A systematic review and meta-analysis of meditative interventions for informal caregivers and health professionals

BMJ Supportive and Palliative Care, 2016 6(2) 160-169 

Marisa Dharmawardene, Jane Givens, Amy Wachholtz, Suzana Makowski, Jennifer Tjia

The aim of this study was to review the evidence for meditative interventions on physical and emotional markers of well-being as well as job satisfaction and burnout among informal caregivers and health professionals.  It concludes that meditation provides a small to moderate benefit for stress reduction but that more research is needed to establish the effects on burnout and caregiver burden.

Fulltext available in BMJ Supportive and Palliative Care

Available in print in Arthur Rank Hospice Library, Brookfields Hospital

Is pedagogy of mortality a good approach to bereavement care?

European Journal of Palliative Care, 2016 May/June 23(3) 146-148

Paul J Moon

In this article, the author argues that one aspect of bereavement care could be to support grievers in developing a meaningful sense of need for active preparation for future death events, including one's own: the pedagogy of mortality.

Available in print in Arthur Rank Hospice Library, Brookfields Hospital

Nicotine withdrawal: an often overlooked and easily reversible cause of terminal restlessness

European Journal of Palliative Care, 2016 May/June 23(3) pp 128-129

Shamila Ginige

Nicotine withdrawal is often overlooked as a possible underlying cause of terminal restlessness or delirium. It is easily reversible and should definitely be considered when assessing delirious patients in palliative care, suggests the author.

Available in print in Arthur Rank Hospice Library, Brookfields Hospital

Use of point-of-care ultrasound in palliative care: a case report

European Journal of Palliative Care, 2016 May/June 23(3) 114-5
Graham Grove and David Holden

Point-of-care ultrasound is increasingly used to complement clinical findings in many specialties beyond emergency medicine and critical care. Here, the authors describe how the technology was used at the home of a patient with presumed malignant ascites to bring symptom relief.

Available in print in Arthur Rank Hospice Library, Brookfields Hospital

A review of the evidence for adjustable compression wrap devices

Journal of wound care, May 2016, vol. 25, no. 5, p. 242-247

Williams, A

Individuals with lymphoedema, venous ulceration and lipoedema often require long-term compression therapy to prevent and manage problems such as chronic ulceration and skin changes, persistent swelling and shape distortion. Adjustable compression wrap devices using hook and loop fasteners, commonly called VELCRO brand fasteners, present new opportunities for improving treatment outcomes, supporting patient independence and self-management in the use of compression therapy. This paper reports the findings of an evidence review of adjustable compression wrap devices in people with lymphoedema, chronic oedema, venous ulceration and lipoedema.

Pharmacological management of bronchorrhea in malignant disease: a systematic literature review

Journal Of Pain And Symptom Management, May 2016, vol. 51, no. 5, p. 916-925

Rémi, Constanze, Rémi, Jan, Bausewein, Claudia

The aim of the review was to identify, appraise and evaluate the effectiveness of symptomatic pharmacological treatments for bronchorrhea.  Limited data was found and it was concluded that a pragmatic strategy of management is needed which should include promising treatment options reported in the literature but should also take into account availability of drugs, individual tolerability and costs.

Barriers and facilitators to end-of-life communication in advanced chronic organ failure

International Journal of Palliative Nursing, May 2016, vol. 22, no. 5, p. 222-229

Van den Heuvel, Liza Amc, Spruit, Martijn A, Schols, Jos Mga, Hoving, Ciska, Wouters, Emiel Fm, Janssen, Daisy Ja

The results of this quantitative, cross-sectional study suggest that the most important barriers for family caregivers were related to uncertainty about expected care and focus on staying alive instead of dying. The facilitators were related to trust in and competence of their physician and earlier experiences with death in their (social) environment. For most barriers and facilitators, agreement between patients and family caregivers was fair to moderate, suggesting an individual approach is needed to improve communication at the end of life.

Available in print in Arthur Rank Hospice, Brookfields Hospital

Cancer-related fatigue in palliative care: a global perspective

International Journal of Palliative Nursing, May 2016, vol. 22, no. 5, p. 244-252

Vilchynska, Tetyana, Beard, Barbara

Apart from exercise, cognitive behavioural therapy and psychosocial interventions, there is an absence of high quality evidence that favours any particular pharmacological and non-pharmacological treatments for cancer-related fatigue. The authors propose solutions for an optimum CRF care pathway in the palliative setting using an integrated care pathway, with an emphasis on treating the symptoms not the syndrome.

Available in print in Arthur Rank Hospice Library, Brookfields Hospital

Shadow into Light: a Bristol-based arts project for bereavement

Bereavement Care, Jan 2016, vol. 35, no. 1, p. 7-12,

Glover, Eleanor, Rice, Gillian, Phillips, Val, Williamson, Claire

Shadow into Light (SIL) is a creative and therapeutic art and writing project offering support to bereaved people, facilitated by a poet and artist with a counsellor also present. They use word and image to investigate and express feelings and assist development of new coping mechanisms, while developing supportive peer relationships. This article outlines the aims of the project and details the content of each session. Evaluation of the first two courses held found that the project was meeting its aims.

Fulltext available in Bereavement Care

Available in print in Arthur Rank Hospice, Brookfields Hospital

Learning from linguistics: structuring our sentences sensitively

Bereavement Care, Jan 2016, vol. 35, no. 1, p. 31-35

Carr, Sarah

This article examines basic techniques to improve sentence clarity to help bereavement support workers to use understandable words and phrases when communicating with clients, both verbally and in writing.  It also describes how to check the readability of  text using a feature built into Microsoft Word. References.

Fulltext available in Bereavement Care

Available in print in Arthur Rank House Library, Brookfields Hospital

A service evaluation of an integrated model of palliative care of cystic fibrosis

Palliat Med. 2016 30 (7) p698-702

Bourke SJ, Booth Z, Doe S, Anderson A, Rice S, Gascoigne A, Quibell R

In this article, the authors report an evaluation of an integrated model of care for people with cystic fibrosis in which palliative specialists worked with the CF team to provide palliative care alongside standard care. Both teams rated this model of care highly and suggest it has successfully overcome difficulties in access to specialist palliative care for patients with CF.

Fulltext available in BMJ Supportive and Palliative Care
Available in print in Arthur Rank House Library, Brookfields Hospital

Advance care planning in England: is there an association with place of death? Secondary analysis of data from the National Survey of Bereaved People

BMJ Supportive & Palliative Care 2016 June 16

Josie Dixon, Derek King, Martin Knapp

The authors used an expressed preference for place of death which was recorded by health care staff as an indicator of advanced care planning in order to explore whether ACP is associated with place of death.  They also considered if enough support was available to care for a person dying at home and the overall quality of care and pain management.  They found a strong association between advance care planning and a range of quality outcomes, including preferred place of death.

Fulltext available in BMJ Supportive and Palliative Care

Available in print in Arthur Rank House Library, Brookfields Hospital

Education and training to enhance end-of-life care for nursing home staff: a systematic literature review

BMJ Supportive & Palliative Care 2016 June 21

Sally Anstey, Tom Powell, Bernadette Coles, Rachel Hale, Dinah Gould

Education is thought to be the most important way of overcoming the difficulties of providing good end of life care in nursing homes.  In this review, the authors found that the methodological quality of the the research was poor and that there is an urgent need to design educational interventions that could potentially improve end of life care in this setting.

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