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LKS Current Awareness Bulletin
Palliative and End of Life Care 2019
A current awareness update service from Library and Knowledge Services. If you know anyone
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Abbas Abbas Bismillah Head of Library and Knowledge Services Email [email protected] 01254 784308 (Ext: 84308) Mobile 0778 996 0868 ELHT Library @elhtlibrary Abbas - @bazzie1967
___________________________________________________________________ Care at the End of Life The document Care at the End of Life: A guide to best practice, discussion and decision-making in and around critical care provides recommendations for effective decision-making and resources for clinical teams and the general public around end of life care. It hopes to encourage open, clear, honest discussions with patients and families enabling improved advance care. Source: The Faculty of Intensive Care Medicine Assisted dying campaign video accused of 'scaremongering' A campaign group's video of a patient dying in agony in a hospice has provoked outrage from doctors and nurses, who say it is '"scaremongering" and "sensationalist". Source: BBC News Unrelieved Pain in Palliative Care in England In England, an estimated 378,427 people receive palliative care each year in a range of specialised and generalised services. Overall, the quality of palliative care in England and the wider UK is regarded as excellent. Despite the excellent provision of palliative care in the UK, it is recognised that not all needs are met, especially within community palliative care. In a new OHE Consulting Report, they assess the extent of this unmet need by estimating the number of palliative care patients who would have their pain relieved if ‘best practice’ was adopted, and some projections of how these numbers may change over time. Source: OHE
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Prime Minister announces £25 million cash boost for hospices to secure their future PM announces £25 million cash injection to protect hospices and palliative care services which support around 200,000 people at the end of their lives. Source: Prime Minister's Office, 10 Downing Street and The Rt Hon Boris Johnson MP Palliative and end of life care: hospital deaths 2006 to 2017 Data is available on hospital deaths in England between 2006 and 2017 by age, sex, geography, deprivation, place of death and cause of death. Source: Public Health England Allied health profession (AHP) guide: enhancing health in care homes Timely access to AHP services supports personalised care, independence, and reduces avoidable admission to urgent care services. A guide has been released which supports AHPs and other health and care staff to make faster progress in improving care for people living in care homes. Source: NHS Improvement End of life care for infants, children and young people with life-limiting conditions: planning and management NICE guideline [NG61] has been updated - it covers the planning and management of end of life and palliative care in for infants, children and young people (aged 0–17 years) with life-limiting conditions. It aims to involve children, young people and their families in decisions about their care, and improve the support that is available to them throughout their lives. Source: NICE Motor neurone disease: assessment and management NICE guideline [NG42] has been updated - it covers assessing and managing motor neurone disease (MND). It aims to improve care from the time of diagnosis, and covers information and support, organisation of care, managing symptoms and preparing for end of life care. Source: NICE National Audit of Care at the End of Life (NACEL) 2019 The National Audit of Care at the End of Life (NACEL) is a comparative audit of the quality and outcomes of care in England and Wales experienced by the dying person and those important to them during the last admission leading to death. It looks at care in acute, community hospitals and mental health inpatient providers. Source: HQIP National Bowel Cancer Audit Short Report – End of Life A short report has been released which aims to look at patients diagnosed with colorectal cancer who were at ‘End of Life’ (defined as identified as being likely to die within 12 months). Source: HQIP Children’s hospices to receive £25 million a year as part of NHS Long Term Plan Funding for children’s hospices will rise to £25 million a year, NHS England has pledged. Source: NHS England End of Life Care Profiles: July 2019 data update The profiles provide an overview of end of life care in England at various geographies. Source: Public Health England
