47 e-Letters

  • Warning - EPaCCS may NOT facilitate home deaths
    Lesley Wye

    As the lead of a Marie Curie funded study of EPaCCS, I welcome the attention that electronic palliative care systems are increasingly receiving. However unlike Petrova et al, I believe the "striking" EPaCCS results on facilitating home deaths mentioned by Petrova et al may largely be explained by selection bias.

    In our mixed methods study, we too found impressive results in that those with an electronic EPaCCS...

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  • Are mental disorders still a significant factor in denying or granting requests for hastened death?
    Keith M. Swetz
    Wilson and colleagues are to be commended for their excellent work in exploring mental illnesses and desire for death in patients receiving palliative care with malignancy. [1] The piece thoughtfully explores the prevalence of depression, anxiety and mood disorders and the association between these diagnoses and a standardized quantification of the patient's desire for death. In all, the authors found that 30.5% of participants e...
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  • Evidence based policy in palliative care - time to learn from our mistakes
    Katherine E. Sleeman

    The article by Petrova et al is timely and thought provoking.1 EPaCCS (Electronic Palliative Care Coordination Systems) have good face value: they appear so obviously a good idea. But scratch beneath the surface, as Petrova and colleagues have done, and important challenges in public perceptions, funding, information governance, context and health care IT become apparent.

    EPaCCS are electronic information system...

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  • Canadian Palliative Care Physicians Concerned about Assisted Suicide too.
    Susan M MacDonald

    British and European palliative care physicians are not alone in their concerns and reluctance to participate in Physician Assisted Suicide/Euthanasia. Canadian Palliative care physicians struggle with this issue as well. In 2010, the Canadian Society of Palliative Care physicians (300 members) were surveyed. (1) The questions were specific: "Are you for or against PAS/Euthanasia?" "Would you provide assisted suicide?" "W...

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  • Palliative Care research in the Francophone world.
    David M Fearon

    Dear Editor,

    We read with great interest the paper by Rhondali et al.(1) and we thank them for their contribution to a very worthwhile topic. We are involved in palliative care research in Mauritania, West Africa, and we appreciate this piece of research coming from France and we hope it will stimulate more palliative care research, not just in France but throughout the francophone world. As the likes of Uganda...

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  • Withdrawal of life sustaining medical devices at the end of life.
    James M. Beattie

    I read with interest the letter from McKenna and others describing the evolution of an algorithm to aid decision making in the withdrawal of life-sustaining medical devices (LSMDs) (1). The briefly described scenario involving the development of cancer in a patient with a left ventricular assist device (LVAD) as a bridge to transplantation is familiar to us in cardiovascular medicine, as is the resulting need for decis...

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  • Choice of oral transmucosal fentanyl for breakthrough cancer pain
    Gary J McCleane

    I am perplexed why this paper by Jandhyala and Fullarton has concluded that "FBT (fentanyl buccal tablet) may have some efficacy advantages over ODT (sublingual oral transmucosal fentanyl) and OTFC (compressed lozenge oral transmucosal fentanyl)..." in the management of breakthrough cancer pain when a paper published at the same time in another journal (Smith H, A comprehensive review of rapid-onset opioids for breakthr...

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  • Opinions of patients with cancer on the relative importance of place of death in the context of a 'good death'
    Akon E. Ndiok

    Re: Opinions of the patients with cancer on the relative importance of place of death in the context of 'good death'. By: Melaine Waghorn, Holly Young and Andrew Davies: BMJ Support Palliative Care 2011:1 310-314

    I am grateful for the opportunity to respond to Waghorn et al, 2011 study on opinion of patient with cancer on the relative importance of place of death. Having looked at the four highlighted domains ass...

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  • End of Life discussion in Heart Failure
    Catherine J Doherty

    This study generated discussion in our hospice about the importance of breaking bad news well and also the importance of these discussions in non cancer related disease. It was interesting the study showed 'people with heart failure had engaged in much less discussion about their condition, and most did not recall a specific conversation with their doctor about their prognosis'. I recently reviewed the literature on chr...

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  • Have no fear, morphine is here!
    Catherine J Doherty

    I welcome this small but useful study highlighting the fear and reluctance of patients and practitioners in using morphine in the setting of chronic heart failure. Over 50% of chronic heart failure patients suffer from pain and caution is needed with nearly all analgesics- NSAIDS and COX2 are contraindicated, neuropathics agents can trigger arrhythmias, steroids exacerbate salt and water retention, soluble drugs such as c...

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