Cancer charity says there is a ‘crisis of communication’ in UK over dying | The Independent
Thousands of cancer patients would prefer to die at home but are forced to suffer “traumatic” deaths in hospital, according to Macmillan. Taboos around talking about death are fuelling a “crisis of communication” in the UK that prevents people from planning their final days, warned the organisation in a new report.
Research by the charity found that while 38 per cent of people who die from cancer die in hospital, just one per cent would choose to do so, with 64 per cent saying they wanted to die at home.
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Elliott, M. & Nicholson, C.A. (2017) BMJ Supportive & Palliative Care. 7:32-38.
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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Bennet, M.L. et al. (2016) BMJ Open. 6:e012576
Objective For patients with advanced cancer, several randomised controlled trials have shown that access to palliative care at least 6 months before death can improve symptoms, reduce unplanned hospital admissions, minimise aggressive cancer treatments and enable patients to make choices about their end-of-life care, including exercising the choice to die at home. This study determines in a UK population the duration of palliative care before death and explores influencing factors.
Conclusions The current timing of referral to palliative care may limit the benefits to patients in terms of improvements in end-of-life care, particularly for older patients and patients with conditions other than cancer.
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NICE has published new NICE guidance: End of life care for infants, children and young people with life-limiting conditions: planning and management (NG61).
This guideline covers the planning and management of end of life and palliative care in for infants, children and young people (aged 0–17 years) with life-limiting conditions. It aims to involve children, young people and their families in decisions about their care, and improve the support that is available to them throughout their lives.
Additional link: NICE news report
Alspach, J.G. (2016) Critical Care Nurse.36(6) pp. 10-11
Although no scientific conclusions can be legitimately drawn from a survey this small, knowing that even a few facilities have now launched meaningful efforts toward getting more critical care nurses to confront, consider, decide, and document their EOL preferences is encouraging.
When you next encounter a patient situation in which the lack of an advance directive creates confusion or stymies development of a clear plan of care, remember that patient could be you. If we don’t know what you want for care when the end of your life draws near, there is no way to ensure that your wishes are respected and followed. Let those who love you know where you want to be, what you want and do not want for care, and let all of your critical care colleagues know your wishes by preparing an advance directive and issuing a copy to whomever will be making decisions on your behalf.
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Martinsson, L. et al. (2016) BMJ Supportive & Palliative Care. 6(4) pp. 452-458
Introduction: Honest prognostication and information for patients are important parts of end-of-life care. This study examined whether an educational intervention could increase the proportion of patients who received information about the transition to end-of-life (ITEOL care).
Method: Two municipalities (in charge of nursing homes) and two hospitals were randomised to receive an interactive half-day course about ITEOL for physicians and nurses. The proportion of patients who received ITEOL was measured with data from the Swedish Register of Palliative Care (SRPC). Patients were only included if they died an expected death and maintained their ability to express their will until days or hours before their death. Four hospitals and four municipalities were assigned controls, matched by hospital size, population and proportion of patients receiving ITEOL at baseline.
Results:The proportion of patients in the intervention group who received ITEOL increased from 35.1% (during a 6-month period before the intervention) to 42% (during a 6-month period after the intervention). The proportion in the control group increased from 30.4% to 33.7%. The effect of the intervention was significant (p=0.005) in a multivariable model adjusted for time, age, gender and cause of death.
Conclusion: More patients at end-of-life received ITEOL after an educative half-day intervention directed to physicians and nurses.
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