Advance care planning uptake among patients with severe lung disease

Sinclair, C. et. al. (2017) BMJ Open. 7:e013415

Objective: Advance care planning (ACP) clarifies goals for future care if a patient becomes unable to communicate their own preferences. However, ACP uptake is low, with discussions often occurring late. This study assessed whether a systematic nurse-led ACP intervention increases ACP in patients with advanced respiratory disease.

Conclusions: Nurse-led facilitated ACP is acceptable to patients with advanced respiratory disease and effective in increasing ACP discussions and completion of formal documents. Awareness of symptom burden, readiness to engage in ACP and relevant psychosocial factors may facilitate effective tailoring of ACP interventions and achieve greater uptake.

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Home palliative care works: but how?

Sarmento, V.P. et al. BMJ Supportive & Palliative Care. Published Online: 23 February 2017

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Objective: To understand patients and family caregivers’ experiences with home palliative care services, in order to identify, explore and integrate the key components of care that shape the experiences of service users.

Conclusions: Home palliative care teams improve patients and caregivers experience of security when facing life-limiting illnesses at home, by providing competent care and being present. These teams should therefore be widely available and empowered with the resources to be present and provide competent care.

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Barriers to Access to Palliative Care

Hawley, P. Palliative Care: Research and Treatment. Published online: 20 February 2017

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Despite significant advances in understanding the benefits of early integration of palliative care with disease management, many people living with a chronic life-threatening illness either do not receive any palliative care service or receive services only in the last phase of their illness. In this article, I explore some of the reasons for failure to provide palliative care services and recommend some strategies to overcome these barriers, emphasizing the importance of describing palliative care accurately. I provide language which I hope will help health care professionals of all disciplines explain what palliative care has to offer and ensure wider access to palliative care, early in the course of their illness.

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Supporting relatives and carers at the end of a patient’s life

Berry, M. et al. (2017) BMJ. 356:j367

  • Effective support can make a considerable difference to the relatives of people who are dying; helping to allay fears, reducing stress and anxiety, and minimising suffering in bereavement.

  • Clear communication around practical considerations (death certificate, funeral arrangements, information around autopsy, etc) and psychosocial support (normalising grief, cultural and spiritual considerations) is key.

  • Doctors need to familiarise themselves with local systems and protocols. Written communication in addition to verbal is beneficial.

All doctors, irrespective of their specialty or the setting in which they work, will care for patients who die. Around half of all deaths occur in hospitals.1 Evidence suggests that the quality of communication around this process is poorer in hospitals than in other settings, according to responses from relatives who have experienced bereavement.2 Over half of NHS complaints concern care of the dying.3

This article discusses how to best support relatives and carers at the end of a patient’s life. While the focus is on the hospital setting, the principles are applicable to community and care home settings. In this article, “relative” encompasses family members, care givers, and those close to the patient. The article presumes throughout that the patient has given consent for information to be shared with relatives (Box 1).

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A qualitative study exploring use of the surprise question in the care of older people

Elliott, M. & Nicholson, C.A. (2017) BMJ Supportive & Palliative Care. 7:32-38.

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Objective: The question “Would you be surprised if this patient were to die in the next 6–12 months?” has been included in UK palliative care guidance with the aim of supporting the identification and care planning of those nearing the end of life. Little is known about how the surprise question is utilised in the care of older people within primary care. This study sought to explore the perceptions and experiences of general practitioners (GPs).

Conclusions: Greater understanding is needed as to the difficulties experienced by GPs when assessing prognosis in older people. We propose a thematic model which could support GPs by focusing assessment on the supportive and palliative care needs of older people nearing the end of life.

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Transferring patients home to die: what is the potential population in UK critical care units?

Coombs M.A. et al. (2017) BMJ Supportive & Palliative Care. 7:98-101

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Objectives: Most people when asked, express a preference to die at home, but little is known about whether this is an option for critically ill patients. A retrospective cohort study was undertaken to describe the size and characteristics of the critical care population who could potentially be transferred home to die if they expressed such a wish.

Conclusions: A little over 20% of patients dying in critical care demonstrate potential to be transferred home to die. Staff should actively consider the practice of transferring home as an option for care at end of life for these patients.

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Obesity associated with less hospice use

scales-1426079_1280A study led by researchers at University of Pittsburgh has found that obesity was associated with less hospice use and in-home death and more Medicare costs during the last six months of life. The team reported in Annals of Internal Medicine on the retrospective cohort study, using data from the Health and Retirement Study.

Morbidly obese patients were found to be the group least likely to use hospice.

Reference: John A. Harris eta l. The Relationship of Obesity to Hospice Use and Expenditures: A Cohort Study Annals of Internal Medicine. [Epub ahead of print 7 February 2017]