The European Association for Palliative Care White Paper on euthanasia and physician-assisted suicide: Dodging responsibility

Chambaere, K. et al. Palliative Medicine. Published online: September 8, 2016

The White Paper of the European Association for Palliative Care (EAPC) on euthanasia and physician-assisted suicide in a previous issue is the result of a consensus-seeking process among representatives of the national palliative care organisations in Europe as well as the EAPC board members about the position statements that had been formulated in an earlier position paper in 2003.

With the aim of providing ‘a viewpoint from the palliative care perspective’ and an overarching ‘normative ethical framework’, the authors end by reaffirming that ‘euthanasia is not a part of palliative care’ despite noting strong dissent and a lack of consensus on pivotal statements.

Read the extract here

Parents’ experience of a follow-up meeting after a child’s death in the Paediatric Intensive Care Unit

Brink, H.L. et al. Intensive and Critical Care Nursing. Published online: 12 August 2016

Objective: ‘To identify parents’ experience of a follow up meeting and to explore whether the conversation was adequate to meet the needs of parents for a follow-up after their child’s death in the Paediatric Intensive Care Unit (PICU).

Design and setting: Qualitative method utilising semi-structured interviews with six pairs of parents 2–12 weeks after the follow-up conversation. The interviews were held in the parents’ homes at their request. Data were analysed using a qualitative, descriptive approach and thematic analysis.

Findings: Four main themes emerged: (i) the way back to the PICU; (ii) framework; (iii) relations and (iv) closure.

Conclusion: The parents expressed nervousness before the meeting, but were all pleased to have participated in these follow-up meetings. The parents found it meaningful that the follow-up meeting was interdisciplinary, since the parents could have answers to their questions both about treatment and care. It was important that the staff involved in the follow-up meeting were those who had been present through the hospitalisation and at the time of the child’s death. Parents experienced the follow-up meeting as being a closure of the course in the PICU, regardless the length of the hospitalisation.

Read the abstract here

Tailored end-of-life care

In this case study from Leeds Teaching Hospitals NHS Trust,  find out how tailored training has helped staff to gain skills and confidence in:

  • symptom management for patients
  • facilitating end-of-life care at home
  • recognising end of life
  • knowledge of community services

Read previous end-of-life care case studies showing the different approaches that trusts use to deliver training.

Experiences in end-of-life care in the Intensive Care Unit: A survey of resident physicians

Mohamed, Z.M. et al. Indian Journal of Critical Care Medicine.  2016;20:459-64

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Background and Aims: The practice of intensive care includes withholding and withdrawal of care, when appropriate, and the goals of care change around this time to comfort and palliation. We decided to survey the attitudes, training, and skills of intensive care residents in relation to end-of-life (EoL) care. All residents at our institute who has worked for at least a month in an adult Intensive Care Unit were invited to participate.

Materials and Methods: After Institutional Ethics Committee approval, a Likert-scale questionnaire, divided into five composite measures of EoL skills including training and attitude, was handed over to individual residents and completed data were anonymized. Frequency and descriptive analysis was performed for the demographic variables. Central tendency, variability, and reliability were examined for the five composite measures. Scale internal consistency was checked by Cronbach’s coefficient alpha. Multivariate forward conditional regression analysis was conducted to examine the association of demographic data or EoL experience to composite measures.

Results: Of the 170 eligible residents, we received 120 (70.5%) responses.

Conclusions:Internal medicine residents have more experience in caring for dying patients and conducting EoL discussions. Even though majority of participants reported that they are comfortable with the concept of EoL care, this does not always reflect the actual practice in the hospital. There is a need for further training in skills around EoL care. As this is a self-assessment survey, the specific measures of attitudes and skills in EoL are poorly reflected, indicating a need for further research.

Read the full article here

Avoiding costly hospitalisation at end of life: findings from a specialist palliative care pilot in residential care for older adults

Chapman, M. et al. BMJ Supportive & Palliative Care. Published Online: 5 August 2016

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Image source: Rowena Dugdale – Wellcome Images // CC BY-NC-ND 4.0

Objectives: Specialist palliative care is not a standardised component of service delivery in nursing home care in Australia. Specialist palliative care services can increase rates of advance care planning, decrease hospital admissions and improve symptom management in such facilities. New approaches are required to support nursing home residents in avoiding unnecessary hospitalisation and improving rates of dying in documented preferred place of death. This study examined whether the addition of a proactive model of specialist palliative care reduced resident transfer to the acute care setting, and achieved a reduction in hospital deaths.

Methods: A quasi-experimental design was adopted, with participants at 4 residential care facilities. The intervention involved a palliative care nurse practitioner leading ‘Palliative Care Needs Rounds’ to support clinical decision-making, education and training. Participants were matched with historical decedents using propensity scores based on age, sex, primary diagnosis, comorbidities and the Aged Care Funding Instrument rating. Outcome measures included participants’ hospitalisation in the past 3 months of life and the location of death.

Results: The data demonstrate that the intervention is associated with a substantial reduction in the length of hospital stays and a lower incidence of death in the acute care setting. While rates of hospitalisation were unchanged on average, length of admission was reduced by an average of 3.22 days (p<0.01 and 95% CI −5.05 to −1.41), a 67% decrease in admitted days.

Conclusions: The findings have significant implications for promoting quality outcomes through models of palliative care service delivery in residential facilities.

Read the full article here

Nationwide survey on volunteers’ training in hospice and palliative care in Poland

Pawłowski, L. et al. BMJ Supportive & Palliative Care. Published online: 29 July 2016

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Background: Volunteers working in hospice and palliative care facilities in Poland undertake various activities which are performed in accordance with legal regulations and the individual policies of each hospice. The aim of this study was to explore the roles and training of volunteers working in hospice and palliative care settings.

Methods: A cross-sectional survey was carried out that investigated the services performed by volunteers and their preparation for work within residential hospices. Questionnaires were distributed to volunteers and hospice representatives, and the responses obtained underwent statistical analysis.

Participants: A total of 180 volunteers and 28 hospice representatives from 29 residential hospices participated in this survey.

Results: All hospices surveyed were supported by volunteers. 79% of volunteers worked alongside patients and performed the following services: accompanying patients (76%), feeding patients (61%), cleaning rooms (48%), dressing and bathing (42%) and organising leisure time (40%). Fewer volunteers were involved in activities outside of patient support—for example, charity work and fundraising (34%), cleaning hospice buildings (23%) as well as providing information and education (22%). According to volunteers, prior to undertaking their duties, 64% participated in theoretical training and 37% took part in a practical course. The majority attended courses relating to general knowledge of hospice and palliative care (64%) and volunteer rights and duties (55%).

Conclusions: Overall, proper training was an essential requirement needed to be fulfilled by volunteers, particularly when involved in direct patient support. Most volunteers were simultaneously involved in various areas of service; therefore, their training should be comprehensive.

Read the full article here

End-of-life care webinar

Nhs Employers. Published online: 28 July 2016

In this end-of-life care webinar we hear from guest speakers who share their knowledge and experience in this important area of healthcare, including:

  • information around the roles of NHS Employers and Health Education England in supporting the end-of-life care agenda
  • good practice from Hampshire Hospitals NHS Foundation Trust about how it is improving end-of-life care for patients through the education and training of staff
  • guidance on starting conversations with patients at the end of life.

Listen to the webinar to find out more…