Thursday 5 June 2008

Prostate cancer: palliative care and pain relief.

Prostate cancer: palliative care and pain relief.
British medical bulletin, 2007 (epub: 12 Jul 2007), vol. 83, p. 341-54, 40 refs
Thompson-J-C, Wood-J, Feuer-D.
Abstract
Introduction Metastatic prostate cancer is incurable and causes significant morbidity. The focus of treatment should be on improving quality of life through appropriate oncological treatment and palliative care. The National Institute for Clinical Excellence guidelines for urological cancer recommends palliative care for all patients with prostate cancer, according to need. This paper outlines the principles of modern palliative care in patients with metastatic prostate cancer within the UK. Discussion We highlight the main physical symptoms encountered in metastatic prostate cancer and their management. We also introduce the UK Department of Health's 'End-of- Life Care Programme'. This initiative intends to improve the lives and deaths of all patients with incurable disease and should be a priority for all health care professionals, within any setting. Conclusion Clearly, we have addressed the management of metastatic prostate cancer within the UK setting, though any of these government initiatives may provide a resource and framework in other countries.

Social science & medicine Dec 2007 (epub: 14 Sep 2007), vol. 65, no. 11

The role of the bioethicist in family meetings about end of life care.
p. 2328-41
Watkins-Liza-T, Sacajiu-Galit, Karasz-Alison.
Abstract
There has been little study of the content of bioethicists' communication during family meeting consultations about end of life care. In the literature, two roles for bioethicists are usually described: the consultant role, in which bioethicists define and support ethical principles such as those enshrined in the rational choice model; and the mediator role, which focuses on the enhancement of communication in order to reduce conflict. In this study, we use observational data to explore how bioethicists support the practice of decision making during family meetings about end of life care. In a study conducted in the Bronx, New York, USA, researchers observed and recorded 24 decision-making meetings between hospital staff and family members of elderly patients identified as being in the last stages of illness, who were unable or unwilling to make the decision for themselves. Bioethics consultants were present during five of those meetings. Although bioethicists referred to the rational choice decision-making hierarchy, we did not see the systematic exploration described in the literature. Rather, our data show that bioethicists tended to employ elements of the rational model at particular turning points in the decision-making process in order to achieve pragmatic goals. As mediators, bioethicists worked to create consensus between family and staff and provided invaluable sympathy and comfort to distressed family members. We also found evidence of a context- dependent approach to mediation, with bioethicists' contributions generally supporting staff views about end of life care. Bioethicists' called to consult on family meetings about end of life care do not appear to adhere to a strict interpretation of the official guidelines. In order to negotiate the difficult terrain of end of life decision making, our data show that bioethicists often add a third role, persuader, to official roles of consultant and mediator.

A critical examination of home care: end of life care as an illustrative case.
p. 2317-27
Exley-Catherine, Allen-Davina.
University of Newcastle upon Tyne, Newcastle upon Tyne, UK. catherine.exley@ncl.ac.uk.
Abstract
Drawing on end of life care as an illustrative case, this paper critically examines the provision of care in the home, identifying a number of inherent tensions. For 60 years the hospital has been the preferred site of care. However, the UK caring division of labour is currently undergoing a process of (re)domestication and the provision of home care is increasingly regarded as a 'gold standard' for the organisation of care, in institutional and domestic contexts. In this paper we argue that while 'home care' policies serve a range of professional and political agendas, they contain unacknowledged contradictions and strains, creating challenges for both family and professional carers. The realities of home care are examined through reconceptualising qualitative data generated from three research projects concerned with dying in the community. We argue that, whilst previous work has highlighted the burdens the redomestication of care places upon carers, home care philosophies and policies have led to over-romanticised notions of care which privilege the value of caring relationships without acknowledging the dynamic interaction of such social relationships with the actual work of caring. Moreover, such policy trends have created a nexus of social expectations and obligations for which modern society is unprepared. With reference to both end of life care, and home care more widely, we argue that health care planners and professionals need to think more critically about the way care is delivered. Home is not merely about a physical space, but the social and emotional relationships therein. Good 'home care,' characterised by attention to patient-centred needs and flexible in design and scope, does not have to be located within the private sphere; relationships may actually be maintained and nurtured by enabling people to have a realistic choice of care in an institution.

Integration of a palliative and terminal care center into a comprehensive pediatric oncology department.

