Teaching health-care providers to query patients with cancer about sexual and gender minority (sgm) status and sexual health

American Journal of Hospice & Palliative Medicine, 2019 36(6) p.533-537

Cathcart-Rake, Elizabeth J.; Breitkopf, Carmen Radecki; Kaur, Judith; et al

End of life is difficult for all patients but sexual and gender minorities (SGM) are prone to isolation and loneliness, especially if their SGM status is unknown or unaccepted. This article summarizes the mandate for understanding cancer issues in SGM populations and the dearth of cancer-related data within this group. It also describes an ongoing 3-part study intended to build a mini curriculum with the goal of helping cancer health-care providers to ask patients with cancer about SGM status and to ask all patients with cancer about sexual health issues. The results of this ongoing study could potentially improve end-of-life care for subgroups of patients.

Imminent death: clinician certainty and accuracy of prognostic predictions

BMJ Supportive & Palliative Care, 2019, May 10

Nicola White, Fiona Reid, Victoria Vickerstaff, Priscilla Harries, Christopher Tomlinson, Patrick Stone

The results of this study show that even when doctors are very (>90%) confident that a patient will die within the next 72 hours, these estimates are only correct on 75% of occasions. It is therefore important for clinicians to convey this level of uncertainty in their communications with patients and relatives. This suggests that while clinical predictions will continue to have a role for routine prognostication, other approaches (such as the use of prognostic scores) may be required for those cases where doctors’ estimates are indeterminate.

Fulltext available in BMJ Supportive and Palliative Care 

Palliative care physicians' perspectives on transferring patients to nursing homes and communication strategies to facilitate this transition: a qualitative study

Palliative Medicine, 2019 33(3) p.323-331
Stiel, Hilary; Nagarajan, Srivalli V.; Forster, Benjamin C.; Clayton, Josephine M.

This study highlights the tension Australian palliative care physicians experience when transferring palliative care patients to nursing home and the complexity involved in decision-making. Physicians identified several communication strategies to engage patients and families to ease the transition.

Allow natural death versus do-not-resuscitate: titles, information contents, outcomes, and the considerations related to do-not-resuscitate decision

BMC Palliative Care 2018, 17:114 | Published on: 10 October 2018 

Sheng-Yu Fan, Ying-Wei Wang and I-Mei Lin

The aims of this study were to explore: (1) how “allow a natural death” versus “do not resuscitate” and specific scenarios and outcomes, influence the willingness to sign a DNR order; and (2) the information needs and consideration of the DNR decisions, and the benefits and barriers of the DNR discussion, in the general population.

Fulltext available in BMC Palliative Care

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 

Development and evaluation of the Dignity Talk question framework for palliative patients and their families: A mixed-methods study

Palliative Medicine; 2018 32(1) p. 195-205
Guo, Qiaohong; Chochinov, Harvey Max; McClement, Susan; Thompson, Genevieve; Hack, Tom

Effective patient-family communication can reduce patients' psychosocial distress and relieve family members' current suffering and their subsequent grief but terminally ill patients and their family members often experience great difficulty in communicating their true feelings, concerns, and needs to each other.  The aims of this study were to develop a novel means of facilitating meaningful conversations for palliative patients and family members, coined Dignity Talk and  to explore the anticipated benefits and challenges.  The questions were endorsed by a majority of participants who felt that Dignity Talk would be valuable in promoting conversations, enhancing family connections and relationships, enhancing patient sense of value and dignity, promoting effective interaction, and attending to unfinished business. 

Addressing a patient's hope for a miracle

Journal of Pain and Symptom Management; 2018 55(2) p. 535-539
Shinall, Myrick C; Stahl, Devan; Bibler, Trevor M

Ill patients may make decisions to continue aggressive life-prolonging care based on hope for a miraculous recovery, and clinicians can find goals of care discussions with these patients extremely challenging.This case presents a typology of ways patients express hope for a miracle along with analysis of the motivations and beliefs underlying such hopes and suggestions for tailored responses by palliative care providers.

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

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

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.

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.

The use of protocol in breaking bad news: evidence and ethos

International Journal of Palliative Nursing, Jun 2016, vol. 22, no. 6, p. 265-271
Dean, Antonia, Willis, Susan

This article discusses health professionals use of protocol in the breaking of bad news, focusing particularly on the SPIKES framework. It examines the evidence of impact on the patient experience and makes recommendations for further outcome-based research. The ethos of the step-wise protocol is debated, questioning whether or not it hinders individualised care and the formation of a genuine relationship between patient and professional. Finally, recommendations for practice are suggested.


Available in print in Arthur Rank Hospice, Brookfields Hospital

How can nurses support relatives of a dying patient with the organ donation option?

Nursing in Critical Care, Jul 2016, vol. 21, no. 4, p. 214-224

Mills, Leanne, Koulouglioti, Christina

The purpose of the literature review was to summarise evidence related to nursing support for a dying patient's family with the option of organ donation. The authors concluded that clear information, sensitively and professionally delivered, helped families understand their loved ones' condition.  This in turn helped them to accept death and to consider the option of organ donation. 

