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Guidelines and Policy Briefs

This page provides links to a range of guidelines and policy briefs.

Guidelines are designed to guide care and practice, and to support professionals in decision making. They are based on latest research and statistics and have a direct application in clinical practice. Clinical guidelines are endorsed by various medical regulatory bodies.

Policy briefs are short, two page documents containing findings from our research translated into key policy recommendations. These are published as and when we have new and important research findings. The impact of this research is crucial for the field, potentially both nationally and internationally. Policy recommendations are targeted towards professionals, organisations and government.

 
 Spasticity in adults_

Spasticity in adults: management using botulinum toxin (2nd edition)

These guidelines provide recommendations for the treatment of adults with spasticity with botulinum toxin (BoNT) as part of an overall patient management programme.

Further research should focus on the totality of what is a complex intervention, and include the physical interventions often applied with pharmacological interventions such as BoNT, in the management of spasticity.

Key messages from this update:

• The inclusion of BoNT within the wider rehabilitation program has been developed. Greater emphasis is included on pre and post injection physical and postural management interventions. Evidence for combined physical and pharmacological interventions is provided where this is available.

• Changes in UK legislation regarding the administration and prescribing of medication mean that, in addition to medical staff, physiotherapists and nurses (and in some instances other health professionals) are trained to inject and/or prescribe BoNT and other pharmacological agents used in the management of spasticity. This was addressed in the last edition, but is expanded and integrated into the practice based advice.

• All BoNT injections should be accompanied by a formal assessment of outcome. Outcome measures should be relevant to the documented goals for treatment. In the last decade a substantial body of work has been undertaken to develop a consistent approach to outcome measurement that can be used in this area of practice. This includes:

• A structured approach to goal attainment (using Goal Attainment Scaling) to capture achievement of the intended goals for treatment.

• A Focal Spasticity Index that applies a limited set of standardised measures alongside GAS; the choice of measures for the individual patient being determined by their priority goal areas for treatment.

The rationale for this is to combine a person-centred approach to goal setting and standardised outcome measurement, which provides comparable information across different populations, practices and programmes of care and avoids excessive burden in data collection.

Clinical implications

The purpose of these guidelines is to provide clinicians with the knowledge and tools to use BoNT appropriately within rehabilitation incorporating spasticity management. The principles are:

• appropriate patient selection

• establishment of clear goals for treatment

• clear establishment of the immediate and on-going treatment programme including rehabilitation and maintenance physical interventions.

• formal evaluation of outcome.

Reference

Royal College of Physicians; British Society of Rehabilitation Medicine; The Chartered Society of Physiotherapy; Association of Chartered Physiotherapists in Neurology and the Royal College of Occupational Therapists (2018). Spasticity in adults: management using botulinum toxin. National guidelines. Guideline Development Group: S Ashford (editor); L Turner-Stokes; R Allison, L Duke; P Moore; G Bavikatte; S Kirker, A Ward, D Bilton. London, Royal College of Physicians.

Further details

Tel: +44 (0)20 3075 1358 (08.00–16.00)

Email: publications@rcplondon.ac.uk 

 

Download a free copy  

 

Order a hard copy (£20.00)

policy-brief

Care homes could overtake hospitals as the most common place to die

Key findings

  • If the recent decline in hospital deaths is sustained, by 2040 deaths in care homes and at home will double, and care homes will become the most common place to die.
  • If there is no expansion of bed-capacity and end-of-life care training for staff in care homes and in home care services, people are likely to seek help from hospitals, putting pressure on an already strained system.

Policy Recommendations

  • We urgently need a policy response that strategically plans for the future increased need for end-of-life care across all care settings.
  • If we are to continue enabling people to die in their preferred place, it is essential to invest more in care homes and community health services.
  • The development of innovative models of care to support increasing numbers of people in their preferred setting at the end of life is imperative.

Download Policy Brief

Evidence Reference

Bone AE, Gomes B, Etkind SN, Verne J, Murtagh FEM, Evans CJ, and Higginson IJ. What is the impact of population ageing on the future provision of end-of-life care? Population-based projections of place of death. Palliative Medicine 2017 doi: 10.1177/0269216317734435.

