A checklist to a good transition

Together For Short Lives, February 2018
Julia Hodgson

Although designed for seriously ill young people to assess how well agencies involved in their education and care are working together to enable a smooth transition, "A checklist to a good transition" can also be a useful tool to guide person-centred discussions between professionals, young people and their family members. Professionals may find that the questions asked in the checklist are good prompts for conversations around transition and advance care planning.

Download the guide from the Together for Short Lives website

Pressure damage scanner has positive impact in hospice

June 2018

Nurses at the first hospice in the UK to trial a ground-breaking scanner designed to detect pressure damage say the device has helped them act sooner to stop ulcers developing and raises questions about the value of traditional skin assessments.

Read more here

People must make plans for their digital legacies (news)

E-Hospice, 5th June 2018

A survey carried out by a hospice in the West Midlands revealed that more than 40 per cent of people did not know what a digital legacy was, and of those that did, only 12 per cent had planned what to do with all or some of their legacy.

You can read more about the results and find out what a digital legacy is on the e-hospice website

Top ten tips palliative care clinicians should know when caring for patients with endometrial cancer

Journal of Palliative Medicine, 2018 21(6)  p857-861
Davidson, Brittany A.; Moss, Haley A.; Arquiette, Jaclyn; Kamal, Arif H.

Patients with locally advanced or metastatic disease that is not amenable to control with radiation and/or chemotherapy commonly present with disease-related symptoms. In this article, a team of gynecologic oncology and palliative care experts have assembled practical tips for the care of women with endometrial cancer. A "Top 10" format is used to highlight issues that may help palliative care physicians understand a patient's prognosis, address common misconceptions about endometrial cancer and improve the quality of shared decision making and goals of care discussions.

Therapeutic procedures for malignant ascites in a palliative care outpatient clinic

Journal of Palliative Medicine, 2018 21(6)  p836-841
Korpi, Säde; Salminen, Veera V.; Piili, Reetta P.; Paunu, Niina; Luukkaala, Tiina; Lehto, Juho T.

The optimal treatment of malignant ascites (MA) and feasibility of the management with free drainage remain unclear. The of this research was to study the success of drainage, complications, and survival after paracentesis or insertion of an indwelling tunneled catheter (TC) for the MA performed on a day-case basis. The authors suggest that free drainage of MA seems feasible in an outpatient clinic and that early insertion of TC should be considered to avoid repeated paracenteses. However, in patients with pancreatic cancer, paracentesis might be an accepted alternative due to their short life expectancy.

Efficacy, tolerability and acceptability of oxycodone for cancer-related pain in adults: an updated Cochrane systematic review

BMJ Supportive and Palliative Care, 2018 8(2)  p117-128
Schmidt-Hansen, Mia; Bennett, Michael I; Arnold, Stephanie; Bromham, Nathan; Hilgart, Jennifer S 

The authors of this updated Cochrane review conclude that oxycodone offers similar levels of pain relief and adverse events to other strong opioids. However, hallucinations occurred less with CR oxycodone than with CR morphine, but the quality of this evidence was very low, so this finding should be treated with utmost caution. Our conclusions are consistent with other reviews and suggest that oxycodone can be used first line as an alternative to morphine. However, because it is cheaper, morphine generally remains the first-line opioid of choice.

A critical appraisal of gabapentinoids for pain in cancer patients

Current Opinion in Supportive and Palliative Care, 2018 12(2) p108-117
Jordan, Roberta I; Mulvey, Matthew R; Bennett, Michael I

This review summarizes recent randomised controlled trials (RCTs) evaluating the use of gabapentinoids for tumour-related and treatment-related pain.  Many of the studies included were limited by small sample size, lack of blinding, and inadequate follow-up.  The authors therefore conclude that more and better quality studies are required but that gabapentinoids may offer benefits to cancer patients with pain, but that careful titration and monitoring of adverse effects is necessary.

Palliative sedation for existential suffering: a systematic review of argument-based ethics literature

Journal of Pain and Symptom Management, 2018 55(6) p1577-1590
Rodrigues, Paulo; Crokaert, Jasper; Gastmans, Chris

Using palliative sedation for controlling refractory existential suffering (PS-ES) is controversial. Complicating the debate is that definitions and terminology for existential suffering are unclear, ambiguous, and imprecise, leading to a lack of consensus for clinical practice.  The authors' analysis revealed mind-body dualism, existential suffering, refractoriness, terminal condition, and imminent death as relevant concepts in the ethical debate on PS-ES. The ethical principles of double effect, proportionality, and the four principles of biomedical ethics were used in the debate.

Developing and evaluating a course programme to enhance existential communication with cancer patients in general practice

Scandinavian Journal of Primary Health Care, 2018 36(2) p142-151

Hvidt, Elisabeth Assing; Ammentorp, Jette; Søndergaard, Jens; Timmermann, Connie; Hansen, Dorte Gilså; Hvidt, Niels Christian

Patients with cancer often desire to discuss existential concerns as part of clinical care but general practitioners (GPs) lack confidence when discussing existential issues in daily practice. The authors report that attending the course resulted in an increase in the participants' confidence in the ability to carry out existential communication. This study adds knowledge to how confidence in existential communication can be increased among GPs.

Fulltext available in Scandinavian Journal of Primary Health Care 

Framework for complexity in palliative care: A qualitative study with patients, family carers and professionals

Palliative Medicine, 2018, 32 (6), p 1078-1090
Pask, Sophie; Pinto, Cathryn; Bristowe, Katherine; et al

The aim is to explore palliative care stakeholders' views on what makes a patient more and less complex and insights on capturing complexity at patient level.

The value of rehabilitation medicine for patients receiving palliative care

American Journal of Hospice and Palliative Medicine; June 2018; 35 (6); p 889-896
Wittry, Sarah A; Ny-Ying Lam; McNalley, Thomas

The objective is to evaluate the scope and effectiveness of rehabilitation interventions and exercise programs in improving the quality of life and distressing symptoms in patients receiving palliative care. This test has proven that current available literature supports the use of these interventions, to improve fatigue, mood, functional independence, breathlessness and pain.

Missed opportunities: advance care planning report

Macmillan 2018

This report examines the role of ACP and explores the barriers to its implementation among people with incurable cancer as well as health social care professionals. It outlines the vital role advance care planning (ACP) can play in ensuring a dying persons wishes are met.

Download the document here

End of life care: a briefing paper

Institute of Public Policy Research, 2018

This briefing paper provides a brief summary of issues around end of life care, including an overview of evidence regarding the impact of location on quality and cost of care. It analyses the data on location and cost of care in England and how it compares at a national and international level. It also provides an analysis of the policy agenda in the UK and suggests key areas where improvements should be made.

Download from the IPPR website 

Providing comprehensive, person-centered assessment and support for family carers towards the end of life

Hospice UK, April 2018
Ewing, Gail; Grande, Gunn

A report that discusses that comprehensive person-centered support for family carers during end of life care requires whole-systems change within healthcare organisations. This document outlines the structures and processes that need to be in place to deliver such change in the form of 10 recommendations.

To download the document click here