Global Palliative Care News Archive

MEDIA WATCH, CREATED AND DISTRIBUTED BY BARRY R. ASHPOLE

Please feel free to share this weekly report with your colleagues.
Barry R. Ashpole, Ontario, CANADA
barryashpole@bell.net

MW 649: Palliative care for patients with substance use disorder and multiple problems: A qualitative study on experiences of healthcare professionals, volunteers and experts-by-experience

Download the complete issue (PDF 425 KB)

Alternatively, set point(s)-of-entry to end-of-life services could be identified, e.g., harm-reduction service or hospitalization for acute exacerbations. Furthermore, an increased attention to advance care planning for this patient group might be an option. Despite patient's denial of disease and dying, it may, for example, be revealing to confront them by asking the surprise question in an opposite way: "would you be surprised if you died in the next 12 months?" Such a question could be the start of exploring attitudes on and acceptance of death, dying and disease for both patients, their proxies and healthcare professionals, volunteers and experts-by-experience. From this study it appeared that many elements of the World Health Organization definition of PC seem a bit too ideal or are challenged within the actual care practice for patients with SUD. Full text: view source »

Mental healthcare and palliative care: Barriers

BMJ SUPPORTIVE & PALLIATIVE CARE | Online – 13 January 2020 – Psychological symptoms are common among palliative care (PC) patients with advanced illness, and their effect on quality of life can be as significant as physical illness. The demand to address these issues in PC is evident, yet barriers exist to adequately meet patients' psychological needs. This article provides an overview of mental health issues encountered in PC, highlights the ways psychologists and psychiatrists care for these issues, describes current approaches to mental health services in PC, and reviews barriers and facilitators to psychology and psychiatry services in PC, along with recommendations to overcome barriers. Patients in PC can present with specific mental health concerns that may exceed PC teams' available resources. PC teams in the U.S. typically do not include psychologists or psychiatrists, but in PC teams where psychologists and psychiatrists are core members of the treatment team, patient well-being is improved. Psychologists and psychiatrists can help meet the complex mental health needs of PC patients, reduce demands on treatment teams to meet these needs and are interested in doing so; however, barriers to providing this care exist. The focus on integrated care teams, changing attitudes about mental health, and increasing interest and training opportunities for psychologists and psychiatrists to be involved in PC, may help facilitate the integration of psychology and psychiatry into PC teams. Abstract: view source »

Bereavement support: From the poor cousin of palliative care to a core asset of compassionate communities

PROGRESS IN PALLIATIVE CARE | Online – 12 January 2020 – The negative consequences of bereavement and the disruption of social relationships put the impact of bereavement squarely into a public health perspective. Adopting and strengthening a compassionate communities approach is necessary, not only for end-of-life care for dying people but also for providing bereavement support. Many palliative care services continue to adopt an unhelpful standardised approach in offering bereavement support. So, who provides support to the bereaved? Who needs support and to what extent? Importantly, who is perceived by bereaved people to have offered them support and was it helpful? Based on reported experiences of the bereaved in a national Australian survey, the majority of this support is provided in informal and other community settings by a range of people already involved in the everyday lives of those recently bereaved. A public health approach to bereavement care is needed to support "everyday assets" in the community without over-reach from professional services. Findings provided empirical evidence for building a community's capacity to provide the type of social and practical support advocated by the compassionate communities approach. This body of work, innovative in content, conceptual model and recruitment approach, challenged the existing bereavement support structure and provision and has influenced practice and policy. Abstract: view source »

MW 648: You're in…but this service requires drug testing

Download the complete issue (PDF 650 KB)

Studies indicate that people with substance use disorders often divert pain medication from their friends or relatives, a complication in the outpatient palliative setting where family or friends frequently serve as caregivers for the patient. Chronic pain management thus becomes a balancing act for the care team; PC professionals question how to ensure end-stage or chronic patients receive the pain-relieving medication they need while not contributing to the possibility of drug diversion. First page view (w. link to references): view source »

Life, love, hope, faith, and death – too complex for Likert

JOURNAL OF PALLIATIVE CARE | Online – 7 January 2020 – More research to examine factors contributing to healthcare disparities at the end of life (EoL) is greatly needed. This article outlines a failed attempt to quantify some of the motivators in medical decision-making for African American families faced with a decision to pursue or forego a percutaneous endoscopic gastrostomy in a loved one at the EoL. It explores the complexities of spirituality, history, culture, and death in the authors' patient population in Charleston, South Carolina, where healthcare disparities are well-documented, and distrust has deep historical roots. It outlines the need for qualitative research, where the defining role of the researcher is to practice the paramount palliative skill of listening. Abstract: view source »

Community participation in palliative care: Reflections from the ground

PROGRESS IN PALLIATIVE CARE | Online – 5 January 2020 – Community participation is a frequently mentioned theme in palliative care projects. Yet most of the projects claiming to be community-led have only minimal participation from the community, usually in the form of resource mobilization. Achieving higher levels of participation, the process of involving community collectives as partners in running, and later taking responsibility to sustain and own the program, is more complex and more difficult to achieve. Common barriers include lack of the mandatory preparatory work to understand the social and political dynamics of the community, facilitators' values and agenda assuming the dominant role in the project, unwillingness on the part of facilitators to give up control and problems with the "political process" that should go with capacity building. Another issue is that community mobilization, being a dynamic cascading process, does not yield to conventional methods of evaluation. Abstract: view source »

MW 647: "It's like a death sentence but it really isn't." What patients and families want to know about hospice care when making end-of-life decisions

Download the complete issue (PDF 400 KB)

The four key decisional themes highlighted in this article – 1) What is hospice care?; 2) Why might hospice care be helpful?; 3) Where is hospice care provided?; and, 4) How is hospice care paid for? – offer tangible touch points that hospice providers can focus on when initiating conversations and shared decision-making around hospice care. These themes may provide a framework to design patient-centered interventions designed to improve communication around hospice decision-making. Full text: view source »

The effect of early and systematic integration of palliative care in oncology on quality of life and health care use near the end of life: A randomised controlled trial

EUROPEAN JOURNAL OF CANCER, 2019;124(1):186-193. To the authors' knowledge, this is the first European study that examined the effect of early integration of palliative care (PC) in oncology on QoL near the end of life (EoL) of cancer patients. They found statistically significant beneficial effects in QoL at the EoL by providing patients with monthly semi-structured consultations with a specialised PC nurse, starting early in the disease trajectory and continuing until death. The plausible mechanism of the long-term benefit of early integrated PC versus on-demand PC could be related to the fact that patients and PC professionals have more time to build a relationship, to focus on coping with the progressive and worsening illness, to address decision-making in relation to cancer treatment and EoL care, and to enhance symptom assessment and management. Research has shown that adequate symptom management, effective communication, and a strong therapeutic bond contribute to quality EoL care. Full text: view source »

Meaningful deaths: Home health workers' mediation of deaths at home

MEDICAL ANTHROPOLOGY | Online – 23 December 2019 – After several generations in the U.S. in which medicalized deaths have become normal, more people are seeking to die at home. However, home deaths lead to emotional uncertainty and practical confusion, in which kin lack a cultural script. In this article the author draws on interviews with patients' kin and their African immigrant home health workers, and show that the care workers helped create a more meaningful death through their knowledge of death, familiarity with the physical processes of death, and their presence, which they used to create pathways for their patients and their kin. Abstract: view source »

Help us to expand the resources on this site quickly.
Please send your suggestions to
Technical Issues? Contact gdraeger@sweetthursdayweb.com

Page Last Modified: Sun Sep 15 2019