Sage Palliative Medicine & Chronic Care

This episode features Sheryn Tan (University of Adelaide, Adelaide, SA, Australia) and Dr Stephen Bacchi (Flinders University, Bedford Park, SA, Australia; Lyell McEwin Hospital, Elizabeth Vale, SA, Australia)   What is already known about the topic? In palliative care patients for whom there is a need for non-oral antiseizure medications, and a preference to avoid intravenous access, options are primarily limited to benzodiazepines. In circumstances where the sedative effects of benzodiazepines are to be avoided, the use of subcutaneous levetiracetam have been reported. There are limited guidelines available regarding the possible use of subcutaneous sodium valproate.   What this paper adds? Several studies have described successful use of subcutaneous sodium valproate in palliative care to manage seizures. While limited, the available data described few adverse effects, aside from an isolated local reaction that is resolved with a change of site. Current routine medication resources may not reflect

This episode features Dr Maria Arantzamendit, (Universidad de Navarra, Institute for Culture and Society-ATLANTES Global Observatory of Palliative Care, Pamplona, Navarra, Spain. IdISNA-Instituto de Investigación Sanitaria de Navarra. Medicina PaliativaK).   What is already known about the topic? Palliative care professionals use coping strategies to deal with the emotional challenges of their work. Coping skills are essential for professionals to stay and remain in palliative care.   What this paper adds? A grounded theory of a five-phase transformative process through which palliative care professionals develop coping capacity and evolve from a phase of emotional contention toward one of care based on inner balance and a transcendent perspective. Key factors influencing the development process are some clinical cases, teamwork, and selfcare. The study shares how the sensations of feeling overwhelmed can sometimes be reversed as professionals come to understand how to care for themselves.   Implicat

This episode features Hannah Scott, (King’s College London, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, London, UK)   What is already known about the topic? Person-centred outcome measures have been shown to improve the quality of care and patient outcomes in adult palliative care when successfully implemented into routine care. Several factors influence implementation in adult services, but they have not been identified in care for children with life-limiting and life-threatening conditions. The views of stakeholders are key to successful development, implementation and use of outcome measures in practice.   What this paper adds? Perceived benefits of using person-centred outcome measures include enhanced understanding of what matters to patients and families, improved communication and collaborative working and standardised data collection and reporting; perceived risks include negative impacts on care and measures not being used as intended. Potentia

This episode features Dr Fiona Kenney and Koby Anderson, (Ottawa Hospital Research Institute, Ottawa, ON, Canada Bruyère Research Institute, Ottawa, ON, Canada)   What is already known about the topic? Previous research demonstrates a high prevalence of severe grief symptoms up to a year post-death of a loved one among those who experienced bereavement during the COVID-19 pandemic. No previous study has assessed changes in the severity of grief more than a year after the death of a loved one during the COVID-19 pandemic.   What this paper adds? This prospective cohort follow-up study found the prevalence of severe grief reaction remained high (28.8%) at 12–18 months post- family member death. One-third (33.3%) of family members experienced persistently high or worsening grief symptoms at the time of their 12–18-month assessment compared to baseline 6–12-month assessment. Grief severity was associated with endotracheal intubation in the deceased, but not with the cause of death (e.g., COVID vs non-COVID ill

This episode features Sue-Ling Chang, (CHU de Québec-Université Laval Research Center, Oncology Division, Québec City, QC, Canada)   What is already known about the topic? There is a growing interest in psilocybin-assisted therapy worldwide, particularly to treat existential distress at the end of life.   What this paper adds? In this study, we show that the social acceptability of psilocybin-assisted therapy to treat existential distress at the end of life is high in Canada and identify factors associated with favourable attitudes of the population towards it.   Implications for practice, theory, or policy Our findings may help mobilise resources to address barriers and challenges for implementing psilocybin-assisted therapy within palliative medicine and society. This could also have implications for policies regarding medical assistance in dying.  Full paper available from:     https://journals.sagepub.com/doi/full/10.1177/02692163231222430  If you would like to record a podcast about your published

This episode features Dr Carlos Seiça Cardoso (Faculty of Medicine, University of Coimbra, Coimbra, Portugal CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal)  What is already known about the topic? The burden of chronic, progressive, incurable and life-threatening illness is increasing, highlighting the need to integrate palliative care into patients’ care plans. Data indicate that involving General Practitioners in the provision of palliative care may improve outcomes for patients and families, but the evidence on the effectiveness of interventions for patients with palliative care needs in primary care is still scarce.  What this paper adds? We developed a training programme, from logistics to content, to be feasible for General Practitioners and to address the main topics in which they identified training needs. A two-tiered intervention was implemented, involving training and a new consultation model; this was shown to be feasible and effective in reduci