 

policy-brief

A&E attendance for people dying with dementia: common and increasing

Key Findings

  • The majority of people with dementia (78.6%) attend Accident & Emergency (A&E) at least once in their last year of life.
  • A&E attendance becomes more common the closer people are to death: 44.5% of people with dementia had at least one A&E attendance in their last month of life; 20.9% had at least one A&E attendance in their last week of life.
  • People who live in care homes have fewer A&E attendances in their last year of life, which may be because plans were put in place to avoid this.
  • A&E attendance has increased over time, by 62% over five years, indicating increasing reliance on emergency care for people dying with dementia.

Policy Recommendations

  • Policy makers must consider a broader range of indicators of the quality of end-of-life care, taking into account not just where a person dies but the care they receive during the preceding months.
  • Investment in community care, including care homes, is likely to be key to avoiding unplanned A&E attendance in the last months of life.

Download Policy Brief

Policy brief "A&E attendance for people dying with dementia: Common and increasing" (PDF 0.5 MB)

Evidence Reference

Sleeman KE, Perera G, Stewart R, Higginson IJ. Predictors of emergency department attendance by people with dementia in their last year of life: Retrospective cohort study using linked clinical and administrative data. Alzheimer’s and Dementia 2017. DOI: http://dx.doi.org/10.1016/j.jalz.2017.06.2267

policy-brief

'Palliative Care Need Projected to Rise by 42% in the Next 25 Years'

New findings from research at the Cicely Saunders Institute, King’s College London:

We undertook a study of palliative care need for the population of England and Wales, and projected this forward 25 years using official mortality forecasts:

  • Our projections show that if recent trends in mortality continue, the number of people who may have palliative care needs will grow out of proportion to changes in population demographics in the next 25 years, meaning that approximately 160,000 (42%) more people per year will need palliative care
  • Deaths from dementia will almost quadruple if recent trends continue, with cancer deaths also projected to rise.

Policy recommendations:

  • The number of people who are likely to need palliative care will grow out ofproportion to changes in population demographics in the next 25 years, and sothere is an urgent need to transform health, social, and palliative care services tomeet this projected growth.
  • Palliative care services need greatly increased resources over the next twodecades to deal with this rising need.Healthcare services must adapt now to meet these projected increased needs.
  • All sectors should put greater focus on the needs and preferences of people at theend of life, particularly those dying from chronic and complex illnesses, such as dementia.
  • Specialist and non-specialist services need to be prepared to care for people for alonger duration as conditions with a longer illness course become more common.

Download:

Policy Brief 'Palliative Care Need Projected to Rise by 42% in the Next 25 Years' (PDF 1.00MB)

Evidence reference:

Etkind S, Bone AE, Gomes B, Lovell N, Evans CJ, Higginson IJ, and Murtagh FEM. How many people will need palliative carein 2040? Past trends, future projections and implications for services. BMC Medicine, 2017. Available at: DOI: 10.1186/s12916-017-0860-2

policy-brief

'Dying at Home or Hospital: Dependent on Wealth, Location & Number of Diseases'

New findings from research at the Cicely Saunders Institute, King’s College London:

Hospital deaths from respiratory diseases, COPD and IPD, fell by 3-6% in the 8 years following the introduction of the End of Life Care Strategy, reversing previous trends. However:

  • People with more than 1 disease or disorder (multimorbidity) did not show a fall in hospital deaths.
  • People with 3 or more different diseases as well as their COPD or IPD, were over a third more likely to die in hospital than those who did not.
  • Deprivation also independently increased the chances of dying in hospital.
  • Living in urban areas increased the chances of hospital death. London had the highest hospital deaths, and the South-West and South East Coast regions had lower hospital deaths than most other regions.

Policy recommendations: 

  • It is essential that future strategies for end of life and palliative care directly target those at highest risk, especially with multimorbidity, and in deprived areas and cities - this may require different approaches.
  • The quality of palliative care is important in all places where people are cared for; home, hospital and hospices. Finding an alternative to hospital for people with multimorbidity may be especially difficult, and may require in-patient beds in hospices, palliative care beds in hospitals or different, more intensive support at home.

