Palliative care strategies offer guidance to clinicians and comfort for COVID-19 patient and families

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Heart & Lung, 2020, vol. 49, no. 3, pp. 227-228

Feder; Akgün; Kathleen M.; Schulman-Green, Dena

The novel coronavirus (COVID-19) has caused a fast-moving, highly distressing global health crisis. Patients of all ages face daunting illness while healthcare systems struggle to meet the growing demand for services. The need for palliative care (PC) is likely to be substantial, and yet, PC specialists are in short supply. This article examines the special considerations in applying core PC principles during the COVID-19 crisis as well as targeted strategies to support patients and families.

Constructing stability - a classic grounded theory of next-of-kin in palliative cancer care

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BMC Palliative Care, 2020, vol. 19, no. 1, pp. 1-9

Werkander, Harstade; Sandgren, Anna

Being next-of-kin to someone with cancer requiring palliative care involves a complex life situation. Changes in roles and relationships might occur and the next-of-kin thereby try to adapt by being involved in the ill person’s experiences and care even though they can feel unprepared for the care they are expected to provide. The aim of this study was to develop a classic grounded theory of next-of-kin in palliative cancer care. The theory shows the complexities of being next-of-kin to someone receiving palliative care, while striving to construct stability.

End-of-life decisions and care in the midst of a global coronavirus (COVID-19) pandemic

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Intensive & Critical Care Nursing, 2020, vol. 58

Pattison, Natalie

This article examines the unprecedented and unfolding global situation with Coronavirus (the virus SaRS Cov-2, leading to the disease named COVID-19) (WHO, 2020) which has forced health care providers across the world to consider end-of-life issues in a very rapidly changing scenario.

Top Ten Tips Palliative Care Clinicians Should Know About Psychosocial and Family Support

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Journal of Palliative Medicine, 2020, vol. 23, no. 2, pp.280-286

Farabelli, Jill P.; Kimberly, Sharon M.; Altilio, Terry; et al.

Palliative care (PC) is perhaps the most inherently interdisciplinary specialty within health care. Comprehensive PC is delivered by a core team of physicians, nurses, social workers, spiritual care providers, pharmacists, and others who address the broad range of medical, psychosocial, and spiritual needs of those living with serious illness. While PC clinicians are typically skilled in screening for distress, the best path to follow when patients screen positive for psychosocial distress or exhibit mental health challenges may not always be clear. This article brings together the perspectives of experienced social workers practicing across PC and hospice settings. It seeks to identify opportunities and rationale for the integration of palliative social work (PSW) in the provision of quality, person-centered, family-focused, and culturally congruent care for the seriously ill. Increasing recognition of the impact of social determinants of health highlights the critical importance of including PSW if we are to better understand and ultimately address the broad range of factors that influence people's quality of life.

Memento Mori: Can art assist student nurses to explore death and dying? A qualitative study.

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Nurse Education Today, 2020, vol. 89

Nicol, Jane; Pocock, Mary

This report looks at how an art-based workshop assisted undergraduate nursing students to explore their experiences and beliefs about death and dying. While this study focused on an educational strategy delivered to student nurses, it is an approach that could be used with other health and social care professionals. Close and critical observation of the selected art increased participant understanding and insight of the many experiences and interpretations of death and dying.

A Palliative Care Program for Volunteers in a Community Setting: A Mixed-Methods Pilot Study

American Journal of Hospice & Palliative Medicine, 2020, vol. 37, no. 6, pp. 455-464

Lee, Jiwon; Lee, Jong-Eun

The objective of community-based palliative care is to improve the quality of life of patients and their families and to share the responsibility of caregiving. However, the evidence of the efficacy of volunteer services in community-based palliative care is insufficient. This pilot study sought to uncover the feasibility and efficacy of a volunteer program in palliative care. In conclusion, a palliative care program was found to be useful for volunteers in finding meaning in life, motivating continued volunteering. Moreover, caregivers were satisfied with the palliative care service of volunteers.

