Pilot Survey of unexpected events in palliative Care.

Observational study, looking at troublesome symptoms, which include breathlessness at rest, breathlessness showering or dressing, urinary incontinence, difficulty passing urine, urinary frequency, nocturia, constipation, diarrhoea, rash, light headedness or dizzy when standing, feeling muddled, difficulty remembering things which happened earlier in the day,difficulty concentrating, vivid dreams or hallucinations, nightmares, night time confusion, blurred vision. falls, headaches, being easily irritated, that may be caused by the total anti-cholinergic load in Palliative Care Participants. This total anti-cholinergic load is generated by the sum of the medications with anti-cholinergic activity. Given that a threshold for symptomatic problems appears likely, understanding the total anti-cholinergic load and how the load changes as a result of prescribing at the end of life is crucial. In addition to the traditional anti-muscarinic medications, increasing evidence suggests many other medications have anti-cholinergic properties including commonly encountered medication such as warfarin, ranitidine, digoxin, codeine and diazepam Many of these medications are continued or commenced during the end-of-life care period.How do Participants experience these effects in a setting where their bodies are often changing rapidly. Fundamentally, are there effects from prescribing that fail to take account of increasing numbers of medications, and from the rapid systemic changes that occur as death approaches such as weight loss, cachexia and impaired organ function. Participants once consented will be asked to complete a self assessment diary identifying any of the above mentioned symptoms, their frequency and level of distress they cause to the participant. Then daily for 8 weeks the participant will be asked to fill out a diary to document any of these troublesome symptoms experienced in the past 24 hours. If the participant is too tired, the diary can be completed by a carer or family member, this would be noted on the diary. Completing the diary should take less than 10 minutes each day. Lastly the participant will be phoned weekly by the study nurse for 8 weeks and will be asked about any troublesome symptoms experienced, any changes in their quality of life,level of mobility, self efficacy, independence, and any deterioration in their condition.So the duration of participant involvement in the study is 8 weeks.