Education:Out-of-hours palliative care: what are the educational needs and preferences of general practitioners?

BMJ Supportive and Palliative Care, 2016, vol 30(3) 362-368
Claire Magee; Jonathan Koffman

This study examines the confidence of out-of-hours general practitioners (GPs) in symptom control and end of life prescribing, and identifies their educational needs and preferences in order to inform recommendations for future education.  The authors conclude that regular e-learning is favoured, but should be blended with other approaches that promote engagement including out-of-hours themed workshops and case discussion. They also suggest that specialist palliative care services should engage with out-of-hours providers to support education.

Full text available in BMJ Supportive and Palliative Care
Available in print in Arthur Rank Hospice, Cambridge

Pharmacovigilance in hospice and palliative care

BMJ Supportive and Palliative Care, 2016, vol 6(3) 

Two articles in this issue look at the net effects of drugs commonly used in palliative settings - pregablin for neuropathic pain and dexamethasone for anorexia.  They both stem from an international pharmacovigilance programme established to better understand how medications affect hospice/palliative care patients.  The aim in both cases is to add to the evidence base for the use of the drugs in these patients.
  
Full text available in  BMJ Supportive and Palliative care - Pregablin for nueropathic pain

Full text available in  BMJ Supportive and Palliative Care - Dexamethasone for anorexia

Available in print in Arthur Rank Hospice Library, Cambridge

Vitamin D and patients with palliative cancer

BMJ Supportive and Palliative Care, 2016, vol 30(3) 287-91
Linda Bjorkhem-Bergman; Peter Bergman

The authors of this review explore the role of vitamin D in the immune system and discuss its potential value in the palliative care of cancer patients. From the results of their own observational study and a case report they suggest that vitamin D supplementation has a beneficial effect on pain and well-being and could reduce susceptibility to infections.

Full text available in  BMJ Supportive and Palliative Care
Available in print in Arthur Rank Hospice Library, Cambridge

Progesterone therapy for the treatment of non-cancer cachexia: a systematic review

BMJ Supportive and Palliative Care, 2016, vol 6(3) 276-86
Joanne K Taylor; Neil Pendleton

The selected studies collated results from 916 patients with HIV/AIDS, end-stage renal failure, chronic obstructive pulmonary disease (COPD) and geriatric cachexia.  The authors conclude that current evidence does not support the use of progesterone therapies for non-cancer cachexia. There may however be a limited role for its use as an appetite stimulant in a palliative context on a case-by-case basis.

Full text available in  BMJ Supportive and Palliative Care
Available in print in Arthur Rank Hospice, Cambridge

The bereavement experiences of lesbian, gay, bisexual and/or trans* people who have lost a partner: A systematic review, thematic synthesis and modelling of the literature

Palliative Medicine; Sep 2016; vol. 30(8) 730-744

Bristowe, Katherine; Marshall, Steve; Harding, Richard

The studies identified in this review described universal experiences of the pain of losing a partner; however, additional barriers and stressors were reported for lesbian, gay, bisexual and/or trans* people, including homophobia, failure to acknowledge the relationship, additional legal and financial issues and the 'shadow' of HIV or AIDS. A novel model was developed to explain how the experience for lesbian, gay, bisexual and/or trans* people is shaped by whether the relationship was disclosed and acknowledged in life and into bereavement and how this impacts upon needs and access to care. 

Full text available in  Palliative Medicine

Available in print in Arthur Rank Hospice Library. Cambridge

Development of a question prompt sheet for cancer patients receiving outpatient palliative care

Journal of Palliative Medicine; Aug 2016; vol. 19(8) 883-887

Arthur, Joseph; Yennurajalingam, Sriram; Williams, Janet; Tanco, Kimberson; Liu, Diane; Stephen, Saneese; Bruera, Eduardo

A question prompt sheet has been shown to improve doctor/patient communication during consultations. The aim of this study was to develop a single-page consensus list of prompt questions for use by patients attending outpatient palliative care. An expert group of experienced physicians and mid-level providers were invited to participate in the study conducted in three Delphi rounds. From this, a 25-item, single-page QPS was developed for use by patients attending outpatient palliative care.

