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SAGE Palliative Medicine & Chronic Care

Want to hear latest research in Palliative Medicine? Want to receive practical guidance to clinical practice in palliative patient care?   Every month, this podcast features an author from Palliative Medicine, a highly ranked, peer reviewed scholarly journal dedicated to improving knowledge and clinical practice in the palliative care. In these focussed 10 minute episodes, the authors provide a personal interpretation of their published work. You’ll hear learn from original papers, reviews, case reports, editorials and other interesting work published in the journal.
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Now displaying: 2017
Dec 15, 2017

This episode features Anna Bone (Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London). This study aimed to project where people will die from 2015 to 2040 across all care settings in England and Wales.

The study was a population-based trend analysis and projections using simple linear modelling. All deaths (2004–2014) from death registration data and predicted deaths (2015–2040) from official population forecasts in England and Wales. Age- and gender-specific proportions of deaths in hospital, care home, home, hospice and ‘other’ were applied to numbers of expected future deaths. 

The study demonstrated that if current trends continue, the number of deaths in care homes and homes will increase by 108.1% and 88.6%, with care home the most common place of death by 2040. If care home capacity does not expand and additional deaths occur in hospital, hospital deaths will start rising by 2023. Due to increasing demand, in order to sustain current trends, end-of-life care provision in care homes and the community needs to double by 2040. An infrastructure across care settings that supports rising annual deaths is urgently needed; otherwise, hospital deaths will increase.Full paper available from: http://journals.sagepub.com/doi/abs/10.1177/0269216317734435

Oct 11, 2017

This episode features Briony Hudson (Louis Dundas Centre for Children’s Palliative Care, UCL Institute of Child Health, London, UK
 and Marie Curie Palliative Care Research Department, UCL Division of Psychiatry, London, UK) and Linda Oostendorp, (Marie Curie Palliative Care Research Department, UCL Division of Psychiatry, London, UK). They describe their study which aimed to explore how children and young people (aged 0–25 years) with life-limiting conditions or life-threatening illnesses and their families were identified, invited and consented to research published in the last 5 years. The study was a systematic of (quantitative, qualitative and mixed methods) research published between 2009 and 2014, recruiting children and young people with life-limiting conditions or life-threatening illness and their families. A total of 215 studies – 152 qualitative, 54 quantitative and 9 mixed methods – were included.

The study demonstrated that all stages of recruitment in children were under reported. Most studies did not provide information of how children were identified or invited to participate in research. Transparency in reporting of participant identification, invitation and consent is needed to enable researchers to understand research implications, bias risk and to whom results apply. Research is needed to explore why consenting participants decide to take part or not and their experiences of research recruitment. Consequently, future papers should clearly state (1) how eligible participants were identified, (2) how people were invited to participate and (3) why people decide to take part or not. Full paper available from: http://journals.sagepub.com/doi/abs/10.1177/0269216316663856


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

Oct 3, 2017

This episode features Wendy Duggleby (University of Alberta, Edmonton,  Canada) who describes a study which aimed to (a) explore the transition experience of family caregivers caring for persons with advanced cancer living in the community, (b) describe potential triggers for transitions, (c) identify what influences this experience, and (d) develop a conceptual framework of their transition experience.

The study was a meta-synthesis review of qualitative (and mixed-method) research, which described caregiving experiences of family caregivers for community-living persons with advanced cancer at the end of life. Seventy-two studies were included.

The study reports how family caregivers experience a “life transition” whereby their lives are permanently altered. The participants described the process of redefining normal which consisted of coming to terms with their situation and connecting with others. Outcomes of these processes were as follows: (a) maintaining a sense of personhood, (b) reframing hope, (c) maintaining self-efficacy, (d) finding meaning, and (e) preparing for the death of their care recipient. The take home message is that family caregivers will reuire support to deal with these significant changes; however, positive outcomes are possible when based on evidence. These findings provide a framework to guide the development of supportive programs and future research. Full paper available from: http://journals.sagepub.com/doi/abs/10.1177/0269216316673548

Sep 4, 2017

This episode features Claudia Virdun (Faculty of Health, University of Technology Sydney (UTS), Ultimo, NSW, Australia) who describes a study which aimed to gain a richer and deeper understanding of elements of end-of-life care that consumers consider most important within the hospital setting.

The study was a meta-synthesis (review of all the qualitative research on a given subject) of consumer narratives reporting what they considered important elements of end of life care. Sixteen studies were included. Synthesis yielded 7 patient and 10 family themes including 6 common themes: (1) expert care, (2) effective communication and shared decision-making, (3) respectful and compassionate care, (4) adequate environment for care, (5) family involvement and (6) financial affairs. Maintenance of sense of self was the additional patient theme, while the four additional family themes were as follows: (1) maintenance of patient safety, (2) preparation for death, (3) care extending to the family after patient death and (4) enabling patient choice at the end of life.