Integration of a palliative and terminal care center into a comprehensive pediatric oncology department.
Pediatric blood & cancer, May 2008, vol. 50, no. 5, p. 949-55
Golan-Hana, Bielorai-Bella, Grebler-Dorit, Izraeli-Shai, Rechavi- Gideon, Toren-Amos.
Abstract
BACKGROUND: The sharp division between curative cancer therapy and palliative care results in the late introduction of palliative care and a high incidence of suffering in children with cancer. We established a Palliative Care Unit (PCU) that is fully integrated with the Pediatric Hematology Oncology Department (PHOD). We wished to explore the impact of such integrative model on patterns of hospitalizations and exposure to palliative care of pediatric oncology patients. PROCEDURES: Retrospective search of medical records of patients admitted to the PHOD since PCU establishment in 1999, and of children who died from progressive disease between 1990 and 2005 was performed. Differences in clinical and prognostic variables between PCU and non-PCU patients, and differences in location of death before and after PCU establishment were evaluated. RESULTS: The majority (59%) of patients, who were hospitalized after the PCU establishment, were hospitalized in the PCU, including 49% of the good prognosis patients and 91% of the poor prognosis patients. Poor prognosis patients were hospitalized in the PCU earlier and with higher frequency compared to children with curable disease. After PCU opening there was a significant decline in the percentage of patients who died in the general pediatric ward, hematology-oncology ward, and at home from 40%, 26% and 28% to 4%, 8%, and 16%, respectively. CONCLUSIONS: Our integrative model results in exposure of the majority of children with cancer to palliative care. For poor prognosis patients, palliative care is introduced early enough to allow gradual transition from symptom control after diagnosis to end of life care.
Comment in: Pediatr Blood Cancer. 2008 May; 50(5):945-6.

Palliative-care trials: how best to publish findings?

Palliative-care trials: how best to publish findings?
The lancet oncology, May 2008, vol. 9, no. 5, p. 411-2
Mauer-Murielle-E, Bottomley-Andrew, Collette-Laurence, Slotman-Ben-J.
Publication type
Comment, Letter.
Comment on: Lancet Oncol. 2008 Mar; 9(3):186-7.

Can the death of a child be good?

Can the death of a child be good?
Journal of pediatric nursing, Apr 2008, vol. 23, no. 2, p. 120-5, 37 refs
Welch-Susan-Bush.
Abstract
Fifty-four thousand children die each year despite the advances in care for children with acute and chronic illnesses. Demands for improved palliative and end-of-life care for children exist. Good death is a concept frequently used in the adult hospice movement. However, how can the death of a child be good? Analysis of good death can assist pediatric nurses to understand the concept and provide a framework for nurses in the clinical and research arenas to work together to develop and provide evidence-based, developmentally appropriate care for dying children and their families.

A qualitative investigation of the palliative care needs of terminally ill people who live alone.

A qualitative investigation of the palliative care needs of terminally ill people who live alone.
Collegian (Royal College of Nursing Australia), 2008, vol. 15, no. 1, p. 3-9
Aoun-S, Kristjanson-L-J, Oldham-L, Currow-D.
Abstract
This paper investigates the support needs of people living alone with a terminal illness from a client perspective. In depth, interviews were conducted with 11 clients from Silver Chain Hospice Care in Western Australia to capture their personal experiences of managing at home alone and to assess their physical, social and emotional needs. Findings provided useful insights with respect to many of the motivations, beliefs and wishes of individuals who endeavour to cope on their own with minimal assistance. The needs of these individuals are practical, emotional, physical and existential. At the heart of these concerns is a strong need to be independent and maintain a sense of dignity at end of life.

Applied physiology nutrition and metabolism Feb 2008, vol. 33, no. 1

Use of parenteral nutrition in patients with advanced cancer.
p. 102-6
Soo-Isaac, Gramlich-Leah.
Abstract
The purpose of this study is to describe patient-related variables in a cohort of advanced cancer patients (ACPs) enrolled in a home parenteral nutrition (HPN) program. This study reviewed the cohort of ACPs enrolled in the Northern Alberta Home Total Parenteral Nutrition Program (NAHTPNP). Thirty-eight ACPs received HPN during the study period, 24% of all patients admitted for PN. Of these, 27 (71%) were female. Mean age was 48.76 y (SD 13.8 y). Bowel obstruction was the most common indication for initiating HPN (84%, 32) and ovarian cancer was the most common malignancy (34%, 13). Patients who began HPN with a Karnofsky performance status (KPS) of greater than 50 (median of 70) were found to have a longer duration of life (median: 6 months) compared with patients who began HPN with a KPS of 50 or below (median=50; median 3 months; p=0.01; two-tailed). There was no difference in survival between malignancy type (p=NS). Advanced cancer is the fastest growing indication for enrollment in the HPN program. ACP demonstrated a 3% average annual increase proportionate to all indications for HPN starts, accounting for 7%-48% of HPN starts from 1999-2006. HPN is an increasingly used therapy for patients with advanced cancer, most commonly for intestinal failure in the setting of bowel obstruction. Initiation of HPN at a higher KPS was associated with a longer duration of life. Further studies are needed to validate the use of TPN in end-stage cancer patients.