The effect of 5 minutes of mindful breathing to the perception of distress and physiological responses in palliative care cancer patients: a randomized controlled study

Journal of Palliative Medicine; Sep 2016; vol. 19(9) 917-924

Ng, Chong Guan; Lai, Kiah Tian; Tan, Seng Beng; Sulaiman, Ahmad Hatim; Zainal, Nor Zuraida

This is a randomized controlled trial involving sixty palliative cancer patients. They were randomly assigned to either 5 minutes of mindful breathing or normal listening arms. There was significant reduction of perceived distress, blood pressure, pulse rate, breathing rate, and galvanic skin response; also, significant increment of skin surface temperature in the 5-minute MB group. The changes in the 5-minute breathing group were significantly higher than the normal listening group. The authors conclude that five-minute MB is a quick, easy to administer, and effective therapy for rapid reduction of distress in palliative setting.

Multidimensional symptom clusters: an exploratory factor analysis in advanced chronic kidney disease

Journal of Advanced Nursing; Oct 2016; vol. 72(10) 2389-2400

Almutary, Hayfa; Douglas, Clint; Bonner, Ann

436 people with stage 4 and 5 chronic kidney disease were recruited to explore the existence of symptom clusters in advanced chronic kidney disease. . Five symptom clusters were consistently identified across all symptom dimensions, with clusters ranging from 2-10 symptoms. Adopting a symptom cluster approach has the potential to significantly advance symptom assessment and nursing care for people in advanced stages of chronic kidney disease.

Developing a policy to empower informal carers to administer subcutaneous medication in community palliative care; a feasibility project

International journal of palliative nursing; Aug 2016; vol. 22(8) 369-378

Lee, Louise; Howard, Kay; Wilkinson, Lyn; Kern, Cheryl; Hall, Sarah

This article describes the development and implementation of a policy to support community professionals to train informal carers to give, 'as required ', subcutaneous medications to their relative. From the small numbers audited it could be suggested that if the process is well managed and the informal carers feel supported they can safely and effectively administer subcutaneous injections in community palliative care. 

Available in print in Arthur Rank Hospice Library, Brookfields Hospital

Thromboembolic disease and breathlessness

Current opinion in supportive and palliative care; Sep 2016; vol. 10(3) 249-255

Noble, Simon

The management of venous thromboembolism remains challenging because the clinical trials informing practice recruited patients that are largely unrepresentative of the advanced disease populations. Recent years have seen several developments in the management of VTE including new oral anticoagulants, an appreciation of the patient's experience of VTE, and the importance of considering other comorbidities in ensuring an individualized approach to VTE treatment. This study reviews the challenges of VTE management within supportive and palliative care.

'I am actually doing something to keep well. That feels really good': Experiences of exercise within hospice care

Progress in Palliative Care; Jul 2016; vol. 24(4) 204-212

Turner K.; Tookman A.; Bristowe K.; Maddocks M.

This qualitative study explored patients' experiences of an exercise programme within a palliative care setting, with the interviews focusing on the perceived impact on all aspects of quality of life. Patients reported an awareness of the positive physical, psychological, and social consequences of exercising. Their experiences reflected on all dimensions of quality of life, the impact of others and the sense of meaning gained through participation in exercise. 

Full text available in Progress in Palliative Care

Available in print in Arthur Rank Hospice Library, Brookfields Hospital

Service delivery of complex interventions for refractory breathlessness

Current opinion in supportive and palliative care; Sep 2016; vol. 103) 228-235

Booth, Sara; Ryan, Richella; Spathis, Anna

The review considers the evidence for different service models existing for helping people manage the chronic, irreversible breathlessness that accompanies advanced disease. Randomized controlled trial evidence confirms that a complex intervention for breathlessness can improve quality of life, reduce symptom impact, and support carers. Some preliminary data suggest prognosis improvement in some people. Integrated care is needed for both rapidly progressive disease, where death is inevitable, and chronic illness, when health improvement is possible.

