Metastatic spinal cord compression: diagnosis and management

BMJ, May 2016
Rasha Al-Qurainy; Emily Collis

This clinical review focuses on the causes, presentation and management of MSCC as a result of extradural masses.

Fulltext available in the  BMJ

Desire for hastened death: how do professionals in specialized palliative care react?

Psycho-oncology, May 2016, vol. 25, no. 5, p. 536-543

Galushko, M, Frerich, G, Perrar, K M, Golla, H, Radbruch, L, Nauck, F, Ostgathe, C, Voltz, R

This study aimed to identify the responses of health professionals working in specialist palliative care to patients' desire for hastened death (DHD).  It identified a number of responses that related to the patients and to themselves as practitioners. The authors concluded that profound personal and professional development that strengthens their own resilience is necessary to respond to the challenges presented by DHD as well as establishing helpful relationships with patients.

Consensus norms for palliative care of people with intellectual disabilities in Europe

European Association of Palliative Care: White Paper, April 2015

This White Paper provides guidance on the care of people with intellectual disabilities and includes background information on its development, research evidence, practice examples and further resources.

Click here to access the document

Advance care planning in motor neuron disease: A qualitative study of caregiver perspectives

Palliative Medicine, May 2016, vol. 30, no. 5, p. 471-478
Murray, Leigh, Butow, Phyllis N, White, Kate, Kiernan, Matthew C, D'Abrew, Natalie, Herz, Helen

This study aimed to explore the acceptability and impact of advance care planning from the point of view of caregivers.  Many of those who took part thought that the ACP document helped, or would help, in terms of patient autonomy, facilitating difficult decision-making and improving communication within families. The authors noted that the timing and manner of its introduction required sensitivity to avoid potential harms in approaching the subject too soon.

Available in print in Arthur Rank Hospice Library, Brookfields Hospital

A systematic review of reasons for gatekeeping in palliative care research

Palliative medicine, Jun 2016, vol. 30, no. 6, p. 533-548

Kars, Marijke C, van Thiel, Ghislaine Jmw, van der Graaf, Rieke, Moors, Marleen, de Graeff, Alexander, van Delden, Johannes Jm

Gatekeeping - preventing eligible patients from inclusion in research - is thought to be the reason for the failure of many studies in palliative care.  This review sought to identify potential gatekeepers and explore their reasons for blocking patients' participation.

Available in print in Arthur Rank Hospice Library, Brookfields Hospital

Factors influencing Australian general practitioners' clinical decisions regarding advance care planning: a factorial survey

Journal of Pain and Symptom Management, Apr 2016, vol. 51, no. 4, p. 718

Sinclair, Craig, Gates, Kiri, Evans, Sharon, Auret, Kirsten Anne

In this study, the authors found that the likelihood of initiating ACP was influenced by GP attitudes and psychosocial aspects of the doctor-patient relationship. They suggest that to encourange engagement with the process, training needs to be targeted at attitudes towards ACP and communication skills.

Underrecognition and undertreatment of pain and behavioral symptoms in end-stage dementia

American Journal of Hospice and Palliative Medicine, Apr 2016, vol. 31, no. 3, p. 276-280

Brecher, David B., West, Tasheba L.

Symptoms in end-stage dementia are often under-recognised and under-treated because of the patients' reduced ability to communicate.  This article highlights the role of assessment scales and pain management in improving behavioral symptoms.  It also explores how an interdisciplinary team approach can develop a care plan to optimise patient care.

Management of breathlessness in patients with advanced cancer: a narrative review

American Journal of Hospice and Palliative Medicine, Apr 2016, vol. 31, no. 3, p. 286-290

Lok, Chan Wing

This article reviews the etiology, assessment and measurement of dyspnea in patients with advanced cancer and  both the pharmacological and nonpharmacological interventions that will provide the greatest relief.

Hospice palliative care volunteers: a review of commonly encountered stressors, how they cope with them, and implications for volunteer training/management

American Journal of Hospice and Palliative Medicine, Mar 2016, vol. 31, no. 2, p. 201-204

Claxton-Oldfield, Stephen

The results of this review suggest that hospice volunteers generally do not perceive their work as highly stressful.  However, potential challenges and the ways in which the volunteers coped with them were identified. 

Hospital at home: home-based end-of-life care

Cochrane Database of Systematic Reviews, Online Publication Date: February 2016 

Sasha Shepperd, Daniela C Gonçalves-Bradley, Sharon E Straus, Bee Wee

The evidence included in this review supports the use of home-based end-of-life care programmes for increasing the number of people who will die at home, although the numbers of people admitted to hospital while receiving end-of-life care should be monitored. Future research should systematically assess the impact of home-based end-of-life care on caregivers.

