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.

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

Exploring the meaning and practice of self-care among palliative care nurses and doctors: a qualitative study

BMC Palliative Care; 2018, 17 (1),  63
Mills, Jason; Wand, Timothy; Fraser, Jennifer A

The aim of the present study was to explore the meaning and practice of self-care as described by palliative care nurses and doctors in Australia.  The findings provide a detailed account of the context and complexity of effective self-care practice previously lacking in the literature. 

Fulltext available in BMC Palliative Care

Palliative care for homeless people: a systematic review of the concerns, care needs and preferences, and the barriers and facilitators for providing palliative care

BMC Palliative Care; 2018, 17 (1) 67
Klop, Hanna T; de Veer, Anke J E; van Dongen, Sophie I; Francke, Anneke L; Rietjens, Judith A C; Onwuteaka-Philipsen, Bregje D

This systematic review aims to summarize evidence about the concerns, palliative care needs and preferences of homeless people, as well as barriers and facilitators for delivering high quality palliative care.

Fulltext available in BMC Palliative Care