Download:

Policy Brief 'Dying at home or hospital: dependent on wealth, location and number of diseases' (PDF 1.00MB)

Evidence reference:

Higginson IJ, Reilly CC, Bajwah S, Maddocks M, Constantini M, Wei G. Which patients with advanced disease die in hospital: a 14 year population-based study of trends and associated factors? BMC Medicine 2017. Available from: DOI 10.1186/s12916-016-0776-2

policy-brief

'Increased Use of Outcome Measures: How and Why They Improve Patient Care'

New findings from research at the Cicely Saunders Institute, King’s College London:

  • Outcome measures are becoming more widely used on a national and international scale in order to improve the quality and cost-effectiveness of service delivery.
  • Palliative needs are beginning to be recognised among a variety of populations beyond those with cancer.
  • The POS family of outcome measures provide brief yet robust tools to capture what matters to patients and families in advanced illness.

Policy recommendations: 

  • Current barriers to implementation of outcome measures are a lack of time, resources and training. There should be increased investment in resources and training, and encouragement to standardise the use of outcome measures in routine palliative care.
  • There is a need to improve existing measures rather than develop new resources for use in clinical practice. There is also a need for future research to compare data collected using outcome measures internationally and compare symptoms and needs across different disease groups.

Download:

Policy Brief 'Increased Use of Outcome Measures: How and Why They Improve Patient Care' (PDF 1.00MB)

Evidence reference:

Collins ES, Witt J, Buasewein C, Daveson BA, Higginson IJ and Murtagh FEM. A Systematic Review of the Use of the Palliative Care Outcome Scale and the Support Team Assessment Schedule in Palliative Care. Journal of Pain and Symptom Management. 2015 December; 50 (6): 842–853. Avalilable from: DOI: 10.1016/j.jpainsymman.2015.07.015       

policy-brief

'Patient Centred Outcome Measures (PCOMs) improve communication and the emotional well-being of the patients in the last stage of life'

New findings from research at the Cicely Saunders Institute, King’s College London:

  • Patients who feedback information about their quality of life via structured questionnaires (PCOMs) report improved emotional well-being.
  • Feedback of PCOMs data also improves communication between patients and health professionals.
  • Information captured by PCOMs help health professionals to identify unmet patient needs and concerns, and allows them to act to deliver more effective and cost-effective care.

Policy recommendations: 

  • Ensure use of PCOMs plays a key role in the formation of clinical care plans to increase emphasis on person-centered care.
  • Provide training and resources to all palliative care health professionals to facilitate effective use of PROMs.
  • Invest in research to further assess the impact of PCOMs feedback on health care outcomes, particularly in regards to the effect on the performance of palliative care multidisciplinary teams.
  • Fund implementation projects to further understand how and why PROMs can work in clinical practice and identify ways in which the measures can be improved.

Download:

Policy Brief 'Patient Centered Outcome Measures (PCOMs) improve communication and the emotional well-being of patients in the last stage of life' (PDF 1.00MB)

Evidence reference:

Etkind SN, Daveson BA, Kwok W, Witt J, Bausewein C, Higginson IJ and Murtagh FEM: Capture, Transfer, and Feedback of Patient-Centered Outcomes Data in Palliative Care Populations: Does It Make a Difference? A Systematic Review. Journal of Pain and Symptom Management. 2015 March; 49 (3): 611-624. Available from: DOI:10.1016/j.jpainsymman.2014.07.010

policy-brief

'IPOS in the UK and Germany: How Interviewing Patients Can Shape Research'

New findings from research at the Cicely Saunders Institute, King’s College London:

  • In response to patient and clinician demands, we have developed the IPOS (Integrated Palliative care Outcome Scale) measure, which has been shaped to reflect the main symptoms and concerns of people with advanced illness
  • This study demonstrates the importance of interviewing people with advanced illness about the measures which are being used to assess and review their individual symptoms and concerns.
  • The use of interviewing in two languages – for the first time in palliative care – provided important additional information. This enabled our team to create a measure which was as relevant and useful as possible for people with advanced illness, and for the professionals caring for them.

Policy recommendations: 

  • IPOS is now available for clinical use; it is one of the few brief measures tested in this population that covers all relevant areas.
  • The refined version of the IPOS is currently undergoing further testing to ensure it works well.
  • The use of cognitive interviewing is a crucial part of refining measures in order to gather a wide range of perspectives from those with advanced illness themselves. Conducting interviews in two languages deepens this understanding.
  • People with advanced illness did not find it distressing or burdensome to complete the questionnaire.