Fulltext available here

Live Discharge from Hospice and the Grief Experience of Dementia Caregivers

Journal of Social Work in End-of-life & Palliative Care 2016, 12 (1-2): 47-62
Stephanie P Wladkowski

This qualitative study (N = 24) explored the experience of caregivers of adults with dementia, including Alzheimer's disease, who experienced a 'live' discharge from hospice. Specifically, the experience of grief is examined.  It concludes that hospice social workers are well positioned to offer emotional and other concrete support to caregivers who experience a 'live' discharge.

Te Kete Marie - the peaceful basket: an initiative for supporting people with dementia or delirium

International Journal of Palliative Nursing 2016, 22 (3): 130-6

Leanne Bolton, Tanya Loveard

Having identified the challenge to staff on an inpatient unit of caring for an increasing number of patients with dementia and delirium, an occupational therapist and two nurses developed a toolkit to improve their care.  The initiative took place in a hospice in New Zealand and the authors hope that sharing their findings will enable it to be duplicated in similar settings.

Available in print in Arthur Rank Hospice Library, Cambridge

Development and efficacy of music therapy techniques within palliative care

Complementary therapies in clinical practice, May 2016, vol./is. 23/(125-129)

Clements-Cortés, Amy

The author presents an overview of music therapy techniques used with palliative care patients with reference to the descriptive and research literature.  She also discusses its role in the grieving and bereavement process.

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.

To access this article click here

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

Walls, wisdom, worries, and wishes: engaging communities in discussion about death, dying, loss, and care using café conversation

Progress in Palliative Care, 2016, vol./is. 24/1(9-14)

McLoughlin, K., McGilloway, S., Lloyd, R., O'Connor, M., Rhatigan, J., Shanahan, M., Richardson, M., Keevey, A.

This paper reflects on the adaptation of the World Café concept to engage with members of the public in Compassionate Communities Café Conversation.  This paper outlines the preparation, presentation, and pilot evaluation of the Compassionate Communities Café Conversation experience in two towns in the Mid-West of Ireland. The experience and findings suggest that this approach offers a potentially very useful framework for use by others as part of a health promoting approach to palliative care.

Available in print in Arthur Rank Hospice Library, Brookfields Hospital

The palliative care needs of people severely affected by neurodegenerative disorders: a qualitative study

Progress in Palliative Care, 2015, vol./is. 23/6(331-342)

Veronese, S., Gallo, G., Valle, A., Cugno, C., Chiò, A., Calvo, A., Rivoiro, C., Oliver, D. J.

The particular needs of people with advanced and progressive neurological disease are not well known. A qualitative approach was used, interviewing people with advanced amyotrophic lateral sclerosis/motor neurone disease (ALS/MND), multiple sclerosis (MS), Parkinson's disease (PD), and multiple systems atrophy (MSA) and their family carers to ascertain their particular needs. Focus groups of health and social care professionals allowed a professional view of the needs. People with progressive disease have many, difficult and distressing symptoms: physical, including pain, movement issues, swallowing and speech problems, psychological, feelings of being abandoned and of anxiety and depression, social, of isolation, of being a burden and of financial issues, and spiritual, of loss of hope and the meaning of life as they approach death.

Available in print in Arthur Rank Hospice Library, Brookfields Hospital

"Sometimes we can't fix things": a qualitative study of health care professionals' perceptions of end of life care for patients with heart failure

BMC Palliative Care, January 2016, vol./is. 15/1(no pagination)

Glogowska M., Simmonds R., McLachlan S., Cramer H., Sanders T., Johnson R., Kadam U.T., Lasserson D.S., Purdy S.

Studies show that patients with advanced heart failure may have a poor understanding of their condition and its outcome and, therefore, miss opportunities to discuss their wishes for EoL care and preferred place of death. We aimed to explore the perceptions and experiences of health care professionals (HCPs) working with patients with heart failure around EoL care. These key professionals can help co-ordinate care and support in the terminal phase of the condition. Links between heart failure teams and specialist palliative care services appear to benefit patients, and further sharing of expertise between teams is recommended.

Fulltext available from National Library of Medicine in BMC Palliative Care

The use of aromasticks to help with sleep problems: A patient experience survey

Complementary therapies in clinical practice, Feb 2016, vol. 22, p. 51-58

Dyer, Jeannie, Cleary, Lise, McNeill, Sara, Ragsdale-Lowe, Maxine, Osland, Caroline

Essential oils may be inhaled by means of an aromastick (a personal inhaler device containing essential oils) as a means of improving sleep. Sixty-five aromasticks were given out over a 13 week period. 94% of patients reported that they did use their aromastick to help them sleep and 92% reported that they would continue to do so. An improvement of at least one point on a Likert scale measuring sleep quality was shown by 64% of patients following the use of an aromastick.

Fulltext available in Complementary Therapies in Clinical Practice

Effect of progressive relaxation exercises on fatigue and sleep quality in patients with chronic obstructive lung disease (COPD)

Complementary therapies in clinical practice, Nov 2015, vol. 21, no. 4, p. 277-281

Akgün Şahin, Zümrüt, Dayapoğlu, Nuray

This research was conducted to investigate the effect of Progressive Muscle Relaxation Technique on fatigue and sleep quality in patients with COPD.  It was determined that PMRT decreased patients' fatigue level and improved their sleep quality.  Progressive relaxation exercises programs represent effective therapeutic intervention approaches for relieving COPD-associated fatigue and sleep quality. 

