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«Citation: Dalkin, Sonia (2014) The Realist Evaluation of a Palliative Integrated Care Pathway in Primary Care: What Works, For Whom and in What ...»

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If there are changes in the situation, then monitors especially may react with more anxiety and less adaptive responding.

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Also some people are in the middle (a subset, perhaps a quarter) so that they are more influenced by changes in the situation.

Hope this helps for now.

Please give us any further details. That would be helpful.

Dr. Suzanne Miller Professor, Senior Member Director, Psychosocial and BioBehavioral Medicine Department Fox Chase Cancer Center Robert C. Young Pavilion - Room 4149 333 Cottman Avenue Philadelphia, Pennsylvania 19111 Tel: (215) 728-4069 Fax: (215) 214-1651 Email: suzanne.miller@fccc.edu Administrative Assistant: Mary Anne Ryan email: (maryanne.ryan@fccc.edu) Tel: (215)728-5296 FCCC webpage: http://www.fccc.edu/research/pid/miller/ Adjunct Professor, Department of Psychiatry, University of Pennsylvania Adjunct Professor, Department of Medicine, Obstetrics and Gynecology, and Public Health, Temple University Adjunct Professor, Institute for Health, Health Care Policy, and Aging Research, Rutgers University Appendix 33 - University ethical approval

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28th September 2011 Dear Sonia School of HCES Research Ethics Sub Committee Title: Understanding integrated care pathways in palliative care - context, approaches, outcomes Following independent peer review of the above proposal, I am pleased to inform you that University approval has been granted on the basis of this proposal and subject to compliance with the University policies on ethics and consent and any other policies applicable to your individual research. You should also have recent CRB and occupational health clearance if your research involves working with children and/or vulnerable adults.

The University’s Policies and Procedures are available from the following web link:

http://www.northumbria.ac.uk/researchandconsultancy/sa/ethgov/policies/?view=Standard It is recommended that you submit the additional information regarding the clinical database to the NHS REC committee. Both the University and NRES strongly advise that the supervisor accompany the student when attending an external REC.

You may now also proceed with your application (if applicable) to:

NHS R&D organisations for approval. Please check with the NHS Trust whether you require a Research Passport, Letter(s) of Access

–  –  –

 Any significant changes to the study design;

Any incidents which have an adverse effect on participants, researchers

–  –  –

Professor David Stanley Chair, School Research Ethics Review Panel Appendix 34 - NHS ethical approval Appendix 35 - Care home end-of-life care plan

–  –  –

We aim to care for people for the remainder of their lives. We are keen that we respect Resident’s and Relatives wishes with all aspects of their care and life during their time at here. It is particularly important that we have plans in place to ensure that we respect and meet the wishes of the Resident and Relatives during the final stages of their life. Because we cannot predict when this will be it is important that we consider this in advance in order that we have plans in place.

–  –  –

If it is the wish of the Resident and their Relative every effort will be made by staff to care for the Resident at Burn Brae Lodge in the final stages of their life. This will include obtaining the support from community services such as the GP, District Nurses and MacMillan Nurses.

–  –  –

(Delete which does not apply) Do you have any other wishes about medical intervention (for example no blood products etc.)?

Yes / No If yes please give details We hope that relatives and family feel able to be involved at this time if this is the residents and relatives wish.

Please detail below any particular wishes for family involvement and who you

wish to be contacted:

Are there any religious issues that you would like to be observed during and /

or after your life has ended? If so give details:

What are your final wishes? Burial / Cremation / Medical Science Does anyone have Enduring Power of Attorney for you? If yes please give

details:

Who will make the final arrangements for you?

Are there any other wishes or comments you would like to make for your care at this time?

–  –  –

Dear Sonia, Thank you for your request.

Permission is granted for you to use the material requested for your thesis/dissertation subject to the usual acknowledgements and on the understanding that you will reapply for permission if you wish to distribute or publish your thesis/dissertation commercially.

Permission is granted solely for use in conjunction with the thesis, and the material may not be posted online separately.

Any third party material is expressly excluded from this permission. If any material appears within the article with credit to another source, authorisation from that source must be obtained.

Kind Regards Emma Willcox Permissions Assistant Description: Description: cid:image003.jpg@01CD4E24.F19D75F0 Appendix 37 – Soft System Methodology Map

–  –  –





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