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Biomedical subjects

I Higginson

Publications and source records attributed to I Higginson.

5 recordsLinked to original sources
PubMed1992

Assessing the symptoms, anxiety and practical needs of HIV/AIDS patients receiving palliative care.

We report the work of two community teams who care for people with AIDS/HIV related illness, the characteristics of patients referred, and the impact of the teams on four aspects of quality of life. Data was collected on 140 patients (85 St. Mary's Home Support Team, 55 Bloomsbury Community Care Team) who were referred to and remained in the care of these teams until death. All patients were male, mean age 37.9 years, 116 were homosexual. Most referrals were from genito-urinary medicine clinics (48%) or AIDS wards (41%). There was a wide range of reasons for referral. At referral 62% were in hospital and 35% at home. Mean time in care was 31 weeks 5 days. Fifty-seven per cent died in hospital, 22% at home and 21% in a hospice. The Support Team Assessment Schedule (STAS), consisting of 17 items of care, was used by the teams to measure aspects of quality of life. Throughout care until death four STAS items: pain control, symptom control, patient anxiety and practical aid are reported in detail. Symptom control was a commonly severe problem at referral and although the teams had some success in improving this item it remained a serious problem throughout care. Patient anxiety, also a commonly severe problem at referral, improved significantly throughout care. Pain control was less commonly severe at referral and improved significantly throughout care. Practical aid, in contrast, was rarely a severe problem at any stage of care.

Acquired Immunodeficiency Syndrome↗
PubMed1991

AIDS and cancer pain treated with slow release morphine.

The use of slow release morphine was compared between those with cancer and those with advanced HIV disease in two retrospective studies covering a total of 512 patients at home. Pain was found to be less severe in HIV/AIDS but still requiring opioid use in over a third of patients of which 14% needed subcutaneous diamorphine infusion when seriously ill at home. Slow release morphine was used by 45% of those with cancer and 17% of those with HIV/AIDS. It was found to be a simple and convenient preparation for use at home with most patients never needing more than 30 mg twice daily. Half the cancer patients prescribed slow release morphine were able to take it until the day of death.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Palliative care: views of patients and their families.

OBJECTIVE: To investigate the current problems and needs of terminally ill cancer patients and their family members, and to discover their views of hospital, community, and support team services. DESIGN: Prospective study of patients and families by questionnaire interviews in the patients' homes. SETTING: Inner London and north Kent (London suburbs). SUBJECTS: 65 Patients, each with a member of their family or a career. MAIN OUTCOME MEASURES: Ratings of eight current problems and ratings and comments on three services-hospital doctors and nurses, general practitioners and district nurses, and the support team staff-obtained after a minimum of two weeks' care from palliative care support teams. RESULTS: Effect of anxiety on the patient's nearest career. and symptom control were rated as the most severe current problems by both patients and families; a few patients and families identified other severe problems. Families' ratings of pain control, symptom control, and effect of anxiety on the patient were significantly worse than the patients' ratings (p less than 0.05). Support teams received the most praise, being rated by 58 (89%) patients and 59 (91%) of family members as good as excellent. General practitioners and district nurses were rated good or excellent by 46 (71%) patients and 46 (71%) family members, but six (9%) in each group rated the service as poor or very bad, and ratings in the inner London district were significantly worse than those in the outer London district. Hospital doctors and nurses were rated good or excellent by 22 (34%) patients and 35 (54%) of family members, and 14 (22%) patients and 15 (23%) family members rated this service as poor or very bad. Negative comments referred to communication (especially at diagnosis), coordination of services, the attitude of the doctor, delays in diagnosis, and difficulties in getting doctors to visit at home. Family members were more satisfied with the services than were patients. CONCLUSIONS: Palliative care needs to include both the patient and family because the needs of the family may exceed those of the patient. Support teams and some hospital and community doctors and nurses met the perceived needs of dying patients and families, but better education and organisation of services are needed.

Adult↗