2014; Volume 15, No 4, April
Media Watch: an annotated list of recent articles about palliative care in the news media and the literature
Burden on family carers and care-related financial strain at the end of life: A cross-national population-based study
European Journal of Public Health | Online – 17 March 2014 – The authors studied 4,466 deaths. GPs judged family carers of patients as physically/emotionally overburdened - 28% (Belgium), 30% (The Netherlands), 35% (Spain) and 71% (Italy). For 8% (Spain), 14% (Belgium), 36% (The Netherlands) and 43% (Italy) patients, GPs reported difficulties in covering care-related costs. Patients <85 years of age (Belgium, Italy) had higher odds of having physically/emotionally overburdened family carers and financial burden. Death from non-malignant illness (vs. cancer) (Belgium and Italy) and dying at home compared with other locations (The Netherlands and Italy) were associated with higher odds of difficulties in covering care-related costs. In all countries studied, and particularly in Italy, GPs observed a considerable extent of physical/emotional overburden as well as difficulties in covering care-related costs among family carers of people at the end of life. Implications for health and social care policies are discussed.
Bad words: Clinical case study about the desires of a patient to prolong her life and the doctors to communicate with her only using "positive" language
The Hastings Report, 2014;44(2):13-14. The clinical ethicist met with Ms. H to clarify what information she wants and does not want to know. She wants to receive any treatment that could prolong her life, regardless of how the treatment affects her ability to engage in activities of daily living. She wants to be included in the decision-making process as much as possible, as long as clinicians use only "positive" language. Ms. H. considers ... "dying," "chemotherapy," "radiation" and "cancer" to be "bad words." For conversations in which these words cannot be avoided, she wants her clinicians to talk to her son. Her desired engagement includes hearing about risks, benefits, and alternatives to treatments if clinicians use only "positive" language. Finally, she says that she rarely sees doctors and that she is "very scared" of hospitals, despite exhibiting a comfortable demeanor.
Benefits of health and social care integration
BMJ Supportive & Palliative Care, 2014; 4(18). Scotland's health boards and local authorities are moving toward integrated funding and service provision. Effective integration will depend on health, social care and third/independent sector partners pooling resources and planning care together, led by clinicians and other professionals. Over seventy-seven patients [i.e., study participants] would have required hospital admission without the integrated service [i.e., Integrated Health & Personal Care Community Support]. Eight-three percent of respondents thought the service had enabled more input into decision making about their care; and, 66% were able to spend more time with their loved ones and have reported an improved quality of life. The voluntary sector is a key partner in supporting the integration agenda with specific expert knowledge.
Promoting palliative care worldwide through international nursing education
Journal of Transcultural Nursing | Online – 4 March 2014 – Though issues related to culture and language may vary, the one commonality that crosses all nations is that its people die. In general, societies seek to provide the best care they are trained to give. Many have few resources to provide this care well. Traditions of the past influence norms and dictate policies and procedures of the present. Since its inception in 2000, the End-of-Life Nursing Education Consortium Project has provided palliative care education to nurses and other members of the interdisciplinary team in six of the seven continents. This article describes the efforts of this project to improve education around the globe, with the goal of providing excellent, compassionate palliative care, irrespective of location, financial status, political views, religion, race, and/or ethnicity.
Difficult conversations: Teaching medical oncology trainees communication skills one hour at a time
Academic Medicine | Online – 19 February 2014 – Medical oncologists need outstanding, patient-centered communication skills to build trust and rapport with their patients and help them make well-informed decisions. Key skills include exploring patients' perspectives, responding to emotion with empathy, and maintaining mindfulness during highly charged conversations. These skills can be taught and learned. Most previously described communication skills training curricula for oncology providers involve multiday retreats, which are costly and can disrupt busy clinical schedules. Many curricula involve a variety of oncology providers, such as physicians and nurses, at various stages of their careers. The authors developed a monthly, one-hour communication skills training seminar series for physicians in their first year of medical oncology subspecialty training. Learners had the opportunity to practice skills during sessions and with patients between sessions. They acquired important skills and found the curriculum to be clinically relevant, judging by anonymous surveys and anonymous responses on reflective writing exercises.
Media Watch is intended as an advocacy and research tool. The weekly report, published by Barry R. Ashpole, a Canadian communications consultant and educator, monitors the literature and the lay press on issues specific to the quality of end-of-life care. It is international in scope and distribution. Each month, this section of the IAHPC will publish an abstract or summary of an article or report of special interest noted in a recent issue of Media Watch (see below).
The current and back issues of the weekly report can be accessed here.