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