Care of breathlessness in a hospice patient with advanced lung cancer

End of Life Journal, 2014, Vol/iss 4/2
Gemma Hodge

This article explores the available evidence regarding best practice in the assessment and management of dyspnoea in patients with advanced lung cancer receiving palliative care and reflects on the care of a woman with advanced lung cancer admitted to a hospice and who had an acute episode of dyspnoea.

Full text available in End of Life Journal

Teaching general practitioners and doctors-in-training to discuss advance care planning: evaluation of a brief multimodality education programme

BMJ Supportive and Palliative Care 2014;Vol/iss 4/3 (313-321)
Karen Detering, William Silvester, Charlie Corke, Sharyn Milnes, Rachael Fullam, Virginia Lewis, Jodie Renton

The authors report the results of the evaluation of an interactive advance care planning (ACP) educational programme for general practitioners and doctors-in-training. They conclude that the programme significantly improved the doctors’ self-reported confidence in discussing advance care planning, improved their scores on the patient e-simulation exercise and was rated highly by the majority of participants.

Full text available in BMJ Supportive and Palliative Care

Available in print in Arthur Rank House Library, Brookfields Hospital

Diagnosing dying: an integrative literature review

BMJ Supportive and Palliative Care 2014;Vol/iss 4/2, (263-270)

Catriona Kennedy; Patricia Brooks-Young; Carol Brunton Gray; Phil Larkin;  Michael Connolly; Bodil Wilde-Larsson; Maria Larsson; Tracy Smith; Susie Chater

The aim of this review was to examine the evidence as to how patients are judged by clinicians as being in the final hours or days of life.The findings support the explicit recognition of ‘uncertainty in diagnosing dying’ and the need to work with and within this concept. Clinical decision making needs to allow for recovery where that potential exists, but equally there is the need to avoid futile interventions

Full text  available in BMJ Supportive and Palliative Care

Available in print in Arthur Rank House Library, Brookfields Hospital

Developing a service for patients with very severe chronic obstructive pulmonary disease (COPD) within resources

BMJ Supportive and Palliative Care 2014; Vol/iss 4/2 (196-201)
Jason Boland, Janet Owen, Rachel Ainscough, Hazim Mahdi

The aim of this service development was to improve local service provision in Barnsley, within the currently available resources, for patients with very severe COPD, to improve patient identification and symptom management, increase advance care planning and the numbers of patients dying in their preferred place, and increase patient and carer support and satisfaction. 

Full text available in BMJ_Supportive_and_Palliative_Care
Available in print in Arthur Rank House Library, Brookfields Hospital

Resuscitation decisions for patients dying in the community: A qualitative interview study of general practitioner perspectives

Palliative Medicine, September 2014, vol./is. 28/8(1053-61)

Miller S, Dorman S

The aim was to investigate how General Practitioners think and feel about making and communicating Do Not Attempt Cardiopulmonary Resuscitation decisions for patients dying in the community. Resuscitation decisions are important in facilitating a peaceful death, but can be difficult for general practitioners to discuss. The authors suggest that GPs might benefit from clearer guidance on when an attempt at resuscitation is unlikely to be successful, especially in non-malignant disease. Team discussions including Gold Standards Framework meetings can give confidence and support in making difficult end-of-life decisions.

Available in print in Arthur Rank House Library, Brookfields Hospital

Palliative sedation therapy: a systematic literature review and critical appraisal of available guidance on indication and decision making

Journal of Palliative Medicine, May 2014, vol./is. 17/5(601-11)

Schildmann E, Schildmann J

Following a review and critical appraisal, the authors found that the guidelines differ considerably on aspects of indication and decision making about PST which are relevant from a clinical as well as ethical perspective. The comparison and critical appraisal can serve as a starting point for the improvement of future PST policies. 

Efficacy of dignity therapy on depression and anxiety in Portuguese terminally ill patients: a phase II randomized controlled trial

Journal of Palliative Medicine, June 2014, vol./is. 17/6(688-95)

Juliao M, Oliveira F, Nunes B, Vaz Carneiro A, Barbosa A

Eighty participants were included in this study and followed for 30 days. The authors conclude that dignity therapy resulted in a beneficial effect on depression and anxiety symptoms in end-of-life care. The therapeutic benefit was sustained over a 30-day period. 

