Lessons from the Literature

2020; Volume 22, No 1, January

Under My Microscope

Dr. Tania Pastrana. Used with permission.

IAHPC Research Advisor Dr. Tania Pastrana selects one article from recently published medical literature and describes why it is worthwhile.

Duration of Palliative Care before Death in International Routine Practice: A systematic review and meta-analysis

Jordan RI, Allsop MJ, ElMokhallalati Y, Jackson CE, Edwards HL, Chapman EJ, Deliens L, Bennett MI. BMC Med 2020; 18(1): 368. DOI: 10.1186/s12916-020-01829-x

Since publication of the well-known clinical intervention study by Temel et al. back in 2010,1 evidence has shown the benefits of early integration of palliative care. These benefits include improved quality of life as a result of reduced symptom intensity, fewer hospitalizations and aggressive treatments, and lower associated end-of-life costs.

Research indicates that palliative care is best offered early, with the ideal duration of palliative care for adults at least three to four months before death. A team led Mike Bennett at the University of Leeds, UK, conducted a systematic review and meta-analysis with the aim of identifying the gap between current routine practice and the ideal duration, and to explore associated patient, service, and country characteristics that influence this duration.

The review shows out that the median duration from initiation of palliative care to death was 18.9 days (IQR 0.1). The duration was related to condition, service type, and level of palliative care development in the country or region. That being said, most of the data came from studies in high-income countries; we do not yet know the situation in the rest of the world.

We can add this to future research topics for palliative care in the new year!

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1. Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, et al. Early Palliative Care for Patients with Metastatic Non-small-cell Lung Cancer. N Engl J Med 2010; 363(8): 733-42.

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Media Watch: Guidelines

The articles below are selected from Barry R. Ashpole’s weekly report, Media Watch.

Saving the Most Lives: A comparison of European triage guidelines in the context of the COVID?19 pandemic

Bioethics | Online – 16 December 2020 – In March 2020, the rapid increase in severe COVID?19 cases overwhelmed the healthcare systems in several European countries. A number of professional associations published COVID?19 triage recommendations in an extremely short time: between 6 March and 27 March. The authors compare recommendations from Austria, Belgium, Germany, Italy and Switzerland, which combine medical and ethical reflections on this situation in some detail. The authors provide a detailed overview on the ethical elements of the recommendations, the differences between them and their coherence. They want to identify shortcomings in regard to a common European response to the current situation. DOI: 10.1111/bioe.12836

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Bolstering General Practitioner Palliative Care: A critical review of support provided by Australian guidelines for life-limiting chronic conditions

Healthcare | Online – 11 December 2020 – General practitioners (GPs) are increasingly expected to provide palliative care (PC) as ageing populations put pressure on specialist services. Some GPs, however, cite barriers to providing this care including prognostication challenges and lack of confidence. PC content within clinical practice guidelines might serve as an opportunistic source of informational support to GPs. This review analysed PC content within Australian guidelines for life-limiting conditions to determine the extent to which it might satisfy GPs’ stated information needs and support them to provide quality end-of-life care. The nine guidelines meeting inclusion criteria were heterogenous in scope and depth of PC domain coverage. DOI: 10.3390/healthcare8040553

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Also of note:

International study on the role of end-of-life doulas A comparative study on doulas’ role and practices of care in Australia, Canada, the UK, and the US. DOI: 10.1177/2632352420973226

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Grief: The epidemic within an epidemicThe authors raise the issue of grief and its public health implications as our death toll rises and rises. And if, by definition, this virus and subsequent limitations on social contacts and diminished grief rituals, complicates our grief and exacerbates the negative outcomes, then we need to acknowledge the epidemic within the epidemic. DOI: 10.1177/1049909120978796

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Project ECHO and pediatric care A model of technology-enabled education and practice for health care professionals who care for children with life-limiting illness. A pan-Canadian initiative that has been successful in achieving perceived changes in knowledge and self-efficacy. DOI: 10.1089/jpm.2020.0496

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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. View current and back issues here.

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