2016; Volume 17, No 12, December
Media Watch: an annotated list of recent articles about palliative care in the news media and the literature
Using telehealth to support end-of-life care in the community: A feasibility study
BMC PALLIATIVE CARE | Online – 17 November 2016 – The trial showed that patients and carers [i.e., study participants] could manage the technology and provide data that would otherwise not have been available to the palliative care service. The average age of patients was 71.6 years ... All 43 patients managed to enter data using the telehealth system. Self-reported data entered by patients and carers did identify changes in performance status leading to changes in care. Over 4,000 alerts were generated. Staff reported that video calls were similar (22.3%) or better/much better (65.2%) than phone calls and similar (63.1%) or better/much better (27.1%) than face-to-face. Issues with the volume of alerts generated, technical support required and the impact of service change were identified.
Helping palliative care healthcare professionals get the most out of mentoring in a low-income country: A qualitative study
BMC PALLIATIVE CARE | Online – 3 November 2016 – The need to adequately support U.K.-based international health volunteers prior to, during and after their trip is recognised at government level. Whilst the need to support mentors is recognised little is known about their support needs. This study explores the lived experience of mentorship in a low-income country and gains insight into mentors’ support and information needs and the barriers and facilitators to mentoring. Participants [in this study] became mentors to help others. Uncertainty about their achievements constituted a significant challenge. This study highlights the need to prepare mentors before their in-country visits by exploring motivation, describing the reality of international volunteering, and ensuring realistic expectations. Post-trip debriefing is important for reducing uncertainty around trip outcomes and maximising transferable impacts. Challenges to mentoring were logistical, related to the concept of mentorship and cultural. Facilitators included shared passion, mentor credibility and serendipity. Awareness of the support needs of mentors and the facilitators and challenges to mentoring can improve mentor preparation and support. This may minimise potential negative emotional impact of being a mentor, maximise positive personal and professional impacts and improve in-country project impact.
End-of-life practices in France under the Claeys-Leonetti Law: Report of three cases in the oncology unit
CASE REPORTS IN ONCOLOGY, 2016; 9 (3): 650-654. On 2 February 2016, the French government enacted the Claeys-Leonetti law introducing the right to deep and continuous sedation and forbade euthanasia for end-of-life patients. This article reports the first descriptions of this kind of intervention at the final stage of life of three patients and highlights the need of patient-centered goals and the importance of close collaboration between the patient, family, and medical and paramedical team to achieve a higher quality of final palliative care.
What have we got to lose?
JOURNAL OF CLINICAL ONCOLOGY | Online – 7 November 2016 – The literature regarding quality of care clearly lists chemotherapy and recurrent admissions in the few weeks before death as indicators of a job badly done, whereas use of palliative targeted therapy in the last month of life has raised the question of whether such treatment might compromise or delay appropriate palliative care near the end of life. And yet, the mythology around going down fighting remains omnipresent, a false ideal romanticized in the celluloid imagery of countless war movies and the commentary of losing football teams. It is interesting to note that there are several simultaneous and perhaps divergent discussions occurring in the medical, legal, and ethical literatures that seek to address what is essentially our common and often existential fear of death and suffering. At one extreme of the conversation is the dialogue concerning physician-assisted suicide; seemingly diametrically opposed is the discussion around the right to try unproven therapies. In reality, both discussions are reflections of our inability to confront our mortality and find dignity and purpose at the end of life.
“We need to talk!” Barriers to GPs’ communication about the option of physician-assisted suicide and their ethical implications: Results from a qualitative study
MEDICINE, HEALTH CARE & PHILOSOPHY | Online – 26 October 2016 – GPs usually care for their patients for an extended period of time, therefore, requests to not only discontinue a patient’s treatment, but to assist a patient in a suicide are likely to create intensely stressful situations for physicians. However, in order to ensure the best patient care possible, the competent communication about the option of physician assisted suicide (PAS) as well as the assessment of the origin and sincerity of the request are very important. This is especially true, since patients’ requests for PAS can also be an indicator for unmet needs or concerns. The analysis of the gathered data shows three main themes why GPs may find it difficult to professionally communicate about PAS: concerns for their own psychological well-being, conflicting personal values or their understanding of their professional role. In the discussion part of this paper the authors re-assess these different themes in order to ethically discuss and analyse how potential barriers to professional communication concerning PAS could be overcome.
Media Watch is intended as an advocacy, education and research tool. The weekly report, published by Barry R. Ashpole, a Canadian communications consultant and educator, monitors the literature and the lay press on issues specific to the quality of end-of-life care. It is international in scope and distribution. Each month, this section of the IAHPC Newsletter will publish an abstract or summary of an article or report of special interest noted in recent issues of Media Watch (see below).