Triggers in advanced neurological conditions: prediction and management of the terminal phase

Jamilla Hussain; Debi Adams; Victoria Allgar; Colin Campbell

doi:10.1136/bmjspcare-2012-000389

Triggers in advanced neurological conditions: prediction and management of the terminal phase

Jamilla Hussain^*, Debi Adams, Victoria Allgar, Colin Campbell

^*Corresponding author for this work

Peninsula Medical School

Research output: Contribution to journal › Article › peer-review

Abstract

ContextThe challenge to provide a palliative care service for individuals with advanced neurological conditions is compounded by variability in disease trajectories and symptom profiles. The National End of Life Care Programme (2010) recommended seven ‘triggers’ for a palliative approach to care for patients with advanced neurological conditions.ObjectivesTo establish the frequency of triggers in the palliative phase, and if they could be reduced to fewer components. Management of the terminal phase also was evaluated.MethodRetrospective study of 62 consecutive patients under the care of a specialist palliative neurology service, who had died. Principle component analysis (PCA) was performed to establish the interrelationship between triggers.ResultsFrequency of triggers increased as each patient approached death. PCA found that four symptom components explained 76.8% of the variance. These represented:rapid physical decline;significant complex symptoms, including pain;infection in combination with cognitive impairment;andrisk of aspiration. Median follow-up under the palliative care service was 336 days. In 56.5% of patients, the cause of death was pneumonia. The terminal phase was recognised in 72.6%. The duration of the terminal phase was 8.8 days on average, and the Liverpool Care of the dying Pathway was commenced in 33.9%. All carers were offered bereavement support.ConclusionsReferral criteria based on the triggers can facilitate appropriate and timely patient access to palliative care. The components deduced through PCA have face validity; however larger studies prospectively validating the triggers are required. Closer scrutiny of the terminal phase is necessary to optimise management.

Original language	English
Pages (from-to)	30-37
Number of pages	0
Journal	BMJ Supportive & Palliative Care
Volume	4
Issue number	1
Early online date	19 Feb 2013
DOIs	https://doi.org/10.1136/bmjspcare-2012-000389
Publication status	Published - Mar 2014

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10.1136/bmjspcare-2012-000389

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title = "Triggers in advanced neurological conditions: prediction and management of the terminal phase",

abstract = "ContextThe challenge to provide a palliative care service for individuals with advanced neurological conditions is compounded by variability in disease trajectories and symptom profiles. The National End of Life Care Programme (2010) recommended seven {\textquoteleft}triggers{\textquoteright} for a palliative approach to care for patients with advanced neurological conditions.ObjectivesTo establish the frequency of triggers in the palliative phase, and if they could be reduced to fewer components. Management of the terminal phase also was evaluated.MethodRetrospective study of 62 consecutive patients under the care of a specialist palliative neurology service, who had died. Principle component analysis (PCA) was performed to establish the interrelationship between triggers.ResultsFrequency of triggers increased as each patient approached death. PCA found that four symptom components explained 76.8% of the variance. These represented:rapid physical decline;significant complex symptoms, including pain;infection in combination with cognitive impairment;andrisk of aspiration. Median follow-up under the palliative care service was 336 days. In 56.5% of patients, the cause of death was pneumonia. The terminal phase was recognised in 72.6%. The duration of the terminal phase was 8.8 days on average, and the Liverpool Care of the dying Pathway was commenced in 33.9%. All carers were offered bereavement support.ConclusionsReferral criteria based on the triggers can facilitate appropriate and timely patient access to palliative care. The components deduced through PCA have face validity; however larger studies prospectively validating the triggers are required. Closer scrutiny of the terminal phase is necessary to optimise management.",

author = "Jamilla Hussain and Debi Adams and Victoria Allgar and Colin Campbell",

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N2 - ContextThe challenge to provide a palliative care service for individuals with advanced neurological conditions is compounded by variability in disease trajectories and symptom profiles. The National End of Life Care Programme (2010) recommended seven ‘triggers’ for a palliative approach to care for patients with advanced neurological conditions.ObjectivesTo establish the frequency of triggers in the palliative phase, and if they could be reduced to fewer components. Management of the terminal phase also was evaluated.MethodRetrospective study of 62 consecutive patients under the care of a specialist palliative neurology service, who had died. Principle component analysis (PCA) was performed to establish the interrelationship between triggers.ResultsFrequency of triggers increased as each patient approached death. PCA found that four symptom components explained 76.8% of the variance. These represented:rapid physical decline;significant complex symptoms, including pain;infection in combination with cognitive impairment;andrisk of aspiration. Median follow-up under the palliative care service was 336 days. In 56.5% of patients, the cause of death was pneumonia. The terminal phase was recognised in 72.6%. The duration of the terminal phase was 8.8 days on average, and the Liverpool Care of the dying Pathway was commenced in 33.9%. All carers were offered bereavement support.ConclusionsReferral criteria based on the triggers can facilitate appropriate and timely patient access to palliative care. The components deduced through PCA have face validity; however larger studies prospectively validating the triggers are required. Closer scrutiny of the terminal phase is necessary to optimise management.

AB - ContextThe challenge to provide a palliative care service for individuals with advanced neurological conditions is compounded by variability in disease trajectories and symptom profiles. The National End of Life Care Programme (2010) recommended seven ‘triggers’ for a palliative approach to care for patients with advanced neurological conditions.ObjectivesTo establish the frequency of triggers in the palliative phase, and if they could be reduced to fewer components. Management of the terminal phase also was evaluated.MethodRetrospective study of 62 consecutive patients under the care of a specialist palliative neurology service, who had died. Principle component analysis (PCA) was performed to establish the interrelationship between triggers.ResultsFrequency of triggers increased as each patient approached death. PCA found that four symptom components explained 76.8% of the variance. These represented:rapid physical decline;significant complex symptoms, including pain;infection in combination with cognitive impairment;andrisk of aspiration. Median follow-up under the palliative care service was 336 days. In 56.5% of patients, the cause of death was pneumonia. The terminal phase was recognised in 72.6%. The duration of the terminal phase was 8.8 days on average, and the Liverpool Care of the dying Pathway was commenced in 33.9%. All carers were offered bereavement support.ConclusionsReferral criteria based on the triggers can facilitate appropriate and timely patient access to palliative care. The components deduced through PCA have face validity; however larger studies prospectively validating the triggers are required. Closer scrutiny of the terminal phase is necessary to optimise management.

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Triggers in advanced neurological conditions: prediction and management of the terminal phase

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