What palliative care can do for motor neurone disease patients and their families

European Journal of Palliative Care, November/December 2013, Vol/iss 20/6 (286-89)
Oliver, David;  Aoun, Samar

Appropriate palliative care is essential for people with motor neurone disease, a progressive and irreversible neurological condition that can have distressing symptoms in its later stages. David Oliver and Samar Aoun detail how and when the specialist palliative care team should get involved.

Available in print at Arthur Rank House, Brookfields Hospital

Requests for non-disclosure of poor prognoses to patients

End of Life Journal, 2013, Vol/iss 3/4
Kristina Reynolds

This article explores the distress that being told about terminal prognoses causes patients and family members/loved ones and highlights some of the reasons for families requesting non-disclosure of terminal diagnosis. Cultural considerations for such requests, effects of non-disclosure on patients and ways in which to resolve the conflict are also discussed.

Available in fulltext in  End of Life Journal
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Leadership Alliance for the Care of Dying People (LACDP):

The LACDP is currently engaging on a key element of its work as part of a planned system-wide response to the recommendations contained in the independent report, More Care, Less Pathway, on the Liverpool Care Pathway.

The engagement has been extended until Friday 31 January 2014 to allow as many people as possible to take part.

Your feedback and views on these proposals will play an important part in helping to inform our final response. If you would like to take part, and have not already done so, please do so online here. 

https://www.engage.england.nhs.uk/consultation/care-dying-ppl-engage

A follow-up bereavement service: ‘completing the patient pathway’

Bereavement Care, December 2013, Vol/iss 32/3 (104-110)

Deborah Ford; Derek Fraser; Keith Morrison

The article describes an initiative, The Bereavement Care Follow up Service (BCFS) in Cambridge University Hospitals NHS Trust which offers brief intervention and support for relatives following the death of a loved one in hospital.  It presents its historical context, its pertinence to grief theory and practice and gives a description and evaluation of the service. The service provides an alternative, less problem-centred pathway to the standard route for those with problems relating to the hospital and gives relatives the opportunity to voice concerns, and to seek information and answers from those best equipped to meet them  Reported satisfaction with the service is high, both among relatives and staff.

Available in fulltext in Bereavement Care
Available in print at Arthur Rank House, Brookfields Hospital

Family focused grief therapy: a versatile intervention in palliative care and bereavement

Bereavement Care, December 2013, Vol/iss 32/3 (117-123)

Melissa P Masterson; Tammy A Schuler; David W Kissane

A diagnosis of advanced stage cancer is a difficult life event for the entire family. Previous studies have demonstrated the negative psychosocial outcomes associated with the burden of caregiving in conjunction with dysfunctional family relations. Family Focused Grief Therapy (FFGT) is a time-limited intervention that has been shown to be effective in aiding dysfunctional families through the promotion of family functioning, communication, cohesiveness, and conflict management. This paper outlines the content of FFGT therapy and highlights its unique aspects as well as the challenges of providing therapy to different types of families in the context of palliative care. 

Available in fulltext in Bereavement_Care

The impact on the family carer of motor neurone disease and intervention with noninvasive ventilation

Journal of Palliative Medicine, December 2013, vol./is. 16/12(1602-9)

Baxter SK, Baird WO, Thompson S, Bianchi SM, Walters SJ, Lee E, Ahmedzai SH, Proctor A, Shaw PJ, McDermott CJ

NIV was perceived as having little impact on carer burden. The data however highlighted a range of sources of other burdens relating to the physical strain of caring and role change; the challenge inherent in having time away; and problems relating to the timing of equipment and service delivery.

How do nurses in specialist palliative care assess and manage breakthrough cancer pain? A multicentre study

International Journal of Palliative Nursing, November 2013, vol./is. 19/11(528-34)

Soden K, Ali S, Alloway L, Barclay D, Barker S, Bird L, Hall L, Perkins P

This mixed-methodology study was undertaken to gain a better understanding of how registered nurses working in specialist palliative care assess and manage breakthrough cancer pain.  The authors conclude that the use of terminology remains variable but that this does not appear to have a negative impact on patient management, which was broadly in line with recently published consensus recommendations. 82% of respondents wanted more education on the assessment of breakthrough cancer pain.

