What influences attitudes towards clinically assisted hydration in the care of dying patients? A review of the literature

BMJ Supportive and Palliative Care 2015;5:3 223-231

Miriam J Gent, Sarah Fradsham, Graham M Whyte, Catriona R Mayland

The aim of the review is to describe the attitudes and knowledge of patients, families, healthcare professionals and the general public regarding clinically assisted hydration (CAH) in the care of dying patients. Developing international evidence suggests that cultural norms and ethical principles of a family, population or healthcare environment influence attitudes towards CAH, particularly where CAH has symbolic meaning; representing care, hope and trust. However, there is surprisingly little robust evidence regarding dying patients, or the wider general public's views, on the perceived value of CAH in the last days and hours of life.

Available in print in Arthur Rank Hospice Library, Brookfields Hospital

Associations between oral complications and days to death in palliative care patients

Supportive Care in Cancer, January 2016, vol./is. 24/1(157-161)

Matsuo K., Watanabe R., Kanamori D., Nakagawa K., Fujii W., Urasaki Y., Murai M., Mori N., Higashiguchi T.

Adverse oral symptoms gradually appear in advanced cancer patients as the disease progresses. We retrospectively investigated the associations between the incidence of oral problems and the days to death (DTD) in patients receiving palliative care.  From their findings, the authors suggest that, during palliative care, oral complications appear more frequently when the DTD period is shorter. These symptoms may be useful indicators when deciding on the proper timing of intensive oral care intervention to decrease oral problems and pain in terminally ill patients.

Malignancy associated hypercalcaemia-responsiveness to IV bisphosphonates and prognosis in a palliative population

Supportive Care in Cancer, April 2016, vol./is. 24/4(1771-1777)

Mallik S., Mallik G., Macabulos S.T., Dorigo A.

The goals of this study were to determine the reversibility of hypercalcaemia amongst patients whose underlying malignancy is not being treated and assess whether correction results in improvement in symptoms attributable to hypercalcaemia, while identifying risk factors that can predict responsiveness.  The authors found that a reduction in calcium level was associated with a significantly prolonged survival, as well as symptomatic improvement, irrespective of whether normocalcaemia was achieved. 

Evaluating the effects of mindfulness-based interventions for informal palliative caregivers: a systematic literature review

Palliative Medicine, Feb 2016, vol. 30, no. 2, p. 117-131Jaffray, Linda, Bridgman, Heather, Stephens, Miranda, Skinner, Timothy

Mindfulness-based interventions may have application in the setting of palliative caregiving. The aim of this review is to describe, evaluate and synthesise the peer-reviewed literature on the effects of mindfulness-based interventions for informal palliative caregivers. Results suggest that mindfulness-based interventions are feasible and acceptable to offer to this group and may provide benefit, particularly in terms of reducing depression and caregiver burden and increasing quality of life. However, effects were not as robust as findings in the wider mindfulness intervention literature. 

Euthanasia and physician-assisted suicide: a white paper from the European Association for Palliative Care.

Palliative Medicine, Feb 2016, vol. 30, no. 2, p. 104-116

Radbruch, Lukas, Leget, Carlo, Bahr, Patrick, Müller-Busch, Christof, Ellershaw, John, de Conno, Franco, Vanden Berghe, Paul, board members of the EAPC

This white paper aims to provide an ethical framework for palliative care professionals on euthanasia and physician-assisted suicide. It also aims to provide an overview on the available evidence as well as a discourse of ethical principles related to these issues. Following a consensus process which sought comments and opinion from experts and nationals organisations this final version was adopted as an official position paper of the European Association for Palliative Care in April 2015.

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Implementation of a pilot telehealth programme in community palliative care: A qualitative study of clinicians' perspectives

Palliative Medicine, Apr 2016, vol. 30, no. 4, p. 409-417

Collier, Aileen, Morgan, Deidre D, Swetenham, Kate, To, Timothy Hm, Currow, David C, Tieman, Jennifer J

The aim of this study was to explore clinicians' perspectives on and experiences of the utilisation of a pilot telehealth model and its integration into a specialist community palliative care programme. The study was conducted in a metropolitan specialist palliative care service in South Australia. Introducing this technology challenged the team to critically explore aspects of current service provision.  

Available in print in Arthur Rank House Library, Brookfields Hospital

Complex decongestive lymphatic therapy with or without vodder ii manual lymph drainage in more severe chronic postmastectomy upper limb lymphedema: a randomized noninferiority prospective study

Journal of Pain and Symptom Management, Dec 2015, vol. 50, no. 6, p. 750-757

Gradalski, Tomasz, Ochalek, Katarzyna, Kurpiewska, Joanna

The purpose of this study was to compare the reduction in edema volume in more advanced (≥20% limb volume difference) postmastectomy arm lymphedema achieved by compression bandaging (CB) and physical exercises vs. the same management augmented by an additional 30 minutes of MLD (Vodder II method). A decrease of limb volume (15.6% in the CB group and 13.8% in the CDT group), edema volume (47.2% and 47.4%, respectively), and limb-related volume change (14.7% and 12.5%) during the intensive phase were observed. This improvement remained constant in both groups after six months of maintenance therapy. The health-related quality of life similarly showed improvement in both groups, with a high level of treatment satisfaction. These results indicate that parallel (immediate and delayed) results may be obtained by CDT without the use of Vodder MLD and CB may be an essential part of lymphedema management. 