Download:

Policy Brief 'IPOS in the UK and Germany: How Interviewing Patients Can Shape Research' (PDF 1.00MB)

Evidence reference:

Schildmann EK, Groeneveld IE, Denzel J, Brown A, Bernhardt F, Bailey K, Guo P, Ramsenthaler C, Lovell N, Higginson IJ, Bausewein C and Murtagh FEM. Discovering the hidden benefits of cognitive interviewing in two languages: The first phase of a validation study of the Integrated Palliative care Outcome Scale. Palliative Medicine. 2015 September. Avaliable from: DOI:10.1177/0269216315608348

policy-brief

'Home death is associated with better patient and caregiver outcomes - but requires wider support'

New findings from research at the Cicely Saunders Institute, King’s College London:

  • Patients who die at homen experince more peace and a similar amount of pain in their last week of life compared to those who die in hospital, and their relatives also experience less grief.
  • Some conditions are almost essential to enable patients to die at home: patient's preference, relative's preference, receipt of home palliative care and district/community nursing. 
  • Patients who discuss preferences, have home visits from their GP and whose relatives take more days off work have greater odds of dying at home. 

Policy recommendations: 

  • Ensure all areas have access to a comprehensive home care package, including specialist palliative care services and 24/7 district/community nursing. There are regions where the workforce providing essential elements of this care package is being reduced. 
  • Facilitate family caregiving, considering social programmes or employment insurance benefits, similar to maternity leave, aimed at supporting families to provide care for their dying relatives. 
  • Encouarge discussion of preferences within the clinical setting. End of life conversations take time and training; they are currently not paid for and do not happen as often as they should.

Download:

Policy Brief 'Home death is associated with better patient and caregiver outcomes - but requires widfer support' (PDF 1.00MB)

Evidence reference:

Gomes B, Calanzani N, Koffman J, Higginson IJ. Is dying in hospital better than home in incurable cancer and what factors influence this? A population-based study. BMC Medicine 2015. Avaliable from: doi:10.1186/s12916-015-0466-5

policy-brief

'Outcome measures in palliative care; a new Clinical Decision Support Tool and Guidance for the Palliative care Outcome Scale'

New findings from research at the Cicely Saunders Institute, King’s College London:

  • A Clinical Decision Support Tool (CDST) for responding to Palliative care Outcome Scale (POS) scores for i) information needs, ii) family anxiety, iii) depression, and iv) breathlessness, and accompanied Guidance on implementing Patient Reported Outcome Measures (PROMs) in clinical palliative care have been developed.
  • Good patient care, psychosocial support, and open communication are important for all POS scores. Assessment and (non) pharmacological interventions are appropriate for increasing scores.
  • 8 Steps (from identifying measurement goals to evaluation of impact) can guide the implementation of PROMs.

Policy recommendations: 

  • Robust outcomes measures (the POS family of measures) are now available for use across palliative and end of life care.
  • This CDST and the Guidance provide clinicians with the resources to support implementation and use of POS. Items of POS are recommended for use in the UK and internationally.

Download:

Policy Brief 'Outcome measures in palliative care; a new Clinical Decision Support Tool and Guidance for the Palliative care Outcome Scale' (PDF 1.00MB)

Evidence reference:

Van Vliet LM, Harding R, Bausewein C, Payne S, Higginson IJ, EUROIMPACT. How should we manage information needs, family anxiety, depression and breathlessness for those affected by advanced disease: development of a clinical decision support tool using a Delphi design. BMC Medicine 2015, 13:263. Avaliable from: 10.1186/s12916-015-0449-6 

policy-brief

'Making a difference in palliative care populations through capture, transfer, and feedback of patient centred outcomes data: A systematic review'

New findings from research at the Cicely Saunders Institute, King’s College London:

  • PCOMs allow us to measure the difference we make to patients in palliative care, but the process of collecting and feeding back this information itself improves patients’ care.
  • It also results in improved emotional and psychological quality of life for palliative care patients
  • There is no difference in symptoms or overall

Policy recommendations: 

  • PCOMs should be implemented more widely in palliative care populations.
  • This will allow us to measure the difference palliative care makes, but will also impact positively on patient care and quality of life.