A feasibility and acceptability study of an adaptation of the Mindful Self-Compassion program for adult cancer patients

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Palliative & Supportive Care,2020, vol. 18, no 2, pp. 130-140

Brooker, Joanne; Julian, John; Millar, Jeremy et al.

Psychosocial interventions that mitigate psychosocial distress in cancer patients are important. The primary aim of this study was to examine the feasibility and acceptability of an adaptation of the Mindful Self-Compassion (MSC) program among adult cancer patients. A secondary aim was to examine pre–post-program changes in psychosocial wellbeing.

Impact of informal cancer caregiving across the cancer experience: A systematic literature review of quality of life

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Palliative & Supportive Care, 2020, vol. 18, no. 2, pp. 220-240
Ochoq, Carol; Buchnam Lunsford, N; Lee Smith, Judith

Informal caregiving may likely increase as the number of cancer survivors grows. Caregiving responsibilities can impact caregivers’ quality of life (QOL). Understanding the current state of the science regarding caregiving QOL could help inform future research and intervention development.

Distress and self-care among chaplains working in palliative care

Palliative & Supportive Care, 2019 17(5)  p.542
White, Kelsey B; Murphy, Patricia E; Jeuland, Jane; Fitchett, George

Although limited, research suggests low levels of burnout or distress among healthcare chaplains; however, there has been no research among chaplains working in specific clinical contexts, including palliative care.  This study explored the distress, self-care, and debriefing practices of chaplains working in palliative care.  It found that these Chaplains appear moderately distressed, possibly more so than chaplains working in other clinical areas. They use debriefing, with non-chaplain palliative colleagues, to process clinical experiences. 

In what ways might group clinical supervision affect the development of resilience in hospice nurses?

International Journal of Palliative Nursing, 2019 25(8) p.387-396

Francis, Amy; Bulman, Chris

There is limited evidence which focuses on the influence of clinical supervision in the development of resilience in hospice nurses. From their research, the authors suggest that it affects the development of resilience by developing confidence at work, regulating emotions, offering a coping strategy, managing expectations, and developing self-awareness, dependent upon individual preference and experience, the local organisational context, and wider social and political factors. Recommendations for practice are offered to enhance the development of resilience through clinical supervision.

The holistic management of fatigue within palliative care

International Journal of Palliative Nursing 2019 25(8) p.368-376
Dean, Antonia

While some international guidelines for the management of fatigue exist, evidence suggests that these are not always implemented. This article reviews the evidence basis for fatigue management and finds that a one-size fits all approach to fatigue management is unrealistic. Research appears to support different interventions at various points in the disease trajectory and this is of importance for service design as palliative care is increasingly introduced earlier in the patient's pathway. 

Lymphoedema in end-of-life care.

International Journal of Palliative Nursing, 2019 25(8) p.407-409
Todd, Marie

The author discusses some of the important issues to consider when caring for patients suffering from lymphoedema in the terminal stage of an illness. Topics covered include the complex interaction between symptoms, their causes, and their management, reluctance of many patients to admit that their condition is beyond treatment, and development of a comprehensive needs-based treatment plan.

Which outcome domains are important in palliative care and when? An international expert consensus workshop, using the nominal group technique

Palliative Medicine, 2019 33(8) p.1058-1068

de Wolf-Linder, Susanne; Dawkins, Marsha; Wicks; et al

When capturing patient-level outcomes in palliative care, it is essential to identify which outcome domains are most important and focus efforts to capture these, in order to improve quality of care and minimise collection burden. The group recommended the domains of 'overall wellbeing/quality of life', 'pain', and 'information needs/preferences' for regular measurement, assessed using 'Phase of Illness'. International adoption of these recommendations will help standardise approaches to improving the quality of palliative care.

