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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: 2019
Dec 12, 2019

This episode features Dr Nicola White  and Dr Linda Oostendorp (Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London (UCL), London, UK). Recognising dying is a core clinical skill. There is inconsistent training in the United Kingdom and both medical students and doctors report feeling unsure and ill prepared when working with a dying patient and their family. This study suggests that the online training resource can alter what information medical students review, to make decisions more like that of the experts. This online training resource could be used to facilitate learning in this complex area, and provide a complementary education approach to clinical training.



Oct 17, 2019

This episode features Brett Scholz (Medical School, The Australian National University, Acton, ACT, Australia).  Consumer involvement is required by policy at all levels of health services. Some health disciplines have well-established research programmes focusing on consumer leadership. Palliative care is philosophically consumer-centred, but there has been less of a focus on consumer leadership at the systemic level of palliative care services. The review demonstrates that consumer leadership is an emerging practice in palliative care services and academia. Despite the potential challenges of consumer leadership, consumers are motivated to be engaged with the sector. Consumers are still not as involved in setting agendas in palliative care as policies require. The review findings extend understandings of how to better support consumer leaders, suggesting palliative care service providers educated by consumer academics may be more aware of power imbalances and thus later be able to use their influence for further consumer leadership. To meet policy requirements and realise benefits brought by consumers’ perspectives, more research conducted with (rather than on) consumers in palliative care is needed. Policy requires partnerships with consumers at all stages of palliative service planning, implementation, delivery and evaluation, but does not provide a guide for best practice about how such partnerships are done without tokenism.

 
Full paper available from: https://journals.sagepub.com/doi/full/10.1177/0269216319854012

 
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 1, 2019

This episode features Mary Scott (Ottowa Hospital Research Institute. Bruyere Research Institute). Many patients and families report improved satisfaction of care when palliative care when they are supported by palliative care specialist teams. Transitions of care from one setting to another are burdensome. Evidence suggests that palliative care can improve this transition from hospital to community support. This narrative systematic review aimed to determine whether paliative care can impact that transition from hospital to home. Fifteen articles were included. Involvement of specialist inpatient palliative care was associated with lower readmission rates, higher referral to hospice and better provision of services after discharge. Heterogenity of study designs were evident. Consequently, futher research is needed to evaluate this area further.

 
Full paper available from: https://journals.sagepub.com/doi/full/10.1177/0269216319870649

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

 

 

Dr Amara Nwosu, MBChB (Commendation), MRCP, PhD

Consultant in Palliative Medicine, Academic Palliative & End of Life Care Department, Royal Liverpool & Broadgreen University Hospitals NHS Trust. 
Honorary Senior Clinical Lecturer, Palliative Care Institute Liverpool, University of Liverpool.
Research Lead, Marie Curie Hospice Liverpool.
Research Scholars Programme, National Institute for Health Research (NIHR) North West Clinical Research Network (CRN)
Technology Editor, Palliative Medicine. Sage Publications. http://pmj.sagepub.com/ 

Office:             0044 151 706 2274
Email:              anwosu@liverpool.ac.uk
Web:                www.pcil.org.uk

http://www.amaranwosu.com/ 
Twitter: @amaranwosu 
AmiPal Palliative care podcast: https://soundcloud.com/mypal

Jul 26, 2019

This episode features Dr Amara Nwosu (Palliative Care Institute Liverpool and Marie Curie Hospice Liverpool, Liverpool, UK).  Medical robots have mainly been used to support surgical procedures and for a variety of assistive uses in dementia and elderly care. There has been limited debate about the potential opportunities and risks of robotics in other areas of palliative, supportive and end-of-life care. The potential opportunities of robotics in palliative, supportive and end-of-life care include a number of assistive, therapeutic, social and educational uses. There is concern that robots will exacerbate healthcare inequalities, disrupt the workforce and reduce face-to-face human interaction. Future work should evaluate the health-related, economic, societal and ethical implications of using robotic technology in palliative, supportive and end-of-life care. There is a need for collaborative research to establish use-cases and policy recommendations to guide the appropriate use of robots for people with serious illness.

