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Objectives: To explore the experiences, acceptability and utility of a decision aid for family carers of people with dementia towards the end of life. Methods: We conducted semi‐structured interviews with a sample of family carers enroled into a 6‐month feasibility study in England, sampling to gain a range of experiences and views, based on relationship to person they cared for (e.g., spouse, adult child), age, gender, and self‐reported use of the decision aid during the feasibility study. Interviews were conducted in March 2021–July 2021 and analysed using reflexive thematic analysis. We used COREQ checklist to report our methods and results. Results: Family carers found the decision aid acceptable, describing it as comprehensive, accessible with relevant information and its presentation enabled good engagement. Experiences of the decision aid covered four main themes which demonstrated the perceived acceptability and utility: 1. A source of support and reassurance; 2. Empowering conversations and confidence; 3. Including the person living with dementia; and 4. Breaking down complexity. Conclusions: An aid focussing on decisions about dementia end of life care supported family carers break down complex and emotive decisions, not only with making decisions in the moment but also in future planning. Patient or Public Contribution: Our three Patient and Public Involvement (PPI) members (all former family carers) were crucial throughout the wider study. PPI supported development of the topic guides, supported trialling the topic guide and interview procedures and finally supported the development of themes as part of the analysis. [ABSTRACT FROM AUTHOR]

Most American and English cancer patients prefer to die at home. Factors associated with greater likelihood of dying at home have been contradictory in many studies and no studies have compared the effects of factors in different countries. The objective of this paper is to compare the factors affecting place of cancer death in two major cities, New York and London. Methods: We use data on all individuals aged ≥40 dying of cancer in London (59604) and New York City (51 668) in the years 1995 through 1998. The probability of death at home is examined in each city as a function of gender, age group (40-55, 56-64, 65-74, 75+), year, type of cancer, and area socioeconomic status, using multiple logistic regression. Results: Although the probability of death at home is the same in the two cities (∼1 in 5), being female lowers the odds of death at home by ∼7% in London, and raises it by ∼22% in New York. Older age is associated with increased odds of dying at home in New York but decreased odds of dying at home in London. Being in the lowest tercile of socioeconomic status (relative to the highest) lowers the odds of death at home by 22% in London and 39% in New York. Conclusion: Site of death varies significantly by patient and area characteristics in both cities, an understanding, which should be taken account of in future planning of end-of-life care. [ABSTRACT FROM AUTHOR]

Background: Terminal illness can cause a financial burden for many households. In England and Wales, fast-track access to welfare payments is available through special rules for the terminally ill (SRTI). Individuals are eligible for SRTI if they are judged to have 6 months or less to live. This criterion has been criticised as lacking a clinical basis, and being unfair for people with conditions where life-expectancy is difficult to accurately assess.Aim: To conduct a budget impact analysis on the possible increase in expenditure of personal independence payments (PIP) following a change in England and Wales to SRTI so that everyone with a terminal illness is eligible.Methods: The fraction of individuals with a given long-term condition was estimated by combining data from the Health Survey for England, the Office for National Statistics (ONS) and the Department for Work and Pensions. Logistic growth modelling and ONS population projections were used to project PIP expenditure from 2020 to 2025. The increased expenditure was calculated for hypothetical scenarios which may occur following an SRTI regime change, specifically an increase of 1, 2 and 3 percentage points in the fraction of individuals claiming PIP under SRTI. Data from the literature on the projected prevalence of mild, moderate and severe dementia was used to calculate the cost if everyone with a given severity of dementia claimed PIP under SRTI.Results: Under the current SRTI regime, PIP expenditure under SRTI was projected to increase from £0.231bn in 2020 to £0.260bn in 2025, compared to equivalent figures of £11.1bn and £12.7bn under non-SRTI. Expenditure in 2025 following an increase in the fraction claiming of 1, 2 and 3 percentage points was projected to be £1.1bn, £1.9bn and £2.7bn respectively. In 2025, PIP expenditure was estimated to be £7.4bn if everyone with dementia claimed under SRTI, compared to £6.4bn if only individuals with moderate and severe dementia claimed, and £4.7bn if only individuals with severe dementia claimed.Conclusion: Changes in SRTI are projected to lead to increases in PIP expenditure. However, the increased cost is small compared to expenditure under non-SRTI, especially as the highest costs were associated with extreme scenarios. [ABSTRACT FROM AUTHOR]

