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Papers by Joseph Low

Clinical Rehabilitation, 2004

six purposively sampled UK postgraduate deaneries. Results: GPRs were satisfied with their course... more six purposively sampled UK postgraduate deaneries. Results: GPRs were satisfied with their course coverage on control of pain, other symptoms and communication skills, and were also moderately confident in applying the knowledge gained in these areas. They showed a high level of knowledge in the management of cancer-related pain. There was less satisfaction with the coverage given to syringe driver use (38%) and bereavement care (36%), with fewer expressing confidence in applying their knowledge to these areas. Conclusions: GPRs have mixed perceptions about their palliative care education. Future educational packages should ensure that GPRs receive planned systematic training in bereavement care and some practical experience in the use of syringe drivers. Both Postgraduate General Practice Education departments and specialist palliative care providers should explore ways of working more closely together to provide GPRs with more expertize in palliative care. Palliative Medicine 2006...

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BMJ Supportive & Palliative Care, 2017

Introduction Family members of patients near the end-of-life value accurate prognostic informatio... more Introduction Family members of patients near the end-of-life value accurate prognostic information that is communicated sensitively by experienced healthcare professionals. This provides opportunities to say goodbye and make decisions about care. Current research is limited and has mostly focused on discussions early in the illness trajectory and with patients and not relatives. Aims and methods This study aims to investigate communication about prognosis and end-of-life care between expert healthcare professionals and the relatives and friends of patients who lack capacity and are approaching the end-of-life. We will record conversations between experienced healthcare professionals and relatives of inpatients at a hospice. Recordings will be analysed using conversation analysis to identify practices used by healthcare professionals and relatives to attempt and accomplish communicative tasks. These tasks are likely to include: raising prognosis and care, receipt of information by re...

International Journal of Behavioral Medicine

Background People with advanced cancer experience psychological distress due to physical symptoms... more Background People with advanced cancer experience psychological distress due to physical symptoms, functional decline, and a limited prognosis. Difficult thoughts, feelings, and emotions may exacerbate distress and lead to avoidance of these experiences which is sometimes referred to as experiential avoidance (EA). Advanced cancer patients may be more likely to engage in EA especially when no obvious solutions to their problems exist. This study aims to examine the terms used to describe EA, the processes that might indicate EA, associations between EA and psychological distress, and to understand why individuals might engage in EA. Methods A mixed-methods review. Literature search of Medline, Embase, Psych INFO, and CINAHL 1980–October 2019. Inclusion: adults ≥ 18 years; advanced cancer not amenable to cure. Exclusion: no measures of EA or psychological distress. Risk of bias and study quality assessed. Evidence of statistical techniques collected. Themes coded, grouped, and develo...

Oral presentations, 2020

Mean 'pain' score changed from 1.9 to 1.2, with 47% of the 125 patients with pain improved. Mean ... more Mean 'pain' score changed from 1.9 to 1.2, with 47% of the 125 patients with pain improved. Mean 'breathlessness' score improved from 1.1 to 0.8, with 48% of the 64 patients with breathlessness improved. Mean 'anxiety' score changed from 1.9 to 1.3, with 42% of the 73 patients with anxiety improved. Mean 'feeling depressed' score changed from 1.5 to 1.0, with 52% of the 56 patients with depressed mood improved. Mean 'information needs' score changed from 1.2 to 0.9, with 78% of the 36 patients wanting more information improved. Conclusions For the first time in UK, an inpatient hospice has systematically used routinely-collected outcomes date to demonstrate the marked positive impact of the clinical care provided.

Gastroenterology Clinics of North America, 2006

Liver disease results in over four million physician visits and over 750,000 hospitalizations per... more Liver disease results in over four million physician visits and over 750,000 hospitalizations per year in the USA. Those with chronic liver disease frequently progress to cirrhosis, end-stage liver disease (ESLD), and death. Patients with ESLD experience numerous complications, including muscle cramps, confusion (hepatic encephalopathy), protein calorie malnutrition, muscle wasting, fluid overload (ascites, edema), bleeding (esophagogastric variceal hemorrhage), infection (spontaneous bacterial peritonitis), fatigue, anxiety, and depression. Despite significant improvements in palliation of these complications, patients still suffer reduced quality of life and must confront the fact that their disease will often inexorably progress to death. Liver transplantation is a valid option in this setting, increasing the duration of survival and palliating many of the symptoms. However, many patients die waiting for an organ or are not candidates for transplantation due to comorbid illness. Others receive a transplant but succumb to complications of the transplant itself. Patients and families must struggle with simultaneously hoping for a cure while facing a life-threatening illness. Ideally, the combination of palliative care with life-sustaining therapy can maximize the patients' quality and quantity of life. If it becomes clear that life-sustaining therapy is no longer an option, these patients are then already in a system to help them with end-of-life care. Keywords End-stage liver disease. Palliative care. Death. Cirrhosis. End-of-life care This article is part of Topical Collection on Liver

