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(2) DOCTORS
OVER-ESTIMATE SURVIVAL OF
TERMINALLY
ILL PATIENTS
(3) IS LEGALISING EUTHANASIA PREMATURE?
(4) DOCTORS
ARE OFTEN STRONGLY AFFECTED
BY PATIENT
DEATHS
(5) HOW DO PEOPLE IN AFRICA WANT TO DIE?
(6) EXPERTS
WELCOME MAJOR REFORMS TO THE
CORONER'S SERVICE
(1) FAMILIES COPE
BETTER AFTER EUTHANASIA
THAN NATURAL DEATH
(Effects of euthanasia on the bereaved
family and friends:
a cross sectional study)
http://bmj.com/cgi/content/full/327/7408/189
The bereaved family and friends of cancer
patients who
die by euthanasia have less grief symptoms
and
post-traumatic stress reactions than the
bereaved of
comparable cancer patients who die a natural
death,
finds a study in this week's BMJ.
Researchers from the Netherlands assessed
189
bereaved family members and close friends
of terminally
ill cancer patients who died by euthanasia
and 316
bereaved family members and close friends
of
comparable cancer patients who died a
natural death
between 1992 and 1999.
The family and friends of cancer patients
who died by
euthanasia had less traumatic grief symptoms,
less
current feeling of grief, and less post-traumatic
stress
reactions than the family and friends
of cancer patients
who died of natural causes. These differences
were
independent of other risk factors.
Possible explanations for less grief symptoms
among the
family and friends of patients who died
by euthanasia
include the opportunity to say goodbye,
being more
prepared for the way and day of the imminent
death, and
being able to talk openly about death,
say the authors.
"Our results should not be interpreted
as a plea for
euthanasia, but as a plea for the same
level of care and
openness in all patients who are terminally
ill," they
conclude.
Contacts:
Nikkie Swarte, Research Fellow or Peter
Heintz,
Professor of Gynaecological Oncology,
Department of
Gynaecology, University Medical Center
Utrecht, The
Netherlands
Email: n.swarte@azu.nl
(2) DOCTORS OVER-ESTIMATE
SURVIVAL OF
TERMINALLY ILL PATIENTS
(A systematic review of physicians'
survival predictions
in terminally ill cancer patients)
http://bmj.com/cgi/content/full/327/7408/195
Doctors tend to over-estimate the survival
of terminally ill
cancer patients, but become more accurate
closer to the
date of death, finds a study in this week's
BMJ.
Accurate prognoses are important so patients
can plan
for death.
Researchers reviewed eight studies involving
more than
1,500 patients over 30 years to assess
the accuracy of
doctors' survival predictions.
They found that doctors' survival predictions
are
frequently inaccurate and usually over-optimistic,
being
out by more than a month a quarter of
the time.
However, their predictions become more
accurate closer
to death.
Despite their tendency to be over-optimistic,
predictions
of up to six months are nevertheless reliable,
being
closely correlated with actual survival.
This suggests that
doctors are able to sense when things
are starting to go
wrong, say the authors.
Doctors need to be aware of their tendency
to
over-estimate survival as it may affect
the patients'
prospects for achieving a good death,
they conclude.
Contact:
Paul Glare, Head of Department, Department
of
Palliative Care, Royal Prince Alfred Hospital,
New
South Wales, Australia
Email: paul@email.cs.nsw.gov.au
(3) IS LEGALISING EUTHANASIA PREMATURE?
(Patients' voices are needed in debates
on euthanasia)
http://bmj.com/cgi/content/full/327/7408/213
Legalising euthanasia is premature when
we still do not
know why patients want it and whether
better end of life
care would change their views, argue researchers
in this
week's BMJ.
Euthanasia debates have focused on suffering,
respect
for patient autonomy, and dignified death,
but little
evidence is available from patients who
desire
euthanasia.
A few studies have shown that patients'
reasons for
wanting euthanasia are not confined to
the physical
effects of disease, but relate to their
whole life
experiences. However, more studies are
urgently needed
to capture their voices, say the authors.
Rather than focusing on assessing the mental
competence
of patients requesting euthanasia or determining
clear
legal guidelines, doctors must acquire
the skills for
providing good end of life care, they
add. These include
the ability to "connect" with patients,
diagnose suffering,
and understand patients' hidden agendas
through
in-depth exploration.
There is much to ponder over the meaning
of a
euthanasia request before we have to consider
its
justification. The desire for euthanasia
must not be taken
at face value, they conclude.
Contacts:
Jimmy Tsui, Hong Kong Hospital Authority
Media
Relations
Ilora Finlay, Professor of Palliative Medicine,
University
of Wales College of Medicine, Cardiff,
UK
Email: iloraf@globalnet.co.uk
(4) DOCTORS ARE
OFTEN STRONGLY AFFECTED
BY PATIENT DEATHS
(Doctors' emotional reactions to
recent death of a patient:
cross-sectional study of hospital
doctors)
http://bmj.com/cgi/content/full/327/7408/185
BMJ Volume
327, pp 185-9
Doctors are often powerfully affected by
the deaths of
patients for whom they care, and some
may need
emotional support, according to a study
in this week's
BMJ.
