Palliative care clinicians’ knowledge of the law regarding the use of the Deprivation of Liberty Safeguards (DoLS)

Barry, C. et al. BMJ Supportive & Palliative Care | Published Online: 24 April 2017

Objectives: To examine palliative care clinicians’ level of knowledge of the law regarding the use of the Deprivation of Liberty Safeguards (DoLS).

 

Conclusions: Clinicians working in palliative care have good levels of knowledge of the DoLS. Despite this concerns were raised, particularly by consultants; uncertainty as to when they should be used and the relevance of the Safeguards in clinical practice. Further guidance should be given to clinicians working in this specialty to ensure that clinical practice is both lawful and in the patients’ best interests.

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How well do we currently care for our dying patients in acute hospitals: the views of the bereaved relatives?

Mayland, C.R. et al. BMJ Supportive & Palliative Care. Published Online: 17 January 2017

Background: The National Care of the Dying Audit—Hospitals (NCDAH) is used as a method to evaluate care for dying patients in England. An additional component to the 2013/2014 audit was the Local Survey of Bereaved Relatives Views using the ‘Care Of the Dying Evaluation’ (CODE) questionnaire.

Conclusions: Adopting a postbereavement survey to NCDAH appears to be feasible, acceptable and a valuable addition. On the whole, the majority of participants reported good or excellent care. A small but significant minority, however, perceived poor quality of patient care with clear and timely communication urgently needed.

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Dying in the hospital setting: end-of-life care that patients and their families describe as being important

Virdun, C. et al. Palliative Medicine. Published online: December 8 2016

B0009947 The maze of trees, emotional cancer journey, artwork

Image source: Michele Angelo Petrone – Wellcome Images // CC BY-NC-ND 4.0

Background: Despite most expected deaths occurring in hospital, optimal end-of-life care is not available for all in this setting.

Conclusion: Consumer narratives help to provide a clearer direction as to what is important for hospital end-of-life care. Systems are needed to enable optimal end-of-life care, in accordance with consumer priorities, and embedded into routine hospital care.

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Spiritual care in palliative care influences patient-reported outcomes

van de Geer, J. et al. Palliative Medicine. Published online: November 9 2016

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Background: Spiritual care is reported to be important to palliative patients. There is an increasing need for education in spiritual care.

Aim: To measure the effects of a specific spiritual care training on patients’ reports of their perceived care and treatment.

Design: A pragmatic controlled trial conducted between February 2014 and March 2015.

Setting/participants: The intervention was a specific spiritual care training implemented by healthcare chaplains to eight multidisciplinary teams in six hospitals on regular wards in which patients resided in both curative and palliative trajectories. In total, 85 patients were included based on the Dutch translation of the Supportive and Palliative Care Indicators Tool. Data were collected in the intervention and control wards pre- and post-training using questionnaires on physical symptoms, spiritual distress, involvement and attitudes (Spiritual Attitude and Involvement List) and on the perceived focus of healthcare professionals on patients’ spiritual needs.

Results: All 85 patients had high scores on spiritual themes and involvement. Patients reported that attention to their spiritual needs was very important. We found a significant (p = 0.008) effect on healthcare professionals’ attention to patients’ spiritual and existential needs and a significant (p = 0.020) effect in favour of patients’ sleep. No effect on the spiritual distress of patients or their proxies was found.

Conclusion: The effects of spiritual care training can be measured using patient-reported outcomes and seemed to indicate a positive effect on the quality of care. Future research should focus on optimizing the spiritual care training to identify the most effective elements and developing strategies to ensure long-term positive effects.

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The physician as patient in palliative care

McMichael, L.C. et al. (2016) Palliative Medicine. 30(9) pp. 889-892

doctor-1639328_960_720Background: Dying physicians may present unique challenges to palliative care teams. Studies of dying physicians are scarce, but those that exist suggest a potential absence of a coordinating clinician, prolongation of curative treatments, resistance to palliative care input and barriers to discussing psychosocial needs.

Aim: The aim was to describe and examine the care provided to physician-patients referred to an Australian palliative care service, and to identify issues faced by the physician-patient and by the treating team.

Design and participants: A retrospective case-note audit of the case notes of medical practitioners referred for palliative care and dying between January 2007 and April 2013 was conducted.

Results: There was evidence of medically qualified friends or family members initiating referrals and directing treatment decisions. There was some evidence of increased consultant-led decision-making and bypassing of usual referral pathways and systems for providing after-hours advice and calling consultants directly. There also appeared to be some reluctance by junior doctors to make decisions, because of the patient’s desire for consultant-level advice only.

Conclusion: This study adds to the growing body of literature that identifies the potential difficulties associated with caring for medical practitioners. By understanding some of the complexity of this particular doctor–patient relationship, clinicians can approach the management of physician-patients facing the end of their lives with a more sound understanding of their particular care needs.

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