Background: Short and valid measures of the impact of a stroke on integration are required in hea... more Background: Short and valid measures of the impact of a stroke on integration are required in health and social settings. The Subjective Index of Physical and Social Outcome (SIPSO) is one such measure. However, there are questions whether scores can be summed into a total score or whether subscale scores should be calculated. This paper aims to provide clarity on the internal construct validity of the subscales and the total scale. Methods: SIPSO data were collected as part of two parallel surveys of the met and unmet needs of 445 younger people (aged 18-65) with non-recent stroke (at least one year) and living at home. Factor, Mokken and Rasch analysis were used. Results: Factor analysis supported a two factor structure (explaining 68 % of the variance) as did the Mokken analysis (overall Loevinger coefficient 0.77 for the Physical Integration subscale; 0.51 for the Social Integration subscale). Both subscales fitted the Rasch model (P> 0.01) after adjusting for some observed d...

Age and Ageing, 2001

Objectives: to compare the effectiveness and costs of a new domiciliary rehabilitation service fo... more Objectives: to compare the effectiveness and costs of a new domiciliary rehabilitation service for elderly stroke patients with geriatric day-hospital care. Design: randomized controlled trial. Participants: stroke patients aged 55q who required further rehabilitation after hospital discharge or after referral to geriatricians from the community. Setting: Poole area, East Dorset, a mixed urban/rural area on the south coast of England. Main outcomes: primaryÐchanges between hospital discharge and 6-month follow-up in physical function as measured by Barthel index. SecondaryÐchanges over this period in Rivermead Mobility Index and mental state (Philadelphia Geriatric Centre Morale Scale) and differences in social activity (Frenchay Activities Index) and generic health status (SF-36). Health service and social service cost per patient were compared for the two groups. Results: 180 patients were eligible and 140 (78%) were randomized. The groups were well balanced for age, sex, social class and initial Barthel index. We achieved follow-up in 88% of subjects who were alive at 6 months. We detected no signi®cant differences in patient outcomes, although there was a non-signi®cant improvement in measures of physical function and social activity in the domiciliary group. Domiciliary patients had more physiotherapy time per session and more district nurse time, and made greater use of social service day centres and home helps. Total cost per patient did not differ signi®cantly between the two groups, with reduced health service costs in the domiciliary arm offset by higher social service costs. Conclusion: no signi®cant differences were detected in the effectiveness of the two services. Neither service in¯uenced patients' mental state, and their social activity remained low. Total costs were similar. A mixed model of day-hospital and domiciliary care may be most cost-effective for community stroke rehabilitation, but this requires further evaluation.

Textbook of Palliative Care

Patient Education and Counseling, 2021

To examine transitions out of prognostic talk in interactions between clinicians and the relative... more To examine transitions out of prognostic talk in interactions between clinicians and the relatives and friends of imminently dying hospice patients. Methods: Conversation analysis of 20 conversations between specialist palliative care clinicians and the families of imminently dying patients in a hospice. Results: Following the provision and acknowledgement of a prognostic estimate, clinicians were able to transition gradually towards making assurances about actions that could be taken to ensure patient comfort. When families raised concerns or questions, this transition sequence was extended. Clinicians addressed these questions or concerns and then pivoted to action-oriented talk, most often relating to patient comfort. Conclusion: In conversations at the end of life, families and clinicians used practices to transition from the uncertainty of prognosis to more certain, controllable topics including comfort care. Practice Implications: In a context in which there is a great deal of uncertainty, transitioning towards talk on comfort care can emphasise action and the continued care of the patient and their family.

ACT protocol paper SPIRIT 2013 Checklist (2015 09 30). File outlining how this protocol paper mee... more ACT protocol paper SPIRIT 2013 Checklist (2015 09 30). File outlining how this protocol paper meets the different guidelines from the SPIRIT 2013 Checklist. (DOCX 22 kb)

What Do Previously Homeless People in London, UK, Think about Advance Care Planning (ACP) and End... more What Do Previously Homeless People in London, UK, Think about Advance Care Planning (ACP) and End of Life Care (EOLC)? A Qualitative Investigation: Abstract number: P311 Abstract type: Poster Bella Vivat;Peter Kennedy;Julian Daley;Nigel Hewett;Joseph Low;Paddy Stone;Julia Riley;Caroline Shulman; Palliative Medicine

