The impact of healthcare professionals’ personality and religious beliefs on the decisions to forego life sustaining treatments

The aim of this study was to assess the opinion of intensive care unit (ICU) personnel and the impact of their personality and religious beliefs on decisions to forego life-sustaining treatments (DFLSTs) | BMJ Open

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Results: The participation rate was 65.7%. Significant differences in DFLSTs between doctors and nurses were identified. 71.4% of doctors and 59.8% of nurses stated that the family was not properly informed about DFLST and the main reason was the family’s inability to understand medical details. 51% of doctors expressed fear of litigation and 47% of them declared that this concern influenced the information given to family and nursing staff. 7.5% of the nurses considered DFLSTs dangerous, criminal or illegal. Multivariate logistic regression identified that to be a nurse and to have a high neuroticism score were independent predictors for preferring the term ‘passive euthanasia’ over ‘futile care’ (OR 4.41, 95% CI 2.21 to 8.82, p<0.001, and OR 1.59, 95% CI 1.03 to 2.72, p<0.05, respectively). Furthermore, to be a nurse and to have a high-trust religious profile were related to unwillingness to withdraw mechanical ventilation. Fear of litigation and non-disclosure of the information to the family in case of DFLST were associated with a psychoticism personality trait (OR 2.45, 95% CI 1.25 to 4.80, p<0.05).

Conclusion: We demonstrate that fear of litigation is a major barrier to properly informing a patient’s relatives and nursing staff. Furthermore, aspects of personality and religious beliefs influence the attitudes of ICU personnel when making decisions to forego life-sustaining treatments.

Full reference: Ntantana, A, et al. (2017) The impact of healthcare professionals’ personality and religious beliefs on the decisions to forego life sustaining treatments: an observational, multicentre, cross-sectional study in Greek intensive care units. BMJ Open. 7:e013916.

The care of older people in care homes

National Institute for Health Research (NIHR) Themed Review: Advancing Care: Research with care homes

There are more than twice as many people living in care homes in England and Wales, than there are people staying in hospital. Yet we know far more about effective treatments in hospital and less about what works most effectively to improve care for older people in care homes. Research in care homes is a relatively new and emerging field.

Advancing Care provides an overview of recent NIHR research on improving the health and care of care home residents. It highlights current research taking place now and explores new approaches being developed in this important area.

The review brings together NIHR research on three themes relating to the care of older people in care homes: Living well – maintaining good health and quality of life, ageing well – managing long term conditions associated with ageing, and dying well – ensuring a good quality end of life. It features:

  • 23 published studies
  • 21 ongoing studies
  • Quotes from care home owners, managers, staff and researchers
  • Where next for care home research?

Better palliative care for people with a dementia

Dementia is the most common neurological disorder worldwide and is a life-limiting condition, but very often is not recognised as such | BMC Palliative Care

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Image source: Susan Lockhart – Wellcome Images // CC BY-NC-ND 4.0

Background: People with dementia, and their carers, have been shown to have palliative care needs equal in extent to those of cancer patients. However, many people with advanced dementia are not routinely being assessed to determine their palliative care needs, and it is not clear why this is so.

Main body: An interdisciplinary workshop on “Palliative Care in Neurodegeneration, with a focus on Dementia”, was held in Cork, Ireland, in May 2016. The key aim of this workshop was to discuss the evidence base for palliative care for people with dementia, to identify ‘gaps’ for clinical research, and to make recommendations for interdisciplinary research practice. To lead the discussion throughout the day a multidisciplinary panel of expert speakers were brought together, including both researchers and clinicians from across Ireland and the UK. Targeted invitations were sent to attendees ensuring all key stakeholders were present to contribute to discussions. In total, 49 experts representing 17 different academic and practice settings, attended.

Key topics for discussion were pre-selected based on previously identified research priorities (e.g. James Lind Alliance) and stakeholder input. Key discussion topics included: i. Advance Care Planning for people with Dementia; ii. Personhood in End-of-life Dementia care; iii. Topics in the care of advanced dementia at home. These topics were used as a starting point, and the ethos of the workshop was that the attendees could stimulate discussion and debate in any relevant area, not just the key topics, summarised under iv. Other priorities.

Conclusions: The care experienced by people with dementia and their families has the potential to be improved; palliative care frameworks may have much to offer in this endeavour. However, a solid evidence base is required to translate palliative care into practice in the context of dementia. This paper presents suggested research priorities as a starting point to build this evidence base. An interdisciplinary approach to research and priority setting is essential to develop actionable knowledge in this area.

Full reference: Fox, S. et al. (2017) Better palliative care for people with a dementia: summary of interdisciplinary workshop highlighting current gaps and recommendations for future research. BMC Palliative Care. Vol. 17 (no. 9)

Social workers’ involvement in advance care planning

Advance care planning is a process of discussion that enables competent adults to express their wishes about end-of-life care through periods of decisional incapacity | BMC Palliative Care

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Although a number of studies have documented social workers’ attitudes toward, knowledge about, and involvement in advance care planning, the information is fragmented. The purpose of this review was to provide a narrative synthesis of evidence on social workers’ perspectives and experiences regarding implementation of advance care planning.