Download:

Policy Brief 'Making a difference in palliative care populations through capture, transfer, and feedback of patient centred outcomes data: A systematic review.' (PDF 1.00MB)

Evidence reference:

Etkind SN, Daveson BA, Kwok W, Witt J, Bausewein C, Higginson IJ, Murtagh FEM. Capture, Transfer, and Feedback of Patient-Centred Outcomes Data in Palliative Care Populations: Does It Make a Difference? A Systematic Review. 2014. Journal of Pain and Symptom Management. (In press)                                                                                         Avaliable from: http://dx.doi.org/10.1016/j.jpainsymman.2014.07.010

guidelines

The management of depression in palliative care (European clinical guidelines)

The first ever clinical guidelines to help professionals across Europe recognise and treat depression in palliative care.

"The management of depression in palliative care" guideline was developed as part of the European Palliative Care Research Collaboration (2006-10) with the support of the European Commission.

Almost one fifth of people receiving palliative care also experience depression which can exacerbate the symptoms of life-threatening, incurable conditions.  Depression can increase people’s distress and decrease their quality of life. 

Based upon the best available evidence and expert opinion, the guideline makes recommendations about how to screen for, diagnose and assess depression, and gives guidance on treatment, including advice about the choice of talking therapy and antidepressants. Our research has shown that antidepressants are effective in these circumstances.

The guideline is available in German, French, Italian and Norwegian as well as English, and there is a summary for patients in the same five languages.

 

Reference: 

If you are citing the guidelines in an article use the primary source (i.e. the published article below):

Rayner L , Price A , Hotopf M , Higginson IJ .  The development of evidence-based European guidelines on the management of depression in palliative cancer care .  European Journal of Cancer . 2011 Mar;47(5):702 - 712. Available from:  10.1016/j.ejca.2010.11.027 (Bibtex) (RIS)

       

General reference for the guidelines:

Rayner L, Higginson IJ, Price A and Hotopf M.  The management of depression in palliative care, European Clinical Guidelines. European Palliative Care Research Collaboration, 2010

Download: 

   Lay summary:

Contact:  If you are using or planning to use these guidelines let us know at palliativecare@kcl.ac.uk 

prolonged-disorders-of-consciousness

Prolonged disorders of consciousness: national clinical guidelines

People in a vegetative or minimally conscious state present a complex array of medical, ethical and legal challenges, and the guidelines address them all, incorporating the most recent clinical and legal developments.

The withdrawal of life-sustaining treatments, and end-of-life care for patients, are contentious and emotive subjects, but the guidelines present the facts clearly and without bias. They lay out for clinicians, other healthcare professionals,service providers and commissioners, what constitutes best practice within the existing legal framework. In addition, the legal profession and families of patients will find the guidelines an invaluable source of concise and up-to-date information.

Alternatively the guidelines can be downloaded from the Royal College of Physicians website (external link)

Download: 

Annexes:
Spasticity-in-adults--management-using-botulinum-toxin-National-guidelines

Spasticity in adults: management using botulinum toxin national guidelines

Local intramuascular injection of botulinum toxin (BT) is an established treatment for spasticity, with strong evidence for its efficacy. The purpose of these guidelines is to provide clinicians with the knowledge and tools to use BT effectively. The keys to successful intervention are appropriate patient selection, establishment of clear goals for treatment and appropriate follow-up therapy.

These guidelines provide clear recommendations on:

 

  • coordinated spasticity management
  • patient selection
  • prescribing, supply and administration of BT by non-medical practictioners
  • follow-up and outcome evaluation

Tools to aid clinicians include a comprehensive and detailed list of injection sites together with appropriate dosages at each site, and several methods of assessing spasticity and outcome of treatment.

If used according to the guidance, BT can improve the lives of those suffering from spasticity and of those caring for them, as well as reducing the overall costs of ongoing care. The guidance is essential reading for all clinicians dealing with stroke patients, people with multiple sclerosis and patients with severe traumatic brain injury.

Alternatively the guidelines can be downloaded from the Royal College of Physicians website (external link)

Reference: 

Ashford S , Turner-Stokes L .  Spasticity in adults: management using botulinum toxin: National Guidelines.  London: Royal College of Physicians of London, 2009. (Bibtex) (RIS)

 Download: 

 Associated publications:  Link to research portal

 Splinting-for-the-prevention-and-correction-of-contractures-in-adults-with-neurological-dysfunction-Practice-guideline-

Splinting for the prevention and correction of contractures in adults with neurological dysfunction

 

This practice guideline provides specific recommendations to support clinical practice and decision-making in splinting when used as an intervention for adults with neurological conditions who have, or are at risk of, contractures.