Withholding versus withdrawing treatment: artificial nutrition and hydration as a model

Current opinion in supportive and palliative care; Sep 2016; vol. 10(3) 208-213

Somers, Emma; Grey, Carl; Satkoske, Valerie

This article explores various cultural perspectives of withholding and withdrawing of life-sustaining treatment utilizing a case involving artificial nutrition and hydration (ANH) to guide ethical discussion. Recent literature challenges the evidence base that feeding tubes for people with advanced dementia lead to significant harm. In light of these new findings, the authors reconsider end-of-life decision making that concerns ANH to determine whether these new findings undermine previous ethical arguments and to consider how to best educate and support patients and families during the decision-making process. 

The pathophysiology of pruritus - a review for clinicians

Progress in Palliative Care; May 2016; vol. 24(3); 133-146

Brennan F.

Pruritus is a troubling and occasionally disabling symptom. This review synthesizes the current understanding of the mechanism of pruritus and argues that a well-informed knowledge of pathophysiology is necessary to both illuminate this area of clinical practice and enhance strategies of management.

Full text available in Progress in Palliative Care

Available in print in Arthur Rank Hospice Library, Brookfields Hospital

Compromised autonomy: when families pressure patients to change their wishes

Journal of Hospice and Palliative Nursing, Aug 2016, vol. 18, no. 4, p. 284-289

Blackler, Liz

When patients are unduly pressured by their families to make medical decisions that are not in line with previously held values, beliefs, or perspectives, autonomy is compromised. Decision making in the context of family involvement and relational autonomy will be explored along with effects of caregiver stressors, patient/family disagreements, and the nuances of substituted judgment. The article also discusses strategies for best working with and advocating for patients who are experiencing compromised autonomy.

Spiritual beliefs, practices, and needs at the end of life: Results from a New Zealand national hospice study

Palliative and Supportive Care, 2016, 30th August

Richard Egan, Rod MacLeod, Chrystal Jaye, Rob McGee, Joanne Baxter, Peter Herbison, Sarah Wood

The authors report the results of a project to investigate people's understanding of spirituality and spiritual care practices in New Zealand hospices.  Participants included patients, family members and staff.  They found that spirituality is broadly understood and considered important for all three of the populations studied. The patient and family populations had high spiritual needs that included a search for meaning, peace of mind, and a degree of certainty in an uncertain world. The healthcare professionals in the hospices surveyed seldom explicitly met the needs of patients and families. Staff had spiritual needs, but organizational support was sometimes lacking in attending to these needs.

Full text available in Palliative and Supportive Care

'Dignity therapy', a promising intervention in palliative care: A comprehensive systematic literature review

Palliative Medicine, 2016, August 26th

Marina Martínez, María Arantzamendi, Alazne Belar, José Miguel Carrasco, Ana Carvajal, María Rullán, Carlos Centeno

Dignity therapy is psychotherapy to relieve psychological and existential distress in patients at the end of life.  The evidence from this review suggests that dignity therapy is beneficial. One randomized controlled trial with patients with high levels of psychological distress shows DT efficacy in anxiety and depression scores. Other design studies report beneficial outcomes in terms of end-of-life experience. Further research should understand how dignity therapy functions to establish a means for measuring its impact and assessing whether high level of distress patients can benefit most from this therapy.

  

Full text available in Palliative Medicine

Available in print in Arthur Rank Hospice Library, Brookfields Hospital

Motor neurone disease - quality standard (QS 126)

National Institute for Health and Care Excellence, July 2016

This standard covers the assessment and management of MND, including end of life care, and is designed to support the measurement of improvement.

