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Welcome to the Palliative Care online newsfeed. Here you’ll find all the latest research, news stories, policy updates and guidelines. View our other newsfeeds for more subject-specific news.

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Continuation of non-essential medications in actively dying hospitalised patients

The objective of this analysis was to examine the use of 11 non-essential medications in actively dying patients | BMJ Supportive & Palliative Care

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This was a planned secondary analysis of data from the Best Practices for End-of-Life Care for Our Nation’s Veterans trial, a multicentre implementation trial of an intervention to improve processes of end-of-life care in inpatient settings. Supported with an electronic comfort care decision support tool, intervention included training hospital staff to identify actively dying patients, communicate the prognosis to patients/families and implement best practices of traditionally home-based hospice care. Data on medication use before and after intervention were derived from electronic medical records of 5476 deceased veterans.

Non-essential medications continue to be administered to actively dying patients. Discontinuation of these medications may be facilitated by interventions that enhance recognition and consideration of patients’ actively dying status.

Full reference: Williams, B.R., et al. (2017) Continuation of non-essential medications in actively dying hospitalised patients. BMJ Supportive & Palliative Care. Published Online First: 13 September 2017.

Death and dying in the UK

Death, dying and devolution | The University of Bath Institute for Policy Research

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The articles in this collection cover what happens before someone dies, including issues around palliative care and support for carers; what happens at death, including issues around the proper regulation of funerals and public financial support for the bereaved; and what happens to those who are left behind, including emotional support for those who have been bereaved and issues around managing the estates of those who have died.

The report reviews policy areas associated with death, dying and bereavement within the context of devolution. It focuses on the national and regional delegation of power, resources and authority across the UK and the implications of this for those who are dying, dead, or bereaved as well as those tasked with organising and running the services that support these groups of people.

The report can be downloaded here

What are families most grateful for after receiving palliative care?

Family members are involved in the care of palliative patients at home and therefore, should be viewed as important sources of information to help clinicians better understand the quality palliative care service patients receive | BMC Palliative Care

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Image source: Ricardo Díaz – Flickr // CC BY-NC-ND 2.0

Qualitative exploratory study based on documentary analysis. Content analysis of 77 gratitude documents received over 8 years by a palliative home service in Odivelas, near Lisbon (Portugal) was undertaken, through an inductive approach and using investigator triangulation. Frequency of distinct categories was quantitatively defined.

Family carers show spontaneous gratitude for the professionalism and humanity found in palliative care. The relational component of care emerges as key to achieve a high quality care experience of palliative care homes service, and could be one indicator of quality of palliative care.

Full reference: Aparicio, M. et al. (2017) What are families most grateful for after receiving palliative care? Content analysis of written documents received: a chance to improve the quality of care. BMC Palliative Care. Published: 6 September 2017

How can primary care enhance end-of-life care for liver disease?

Qualitative study of general practitioners’ perceptions and experiences | BMJ Open

Liver disease is the third most common cause of premature death in the UK. The symptoms of terminal liver disease are often difficult to treat, but very few patients see a palliative care specialist and a high proportion die in hospital. Primary care has been identified as a setting where knowledge and awareness of liver disease is poor. Little is known about general practitioners’ (GPs) perceptions of their role in managing end-stage liver disease.

GPs expressed a desire to be more closely involved in end-of-life care for patients with liver disease but identified a number of factors that constrained their ability to contribute. These fell into three main areas; those relating directly to the condition, (symptom management and the need to combine a palliative care approach with ongoing medical interventions); issues arising from patients’ social circumstances (stigma, social isolation and the social consequences of liver disease) and deficiencies in the organisation and delivery of services. Collaborative working with support from specialist hospital clinicians was regarded as essential, with GPs acknowledging their lack of experience and expertise in this area.

Full reference: Standing, H. et al. (2017) How can primary care enhance end-of-life care for liver disease? Qualitative study of general practitioners’ perceptions and experiences. BMJ Open. 7:e017106.