Researchers at two teaching hospitals in
the United
States investigated the emotional reactions
of 188
doctors who cared for 68 patients at the
time of their
death.
Most doctors (74%) thought that taking
care of the
patient was a satisfying experience. Many
reported
moderate emotional impact from a patient's
death,
though 31% rated the death as having strong
emotional
impact.
Women and those doctors who had cared for
the patient
for a longer time experienced stronger
emotional
reactions. Level of training was not related
to emotional
reactions, but interns (equivalent to
UK junior house
officers) reported needing more emotional
support than
attending physicians (equivalent to UK
consultants).
Doctors reported "feeling upset when thinking
about the
patient" and feeling "numb" after the
death. They also
reported "getting emotional support from
others" and
"trying to see the death in a different
light to make it seem
more positive" as coping strategies.
Although most junior doctors discussed
the patient's
death with an attending physician, less
than a quarter
found senior teaching staff to be the
most helpful source
of support.
This research provides new insights into
the effect of
patients' deaths on doctors and raises
some questions
about current medical training in the
United States, say
the authors. Medical teams may benefit
from debriefing
within the department to give junior doctors
an
opportunity to share emotional responses
and reflect on
the patient's death.
Contact:
Ellen Redinbaugh, Research Instructor,
Department of
Behavioural Medicine and Oncology, University
of
Pittsburgh Cancer Institute, Pittsburgh,
USA
Email: ellenr@pitt.edu
(5) HOW DO PEOPLE IN AFRICA WANT TO DIE?
(A good death in Uganda: survey of
needs for palliative
care for terminally ill people in
urban areas)
http://bmj.com/cgi/content/full/327/7408/192
(Quality care at the end of life
in Africa)
http://bmj.com/cgi/content/full/327/7408/209
Terminally ill people in Africa want to
die at home
without pain, stigma, or financial hardship.
Yet two
articles in this week's BMJ show how poverty,
limited
healthcare services, and poor access to
pain relief are
major barriers to improving end of life
care.
In the first study, terminally ill patients
in Uganda believe
a "good death" occurs at home, in the
absence of pain
and other distressing symptoms, without
stigma, and with
adequate finances for the basic needs.
However, in reality, most terminally ill
people experience
financial hardship, says Ekiria Kikule
of Hospice Africa.
In the second study, members of a WHO project
to
improve palliative care in Africa find
that the greatest
needs of terminally ill patients were
for adequate pain
relief, accessible and affordable drugs,
and financial
support.
Terminal illness often causes family financial
crisis
because of loss of income from both patient
and family
caregiver, write the authors.
Special emphasis should be given to home
based
palliative care provided by trained family
and community
caregivers to counteract the severe shortage
of
professional healthcare workers, they
conclude.
Contacts:
Ekiria Kikule, Hospice Africa (Uganda),
Kampala,
Uganda
Email: ekikule@hospiceafrica.or.ug
Cecilia Sepulveda, Programme on Cancer
Control,
World Health Organisation, Geneva Switzerland
Email: sepulvedac@who.int
(6) EXPERTS WELCOME
MAJOR REFORMS TO THE
CORONER'S SERVICE
(Editorial: Reforming the coroner's
service)
http://bmj.com/cgi/content/full/327/7408/175
Proper death investigation protects the
public and cannot
be neglected any longer, write two senior
forensic
doctors in this week's BMJ.
Christopher Milroy and Helen Whitwell,
Professors of
Forensic Pathology at the University of
Sheffield argue
that the current system is fragmented,
legalistic, and
inadequately funded. They welcome the
recent review of
the coroner's service, and the Shipman
inquiry report,
which they say "will result in major changes."
The review proposes that all coroners should
be legally
qualified and overall responsibility for
the coroner's
system will be vested in a national "coronial
council." The
Shipman inquiry advocates properly trained
coroner's
investigators, headed by a chief investigator,
to replace
the current system of coroner's officers.
Both the review and the inquiry propose
greater medical
input into the coroner's system and both
recommend
replacing the current system of death
certification and
cremation certificates with one unified
process.
The inquiry also supports the close association
of
forensic medicine and the coroner's service,
a situation
that has existed in Sheffield for three
decades but which
has not been replicated elsewhere in the
United
Kingdom, say the authors.
These proposals would mean greater integration
of the
services required in death investigation,
with medical
issues left to those with appropriate
medical training, add
the authors. The new system will require
funding, but the
status quo is not acceptable, they conclude.
Contact:
Christopher Milroy, Professor of Forensic
Pathology,
University of Sheffield, UK
Email: c.m.milroy@sheffield.ac.uk
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