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.

Read the abstract here

Family caregivers’ conceptualisation of quality end-of-life care for people with dementia

Davies, N. et al. Palliative Medicine. Published online: October 25, 2016

Background: People with dementia have been described as the ‘disadvantaged dying’ with poor end-of-life care. Towards the end of life, people with dementia cannot report on the care they receive. It is therefore important to talk to caregivers; however, few have explored the views about end-of-life care from the caregivers’ perspective. The majority of research on family caregivers has focussed on the burden and psychological impact of caring for a relative with dementia.

Aim: This study aimed to explore the views of family caregivers about quality end-of-life care for people with dementia.

Design: Qualitative study using in-depth interviews and analysed using thematic analysis.

Setting/participants: Purposive sampling from a third sector organisation’s caregiver network was used to recruit 47 caregivers in England (2012–2013), consisting of (1) family caregivers of someone who had recently received a diagnosis of dementia, (2) family caregivers currently caring for someone with dementia and (3) bereaved family caregivers.

Results: Three over-arching themes were derived from the interviewees’ discourse, including maintaining the person within, fostering respect and dignity and showing compassion and kindness.

Conclusion: End-of-life care for people with dementia does not differ from care throughout the dementia trajectory. Throughout the findings, there is an implicit underlying theme of conflict: conflict between family caregivers and an increasingly systematised service of care and conflict between family caregivers and professionals. This study has in particular demonstrated the importance of the psycho-social aspects of care, aligning with the holistic definition of palliative care.

Read the full article here

Early palliative care improves coping & quality of life for patients with incurable cancers

ScienceDaily | Published online: 7 September 2016.

A randomized clinical trial found that introducing palliative care shortly after a diagnosis of certain metastatic cancers greatly increases a patient’s coping abilities, as well as overall quality of life. Researchers also found that early integration of palliative care results in an increase in discussions about patient end-of-life care preferences.

The findings are part of a growing body of evidence demonstrating the benefits of palliative care on patient quality of life. This study will be presented at the upcoming 2016 Palliative Care in Oncology Symposium in San Francisco.

To explore the effects of early palliative care, researchers randomly assigned 350 patients, who had been recently diagnosed with incurable lung or non-colorectal gastrointestinal cancer, to receive early palliative care integrated with oncology care or oncology care alone.

Read the abstract commentary here

Improving the quality of care in the last days of life: A practical guide to getting the medications right

London Clinical Networks. Published online: 14 July 2016

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This document identifies best practice in the way medications should be managed in the last days of life. It sets out high level, evidence-based recommendations to help guide those responsible for care to review their processes and consider ways to make change where necessary.

This document aligns with Statement 11 in the NICE Quality Standard 13, End of life care for adults by addressing what needs to be done with people’s medications so that the care they are offered remains coordinated and delivered in the best way possible.

NHS England’s publication Actions for end of life care: 2014-162 sets out its commitment for statutory and voluntary partners in health and social care to work together to develop a vision for end of life care in future. This work is being carried out by the Ambitions for End of Life Care Partnership . The Partnership aims to transform experiences of end of life care by focusing on what would improve person-centred care, encouraging local communities to engage with the need for high quality care at the end of life, highlighting what would enable better coordination of care in the last days of life, and supporting networks of facilitators and champions.

Read the full report here

National Survey of Bereaved People (VOICES): England, 2015

ONS Statistical Bulletin

Main points:

  • 3 out of 4 bereaved people (75%) rate the overall quality of end of life care for their relative as outstanding, excellent or good; 1 out of 10 (10%) rated care as poor.
  • Overall quality of care for females was rated significantly higher than males with 44% of respondents rating the care as outstanding or excellent compared with 39% for males.
  • 7 out of 10 people (69%) rated hospital care as outstanding, excellent or good which is significantly lower compared with care homes (82%), hospice care (79%) or care at home (79%).
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Image source: ONS

  • Ratings of fair or poor quality of care are significantly higher for those living in the most deprived areas (29%) compared with the least deprived areas (22%).
  • 1 out of 3 (33%) reported that the hospital services did not work well together with GP and other services outside the hospital.
  • 3 out of 4 bereaved people (75%) agreed that the patient’s nutritional needs were met in the last 2 days of life, 1 out of 8 (13%) disagreed that the patient had support to eat or receive nutrition.
  • More than 3 out of 4 bereaved people (78%) agreed that the patient had support to drink or receive fluid in the last 2 days of life, almost 1 out of 8 (12%) disagreed that the patient had support to drink or receive fluid.
  • More than 5 out of 6 bereaved people (86%) understood the information provided by health care professionals, but 1 out of 6 (16%) said they did not have time to ask questions to health care professionals.
  • Almost 3 out of 4 (74%) respondents felt hospital was the right place for the patient to die, despite only 3% of all respondents stating patients wanted to die in hospital.

Read the full report here

Palliative care reimagined: a needed shift

Abel, J & Kellehear, A. BMJ Supportive & Palliative Care doi:10.1136/bmjspcare-2015-001009

Abstract: Palliative care, since its inception over 60 years ago, has set the standard of how to care for people who are dying. Key features among these standards have been the professional development of clinical specialisms such as palliative medicine and palliative nursing; the essential addition of the multidisciplinary team to these two new specialisms that included social, spiritual and allied health workers—an outgrowth of the recognition that routine work with the dying, their carers, and the bereaved required more than solely clinical skills; and the unique partnership with communities that yielded the volunteer movement within palliative care. Professional, evidence-based symptom management and the importance of supportive care in its widest possible sense were and remain the cornerstones of the modern palliative care approach.

However, the majority of people with terminal illnesses do not have access to palliative care teams, whose main focus of care remains patients with cancer. In the context outlined above this paper therefore poses two key questions: how can we provide an equitable level of care for all people irrespective of diagnosis and how can we increase the range and quality of non-medical/nursing supportive care in a context of diminishing resources? We argue that an important opportunity and solution can be found by adopting the principles of a public health approach to end-of-life care.

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.