Beyond the bucket list: unfinished business among advanced cancer patients

Psycho-oncology, 2018 27(11) p.2573-2580

Masterson M.P.; Slivjak E.; Breitbart W.; et al

This study aimed to examine the prevalence and common themes of unfinished business (UB) and its associations with distress among advanced cancer patients. The authors conclude that unfinished business was both prevalent and distressing in their sample and that their findings underscore the need to develop and implement interventions designed to help patients resolve or find solace with UB.

Fulltext available in  Psycho-oncology

Instruments to evaluate complexity in end-of-life care

Current Opinion in Supportive and Palliative Care, 2018 12(4) p. 480-88

Martin-Rosello, Maria Luisa; Sanz-Amores, Maria Reyes; Salvador-Comino, Maria Rosa

This review presents the state of art of the role of complexity in specialist palliative care provision. Complexity science, complexity frameworks, as well as tools evaluating complexity in palliative care are described.

Top ten tips palliative care clinicians should know about parkinson's disease and related disorders

Journal of Palliative Medicine, 2018 21(10)  p.1507-1517
Katz, Maya; Galifianakis, Nicholas B.; Goto, Yuika; et al

A team of Parkinson's Disease and Palliative Care experts assemble practical tips for the care of people with PD. The "Top 10" format emphasizes the most relevant issues to enable PC clinicians to provide optimal care for those suffering with this complex neurodegenerative disease.

Cultural factors influencing advance care planning in progressive, incurable disease: a systematic review with narrative synthesis.

Journal of Pain and Symptom Management, 2018 56(4) p.613-636

McDermott, Ella; Selman, Lucy Ellen

Low uptake of advance care planning indicates it is less acceptable to patients of some cultural backgrounds. The objectives of this study were to explore how cultural factors influence ACP for patients with progressive, incurable disease and how ACP might be made cross-culturally appropriate.

Benzodiazepines for agitation in patients with delirium: selecting the right patient, right time, and right indication

Current Opinion in Supportive and Palliative Care, 2018 12(4) p.489-94

Hui, David

This review provides an evidence-based synopsis on the role of benzodiazepines in patients with agitated delirium.

Complementary and Alternative Medicine in hospice and palliative Care: a systematic review

Journal of Pain and Symptom Management, 2018 56(5) p.781-94

Zeng, Yvette S; Wang, Connie; Ward, Kristina E; Hume, Anne L

The objectives of this study were to evaluate the available evidence on the use of complementary or alternative medicine (CAM) in hospice and palliative care and to summarize their potential benefits. Therapies included acupressure, acupuncture, aromatherapy massage, breathing, hypnotherapy, massage, meditation, music therapy, reflexology, and reiki.

Top ten tips for palliative care clinicians caring for heart failure patients

Journal of Palliative Medicine, 2018 21(11) p.1646-1650
Warraich, Haider Javed; Rogers, Joseph G.; Dunlay, Shannon M.; Hummel, Ellen; Mentz, Robert J.

Continuing the 'Top Ten Tips' series, a team of experts provide high-yield tips to address challenges faced by palliative care clinicians in the management of patients with heart failure.

An Admiral Nursing and hospice partnership in end-of-life care: innovative practice

Dementia, 2018 October 22
Karen Harrison Dening, Jaqueline Crowther, Sadaf Adnan

In partnership with Dementia UK Kirkwood Hospice in West Yorkshire embarked upon a two-year pilot to introduce the first end-of-life care Admiral Nurse to their Specialist Community Palliative Care Team to identify and support people with dementia who required palliative and end-of-life care. This paper describes and discusses this innovative partnership and outcomes from year one evaluation and sets out its future plans.

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

Hope tree: an interactive art installation to facilitate the expression of hope in a hospice setting

American Journal of Hospice & Palliative Medicine, 2018 35(10) p.1273-1279
Collins, Andrew; Bhathal, Darpanjot; Field, Tara; Larlee, Randene; Paje, Rachael; Young, Daneen

Patients can continue to have hope or be hopeful, even in the face of a terminal illness. In this paper the authors address the question 'Can participation in a creative writing practice improve the expression of hope in a hospice setting?' Each expressed hope placed on the "Hope Tree" was independently coded by all research team members utilizing inductive content analysis. Eight major themes emerged from the data: "Peace," "Dreams," "Total well-being," "Acknowledgment of loss," "Relationships," "Hospice care," "Spirituality," and "Dichotomies." It was concluded that the Hope Tree is a creative art project that can be used within a hospice environment to promote hope among family members and the health-care professionals who care for patients.