Background: Cancer affects millions of individuals globally, with a mortality rate of over eight million people annually. Although palliative care is often provided outside of specialist services, many people require, at some point in their illness journey, support from specialist palliative care services, for example, those provided in hospice settings. This transition can be a time of uncertainty and fear, and there is a need for effective interventions to meet the psychological and supportive care needs of people with cancer that cannot be cured. Whilst Acceptance and Commitment Therapy (ACT) has been shown to be effective across diverse health problems, robust evidence for its effectiveness in palliative cancer populations is not extensive. Method: This mixed-methods study uses a single-case experimental design with embedded qualitative interviews to pilot test a novel intervention for this patient group. Between 14 and 20 patients will be recruited from two hospices in England and Scotland. Participants will receive five face-to-face manualised sessions with a psychological therapist. Sessions are structured around teaching core ACT skills (openness, awareness and engagement) as a way to deal effectively with challenges of transition into specialist palliative care services. Outcome measures include cancer-specific quality of life (primary outcome) and distress (secondary outcome), which are assessed alongside measures of psychological flexibility. Daily diary outcome assessments will be taken for key measures, alongside more detailed weekly self-report, through baseline, intervention and 1-month follow-up phases. After follow-up, participants will be invited to take part in a qualitative interview to understand their experience of taking part and acceptability and perceived effectiveness of the intervention and its components. Discussion: This study is the first investigation of using ACT with terminally ill patients at the beginning of their transition into palliative treatment. Using in-depth single-case approaches, we will refine and manualise intervention content by the close of the study for use in follow-up research trials. Our long-term goal is then to test the intervention as delivered by non-psychologist specialist palliative care practitioners thus broadening the potential relevance of the approach. Trial registration: Open Science Framework, 46033. Registered 19 April 2018. [ABSTRACT FROM AUTHOR]

Presents a case study which described the introduction of Liverpool Care Pathway (LCP) for optimal care of patients dying from stroke in England and Wales. Key areas of care before and after implementation of the LCP; Number and proportion of patients who met the standard in key areas of care; Results of the study.

: Aim To examine time trends and deprivation gradients in fire-related deaths and injuries. : Methods A cross-sectional study and time trend analysis using data on fire casualties in England between 1995 and 2004 obtained from the Department for Communities and Local Government. Injury rates were calculated assuming a Poisson distribution. Incidence rate ratios (IRRs) were calculated to compare changes in deprivation gradients over time. : Results There were significant reductions in fatal and non-fatal fire injuries in children (fatal injuries IRR χ21 = 11.18, P < 0.001; non-fatal injuries IRR χ22 = 61.44, P < 0.001), adults (fatal injuries IRR χ21 = 15.99, P < 0.001; non-fatal injuries IRR χ22 = 183.25, P < 0.001) and older people (fatal injuries IRR χ21 = 56.88, P < 0.001; non-fatal injuries IRR χ22 = 54.09, P < 0.001) between 1995 and 2004. Adult and child fire deaths were most commonly caused by smokers materials (e.g. cigarettes, cigars and tobacco), and cigarette lighters and matches, respectively. Cooking appliances caused most non-fatal fire injuries. Injury rates increased with increasing levels of deprivation and deprivation gradients did not change over 10 years. : Conclusions Fire prevention interventions should promote the safe use of cooking and heating appliances and the responsible use of smokers materials, lighters and matches, and should target those at greater risk of fire, including the socially disadvantaged. [ABSTRACT FROM AUTHOR]