ANNALS OF SURGERY | Online – 9 May 2016 – The current system for educating surgical trainees enjoys well-deserved acclaim for producing thoughtful and technically skilled individuals, but continues to inadequately prepare and train young surgeons to care for seriously ill and dying patients. Accordingly, a dramatic change to structure palliative and end-of-life care into surgical training and the willingness of practicing surgeons to actively participate in this care are essential. A focus on trainees will yield a generation of surgeons empowered to shift the culture of surgery away from a cure-focused model towards a more patient-centered stance. The ultimate goal is to better equip all surgeons the skills to manage all stages of disease including care at the end of life.
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BMC MEDICAL ETHICS | Online – 27 April 2016 –The present study demonstrates significant question framing and order effects in a survey on attitudes towards assisted dying. Journalists, politicians and others should be aware of such effects and interpret survey results accordingly, as should researchers who conduct attitude surveys in bioethics. Designs as per the principles of survey experiments may enrich the yield of such surveys.
BMC Palliative Care | Online – 14 May 2016 – To date this is the largest study on sedation at the end of life and provides preliminary insights into the prevalence of, and indications for, palliative sedation in Austria. It supports previous data, which suggest that palliative sedation, when properly administered, is an appropriate therapeutic procedure that does not shorten the period of time from admission to a palliative care ward/mobile care team until death. In order to minimize variation and enhance safety in clinical practice, implementation of a nation-wide guideline for the use of palliative sedation will be developed in Austria.
HEALTH & JUSTICE | Online – 3 May 2016 – Prisoners are a group with complex needs and high levels of social disadvantage and exclusion. Indigenous Australians are over represented in the prison system and experience higher rates of cancer mortality. This review found a very small evidence base and no studies from Australia. Therefore a strong conclusion to be drawn from the limited data is that further rigorous, empirical research is needed to better elucidate how the barriers to adequate cancer care for prisoners may be identified and overcome, in Australia and internationally. In particular, the experiences of indigenous prisoners with cancer are largely invisible in the research literature. The main themes identified here offer potential starting points for future research and policy development to better align access and service use with best practice for cancer care in Australia.
JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | Online – 12 May 2016 – Two evolving disciplines in medicine have brought new ways of thinking about health and disease. One is palliative care (PC), which focuses on improving the quality of life of patients with serious illnesses and their families. A second is population health, which focuses on improving the health of populations, with a special emphasis on reducing disparities in health outcomes and improving the value of health care. Although PC and population health are related, there has been limited discussion about how these two disciplines can support and complement each other. This synergy is key to improving the quality of care of frail older persons with chronic, life-limiting illnesses. The authors describe the potential synergies between these two disciplines and propose next steps to foster collaboration.
JOURNAL OF AMERICAN MEDICAL DIRECTORS ASSOCIATION | Online – 6 May 2016 – More and more people will live to a very old age in Europe and many of them will develop severe functional and cognitive deficiencies in the last years of life. The number of people dying in care homes after being admitted for a relatively short period is predicted to increase substantially. Hence, this study is timely and aims to optimally inform policy- and decision-makers at international but also at national and regional levels on the current state of affairs of dying in care homes and the possible benefits of different systems of care provision. Using the results of the 6-country study,1 the authors hope to provide important recommendations that can also apply to other countries with similar health and long-term care systems as those of the countries involved in PACE. The PACE methodology can also serve as a reference for other countries that wish to initiate large-scale representative end-of-life care research in these settings.
1. Belgium, Finland, Italy, the Netherlands, Poland, and the U.K.
OMAN MEDICAL JOURNAL, 2016; 31(3):161-163. Similar to other developing countries, Oman is encountering the challenge of a rising incidence of cancer due to an aging population and a higher prevalence of lifestyle-related risk factors. Despite the remarkable progress made in the health care services, palliative care (PC) services are still limited. The time has come now to strengthen the PC movement in Oman. This can only be achieved by exerting more efforts to convince policymakers about the enormous benefits of PC to the health care system as a whole. There should be attempts to integrate PC at every level of care, especially at the primary health care level to include home and community-based care. The community, clinical, and administrative leaders should be engaged to help them to identify the great need for PC. Efforts are also required to overcome known barriers, and to identify and overcome unique challenges in Oman. In particular, lack of governmental policies on PC and governmental regulations on access to opioids. Key to success is integrating PC training in all health institutions and partnerships between governmental and non-governmental organizations.
RELIGIONS | Online – 9 May 2016 – This paper aims to demonstrate the absence of contextual factors in studying spirituality at the end of life and to highlight the growing recognition of the importance of history, culture and traditions as resources to enrich our understanding of spirituality. An exploration of the concept of spirituality, an overview of the trajectory of the study of spirituality, and a review of existing methodological stances reveal the silent space in current approaches to understanding spirituality at the end of life.
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).