSGI more than once. Outcome measure results depict favourable changes after group attendance. Recruitment and retention data highlight challenges. CONCLUSIONS: Information gained from this study will be used to improve planning and delievery of future PSGI’s.

PURPOSE: (1) Investigate supportive care needs and preferences of parents of children with cancer (2) Assess the feasibility and preliminary outcomes of a Parent Support Group Intervention (PSGI). METHODS: One-hundred and eight parents completed the Parent Support Survey (PSS). Data were utilized in the creation of a PSGI. The PSGI consisted of eight 1.5-hour sessions encompassing guided group discussion. As part of feasibility, acceptability, recruitment/retention and preliminary outcomes were assessed. Parents completed outcome measures assessing knowledge of disease/treatment management, community/hospital/family resources, perception of social support and feelings of distress/anxiety. RESULTS: From the PSS, 86/108 (80%) of parents expressed interest in a PSGI. Fourteen parents attended the PSGI only once and 14 parents attended the PSGI more than once. Outcome measure results depict favourable changes after group attendance. Recruitment and retention data highlight challenges. CONCLUSIONS: Information gained from this study will be used to improve planning and delievery of future PSGI’s.

PURPOSE: (1) Investigate supportive care needs and preferences of parents of children with cancer (2) Assess the feasibility and preliminary outcomes of a Parent Support Group Intervention (PSGI). METHODS: One-hundred and eight parents completed the Parent Support Survey (PSS). Data were utilized in the creation of a PSGI. The PSGI consisted of eight 1.5-hour sessions encompassing guided group discussion. As part of feasibility, acceptability, recruitment/retention and preliminary outcomes were assessed. Parents completed outcome measures assessing knowledge of disease/treatment management, community/hospital/family resources, perception of social support and feelings of distress/anxiety. RESULTS: From the PSS, 86/108 (80%) of parents expressed interest in a PSGI. Fourteen parents attended the PSGI only once and 14 parents attended the PSGI more than once. Outcome measure results depict favourable changes after group attendance. Recruitment and retention data highlight challenges. CONCLUSIONS: Information gained from this study will be used to improve planning and delievery of future PSGI’s.