The ‘good death’ and reduced capacity: a literature review

Mortality; Nov 2018; vol. 23 (no. 4); p. 381-395
Read, Simon; MacBride-Stewart, Sara

This review explores the themes that contribute to a good death, specifically examining their applicability to those who lack mental capacity to make their own decisions. Largely the literature on a ‘good death’ builds on an underlying assumption that the dying patient is cognisant and capable of rationalising their death. The authors suggest that specific consideration is required on how to achieve a ‘good death’ for those with reduced capacity.

On healing and palliative care

European Journal of Palliative Care, 2018 25(3)  p.134-137

Lucas, Viv

Modern medicine has become so entrenched with the requirement for evidence, skills, competencies, outcomes and conformity that the concept of healing has been almost entirely forgotten. Viv Lucas investigates healing and what it means both as a concept generally and to palliative care specifically.

Fulltext available in European Journal of Palliative Care

Available in print in Arthur Rank Hospice, Cambridge

Psychological ideas in palliative care: distress, adjustment and coping

European Journal of Palliative Care, 2018 25(3) p.120-124
Strachan, Jenny; Clark, Lucy

Many patients, family and staff use the word ‘traumatic’ when discussing end-of-life experiences. As with many terms considered in this series, ‘trauma’ and ‘traumatised’ mean something more specific in a clinical sense than they do in common usage. The authors consider what it means to be traumatised, and how the condition might be recognised and managed in a palliative care setting?

Fulltext available in European Journal of Palliative Care

Available in print in Arthur Rank Hospice Library, Cambridge

Creating a legacy -- a tool to support end-of-life patients

European Journal of Palliative Care, 2018 25(3)  p.116-119
Vidal, Carolina; Gonçalves, Ana Luísa; Pavoeiro, Marta

Beside the psychological impact, there is increasing evidence that creating a legacy alleviates physical symptoms.  In this paper, the authors explore the concept  and creation of legacy, explaining the physical and spiritual benefits for both patients and their carers/families.

Fulltext available in European Journal of Palliative Care
Available in print in the Arthur Rank Hospice Library, Cambridge

Music therapy in UK palliative and end-of-life care: a service evaluation

BMJ supportive & palliative care; Sep 2018; vol. 8 (no. 3); p. 282-284
Graham-Wisener, Lisa; Watts, Grace; Kirkwood, Jenny; Harrison, Craig; McEwan, Joan; Porter, Sam; Reid, Joanne; McConnell, Tracey Helena

This service evaluation aims to identify the provision, role and perceived impact of UK music therapists in supporting patients receiving palliative and end of life care (PEOLC), their families and health and social care professionals. It was found that although the evidence suggests that provision of music therapy in UK PEOLC settings in the past 10 years has increased, lack of sustainable funding means the role is not consistently accessible in this setting.

Integrated breathlessness services for people with chronic conditions

Current Opinion in Supportive and Palliative Care, 2018 12(3) p.227-231

Bausewein, Claudia; Schumacher, Philipp; Bolzani, Anna

This review aims to describe recent studies evaluating the effects of breathlessness services for patients with advanced chronic conditions. The authors suggest that as the prevalence of breathlessness due to advanced disease is high and increasing, more such services should be provided to support patients throughout the course of their disease.

Psychological support for patients with cancer: evidence review and suggestions for future directions

Current Opinion in Supportive and Palliative Care, 2018 12(3) p.276-292

Hulbert-Williams, Nicholas J; Beatty, Lisa; Dhillon, Haryana M.

This article reviews contributions to the psychological literature published since January 2017. The majority of new psychological intervention research in cancer has used cognitive behavioural therapy (CBT) or mindfulness-based interventions. CBT has been considered a gold-standard intervention and recent evidence justifies continuation of this. Recent reviews call into question the validity of evidence for mindfulness-based interventions. A smaller number of trials using acceptance and commitment therapy, meta-cognitive therapy, dignity therapy and coaching have emerged, and whereas findings are promising, additional fully powered trials are required. Weaker evidence exists for counselling, support-based and narrative therapy interventions.

