Upper extremity subcutaneous lymphatic drainage "lymphocentesis" for symptom relief in end-stage breast cancer

American Journal of Hospice & Palliative Medicine, 2019 36(2) p. 111-115

Liao, Pamela; Rossini, Kathleen; Sauls, Roberts

Subcutaneous drainage is a technique that has been used in some case reports for the lower extremity and sacrum with good results. This report describes an adapted technique of subcutaneous drainage for treating upper extremity lymphedema in the palliative setting.

Top ten tips palliative care clinicians should know about spinal tumors

Journal of Palliative Medicine, 2019 22(1) p. 84-89

Theresa Williamson, Brice Painter, Elizabeth P Howell, C Rory Goodwin

Continuing the 'Top Ten Tips' series, this month's issue looks at crossfunctional collaboration between palliative care, radiation oncology, medical oncology, and neurosurgery which is crucial both in the maximization of available treatment options and optimization of quality of life for patients with metastatic spine tumours.

Music intervention as a tool in improving patient experience in palliative care

American Journal of Hospice & Palliative Medicine, 2019 36(1) p. 45-49

Peng, Cynthia S.; Baxter, Kelly; Lally, Kate M.

In this study, following live music intervention sessions, patients reported significant decreases in pain, anxiety, nausea, shortness of breath, and feelings of depression along with significant increase in feelings of well-being. Opioid use in time periods after the music intervention trended toward decreased usage when compared to the equivalent time period before. Finally, compiled personal narratives of patients' and families' experiences of the music intervention demonstrated common themes of spirituality, comfort, relaxation, escape, and reflection.

"Remembrance": a self-care tool for clinicians

Journal of Palliative Medicine 2018 December 15

Sue E Morris, John P Kearns, Amanda Moment, Kathleen A Lee, Jane deLima Thomas

This article describes the development of "Remembrance," an interdisciplinary approach to acknowledge and process the deaths of patients on an inpatient palliative care unit. The authors suggest that such a practice is an important component of both quality end-of-life care and clinician self-care, which should be routinely taught and incorporated into clinical services. A template is included that summarises the approach, which can be easily adapted by other hospitals/services to use.

Fulltext available in Journal of Palliative Medicine 

'I've no fear of dying alone': exploring perspectives on living and dying alone

Mortality, 2019 24(1) p. 17-31
Caswell, Glenys; O'Connor, Mórna

This paper reports findings from a study which explored ways of investigating individuals' perspectives on dying alone at home. For the older people, the idea of dying alone was less problematic than the idea of needing care and support from others, and the perceived loss of independence that this would entail. The nurses would prefer no one to die alone, but believed they had seen patients managing their own dying so that they could be alone at the moment of death. The paper suggests that dying alone may be a problem for survivors, rather than for the person who is dying.

Diagnosis, assessment and management of constipation in advanced cancer: ESMO Clinical Practice Guidelines

Annals of Oncology: Official Journal of the European Society for Medical Oncology, 2018 29 (Supplement 4) p. iv111-iv125
P J Larkin, N I Cherny, D La Carpia, M Guglielmo, C Ostgathe, F Scotté, C I Ripamonti

The 2018 ESMO Clinical guidelines on diagnosis, assessment and management of constipation in advanced cancer update evidence in relation to strategies for management. Opioid analgesics for cancer pain pose specific challenges for constipation management. A recommendation for the use of peripherally-acting mu-opioid receptor antagonists (PAMORAS) including prolonged-released formulations in the management of refractory constipation is included.

Fulltext available at the European Society for Medical Oncology

The use of humor in palliative care: a systematic literature review

American Journal of Hospice & Palliative Care 2018, 35 (10): 1342-1354
Miguel Ángel Cuervo Pinna, Vinita Mahtani-Chugani, Miguel Ángel Sánchez Correas, Alvaro Sanz Rubiales

The acceptance of the use of humour by terminal stage patients and health-care professionals has not been studied in depth and is not free from controversy. The aim of the study was to understand the significance, appropriateness, and pertinence of the use of humour in palliative care and to analyse its applicability.

