CHINNADURAI R, MILLER M, LOWNEY A, SINHA S.
Abstract
Background and Aims
Calciphylaxis is a rare disease usually seen in patients with end-stage renal disease. Pain is a hallmark of this disease and can be extremely difficult to control. Anecdotal data suggests that pain management in calciphylaxis is unsatisfactory with differing practice, variable across the United Kingdom (UK) and also around the world. This knowledge, attitude and practice (KAP) survey aims to gather information on the current practice in the management of pain in patients with calciphylaxis.
Method
A pre-tested online questionnaire was circulated among physicians (renal and palliative care) involved in the management of pain in calciphylaxis. (https://www.gmann.co.uk/ website/calciphylaxis-pain-management-survey.cfm). The questionnaire included a mix of open-ended questions and questions with drop down options.
Results
One hundred and six clinicians responded to the survey of which 60 (57%) respondents were from palliative medicine and the remainder 46 (43%) were from renal medicine. There were 31 (30%) respondents, across both specialties who had not encountered any patients with a diagnosis of calciphylaxis (renal-2, palliative care-29). 18% of renal physicians refer patients to palliative care team, 32% refer to pain team and 50% refer to both. Only 3% of the palliative medicine respondents indicated that they’d received a referral from the renal team at the time of diagnosis. Opioids were the preferred initial drug of choice for the management of all types of pain although the preferred drug varied with the specialities (Fig–1). Paracetamol was universally selected as the preferred first-choice adjuvant agent for management of all types of pain. Additional procedures to aid pain management (epidural analgesia and nerve blocks) were used by 6.6% of respondents. A majority (83%) felt the presence of infection impacts on the effectiveness of pain control. The importance of advanced care planning was also highlighted with 72% undertaking advanced care planning discussions often or most of the times.
Conclusion
In conclusion, there was wide variation in the current practice of management of pain in calciphylaxis, with variation between renal specialists and palliative care specialists. Referral to pain specialists is not universal despite the severe nature of the pain experienced by patients with calciphylaxis. The data generated will enable us to develop a practice guideline to support complex pain management in a group of patients with multiple comorbidities.
P1408
PAIN MANAGEMENT IN CALCIPHYLAXIS: A KNOWLEDGE, ATTITUDE AND PRACTICE SURVEY AMONG PHYSICIANS
Rajkumar Chinnadurai, Mary Miller, Aoife Lowney, Smeeta Sinha
Nephrology Dialysis Transplantation, Volume 35, Issue Supplement_3, June 2020, gfaa142.P1408, https://doi.org/10.1093/ndt/gfaa142.P1408
Published: 06 June 2020
SUTHERLAND AE, STICKLAND J, WEE B.
BMJ Support Palliat Care 2020; doi: 10.1136/ bmjspcare-2020-002326
Abstract
During the Covid-19 pandemic, a strategy to minimise face-to-face (FtF) visits and limit viral
spread is essential. Video consultations offer clinical assessment despite restricted movement of people. We undertook a rapid literature review to identify the highest currently available level of evidence to inform this major change in clinical practice. We present a narrative synthesis of the one international and one national guideline and
two systematic reviews—all published within the last 18 months.
The global evidence appears to support video consultations as an effective, accessible,
acceptable and cost-effective method of service delivery. Organisations must ensure software is simple, effective, reliable and safe, with the highest level of security for confidentiality. Although video consultations cannot fully replace FtF, they can radically reduce the need for FtF and the risk of Covid-19 spread in our communities while maintaining high standards of care. For patient safety, it will be critical to follow the WHO guidance regarding: a standard operating procedure; clinical protocols for when video consultations can (and cannot) be used; policies to ensure equity of access in disadvantaged populations; adequate staff training; and administrative support to coordinate appointments.
SUTHERLAND A, CAREY M, MILLER M.
Has been successfully submitted online and is presently being given full consideration for publication in BMJ Support Palliat Care. April 2020
HARRIS-SKILLMAN E, CHAPMAN S, LOWNEY A, MILLER M, FLIGHT W.
BMJ Support Palliat Care 2020;0:1–3. doi:10.1136/bmjspcare-2020-002274
Abstract
Objectives: Optimal cystic fibrosis (CF) end of-life care (EOLC) is a challenge. There is little formal guidance about who should deliver this and how CF multi-disciplinary teams should interact with specialist palliative care. We assessed the knowledge, experience and preparedness of both CF and palliative care professionals for CF EOLC.
Methods: An electronic questionnaire was distributed to all members of the Oxford adult CF and palliative care teams. Results 35 of a possible 63 members responded (19 CF team; 16 palliative care). Levels of preparedness were low in both groups. Only 11% of CF and 19% of palliative care team members felt fully prepared for EOLC in adult CF. 58% of CF members had no (21%) or minimal (37%) general palliative care training. Similarly, 69% of the palliative care team had no CF-specific training. All respondents desired additional education. CF team members preferred further education in general EOLC while palliative care team members emphasised a need for more CF-specific knowledge.
Conclusions: Few members of either the CF or palliative care teams felt fully prepared to deliver CF EOLC and many desired additional educations. They expressed complementary knowledge gaps, which suggests both could benefit from increased collaboration and sharing of specialist knowledge.