This episode features Ellis Slotman (Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands)  What is already known about the topic? Potentially inappropriate end-of-life care in patients with cancer is still common. The COVID-19 pandemic has been shown to affect cancer diagnosis and treatment, but evidence on how the pandemic has affected end-of-life care is limited.   What this paper adds? The COVID-19 pandemic was associated with less potentially inappropriate care at the end of life in patients with cancer.  The decline in potentially inappropriate end-of-life care was driven by fewer hospitalizations and intensive care unit admissions in the last month of life and fewer hospital deaths.   Implications for practice, theory, or policy The findings of this study raise important questions as to which pandemic related changes in end-of-life care delivery and decision making might be able to contribute to appropriate end-of-life care for future patients.  Ensuring that awareness fo

This episode features Dr Vanessa Abrahamson, (Centre for Health Services Studies, University of Kent, Kent, UK).   What is already known about the topic? Increasingly, people at end-of-life want to die at home but this relies heavily on family carers to support the patient. Many carers struggle with the practical and emotional burden of caring for a loved one at home. Services providing hospice care at home are highly rated by carers but access is limited and the model of care varies greatly between services, with little data on how this affects patient/carer experiences.   What this paper adds? Hospice-at-home services need to set clear expectations from the start so that families know exactly what the service can, or cannot, provide; this helps establish confidence in the service and build a strong relationship with the carer. Carers valued the expertise of hospice staff (in death and dying) and that they had time to care in a flexible and compassionate manner, which other services lacked. Carers f

This episode features Dr Nivedita Ashok, (University College London, London, UK).   What is already known about the topic? Individuals with intellectual disability or serious mental illness have high rates of mortality due to physical comorbidities. These populations have specific needs that should be met to provide optimum palliative care and maintain optimum mental healthcare at the end-of-life. While research exists describing the problems these populations face, little is known about how to improve care for them.   What this paper adds? By focusing on lived experiences of patients/service users, carers and healthcare professionals this paper synthesises existing evidence into multivoiced perspectives on what works, does not work, plus challenges and opportunities for improvement. Assumptions and misunderstandings about the role of mental capacity assessment to appropriately involve the patient in decision-making are common, while adapting training for palliative care staff to address concerns and

This episode features Caitlin Spooner (Marie Curie Palliative Care Research Department, University College London, London, UK).  What is already known about the topic? - Currently, there is no gold standard for evaluating how different methods of prognosticating in advanced cancer impact on patient care. - Prognostic models are principally evaluated by their statistical performance, determining their discrimination and calibration. However, before any prognostic model can be recommended for use in clinical practice, it is necessary to demonstrate whether or not it has a beneficial impact on patient care. - There is a lack of consensus among stakeholders about how to assess the impact of prognostication in advanced cancer, with prognostic studies varying in the outcomes they select.  What this paper adds? - We identified a wide variety of outcomes and measures used in published studies, which makes inter-study comparability problematic. - Our findings highlight the widespread effect that prognostication in adv

This episode features Dr Amara Nwosu (Lancaster Medical School, Lancaster University, Lancaster, UK; Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK; and Marie Curie Hospice Liverpool, Liverpool, UK). The podcast is an overview of a published editorial on telehealth in palliative care. Dr Nwosu highlights the unrealised potential of palliative care telehealth, and discusses the opportunities and challenges associated with telehealth. Finally, Dr Nwosu describes the next steps needed for research evaluating palliative care telehealth.   Full paper available from:    https://journals.sagepub.com/doi/full/10.1177/02692163231182461   If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu: a.nwosu@lancaster.ac.uk

This episode features Dr Gursharan K Singh (Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia). What is already known about the topic: - The degree to which individuals access and use palliative and end-of-life care services varies across communities and countries. What this paper adds: - This study found that the South Asian community (in Bradford, UK) are currently not ready to engage with palliative and end-of-life care services despite local initiatives to improve awareness. They are at the “pre-planning stage” (see Table 1) about end-of-life care options and of the services that are available to them. - This study also found evidence that the services that aim to support people from minoritised ethnic communities at the end-of-life are not ready to address ethnic inequities. - Such services were found to have: (i) a narrow focus during advance care planning, (ii) poor integration of voluntary and community services (iii) and limit

This episode features Hannah May Scott (Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King’s College London, London, UK).   What is already known about the topic? - Although spiritual concerns are recognised as a core component of palliative care for children, there is a paucity of primary data. - Self-report data from children is rare, and existing evidence is largely proxy data from parents or health and social care professionals and mainly focused on the religious aspect of spiritual care for cancer patients.   What this paper adds? - Specific spiritual concerns among children with a range of life-limiting and life-threatening conditions and their families (parents and siblings) included: living life to the fullest, meaning of life and leaving a legacy, uncertainty about the future, determination to survive, accepting or fighting the future and role of religion. - This work broadens understanding of the spiritual domain for these children beyond religious

