Accuracy and usefulness of the Palliative Prognostic Index in a community setting.

PURPOSE: In a community setting characterised by scarce inpatient palliative care resources, a precise prognosis could help determine which patients should be prioritised for end-of-life admission. AIM: The aim of this study was to assess the validity of the Palliative Prognostic Index (PPI) and to determine whether it is a helpful tool for nurses to administer as part of the admission protocol in the palliative care service of a community hospital. RESULTS: The PPI was a moderately accurate prognostic tool when assessing the frequency of 14-day overstay; 81% of patients died within 14 days of their expected prognosis. Based on sensitivity and specificity, the accuracy of the prognoses was acceptable for the 6-week prognosis group (80%), and poor for the 3-week prognostic group (53%). The tool was easy to administer by the admission nurse receiving referrals. CONCLUSION: A nurse-administered and minimally-invasive prognostic tool was helpful in this context.

Providing in-home palliative care within a generalist caseload: a chance for nurses to reflect on life and death.

At a time when the need for in-home palliative care is on the rise, the aim of this interpretive phenomenological study was to understand the experiences of homecare nurses providing palliative care within a generalist caseload. Eight such nurses from one district of Quebec were interviewed. Data analysis was carried out according to the phenomenological method developed by Giorgi. Three themes emerged from the analysis: supporting the patient and his/her family, being concerned about providing quality care, and being confronted with death fosters personal development. The findings that gave rise to the first two themes echo similar findings from the literature, but those from which the third theme emerged are more novel. Important considerations for personal and professional development are extrapolated from these findings.