The prevalence of anxiety and depression in palliative care patients with cancer in Western Australia and New South Wales.

OBJECTIVES: To examine the prevalence and predictors of depression and anxiety in palliative care patients with cancer in Western Australia and New South Wales. DESIGN, SETTING AND PARTICIPANTS: A descriptive study of 266 consecutive patients at a range of inpatient and outpatient settings including home care, hospices, and private and tertiary care hospitals in WA and NSW from 1 March to 30 June 2002. MAIN OUTCOME MEASURES: Self-reported anxiety and depression using the Hospital Anxiety and Depression Scale (HADS) at a cut-off score of > or = 8 on each subscale (depression and anxiety) for possible cases, and of > or = 11 for probable cases; a cut-off score of > or = 19 was used for probable combined depression and anxiety. RESULTS: Patients included 200 in WA and 66 in NSW. For the whole sample, 45.8% of patients were possibly depressed and 22.7% probably depressed; 36.9% were possibly anxious and 19.8% probably anxious. About 25% of patients had probable combined depression and anxiety. Logistic regression analyses indicated that past anxiety in the family predicted probable depression, while age, marital status and past depression predicted probable anxiety. Age and past depression predicted probable combined depression and anxiety. CONCLUSIONS: These findings underscore the need for routine screening for anxiety and depression in palliative care settings, including questions about past personal and family history of anxiety and depression, and the need for a range of interventions and support services.

Evaluation of the Bereavement Risk Index (BRI): a community hospice care protocol.

AIM: to test the validity, reliability and feasibility of using a modified version of Parkes' (1993) Bereavement Risk Index (BRI) and bereavement support protocol in an Australian home hospice care setting. In addition, the study aimed to explore what types of family members are most likely to experience a more difficult grief reaction. DESIGN: a prospective, descriptive study was used. One hundred and fifty bereaved family members participated. Bereaved family members were classified as high, medium or low risk and received a structured bereavement support protocol based on their level of risk as measured by the BRI. FINDINGS: results indicated that a shorter 4-item version of the BRI was more internally consistent than the longer version and demonstrated good predictive validity when correlated with outcome measures at 3 months following the patient's death. CONCLUSION: the modified 4-item BRI demonstrated acceptable reliability and validity and was brief and simple to use. Nurses were able to use the instrument with minimal training and were able to adhere to a matched bereavement support protocol.

Evaluation of a nurse education workshop on children's grief.

This paper provides an overview of the development and evaluation of an educational program to increase the knowledge of hospice and paediatric nurses who support grieving children and improve their attitudes toward death and bereavement. The specific target groups for the project included nurses providing care through community-based hospice services and inpatient palliative care units, as well as nurses providing inpatient and community-based care at a children's teaching hospital. Fifty-nine nurses from hospice, community and inpatient settings participated in three workshops. Results indicated that the workshop produced a sustained improvement in bereavement knowledge among the nurses and an improvement in their attitudes toward death and bereavement.

Evaluation of a night respite community palliative care service.

A three-phase project was undertaken to develop and evaluate a community night respite palliative care service for patients and family carers. An assessment tool to identify those most in need of night respite was developed and tested. The tool was reliable and feasible for use in practice. Care aides were trained to provide night respite. Fifty-three patients participated over 11 months. Findings revealed the types of patients and families most in need of night respite, the amount of respite needed, and location of death. There is evidence that patients who would have been transferred to an inpatient setting for end-of-life care were able to die at home with the support of the night respite service. Families were extremely appreciative of the service and a limited cost comparison suggested costs were lower than if patients had been transferred to hospital and/or inpatient hospice care. Recommendations for practice are offered.

Intrathecal catheters: developing consistency in filter use and dressings in Perth, Australia.

The use of opioids presents practitioners with many challenges, such as the variation in responses and side effects seen with traditional methods of administration. This has prompted an increase in the consideration of the intrathecal route for the management of patients with refractory cancer pain. Although this has increased the therapeutic options available to patients, it has also led to more complicated pain management strategies. In Perth, Western Australia, it was identified that clinical variations, especially in the programming of the pump maintenance of the filters and associated dressings, occurred between service providers, causing confusion and anxiety for patients, families and practitioners. This article discusses a review of nursing management of patients receiving intrathecal analgesia and the collaboration of all services in the development of evidence-based policy.