Palliative use of noninvasive ventilation: navigating murky waters

Journal of Palliative Medicine, June 2014, vol./is. 17/6(657-61)

Quill CM, Quill TE

The authors describe the use of NPPV in four patients with advanced disease and preexisting treatment-limiting directives. They discuss some of the ethical dilemmas and unintended consequences that may accompany the use of NPPV in such circumstances and review the benefits and burdens of palliative NPPV.  They conclude with a summary of principles that can be used as a guide to decision making regarding palliative NPPV.

Delirium in palliative and end of life care

Journal of Pain & Symptom Management, August 2014, vol./is. 48/2

This is a themed issue of the journal with a range of articles relating to delirium.  Titles include:

• Clinical practice guidelines for delirium management: potential application in palliative care
• Treating an established episode of delirium in palliative care: expert opinion and review of the current evidence base with recommendations for future development
• End-of-life delirium: issues regarding recognition, optimal management, and the role of sedation in the dying phase
• Practical assessment of delirium in palliative care
• A relational ethical approach to end-of-life delirium

Available in print in Arthur Rank House Library, Brookfields Hospital

The implications of mandatory do not attempt cardiopulmonary resuscitation discussions

International Journal of Palliative Nursing, July 2014, vol./is. 20/7(323-5)

Berry PA

A discussion on the recent Court of Appeal judgement in the case of Tracey vs Cambridge University Hospital HNS Foundation Trust relating to the failure to consult on the placement of a DNACPR notice in the patient's medical record.

Available in print in Arthur Rank House Library, Brookfields Hospital

'Cancer changes everything!' Exploring the lived experiences of women with metastatic breast cancer

International Journal of Palliative Nursing, July 2014, vol./is. 20/7(334-42)

Krigel S, Myers J, Befort C, Krebill H, Klemp J

The aim of this study was to further explore the lived experiences of women with metastatic breast cancer (MBC), to inform the development of interventions to enhance survivorship care for women with advanced disease. 

Full text available in International Journal of Palliative Nursing

Available in print in Arthur Rank House Library, Brookfields Hospital

Breathlessness in motor neurone disease: a review of the current strategies and gaps in the evidence

Current Opinion in Supportive & Palliative Care, September 2014, vol./is. 8/3(213-7)

Allcroft P

Palliative care teams are increasingly becoming involved in the complex care of these patients at an earlier stage in their illness. Assessment of breathlessness and its successful management improves the QoL of patients with MND and may minimize hospitalisation.

Full text available in Current Opinion in Supportive and Palliative Care

Preparedness planning before mechanical circulatory support: a "how-to" guide for palliative medicine clinicians

Journal of Pain & Symptom Management, May 2014, vol./is. 47/5(926-935.e6)

Swetz KM, Kamal AH, Matlock DD, Dose AM, Borkenhagen LS, Kimeu AK, Dunlay SM, Feely MA

Previous literature has suggested that palliative medicine providers are well poised to assist cardiologists, cardiothoracic surgeons, and the multidisciplinary cardiovascular team with promotion of informed consent and initial and iterative discussions regarding goals of care. Here, the authors outline several key aspects of preparedness planning and detail strategies for engaging patients who are receiving mechanical circulatory support in the process. 

Full text available from Elsevier in Journal of Pain and Symptom Management

Available in print in Arthur Rank House Library, Brookfields Hospital

Care strategy for death rattle in terminally ill cancer patients and their family members: recommendations from a cross-sectional nationwide survey of bereaved family members' perceptions

Journal of Pain & Symptom Management, July 2014, vol./is. 48/1(2-12)

Shimizu Y, Miyashita M, Morita T, Sato K, Tsuneto S, Shima Y

The authors aimed to clarify death rattle-related emotional distress levels among family members and their perceptions of the need for death rattle care improvement and explore the factors influencing both these issues. 

Full text available from Elsevier in Journal of Pain and Symptom Management

Available in print in Arthur Rank House Library, Brookfields Hospital

The challenges of providing palliative care for people with intellectual disabilities: a literature review

International Journal of Palliative Nursing, June 2014, vol./is. 20/6(279-84)

Dunkley S, Sales R

This literature review explores the challenges of providing palliative care for people with intellectual disability,  highlighting the need for ongoing staff development focusing on staff confidence, collaborative working between professionals, and the empowerment of people with intellectual disability to be involved in decisions about their end-of-life care. 