Fulltext available in Complementary Therapies in Clinical Practice

What does end stage in neuromuscular diseases mean? Key approach-based transitions

Current opinion in supportive and palliative care, Dec 2015, vol. 9, no. 4, p. 361-368

Tripodoro, Vilma Adriana, De Vito, Eduardo Luis

The purpose of this article is to revise the definition of end stage in the setting of neuromuscular disease (NMD), to understand the implications for the patient, family and healthcare team, and to address the obstacles involved in the lack of definition.  Better end-stage NMD definitions should help to identify the goals of care, but a broad range in time and intensity of deterioration make a valid definition difficult. This article emphasizes the relevance of an integrated approach through the whole trajectories of NMD patients considering key transitions.

Unexpected death in palliative care: what to expect when you are not expecting

Current opinion in supportive and palliative care, Dec 2015, vol. 9, no. 4, p. 369-374

Hui, David

When death occurs suddenly and earlier than anticipated, it is considered as an unexpected death. In this article, the author discusses when death is expected and unexpected, and reviews the frequency, impact, causes, and approach to unexpected death in the palliative care setting. Unexpected death has significant impact on care, including unrealized dreams and unfinished business among patients, a sense of uneasiness and complicated bereavement among caregivers, and uncertainty in decision making among healthcare providers. 

Living with advanced cancer and an uncertain disease trajectory: an emerging patient population in palliative care?

BMJ Support Palliat Care 2015; vol/is 5/4, p 352-357
Elizabeth A Lobb, Judith Lacey, John Kearsley, Winston Liauw, Lesley White and Annmarie Hosie

Participants in this study represent an emerging cancer patient population who are receiving palliative therapies. Our study suggests that a flexible model of care is needed to support the needs of people who may still be receiving some form of chemotherapy and/or radiotherapy, and remain well. This model may need to take more of an intermittent approach, that is, as required for specific symptom management, rather than patients being linked continuously to a palliative care service for long periods of time.

Available in print in Arthur Rank Hospice Library, Brookfields Hospital

Defining the palliative care patient: its challenges and implications for service delivery

BMJ Support Palliat Care 2015; vol/is 5/4, p 46-52

Helen Mitchell, Simon Noble, Ilora Finlay and Annmarie Nelson

Within the UK, general practitioners (GPs) are required to maintain a register of palliative patients under their care. We explored GPs' views of what defines a palliative care patient in the context of identifying clinical service needs.  Achieving health policy targets which require identification of palliative patients will continue to be a challenge until a workable and reliable definition of the term ‘palliative’ is agreed upon.

Available in print in Arthur Rank Hospice Library, Brookfields Hospital

Service user perspectives on palliative care education for health and social care professionals supporting people with learning disabilities

BMJ Support Palliat Care 2015 December, vol/is 5/5, p 531-7
Dorry McLaughlin, Owen Barr, Sonja McIlfatrick and Roy McConkey

Evidence from European and American studies indicates limited referrals of people with learning (intellectual) disabilities to palliative care services. This study aimed to elicit the views of people with learning disabilities, and their family carers concerning palliative care, to inform healthcare professional education and training.

Available in print in Arthur Rank Hospice Library, Brookfields Hospital

Prognostic factors of 30-day mortality after palliative procedures in patients with malignant pleural effusion

Annals of surgical oncology, Nov 2015, vol. 22, no. 12, p. 4083-4088 

Abrao, Fernando Conrado, de Abreu, Igor Renato Louro Bruno, Fogarolli, Mariana, Caxeiro, Giovanna, Bezerra, Camila Borges Saes, de Cerqueira Cesar, Fernanda Prado, Rocha, Poline Spitti, Younes, Riad Naim

The aim of this study was to identify predictors of 30-day mortality in patients with malignant pleural effusion (MPE) who need pleural palliative procedures. The authors identified four factors that are easily recognized in daily practice and can help select patients with low life expectancy, therefore preventing invasive procedures and hospitalizations for this subgroup of patients.

Internet-based exposure and behavioral activation for complicated grief and rumination: a randomized controlled trial

Behavior therapy, Nov 2015, vol. 46, no. 6, p. 729-748

Eisma, Maarten C, Boelen, Paul A, van den Bout, Jan, Stroebe, Wolfgang, Schut, Henk A W, Lancee, Jaap, Stroebe, Margaret S

This study examined the effectiveness and feasibility of therapist-guided internet-delivered exposure (EX) and behavioral activation (BA) for complicated grief and rumination. Results supported potential applicability of online exposure but not behavioral activation to decrease complicated grief and rumination. 

Fulltext available from Elsevier in Behavior Therapy