Fulltext available in Palliative Medicine

Volunteers in a biography project with palliative care patients – a feasibility study

BMC Palliative Care, 2019 18(79) 

Michaela Hesse, Simon Forstmeier, Henning Cuhls & Lukas Radbruch

This study evaluated the feasibility of training hospice volunteers in biographical interviews of patients confronted with a life-limiting disease. For the purpose of this study, we evaluated resources such as time needed for training, coordination and supervision, outcome such as completion of the intervention in appropriate time and risks such as causing distress in patients or volunteers as major determinants of feasibility.  Volunteers felt that their involvement was personally rewarding and there were no systematic problems or negative experiences reported either by volunteers or by patients.

Fulltext available in BMC Palliative Care 

Music in palliative care: a qualitative study with patients suffering from cancer

BMC Palliative Care, 2019 18(78)

Sandrine Pommeret, Jan Chrusciel, Catherine Verlaine, et al

This study aimed to examine how cancer patients hospitalized in the palliative care unit experienced a musical intervention. Two artists performed in the palliative care unit once a week from 9:30 am to 5:30 pm. The authors report both positive emotions but also found patients encountered difficulties during the intervention. They conclude that although music appeared to benefit the patients, it sometimes reminded them of their altered state and some experienced difficulties related to physical exhaustion. 

Fulltext available in BMC Palliative Care

Plissit interventions and sexual functioning: useful tools for social work in palliative care?

Journal of Social Work in End-of-Life & Palliative Care, September 2019 p.1-18

Bennett, Michael R

The PLISSIT model is a framework to effectively initiate the conversation about sexual concerns. This rapid review and small meta-analysis explores and clarifies knowledge about the effectiveness of PLISSIT in resolving sexual dysfunction and considers its utility as a social work intervention in a palliative care setting.

Evaluating the effects of the pharmacological and nonpharmacological interventions to manage delirium symptoms in palliative care patients: systematic review

Current Opinion in Supportive and Palliative Care, September 2019

Skelton, Luke; Guo, Ping

This review aims to evaluate the effects of the pharmacological and nonpharmacological interventions used to manage delirium symptoms in this patient group. A recent study has suggested there is no role for antipsychotic medication in the management of delirium in palliative care patients, which is a move away from previous expert opinion. In addition, recent findings suggest there may be a role for the use of antipsychotics in combination with benzodiazepines in the management of agitated delirium.  The authors conclude that it is too early to abandon the use of antipsychotic medication entirely in the management of delirium, however there remains inadequate evidence to support the routine use of either pharmacological or nonpharmacological interventions. 

Prelude to death or practice failure? Trombley-Brennan terminal tissue injury update

American Journal of Hospice & Palliative Medicine, 2019 36(11) p.1016-1019

Brennan, Mary R.; Thomas, Lily; Kline, Myriam

In 2012, a study explored the emergence of unique skin changes in end-of-life patients admitted to a palliative care unit. The purpose was to describe the skin changes and identify the relationship between these changes and time of death. 80 patients were included and the skin changes were found to be unique and different from Kennedy terminal ulcers and deep tissue injuries. Median time from identification of skin changes and death was 36 hours. The phenomenon was named as Trombley-Brennan terminal tissue injury. The current article presents findings that include the study of an additional 86 patients. The results further validate the phenomenon and its relationship with time of death.

Lymphoedema in advanced cancer: does subcutaneous needle drainage improve quality of life?

BMJ Supportive & Palliative Care, August 2019

Landers, Amanda; Holyoake, Julia

Lower limb lymphoedema in the palliative care population has limited treatment options. Subcutaneous needle drainage is an underused procedure that has previously been described in the literature for refractory lymphoedema. This study aimed to quantify the potential improvements to quality of life and the adverse outcomes for this group of patients.  The authors conclude that this intervention appears to improve quality of life in those with lower limb lymphoedema facing a life-limiting illness.

Fan therapy for the treatment of dyspnea in adults: a systematic review

Journal of Pain and Symptom Management, 2019 58(3) p.481-486

Qian, Yu; Wu, Yuan; Rozman de Moraes, Aline

Limited direct evidence from randomized controlled trials indicates that fan therapy may effectively alleviate dyspnea. Additional trials are warranted to confirm this finding and explore the use of fan therapy for the treatment of dyspnea in more diverse populations and settings.