Full text available from EBSCO in International Journal of Palliative Nursing

Available in print in Arthur Rank House Library, Brookfields Hospital

Current assessment and treatment strategies of dysphagia in head and neck cancer patients: a systematic review of the 2012/13 literature

Current Opinion in Supportive & Palliative Care, June 2014, vol./is. 8/2(152-63)

Kraaijenga SA, van der Molen L, van den Brekel MW, Hilgers FJ 

This review focuses on the rapidly growing literature published during the past 2 years about the current assessment and treatment strategies of dysphagia in HNC patients. 

Full text available from Ovid in Current Opinion in Supportive and Palliative Care

"It's alright to ask for help": findings from a qualitative study exploring the information and support needs of family carers at the end of life

BMC Palliative Care, 2014, vol./is. 13/(22)

Harrop E, Byrne A, Nelson A

Results from four focus groups with Clinical Nurse Specialists, healthcare assistants, former and current carers at a hospice in the UK, suggest three domains which could underpin the development of educational or information based resources for carers: developing knowledge and competence; facilitating preparedness; supporting role recognition and confidence building.

Full text available from Proquest in BMC Palliative Care

Full text available from BioMedCentral in BMC Palliative Care

Blended e-learning and end of life care in nursing homes: a small-scale mixed-methods case study

BMC Palliative Care, 2014, vol./is. 13/(31)

Farrington CJ

This paper evaluates the impact of a blended training course for group c staff (i.e. staff with relatively infrequent contact with end of life care) in a nursing home in the East of England, while also considering barriers to change in practice. The author concludes that while blended e-learning courses have the potential to generate positive change in participants' understandings of and confidence about End of Life Care, organizational and inter-professional obstacles must be overcome in order to translate these changes into improved end of life care delivery in nursing (and residential) homes.

Full text available from Proquest in BMC Palliative Care

Full text available from BiomedCentral in BMC Palliative Care

Caregiver evaluation of the ACTIVE intervention: "it was like we were sitting at the table with everyone"

American Journal of Hospice & Palliative Medicine, June 2014, vol./is. 31/4(444-53)

Oliver DP, Albright DL, Kruse RL, Wittenberg-Lyles E, Washington K, Demiris G

This study evaluates the participant experience of the ACTIVE (assessing caregivers for team intervention via video encounters) intervention, designed to use web conferencing technology to overcome the barriers of participation in the development and review of individual care plans. 

The changing face of grief: Contemporary directions in theory, research, and practice

Progress in Palliative Care, 01 June 2014, vol./is. 22/3(125-130)
Robert A Neimeyer

This brief article reviews the conceptual developments in grief work and the emerging therapies they suggest and argues that their inclusion in professional training can support professionals who work with families at the end of life and beyond.

Available in print in Arthur Rank House Library, Brookfields Hospital

Bereavement and palliative care: A public health perspective

Progress in Palliative Care, 01 June 2014, vol./is. 22/3(131-135)
Bruce Rumbold; Samar Aoun

In this paper the authors argue that palliative care services should match their commitment to providing a good death with a commitment to supporting good grief and that this means investing their efforts principally in developing a community capacity for bereavement care rather than seeking to deliver specialised services only to relatives and friends of those who have received palliative care services.

Available in print in Arthur Rank House Library, Brookfields Hospital

Caring for the carer: The lessons of research

Progress in Palliative Care, 01 June 2014, vol./is. 22/3(150-154)
Kenneth J Doka

This paper explores the phenomenon of carer grief as experienced by many who counsel or work with individuals who are ill, dying or bereaved.  It also identifies both individual and organisational strategies that help carers in coping with their grief.

Available in print in Arthur Rank House Library, Brookfields Hospital

Bereavement needs assessment - Piloting a process

Progress in Palliative Care, 01 June 2014, vol./is. 22/3(143-149)
Tania Brocklehurst; Clare Hearnshaw; Linda Machin

Professionals from seven hospices and carers' organisations in Hertfordshire and Luton piloted the use of the 'Range of Response to Loss Bereavement Self-Assessment Tool' (RRL BSA). Practitioners involved in the pilot believed the responses to the assessment tool accurately reflect the level of the clients' bereavement needs.

Available in print in Arthur Rank House Library, Brookfields Hospital

Complicated grief - a challenge in bereavement support in palliative care: An update of the field

Progress in Palliative Care, 01 June 2014, vol./is. 22/3(136-142)

Mai-Britt Guldin

This paper addresses issues relating to complicated grief as a bereavement-related disorder.  The current implications and challenges in palliative care bereavement support are discussed.

