2016; Volume 17, No 8, August
Media Watch: an annotated list of recent articles about palliative care in the news media and the literature
Integrated palliative care in Europe: A qualitative systematic literature review of empirically-tested models in cancer and chronic disease
AMERICAN JOURNAL OF HOSPICE & PALLIATIVE MEDICINE | Online – 8 July 2016 – This is the first qualitative systematic literature review of models on integrated palliative care (PC) in patients with malignant and non-malignant disease in Europe. It represents the combined effort of an international consortium of six partners in six different European countries (Belgium, Germany, Hungary, Spain, The Netherlands and U.K.). Based on the results, the authors have proposed a generic framework for integrated PC in patients with cancer and chronic disease. The proposed generic identifies the importance of employing a PC-trained multidisciplinary team and of having a threefold focus: 1) On treatment; 2) Consulting; and, 3) Training. Each component of the framework has been already empirically assessed, however, the overall framework has not. Such a study not only will provide empirical evidence on the framework’s efficacy but will also shed light on possible weaknesses that can be only traced post-implementation. Additionally, it would be interesting to conduct the same systematic review in non-European countries and perform a comparative analysis in a worldwide scale.
Controversies surrounding continuous deep sedation at the end of life: The parliamentary and societal debates in France
BMC MEDICAL ETHICS | Online – 29 June 2016 – France is currently in the midst of a fierce debate on what constitutes a dignified end of life and which practices are acceptable for physicians to perform. At the very core of the debate is the practice of continuous deep sedation. As argued in this paper, what is playing out is a unique opportunity to clarify the legality of continuous deep sedation as an end-of-life practice. Recognizing continuous deep sedation as a sui generis practice could remove the need to portray the practice either as symptom control or as a form of euthanasia. This might make it less difficult to focus on the issues that are most relevant and pertinent to continuous deep sedation.
The effect of bereavement groups on grief, anxiety, and depression: A controlled, prospective intervention study
BMC PALLIATIVE CARE | Online – 12 July 2016 – Before the bereavement group intervention, most respondents (81 %) reported levels of severe grief. Participants did not fare significantly better than non-participants. Those who did not want to participate reported less grief and anxiety than both participants and non-participants who had wanted to participate. No differences in levels of depression were detected between any groups either before or after the intervention. Open-ended questions revealed anonymous, mostly positive effects of participation in bereavement groups, which were not captured by the questionnaires measuring grief, anxiety, and depression. This underlines the need for a qualitative approach to gain better understanding and more in-depth insights of the subjective benefits experienced from participation.
Best practices in developing a national palliative care policy in resource limited settings: Lessons from five African countries
eCANCER | Online – 7 July 2016 – Given the high unmet need for palliative care (PC) in Africa and other resource limited settings, it is important that countries embrace the public health approach to increasing access through its integration within existing healthcare systems. To give this approach a strong foundation that would ensure sustainability, the World Health Organization urges member states to ensure that policy environments are suitable for this intervention. The development, strengthening, and implementation of national PC policies is a priority. Given the lack of a critical mass of PC professionals in the region and deficiency in documenting and sharing best practices as part of information critical for regional development, policy development becomes a complex process. This article shares experiences with regard to best practices when advocating the national PC policies. It also tells about policy development process, the important considerations, and cites examples of policy content outlines in Africa.
Coming home to die: Six Nations of the Grand River Territory develops community-based palliative care
INTERNATIONAL JOURNAL OF INDIGENOUS HEALTH, 2016; 11(1): 50-74. This paper describes the development and implementation of a community-based palliative care (PC) program in Six Nations of the Grand River Territory, Ontario, Canada. Six Nations’ innovative program is grounded in a vision to provide access to quality PC at home and incorporate Haudenosaunee traditional teachings. A community-based Project Advisory Committee led the development process, and a Leadership Team of local and regional PC partners led implementation. Outcomes included: 1) Creation of a Palliative Shared Care Outreach Team, including a First Nations physician, nurse, and social worker; 2) Development of a detailed care pathway for clients who need PC; 3) Increased home deaths (55) as compared to hospital (22) or hospice (6) deaths; 4) Access to PC education and mentorship for local healthcare providers; 5) Incorporation of traditional teachings to support clients and staff dealing with death, dying, grief, and loss; and, 6) Creation of a PC program booklet for Six Nations Health Services. This unique initiative reduces disparities in access to quality palliative home care and demonstrates that First Nations communities can successfully undertake a process of community capacity development to create unique and culturally responsive PC programs. Challenges included overcoming federal and provincial jurisdictional issues in provision of health services through collaborative partnerships at the local and regional level.
Developing research, policy and practice in palliative care for people with intellectual disabilities will benefit everyone
PALLIATIVE MEDICINE, 2016; 30 (7): 613-615. People with intellectual disabilities are a sizeable minority group, making up approximately 2% of the population [in the U.K.]. They need specific attention when they reach the end of life. While many of the palliative care needs of people with intellectual disabilities may be no different from those of the general population, they often present with unique issues, challenges and disadvantageous circumstances that make it more difficult to meet those needs. It has been shown decisively that people with intellectual disabilities have poorer health outcomes than the general population for reasons unrelated to the causes of their cognitive impairment, but rather, due to failings within healthcare systems. This is compounded by persistent negative attitudes and assumptions about quality of life of people with life-long cognitive impairments. These failings are not limited to acute hospital services or social care settings.
Media Watch is intended as an advocacy, education 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 recent issues of Media Watch (see below).
Read the current and back issues of the weekly report.