Home parenteral nutrition in advanced cancer: where are we?
p. 1-11, 42 refs,
Mackenzie-Michelle-L, Gramlich-Leah.
Abstract
Patients with advanced and incurable cancer are a compelling group. Questions and comments that these individuals and their families have may include: My daughter is expecting our first grandchild in 3 months--can I hope to see our new family member? ; I can't keep any food down--is there anything I can do? ; I am worried about losing so much weight, and feeling tired and weak--is there anything that may help? ; Will I suffer a lot?. Indeed, the most pressing concerns of the patient relate to predictions about survival and control of symptoms. The clinician taking care of the patient may wonder what is the utility or futility of home parenteral nutrition (HPN) in both the individual with advanced cancer and in this population of patients at large, whether there is potential for harm such as increasing the burden of care or prolonging suffering, and how to optimize care and communication with the patient and their families. The nutrition scientist may want to know what the implications of advanced cancer are on nutrient requirements and utilization, whether there are markers that would differentiate between cachexia and simple starvation, and whether it is possible to use specific nutrients to modify the disease process. This review will provide insights into the understanding of the role of HPN in advanced cancer and opportunities for further investigation.

BMJ (Clinical research ed.), 26 Apr 2008, vol. 336, no. 7650

Palliative care toolkit developed for staff in developing countries.
Full text available at BMJ Publishing Group for NHS
BMJ (Clinical research ed.), 26 Apr 2008, vol. 336, no. 7650, p. 913
Coombes-Rebecca.
Publication type
News.

Palliative Care Beyond Cancer: Care for all at the end of life.
Full text available at BMJ Publishing Group for NHS
BMJ (Clinical research ed.), 26 Apr 2008 (epub: 08 Apr 2008), vol. 336, no. 7650, p. 958-9, Murray-Scott-A, Sheikh-Aziz. .

Palliative Care Beyond Cancer: Reliable comfort and meaningfulness.
Full text available at BMJ Publishing Group for NHS
BMJ (Clinical research ed.), 26 Apr 2008 (epub: 08 Apr 2008), vol. 336, no. 7650, p. 958-9,
Lynn-Joanne

Global efforts to improve palliative care

Global efforts to improve palliative care: the International End-of- Life Nursing Education Consortium Training Programme.
Journal of advanced nursing, Jan 2008, vol. 61, no. 2, p. 173-80
Paice-Judith-A, Ferrell-Betty-R, Coyle-Nessa et al
Abstract
AIM: This paper is a report of an evaluation study to determine the feasibility and effectiveness of the End-of-Life Nursing Education Consortium-International training conference in providing education and support materials to participants so they might return to their home countries and disseminate palliative care information. BACKGROUND: More than 50 million people die each year, many without access to adequate pain control or palliative care. Numerous barriers to implementation of palliative care exist, including lack of education provided to healthcare professionals regarding these principles. Because they spend the most time with patients and their families, nurses have the greatest potential to change the way palliative care is provided. METHOD: A Course Evaluation Form and a Postcourse Activity Evaluation was completed by a convenience sample of 38 nurses from 14 Eastern and Central European, former Soviet, and Central Asian countries. The data were collected in 2006 using Likert scales and open-ended questions. FINDINGS: Evaluations of speakers ranged from a mean of 4.4 to 4.9 on the 5-point scale, with five denoting the highest level. The mean rating of the conference overall was 4.9. Strengths included the professional level of presentations, practical, clinically based content, extensive resources and availability of the educators. CONCLUSION: The first End-of-Life Nursing Education Consortium-International training programme demonstrated the feasibility of providing high-quality, essential education to nurses from a variety of countries. Because End-of-Life Nursing Education Consortium is designed as a train-the-trainer programme, assistance with translation to native languages, along with textbooks and other resources, is needed to allow participants to fully implement this curriculum.