The full document can be accessed at  MND (QS 126)

Inpatient transfer to a care home for end-of-life care: What are the views and experiences of patients and their relatives? A systematic review and narrative synthesis of the UK literature

Palliative Medicine 2016 July 28

Tabitha Thomas, Isla Kuhn, Stephen Barclay

Transfers from hospital or 'hospice palliative care units' to care homes for end-of-life care are an increasingly common part of clinical practice but are a source of anxiety and distress for patients, relatives and healthcare professionals. This review revealed that the UK literature concerning patient transfers to care homes is very limited. Further research is urgently needed in this area, especially studies of patients themselves, in order to understand their experiences and views.

Fulltext available in Palliative Medicine

Advance care planning in motor neuron disease: a systematic review

Palliative & Supportive Care, Aug 2016, vol. 14, no. 4, p. 411-432

Murray, Leigh, Butow, Phyllis N.

This review aims to summarize what is known about the prevalence, content, patient/caregiver benefits, healthcare professional awareness/support, and healthcare outcomes associated with ACP in the MND setting. 

Fulltext available in Palliative and Supportive Care

The mental health and mortality impact of death of a partner with dementia

International Journal of Geriatric Psychiatry, Aug 2016, vol. 31, no. 8, p. 929-937

Shah, Sunil M, Carey, Iain M, Harris, Tess, DeWilde, Stephen, Victor, Christina R, Cook, Derek G

The health in the year before and after loss of a partner with dementia compared with other bereavements is described.  In the year before bereavement, partners of individuals dying with dementia experience poorer mental health than those facing bereavement from other causes, and their partner is less likely to receive palliative care. In the year after, individuals whose partner died with dementia experience some attenuation of the adverse health effects of bereavement. Services need to address the needs of carers for individuals dying with dementia and improve access to palliative care. 

A prospective study of patient-centred outcomes in the management of malignant pleural effusions

International Journal of Palliative Nursing 2016 July 2, 22 (7): 351-8

Susan Walker, Marijana Zubrinic, Christine Massey, Yaron Shargall, Eric Bédard, Gail Darling

The aim of the study was to evaluate quality of life and satisfaction with treatment using patient-reported outcomes for four different treatment strategies. The authors found no significant difference between the treatments.  While all treatment options addressed the patients' symptoms and relieved dyspnoea, an indwelling pleural catheter offered effective treatment with minimal discomfort and time in hospital yet still high satisfaction.

Available in print in Arthur Rank Hospice, Brookfields Hospital 

An unusual presentation of acute lithium toxicity in a hospice

European Journal of Palliative Care, July/August 2016, Volume 23 Number 4, p162-4

Jennifer Hayes, Fay Murray-Brown, Alison Stewart and Rebecca Baines

Lithium is a widely used treatment for mood disorders but, although effective, it has a narrow therapeutic window. Palliative care patients taking lithium are at increased risk of toxicity. This article describes an atypical case of acute lithium toxicity in a woman with symptoms resembling those of panic episodes.

Available in print in Arthur Rank Hospice Library, Brookfields Hospital

Respite for patients and carers in neurodegenerative disease: a grounded theory study

European Journal of Palliative Care, July/August 2016, Volume 23 Number 4, p175-9

Diane Laverty, Anne Arber and Sara Faithfull

The authors present the results of a grounded theory study that aimed to determine what residential respite care can offer to patients with neurodegenerative diseases and their carers, the issues and concerns for the carer in relation to respite and how respite can be used to provide a therapeutic outcome for patients and carers.

Available in print in Arthur Rank Hospice Library, Brookfields Hospital

Two worlds: Adolescents' strategies for managing life with a parent in hospice

Palliative and Supportive Care, 2016 June, vol/iss 14/3, p177-86

Denice Kopchak Sheehan, M. Murray Mayo, Grace H. Christ, Kim Heim, Stephanie Parish, Ghada Shahrour and Claire Burke Draucker

This study explored the strategies adolescents used to cope with their parents' illness in the last months of life and shortly after their death. The authors describe the 'two worlds' in which adolescents live and the stages through which they pass in the course of the parent's illness and following bereavement. The results of this research can help in the development of targeted interventions to meet an adolescent's specific needs.