Supporting self-management in palliative care throughout the cancer care trajectory

Current Opinion in Supportive and Palliative Care, 2018 12(3) p.299-307

Schulman-Green, Dena; Brody, Abraham; Gilbertson-White, Stephanie; Whittemore, Robin; McCorkle, Ruth

In this review, the authors consider the complementary relationship of self-management and palliative care and how they support living with cancer as a chronic illness. Recent studies provide evidence of support among patients, family caregivers and healthcare professionals for integration of self-management interventions into palliative cancer care across the care trajectory, including the phases of curative care, palliative care, end-of-life care and bereavement.

Managing medicines for patients dying at home: a review of family caregivers' experiences

Journal of Pain and Symptom Management, September 2018
Wilson, Eleanor; Caswell, Glenys; Turner, Nicola; Pollock, Kristian

The aim of the article is to explore the literature focused on family caregivers' experiences of medications management for patients being cared for and dying at home.  The authors concluded that as increasing demands are placed on family caregivers, there remains limited acknowledgement or understanding of the challenges they face, how they cope, or could be best supported. Alongside training, family caregivers need access to 24hrs support and medication reviews to rationalise unnecessary medications.  The ethical challenges arising from administering medicines at the end of life also need to be acknowledged and discussed.

Fulltext available in Journal of Pain and Symptom Management

Is cancer fundraising fuelling quackery?

BMJ 2018 September 12
Melanie Newman

Crowdfunding sites are helping people with advanced cancer spend thousands of pounds on unproved and alternative treatments. Melanie Newman examines calls to help ensure patients and their donors are not being exploited.

Fulltext available in the BMJ

Top ten tips palliative care clinicians should know about interventional symptom management options when caring for patients with gastrointestinal malignancies.

Journal of Palliative |Medicine, 2018 21(9):1339-1343
Johnson AM, Spaete JP, Jowell PS, Kamal AH, Fisher DA.

Patients diagnosed with advanced stages of gastrointestinal (GI) malignancies are often quite symptomatic, with symptoms primarily related to anatomic sites of obstruction. Issues that may help palliative care physicians recognize common presentations of advanced GI malignancies, address interventional approaches to improve symptom burden, and improve the quality of shared decision making and goals-of-care discussions are highlighted.

Mu‐opioid antagonists for opioid‐induced bowel dysfunction in people with cancer and people receiving palliative care

Cochrane Database of Systematic Reviews 2018 June 5
Candy B, Jones L, Vickerstaff V, Larkin PJ, Stone P.

Update of 2 Cochrane reviews identified 4 new trials. Conclusions for naldemedine are new, suggesting that taken orally, it improves bowel function over 2 weeks but increases risk of adverse events. Conclusions on naloxone and methylnaltrexone have not changed.

Fulltext available from the Cochrane Library 

Mending the heart and mind during times of loss: a review of interventions to improve emotional well-being during spousal bereavement

Bereavement Care, 2018 37(2) p. 44-54
Shahane, Anoushka D.; Fagundes, Christopher P.; Denny, Bryan T.

In this paper the authors review evidence from existing pharmacological and psychotherapeutic treatment approaches for normal bereavement, complicated grief, and bereavement-related depression, and look ahead to promising future interventions.

End-of-life decision-making for people in a minimally conscious state: A review of the application of the mental capacity act 2005

Indian Journal of Palliative Care, 2018 24(3) p 334-344
Curtice, Martin; Two, Jessica; Packer, Jonathan

This article provides an overview of key sections of the Mental Capacity Act applied in end-of-life minimally conscious state cases and reviews seminal cases elucidating how the Act has been applied. It further describes the evolution of how courts have interpreted the doctrine of best interests when considering withholding or withdrawing clinically assisted nutrition and hydration and other life-sustaining treatments.