The take home message is that patients and carers have been consistent in the factors that they consider important in end of life care. Systems are needed to enable optimal end-of-life care, in accordance with consumer priorities, and embedded into routine hospital care. Full paper available from: http://journals.sagepub.com/doi/abs/10.1177/0269216316673547


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

Aug 23, 2017

This episode features Suresh Kumar Chhetri (Preston MND Care and Research Centre, Department of Neurology, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK) who describes a study which aimed to explore patients' experience of enteral feeding and its impact on quality of life.

The study was a questionnaire based prospective analysis of 21 MND patients receiving enteral feeding followed at 3, 6 an 12 months post gastrostomy. The questionnaire was asked participants about their quality-of-life.

The study focused on four main themes: (1) problems with enteral feeding (2) improved quality-of-life (3) no change in quality-of-life and (4) worse quality-of-life. The research found that most of the study participants acknowledged the importance of enteral feeding and had a positive attitude to this practice. However, the positive impact of enteral feeing may not be observable in the first few months post gastrostomy. Full paper available from: http://journals.sagepub.com/doi/abs/10.1177/0269216316679928

Aug 18, 2017

This episode features Professor Matthew Allsop (Leeds Institute of Health Sciences, University of Leeds, Leeds, UK) who describes a study that outlined and applied an evaluation framework to examine how and when electronic documentation of advance care planning is occurring in end of life care services.

The study extracted data from electronic palliative care coordination systems for 82 of 108 general practices across a large UK city. 

This study reports the first methodology for evaluating how and when electronic palliative care coordination systems documentation is occurring. It raises questions about what can be drawn from routine data collected through electronic palliative care coordination systems and outlines considerations for future evaluation.. Full paper available from: http://journals.sagepub.com/doi/full/10.1177/0269216316663881

Jul 18, 2017

This episode features Professor Liz Forbat (Australian Catholic University, Canberra, ACT, Australia) and Rachel Bilton-Simek (Calvary Public Hospital Bruce, Canberra, ACT, Australia). Together they describe a Single-arm mixed-method feasibility proof-of-concept trial which aimed to design and test an innovative distance-learning educational package (PrECEPt: PalliativE Caregivers Education Package).

The study determined that distance learning is acceptable and feasible for both caregivers and healthcare professionals. Two modules were developed and tested (nutrition/hydration and pain management) with 18 caregivers. The materials did not have a statistically significant impact on carer self-efficacy. However, statistically significant improvements were observed on the two subsidiary measures of (1) caregiving tasks, consequences and needs (p = 0.03, confidence interval: 0.72, 9.4) and (2) caregiver preparedness (p = 0.001, confidence interval: −1.22, −0.46). 

In conclusion the findings demonstrates education improves caregiver preparedness and is a feasible and acceptable approach. Full paper available from: http://journals.sagepub.com/doi/full/10.1177/0269216317712849

Jul 3, 2017

This episode features the work of Philippa Cahill et al (School of Medicine, The University of Notre Dame Australia, Sydney, NSW, Australia) who describes a systematic review that examines the evidence supporting family meetings as a strategy to address the needs of palliative patients and their families.

The authors found that there was low-level evidence to support family meetings. Only two quantitative pre- and post-studies used a validated palliative care family outcome measure with both studies reporting significant results post-family meetings. Four other quantitative studies reported significant results using non-validated measures.

In conclusion the findings demonstrates that there is a paucity of evidence to support family meetings in the inpatient palliative care setting. Further research using more robust designs, validated outcome measures, and an economic analysis are required to build the family meeting evidence before they are routinely adopted into clinical practice. Full paper available from: http://journals.sagepub.com/doi10.1177/0269216316658833

Jul 3, 2017

This episode features the work of Professor David Currow et al (Flinders University, Adelaide, SA, Australia) who describes a study which aimed to compare characteristics, expressed unmet needs and outcomes for spousal caregivers, with other caregivers at the end of life, by gender and age. The study used data from The South Australian Health Omnibus (an annual, random, face-to-face, cross-sectional survey wherein respondents are asked about end-of-life care). The authors found that bereaved spousal caregivers were more likely to be older, female, better educated, have lower incomes, less full-time work, English as second language, sought help with grief and provided more day-to-day care for longer periods. Spousal caregivers were less likely to be willing to take on caregiving again, less able to ‘move on’ with life and needed greater emotional support and information about illness and services. In conclusion, spousal caregivers are different from other caregivers, with more intense needs that are not fully met. Full paper available from: http://journals.sagepub.com/doi/abs/10.1177/0269216316663855?journalCode=pmja

