Sage Palliative Medicine & Chronic Care

This episode features Professor Miriam Johnson (Hull York Medical School, UK). People with heart failure have poor access to palliative care. People with advanced heart failure have poorer access to palliative care than people with cancer and the evidence base in support of heart failure palliative care is less developed. This systematic review draws together the current literature, both observational and experimental, investigating the use of palliative care in people with symptomatic heart failure. The findings support the use of multi-disciplinary palliative care in this patient group, as distinct from single components only, but trials do not identify who would benefit most from specialist palliative referral. There are no sufficiently robust multi-centre evaluation phase trials to provide generalisable findings. Full paper available from:  https://journals.sagepub.com/doi/full/10.1177/0269216319859148   If you would like to record a podcast about your published (or accepted) Palliative Medicine paper,

This episode features  Dr Bridget Candy and Dr Megan Armstrong (Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK)      Conventional therapies are not always sufficient to provide satisfactory relief of symptoms to those at an advanced stage of a disease. Evidence on the effectiveness of complementary therapies improving the well-being of people with advanced diseases is uncertain; however, palliative care services often offer such therapies as a way to reduce stress and promote relaxation. This systematic review of qualitative studies found cancer patients (irrespective of disease stage) viewed complementary therapies as providing a sense of physical and psychological well-being. Participants with advanced cancer perceived an improvement in their physical and psychological well-being during and after the complementary therapy session. Participants with advanced cancer experienced a form of escapism or living in the moment that took away their worri

This episode features Deidre Morgan (Palliative and Supportive Services, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia).   Functional decline can be anticipated for people with life-limiting illnesses. Trajectories of functional decline differ in shapes and patterns. Understanding patterns of functional decline has implications for patient care and design of responsive health services. This prospective study identifies two contemporary trajectories of functional decline for patients receiving specialist palliative care in the last 120 days of life. Precipitous deterioration in functional decline for cancers, solid organ failure and cardiovascular disease occurs as cohorts of patients approach Australia-modified Karnofsky Performance Status (AKPS) of 40. The pattern of functional decline for the neurological and dementias cohorts is flatter, showing a prolonged period of low function. Study findings highlight that different types of care responses and resource allocation

This episode features Katrin Gerber ( National Ageing Research Institute & Queensland University of Technology).   Research  suggests that people generally would like to receive their end of life care at home. This study aimed to examine the decision making process of how preferences are formed. This qualitative study involved interviews of 9 terminally patients and 8 family carers. The authors found that people's preferences for place of end of life care depended on various factors. Preferences changed with the demands of the situation and were affected by factors such as symptoms, carer capacity and prognosis. This paper further details that instead of only asking 'where do you want to die?' healthcare professionals could consider  asking 'why?' to further understand how preferences are formed and change.   Full paper available from:  No weblink available yet   If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu: anwosu@liver

This episode features Sarah Combes (Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, UK).   Older people living with frailty are projected to become one of the largest future users of palliative care. Advance care planning can improve person centred end of life care. However advance care planning is relatively uncommon in frail elders due to many challenges. This review aimed to understand how advance care planning could be better implemented in frail elder population, and to develop a conceptual model to underpin future development. The study concluded that a system wide approach is needed that recognised the importance of living well now, relationships and early engagement. All stakeholders have educational needs; specifically clinicians need to be given the opportunity to develop skills and competencies to recognise, proactively use and create advance care planning opportunities at the end of life.     Full paper available from: https://journals.sagepub.com

This episode features Dr Bella Vivat (Marie Curie Palliative Care Research Department, UCL, London, UK) and Professor Paddy Stone (Marie Curie Palliative Care Research Department, UCL, London, UK).   Sedative medication may be used to manage intractable symptoms at the end of patients’ lives. No UK guidelines specifically address the detail of how sedatives should be used, but international guidelines endorse monitoring the depth of sedation, and the European Association for Palliative Care (EAPC) framework recommends that monitoring should relate to the aim of using sedatives. Despite internationally agreed guidelines and recommendations, use varies widely between countries and settings, including the depth of sedation sought, and the dosages administered.  This study shows that usual practice when using sedative medication in two palliative care settings in London, UK, is predominantly to use low dosages of midazolam to achieve patient comfort, rather than to sedate patients. Practice in these London setti

This episode features Dr Catriona Mayland (University of Sheffield, UK).   The Quality of Death Index showed variability in the international provision of care for the dying. In order to improve care, we need to have validated outcome measures to assess the current quality of care. One method of evaluation is to use the views from the bereaved relatives to assess their own perceptions and as proxy measures for the patient. We have developed a common, core international ‘Care Of the Dying Evaluation’ (i-CODE) questionnaire, assessing both patient care and family-carer support. Engagement of patient and public representatives and bereaved relatives has informed the development process adding to the face and content validity of i-CODE. i-CODE will enable a transnational comparison of care for the dying to be conducted. Results of i-CODE can be used directly for quality improvement purposes. i-CODE may be further developed into an international standard and benchmarking tool.   Full paper available from: https://