Available in print in Arthur Rank House Library, Brookfields Hospital

Breaking down the silos: Collaboration delivering an efficient and effective response to palliative care emergencies

Progress in Palliative Care, 01 August 2014, vol./is. 22/4(212-218)
Kate Swetenham; Hugh Grantham; Karen Glaetzer

The objective is to explore the introduction of a rapid response team using a partnership model involving extended care paramedics in South Australia. Early data reveals that 90% of unnecessary and unwanted hospital admissions have been avoided in the palliative care population.

Available in print in Arthur Rank House Library, Brookfields Hospital

What is the cancer patient's own experience of participating in an occupational therapy-led relaxation programme?

Progress in Palliative Care, 01 August 2014, vol./is. 22/4(206-211)
Jill Cooper

This study investigated 10 cancer patients' experiences of a relaxation programme run by occupational therapists in a specialist cancer centre.  The main conclusion was that patients were not just attending relaxation for their anxiety but also held strong beliefs that the relaxation helped them cope with symptoms and other issues arising from their cancer experiences.

Available in print in Arthur Rank House Library, Brookfields Hospital

Survivorship care plans

Oncology Nursing Forum, 01 July 2014, vol./is. 41/4(447-448)

Behrend, Susan Weiss

The purpose of this pilot study was to test the feasibility of a telephone counseling program for cancer survivors. The Cancer Survivor Telephone Education and Personal Support (C-STEPS) program was developed to address psychosocial and health behavior outcomes among cancer survivors. According to Garrett et al. (2013), this was the first telephone counseling intervention to simultaneously address psychosocial and health behavior in this patient population.

Available in print at Arthur Rank House Library, Brookfields Hospital

New Bereavement Care Service Standards

Bereavement Care, 01 April 2014, vol./is. 33/1(28-32)

Kerslake, Debbie, Chaplin, Dawn, Hartley, Jonathan, Wadey, Anne

The new Bereavement Care Service Standards, developed as part of the Gold Standard Bereavement Care Project, set out what needs to be addressed in order for services to be both safe and effective in meeting the needs of bereaved people. This article outlines the development process, and shows how the Standards can apply to the voluntary sector, NHS service providers, and to individual practitioners.

Available in print at Arthur Rank House Library, Brookfields Hospital

Bereavement theory: recent developments in our understanding of grief and bereavement

Bereavement Care, 01 April 2014, vol./is. 33/1(7-12)

Hall, Christopher

This article looks at how early stage theories of grief came to be rejected and examines more recent theories which also consider the cognitive, social, cultural and spiritual dimensions of grief and loss. It goes on to highlight emerging trends in bereavement theory, potential complications of grief, and the evidence for the efficacy of grief interventions.

Available in print at Arthur Rank House Library, Brookfields Hospital

The emotional labour of caring for patients at the end of life

End of Life Journal, 2014 Spring, Vol/iss 4/1

Deborah Holman

This article will discuss the emotional labour of nursing - defined as the emotional cost to nurses of managing, hiding and suppressing their emotions - and explore the significance and therapeutic value of emotional labour in the lives of patients at the end of life. It will then discuss the implications of emotional labour for the nursing profession in relation to the need to ensure nurses receive more support and education regarding managing their emotions whilst caring for others.

Fulltext available in End of Life Journal

Holistic assessment of a woman admitted to a hospice with anxiety

End of Life Journal, 2014 Spring, Vol/iss 4/1

Rebecca Newman

In advanced disease, symptoms of anxiety can be difficult to differentiate from symptoms of physical disease. Therefore, anxiety states are often undiagnosed in palliative care patients. The aim of the article is to show how a holistic assessment can successfully address anxiety at the end of life. However, it is recommended that formal assessments of psychological well-being are also required for patients with significant psychological needs to evaluate the effectiveness of the interventions and approaches used. 

Fulltext available in End of Life Journal

Physical exercise and therapy in terminally ill cancer patients: a retrospective feasibility analysis.

Supportive Care in Cancer, May 2014, vol./is. 22/5(1261-8)

Jensen W, Bialy L, Ketels G, Baumann FT, Bokemeyer C, Oechsle K

From this study it was concluded that PE/PT were feasible in >90 % of terminally ill cancer patients to whom PE/PT had been offered. Physical exercises, relaxation therapy, and breathing training were the most frequently applicable methods. Prospective trials are needed to evaluate the efficacy of specific PE/PT programs in terminally ill cancer patients.

