2016; Volume 17, No 3, March
Media Watch: an annotated list of recent articles about palliative care in the news media and the literature
Interviews with Irish healthcare workers from different disciplines about palliative care for people with Parkinson’s disease: A definite role but uncertainty around terminology and timing
BMC PALLIATIVE CARE | Online – February 2016 – This study identified key barriers, and through suggestions to tackle these – facilitators, to delivering palliative care (PC) to people with Parkinson’s disease (PD). Findings indicate that PC may be facilitated in this population by increased public awareness of the role of PC, education for healthcare workers (HCW) in both specialist and generalist settings, education for patients and families, better communication and integrated care models, and increased resources. A key clinical implication is that all HCWs need to be trained in the assessment of PC needs of their PD patients. The implication for policy is that clear evidence-based guidelines should be introduced to promote the adoption of a PC approach, including referral to specialist PC where needed. This current study, the largest and most comprehensive multiple discipline exploration of HCW views, adds to the previous qualitative literature in this area, together mandating that people with PD should be receiving PC from their HCW team.
The needs, models of care, interventions and outcomes of palliative care in the Caribbean: A systematic review of the evidence
BMC PALLIATIVE CARE | Online – 22 January 2016 – This systematic review has revealed that the peer-reviewed literature offers little evidence on palliative care (PC) needs of the Caribbean population. The available evidence was broadly divided into healthcare practitioners’ needs, patients’ needs and healthcare institutional needs. They included patients’ needs for access to analgesia, preferred place of care/death and multidimensional aspects of support needed for patients and their caregivers. Healthcare practitioners spoke about their need for health policy and education in PC. In addition, needs of more trained staff and the services in PC were cited as institutional needs. The models of care existent in the Caribbean were not well described in the peer-reviewed literature. There were no intervention studies. It is timely to now develop and evaluate evidence-based PC services in the Caribbean.
Report of the European Respiratory Society/European Cystic Fibrosis Society task force on the care of adults with cystic fibrosis
EUROPEAN RESPIRATORY JOURNAL, 2016; 47(2): 420-428. The improved survival in people with cystic fibrosis (CF) has led to an increasing number of patients reaching adulthood. This trend is likely to be maintained over the next decades, suggesting a need to increase the number of centers with expertise in the management of adult patients with CF. These centers should be capable of delivering multidisciplinary care addressing the complexity of the disease, in addition to addressing the psychological burden on patients and their families. Further issues that require attention are organ transplantation and end-of-life management. Lung disease in adults with CF drives most of the clinical care requirements, and major life-threatening complications, such as respiratory infection, respiratory failure, pneumothorax and haemoptysis, and the management of lung transplantation require expertise from trained respiratory physicians. The taskforce therefore strongly recommends that medical leadership in multidisciplinary adult teams should be attributed to a respiratory physician adequately trained in CF management.
Extract from the task force report
Adult CF centers should ensure they have the adequate skills and facilities to deal with palliative care (PC) for people with CF. End-of-life care (EOLC) is ideally delivered in an adult center where appropriate discussions and arrangements can be facilitated and the autonomy of the individual is respected and protected. This is best achieved by collaboration with specialists in PC though primary responsibility for patients usually remains with the CF team. Many patients now die from late complications of lung transplantation and in these cases EOLC could be provided in CF centers as well as in lung transplant units.
Nurses’ knowledge of advance directives and perceived confidence in end-of-life care: A cross-sectional study in five countries
INTERNATIONAL JOURNAL OF NURSING PRACTICE | Online – 28 January 2016 – Confidence among nurses is a barrier to the provision of quality end-of-life care (EOLC). This study investigated nurses' knowledge of advance directives and perceived confidence in EOLC, in Hong Kong, Ireland, Israel, Italy and the U.S. In all countries, older nurses and those who had more professional experience felt more confident managing patients’ symptoms at end-of-life and more comfortable stopping preventive medications at end-of-life. Nurses in the U.S. reported that they have more knowledge and experience of advance directives compared with other countries. In addition, they reported the highest levels of confidence and comfort in dealing with EOLC. Although legislation for advance directives does not yet exist in Ireland, nurses reported high levels of confidence in EOLC.
“Am I dying doctor?”: How end-of-life care is portrayed in television medical dramas
JOURNAL OF PALLIATIVE CARE & MEDICINE | Online – 25 January 2016 – The present study shows that healthcare professionals in television medical dramas talked with patients or loved ones about end-of-life. However, these discussions are often limited to discussions about the possibility of dying and treatment options. Topics such as preferences for life-sustaining treatments, advance directives, and palliative care were rarely discussed. Therefore television medical dramas don’t seem to contribute in empowerment of patients and loved ones in the process of advance care planning (ACP) and don’t facilitate behavior change resulting in increased willingness to be engaged in end-of-life communication. However, they could influence patients’ and loved ones’ attitudes regarding ACP, cardiopulmonary resuscitation, and dying. Therefore, healthcare professionals need to take into account this influence when having discussions about end-of-life.
End-of-life care for patients dying of stroke: A comparative registry study of stroke and cancer
PLOS ONE | Online – 4 February 2016 – Although stroke is a significant public health challenge and the need for palliative care (PC) has been emphasized for these patients, there is limited data on end-of-life care (EOLC) for patients dying from stroke. Compared to patients dying of cancer, the patients dying of stroke had a significantly higher prevalence of having death rattles registered, but a significantly lower prevalence of nausea, confusion, dyspnea, anxiety, and pain. Patients dying of stroke had significantly lower odds ratio of having informative communication from a physician about the transition to EOLC and of their family members being offered bereavement follow-up. The results indicate differences in EOLC between patients dying of stroke and those dying from cancer.
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 Newsletter will publish an abstract or summary of an article or report of special interest noted in a recent issue of Media Watch (see below).
Read the current and back issues of the weekly report.