Baseline HRQL is a statistically significant predictor of survival for patients with advanced lung cancer. When used along with traditional clinical factors, patient-reported baseline HRQL assessment using the FACT-G provides additional prognostic information to the patient and clinician.

Stroke is the third-leading cause of death in Canada. Approximately 20% of people who have a stroke will die within one month from direct consequences of the stroke or its complications 1 . Most patients with severe stroke will die within one month; a significant number will die within ten days of the onset of symptoms 2,3 . However, few approaches to palliative care have been established in centres which care for these patients, and many of these have not been formally examined 4 . It has been estimated that 8% of hospital inpatients admitted with cerebrovascular disease have some need for palliative care, and ABSTRACT: Background: A recent survey found few guidelines on the provision of palliative care following stroke; none examined the efficacy or results of any such process. The role of the patient's family in decision making and in conflicts with staff has not been evaluated. We sought to formally evaluate the use of locally-developed palliative care guidelines on our Acute Stroke Unit (ASU). Methods: We retrospectively examined records of 104 patients who died on our ASU over a two-year period to determine if our existing palliative guidelines were reflected in clinical practice, and to identify conflicts that arose. Data on medical and nursing care, palliative decisions, and medication use were compared to the ASU's existing palliative care guidelines. Family concerns about the palliative process were also reviewed. Results: Of patients admitted to the stroke unit, 104 (16% of total admissions) died. Ninety-four (90.4%) of these were palliated; all received routine nursing and comfort care prior to death. Median time from admission to palliation was 3.6 days; median time from admission to death was 8.5 days. Most had vital signs (98.9%), investigations (100%) and non-palliative medications (95.7%) stopped, and had nasogastric feeding (96.8%) and intravenous fluids (87.2%) withdrawn or never begun. Most were treated with morphine (93.6%) and scopolamine (81.9%). Concerns raised by family members centered around hydration and feeding (45.7%), doubts about palliative care (27.8%) and patient comfort (18.2%). Conclusions: A formal approach to palliation results in timely decisions regarding end of life care with relatively few conflicts. Further work to address the specific concerns of families is needed.RÉSUMÉ: Évaluation d'une approche de soins palliatifs organisés chez les patients atteints d'un accident vasculaire cérébral sévère. Contexte : Une enquête récente a montré qu'il existe peu de lignes directrices concernant les soins palliatifs après un accident vasculaire cérébral (AVC) et qu'aucune n'en évaluait l'efficacité ou les résultats. Le rôle de la famille du patient dans la prise de décision et dans les conflits avec le personnel n'a pas été évalué. Le but de notre étude était d'évaluer formellement l'utilisation de lignes directrices mises au point localement concernant les soins palliatifs dans notre unité d'AVC aigu (UAVCA). Méthodes : Nous avons examiné de façon prospective les dossiers de 104 ...

The framework, released in 2017, and the selection and implementation of education programs were a significant undertaking. The framework will support the implementation of the Nova Scotia Integrated Palliative Care Strategy, enhance the interprofessional nature of palliative care, and guide the further implementation of education programs. Other jurisdictions have expressed considerable interest in the framework.

We provide evidence on the magnitude of change in FACT-F score that is associated with the perception by patients of improvement in fatigue and magnitude of change in score that is associated with worsening in fatigue.