A Phase II trial evaluating the palliative benefit of second-line oral ibandronate in breast cancer patients

A Phase II trial evaluating the palliative benefit of second-line oral ibandronate in breast cancer patients with either a skeletal related event (SRE) or progressive bone metastases (BM) despite standard bisphosphonate (BP) therapy.
Breast cancer research and treatment, Mar 2008 (epub: 02 May 2007), vol. 108, no. 1, p. 79-85
Clemons-Mark, Dranitsaris-George, Ooi-Wei, Cole-David-E-C.
Abstract
BACKGROUND: Despite bisphosphonate treatment, most patients with metastatic breast cancer will have either progressive bone metastases or skeletal related events (SREs). We evaluated the impact of second- line ibandronate on pain control and markers of bone turnover in these patients. METHODS: Patients with either an SRE or bony progression while on clodronate or intravenous (IV) pamidronate were switched to oral ibandronate 50 mg daily for 12 weeks. Pain scores and urinary N-telopeptide were evaluated weekly for 4 weeks and at weeks 8 and 12. There was no change in systemic anti-cancer treatment in the month before or after commencing study treatment. Palliative response was defined as a > or = two-unit reduction in the worst pain score. Patient preferences between IV and oral bisphosphonate therapy were assessed. RESULTS: Thirty women completed the study. By week 12, patients experienced a significant improvement in pain control (OR = 0.41; P = 0.028) with 12 of 26 (46.2%) evaluable patients achieving a palliative response. Of the 23 patients who had received first-line IV pamidronate, 20 of 23 (87.0%) preferred oral therapy. CONCLUSION: Patients with either progressive bone metastases or SREs while on clodronate or pamidronate may experience significant pain palliation with a switch to a more potent bisphosphonate. If confirmed by randomized trials, clinicians can start moving away from the paradigm whereby patients remain on a single bisphosphonate regimen throughout the course of their disease.
Publication type
Clinical-Trial-Phase-II, Journal-Article.

Palliative & Supportive Care, Mar 2008, vol. 6, no. 1

Clinical evaluation of the Mood and Symptom Questionnaire (MSQ) in a day therapy unit in a palliative support centre in the United Kingdom.
p. 51-9
Chapman-Elizabeth, Whale-Judith, Landy-Annette, Hughes-David, Saunders-Margaret.
Abstract
OBJECTIVE: To evaluate the use of the Mood and Symptom Questionnaire (MSQ) within a program of structured psychosocial interventions in a Supportive and Palliative Care Center. Palliative care patients have a range of psychological symptoms as well as physical symptoms. Considerable expertise in controlling pain and fear of pain, other physical symptoms, and psychosocial distress has been built up in hospices and palliative care units. This expertise can be used even at late stages in the patient's illness to improve quality of life. METHOD: We evaluated the usefulness of the MSQ to record patient responses, as an aid to patient/staff discussions, and as a staff- training tool. The questionnaire consisted of visual analog scales completed by the patient with a staff member present. Using the tool increased the opportunities for staff and patients to discuss problematic psychosocial issues. Where possible, we obtained data at two time points and compared the responses. RESULTS: The MSQ was rapidly accepted as a clinical tool in the day therapy setting by staff and the patients. The process of completing the questionnaire encouraged patients to face and discuss difficult issues. Discussion of the issues raised on the questionnaire had a wider effect, influencing interactions and communications through the unit and facilitating wider discussion of other nonpain symptoms. The medical psychotherapist associated with the unit used the MSQ responses as a training tool to increase staff awareness and knowledge and understanding of psychological issues related to the patients' total pain experience by discussing the questionnaires with them. SIGNIFICANCE OF RESULTS: The use of this tool helped to identify some psychological issues that proved relatively straightforward to address once uncovered. Patients benefited from this opportunity when their remaining time was relatively short. Their quality of life at the end of their lives was improved.