Fulltext available in Palliative and Supportive Care

The use of protocol in breaking bad news: evidence and ethos

International Journal of Palliative Nursing, Jun 2016, vol. 22, no. 6, p. 265-271
Dean, Antonia, Willis, Susan

This article discusses health professionals use of protocol in the breaking of bad news, focusing particularly on the SPIKES framework. It examines the evidence of impact on the patient experience and makes recommendations for further outcome-based research. The ethos of the step-wise protocol is debated, questioning whether or not it hinders individualised care and the formation of a genuine relationship between patient and professional. Finally, recommendations for practice are suggested.


Available in print in Arthur Rank Hospice, Brookfields Hospital

A team approach to recruitment in hospice research: engaging patients, close people and health professionals

International Journal of Palliative Nursing, Jul 2016, vol. 22, no. 7, p. 324-332

L Campbell, Cathy, Bailey, Cara, Armour, Kathy, Perry, Rachel, Orlando, Rosanna, Kinghorn, Philip, Jones, Louise, Coast, Joanna

Research in hospice settings is very challenging. This paper describes a case study of a successful multidisciplinary research team approach (MDRT) to the recruitment of participants (hospice patients, family members and health professionals) for a study in a hospice setting on the economic evaluation of end-of-life care.

Available in print in Arthur Rank Hospice Library, Brookfields Hospital

Considering the impact of stigma on lesbian, gay and bisexual people receiving palliative and end-of-life care

International Journal of Palliative Nursing, Jul 2016, vol. 22, no. 7, p. 334-340

Chidiac, Claude, Connolly, Michael

Stigma can have a negative effect on health and wellbeing and can influence the type of care received from health and social care professionals, including those working in palliative care. This paper presents a discussion of the impact that stigma has on LGB people who access and receive palliative and end-of-life care.

Available in print in Arthur Rank Hospice Library, Brookfields Hospital

How can nurses support relatives of a dying patient with the organ donation option?

Nursing in Critical Care, Jul 2016, vol. 21, no. 4, p. 214-224

Mills, Leanne, Koulouglioti, Christina

The purpose of the literature review was to summarise evidence related to nursing support for a dying patient's family with the option of organ donation. The authors concluded that clear information, sensitively and professionally delivered, helped families understand their loved ones' condition.  This in turn helped them to accept death and to consider the option of organ donation. 

The influence of Kinesiology Taping on the volume of lymphoedema and manual dexterity of the upper limb in women after breast cancer treatment

European Journal of Cancer Care, 2016, 25 (4) 647-660

J. Taradaj PT, T. Halski PT,  J. Rosinczuk, R. Dymarek, A. Laurowski and A. Smykla

In addition to evaluating the effect of kinesiology taping on the size of lymphoedema and manual dexterity  the authors also examined whether the application of KT can replace the traditional and standard multilayered bandaging in the treatment of upper extremity lymphoedema.  After 4-weeks of therapy, they concluded that taping was not an effective method of reducing lymphoedema II and III and cannot yet replace the traditional and standard multilayered bandaging in the treatment of upper extremity lymphoedema.

Cardiovascular implanted electronic devices in people towards the end of life, during cardiopulmonary resuscitation and after death: guidance from the Resuscitation Council (UK), British Cardiovascular Society and National Council for Palliative Care

Heart. 2016 June;102 (Suppl 7) A1-A17
David Pitcher, Jasmeet Soar, Karen Hogg, et al

This document has been developed to provide guidance for all healthcare professionals who may encounter people with CIEDs in the situations described and for healthcare managers and commissioners. Its aim is to:

• Help to ensure that people who have CIEDs, or are considering implantation of one, receive explanation of and understand the practical implications and decisions that this entails
• Promote a good standard of care and service provision for people in the UK with CIEDs in the circumstances described
• Offer relevant ethical and legal guidance on this topic
• Offer guidance on the delivery of services in relation to deactivation of CIEDs where appropriate
• Offer guidance on whether any special measures are needed when a person with a CIED receives cardiopulmonary resuscitation
• Offer guidance on the actions needed when a person with a CIED dies
• 
  

Fulltext available in HEART

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