Fulltext available in Indian Journal of Palliative Care

A purpose-designed monofilament-fibre pad for debridement of hard-to-reach wounds: experience in clinical practice

Journal of Wound Care, 2018 23(7) p 421-425
Dissemond, Joachim; Eberlein, Thomas; Bültemann, Anke; Riepe, Gunnar; Stoffels, Ingo; Stephen-Haynes, Jackie; Roes, Claas; Martin, Abel

This multicentre, international user test was performed by experienced physicians and nurses in Germany and the UK, who used the monofilament-fibre pad in their clinical practice, after which they completed an evaluation questionnaire. The monofilament-fibre pad effectively, easily and safely removed slough and debris from wounds of various aetiologies and was effective in wounds of different shapes, such as in cavity wounds and those in hard-to-reach locations, and compared favourably to standard methods of debridgement.

Medicinal cannabinoids in palliative care

British Journal of Clinical Pharmacology, 2018 June
Meera Agar

There is strong public support for the availability of medicinal cannabis, particularly for people with palliative diagnoses, though clinical data to date has been inconclusive in key symptoms such as pain and nausea, and data from other settings such as chemotherapy‐induced nausea and vomiting not readily extrapolated. In people with refractory symptoms, the consideration of unregistered products or off‐label prescribing should be guided by the potential influences of pharmacokinetic, pharmacodynamic and drug–drug interactions, supported by an informed discussion with the patient, and regular review of net clinical benefit.

Fulltext available in British Journal of Clinical Pharmacology

Difficulties for a practitioner preparing a family for the death of a parent: a narrative inquiry

Mortality, 2018 23(3) p 247-260
Macpherson, Catriona

A practitioner inquiry within an NHS specialist palliative care context used narrative methods to explore difficulties faced by practitioners when assisting a family in the process of preparing a child for the death of a parent.

Psychological interventions in palliative care

Current Opinion in Psychiatry, 2018 31(5) p 389-395
Pia von Blanckenburg, Nico Leppin

This paper provides an update on recent studies about psychological interventions in palliative (mainly cancer) care with a focus on physical, psychological, spiritual, and social aspects.

Advance care planning in dementia: recommendations for healthcare professionals

BMC Palliative Care, June 2018 
Ruth Piers, Gwenda Albers, Joni Gilissen, et al

No high-quality guidelines are available for ACP in dementia care.  The authors aimed to develop evidence-based clinical recommendations to guide professionals across settings in the practical application of ACP for people living with dementia.

Fulltext available in BMC Palliative Care

The difficulties of discharging hospice patients to care homes at the end of life: a focus group study

Palliative Medicine, 2018 32(7) p.1267-1274
Thomas, Tabitha; Clarke, Gemma; Barclay, Stephen

The aim of this study was to investigate the issues that arise when patients are transferred from hospice to care home at the end of life, from the perspective of the hospice multidisciplinary team. Difficulties identified included (1) ethical concerns (dilemmas around the decision, lack of patient autonomy and allocation of resources); (2) communication challenges; and (3) discrepancies between the ideals and realities of hospice palliative care. The authors suggest that further research is needed to understand patients' experiences concerning moving to care homes for end of life care in order that interventions can be implemented to mitigate patients' and families' distress.

The engagement of young people in their own advance care planning process: A systematic narrative synthesis

Palliative Medicine, 2018 32(7) p.1147-1166
Hughes, Ben; O'Brien, Mary R.; Flynn, Anita; Knighting, Katherine

With an increasing number of young people living with life-limiting conditions there is a need to understand how far young people are engaged in their own advance care planning in order to shape future practice and facilitate young people's wishes. The aim of this study was to identify and assess the current evidence to determine the barriers and facilitators to the engagement of young people in their own advance care planning process.

How might organisational institutionalism support the challenges of the modern hospice?

International Journal of Health Planning and Management, 2018, 28th June
E. Hodges; S. Read

The authors argue that the external environment within which UK charitable hospice care operates is changing. This paper outlines a number of environmental and influencing factors driving and impacting those changes. A model of institutional change is introduced, explored, and considered from the context of hospice. 

Dementia: assessment, management and support for people living with dementia and their carers. (Guideline)

National Institute for Health and Care Excellence (NICE)

June 2018

This guideline covers diagnosing and managing dementia (including Alzheimer’s disease). It aims to improve care by making recommendations on training staff and helping carers to support people living with dementia.  Section 1.10 makes recommendations for Palliative care.