This episode features Dr Ann Dadich (Western Sydney University, Austrailia) Specialist home-based palliative care can improve symptom management and quality of life and prevent hospitalisation at the end-of-life. There is significant variation in how home-based palliative care is delivered, even within similar jurisdictions. The clinical practices and contextual factors that enable exemplary palliative care are not well understood. The study identified some of the characteristics that enable brilliant home-based palliative care – notably: anticipatory aptitude and action; a weave of commitment among different individuals, within and beyond a palliative care service; flexible adaptability; and team capacity-building. Using the combined methodology of positive organisational scholarship in healthcare and video-reflexive ethnography, this study also revealed the importance of context in delivering brilliant home-based palliative care. The aforesaid conditions can be adapted for use within other services, partic

This episode features Dr Simon Etkind (Cicely Saunders Institute,  King’s College London, London, UK).   To be person-centred, care should take into account individual preferences. Some influences on care preferences in older people have been described. These include the family and care context, individual response and illness-related factors. Older people living with frailty are at high risk of acute illness episodes; the influences on preferences in the context of frailty and recent acute illness have not been explored. Achieving normality, by ‘getting back to normal’ or ‘finding a new normal’ influences preferences in frail older people with recent acute illness, as participants seek care that will help them find this normality. Preferences are also influenced by the way people respond to changing health and care experiences. We propose a model of influences on care preferences in the context of recent acute illness. The influences described in this model can act as a guide for discussion and elicitation o

This episode features Dr Huw Williams ( Cardiff University, UK) Around 2% –3 % of consultations in primary care are prone to patient safety incidents. Patients receiving palliative care are not immune to patient safety concerns. ‘Out-of-hours’ services are responsible for providing care for two-thirds of the working week (18:30 to 08:00 on weekdays, and all hours at weekends in the United Kingdom). Target patient safety issues for improving palliative care in the out-of-hours setting include medication provision, timely access to care and non-medication treatments such as catheter care and information transfer between providers. Harm outcomes commonly include pain, emotional distress, unnecessary hospital admission, and hastened death. Interventions to address frequently identified sources of harm are presented and should be evaluated robustly in future implementation studies.   Full paper available from: https://journals.sagepub.com/doi/full/10.1177/0269216318817692   If you would like to record a podcast a

This episode features Dr Sophie Rees ( University of Warwick, Coventry, UK ) and Dr Ann Hutchinson ( University of Hull, Hull, UK ) Cancer patients are at an increased risk of thrombosis. Current guidance for treatment is injected anticoagulants although there is some doubt as to the long-term acceptability of injections to patients. Many cancer patients are unaware of their increased risk of thrombosis or of the symptoms that should prompt seeking medical attention. Cancer patients find injected anticoagulants acceptable in the context of cancer, especially when given support to overcome initial anxieties. Patients find taking tablets easier, but would only choose tablets over injections if found to be as safe and effective as injected anticoagulants. Cancer patients must be informed of their increased risk of thrombosis and the symptoms for which they should seek help. Rivaroxaban tablets could be offered as a choice when there are sufficient robust data to support the risk–benefit balance. Full paper avai

This episode features Dr Alex Chan (Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA). Routine assessment of many established quality indicators is nearly impossible because the information is embedded as unstructured free text within electronic clinical notes. A key example of this is timely documentation of patient care preferences in critically ill older adults. The paper demonstrates that deep learning algorithms can be applied to assess a palliative care quality measure endorsed by the National Quality Forum. The deep learning algorithm analyzed clinical notes >18,000 times faster than clinician coders (0.022 s/note vs 402 s/note). The algorithms can analyze electronic clinical notes in a tiny fraction of the time needed for manual review, offering a practical option for rapid audit and feedback regarding care preference documentation at the system and clinician level.   Full paper available from: https://journals.sagepub.com/doi/full/10.1177/026921631881

This episode features Dr Hazel Coop and Dr Clare Marlow (WM CARES (West Midlands Collaborative Actioning Research in End of life and Supportive care), New Cross Hospital, Wolverhampton, UK). This regional survey  aimed to determine whether palliative care professionals in the West Midlands (United Kingdom) have discussions about digital legacy with their patients. A total of 210 questionnaire survey responses were received from the 10 participating hospices (response rate of 35%). The majority of respondents (96%, 201/210) had never discussed a patient’s digital legacy with them. The results suggest that palliative care professionals in the West Midlands do not have discussions about digital legacy with patients, largely because of lack of awareness and confidence.   Full paper available from: http://journals.sagepub.com/doi/full/10.1177/0269216318802748   If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu: anwosu@liverpool.ac.uk