This episode features Dr Jenny Lau (Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada; Division of Palliative Care, University Health Network, Toronto, ON, Canada) and Dr. Daniel Buchman (Everyday Ethics Lab, Centre for Addiction and Mental Health, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; University of Toronto Joint Centre for Bioethics, Toronto, ON, Canada)   What is already known about the topic? •             Communicable disease epidemics and pandemics, such as the COVID-19 pandemic, intensify the healthcare inequities encountered by people who use drugs. •             Pandemics are expected to increase the demand for palliative care resources. •             People who use drugs with life-limiting illnesses experience inequities in access to palliative care. •             There is limited evidence b

This episode features Dr Rachael Moss (Bradford Institute for Health Research, Bradford Teaching Hospitals Foundation Trust, Bradford, UK). What is already known about the topic: - The degree to which individuals access and use palliative and end-of-life care services varies across communities and countries.   What this paper adds: - This study found that the South Asian community (in Bradford, UK) are currently not ready to engage with palliative and end-of-life care services despite local initiatives to improve awareness. They are at the “pre-planning stage” (see Table 1) about end-of-life care options and of the services that are available to them. - This study also found evidence that the services that aim to support people from minoritised ethnic communities at the end-of-life are not ready to address ethnic inequities. - Such services were found to have: (i) a narrow focus during advance care planning, (ii) poor integration of voluntary and community services (iii) and limited understanding of what a go

This episode features Isabel Vandenbogaerde (End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Ghent, Belgium). What is already known about the topic: Involvement of family carers in advance care planning conversations is crucial for end-of-life decision-making. Family carers are willing to engage in advance care planning conversations, but experience barriers in doing so. Healthcare professionals may play an important role in supporting family carers in these advance care planning conversations. What this paper adds: About half of the family carers have an advance care planning conversation with their relative in the final 3 months of life. Family carers were more likely to engage in advance care planning in case they were 55 of age or younger, had a medical degree (e.g. nurse or doctor), and when specialist palliative care services were involved The majority of family carers received advance care planning conversation support from a healthcare professional by per

This episode features Dr Joyce Chung and Weilin Chen (School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China). What is already known about the topic: End-of-life communication can improve patients’ quality of life, ease the bereavement experience, raise care satisfaction and reduce the utilisation of aggressive and expensive medical care. Healthcare professionals’ perceived barriers, such as fear of causing distress, impede the delivery of end-of-life conversations in a professional, sensitive and appropriate manner. The communication strategies available to healthcare professionals for discussing end-of-life issues with terminally ill patients and their families have not yet been systematically summarised. What this paper adds: This review systematically examines, summarises and presents recommended end-of-life communication strategies for healthcare professionals. It organises these communication strategies into seven themes that should be considered when deliv

This episode features Suzanne Smith (Master of Palliative Care student, Flinders University, Australia; Victorian Paediatric Rehabilitation Service, Australia), Dr Megan Doherty (University of Ottawa, ON, Canada; Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada) and Dr Mostofa Kamal Chowdhury  (BangabandhuSheikh Mujib Medical University, Dhaka, Bangladesh). What is already known about the topic: The majority of children who need, but cannot access essential palliative care and pain relief, live in low-and middle-income countries. An estimated 10 million Bangladeshi children live with a disability and associated serious health-related suffering that may lead to premature death. Children from low- and middle-income countries are underrepresented or absent from existing palliative care reviews. What this paper adds: This review illuminates the extreme health-related suffering experienced by children with disability and their families in Bangladesh in the physical, social, and emotional/spiritual d

This episode features Dr Richard Green (University of Surrey, Guildford, UK). Multimorbidity is increasing substantially worldwide, is associated with greater use of healthcare services, lower quality and quantity of life, and rises with age. Older people with multimorbidity are expected to become the main recipients of palliative care in the coming decades; however, there is limited evidence of their specific needs. Older people’s voices are vital to understanding their own palliative care needs and priorities, but these voices are hampered by structural inequities in service provision. This is the first paper reporting on the expressed palliative care needs of community-dwelling older people with multimorbidity. The most common palliative care needs identified across need domains were pain, function, unhappiness, staying socially connected, future planning, person-centred care and having meaning and purpose in life. This paper highlights different priorities between the reported items in tools used to col

This episode features Dr Andrew Page (Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK). Cancer pain is common, extremely debilitating, and undertreated worldwide. We do not know if non-steroidal anti-inflammatory drugs (aka NSAIDs or “anti-inflammatories”) are effective in managing cancer pain of any type. To further scientific understanding, UK palliative care doctors advocate a pragmatic trial to determine the role, if any, of NSAIDs as opioid adjuncts for treating cancer-induced bone pain. Numbers treated for cancer-induced bone pain at a single regional radiotherapy centre (478 per year) support the feasibility of trial recruitment. Considering eGFR and contraindicating co-morbidities, two-thirds could be suitable for NSAID prescription if proven efficacious. Suitability for NSAID prescription reduces with age, with the proportion unsuitable increasing in those over 65 years old. Recruitment to a future trial of NSAIDs in the management of cancer-indu