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.
This special issue of Illness, Crisis & Loss comprises an editorial and 4 applied explorations of disenfranchised grief using different methodologies, regarding a diverse spectrum of individuals.
Clinical Medicine Insights: Cardiology | Online – 4 December 2018 – This feature article…aims to outline important gaps in guidelines for patients with multiple comorbidities and the elderly. Congestive heart failure (CHF) diagnosis manifests as a 3-phase journey between the hospital and community, during acute, chronic stable, and end-of-life (palliative) phases. This journey requires in variable intensities a combination of multidisciplinary care within tertiary hospital or ambulatory care from hospital outpatients or primary health services, within the general community. Management goals are uniform, i.e., to achieve the lowest New York Heart Association class possible, with improvement in ejection fraction, by delivering gold standard therapies within a CHF program. Comorbidities are an important common denominator that influences outcomes. Comorbidities include diabetes mellitus, chronic obstructive airways disease, chronic renal impairment, hypertension, obesity, sleep apnea, and advancing age. Geriatric care includes the latter as well as syndromes such as frailty, falls, incontinence, and confusion. Many systems still fail to comprehensively achieve all aspects of such programs.
BMJ Open | Online – 25 November 2018 – The aim of this research was to understand how doctors, with a measured prognostic ability, recognise when a patient is imminently dying. The authors found that for hospice inpatients with end-stage malignancy, the Palliative Performance Score (PPS) was the most influential factor in doctors’ decision making, followed by the presence of Cheyne-Stokes breathing, decline in overall condition, level of agitation or sedation, presence of noisy respiratory secretions and peripheral cyanosis. This insight into the decision making of top prognosticators could be used to develop teaching resources to help less experienced doctors to model their own judgement policies on those of the experts. Using the authors’ results as a guide, novices could be taught to hone their clinical intuition by giving greater weight to certain factors (e.g., PPS and presence of Cheyne-Stokes breathing) over other less important factors (e.g., noisy respiratory secretions, peripheral cyanosis, urinary output). A similar approach to improving the decision-making abilities of novices by teaching them to model their judgement policies on those of experts has been shown to be successful in other (non-prognostic) situations and with other health and social care professionals. This research is important because, implicit in most clinical guidelines and policies about end of life care, is the assumption that it is possible to recognise which patients are, or are not, imminently dying. The National Institute for Health & Care Excellence guideline on end-of-life care describes the recognition of imminent death as an essential first step towards improving care for dying patients.1 However, the guideline does not clearly explain how doctors are expected to identify such patients, nor how novice doctors can be expected to learn or improve this clinical skill. It is noteworthy that in the prognostic test we developed, we found no discernible difference in the prognostic accuracy of doctors by age or seniority, suggesting that experience alone does not make a better prognosticator.
1. Care of dying adults in the last days of life. National Institute for Health & Care Excellence. December 2015.
INTERNATIONAL JOURNAL OF PUBLIC HEALTH | Online – 30 November 2018 – Palliative care (PC) has just started to enter the “culture” of humanitarian organisations... Humanitarian organisations are less experienced in managing chronic conditions with long courses that are steeply increasing the number of patients who need PC. We still know little about how to integrate PC or advanced pain control into medical emergency assistance projects,1 but the WHO is extending its guidelines on PC to cover emergency assistance,2 and the new edition of the Sphere Handbook, a collection of recommendations and standards for humanitarian assistance, contains a chapter on PC.3
1. What do humanitarian emergency organizations do about palliative care? A systematic review. Medicine, Conflict & Survival. December 2017.
2. Integrating palliative care and symptom relief into responses to humanitarian emergencies and crises. World Health Organization. September 2018.
3. The Sphere Handbook: Humanitarian charter and minimum standards in humanitarian response. Sphere Association. 2018.
Editor’s Note: Barry Ashpole has updated his prison hospice backgrounder, ‘End-of-Life Care in the Prison Environment,’ on 1 November 2018. It can be downloaded/viewed here.