BMC PALLIATIVE CARE | Online – 20 May 2015 – The proportion of deaths in hospital ranged from 17% in the U.S. to 75% in South Korea. Hospital was the most prevalent place of death in France (40%), Hungary (60%), and South Korea; nursing home in New Zealand (71%), Belgium (52%), U.S. (50%), Canada (48%), and Czech Republic (44%); home in Mexico (73%), Italy (51%), and Spain (46%). The chances of dying in hospital were consistently higher for men (Belgium, France, Italy, U.S., Canada), those younger than 80 years (Belgium, France, Italy, U.S., Mexico), and those living in areas with a higher provision of hospital beds (Italy, U.S.). In several countries a substantial proportion of deaths from Parkinson’s disease (PD) occurs in hospitals, although this may not be the most optimal place of terminal care and death. Unless place of death becomes a major focus for quality end-of-life care persons with serious progressive illnesses, such as those who suffer from PD, will continue to need to rely on hospitals for terminal care.
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BMC PALLIATIVE CARE | Online – 9 May 2015 – The effects of the Liverpool Care Pathway (LCP) have never been investigated in older patients dying in acute geriatric hospital wards and its content and implementation have never been adapted to this specific setting. Moreover, the LCP has recently been phased out in U.K. hospitals. For that reason, this study aims to develop a new care programme to improve care in the last days of life for older patients dying in acute geriatric wards. Phase 0 consisted of a review of existing LCP programmes from the U.K., Italy, and The Netherlands, a literature review to identify key factors for a successful LCP implementation and an analysis of the concerns raised in the UK. In phase 1, the authors developed a care programme for the last days of life for older patients dying in acute geriatric wards based on the results of phase 0. Results of Phase 0 resulted in the identification of nine important components within the LCP programmes, five key factors for a successful LCP implementation, and a summary of the LCP concerns raised in the U.K. Based on these findings the authors developed a new care programme consisting of: 1) an adapted LCP document or Care Guide for the older patients dying in an acute geriatric ward; 2) supportive documentation; and, 3) an implementation guide to assist health care staff in implementing the care programme on the acute geriatric ward.
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BMC PALLIATIVE CARE | Online – 18 April 2015 – More people die in hospital than in any other setting which is why it is important to study the outcomes of hospital care at end of life. This study shows significant differences in how care outcomes, including pain, were assessed by nurses, doctors and relatives. Care inputs operate in a mutually reinforcing manner to generate care outcomes, which implies that improvements in one area are likely to have spill-over effects in others. Building on these findings, the Irish Hospice Foundation has developed an audit and review system to support quality improvement in all care settings where people die.
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BMC RESEARCH NOTES | Online 30 April 2015 – The increasing incidence of cancer and chronic diseases in South Asia has created a growing public health and clinical need for palliative care in the region. As an emerging discipline with increasing coverage, palliative care must be guided by evidence. In order to appraise the state of the science and inform policy and best practice in South Asia this study aimed to systematically review the evidence for palliative care models, interventions, and outcomes. The search identified only 16 articles, reporting a small range of services. The 16 articles identified India as having the greatest number of papers within South Asia, largely focused in the state of Kerala. Nepal and Pakistan reported a single study each, with nothing from Bhutan, Afghanistan, Maldives or Bangladesh. Despite the large population of South Asia, the authors found only four studies reporting intervention outcomes, with the remaining reporting service descriptions. The dearth of evidence in terms of palliative care outcomes, and the lack of data from beyond India, highlight the urgent need for greater research investment and activity to guide the development of feasible, acceptable, appropriate and effective palliative care services. There is some evidence that suggests implementation of successful and well-developed community based models of palliative care may be replicated in other resource-limited settings.
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OMEGA – JOURNAL OF DEATH & DYING, 2015;71(1):3-18. Results [of this study] suggested that gender of the adult child and age level of the participant were important factors contributing to the grief response, and women were found to have more difficulty adjusting to the loss of a parent as well as demonstrating a more intense grief response. Young adults were found to be more impacted by the loss of a parent than were middle-aged adults. Those who were single or separated were similarly more impacted versus those who were married, where more young adults were single/separated and more middle-aged adults were married. Cause of death was only mildly influential in influencing responses to parental loss and did not interact with other studied variables. These results point to the importance of support from others in coping with a parent’s death as well as for the counseling of bereaved persons who may be at risk for difficulties in coping with the death of a parent and enable a more precise understanding of individual grief processes across the adult lifespan.
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PLOS ONE | Online – 22 April 2015 – Most doctors report conducting effective end-of-life (EOL) conversations with seriously ill patients is challenging, especially with ethnic minority patients and their families. The authors identify six primary barriers doctors report in conducting effective EOL conversations and demonstrate that the doctors’ age, ethnicity and sub-specialty influence their perceptions of these barriers. As the U.S. is becoming increasingly diverse and as ethnic patients are more likely to consume ineffective and burdensome high-intensity treatments at the EOL, there is an urgent need to train doctors in conducting culturally effective conversations early in the trajectory of a chronic or serious illness in order to facilitate dignity at the EOL for diverse Americans.
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Media Watch is intended as an advocacy 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 a recent issue of Media Watch (see below).
The current and back issues of the weekly report.
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