Measuring symptom distress among frail elders capable of providing self reports.

This study aimed to develop a valid and reliable method of measuring symptom distress in frail elderly people capable of providing self reports. We tested a tool used in palliative care settings with 46 elders in residential aged care, refined the tool, and tested the new version with 48 additional elders. Items assessed the prevalence and severity of distress attributed to nausea; pain; insomnia; fatigue; and breathing, bowel and appetite problems in the first phase, and pain; insomnia; fatigue; and breathing, bowel, and bladder problems in the second phase. Participants rated symptom distress on a 10-point scale over 5 days. Internal consistency reliability coefficients for the revised tool ranged from 0.50 to 0.64. Concurrent validity with an established measure of well-being was demonstrated. Further research will assess stability. The tool provides a valid overview of symptom distress in frail aged people able to provide self reports.

"A planning guide": Developing a consensus document for palliative care service provision.

Over the past 30 years, palliative care services have developed in an ad-hoc way in Australia and around the world. Community expectations for palliative care have grown in recent years. As palliative care has evolved, the World Health Organization definition of palliative care has changed substantially. The changes challenge those who are involved in planning, funding and provision of services to meet new expectations. Many services have not attracted adequate nursing, medical and allied health resources to provide interdisciplinary palliative care. A national consensus document ("a planning guide") has been developed in consultation with key stakeholders and organisations. It outlines the minimum needs for service provision, independent of fundholders and models of service delivery.

Evaluating the Navigate Care Model: clinical palliative care pathways based on anticipated care outcomes.

The Navigate Care Model (NCM) specifies clinical pathway assignments for hospice patients based on the anticipated outcomes of death, discharge home, or discharge into residential care. This study, set in a freestanding, inpatient hospice, evaluated the effects of NCM implementation on 338 patients, 154 family members and the organization, including 49 staff. Accuracy of pathway assignment on admission was also assessed. The results indicate that patients' symptoms were managed as well or better than previously, as compared with 1998 data. Discharged patients reported being highly satisfied with care and there were fewer readmissions. Families reported greater satisfaction with care than those surveyed previously, as compared with 1999 data. Staff reported initial negative effects but elected to retain a refined version of the model after the study. Pathway assignments on admission were correct 64% of the time, 92% correct when assignment was for terminal care. Clinical pathways based upon the expected outcomes of death or discharge appear to offer benefits for patients and families.