Available in fulltext in International Journal of Palliative Nursing

Available in print at Arthur Rank House, Brookfields Hospital

Malignant pleural effusion in the palliative care setting

International Journal of Palliative Nursing, July 2013, vol./is. 19/7(320, 322-5)

Arber A, Clackson C, Dargan S

This paper discusses the palliative treatment options for malignant pleural effusion, which include thoracentesis, medical pleurodesis and indwelling pleural catheter. It is important that decisions about treatment are made within the multidisciplinary team and alongside the patient and family. Treatment goals are concerned with the relief or elimination of dyspnoea, restoration of near-normal activity and function, and avoidance of inpatient care.

Available in fulltext in International Journal of Palliative Nursing

Available in print at Arthur Rank House Library, Brookfields Hospital

The management of hypercalcaemia in advanced cancer

International Journal of Palliative Nursing, July 2013, vol./is. 19/7(327-31)
Pettifer A, Grant S

Hypercalcaemia is common in patients with advanced cancer. It usually responds to palliative treatment but, if left untreated, is potentially fatal. It can be difficult to detect as its symptoms can also be attributed to other common aspects of advanced malignancy. It is therefore essential that nurses are aware of the underlying physiology and can identify which patients are at risk of becoming hypercalcaemic. Hypercalcaemia often recurs and can become increasingly difficult to treat. Such refractory hypercalcaemia requires sensitive and considered management with advance care planning, particularly as difficult treatment dilemmas may arise if and when malignancy advances.

Available in fulltext in International Journal of Palliative Nursing
Available in print at Arthur Rank House, Brookfields Hospital

Achieving effective control in cancer pain: a review of current guidelines

International Journal of Palliative Nursing, December 2013, vol./is. 19/12(584-91)

Fielding F, M Sanford T, P Davis M

Progress in cancer treatment means people will live longer with the sequelae of cancer and disease-directed treatments. Current guidelines go beyond the unidimensional World Health Organization step-wise approach to pain management model by addressing comprehensive assessment, pharmacological management of opioids and adverse effects associated with opioid use, the role of adjuvants, and the application of non-pharmacological treatments. By following current guidelines promoting a multifaceted approach to the management of cancer-related pain and advocating for patient-centered care, nurses are uniquely positioned to champion effective cancer pain management.

Available in fulltext in International Journal of Palliative Nursing

Available in print at Arthur Rank House Library, Brookfields Hospital

Nurses' experiences caring for patients and families dealing with malignant bowel obstruction

International Journal of Palliative Nursing, December 2013, vol./is. 19/12(593-8)

Daine P, Stilos K, Moura S, Fitch M, McAndrew A, Gill A, Wright F

Malignant bowel obstruction (MBO) is a well-recognised complication of advanced abdominal and pelvic cancers. This qualitative study explored the perspectives of nurses from a palliative care unit, in-patient acute care oncology units, ambulatory cancer setting, and the community on their experiences of caring for patients with MBO and their families. Nurses have an important that role that involves identifying MBO signs and symptoms, having knowledge of treatment and symptom management options, and helping patients transition from a curative to a palliative philosophy of care.

Available in fulltext in International Journal of Palliative Nursing

Available in print at Arthur Rank House, Brookfields Hospital

An update on the importance of monitoring serum magnesium in advanced disease patients

Current Opinion in Supportive & Palliative Care, December 2013, vol./is. 7/4(396-405)

Centeno C, Lopez Saca JM 

Patients with advanced diseases are exposed to many causes of hypomagnesaemia, the most frequent being pharmacological causes through the administration of chemotherapy, antibiotics, proton pump inhibitors, and so on. Studies have shown a direct relationship between low levels of magnesium and nonspecific symptoms including pain that is difficult to control. The objective of this review is to demonstrate the importance of measuring magnesium levels in the blood of these patients. 

Available in fulltext in Current Opinion in Supportive and Palliative Care

Dying of brain tumours: specific aspects of care

Current Opinion in Supportive & Palliative Care, December 2013, vol./is. 7/4(417-23)

Steigleder T, Stiel S, Ostgathe C

This review of publications dealing with advanced stages of brain tumours tries to assess the knowledge gained in the past 2 years and to develop an outlook for further investigations. Data suggest that patients with primary or metastatic brain tumours often have a high symptom burden and unmet needs for palliative care and symptoms are hard to diagnose; patients suffer often and early from cognitive impairment but are rarely appropriately prepared concerning end-of-life wishes. This reflects on their caregivers' burden as well. 

Available in fulltext in Current Opinion in Supportive and Palliative Care