Jun 13, 2017

This episode features the work of Dr Eliza M Park et al (Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA) who describes a study which aimed to describe the experience of living with advanced cancer as a parent, including illness experience, parental concerns, and treatment decision making and to explore whether these experiences differ by their functional status. The study was a cross-sectional, qualitative study using in-depth, semi-structured interviews. Data were analyzed using thematic content analysis. The results demonstrated four themes regarding the experience of being a parent with advanced cancer: (1) parental concerns about the impact of their illness and death on their children, (2) “missing out” and losses of parental role and responsibilities, (3) maintaining parental responsibilities despite life-limiting illness, and (4) parental identity influencing decision making about treatment. Full paper available from: http://journals.sagepub.com/doi/abs/10.1177/0269216316661686

May 8, 2017

This episode features the work of Dr Hilde Buiting et al (Netherlands Cancer Institute, Amsterdam and Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht) who conducted a medical record review of patients selected selected patients from the nationwide Netherlands Cancer Registry. The aim of the study was to explore the content of medical records of patients with advanced non-small cell lung cancer and pancreatic cancer with specific emphasis on doctors’ notes about decisions on palliative systemic treatment. Full paper from: http://journals.sagepub.com/doi/abs/10.1177/0269216316661685?journalCode=pmja

May 8, 2017

This episode features the work of Dr Peter Tanuseputro et al (Bruyère Research Institute and Ottawa Hospital Research Institute, Ottawa, ON, Canada) who conducted a retrospective population-level cohort study, describing palliative care in the last year of life using linked health administrative databases which the aim to provide a population perspective on end-of-life palliative care delivery across health sectors. Full paper from: http://journals.sagepub.com/doi/full/10.1177/0269216316653524

May 8, 2017

This episode features the work of Dr Alze Tavares et al (Hospital Paulistano, Sao Paulo, Brazil) who conducted a study which aimed to implement a patient-centred outcome measure in daily practice, in order to fulfil one quality indicator, which is to improve pain during the 72 hours after admission, in at least 75% of patients.. Full paper from: http://journals.sagepub.com/doi/full/10.1177/0269216316655349

Mar 27, 2017

In this episode Dr James Downar (University of Toronto, Canada) presents a study which aimed to determine whether standardized patient simulation offers benefit over didactic sessions alone for improving skill and comfort discussing goals of care of first-year internal medicine residents. Full paper from: http://journals.sagepub.com/doi/full/10.1177/0269216316652278

Mar 21, 2017

In this episode Professor Robin Cohen (Departments of Oncology and Medicine, McGill University, Montreal, QC, Canada) presents a study which aimed to revise the McGill Quality of Life Questionnaire (McGill Quality of Life Questionnaire–Revised) while maintaining or improving its psychometric properties and length, keeping it as close as possible to the McGill Quality of Life Questionnaire to enable reasonable comparison with existing McGill Quality of Life Questionnaire literature. A copy of the questionnaire can be requested by email (robin.cohen@mcgill.ca).  Full paper from: http://journals.sagepub.com/doi/full/10.1177/0269216316659603

Feb 28, 2017

In this episode Simon Noah Etkind (King’s College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, London, UK) presents the results of a secondary thematic analysis of interviews study. The study aimed to understand patient experiences of uncertainty in advanced illness and subsequently develop a typology of patients’ responses. Full paper from: http://journals.sagepub.com/doi/full/10.1177/0269216316647610

Jan 27, 2017

In this episode Dr Alastair Canaway (Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick) presents the findings of  study which aimed to develop an outcome measure suitable for use in economic evaluation that captures the benefits of end-of-life care to those close to the dying. Full paper from: http://journals.sagepub.com/doi/abs/10.1177/0269216316650616

Jan 27, 2017

In this episode Yolanda Penders (End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium) presents a study which aimed to investigate the self-reported out-of-pocket costs associated with healthcare in the last year of life of older adults in Europe. Full paper from:http://pmj.sagepub.com/content/early/2016/04/27/0269216316647206.abstract

Jan 26, 2017

In this episode  Camilla Zimmermann (University of Toronto) presents the findings of qualitative study which aimed to determine, from a participant perspective, the experience of receiving early palliative care and elements of that care. Full paper from: http://journals.sagepub.com/doi/abs/10.1177/0269216316649126

Jan 24, 2017

In this episode Professor Myra Bluebond-Langner (Louis Dundas Centre for Children’s Palliative Care) discusses the challenges faced by researchers aiming to recruit children and young people (CYP) with life-limiting conditions (LLCs) or life-threatening illnesses (LTIs) to research studies. For the full paper: http://pmj.sagepub.com/content/30/10/979

Jan 24, 2017

In this episode Dr Richard Harding (Kings College London) presents a study of drug-susceptible and drug-resistant tuberculosis. Specifically the study aimed to (1) identify most burdensome problems, (2) compare intensity of problems for drug-susceptible and drug-resistant tuberculosis and (3) identify predictors of problem identifiers. Full paper from: http://pmj.sagepub.com/content/30/9/862.long

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