Psychiatrist-determined suitability of patients on long-acting injectable antipsychotics to be discharged from specialist to primary care.

OBJECTIVE: We aim to determine psychiatrists' identified factors associated with suitability of discharging patients on long-acting injectable antipsychotics (LAI) from specialist to primary care. METHOD: We undertook a retrospective observational study utilising case file reviews. A questionnaire was developed specifically for this including sociodemographic information, clinical characteristics of the patients and clinical opinion on suitability of discharge to primary care. RESULTS: In total, 72 case files (51 men, 21 women) were included in the study. The most common diagnosis was schizophrenia (71%) and Risperidone was the most often used LAI (71%). Fourteen (19%) of the patients were deemed suitable for discharge to primary care. A minimum period of 1 year of stability, having good cognitive function and insight, and absence of high-risk history were associated with suitability for discharge. CONCLUSIONS: Treating psychiatrists consider only a minority of patients on long-acting injection antipsychotics as suitable for discharge to primary care.

'They patiently heard what we had to say... this felt different to me': the palliative care needs and care experiences of advanced cancer patients and their families in Bangladesh.

BACKGROUND: In 2008, 70% of cancer deaths occurred in low- and middle-income countries. This study aimed to describe the needs and experiences of patients and families who received palliative care in Bangladesh, and those of the providing clinicians, in order to inform fledgling service development. METHODS: Patients, family members and specialist palliative care physicians (n=20) participated in a cross-sectional semistructured qualitative study. Following peer review of coding units, relational codes were established and a resulting frame constructed. RESULTS: The data fit well within the existing domains of palliative care, as respondents described the family-wide distress and impact of the disease, psychological, physical and social problems. However, the contextual experience of cancer in this setting revealed particular challenges, as respondents described anger, helplessness and mistrust towards existing (non-palliative) healthcare. Poor patient-doctor communication and unmet need for information contributed greatly to these poor experiences. By contrast, experience of palliative care was explained in radically different terms, with a clear shift in the nature of the interaction and resulting care, to bring effective communication and relief from suffering. CONCLUSION: To alleviate the distress to cancer patients and their families, it is essential for oncologists to receive adequate training in palliative care, especially in communication, holistic assessment and information giving. To meet the massive challenge in a country like Bangladesh, palliative care should be mainstreamed into the existing healthcare system for a feasible and sustainable public health approach.

The use of morphine to control pain in advanced cancer: an investigation of clinical usage in Bangladesh.

In 2007, 13% of all deaths worldwide were due to cancer, and of these 72% occurred in low- and middle-income countries. Opioids are essential for the successful delivery of palliative care and pain control. This paper reports data from a cross-sectional survey that aimed to investigate the use of morphine in advanced cancer in palliative care setting in Bangladesh, in order to inform clinical practice and fledgling service development. The study was a single semi-structured qualitative interview study. Cancer patients, family members and palliative care specialists (20 in total) were interviewed in two medical settings. Transcripts were transcribed verbatim, translated and cross-checked with two local interpreters. Data were imported into NVIVO 8 for coding. A coding frame was generated following line by line coding. Relational codes were established following peer review of coding units and the resulting frame. Despite having been under the pain and palliative care clinics only six out of 10 patients had received morphine. Lack of morphine availability resulted in physical suffering of patients and emotional distress of their families. Lack of availability of morphine was identified as the main barrier to pain control. International attention and collaboration with local policy makers is needed to simplify narcotic regulations and increase the availability of morphine.