Full paper available from:   https://journals.sagepub.com/doi/full/10.1177/0269216319857628
 
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 26, 2019

This episode features André Filipe Ribeiro (Universidade do Porto, Porto, Portugal). The number of patients with morbidities and other complex injuries due to burns has grown over the years. This kind of burn injuries can have a high impact in the physical and psychological health, cause social transformations and changes in role functioning. Palliative care is an active and global specialty of care that can take prominence as a strengthening component of integrated treatment. This systematic review offers a comprehensive overview about the potential benefits of integrating palliative care in burn intensive care units. The integration of palliative care in burn intensive care units can improve patients’ comfort, decision-making processes, and family care. This systematic review can raise awareness about the potential of integrating palliative care in burn intensive care units to both policy makers and healthcare professionals. This review highlights the need for further research in order to develop a better understanding on how palliative care can be best integrated in the care process of patients in burn intensive care units.
 
Full paper available from:   https://journals.sagepub.com/doi/10.1177/0269216319862160

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 22, 2019

This episode features Rebecca Anderson (Marie Curie Palliative Care Research Department,  University College London, London, UK).  Poor communication from healthcare professionals is a common complaint from relatives of patients at the end-of-life. Communication with relatives at this time is important for high quality end-of-life care and for relatives’ long-term well-being. Common communication strategies are identified including highlighting the patient’s deterioration to aid decision-making, references to patient wishes, providing relatives with options, tailoring information to individuals and using pacing and staging of information. Healthcare professionals state a belief in using honest, direct language and involving families in decision-making, but there is variation in the extent to which this is implemented in practice. Nurses and allied healthcare professionals play an important role in providing individualized communication with relatives. There is a need for more research on communication with relatives in palliative care settings and with different members of the multidisciplinary team. Training is needed to help healthcare professionals to translate communication guidelines into practice while considering their own emotional needs. Interventions such as question prompt list could also be used to help relatives get the information they need.
 

Full paper available from: https://journals.sagepub.com/doi/full/10.1177/0269216319852007

 
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 19, 2019

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, please contact Dr Amara Nwosu: anwosu@liverpool.ac.uk

Jul 3, 2019

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 worries about their disease and future. Participants with advanced cancer highlight how they would like the complementary therapy delivered including the importance of building a special relationship with the complementary therapist and a need for more frequent sessions. Hospices and other palliative care environments should continue/consider offering aromatherapy, reflexology and massage where possible and it should be seen as an important aspect of the palliative care people receive. Researchers should develop complementary therapy interventions in the ways in which the palliative care population, with cancer and other advanced diseases, wish them to be delivered.
 
 
Full paper available from:  https://journals.sagepub.com/doi/full/10.1177/0269216319846440

 
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

May 7, 2019

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 may be needed at different time points in different trajectories. This may require rapid mobilisation of carer support and modification of care plans preceding a precipitous functional decline (Trajectory 1). Extended periods of support to maintain patient function and support carers are required for those with a prolonged slow rate of functional decline (Trajectory 2).


Full paper available from:  https://journals.sagepub.com/doi/full/10.1177/0269216319839024
 
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

May 7, 2019

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@liverpool.ac.uk

May 3, 2019

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/doi/full/10.1177/0269216319845804

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 11, 2019

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 settings broadly aligns with EAPC recommendations for proportionate use of sedatives at the end of life. Nevertheless, although the EAPC framework also recommends systematic objective monitoring to monitor the effects of sedatives, clinicians in these settings use only clinical observation, never structured objective tools, even when using high doses of sedatives.

The term ‘palliative sedation’ does not usefully describe all uses of sedative medication in palliative care, since this implies sedation is the aim, which is not always the case. Proportionate sedation might be a preferable term for the type of practice we found in our study. Palliative care guidelines and definitions should clearly distinguish between deep sedation and other uses of sedatives in palliative care. When higher doses of sedative medication are used and/or when the specific intention is to sedate a patient, clinicians may need to employ more structured monitoring of sedative effects.
 
Full paper available from: https://journals.sagepub.com/doi/full/10.1177/0269216319826007
 
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 17, 2019

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://journals.sagepub.com/doi/full/10.1177/0269216318818299

 
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 17, 2019

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, particularly those committed to brilliant palliative care. Despite the contributions of this study, policies are required to guide and sustain brilliant home-based palliative care across different settings.
 
Full paper available from: https://journals.sagepub.com/doi/full/10.1177/0269216318807835

 
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 9, 2019

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 of current and future care preferences in this population. When addressing care preferences with patients and families, clinicians should discuss what may be an achievable normal for them within their social context. Prospective longitudinal study will allow exploration of influences on the stability of care preferences following acute illness.

 
Full paper available from: https://journals.sagepub.com/doi/full/10.1177/0269216318817706

Jan 7, 2019

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 about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu: anwosu@liverpool.ac.uk

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