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. 

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.

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.

Prescribing in chronic severe hepatic impairment

Journal of Pain and Symptom Management, 2019 58(3) p.515-537

Wilcock, Andrew; Charlesworth, Sarah; Prentice, Wendy, et al

A Therapeutic Review aimed at providing essential independent information for health professionals about drugs used in palliative and hospice care.

MASCC recommendations on the management of constipation in patients with advanced cancer

Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer 2019 August 9

Andrew Davies, Charlotte Leach, Ricardo Caponero, Andrew Dickman, et al

The Palliative Care Study Group of the Multinational Association for Supportive Care in Cancer produced 15 recommendations, with varying levels of evidence and so varying categories of guideline. The recommendations relate to the assessment, the treatment, and the re-assessment of constipation. and provide a framework for the management of constipation in advanced cancer.

Hydration and symptoms in the last days of life

BMJ Supportive and Palliative Care, 2019 August 31 (online first)

Martine E Lokker, Agnes van der Heide, Wendy H Oldenmenger, et al

Consensus about the most appropriate management for terminally ill patients with limited oral fluid intake is lacking. The objective of this study which included 371 patients, is to investigate to what extent the amount of fluid intake, preceding and during the dying phase, is related to the occurrence of death rattle and terminal restlessness. The authors suggest that caution with fluid intake to prevent development of death rattle does not seem to be necessary. They further conclude that a higher amount of fluid intake during 48–25 hours before death may be associated with the occurrence of terminal restlessness during the last 24 hours of life. These results suggest that actively providing dying patients with artificial fluid may not be beneficial.

Fulltext available in BMJ Supportive and Palliative Care

Kennedy terminal ulcers: a scoping review

Journal of Hospice & Palliative Nursing, 2019 21(4) p.257-263

Latimer, Sharon; Shaw, Joanie; Hunt, Tracey; Mackrell, Kristyn; Gillespie, Brigid M.

Kennedy terminal ulcers, a subset of pressure injuries, are associated with the dying process. This scoping review aimed to identify and map the published literature on Kennedy terminal ulcers in terms of its definition, prevalence, assessment, treatment, management, health care costs, and quality of life for patients in all health care settings. It revealed significant knowledge and clinical practice gaps in patient assessment, management, and treatment of Kennedy terminal ulcers. Timely patient education may help them to make informed care and quality end-of-life decisions.

Pressure ulcers in patients receiving palliative care: a systematic review

Palliative Medicine, 2019 33(7) p.770-782

Ferris, Amy; Price, Annie; Harding, Keith

This systematic review aims to quantify the prevalence and incidence of pressure ulcers in patients receiving palliative care and identify the risk factors for pressure ulcer development in these patients as well as the temporal relationship between pressure ulcer development and death. Overall pressure ulcer prevalence and incidence were found to be 12.4% and 11.7%, respectively, which is higher than in the general population. Skin failure, as with other organ failures, may be an inevitable part of the dying process for some patients.

Psychosocial interventions for pain management in older adults with dementia: a systematic review of randomized controlled trials

Journal of Advanced Nursing, 2019 75(8) p.1608-1620

Pu L; Moyle W; Jones C; Todorovic M.

The findings of this review suggest that psychosocial interventions may be potentially effective alternatives for pain management in people with dementia, perhaps leading to a reduction in pain medication. However, the authors warn that caution is needed in interpreting these results due to limited studies, risk of bias and heterogeneity across studies.

Benzodiazepines and/or neuroleptics for the treatment of delirium in palliative care: a critical appraisal of recent randomized controlled trials.

Annals of Palliative Medicine, 2019 Mar 26.
Gaertner J1, Eychmueller S2, Leyhe T3, Bueche D4, Savaskan E5, Schlögl M

Despite the lack of randomized-controlled-trials (RCTs) benzodiazepines and neuroleptic agents are used extensively in palliative care for the pharmacological management of delirium.  This is a narrative summary of the findings of two RCTs and practical recommendations are presented. The recently published landmark RCTs provide moderate evidence to adopt recommendations from other medical specialties (i.e., intensive care, geriatrics) to the field of palliative care.