Social Science & Medicine, 1999

To identify all the studies on stroke carers. Within the wider review, the authors aimed to outli... more To identify all the studies on stroke carers. Within the wider review, the authors aimed to outline the main findings and methodological criticisms of studies that examined the health service provision for informal stroke carers. Searching EMBASE on BIDS, MEDLINE and PsycLIT were searched from 1980 to 1997 using the following terms: 'carers', 'caregivers', 'stroke', 'quality of life', 'stroke services' and 'delivery of health care'. Only articles published in English and in peer-reviewed journals were selected. Study selection Study designs of evaluations included in the review All designs of studies were to be included in the review. Specific interventions included in the review Stroke services provided to informal carers of stroke victims. Participants included in the review Informal carers of elderly (greater than 55 years) stroke victims. Voluntary workers or those in the employment of statutory services were excluded. Outcomes assessed in the review Coping in carers, assessed as psychological health, carer burden, physical health, social health, and miscellaneous including measure of knowledge of stroke or stroke care or additional help; educational needs; psychosocial loss; carer satisfaction; carers perceived needs. How were decisions on the relevance of primary studies made? The authors do not state how the papers were selected for the review, or how many of the reviewers performed the selection. Assessment of study quality Studies were assessed for their methodological rigour in terms of sample size, description of carer sample, design of study, and assessment tools used. The authors do not state how the papers were assessed for validity, or how many of the reviewers performed the validity assessment. Data extraction The authors do not state how the data were extracted for the review, or how many of the reviewers performed the data extraction.

Palliative Medicine, 2005

Objectives: To explore the experiences of people involved in UK palliative care day services (PCD... more Objectives: To explore the experiences of people involved in UK palliative care day services (PCDS) and identify the important outcomes of this service. Methods: Focus groups were carried out separately with patients, informal carers and volunteers from four purposively selected palliative care day units and with day unit managers from 11 units. Results: Patients benefited from both the support of PCDS professionals and social support of fellow PCDS patients, which contributed to a perceived improvement in their quality of life. Carers appreciated both the respite and support from PCDS, but acknowledged that they still had a poor quality of life. The challenges facing PCDS include the difficulties of discharging patients and the future role of volunteers. Discussion: PCDS improved patients' perceived quality of life and future evaluations on patient outcomes could use concepts such as self-esteem, selfworth and confidence. Future service provision could explore the possibility o...

Journal of Pain and Symptom Management, 2005

Fifty percent of patients admitted to hospices cite constipation as a concern. This study evaluat... more Fifty percent of patients admitted to hospices cite constipation as a concern. This study evaluates how constipation was managed in 11 hospices. Patients and nurses completed questionnaires at two time points: baseline and 7-10 days later. Outcomes were evaluated using a Constipation Visual Analogue Scale and a satisfaction with management of constipation questionnaire. A total of 475 patients participated; 413 completed both assessments. Forty-six percent of patients reported no constipation and 15% of patients reported severe constipation. For 75% of patients, no change in the perception of constipation was observed over the study period. Patients expressed satisfaction with their constipation management. The severity of constipation was overestimated by nurses in many patients. The findings indicate that constipation was being prevented or reasonably well managed. However, severe constipation continues to be a problem. Assessment of patients' bowel function needs to be more rigorous and those identified as severely constipated need daily monitoring.

Journal of Pain and Symptom Management, 2009

Journal of Pain and Symptom Management, 2012

Context. Palliative care rehabilitation aims to maximize physical and psychological functioning, ... more Context. Palliative care rehabilitation aims to maximize physical and psychological functioning, but negative thoughts can hinder patients from attempting this approach. Acceptance and commitment therapy (ACT), a modified form of cognitive behavioral therapy, encourages individuals to experience and manage negative emotions by focusing on changing individual behavior and so improve functioning. ACT has been used in many health-related behavioral interventions but not in palliative care rehabilitation. Objectives. To investigate the relationship between acceptance (often called experiential acceptance in ACT) and psychological and physical status. Methods. Cross-sectional study in which a consecutive sample of patients attending a specialist palliative care day therapy unit for rehabilitation completed the Acceptance and Action Questionnaire-II to measure acceptance and the Kessler-10 questionnaire to measure psychological morbidity. Physical function was assessed by a timed two-minute walking test and one-minute sit-to-stand test. Correlation statistics and multivariable regression analyses were used to explore the strength of relationships between acceptance and psychological morbidity and physical function. Results. One hundred one patients were recruited, mainly white women with a mean age of 64 years. Correlation analysis showed a negative association between acceptance and psychological morbidity (r ¼ À0.59) and a positive association between acceptance and sit to stand (r ¼ 0.27) and distance walked (r ¼ 0.21). All three of these relationships were statistically significant after adjustment. Conclusion. These associations suggest that it may be possible to reduce psychological morbidity and improve physical mobility by increasing patients' acceptance using an ACT-based intervention. Future work is now needed to develop an ACT-based intervention in palliative care rehabilitation and test its