This episode features Dr Cathy Payne (Institute of Nursing and Health Research, Ulster University, Newtownabbey, UK). This qualitative study aimed to explore the experiences and perceptions of patients and healthcare professionals on the feasibility and acceptability of palliative rehabilitation during advanced lung cancer treatment. The results of this study demonstrated that patient participants perceived that an individualised behaviour change programme which combined physical activity, exercise and nutritional guidance was of value and should be offered to all those wishing to be actively involved in their cancer management. Engagement in a palliative rehabilitation study led healthcare professionals to have more positive attitudes towards rehabilitation as a component of advanced cancer treatment. This study highlights the potential impact of palliative rehabilitation as a component of advanced cancer management, but further work is needed to incorporate rehabilitation within lung cancer treatment path

This episode features Dr Karen Neoh (St Gemma’s Academic Unit of Palliative Care, University of Leeds, Leeds, UK). This national audit  aimed to determine national transfusion practice in hospices and compare this against National Institute for Health and Care Excellence and British Society of Haematology guidelines to develop recommendations to improve practice. The results demonstrated that patients are not usually investigated for the cause of their anaemia, of those that were a significant proportion would have benefitted from B12, folate or iron supplementation, although these were rarely used. Transfusion practice remains too liberal despite greater risks of transfusion-associated circulatory overload in patients with advanced disease. Only 18% of transfused patients had an improvement maintained up to 30 days; 42% had no or very transient benefit, and 32% were dead at 30 days. The authors conclude that more rigorous investigation of anaemia, increased use of alternative therapies and a more restricti

This episode features Professor Mari Lloyd Williams (Academic Palliative and Supportive Care Studies Group, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK). This was a pilot trial to determine the effect of a focused narrative intervention on depression in palliative care patients when used in addition to usual care. The study found that focused narrative intervention can be an effective intervention for moderate to severe depression in palliative care patients when used in addition to usual care. The effect of the intervention appears to be sustained at 6-week follow-up. Those randomised to the intervention appeared to have longer survival than patients randomised to usual care. This study supports the requirement for a larger randomised controlled trial. The focused narrative intervention could be delivered by any member of a palliative care team. The cost benefits of the intervention need to be explored in further studies. Full paper available from: http://journals.sag

This episode features Marc Sampedro Pilegaard (The Research Initiative of Activity Studies and Occupational Therapy, Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark). This randomised controlled trial aimed to evaluate the efficacy of the ‘Cancer Home Life-Intervention’ compared with usual care with regard to patients’ performance of, and participation in, everyday activities, and their health-related quality of life. The ‘Cancer Home-Life Intervention’ is a brief, tailored, occupational therapy–based and adaptive programme for people with advanced cancer targeting the performance of their prioritised everyday activities. The study recruited home-living adults diagnosed with advanced cancer experiencing functional limitations were recruited from two Danish hospitals. They were assessed at baseline, and at 6 and 12 weeks of follow-up. The primary outcome was activities of daily living motor ability. The results demonstrated that there was effect 

This episode features Matthew Allsop (St Gemma’s Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK). This retrospective cohort study aimed to identify patient and organisational factors that influence the duration of hospice-based palliative care in the United Kingdom prior to death. The results of this study found that despite increasing rhetoric around early referral, patients with advanced disease are receiving referrals to hospice specialist palliative care very late in their illness trajectory. Age and diagnosis persist as determinants of duration of hospice specialist palliative care before death. Full paper available from: http://journals.sagepub.com/doi/abs/10.1177/0269216318781417 If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu: anwosu@liverpool.ac.uk

This episode features Professor David Currow (University of Technology Sydney, Ultimo, NSW, Australia. Wolfson Palliative Care Research Centre, University of Hull, Hull, UK). This transnational online survey aimed to determine the impact of a phase III randomised controlled trial on palliative care clinicians’ self-reported practice change.  The orginal study in question described the use of octreotide in the management of inoperable malignant bowel obstruction. This survey was distributed in 2016, 2 years after the first publication of the study in a peer-reviewed journal.The results demonstrated that out of 106 respondents, 52 (49.1%) indicated modified practice (60.9% of those who had previously prescribed octreotide in this setting). In those who reported practice change, most frequently octreotide was now used when other therapies failed. The results suggest that there is a cohort of ‘early adopters’ within palliative care practice as new evidence becomes available. Full paper available from: http://jou

This episode features Dr Karen Neoh (St Gemma's Academic Unit of Palliative Care). This is the first study to interview hospice inpatients to explore their views about the corneal donation. The study found that patients are willing to discuss donation and further exploration of patients views should be undertaken. Full paper available from: No link avilable yet If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu: anwosu@liverpool.ac.uk