Fulltext available in Annals of Palliative Medicine

Management of venous thromboembolism in far-advanced cancer: current practice

BMJ Supportive & Palliative Care 2019 June 25

Simon Noble, Sophie Banerjee, Nikki Jane Pease

Guidelines suggest that indefinite anticoagulation be considered for patients with ongoing active cancer.  This paper reviewed current practice and associated symptoms at the end of life for patients with advanced cancer who had been anticoagulated for VTE.  

The majority of cancer associated thrombosis patients with metastatic disease remain anticoagulated up to or within days of death. Despite the limitations of retrospective data across healthcare settings, the authors suggest that anticoagulation as death approaches confers a significant bleeding risk without additional benefit of preventing VTE symptoms.

Opioid use in palliative care: new developments and guidelines

Prescriber, 2019 30(4) p.25-31

Lucy Bemand-Qureshi; Faye Gishen; Adrian Tookman

This article looks at the analgesic options available and reviews recent evidence and guidelines.

Full text available in Prescriber

Breakthrough cancer pain in patients with abdominal visceral cancer pain

Journal of Pain and Symptom Management, 2019 57(5) p.966-970
Mercadante, Sebastiano; Adile, Claudio; Masedu, Francesco; Valenti, Marco; Aielli, Federica

The study aim was to assess the characteristics of breakthrough cancer pain (BTcP) in patients with abdominal cancer pain, and the eventual factors associated with its presentation.  Four hundred and fourteen patients were included.  The researchers found that in nearly a third of patients, the breakthrough pain was predictable and that ingestion of food was the most frequent trigger. 

Risk reduction and management of delirium

Scottish Intercollegiate Guidelines Network, March 2019

This guideline provides recommendations based on current evidence for best practice in the detection, assessment, treatment and follow up of adults with delirium, as well as reducing the risk of delirium. The guideline applies to all settings: home, long-term care, hospital, and hospice.

Fulltext available at the SIGN website

Systematic bias in cancer patient-reported outcomes: symptom 'orphans' and 'champions'.

BMJ Supportive & Palliative Care, 2019 9(1) p. 67-74
Thomas, Shirley; Walsh, Declan; Aktas, Aynur

In this context, 'orphans' were defined as any symptom not assessed in any of the six selected instruments referenced; 'champions', in contrast, were present in all six. Of 46 checklist cancer symptoms, over a third were orphans. Only 5 checklist symptoms were champions: fatigue, pain, anorexia, dyspnoea and nausea. The bias appears to disproportionately affect gastrointestinal and neuropsychiatric symptoms. It's suggested that symptom studies should specifically report the limitations and account for the inherent item bias of any instrument used.

Fulltext available in Arthur Rank Hospice Library, Cambridge

Top ten tips palliative care clinicians should know about medical cannabis

Journal of Palliative Medicine, 2019 22(3) p. 319-325
Briscoe, Joshua; Kamal, Arif H.; Casarett, David J.

The use of medical cannabis is increasing significantly in spite of limited and sometimes contradictory data about its effectiveness. This article seeks to dispel myths about medical cannabis and provides a balanced view of the benefits and burdens of this therapeutic option, providing evidence where it exists and offering practicing clinicians guidance on conditions in which medical cannabis is likely to be helpful or burdensome.

Anticipatory prescribing of injectable medications for adults at the end of life in the community: a systematic literature review and narrative synthesis

Palliative Medicine 2019 33(2) p. 160-177
Bowers, Ben; Ryan, Richella; Kuhn, Isla; Barclay, Stephen

The anticipatory prescribing of injectable medications to provide end-of-life symptom relief is an established community practice in a number of countries. However, current anticipatory prescribing practice and policy is based on an inadequate evidence base. The authors conclude that the views and experiences of patients and their family carers towards anticipatory prescribing need urgent investigation and that further research is needed to investigate the impact of anticipatory prescribing on patients' symptoms and comfort, patient safety, and hospital admissions.

Brief psychosocial interventions improve quality of life of patients receiving palliative care: a systematic review and meta-analysis

Palliative Medicine, 2019 33(3) p. 332-345
Warth, Marco; Kessler, Jens; Koehler, Friederike, et al

The authors reported the effects of 17 interventions involving 1248 patients. They conclude that brief psychosocial interventions can improve clinically relevant health outcomes, including improvement in quality of life and a reduction in emotional and existential distress compared to the control groups.