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