The ‘safe death’: an ethnographic study exploring the perspectives of rural palliative care patients and family caregivers

Palliative Medicine, 2018 32(10) p. 1575-1583
Rainsford, Suzanne; Phillips, Christine B.; Glasgow, Nicholas J.; MacLeod, Roderick D.; Wiles, Robert B.

It was found that a ‘safe death’ was central to a ‘good death’ and was described as a death in which one could maintain (1) a connection with one’s previous identity; (2) autonomy and control over decisions regarding management of end-of-life care and (3) not being overwhelmed by the physical management of the dying process. For all participants, the preferred place of death was the ‘safe place’, regardless of its physical location. The authors conclude that a home death is not essential for and does not ensure a ‘good death’.

Development, validity and reliability testing of the East Midlands Evaluation Tool (EMET) for measuring impacts on trainees' confidence and competence following end of life care training

BMJ Supportive & Palliative Care, 2018 8(4)  p.439-446
Whittaker, B; Parry, R; Bird, L; Watson, S; Faull, C; 

The EMET comprises 27 items with Likert-scaled responses supplemented with questions seeking free-text responses. The authors suggest that this tool is effective in assessing impacts of end of life care training and gathering feedback on training events.

Available in print in Arthur Rank Hospice Library, Cambridge

Crash course in EPaCCS (Electronic Palliative Care Coordination Systems): 8 years of successes and failures in patient data sharing to learn from

BMJ Supportive & Palliative Care, 2018 8(4), p447-455
Petrova, Mila; Riley, Julia; Abel, Julian; Barclay, Stephen

EPaCCS are England's pre-eminent initiative in enabling advance care planning and improved communication and coordination at the end of life but have been extremely challenging to develop and implement. The authors discuss the current EPaCCS landscape and way forward, summarise key facts concerning the availability, uptake, outcomes and costs of EPaCCS and outline the key challenges and drivers. 

Fulltext available in BMJ Supportive & Palliative Care

Available in print in Arthur Rank Hospice Library, Cambridge

Dying in long-term care: perspectives from sexual and gender minority older adults about their fears and hopes for end of life

Journal of Social Work in End-of-Life & Palliative Care, Nov 2018 ; p. 1-16
Kortes-Miller, Katherine; Boulé, Jessica; Wilson, Kimberley; Stinchcombe, Arne

This qualitative study from Canada explored the hopes and fears of older LGBTQ + adults considering long-term care as they face end of life. Fears included social isolation, decreased independence and capacity for decision-making, increased vulnerability to LGBTQ+-related stigma as well as exposure to unsafe social and physical environments. The authors conclude there is a need for palliative care specialists and long-term care home staff to address the unique health needs of older LGBTQ + adults nearing the end of life in order to create supportive and inclusive long-term care environments.

Welcoming death: exploring pre-death grief experiences of caregivers of older adults with dementia

Journal of Social Work in End-of-Life & Palliative Care, Nov 2018 ; p. 1-17
Hovland, Cynthia

This qualitative study explored the end-of-life experiences for 36 bereaved family caregivers of older adults with dementia, focusing on understanding their experiences with pre-death grief. These caregivers shared experiences with the phenomenon of "welcoming death" and findings highlighted the primary reasons they anticipated, accepted, or wished for the death of their family member with dementia. With the overarching goal of improving bereavement outcomes and reducing feeling of guilt, the author recommends pre-death grief support services throughout the caregiving process.

Systematic review and meta-analysis on non-opioid analgesics in palliative medicine

Journal of Cachexia, Sarcopenia and Muscle 2018 October 29

Robert H Schüchen, Martin Mücke, Milka Marinova, Dmitrij Kravchenko, Winfried Häuser, Lukas Radbruch, Rupert Conrad

This systematic review aimed to bring together the evidence for pain relief in palliative care but was able to identify only studies dealing with cancer pain.  The review summarises this evidence and highlights the lack of evidence for the management of pain with non-opioids in conditions other than cancer. 

Fulltext available at Wiley Online Library