Barriers and facilitators to end-of-life communication in advanced chronic organ failure

International Journal of Palliative Nursing, May 2016, vol. 22, no. 5, p. 222-229

Van den Heuvel, Liza Amc, Spruit, Martijn A, Schols, Jos Mga, Hoving, Ciska, Wouters, Emiel Fm, Janssen, Daisy Ja

The results of this quantitative, cross-sectional study suggest that the most important barriers for family caregivers were related to uncertainty about expected care and focus on staying alive instead of dying. The facilitators were related to trust in and competence of their physician and earlier experiences with death in their (social) environment. For most barriers and facilitators, agreement between patients and family caregivers was fair to moderate, suggesting an individual approach is needed to improve communication at the end of life.

Available in print in Arthur Rank Hospice, Brookfields Hospital

Learning from linguistics: structuring our sentences sensitively

Bereavement Care, Jan 2016, vol. 35, no. 1, p. 31-35

Carr, Sarah

This article examines basic techniques to improve sentence clarity to help bereavement support workers to use understandable words and phrases when communicating with clients, both verbally and in writing.  It also describes how to check the readability of  text using a feature built into Microsoft Word. References.

Fulltext available in Bereavement Care

Available in print in Arthur Rank House Library, Brookfields Hospital

Desire for hastened death: how do professionals in specialized palliative care react?

Psycho-oncology, May 2016, vol. 25, no. 5, p. 536-543

Galushko, M, Frerich, G, Perrar, K M, Golla, H, Radbruch, L, Nauck, F, Ostgathe, C, Voltz, R

This study aimed to identify the responses of health professionals working in specialist palliative care to patients' desire for hastened death (DHD).  It identified a number of responses that related to the patients and to themselves as practitioners. The authors concluded that profound personal and professional development that strengthens their own resilience is necessary to respond to the challenges presented by DHD as well as establishing helpful relationships with patients.

Patient and caregiver opinions of motivational interviewing techniques in role-played palliative care conversations: a pilot study

Journal of Pain and Symptom Management, Jul 2015, vol. 50, no. 1, p. 91-98 

Pollak, Kathryn I, Jones, Jacqueline, Lum, Hillary D, De La Cruz, Scott, Felton, Susanne, Gill, Arvin, Kutner, Jean S

The aim of this pilot study was to describe how patients and caregivers perceived MI techniques in palliative care role-play encounters. Qualitative analyses revealed that participants independently identified the following helpful communication elements that are consistent with core MI techniques: reflection and validation of values, support of autonomy and flexibility, and open questions acting as catalysts for discussion. Participants rated the MI-trained physician slightly higher on the perceived empathy scale. The authors conclude that the use of MI techniques shows promise for improving palliative care discussions.

Fulltext available in Journal of Pain and Symptom Management

Available in print in Arthur Rank House Library, Brookfields Hospital

Social media and palliative medicine: a retrospective 2-year analysis of global Twitter data to evaluate the use of technology to communicate about issues at the end of life

BMJ supportive & palliative care, June 2015  5(2):207-12
Nwosu AC;  Debattista M;  Rooney C;  Mason S.

The scope and breadth of the use of Twitter to discuss end-of-life care has not previously been reported. The authors' aim was to determine the frequency, sentiment and trend of Twitter 'tweets' containing palliative care-related identifiers (hashtags) and/or phrases sent by users over a 2-year period.  They found that a lot of discussion about palliative care is taking place on Twitter, and the majority of this is positive. Social media presents a novel opportunity for engagement and ongoing dialogue with public and professional groups. 

• Fulltext available in BMJ Supportive and Palliative Care
• • Available in print in Arthur Rank House Library, Brookfields Hospital

A communication training perspective on AND versus DNR directives

Palliative & Supportive Care, April 2015, 13(2):385-7

Levin TT;  Coyle N.

An alternative, "Allow Natural Death" (AND), has been proposed as a better way of framing end of life discussions.   The authors contrast the advantages and disadvantages of the term AND from the communication training perspective and suggest that AND-framing language replace DNR as a better way to facilitate meaningful end-of-life communication. One well-designed, randomized, controlled simulation study supports this practice. We also consider the communication implications of "natural" versus "unnatural" death.

Fulltext available in Palliative and Supportive Care

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Breaking bad news about transitions to dying: a qualitative exploration of the role of the District Nurse

Palliative Medicine, Feb 2015, vol. 29, no. 2, p. 138-146

Griffiths, Jane, Ewing, Gail, Wilson, Charlotte, Connolly, Michael, Grande, Gunn

Patients and families need to know the patient is approaching the dying phase, yet evidence suggests breaking bad news about the patient's transition to dying rarely happens. The authors suggest that while District Nurses are ideally placed to carry out this work, it is complex and they are unprepared for it. They conclude that DNs urgently need carefully tailored training in this aspect of their work, to enable them to provide optimal end of life care. 

Fulltext available in Palliative Medicine

Available in print in Arthur Rank House Library, Brookfields Hospital