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]

The experience of providing end of life care at a children’s hospice

McConnell, T. & Porter, S. BMC Palliative Care. Published online: 13 February 2017

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Background: More attention is being paid to the wellbeing of staff working in stressful situations. However, little is known about staff experience of providing end-of-life care to children within a hospice setting. This study aims to explore the experiences of care team staff who provide end-of-life care within a children’s hospice.

Conclusions: Service and policy initiatives should encourage open, informal peer/organisational support among the wider children’s palliative care sector. Further research should focus on paediatric palliative care education, particularly in relation to symptom management and communication at end-of-life, harnessing the expertise and breadth of knowledge that could be shared between children’s hospices and hospital settings.

Read the full article here

Treatment targeted at underlying disease versus palliative care in terminally ill patients

Reljic, T. et al. BMJ Open. 7:e014661

Objective: To assess the efficacy of active treatment targeted at underlying disease (TTD)/potentially curative treatments versus palliative care (PC) in improving overall survival (OS) in terminally ill patients.

Results: Initial search identified 8252 citations of which 10 RCTs (15 comparisons, 1549 patients) met inclusion criteria. All RCTs included patients with cancer. OS was reported in 7 RCTs (8 comparisons, 1158 patients). The pooled results showed no statistically significant difference in OS between TTD and PC (HR (95% CI) 0.85 (0.71 to 1.02)). The heterogeneity between pooled studies was high (I2=62.1%). Overall rates of adverse events were higher in the TTD arm.

Conclusions: Our systematic review of available RCTs in patients with terminal illness due to cancer shows that TTD compared with PC did not demonstrably impact OS and is associated with increased toxicity. The results provide assurance to physicians, patients and family that the patients’ survival will not be compromised by referral to hospice with focus on PC.

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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.

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Hospices still outperform hospitals on quality of care at end of life | The BMJ

BMJ 2015;351:h3776

Bereaved people in England rate the care provided by hospitals at the end of their relative’s life lower than that provided by hospices, care homes, and services in the community, show the results of a survey published by the Office for National Statistics.1

Overall, 75% of bereaved people rated the quality of care of their relative or friend in the last three months of life as outstanding, excellent, or good and 10% as poor, found the annual national survey of bereaved people, VOICES (Views of Informal Carers—Evaluation of Services).

However, quality of care was rated lower when the patient died in hospital than when they died in other settings: 69% of bereaved people whose relative or friend died in a hospital rated the care as outstanding, excellent, or good, compared with 83% where the death occurred in a hospice, 82% in a care home, and 79% at home.

Ratings of fair or poor quality of care were higher, across all care settings, among people living in the most deprived areas (30%) than among those in the least deprived (21%).

Furthermore, a third (33%) of relatives and friends of patients admitted to hospital at some stage during the last three months of their life reported that the hospital services did not work well with GP and other services outside the hospital. Hospital staff were also less likely to be rated as “always showing dignity and respect”: the proportions were 59% for hospital doctors and 53% for hospital nurses but 88% and 85%, respectively, for doctors and nurses in hospices.

via Hospices still outperform hospitals on quality of care at end of life | The BMJ.

“We cannot do it without you” – the impact of volunteers in U.K. hospices

Hospices and hospice volunteering in the U.K. are undergoing significant change. It is important that the role and impact of volunteering on such organisations is understood if the planning of, and approach to, future services are to be both holistic and effective. This paper gives a brief overview of a research study that explored volunteering from a strategic perspective and considered its impact on a number of key organisational viability factors. The findings gained from respondents (trustees, senior staff and volunteers) indicate that volunteers are understood to be a key strategic resource and to be important in helping organisations to achieve their goals. Volunteers, however, were not always involved in contributing to strategy development and there was little evidence of planning for volunteer involvement. While respondents agreed that most hospice trustees are volunteers, there was little recognition of the significant responsibilities of volunteers in organisational governance. Although trustees indicated that they had an effective level of engagement both with volunteers and with staff, the perceptions of staff and volunteers indicated otherwise.

Reference:  Scott R. “We cannot do it without you” – the impact of volunteers on UK hospices. European Journal of Palliative Care. 2015; 22(2):80-83.