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dc.contributor.advisorMurray, Scotten
dc.contributor.authorBoyd, Kirsty Jeanen
dc.date.accessioned2017-08-18T14:35:31Z
dc.date.available2017-08-18T14:35:31Z
dc.date.issued2016-07-02
dc.identifier.urihttp://hdl.handle.net/1842/23389
dc.description.abstractIdentifying people with advanced illnesses whose health is deteriorating, assessing their needs and planning care proactively with them are healthcare priorities given the demographic trend of ageing populations in the UK and internationally. Over the past 10 years (2004-2014), I have led a series of research studies that have made an important academic contribution to improving palliative care services for patients with heart disease and advanced multimorbidity. My first paper reported secondary analysis of data generated from a qualitative study of the illness and care experiences of patients with advanced heart failure. This work used innovative, qualitative research methods to explore and understand patient, carer and health professional perspectives over time. My second study then evaluated whether health and social care services were configured and delivered in response to the needs of people with heart failure and their families. This led me to recommend an anticipatory care framework which integrated a palliative care approach with other aspects of treatment and care. Around this time, advance care planning (planning ahead to facilitate end-of-life care aligned with people’s goals and preferences) was being strongly advocated by NHS health policy makers despite limited research in the UK. For my third study, I evaluated an evidence-based, educational intervention for general practitioners while also exploring barriers and facilitators to advance care planning in primary care for patients with cancer or other advanced conditions. It was becoming increasingly clear that failure to identify people with deteriorating health and a high risk of dying in a timely way was a major barrier to more effective palliative care. The problem was greatest for patients with non-malignant conditions whose illness trajectory is much less easy to predict than in cancer populations. I therefore started to research and develop a new clinical tool designed to prompt early, proactive patient identification in routine clinical practice – the Supportive and Palliative Care Indicators Tool (SPICT). My fourth research paper reported an evaluation of the SPICT in a mixed-methods study in a large tertiary care hospital. The SPICT was then used to identify people with multimorbidity for my fifth study, a longitudinal exploration of patient and carer experiences of hospital admission and ongoing community care. In my final paper, I drew on my previous research and combined this with well-developed approaches to timely identification and effective communication. I described the design of a successful pilot randomised trial of future care planning with people who had advanced heart disease and their carers. This thesis presents a critical review of these six research studies setting them in context and demonstrating the impact they have had in ensuring that high quality research evidence informs current and future developments in palliative care policy and clinical practice.en
dc.language.isoen
dc.publisherThe University of Edinburghen
dc.relation.hasversionBoyd KJ, Murray SA, Kendall M, Worth A, Benton TF, Clausen H. Living with advanced heart failure: a prospective, community based study of patients and their carers. Eur J Heart Fail. 2004; 6(5):585-591. http://www.ncbi.nlm.nih.gov/pubmed/15302006en
dc.relation.hasversionBoyd KJ, Worth A, Kendall M, Pratt R, Hockley J, Denvir M, Murray SA. Making sure services deliver for people with advanced heart failure: a longitudinal qualitative study of patients, family carers, and health professionals. Palliat Med. 2009; 23(8):767-776. http://pmj.sagepub.com/content/23/8/767en
dc.relation.hasversionBoyd K, Mason B, Kendall M, Barclay S, Chinn D, Thomas K, Sheikh A, Murray SA. Advance care planning for cancer patients in primary care: a feasibility study. Br J Gen Pract. 2010; 60(581):e449-458. http://www.ncbi.nlm.nih.gov/pubmed/21144189en
dc.relation.hasversionHighet G, Crawford D, Murray SA, Boyd K. Development and evaluation of the Supportive and Palliative Care Indicators Tool (SPICT): a mixedmethods study. BMJ Support Palliat Care. 2014; 4(3):285-290. http://spcare.bmj.com/content/4/3/285.full.pdf+htmlen
dc.relation.hasversionMason B, Nanton V, Epiphaniou E, Murray SA, Donaldson A, Shipman C, Daveson B, Harding R, Higginson I, Munday D, Barclay S, Dale J, Kendall M, Worth A, Boyd K. “My body’s falling apart”. Understanding the experiences of patients with advanced multimorbidity to improve care: serial interviews with patients and carers. BMJ Support Palliat Care. 2013; 0:1–6.doi:10.1136/bmjspcare-2013-000639. http://spcare.bmj.com/content/early/2014/05/28/bmjspcare-2013- 000639.full.pdf+htmlen
dc.relation.hasversionDenvir MA, Highet G, Robertson S, Cudmore S, Reid J, Ness A, Hogg K, Weir C, Murray S, Boyd K. Future care planning for patients approaching end-of-life with advanced heart disease: an interview study with patients, carers and healthcare professionals exploring the content, rationale and design of a randomised clinical trial. BMJ Open. 2014;4:e005021.doi:10.1136/bmjopen-2014-005021. http://www.ncbi.nlm.nih.gov/pubmed/25023130en
dc.subjectpalliative careen
dc.subjectheart failureen
dc.subjectprimary careen
dc.subjectend-of-life careen
dc.titleEarly palliative care for people with advanced illnesses: research into practiceen
dc.typeThesis or Dissertationen
dc.type.qualificationlevelDoctoralen
dc.type.qualificationnamePhD(P) Doctor of Philosophy by Research Publicationsen


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