Media Watch

2018; Volume 19, No 9, September

Media Watch

An annotated list of recent articles about palliative care in the news media and the literature

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 publishes selected abstracts or summaries of articles or reports of special interest from recent issues of Media Watch.

Thematic issue: Roles of physicians in healthy dying

American Medical Journal of Ethics, 2018 (Vol. 20, No. 8) pp. E675-792.

Prioritizing information topics for relatives of critically ill patients: Cross-sectional survey among intensive care unit relatives and professionals

WIENER KLINISCHE WOCHENSCHRIFT | Online – 9 August 2018 – In this study, a broad variety of topics was subjectively relevant to ICU relatives [e.g., “diagnosis,” “treatment,” “comfort,” “family” and “end of life.” There was a substantial discrepancy between relatives and ICU professionals in the subjective importance of topics: not a single top five topic for relatives featured among the top five topics for medical professionals. In the clinical routine it may be useful to focus conversations on the most relevant topics. When subjectively low-rated topics are objectively important (and vice versa), the recognition of this misconception should be openly discussed with family members and this may help reduce unrealistic expectations. Future larger studies should evaluate the information needs of ICU relatives in different regions, ethnicities and across different pathologies.

DOI: 10.1007/s00508-018-1377-1

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N.B. English language article.

Palliative care: A proposal for undergraduate education in medicine

Revista Brasileira de Geriatria e Gerontologia, 2018;21(3): One of the earliest attempts to publish a curriculum for the teaching of palliative care (PC) at undergraduate level took place in Canadian medical schools in 1993. The American Academy for Hospice & Palliative Medicine subsequently published a core curriculum in 1998. The European Association for Palliative Care established a summary of a proposed curriculum, setting out the minimum of knowledge and skills that a medical student should acquire during his/her undergraduate course. In 2008 the Société Canadienne des Médecins des Soins Palliatifs proposed six items in which to divide competencies: medical expertise in pain and other symptoms, medical expertise in psychosocial and spiritual needs, and the roles of administrator, communicator, collaborator and promoter of health. Subsequently, similar projects were implemented in Japan, the U.K. and Colombia. In Brazil, the Universidade Federal de São Paulo was the first medical school to offer PC courses on an elective basis to undergraduate students in Medicine, between 1994 to 2008. In 2003, a compulsory PC discipline was created at the Universidade de Caxias do Sul. Despite these examples of approaches to PC in education, which were later followed by other universities, there is a lack of correlation between the provision of instruction in PC and the perception of its importance in most medical schools. Such schools have described insufficient time, a lack of faculty expertise and the time-consuming demands of multiple interests as the reasons for the lack of curricular under-representation of PC. Yet by placing the student in contact with PC during training we can help to improve patient care. This study, therefore, aims to propose essential skills for the teaching of PC in undergraduate courses in Medicine.

DOI: 10.1590/1981-22562018021.180008

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N.B. English language article. Click on pdf icon to access Portuguese language version.

Quality of end-of-life care in patients with dementia compared to patients with cancer: A population-based register study

Plos One | Online – 30 July 2018 – Globally, dementia is one of the leading causes of death. Given the growing elderly population in the world, the yearly number of deaths by dementia is expected to increase. Patients dying from dementia are reported to suffer from a burden of symptoms similar to that of patients with cancer, but receive less medication against symptoms, have a lower probability of palliative care (PC) planning and seldom have access to specialised PC. Studies investigating the quality of PC in dementia are scarce. The aim of this Swedish national study was to compare the quality of end-of-life care (EoLC) between patients with dementia and patients with cancer regardless of place of care. The findings indicate that patients dying from Alzheimer’s disease and other types of dementia receive a poorer quality of EoLC concerning several important EoLC areas when compared to patients dying from cancer. Guidelines for EoLC in Sweden cannot explain or justify these differences. Further studies are needed to find possible ways to improve EoLC in the large and growing group of patients dying from dementia.

DOI: 10.1371/journal.pone.0201051

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Joint position statement Indian Association of Palliative Care and Academy of Family Physicians of India – The way forward for developing community-based palliative care program throughout India: Policy, education, and service delivery considerations

Journal of Family Medicine & Primary Care, 2018;7(2):291-302. A taskforce was formed with Indian and international expertise in palliative care (PC) and family medicine to develop this paper... The taskforce recommends: 1) PC should be integrated into all levels of care including primary care with clear referral pathways, networking between PC specialist centers and family medicine physicians and generalists in community settings, to support education and clinical services; 2) Implement the recommendations of the National Health Policy 2017 to develop services and training programs for upskilling of primary care doctors in public and private sector; 3) Include PC as a mandatory component in the undergraduate and postgraduate curriculum of family physicians; 4) Improve access to necessary medications in urban and rural areas; 5) Provide relevant in-service training and support for PC to all levels of service providers including primary care and community staff; and, 6) Generate public awareness about PC and empower the community to identify those with chronic disease and provide support for those choosing to die at home.

DOI: 10.4103/jfmpc.jfmpc_99_18

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Heart failure patients actually live longer in tailored hospice, while using less care

Medpage Today | Online – 8 August 2018 – Advanced heart failure (HF) patients who received HF-tailored hospice care used less healthcare, lived longer, and were less likely to die in the hospital, according to a propensity score-matched Medicare analysis. Hospice enrollees who had at least two heart failure discharges within 6 months had substantially less healthcare utilization in the next 6 months after second hospital discharge. Compared with propensity-matched HF patients not in hospice, they averaged fewer of the following: 1) Emergency department (ED) visits (2.64 versus 2.82, P=0.04): ICU stays (1.25 versus 1.51); and, 3) Hospital days (3.90 versus 4.67). Moreover, hospice patients survived for a median of 80 days, versus 71 days for non-hospice patients... And only 3% of hospice patients died in a hospital setting compared with 56% of non-hospice patients, reported Laura Gelfman, of Icahn School of Medicine at Mount Sinai in New York City, and colleagues... “Given these benefits of hospice for these patients, more patients should receive this comprehensive care,” said Gelfman in an interview with MedPage Today. And it's a win-win, commented Craig D. Blinderman, of Columbia University Medical Center in New York City, who was not involved in the study. “While the study was not designed to assess whether hospice and dying at home was concordant with the patients’ goals of care, the assumption is that it was, given that most Americans when asked about their preferred place to die would not want to die in the hospital, but prefer to die at home," he told MedPage Today.

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Origins and effects of the 2014–2016 National Strategy for Palliative Care in Croatia

Health Policy | Online – 20 July 2018 – Croatia is among the last countries in Europe to develop organized palliative care (PC) at the national level. Real changes in this area started after the parliamentary elections in 2011 and culminated in the 2013 adoption of the Strategic Plan for Palliative Care Development 2014-2016. The National Board for Palliative Care, appointed by the Ministry of Health, was in charge of creating a scalable PC model and national guidelines. The Board drew on experiences from both neighbouring countries with similar societies and/or health care models (Bosnia and Herzegovina, Poland) and an international leader in PC (U.K.). It recognised that provision of PC in Croatia, thus far based on volunteering and isolated enthusiastic activities, needed to be improved through professionalization, regulation, and organized development. A variety of policy measures was used to implement these changes, including the introduction of professional guidelines and new payment models. The development of new PC structures and services significantly increased the number of patients who could access PC, from around 1-2% of patients needing such care in 2011 to 20-35% in 2014. It also ensured the provision of more appropriate services at each point of the PC pathway. The Strategy was extended for the 2017-2020 period.

DOI: 10.1016/j.healthpol.2018.07.011

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