For references where there is a link to the full text, you may need to use your NHS Athens username & password to access
Caring as a source of death anxiety in palliative care Brian Nyatanga British Journal of Community Nursing Volume 24, Issue 902 Sep 2019 Published Online:7 Sep 2019 https://doi.org/10.12968/bjcn.2019.24.9.452 Family experiences of oncological palliative and supportive care in children: can we do better? Jan Plessis David Stones Michelle Meiring
International Journal of Palliative Nursing Volume 25, Issue 902 Sep 2019 Published Online:4 Oct 2019 https://doi.org/10.12968/ijpn.2019.25.9.421 What do relatives value most in end-of-life care for people with dementia? Sascha BoltJenny van der SteenJos Schols Sandra Zwakhalen Judith Meijers International Journal of Palliative Nursing Volume 25, Issue 902 Sep 2019 Published Online:4 Oct 2019 https://doi.org/10.12968/ijpn.2019.25.9.432 End-of-life care for older people with dementia is often sub-optimal. Understanding the experiences of the relatives involved in the care of the person with dementia may help to improve care practice. Team approaches in palliative care: a review of the literature GVMC Fernando, Sean Hughes Published Online:4 Oct 2019 https://doi.org/10.12968/ijpn.2019.25.9.444 Abstract. Background: Interdisciplinary team involvement is commonplace in many palliative care settings across the world. Teamwork is perceived by many experts as an indispensable functionality of palliative care teams. Significantly different structural and functional attributes of these teams between regional and organisational contexts could potentially act both as strengths and weaknesses towards their overall productivity. The sustainability and resilience of the team also has an indirect bearing on the team functioning. Opioid use disorder and chronic pain: challenges for palliative care practice Brenda Peters-Watral Published Online:4 Oct 2019https://doi.org/10.12968/ijpn.2019.25.9.453 Abstract . Along with a well-documented increase in opioid use disorder (OUD) and a rapidly escalating rate of fatal overdose in North America, inadequate management of chronic pain remains a pervasive problem. The increasing number of individuals living with OUD also experience multiple cancer risk factors, which are related to their substance use, while people with cancer diagnoses have similar risks of current or past addiction as the general population. Recent pain guidelines focus on chronic non-cancer pain and do not include recommendations for cancer pain management. Managing cancer pain at the end of life is more challenging in people with current or past substance use disorder (SUD), especially OUD. Addressing these challenges requires confronting stigmas and stereotypes, building knowledge among palliative care providers and assessing the risks and benefits of opioids for pain management on an individual basis in order to continue to provide the holistic care.
Synopses of a selection of recently published research articles of relevance to palliative care Karen Heggs International Journal of Palliative Nursing Volume 25, Issue 902 Sep 2019 Holistic management of malignant wounds in palliative patients Lynn Cornish British Journal of Community Nursing Volume 24, Issue Sup 901 Sep 2019 Abstract. Malignant wounds are a complication of cancer, and usually occur in those individuals with advanced disease. When healing ceases to be the goal, treatment is centred around symptom control and improving quality of life. Caring for individuals with malignant wounds presents challenges for patients, their families and nurses alike. This article discusses the holistic management of malignant wounds, with an emphasis on the control of both physical and psychosocial symptoms of wound management, as well as the impact that this may have on all those involved. Common physical symptoms of malignant wounds include malodour, bleeding, pain, exudate and pruritis. Psychosocial symptoms may result in social isolation and depression. All these symptoms have a huge impact, not only on patients and their families, but also on healthcare professionals both during and after care. Managing these symptoms requires a multidisciplinary approach to facilitate the best possible outcomes for patients and their caregivers. Palliative care after the Liverpool Care Pathway: a study of staff experiences
