Lessons from the Literature

2021; Volume 22, No 8, August

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

Under My Microscope

Dr. Tania Pastrana. Used with permission.

By Dr. Tania Pastrana
IAHPC Research Advisor

Evidence-Based Management of Depression in Palliative Care: A systematic review

Perusinghe M, Chen, KY, McDermott B. J Palliat Med 2021; 24(5): 767-781. DOI: 10.1089/jpm.2020.0659

People with advanced life-limiting illnesses and extremely short prognoses have a high prevalence of depression, which has an important impact on their quality of life as well as the wish for their anticipated death. Lee et al. suggest that clinicians need to be proactive in recognizing and assessing symptoms of depression to permit timely intervention.1

A team led by Minurika Perusinghe conducted a systematic review with the aim “to establish a better understanding of evidence-based treatments for depression in the palliative care setting, pharmacological, nonpharmacological, and combined approaches.” The researchers included 39 studies and found that there are multiple treatment modalities that could be beneficial for patients with depression in the palliative setting. Among pharmacological therapy, antidepressants such as SSRIs and mirtazapine or stimulants like methylphenidate have shown benefit, especially when these medications are used in combination. Nonpharmacological therapy, such as dignity therapy and music therapy, also appear to be beneficial.

The evidence for treatment of depression in palliative care context is still weak, but advancing.


1. Lee, W, Pulbrook, M, Sheehan, C, Kochovska, S, Chang, et al. Clinically Significant Depressive Symptoms Are Prevalent in People With Extremely Short Prognoses—A systematic review. J Pain Symptom Manage 2021; 61(1): 143-166.e142. DOI: 10.1016/j.jpainsymman.2020.07.011

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Depression can be quite common in the palliative care population. The estimated prevalence ranges from 24% to 70%. Depression in this population leads to a decreased quality of life and may lead to a desire for an earlier death. We conducted a systematic review to establish a better understanding of the available treatment interventions, both pharmacological and nonpharmacological specific to the palliative population. PubMed, PsycINFO, and CINAHL databases were searched using the MeSH terms: Palliative Care, Palliative Medicine, Terminal Illness, End of Life Care, and Depression or Depressive Disorder, as well as the keywords palliative care, care palliative, and depression. We considered all published peer-reviewed articles written in English and pertaining to humans. Articles were hand searched from citations. The Mixed Methods Appraisal Tool was used for study quality appraisal. Thirty-nine eligible articles were found; 29 articles examined nonpharmacological options, while 10 focused on pharmacological options. The 29 articles discussing nonpharmacological methods discussed 22 interventions. Of the 22 interventions, 10 showed therapeutic benefit. Of the 10 studies focusing on pharmacological interventions, seven showed therapeutic benefit. This is the first systematic review that examined both nonpharmacological and pharmacological methods to treat depression in the palliative setting. There is evidence to indicate that methylphenidate and antidepressants can provide a therapeutic benefit for palliative care patients with depressive symptoms. This benefit may be enhanced when these medications are used in combination. The use of music therapy or future-focused psychotherapy may also be beneficial in the treatment of depression.

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Media Watch: Lessons learned from COVID-19

The articles below, selected from recent issues of Barry R. Ashpole’s weekly report Media Watch, focus on COVID-19 from a hospice and palliative care perspective in North America, Europe, and Asia-Pacific.

North American perspective

Expanding the Palliative Care Workforce during the COVID-19 Pandemic: An evaluation of core palliative care skills in health social workers

Journal of Palliative Medicine | Online – 30 June 2021 – Besides palliative care (PC) physicians or advanced practice providers, health social workers (SWs) were the next most common group to lead goals-of-care conversations for high-mortality risk patients. With minimal training, health SWs were able to increase their use of the following core PC skills: “identify or document a healthcare proxy or surrogate decision-maker,” “assess prognostic understanding” and “coordinate care between medical teams.” DOI: 10.1089/jpm.2021.0027

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Innovation in a Crisis: Lessons learned from the rapid development of an end-of-life palliative care unit during the COVID-19 pandemic

Journal of Palliative Medicine | Online – 4 June 2021 – As COVID-19 surged in Boston in March of 2020, the authors saw a rapid influx of patients, many of whom were suffering from immense physical and psychosocial symptoms at the end of life (EoL). To address this as well as systems challenges, the inpatient palliative care team was tasked with developing a 12-bed Palliative Care Compassion Unit in 10 days for patients with and without COVID-19 at EoL. DOI: 10.1089/jpm.2021.0035

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European perspective

Community End-of-Life Care during COVID-19: Findings of a UK primary care survey

BJGP Open | Online – 11 June 2021 – This study identifies the contrasting and potentially conflicting roles that emerged between general practitioners and community nurses in their responses to the increased demand and complexity of palliative and end-of-life care in the community in the early months of the COVID-19 pandemic. The significant emotional impact, especially for community nurses, needs to be addressed alongside promoting effective, collaborative and mutually supportive team working that can recognise and quickly adapt to changing patient needs. DOI: 10.3399/BJGPO.2021.0095

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Are Public Health Measures and Individualised Care Compatible in the Face of a Pandemic? A national observational study of bereaved relatives’ experiences during the COVID-19 pandemic

Palliative Medicine | Online – 31 May 2021 – This research represents the first U.K. study of bereaved relatives’ views about quality of care and family support provided during the last days of life and highlights the challenges and emotions experienced during the COVID-19 pandemic. This study closely examines the quality of the dying experience which can have subsequent impact on grief. DOI: 10.1177/02692163211019885

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Asia-Pacific perspective

Telehealth: Rapid adoption in community palliative care due to COVID-19—patient and professional evaluation

Palliative Medicine | Online – 23 June 2021 – 74 patients and 22 healthcare professionals returned surveys. Both groups felt comfortable using telehealth, however, also encountered a range of issues when undertaking telehealth consultations. The preference of both groups was for a community palliative care (PC) service model which combined face-to-face and telehealth consultations. This study is one of the first to directly address this question and as such provides useful guidance for health services when planning future community PC service models. DOI: 10.1136/bmjspcare-2021-002987

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A related report from the UK: Video Hospice Consultation in COVID-19: Professional and patient evaluations


Not Remembering History, Dooms Us to Repeat It: Using the lessons of the global HIV response to address COVID-19

AIDS Behav, 2020; 24: 3288–3290. Global health in 2020 has been dominated by COVID-19 and high-income countries (HICs) are setting most of the priorities. Currently, two-thirds of the headquarters of global organizations involved in health and health policy are located in only three HICs (USA, UK and Switzerland). Drawing on decades of lessons from the HIV epidemic, we argue in this commentary that LMICs need to design and implement their own COVID policies, to build on their strengths and also to have the courage to resist policy and financial directives from HICs. DOI: 10.1007/s10461-020-03066-y

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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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