End-of-life care in nursing home settings: do race or age matter?
p. 21-7
Reynolds-Kimberly-S, Hanson-Laura-C, Henderson-Martha, Steinhauser- Karen-E.
Abstract
OBJECTIVE: One-quarter of all U.S. chronic-disease deaths occur in nursing homes, yet few studies examine palliative care quality in these settings. This study tests whether racial and/or age-based differences in end-of-life care exist in these institutional settings. METHODS: We abstracted residents' charts (N = 1133) in 12 nursing homes. Researchers collected data on indicators of palliative care in two domains of care--advance care planning and pain management--and on residents' demographic and health status variables. Analyses tested for differences by race and age. RESULTS: White residents were more likely than minorities to have DNR orders (69.5% vs. 37.3%), living wills (39% vs. 5%), and health care proxies (36.2% vs. 11.8%; p < .001 for each). Advance directives were highly and positively correlated with age. In-depth advance care planning discussions between residents, families, and health care providers were rare for all residents, irrespective of demographic characteristics. Nursing staff considered older residents to have milder and less frequent pain than younger residents. We found no disparities in pain management based on race. SIGNIFICANCE OF RESULTS: To the extent that advance care planning improves care at the end of life, racial minorities in nursing homes are disadvantaged compared to their white fellow residents. Focusing on in-depth discussions of values and goals of care can improve palliative care for all residents and may help to ameliorate racial disparities in end-of-life care. Staff should consider residents of all ages as appropriate recipients of advance care planning efforts and should be cognizant of the fact that individuals of all ages can experience pain. Nursing homes may do a better job than other health care institutions in eliminating racial disparities in pain management.

Palliative care in non - malignant disease

Palliative care in non - malignant disease
Ramachandran , R
Practice Nurse 2008 ; VOL 35 ; PART 9
From EBSCO ( Health Business FullTEXT Elite ) - via Athens (08/2003 - /)
Page: 44-49
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Palliative Care , Social Work and Service Users

Palliative Care , Social Work and Service Users : Making Life Possible
Parker , J
2008 ; VOL 51 ; PART 3 (2008-May)
International Social Work
Page: 416-417
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Palliative care: core skills and clinical competencies

Palliative care: core skills and clinical competencies
Glare , P . A
ISSUE: 2008 ; VOL 188 ; PART 8
Medical Journal of Australia , The From Free Medical Journals . com [PDF] (/1996 - /)
Page: 482
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British Journal of Nursing 2008 ; Vol 17 ; Part 8

Supportive and palliative care for the patient with end - stage renal disease
Noble , H
Journal Title:Access
From EBSCO ( CINAHL with Full Text ) - via Athens (04/1992 - /)
Page: 498-505
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Palliative care nursing in relation to people with intellectual disabilities
Read , S . ; Thompson - Hill , J .
From EBSCO ( CINAHL with Full Text ) - via Athens (04/1992 - /)
Page: 506-511
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Policy and non - cancer palliative care

Policy and non - cancer palliative care : the key policy papers to influence service provision
Russell , S
Practice Nurse 2008 ; VOL 35 ; PART 8
Practice Nurse From EBSCO ( CINAHL with Full Text ) - via Athens (08/2003 - /)
Page: 42-47
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International Journal of Palliative Nursing 2008 ; Vol 14 ; Part 4

Involving patients in care and research
Johnston , B
From EBSCO ( CINAHL with Full Text ) - via Athens (01/2002 - /)
Page: 160-161
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Supporting children and families facing death of a parent : part one
Kennedy , C . ; McIntyre , R . ; Worth , A . ; Hogg , R .
From EBSCO ( CINAHL with Full Text ) - via Athens (01/2002 - /)
Page: 162-168
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Access to hospice care : multi - professional specialist perspectives in South Africa
Ens , C . D . L . ; Gwyther , L . ; Chochinov , H . M . ; Moses , S . ; Jackson , C . ; Harding , R .
From EBSCO ( CINAHL with Full Text ) - via Athens (01/2002 - /)
Page: 169-174
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Diagnosis and management of malignant spinal cord compression : part two
Drudge - Coates , L ; Rajbabul , K .
From EBSCO ( CINAHL with Full Text ) - via Athens (01/2002 - /)
Page: 175-181
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When advanced cancer patients won't eat : family responses
McClement , S . E . ; Harlos , M .
From EBSCO ( CINAHL with Full Text ) - via Athens (01/2002 - /)
Page: 182-188
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Communication difficulties and intellectual disability in end - of - life care
Tuffrey - Wijne , I ; McEnhill , L .
From EBSCO ( CINAHL with Full Text ) - via Athens (01/2002 - /)
Page: 189-195
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Supervision needs of nurses working in the community
Fletcher , S
From EBSCO ( CINAHL with Full Text ) - via Athens (01/2002 - /)
Page: 196-203
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