While primarily a tool to support occupational therapists and physiotherapists in their practice, this document will also be of interest to students, researchers, service users, commissioners and any others who wish to gain insight into the roles and responsibilities of clinicians in this area

Alternatively the guidelines can be downloaded from the  College of Occupational Therapists (external link)

Reference: 

Ashford S .  Splinting for the prevention and correction of contractures in adults with neurological dysfunction; College of Occupational Therapists and Association of Chartered Physiotherapists in Neurology:  Guideline Development Group: Stephen Ashford, Tess Baird, Karen Hoffman, Cherry Kilbride, Joanne Tuckey . London: College of Occupational Therapists, 2015. (Bibtex) (RIS)

Download:

 
policy-brief

'Palliative Care: part of the solution to the Accident & Emergency Crisis?'

New findings from research at the Cicely Saunders Institute, King’s College London:

  • Palliative care reduces the odds of cancer patients attending the A&E department in the last month of life by 50%. 
  • Men, patients from Black ethnic minority groups, patients with a diagnosis of lung cancer and those of lowest socio-economic status have increased odds of attending an A&E department in the last month of life. 

Policy recommendations:

  • Palliative care services for patients with advanced cancer should be part of any programme designed to reduce A&E department admissions. 
  • Palliative care resources should be targeted towards patients in high-risk groups to increase not only the benefit to those patients, but also the cost-effectiveness of resource allocation.
Download:

Evidence reference: 

Henson LA , Gao W , Higginson IJ , Smith M , Davies JM , Ellis-Smith C  et al.  Emergency Department Attendance by Patients With Cancer in Their Last Month of Life:  A Systematic Review and Meta-Analysis .  Journal of clinical oncology : official journal of the American Society of Clinical Oncology . 2015 Feb;33(4):370-376. Available from: 10.1200/JCO.2014.57.3568 (Bibtex) (RIS)
policy-brief

'Should we increase the provision of home palliative care for patients and their families?'

  New findings from research at the Cicely Saunders Institute, King’s College London:

  • Receiving expert home palliative care doubles the odds of dying at home 
  • For one additional person to die at home, five more need to receive home palliative care
  • Home palliative care can also reduce symptom burden in patients with advanced illness 
  • There was evidence of no impact on family caregivers’ grief 
  • Evidence on cost-effectiveness is inconclusive 
  • Models of home palliative care varied, usual care was not always defined and studies often used different tools to assess health outcomes

Policy recommendations:

  • Invest in home palliative care services
  • Include home palliative care development in national health policies and strategies
  • Apply findings to your local population in order to plan future home palliative care  
Download:
Evidence reference: 
 
Gomes B , Calanzani N , Curiale V , McCrone P , Higginson IJ .  Effectiveness and cost-effectiveness of home palliative care services for adults with advanced illness and their caregivers .  Cochrane Database of Systematic Reviews . 2013;N/A(6):N/A. CD007760. Available from:  10.1002/14651858.CD007760.pub2 (Bibtex) (RIS)

policy-brief

'What influences older people's transition to hospital at the end of life?'

New findings from research at the Cicely Saunders Institute, King’s College London:

  • There is a reliance on hospital care at the end of life for older people, despite the majority preferring to die in their usual place of care.
  • Older people who experience severe breathlessness in the last week of life, or have a primary diagnosis of respiratory disease are more likely to transition to hospital as their place of death.
  • Older people who have discussed end of life care preferences, or who identify a key health professional who they can rely on, are less likely to transition to hospital. 

Policy recommendations: 

  • Invest in evidence-based community breathlessness services for older people to reduce end of life transition to hospital.
  • Assign a key healthcare professional, skilled in coordinating care, facilitating complex discussions and in future care planning with older people and their family.
  • Increase training for community health care professionals in communication of difficult conversations and anticipatory care planning for older people with uncertain illness trajectories. 
Download:
Evidence reference:
 
Bone AE, Gao W, Gomes B, Sleeman KE, Maddocks M, Wright J, Yi D, Higginson IJ, Evans CJ. Factors Associated with Transition from Community Settings to Hospital as Place of Death for Adults Aged 75 Years or Older: A Population-Based Mortality Follow-back Survey. Journal of the American Geriatrics Society 2016 doi. 10.1111/jgs.14442
Avaliable from: 10.1111/jgs.14442/ful 
  Palliative Care Need Projected to Rise by 42% in the Next 25 years



 

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