Catastrophic bleeds during end-of-life care in haematology: controversies from Australian research

Abstract

The important recommendation from this research is the resounding need for further work on this topic in order to provide clear guideline for best practice in clinical and supportive care.

Transfusion in Palliative Cancer Patients: A Review of the Literature

“…47 This latter extreme is still controversial even among the different members of the sanitary staff attending the patient. 46 As most cost studies do not focus on transfusional activity alone but rather on the total cost of hospital or home care, it is difficult to draw conclusions exclusively regarding transfusional activity. Demonstrating that home care of PCPs 54 or that the development of acute palliative care units in hospitals 48 are costeffective measures does not necessarily mean that transfusion costs in these circumstances are also lower.…”

“…43,44,46,49,[52][53][54] Moreover, it has been published that 40% of unnecessary hospital admissions are due to transfusions, 55 so this is a potential way to reduce hospitalization costs. While all authors consider this should be a priority, this service requires a very well organized infrastructure, 49 which is time consuming and puts a strain on other resources (financial, transport, etc.…”

“…Infrastructure [43][44][45][46][47][48][49][50][51][52][53][54] For most authors, home transfusions are desirable for the patient and family's comfort, as the displacement to hospitals for transfusion is disturbing. 43,44,46,49,[52][53][54] Moreover, it has been published that 40% of unnecessary hospital admissions are due to transfusions, 55 so this is a potential way to reduce hospitalization costs.…”

Management of respiratory symptoms in paediatric palliative care

“…Children with neuromuscular weakness Mechanical insufflation/exsufflation can increase peak cough flow and improve secretion clearance [66][67][68] Mechanical insufflation/exsufflation should be considered as an adjunct to chest physiotherapy in children with insufficient cough strength to remove secretions from airway although there is little evidence to support this approach [71,72].…”

Ethics of crisis sedation: questions of performance and consent

“…We inhabit a culture within which death is a relatively taboo subject and, as implied by the fact that there is a contemporary movement towards greater death awareness,42 there is a distinct lack of familiarity with the topic and some patients who are dying (and, to a degree, their families) will prefer to maintain a certain lack of awareness, at least insofar as is possible 43. Respecting the patient’s preferences would, then, involve striking a balance between telling the patient the information that they wish to know and shielding them from a level of detail that they would find disconcerting at best and particularly distressing at worst 28. It would, we think, be a mistake to suppose that acting in this way is mere paternalism.…”