Dying at home more peaceful, but requires discussion

For terminally ill cancer patients and their loved ones, dying at home can be more peaceful with less grief among family members. But the option requires talking about preferences, access to a comprehensive home care package, and time off from work for family caregivers, according to a study in BMC Medicine. Barbara Gomes, BSc, MSc, PhD, of the Cicely Saunders Institute at King’s College London, and colleagues questioned 352 bereaved family members of patients who died in the hospital or at home. Wherever they passed away, patients experienced about the same amount of pain.

Full reference:  Is dying in hospital better than home in incurable cancer and what factors influence this? A population-based study.  BMC Medicine 2015, 13:235.

Living with and dying from advanced heart failure.

Heart failure (HF) is a life-limiting illness and patients with advanced heart failure often suffer from severe physical and psychosocial symptoms. Particularly in older patients, HF often occurs in conjunction with other chronic diseases, resulting in complex co-morbidity. This study aims to understand how old and very old patients with advanced HF perceive their disease and to identify their medical, psychosocial and information needs, focusing on the last phase of life.

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Bereaved Caregiver Perception of Quality of Care in the Final Week of Life

Cancer caregivers are key stakeholders in the final weeks of life and in bereavement. Research has highlighted end-of-life (EOL) factors important to caregivers, as well as factors contributing to caregiver mental health and bereavement outcomes.

This study’s purpose was to identify modifiable predictors of caregivers’ Caregiver Evaluation of Quality of End of Life Care (CEQUEL) scores, with the broader aim of informing clinical interventions to improve caregiver impressions of care and subsequent bereavement adjustment.

Findings suggest that place of death and hospice length of stay best predict bereaved caregiver evaluations of quality of EOL care. These findings equip health care providers with modifiable targets to improve caregivers’ experience of EOL care and subsequent bereavement.

Full reference: Higgins, P et al, Factors Predicting Bereaved Caregiver Perception of Quality of Care in the Final Week of Life: Implications for Health Care Providers  Journal of Palliative Medicine. October 2015, 18(10): 849-857

How do junior doctors in the UK learn to provide end of life care: a qualitative evaluation of postgraduate education

BMC Palliative Care 2015, 14:45

Stethoscope

Background
The fundamental importance of good end of life care has been well documented however recent national publications have high-lighted inadequacies in training in this area. For many patients dying in the UK today care is provided in hospital and the number of inpatient deaths is forecast to climb significantly in future. The demands of providing medical care for these patients by junior doctors will continue to rise. However, there is currently only limited research on training for doctors in this setting.

Methods
A qualitative study using semi-structured interviews of trainees working in general medicine analysed utilising a grounded theory approach.

Results
Eleven medical trainees from nine different medical schools participated. They had worked in fifteen different UK hospitals in the course of their careers. All of the doctors interviewed felt generally confident in managing a dying patient. This had developed at postgraduate level and increased when working in certain key specialties. Emerging themes fell into five main categories: perceived ability in clinical management, different learning opportunities experienced, the impact of variations in approach to end of life care, the role of the specialist palliative care team and suggestions for improvements to training. All participants felt further teaching would be beneficial.

Conclusions
This study identified key areas where training could be improved. This included small changes in everyday practice to shift the emphasis for trainees to education. There also needs to be focus on end of life care in the curriculum, formal teaching programmes and assessment of junior doctors. The specialist palliative care team played a vital role in training as well as service provision. For those working in this specialty, every clinical encounter provides an opportunity for education. Specifically targeting junior doctors will not only improve patient care today but empower the consultants of the future.

via BMC Palliative Care | Abstract | How do junior doctors in the UK learn to provide end of life care: a qualitative evaluation of postgraduate education.

Strategies to implement evidence into practice to improve palliative care: recommendations of a nominal group approach with expert opinion leaders

BMC Palliative Care 2015, 14:47

Background
In the past decades, many new insights and best practices in palliative care, a relatively new field in health care, have been published. However, this knowledge is often not implemented. The aim of this study therefore was to identify strategies to implement improvement activities identified in a research project within daily palliative care practice.

Methods
A nominal group technique was used with members of the IMPACT consortium, being international researchers and clinicians in cancer care, dementia care and palliative care. Participants identified and prioritized implementation strategies. Data was analyzed qualitatively using inductive coding.

Results
Twenty international clinicians and researchers participated in one of two parallel nominal group sessions. The recommended strategies to implement results from a research project were grouped in five common themes: 1. Dissemination of results e.g. by publishing results tailored to relevant audiences, 2. Identification and dissemination of unique selling points, 3. education e.g. by developing e-learning tools and integrating scientific evidence into core curricula, 4. Stimulation of participation of stakeholders, and 5. consideration of consequences e.g. rewarding services for their implementation successes but not services that fail to implement quality improvement activities.

Discussion
The added value of this nominal group study lies in the prioritisation by the experts of strategies to influence the implementation of quality improvement activities in palliative care. Efforts to ensure future use of scientific findings should be built into research projects in order to prevent waste of resources.

via BMC Palliative Care | Abstract | Strategies to implement evidence into practice to improve palliative care: recommendations of a nominal group approach with expert opinion leaders.

Is home always the best and preferred place of death? | The BMJ

BMJ 2015;351:h4855

The current orthodoxy is that home is the best and preferred place of death for most people. Kristian Pollock questions these assumptions and calls for greater attention to improving the experience of dying in hospital and elsewhere

Place of death has become a key indicator of the quality of end of life care, underpinned by the conviction that most people would prefer to die at home. The institutional environment of acute hospital wards is considered an inappropriate and undesirable place in which to die, and there are concerns about poor quality of care. The need to reduce costs is a further incentive for reducing deaths in hospital. However, the evidence on patients’ preferences is unclear and conflicting. Regardless of preference, hospital will remain the most common place of death for the foreseeable future. Far from neglecting and disregarding the hospital as a site of terminal care, much greater thought and adequate resources must be directed to enabling hospitals to provide excellent support for dying patients and their families.

Read the full article via Is home always the best and preferred place of death? | The BMJ.