Ebony Lewis


Perceived barriers and facilitators for general practitioner-patient communication in palliative care: a systematic review.

Slort W, Schweitzer BP, Blankenstein AH, Abarshi EA, Riphagen II, Echteld MA, Aaronson NK, van der Horst H, Deliens L

End-of-life priorities of older adults with terminal illness and caregivers: A qualitative consultation.

Lewis ET, Harrison R, Hanly L, Psirides A, Zammit A, McFarland K, Dawson A, Hillman K, Barr M, Cardona M

This study aimed to explore patient and family experiences and identify factors deemed important to quality EOL care. Our study highlights that to better adhere to EOL patient's wishes a reorganization of care needs is required. The readiness of the health system to cater for this expectation is questionable as real choices may not be available in acute hospital settings. With an ageing population, a reorganization of care which influences the way we manage terminal patients is required.

Dissonance on perceptions of end-of-life needs between health-care providers and members of the public: Quantitative cross-sectional surveys.

Cardona M, Lewis E, Shanmugam S, Nicholson M, Williamson M, Hanly L, Hillman K

To investigate views, determinants and barriers to end-of-life discussions for doctors, nurses and members of the public (MoP) and their acceptability of risk prediction tools. A dissonance exists between doctor/nurses perception of older peoples' preference for receiving prognostic information and the public desire for involvement in decision-making at the end of life. As public attitudes change, strategies for greater involvement of patients in shared end-of-life planning are warranted.

Which frailty scale for patients admitted via Emergency Department? A cohort study.

Lewis ET, Dent E, Alkhouri H, Kellett J, Williamson M, Asha S, Holdgate A, Mackenzie J, Winoto L, Fajardo-Pulido D, Ticehurst M, Hillman K, McCarthy S, Elcombe E, Rogers K, Cardona M

To determine the prevalence of frailty in Emergency Departments (EDs); examine the ability of frailty to predict poor outcomes post-discharge; and identify the most appropriate instrument for routine ED use. This study confirms that screening for frailty in older ED patients can inform prognosis and target discharge planning including community services required. The CFS was as accurate as the Fried and SUHB in predicting poor outcomes, but more practical for use in busy clinical environments with lower level of disruption. Given the limitations of objectively measuring frailty parameters, self-report and clinical judgment can reliably substitute the assessment in EDs. We propose that in a busy ED environment, frailty scores could be used as a red flag for poor follow-up outcome.

Efficacy of a tool to predict short-term mortality in older people presenting at emergency departments: Protocol for a multi-centre cohort study.

Cardona M, Lewis ET, Turner RM, Alkhouri H, Asha S, Mackenzie J, Perkins M, Suri S, Holdgate A, Winoto L, Chang CW, Gallego-Luxan B, McCarthy S, Kristensen MR, O'Sullivan M, Skjøt-Arkil H, Ekmann AA, Nygaard HH, Jensen JJ, Jensen RO, Pedersen JL, Breen D, Petersen JA, Jensen BN, Mogensen CB, Hillman K, Brabrand M

Predictive validity of the CriSTAL tool for short-term mortality in older people presenting at Emergency Departments: a prospective study.

Cardona M, Lewis ET, Kristensen MR, Skjøt-Arkil H, Ekmann AA, Nygaard HH, Jensen JJ, Jensen RO, Pedersen JL, Turner RM, Garden F, Alkhouri H, Asha S, Mackenzie J, Perkins M, Suri S, Holdgate A, Winoto L, Chang DCW, Gallego-Luxan B, McCarthy S, Petersen JA, Jensen BN, Backer Mogensen C, Hillman K, Brabrand M

The modified CriSTAL tool (with CFS instead of Fried's frailty instrument) has good discriminant power to improve prognostic certainty of short-term mortality for ED physicians in both health systems. This shows promise in enhancing clinician's confidence in initiating earlier end-of-life discussions.

Prospective Validation of a Checklist to Predict Short-term Death in Older Patients After Emergency Department Admission in Australia and Ireland.

Cardona M, O'Sullivan M, Lewis ET, Turner RM, Garden F, Alkhouri H, Asha S, Mackenzie J, Perkins M, Suri S, Holdgate A, Winoto L, Chang DCW, Gallego-Luxan B, McCarthy S, Hillman K, Breen D

The modified CriSTAL tool (with CFS instead of Fried's frailty instrument) had good discriminant power to improve certainty of short-term mortality prediction in both health systems. The predictive ability of models is anticipated to help clinicians gain confidence in initiating earlier end-of-life discussions. The practicalities of embedding screening for risk of death in routine practice warrant further investigation.

Who Benefits from Aggressive Rapid Response System Treatments Near the End of Life? A Retrospective Cohort Study.

Cardona M, Turner RM, Chapman A, Alkhouri H, Lewis ET, Jan S, Nicholson M, Parr M, Williamson M, Hillman K

Identifiable risk factors clearly associated with poor clinical outcomes and death can be used as a guide to administer less aggressive treatments, including reconsideration of ICU transfers, adherence to NFR orders, and transition to end-of-life management instead of calls to the RRS team.

Recognising older frail patients near the end of life: What next?

Cardona-Morrell M, Lewis E, Suman S, Haywood C, Williams M, Brousseau AA, Greenaway S, Hillman K, Dent E

Evidence still insufficient that advance care documentation leads to engagement of healthcare professionals in end-of-life discussions: A systematic review.

Lewis E, Cardona-Morrell M, Ong KY, Trankle SA, Hillman K

Perceived effectiveness of advance care documentation in encouraging end-of-life discussions appears to be high but is mostly derived from low-level evidence studies. This may indicate a willingness and openness of patients, surrogates and staff to perceive advance directives as an instrument to improve communication, rather than actual evidence of timeliness or effectiveness from suitably designed studies. The assumption that advance care documentations will lead to higher physicians' confidence or engagement in communicating with patients/families could not be objectively demonstrated in this review.

Pre-existing risk factors for in-hospital death among older patients could be used to initiate end-of-life discussions rather than Rapid Response System calls: A case-control study.

Cardona-Morrell M, Chapman A, Turner RM, Lewis E, Gallego-Luxan B, Parr M, Hillman K

In a sample of older deteriorated patients requiring a RRS attendance, multiple indicators of chronic illness, cognitive impairment and frailty were significantly associated with high risk of death. These clinical features beyond the evident orders for limitation of medical treatment should signal the need for clinicians to initiate end-of-life discussions that may prevent futile interventions.