Facilitating change and adaptation: the experiences of current and bereaved carers of patients with severe chronic obstructive pulmonary disease

Journal of Palliative Medicine, April 2014, vol./is. 17/4(421-7)

Philip J, Gold M, Brand C, Miller B, Douglass J, Sundararajan V

This study seeks to understand the experiences and needs of family carers of people with severe COPD.  The impact of caring borne by family carers is substantial and life changing. Health professionals may assist carers in their role through acknowledgement, facilitating recognition of the changes that have occurred (and their implications), and enabling creative adaptive responses for carers. Such assistance is likely to enhance the ability of carers to continue in this demanding role.

When open-ended questions don't work: the role of palliative paternalism in difficult medical decisions

Journal of Palliative Medicine, April 2014, vol./is. 17/4(415-20)

Roeland E, Cain J, Onderdonk C, Kerr K, Mitchell W, Thornberry K

Paternalism, characterized as the antithesis of autonomy, is widely dismissed as having any role in medicine. The authors disagree and argue that paternalism still has an important role in medical decision making.

Use of corticosteroids for anorexia in palliative medicine: a systematic review

Journal of Palliative Medicine, April 2014, vol./is. 17/4(482-5)

Miller S, McNutt L, McCann MA, McCorry N

As a result of this review, the authors conclude that corticosteroids are beneficial in treating anorexia in palliative care patients with malignancies; however there is no evidence for their use in anorexia due to end-stage nonmalignant disease. There is insufficient evidence to recommend any particular corticosteroid drug over another, or to recommend a dosing regimen.

Intimate partner violence in an outpatient palliative care setting

Journal of Pain & Symptom Management, April 2014, vol./is. 47/4(806-13)

Culver Wygant CR, Bruera E, Hui D

Palliative care patients may be at high risk for intimate partner violence because they are generally more vulnerable and dependent and more isolated as a result of physical and functional deterioration. In this article, the authors discuss a patient with advanced cancer who experienced IPV in the palliative care setting and use the case to highlight some of the management issues regarding IPV.

Fulltext available Journal of Pain and Symptom Management

Available in print at Arthur Rank House Library, Brookfields Hospital

Dying with dementia: symptoms, treatment, and quality of life in the last week of life

Journal of Pain & Symptom Management, April 2014, vol./is. 47/4(710-20)

Hendriks SA, Smalbrugge M, Hertogh CM, van der Steen JT

The aim of this study was to investigate symptom prevalence and prescribed treatment, explore associations with quality of life (QOL) in the last week of life, and examine symptom prevalence by cause of death of nursing home residents with dementia.

Available in fulltext in Journal of Pain and Symptom Management

Available in print at Arthur Rank House Library, Brookfields Hospital

Breakthrough cancer pain: the role of the nurse

International Journal of Palliative Nursing, March 2014, vol./is. 20/3(126-9)

Buchanan A, Davies A, Geerling J

Breakthrough pain is common in patients with cancer and is a significant cause of morbidity in this group of patients. Breakthrough pain is a heterogeneous condition, and so its management needs to be individualised. This paper describes the management of breakthrough pain and, specifically, the recently published guidelines of the European Oncology Nursing Society.

Available from EBSCOhost in International Journal of Palliative Nursing

Available in print at Arthur Rank House Library, Brookfields Hospital

Advice from children and adolescents on final conversations with dying loved ones.

Death Studies, 01 May 2014, vol./is. 38/5(308-314)

Keeley, Maureen P., Generous, Mark A.

To understand more about final conversations (communication between loved ones from the point of terminal diagnosis until death), 49 children/adolescents provided final conversation advice for other youth and for the dying person. The main finding was that young people should be included in the death process.

Managing the effects of cardiac cachexia

Journal of Hospice and Palliative Nursing, Feb 2014, vol. 16, no. 1, p. 15-20

Carlson, Heather, Dahlin, Constance M.

Although cachexia is common in cancer, it is poorly understood in noncancer diagnoses. This article reviews cancer cachexia in cardiac disease. The definition, pathophysiology, and assessment specific to cardiac disease are delineated. Diagnostic workup is discussed and pharmacological and nonpharmacological interventions are offered.