Available in print in Arthur Rank Hospice Library, Brookfields Hospital

Pilot study of a brief behavioral intervention for dyspnea in patients with advanced lung cancer

Journal of Pain and Symptom Management, Dec 2015, vol. 50, no. 6, p. 854-860

Greer, Joseph A, MacDonald, James J, Vaughn, Jeanne, Viscosi, Elene, Traeger, Lara, McDonnell, Theresa, Pirl, William F, Temel, Jennifer S

This pilot study examined the feasibility and utility of delivering a brief behavioral intervention for dyspnea in patients with lung cancer. The manualized intervention consisted of two sessions in which nurse practitioners taught participants breathing and relaxation techniques within the infusion clinic and encouraged home practice. In this sample patients reported improvements in dyspnea, QOL, and mood.

Available in print in Arthur Rank House Library, Brookfields Hospital

Patient-controlled therapy of breathlessness in palliative care: a new therapeutic concept for opioid administration?

Journal of pain and symptom management, Mar 2016, vol. 51, no. 3, p. 581-588

Schmitz, Andrea, Schulz, Christian, Friebel, Uta, Hohlfeld, Thomas, Bausewein, Claudia

Often, severity of breathlessness increases quickly, calling for rapid symptom control.  The aim of this pilot study was to investigate whether intravenous opioid PCT can be an effective therapeutic method to reduce breathlessness in patients with advanced disease. Secondary aims were to study its feasibility and acceptance in patients with refractory breathlessness.  The authors conclude that opioid PCT is a feasible and acceptable therapeutic method to reduce refractory breathlessness in palliative care patients. 

Nurses' resilience and nurturance of the self

International Journal of Palliative Nursing, Oct 2015, vol. 21, no. 10, p. 504-510

Shimoinaba, Kaori, O'Connor, Margaret, Lee, Susan, Kissane, David

The purpose of this study was to explore the nature of nurses' resilience and the way it is developed. Self-nurturing was evident as the way nurses developed resilience, which included knowledge of self, coping adaptively, valuing care and accepting limitations. However, none had educational pathways to build greater resilience. Integrating support and education to foster nurses' resilience is important to enable self-protection, as well as the provision of high quality care.

Available in print in Arthur Rank Hospice Library, Brookfields Hospital

Rapid discharge from hospital in the last days of life: an evaluation of key issues and the discharge sister role

International Journal of Palliative Nursing, Dec 2015, vol. 21, no. 12, p. 588-595

Jones, Susan, Hamilton, Sharon, Nicholson, Alex

This study explored the issues surrounding rapid discharge from hospital in the final days of life, and evaluated the contribution of a discharge sister role. A qualitative design was used, incorporating focus groups and interviews with key stakeholders. A total of 75 staff and 7 carers participated. Rapid discharge is challenging and requires high levels of skill. The discharge sister navigated complex organisational systems to facilitate rapid discharge for those who might otherwise have died in hospital.

Available in print in Arthur Rank Hospice Library, Brookfields Hospital

The use of corticosteroids in reducing cancer-related fatigue: assessing the evidence for clinical practice

International Journal of Palliative Nursing, Jan 2016, vol. 22, no. 1, p. 5-9

Begley, Sarah, Rose, Kevin, O'Connor, Margaret

A widely used strategy to treat fatigue in palliative care is the use of corticosteroids but, despite being frequently prescribed, evidence of their effectiveness is ambiguous. This paper used a systematic approach to explore literature to determine evidence about whether the use of corticosteroids improves levels of cancer-related fatigue in people with advanced cancer.  The four included studies all reported improvements in patient-reported fatigue as a result of taking corticosteroids, although the quality of results varied and only a few were deemed to have statistically significant results. While there is some evidence that corticosteroids can improve cancer-related fatigue, more rigorous research is required.

Available in print in Arthur Rank Hospice Library, Brookfields Hospital

Short break and emergency respite care: what options for young people with life-limiting conditions?

International Journal of Palliative Nursing, Feb 2016, vol. 22, no. 2, p. 57-65

Mitchell, Tracy K, Knighting, Katherine, O'Brien, Mary R, Jack, Barbara A

Service providers face difficult decisions about how best to develop services for the increasing numbers of young people with life-limiting conditions who require palliative care.  The purpose of this two-phase evaluation study was to explore alternative short break and emergency respite care options to children's hospice care. There were few, or no, alternatives when children's hospice care was not available that can meet the need of young people with life-limiting conditions, creating anxiety for children's hospice users and those leaving the service as a result of reaching transition age or through no longer meeting the children's hospice eligibility criteria. 

Available in print in Arthur Rank Hospice Library, Brookfields Hospital

Palliative care for people with dementia: a literature review

International Journal of Palliative Nursing, Feb 2016, vol. 22, no. 2, p. 76-81

Lillyman, Sue, Bruce, Mary

This literature review has identified several key themes in relation to the person dying with dementia including: diagnosis of the dying phase, appropriate timing of referral to specialist palliative care services; ethical decisions in relation to medication and nutrition; the environment; undertreatment especially, for pain relief; over and burdensome treatment interventions; carer involvement; collaborative working and advance decision making.

Available in print in Arthur Rank House Library, Brookfields Hospital

Conservative care of the elderly ckd patient: a practical guide

Advances in Chronic Kidney Disease, Jan 2016, vol. 23, no. 1, p. 51-56 

Raghavan, Divya, Holley, Jean L

Palliative or supportive care should be routine for conservatively managed CKD patients. Decision-making about dialysis or conservative management requires patients and families be given information on prognosis, quality of life on dialysis, and options for supportive care. Advance care planning is the process by which these issues can be explored. Patients with ESRD have a high symptom burden, which needs to be addressed in any treatment plan. Common symptoms include pain, fatigue, insomnia, pruritus, anorexia, and nausea. Recommendations for management are discussed in the article. 

Fulltext available in Advances in Chronic Kidney Disease