Heather Collins, Peter Raby Published Online: 8 Aug 2019 https://doi.org/10.12968/bjon.2019.28.15.1001 Abstract. The objective of this study was to explore nurses' perceptions of end-of-life care following the withdrawal of the Liverpool Care Pathway (LCP). Thirteen semi-structured interviews were conducted with nurses working in palliative care. Data were analysed using thematic analysis. Three themes emerged: perceptions of the LCP, prevailing issues, and patients' and families' experiences. This study suggested that the removal of the pathway has not remedied the issues attributed to it. Further, the way in which the LCP was removed indicates that the non-expert media can play a negative role in how palliative care is perceived, which inhibits the care process. In this respect it is important that ‘insider’ voices are also heard, in order to educate and also redress disinformation. Similarly, broader, persisting, contextual challenges facing staff need addressing in order to prevent a repeat of the issues leading to the removal of the LCP. The holistic management of fatigue within palliative care Antonia Dean International Journal of Palliative Nursing Volume 25, Issue 802 Aug 2019 Published Online:22 Aug 2019 https://doi.org/10.12968/ijpn.2019.25.8.368 Abstract. Background: Fatigue is a common symptom experienced by people with cancer and other long-term, non-malignant conditions. It can be disease-related or caused by treatments such as chemotherapy or radiotherapy. Patients frequently report this as a distressing symptom and, while some international guidelines for its management exist, evidence suggests that these are not always implemented. Supporting the bereaved in palliative care Brian Nyatanga Published Online: 1 Aug 2019 https://doi.org/10.12968/bjcn.2019.24.8.399 Loss, grief and bereavement are relatives in palliative care terms, as these three notions are connected. Loss in the form of death leads to grief, which is the expression of the pain or hurt caused by the loss. The expression of grief and the period over which it is expressed is often referred to as the bereavement phase. It follows, therefore, that when bereavement is discussed, the loss and grief associated with it should also be kept in mind. Bereavement comes directly from grief that has been triggered by a loss. In palliative care, the loss is often the death of a loved one. Case studies on careers in palliative care community nursing British Journal of Community Nursing Volume 24, Issue 7 02 Jul 2019 LOROS Hospice provides free, high-quality, compassionate care and support to terminally ill patients, their family and carers, both at the hospice and in patients' own homes. Its community nursing team delivers palliative care to around 2500 individuals a year across Leicester, Leicestershire and Rutland. This article describes the experiences of two individuals who work in community care at LOROS. Published Online:2 Jul 2019 https://doi.org/10.12968/bjcn.2019.24.7.344 When words make a difference in palliative care Brian Nyatanga British Journal of Community Nursing Volume 24, Issue 702 Jul 2019 Published Online:2 Jul 2019 https://doi.org/10.12968/bjcn.2019.24.7.347 The benefits of a hospital palliative care team Federica Sganga Christian Barillaro Andrea Tamburrano Nicola Nicolotti Andrea Cambieri Roberto Bernabei Adriana Turriziani Published Online:24 Jul 2019 https://doi.org/10.12968/ijpn.2019.25.7.345 International Journal of Palliative Nursing Volume 25, Issue 702 Jul 2019 Abstract. Aim: To investigate the association between a hospital palliative care unit assessment and hospital outcome. What are the challenges for nurses when providing end-of-life care in intensive care units? Ian Griffiths
British Journal of Nursing Volume 28, Issue 16 12 Sep 2019 Published Online:13 Sep 2019 https://doi.org/10.12968/bjon.2019.28.16.1047 Abstract. Aim: this literature review aimed to explore qualitative studies in which nurses discussed the challenges they face when delivering end-of-life care in intensive care units (ICUs). Analysis and discussion of the studies' findings aimed to contribute to the current evidence base surrounding the subject. Thinking about strengths in end-of-life nursing practice: the case of intensive care unit nurses Brandi Vanderspank-Wright David Kenneth Wright Kim McMillan International Journal of Palliative Nursing Volume 25, Issue 802 Aug 2019 Published Online:22 Aug 2019 https://doi.org/10.12968/ijpn.2019.25.8.378 Abstract. Background: The intensive care unit (ICU) is a care context that is sometimes described as being unconducive to the values and ideals of a good death in end-of-life care. Such assumptions render the ICU emblematic of a troubling discourse about end-of-life care in this clinical context. A review of the literature on family decision-making at end of life precipitating hospital admission Susan Procter MuiKeow Ooi Charlotte Hopkins Geraldine Moore British Journal of Nursing Volume 28, Issue 1311 Jul 2019 Published Online:13 Jul 2019https://doi.org/10.12968/bjon.2019.28.13.878 Abstract Around 70% of people would prefer to die at home, yet around 50% die in hospital, according to Dying Matters. In collaboration with a local hospice, a literature review was undertaken to address the question: ‘what factors precipitate admission to hospital in the last few days of a person's life for those who had expressed a preference to die at home?’ Four electronic databases were searched, with a date range of 2008 to 2018. After 80 articles were screened, 13 were included in the review. The findings identified a number of barriers experienced by people with non-cancer conditions nearing the end of life and their family carers, which inhibit the transition to end-of-life care. The findings suggest that hospice support for non-cancer patients with a deteriorating health trajectory needs to precede patient and family recognition that end-of-life care is needed. https://openathens.nice.org.uk/
BMJ Best PracticeBMJ Best Practice is a decision-support tool published by the BMJ Group and is a single source of evidence based medicine, which combines the latest research evidence, guidelines and expert opinion – providing essential learning on prevention, diagnosis, treatment and prognosis. BMJ Best Practice is of use to all staff - Doctors, Nurses and Midwives, HCAs, Patients, Volunteers, Admin. The website also has a CME/CPD activity tracking tool which logs your searches and active hours and allows users to create activity certificates to support revalidation and CME/CPD
BMJ Learning FREE learning modules for ALL staff and students at ELHT
We can show you how you too can access these resources and more. Have you heard of BMJ Learning? Do you know how to register? Do you need help finding courses? Free training sessions on BMJ Learning to all staff and students at East Lancashire Hospitals. We will show you how to register and find eLearning courses
relevant to you. These courses can be counted towards your CPD and you will receive a certificate of completion. How to Book
Go to http://bit.ly/2obLR99
Choose your 30-minute slot
Come to the Learning Centre Library, RBTH on your chosen time - we will be provide tea, coffee and biscuits too!
If you cannot attend these sessions please contact Abbas Bismillah, Head of Library and Knowledge
Services (Ext. 84308) to arrange one for a more convenient time.
BMJ Learning Courses Clinical pointers: Palliative care in the community A practical guide to the latest developments in palliative care in the community. Learn about the latest thinking on symptom control in patients nearing the end of their lives, recent medicolegal topics that affect palliative care, and the key points from the 2015 NICE guideline on care of dying adults. Ask the consultant: Palliative care In our series for internal medicine trainees, Dr Chris Farnham, consultant in palliative medicine at Whipps Cross hospital, Bart’s Health NHS Trust, answers trainees’ questions on switching opioids, managing nausea and vomiting, prescribing in patients with renal and liver disease, starting fluids, and coping with sudden terminal bleeds. Palliative care during the out of hours period: in association with Macmillan Cancer Support This module explores how to manage symptoms in terminal patients, and outlines the principles of pain management in palliative care. Clinical pointers: Palliative care in non-malignant disease Patients with end-stage non-malignant disease may not receive the same level of palliative care compared with patients with cancer, even though they often experience similar distressing symptoms. Palliative care should be based on need rather than diagnosis; this module provides evidence based, practical tips to help improve the practice of GPs in providing palliative care to patients with non-malignant disease. Hospital presentations: palliative and end of life care An interactive, case based module for medical trainees covering assessing the needs of a patient recognised to be in the last days or weeks of life, along with symptom control and advance care planning.
Come and join our Reflective Reading Club which will provide attendees with 3 hours of valuable CPD! It will give healthcare staff the opportunity to read, discuss and to critically reflect upon a published paper using a set of guided questions. Participants are required to read a pre-set paper prior to attending the session.
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Library and Knowledge Services Team Abbas Bismillah Head of Library and Knowledge Services Clare Morton Library Operational Services Manager Patrick Glaister Clinical Librarian Judith Aquino E-Resources Librarian Sarah Glover Library Services Officer Charlotte Holden Library Services Officer Lauren Kay Library Services Officer
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