Fulltext available on NICE website

Contemporary best practice in the management of malignant pleural effusion

Therapeutic Advances in Respiratory Disease 2018, 12: 1753466618785098

Coenraad F N Koegelenberg, Jane A Shaw, Elvis M Irusen, Y C Gary Lee

Malignant pleural effusion (MPE) affects more than 1 million people globally but there is a lack of evidence on the therapeutic approach to MPE, and, as a result, a high degree of variability in its management. This review aims to provide practicing clinicians with an overview of the current evidence on the management of MPE and to provide guidance on how to approach individual cases.

Fulltext available at Sage Publications

Laycarers can confidently prepare and administer subcutaneous injections for palliative care patients at home: A randomized controlled trial

Palliative Medicine, 2018 32(7)  p1208-1215
Healy, Sue; Israel, Fiona; Charles, Margaret; Reymond, Liz

This Australian study explored differences in laycarers' confidence in administering subcutaneous injections depending upon whether a laycarer, registered nurse or pharmacist prepared injections for subsequent administration by laycarers.  Results indicated that upskilled laycarers can confidently administer subcutaneous injections for loved ones, regardless of who prepares injections. This finding can improve patient outcomes and potentially decrease unwanted admissions to inpatient facilities.

A retrospective medical records review of risk factors for the development of respiratory tract secretions (death rattle) in the dying patient

Journal of Advanced Nursing, 2018 74(7)  p1639-1648
Kolb, Hildegard; Snowden, Austyn; Stevens, Elaine; Atherton, Iain

The identification of risk factors for the development of death rattle would allow for targeted interventions.  Two hundred consecutive medical records of mainly cancer patients who died in a hospice inpatient setting between 2009-2011 were reviewed. Fifteen potential risk factors were investigated.  The authors conclude that dying patients with a requirement for a high dose of Midazolam have an increased likelihood of developing death rattle.

Pressure injury progression and factors associated with different end-points in a home palliative care setting: a retrospective chart review study

Journal of Pain and Symptom Management, 2018 56(1)  p23-32
Artico, Marco; D'Angelo, Daniela; Piredda, Michela; et al

The authors of this study carried out in Italy conclude that pressure injury healing is a realistic aim in home palliative care, particularly for injuries not exceeding Stage II occurring at least two weeks before death. When assessing pressure injuries, their results highlight the need to also pay attention to artificial nutrition, continuous deep sedation, and the caregiver's role and gender.

Palliative sedation in terminal cancer patients admitted to hospice or home care programs: does the setting matter? Results from a national multicenter observational study

Journal of Pain and Symptom Management, 2018 56(1)  p33-43
Caraceni, Augusto; Speranza, Raffaella; Spoldi, Elio et al

The aim of this study was to compare palliative sedation rates in the hospice care and home care settings, patient clinical characteristics before and during palliative sedation, the decision-making process and clinical aspects of palliative sedation. 

Psychotherapy targeting depression and anxiety for use in palliative care: a meta-analysis

Journal of Palliative Medicine, 2018 21(7)  p1024-1037
Fulton, Jessica J.; Ramos, Katherine; Porter, Laura S.; Newins, Amie R.

This meta-analysis examined the effect of psychotherapy on depression and anxiety among individuals with any condition appropriate for palliative care. Overall, findings suggest that psychotherapy in palliative care populations reduced depression (large effect) and anxiety (small effect) symptoms. Psychotherapy also improved quality of life (small effect). Significant moderators of intervention effects included type of intervention and provider, number and length of treatment sessions, and sample age. Cognitive-behaviorally based and other therapies (e.g., acceptance, mindfulness) showed significant effects, as did interventions delivered by mental health providers. More treatment sessions were associated with greater effect sizes; longer sessions were associated with decreased effect sizes. 

Ten tips palliative care pharmacists want the palliative care team to know when caring for patients

Journal of Palliative Medicine, 2018 21(7) p 1017-1023
Uritsky, Tanya J.; Atayee, Rabia S.; Herndon, Christopher M.; Lockman, Kashelle; McPherson, Mary Lynn; Jones, Christopher A.

Pharmacists, experts in the nuances of medication management, are valuable resources and colleagues for palliative care providers. This article will offer 10 useful clinical pharmacy tips that PC pharmacists think all PC providers should know for safe and effective symptom management.