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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: 2018
Dec 10, 2018

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 available from: https://journals.sagepub.com/doi/10.1177/0269216318815377

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

Nov 27, 2018

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/10.1177/0269216318810421

 
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

Nov 2, 2018

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

Oct 15, 2018

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 pathways. Further research is needed to determine if the views held by patient participants are reflective of the wider population of those receiving systemic therapy with palliative intent.

Full paper available from: http://journals.sagepub.com.liverpool.idm.oclc.org/doi/full/10.1177/0269216318794086

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 15, 2018

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 restrictive approach to red blood cell transfusions are needed. Furthermore, clinicians should discuss with patients the limited benefit versus higher risks of red blood cell transfusion in this patient group to inform treatment decisions and ensure informed consent.

Full paper available from: http://journals.sagepub.com.liverpool.idm.oclc.org/doi/full/10.1177/0269216318801755

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 12, 2018

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.sagepub.com/doi/full/10.1177/0269216317711322

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 7, 2018

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 Cancer Home-Life Intervention was found on the primary outcome; however, people with advanced cancer have substantial problems performing activities of daily living. The majority need an intervention addressing these problems. Therefore, will benefit from occupational therapy. Future research should identify the appropriateness of the intensity, duration and timing of the intervention. 

Full paper available from: http://journals.sagepub.com/doi/abs/10.1177/0269216317747199


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

Jul 17, 2018

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

Jul 12, 2018

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://journals.sagepub.com/doi/abs/10.1177/0269216318778460?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed

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

Jul 5, 2018

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

Apr 25, 2018

This episode features Merryn Gott (School of Nursing, The University of Auckland, Auckland, New Zealand). The aim of this study was to explore the role of community at end of life for people dying in advanced age from the perspective of their bereaved family caregivers. The study used a constructionist framework underpinned a qualitative research design. Data were analysed using critical thematic analysis.
A reduction in the social networks and community engagement of the older person was identified in the end-of-life period. Numerous barriers to community engagement in advanced age were identified. This study provides strong support for public health approaches to palliative care that advocate building social networks around people who are dying and their family carers. However, it also indicates that strategies to do so must be flexible enough to be responsive to the unique end-of-life circumstances of people in advanced age.

Full paper available from: http://journals.sagepub.com/doi/abs/10.1177/0269216317735248


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

Apr 10, 2018

This episode features Professor Miriam Johnson (Director, Wolfson Palliative Care Research Centre, Hull York Medical School). The aim of this study was to: establish cardiology led palliative care versus usual care was feasible, to assess quality of data capture, to facilitate future sample size calculation and to assess survival.  Study design was a feasibility, non-randomised trial, which recruited unmatched symptomatic heart failure patients who were receiving maximal therapy for their disease.

The study recruited 77 participants (43 in palliative cardiology and 34 usual care). The study concluded that a future trial is feasible. No difference in survival was noted between the intervention and control groups. This study concludes that cardiology led palliative care may improve care delivery, but further research is required to test this hypothesis further.

Full paper available from:https://doi.org/10.1177/0269216318763225

Mar 16, 2018

This episode features Rachel Depner (Palliative Care Institute, The Center for Hospice & Palliative Care, New York, USA). She reports on her study which aimed to (a) describe a prison-based end-of-life program utilizing inmate peer caregivers, (b) identify inmate-caregiver motivations for participation, and (c) analyze the role of building trust and meaningful relationships within the correctional end-of-life care setting. A total of 22 semi-structured interviews were conducted with inmate-caregivers. Data were analyzed using Consensual Qualitative Research methodology. The study finds that, in total, five over-arching and distinct domains emerged; this manuscript focuses on the following three: (a) program description, (b) motivation, and (c) connections with others. The findings suggest that inmate-caregivers believe they provide a unique and necessary adaptation to prison-based end-of-life care resulting in multilevel benefits. These additional perceived benefits go beyond a marginalized group gaining access to patient-centered end-of-life care and include potential inmate-caregiver rehabilitation, correctional medical staff feeling supported, and correctional facilities meeting end-of-life care mandates. Additional research is imperative to work toward greater standardization of and access to end-of-life care for the incarcerated.

Full paper available from: http://journals.sagepub.com/doi/abs/10.1177/0269216318755624?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed

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

 

Mar 15, 2018

This episode features Professor Gunn Grande (University of Manchester, Manchester, UK). The aim of this qualitative study was to explore whether and how family carers are currently supported during patient discharge at end of life; to assess perceived benefits, acceptability and feasibility of using The Carer Support Needs Assessment Tool (CSNAT) Approach in the hospital setting to support carers. The study identified current barriers to supporting carers at hospital discharge, which were an organisational focus on patients’ needs, what practitioners perceived as carers’ often ‘unrealistic expectations’ of end-of-life caregiving at home and lack of awareness of patients’ end-of-life situation. The CSNAT Approach was viewed as enabling carer support and addressing difficulties of discussing the realities of supporting someone at home towards end of life. Implementation in hospital required organisational considerations of practitioner workload and training. To enhance carer support, a two-stage process of assessment and support (hospital with community follow-up) was suggested using the CSNAT as a carer-held record to manage the transition.

This study identifies a novel intervention, which expands the focus of discharge planning to include assessment of carers’ support needs at transition, potentially preventing breakdown of care at home and patient readmissions to hospital.

Full paper available from: http://journals.sagepub.com/doi/abs/10.1177/0269216318756259?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed

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

Jan 22, 2018

This episode features Dr. Mariona Guerrero (Universitat Internacional de Catalunya, Barcelona, Spain). She reports on her systematic review which aimed to identify meaning in life interventions implemented in patients with advanced disease and to describe their context, mechanisms and outcomes.

The study was a Systematic review of four electronic databases, and involved a realist synthesis of meaning in life interventions using criteria from the Realist And Meta-narrative Evidence Syntheses: Evolving Standards project.

A total of 12 articles were included in the systematic review, corresponding to nine different interventions. Analysis of context, mechanisms and outcomes configurations showed that a core component of all the interventions was the interpersonal encounter between patient and therapist, in which sources of meaning were explored and a sense of connectedness was re-established. Meaning in life interventions were associated with clinical benefits on measures of purpose-in-life, quality of life, spiritual well-being, self-efficacy, optimism, distress, hopelessness, anxiety, depression and wish to hasten death. This review provides an explanatory model of the contextual factors and mechanisms that may be involved in promoting meaning in life. These approaches could provide useful tools for relieving existential suffering at the end of life.

Full paper available from: http://journals.sagepub.com/doi/abs/10.1177/0269216316685235

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

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