Suchergebnisse

Every hospital, mental health, primary care and specialist trust in the English National Health Service (NHS) should have a Patient Advice and Liaison Service (PALS), to provide information and support to NHS patients with questions or concerns. PALS should also act as a catalyst for service improvement. This article draws on findings from a qualitative study of London PALS. In particular, it focuses on data generated during observation of meetings of PALS staff in each of London'. five Strategic Health Authority (SHA) sectors, over a period of nearly two years. It describes two types of support received by PALS staff horizontal peer support (the sector meetings themselves; other informal and local PALS contacts; the National PALS Development Group) and vertical hierarchical support (the trusts where PALS are based; Strategic Health Authorities; the Department of Health (DoH)). PALS staff appreciated horizontal support more unequivocally than vertical. Both types of support (horizontal and vertical) reflect parallel government agendas. The Government intends the NHS to become a much flatter hierarchy, and in non-hierarchical structures, staff are expected to look to peers for support. However, a centralised performance management regime also requires staff to look upwards for guidance. As 'boundary spanners' working between services and service users, PALS staff are at risk of isolation, and need both types of support to be effective

Objective The Gynecologic Cancer InterGroup (GCIG)-Symptom Benefit Study was designed to evaluate the effects of chemotherapy on symptoms and health-related quality of life (HRQL) in women having chemotherapy for platinum resistant/refractory recurrent ovarian cancer (PRR-ROC) and potentially platinum sensitive with >= 3 lines of chemotherapy (PPS-ROC >= 3). Methods Participants completed the Measure of Ovarian Cancer Symptoms and Treatment (MOST) and European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire QLQ-C30 questionnaires at baseline and every 3-4 weeks until progression. Participants were classified symptomatic if they rated >= 4 of 10 in at least one-third of symptoms in the MOST index. Improvement in MOST was defined as two consecutive scores of = 10 points above baseline in the QLQ-C30 summary score scale (range 0-100). Results Of 948 participants enrolled, 910 (96%) completed baseline questionnaires: 546 with PRR-ROC and 364 with PPS-ROC >= 3. The proportions of participants symptomatic at baseline as per MOST indexes were: abdominal 54%, psychological 53%, and disease- or treatment-related 35%. Improvement was reported in MOST indexes: abdominal 40%, psychological 35%, and disease- or treatment-related 38%. Median time to improvement in abdominal symptoms occurred earlier for PRR-ROC than for PPS-ROC >= 3 (4 vs 6 weeks, p=0.044); median duration of improvement was also similar (9.0 vs 11.7 weeks, p=0.65). Progression-free survival was longer among those with improvement in abdominal symptoms than in those without (median 7.2 vs 2.5 months, p= 3 (p=0.29), and 102/481 (21%) of those with abdominal symptoms at baseline. Conclusion Over 50% of participants reported abdominal and psychological symptoms at baseline. Of those, 40% reported an improvement within 2 months of starting chemotherapy. Approximately one in six participants reported an improvement in HRQL. Symptom monitoring and supportive care is important as chemotherapy palliated less than half of symptomatic participants. ; Funding Agencies|NHMRCNational Health and Medical Research Council of Australia [1063012, 570893]; Target Ovarian Cancer [UCL-P001AL]; Cancer Research UKCancer Research UK; UCL Cancer Trials Centre [C444/A15953]; Australian Government through Cancer AustraliaAustralian Government; NHMRC Program grantNational Health and Medical Research Council of Australia; Department of HealthEuropean Commission