Thirty-one articles met the eligibility criteria. Six research themes were identified: social workers’ attitudes toward advance care planning; social workers’ knowledge, education and training regarding advance care planning; social workers’ involvement in advance care planning; social workers’ perceptions of their roles; ethical issues relevant to advance care planning; and the effect of social work intervention on advance care planning engagement. The findings suggest that there is a consensus among social workers that advance care planning is their duty and responsibility and that social workers play an important role in promoting and implementing advance care planning through an array of activities.

This study provides useful knowledge for implementing advance care planning through illustrating social workers’ perspectives and experiences. Further studies are warranted to understand the complexity inherent in social workers’ involvement in advance care planning for different life-limiting illnesses or within different socio-cultural contexts.

Full reference: Chong-Wen, W. et al. (2017) Social workers’ involvement in advance care planning: a systematic narrative review. BMC Palliative Care. Published online: 10th July 2017

Nurse-led intervention helps carers’ manage medication and cancer pain

The potential benefits of a new nurse-led intervention in supporting carers to manage pain medication in people with terminal cancer are explored in this article | ScienceDaily

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Image source: frankieleon – Flickr // CC BY 2.0

A study funded by Marie Curie and Dimbleby Cancer Care published today shows the potential benefits of a new nurse-led intervention in supporting carers to manage pain medication in people with terminal cancer. Researchers from the University of Southampton, Cardiff University and University of Leeds have developed a nurse-led intervention to help carers with medication management, and evaluated its use in routine practice.

The Cancer Carers’ Medicines Management (CCMM) intervention addresses carers’ beliefs, knowledge and skills and promotes self-evaluation of competence. It centres on a structured conversational process between a nurse and carer. It is the first time that a study has attempted to integrate an intervention developed using input from carers and nurses into routine palliative care. The research showed that the CCMM intervention compared favourably with current practice as it offered a more systematic and comprehensive approach to supporting carer management of pain medicines.

Integrated heart failure care and palliative care at home

Patients with severe heart failure suffer from a high symptom burden and high mortality | BMJ Supportive & Palliative Care

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Image source: Rick&Brenda Beerhorst – Flickr // CC BY 2.0

Objectives: European and Swedish guidelines for HF care recommend palliative care for these patients. Different models for integrated palliative care and HF care have been described in the literature. No studies were found that qualitatively evaluated these models. The purpose of this study is to describe patients’ experiences of a new model of person-centred integrated HF and palliative care at home.

Method: Interviews were conducted with 12 patients with severe HF (New York Heart Association class III–IV) and included in the research project of Palliative advanced home caRE and heart FailurE caRe (PREFER). Qualitative content analysis was used for data analysis.

Results: Two themes and a total of five categories were identified. The first theme was feeling secure and safe through receiving care at home with the categories: having access to readily available care at home, being followed up continuously and having trust in the team members’ ability to help. The second theme was being acknowledged as both a person and a patient, with the following two categories: being met as a person, participating in decisions about one’s care and receiving help for symptoms of both HF and comorbidities.

Conclusions: Person-centred integrated HF and palliative care provides a secure environment and holistic care for patients with severe HF. This approach is a way to improve the care management in this population.

Full reference: Talabani, N. et al. (2017) Patients’ experiences of person-centred integrated heart failure care and palliative care at home: an interview study. BMJ Supportive & Palliative Care. Published Online First: 7th July 2017.

Integrating chaplaincy into healthcare

Spiritual care can be an important source of support for patients dealing with chronic or terminal illnesses, and it is a key component of palliative care | BMJ Supportive & Palliative Care

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Studies have shown that patients would like more frequent discussions on religion and spirituality (R/S) while in the hospital, but many patients do not have the chance to do so. One way to ensure that R/S is addressed during a hospital stay is via chaplain referrals. One study showed that chaplain visits are associated with increased patient satisfaction, and patients more often endorsed that staff met their emotional and spiritual needs, although research shows differences among professionals in chaplaincy referral rates; nurses have been shown to have higher likelihood of referring than physicians and social workers (SWs).

With the advent of the electronic health record (EHR), we felt it was important to explore whether or not healthcare professionals (HCPs) are interested in technology for requesting chaplains, and therefore improve access to spiritual care for patients. In fact, some initial research shows potential benefits of using electronic means to better identify and target patients in need of a chaplain visit, and one innovative palliative care service using pagers for referrals was reported as highly valuable by nurses to patients and the clinical team.

Here, we report results from a quality improvement (QI) project aimed at improving chaplaincy referrals, and therefore spiritual care, at a major academic centre in New York City, with a focus on gauging interest in technology-driven means for chaplain referrals.

Full reference: Rhee, J.Y. et al. (2017) Integrating chaplaincy into healthcare: a survey shows providers are interested in technology-based options. BMJ Supportive & Palliative Care. Published Online First: 7th July 2017.