Quality standard: Care of dying adults in the last days of life

National Institute for Health and Care Excellence, March 2017

This quality standard covers the clinical care of adults (aged 18 and over) who are dying, during the last 2 to 3 days of life. It describes high-quality care in priority areas for improvement.

Importnat note: This quality standard does not cover care before the last few days of life, such as palliative care or ‘end of life care’ (often defined as care during the last year or so of a progressive disease), or care after death. These are included in NICE’s Quality Standard QS13 for end of life care for adults.

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A walk through bereavement theory

End of Life Journal, 2017, 6(1)
Isabel Dosser

The aim of this article is to give nurses and other health professionals an overview of some of the main bereavement theories which have developed over the last 50 years, enabling them to better understand the grief process and provide evidence-based support to patients and families.

Testamentary capacity and palliative care: helping patients implement estate planning

European Journal of Palliative Care, 2017, 24(2) 58-63
Kieran M Kennedy, Julien O’Riordan, Eileen Mannion and Sharon Beatty

This is the first in a new series offering practical advice to all members of the palliative care team on a range of legal and ethical issues. Here, the authors outline and discuss the appropriate ways of helping patients to implement estate planning by assessing, and maximising, their ability to make or change a valid will.

Available in print in the Arthur Rank Hospice Library, Cambridge

Psychological ideas in palliative care: attachment theory

European Journal of Palliative Care, 2017, 24 (1) 24-27
Jenny Strachan

This is the first in a series of articles that explores psychological concepts and translates them into practical advice to promote psychologically informed practice for people working in both clinical and non-clinical palliative care roles.  Here, the author suggests that care should be adapted to meet the needs of patients with different attachment styles and that attachment theory should be among the considerations of policy and process development.

Available in print in  the Arthur Rank Hospice Library, Cambridge

2016 Updated MASCC/ESMO consensus recommendations: Management of nausea and vomiting in advanced cancer

Supportive Care in Cancer, 2017, 25(1) 333-340

Walsh D.; Davis M.; Ripamonti C.; Bruera E.; Davies A.; Molassiotis A.

The aim of this paper was to develop a set of evidence-based guidelines for the management of different syndromes related to nausea and vomiting in advanced cancer.  The authors found that the level of evidence in most studies is low, but conclude that the drug of choice is metoclopramide, with alternative options including haloperidol, levomepromazine, or olanzapine. For bowel obstruction, the recommendation is to use octreotide given alongside an antiemetic (haloperidol) and where octreotide is not an option to use an anticholinergic antisecretory agent. For opioid-induced nausea and vomiting, no recommendation could be made. 

Fulltext available in  Supportive Care in Cancer

Evidence on the analgesic role of bisphosphonates and denosumab in the treatment of pain due to bone metastases: A systematic review within the European Association for Palliative Care guidelines project

Palliative Medicine, 2017, 31(1) 5-25
Porta-Sales, Josep; Garzón-Rodríguez, Cristina; Llorens-Torromé, Silvia; Brunelli, Cinzia; Pigni, Alessandra; Caraceni, Augusto

The aims of this review were to appraise the evidence for the efficacy and safety of biphosphonates and denosumab in controlling pain and the appropriate schedule of administration.  The authors found that the evidence to support an analgesic role is weak but that they do appear to be helpful in delaying the onset of bone pain. 

Fulltext available in Palliative Medicine

Available in print in the Arthur Rank Hospice Library, Cambridge

Economics of palliative and end of life care (special issue)

Palliative Medicine, 2017 31(4) 

This issue of Palliative Medicine contains a range of articles exploring various aspects of the economics of providing and funding palliative and end of life care.  Among the topics covered are:

• The use of Quality-Adjusted Life Years (QUALYs) in cost-effectiveness analyses in palliative care
• The contributions of family caregivers at end of life: a national post-bereavement census survey of cancer carers' hours of care and expenditures
• Costs of formal and informal care in the last year of life for patients in receipt of specialist palliative care

Fulltext available in Palliative Medicine

Available in print in the Arthur Rank Hospice Library, Cambridge

Identifying and addressing the support needs of family caregivers of people with motor neurone disease using the Carer Support Needs Assessment Tool

Palliative and Supportive Care, 2017 15(1) 32-43

Aoun, S., Deas, K., Kristjanson, L., & Kissane, D. 

The caregivers who took part in this study identified the highest support priorities as “knowing what to expect in the future,” “knowing who to contact if concerned,” and “equipment to help care”. It was found that the CSNAT was judged to be relevant and useful by both caregivers and care advisers, providing a structured approach to facilitating discussions and addressing needs.

Fulltext available in Palliative and Supportive Care

Caregivers' perspectives on the use of long-term oxygen therapy for the treatment of refractory breathlessness: a qualitative study

Journal of Pain and Symptom Management, 2017, 53(1) 33-39

Collier, Aileen; Breaden, Katrina; Phillips, Jane L; Agar, Meera; Litster, Caroline; Currow, David C

The benefits of long-term oxygen therapy are often overestimated and its potential harms are underestimated.   The authors argue that caregivers should be provided with opportunities to collaborate with clinicians in evidence-based decision making and efforts should be made to provide them with information and education about the most effective pharmacological and nonpharmacological strategies to manage refractory breathlessness in a palliative care setting, including the appropriate use of LTOT, to enable them to do so.

Integrating supportive care principles into dialysis decision making: a primer for palliative medicine providers

Journal of Pain and Symptom Management, 2017, 53(3) 656-662

Moss, Alvin H

Because of their multiple comorbidities, high symptom burden, and limited life expectancy, CKD patients would benefit from the integration of supportive care principles into their routine care. This article addresses how supportive care specialists can collaborate with nephrology clinicians to provide patient-centered supportive care and identifies resources to assist them.

Systematic review and meta-analysis of acupuncture to reduce cancer-related pain

European Journal of Cancer Care, 2017,  26 (no. 2)

Chiu, H Y; Hsieh, Y J; Tsai, P S

From their review, the authors concluded that acupuncture is effective in relieving cancer-related pain, particularly malignancy-related and surgery-induced pain. Their findings suggest that acupuncture can be adopted as part of a multimodal approach for reducing cancer-related pain.

Supporting children and young people with Autism Spectrum Disorder through bereavement

Bereavement Care, 2016, 35(3) 94-101

Koehler, Katie

The author explores some of the underlying perceptual and processing difficulties observed in children with ASD that may affect their understanding of death and their reaction to a bereavement.  It suggests some approaches which may help children and includes a list of helpful resources.

Fulltext available in Bereavement Care

Available in print in Arthur Rank Hospice Library, Cambridge

Symptomatic management of neurodegenerative disease in the elderly

Progress in Palliative Care, 2017, 25(1) 11-16

Oliver, David J; Veronese, Simone

An overview of the symptoms and psychological and social issues experienced by elderly patients with neurodegenerative diseases and the value of a palliative care approach throughout the disease trajectory for patients, families and carers.

Fulltext available in Progress in Palliative Care

Available in print in Arthur Rank Hospice Library, Cambridge

Falls toolkit

Hospice UK, 2016

Hospice UK has updated its online toolkit aimed at managing and preventing falls.

https://www.hospiceuk.org/what-we-offer/clinical-and-care-support/clinical-resources