Media Watch is a weekly report intended as an advocacy, education, and research tool. Published by Barry R. Ashpole, a Canadian communications consultant and educator, Media Watch 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 publishes selected abstracts or summaries of articles or reports of special interest from recent issues.
JOURNAL OF INTERNATIONAL HUMANITARIAN ACTION | Online – 20 April 2018 – The authors present findings from a review of the literature (2005-2017) on palliative care (PC) in humanitarian crises (e.g., disasters, armed conflicts, epidemics). This review set out to describe PC needs, practices, barriers, and recommendations in humanitarian crisis settings. It contributes to current discussions within the field of humanitarian healthcare aimed at clarifying whether or not and how best to respond to PC needs in humanitarian crises. Analysis of 95 peer-reviewed and gray literature documents reveal a scarcity of data on PC needs and interventions provided in crises, challenges of care provision particularly due to inadequate pain relief resources and guidelines, a lack of consensus on the ethics of providing or limiting PC as part of humanitarian healthcare response, and the importance of contextually appropriate care. These findings suggest more research and open discussion on PC in humanitarian crises are needed. This review contributes to defining PC needs in humanitarian crises, building consensus on humanitarian healthcare organizations’ ethical responsibilities towards individuals and families with PC needs, and developing realistic and context-appropriate policies and guidelines.
BMC PALLIATIVE CARE | Online – 8 May 2018 – This review highlights the key features of culturally safe service delivery that have been reported to be working well in the Indigenous palliative care (PC) context. A flexible approach, adaptability to the context and “buy-in” from local communities are reported to be some of the essential features of successful service models to deliver PC services to Indigenous populations and the literature emphasises that a “one size fits all” approach is not appropriate. This flexibility must incorporate family involvement in decision-making and extend to the referral process, such that family members are able to refer patients to specialist PC services. Flexibility in these settings augments Indigenous representation and retention within the health workforce.
FRONTIERS IN PUBLIC HEALTH | Online – Accessed 7 May 2018 – Globally, 98% of children who need palliative care (PC) live in low- or middle-income countries, where there are very few PC services available. In this report, the authors describe the key steps and practical considerations to develop and implement a pediatric PC consultation service at a tertiary hospital in a resource limited setting in Dhaka, Bangladesh. The crucial aspects of this pilot project included raising awareness among hospital administrators and clinical staff, providing education and training for hospital staff, implementing a clinical PC service, and collecting data to define the PC needs of children with cancer. The use of volunteers to provide play, art, and music was a simple and effective way to expand the PC supports in which this small pediatric PC team was able to provide. The authors discuss the practical implications, lessons learned, and limitations of their approach under four key aspects of the project.
ANNALS OF PALLIATIVE MEDICINE | Online – Accessed 1 May 2018 – Over many years the project of hospice volunteering of prisoners in Poland has helped to break down stereotyping and the perceptions of prisoners, starting with the Gdansk experience, where they gradually became full members of a care team... Over 600 prisoners have passed through the hospice in Gdansk in over 10 years of cooperation. Convicts, who are mostly doing time on charges of burglary, non-payment of alimony and petty crime, see working in the hospice as a chance to change their attitudes. They see a different world, in which compassion and understanding for other people are most important. Some volunteer prisoners, after their release from a correctional facility, have been employed by the hospice in Gdansk. It is believed that such places as a hospice, where we undergo extreme experiences, can provide more radical answers to questions regarding our own attitudes. The initial data has showed that those who work in hospices receive better results in re-education and have the chance to receive a reduction of their sentence. Thanks to the correctional programs, prisoners are currently working in over 40 hospices and more than 70 nursing homes, helping patients in the need of everyday care.
MEDSCAPE | Online – 25 April 2018 – Despite the proven benefits of early palliative care (PC) for oncology patients, integration of PC remains a challenge. At Johns Hopkins Medicine, the TEAM (Time, Education, Assessment, and Management) approach is being used to improve oncology outcomes by incorporating PC in practice for patients with advanced breast cancer. TEAM requires approximately one hour of additional time with the patient each month, focused on patient education, assessment, and management. “It is an extra hour every month, not once. [But] it doesn’t have to be done by the doctor. It can be an advanced practice or [other trained] nurse,” said Thomas Smith, MD, director of palliative medicine and professor of oncology at Johns Hopkins. The hour can be spent in person, by phone, or by telemedicine, but it has to be structured and include assessments, he added. The benefits of early PC have been firmly established. In 6 of 13 large randomized trials, early outpatient PC has been shown to improve survival, and no trials have identified any harms. Early PC also decreases costs, with one recent study showing that a new PC program at Johns Hopkins saved roughly $3.5 million on health system finances over one year. Of note, said Smith, other studies have shown that patients who use hospice live a month longer than patients who don’t use hospice.
PALLIATIVE MEDICINE | Online – 8 May 2018 – Community-based specialized palliative care (PC) has been shown to improve symptom management and quality of life, and reduce healthcare costs compared to usual homecare. Existing validated frameworks on community-based PC teams, however, describe theoretical phases and antecedent factors, but lack operational and practical details required for team development. The authors synthesize the experiences from fifteen diverse specialized, community-based PC teams. They detail the characterizing features, activities, milestones, and challenges unique to each of four stages of team evolution evident: inception, start-up, growth, and mature. The authors describe output and outcome measures that are appropriate to each stage. Defining common stages in the evolution of community-based PC teams can inform the development of new teams. Using stage-appropriate milestones and measures can gauge progress and set realistic expectations for team growth.