How well do we currently care for our dying patients in acute hospitals

The aim of this study was to evaluate quality of care provided to dying patients and their families in acute hospitals from the perspective of bereaved relatives | BMJ Supportive & Palliative Care

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Background: The National Care of the Dying Audit—Hospitals (NCDAH) is used as a method to evaluate care for dying patients in England. An additional component to the 2013/2014 audit was the Local Survey of Bereaved Relatives Views using the ‘Care Of the Dying Evaluation’ (CODE) questionnaire.

Conclusions: Adopting a postbereavement survey to NCDAH appears to be feasible, acceptable and a valuable addition. On the whole, the majority of participants reported good or excellent care. A small but significant minority, however, perceived poor quality of patient care with clear and timely communication urgently needed.

Full reference: Mayland, C.R. et al. (2017) How well do we currently care for our dying patients in acute hospitals: the views of the bereaved relatives? BMJ Supportive & Palliative Care. Vol. 07 (Issue 03) pp. 316-325.

Marie Curie Research Conference Abstracts 2017

Selected abstracts from the conference:

  • 14 Managing uncertainty in care for people with dementia at the end of life: the use of heuristics

Do Not Attempt Resuscitation Orders(DNAR) and their contemporary counterparts are cornerstones of End of Life care and as such, of importance within medical education. Previous research indicates the need for a better understanding of patient and physicians perceptions of DNAR topics.

Davies, N. et al. (2017) 14 Managing uncertainty in care for people with dementia at the end of life: the use of heuristics. BMJ Supportive & Palliative Care. Vol. 07 (Issue 03) p. A352.

  • 21 Exploring the effectiveness of a mindfulness-based intervention for staff in a palliative care setting

Palliative care staff engage in emotional and stressful work; however, research is yet to offer any insights as to what types of psychosocial intervention can effectively improve staff psychological well-being (Hill, Dempster, Donnelly, & McCorry, 2016). This research aims to evaluate the effectiveness of a Mindfulness-Based Intervention (MBI), which was condensed to make it more feasible for staff to attend, to improve the psychological well-being of palliative care staff.

Hill, R.C. et al. (2017) 21 Exploring the effectiveness of a mindfulness-based intervention for staff in a palliative care setting. BMJ Supportive & Palliative Care. Vol. 07 (Issue 03) pp. A354-A355.

  • 28 Do not attempt resuscitation: university of aberdeen student perspectives

Do Not Attempt Resuscitation Orders(DNAR) and their contemporary counterparts are cornerstones of End of Life care and as such, of importance within medical education. Previous research indicates the need for a better understanding of patient and physicians perceptions of DNAR topics.

Koshias, A. et al. (2017) 28 Do not attempt resuscitation: university of aberdeen student perspectives. BMJ Supportive & Palliative Care. Vol. 07 (Issue 03) pp. A357-A358

 

 

 

 

Can the ‘surprise question‘ be used to correctly identify people nearing the end of life?

The surprise question (SQ) (“Would you be surprised if this patient died within the next χ months?”) offers an alternative to standard prognostic estimates | BMJ Supportive & Palliative Care

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Methods: We searched numerous databases, including: Medline, Embase, CINAHL, AMED. Studies were included if they reported the SQ and were written in English.

Results: Out of the 357 studies identified, 22 were included in the review. In these studies, 25 718 estimates were reported. The results showed a wide variation in the reported accuracy of the SQ, with sensitivity ranging from 11.6% to 96.6% and specificity ranging from 13.9% to 78.6%. The AUROC score across the studies ranged from 0.512 to 0.822. Doctors appeared to be more accurate than nurses at recognising people in the last year of life (c-statistic=0.735 vs. 0.688).

Conclusions: The performance of the SQ varied greatly across the studies. Further work is required to understand the processes by which clinicians arrive at their prognostic estimates, to refine the accuracy of the SQ and to compare its performance against other more sophisticated prognostic tools, particularly in populations where a higher proportions of deaths occur.

Full reference: Vickerstaff, V. et al. (2017) 60 Can the ‘surprise question‘ be used to correctly identify people nearing the end of life?: a review. BMJ Supportive & Palliative Care. Vol. 07 (Issue 03) A371.