Lessons from the Literature

Volume 23, Number 12: December 2022

On My Radar

This the final edition of Barry Ashpole’s On My Radar. He is now fully retired from producing MediaWatch, from which this column is taken. The long-running, popular, and useful review of the medical literature from the point of view of improving palliative and hospice care may be over, but new projects await!

Better Regulation of End-of-Life Care: A call for a holistic approach

BP White, L Willmott, E Close. J Bioethical Inquiry 2022. Published online October 17, 2022. DOI: 10.1007/s11673-022-10213-8

Existing regulation of end-of-life care is flawed. Problems include poorly-designed laws, policies, ethical codes, training, and funding programs, which often are neither effective nor helpful in guiding decision-making. This leads to adverse outcomes for patients, families, health professionals, and the health system as a whole. A key factor contributing to the harms of current regulation is a siloed approach to regulating end-of-life care.

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Co-Designing Community Out-of-Hours Palliative Care Services: A systematic literature search and review
C Low, P Manasivayam, T Barnett. Palliat Med 2022. Published online November 9, 2022. DOI: 10.1177/02692163221132

The review found that out-of-hours palliative care service research does not report a high level of end-user engagement. Whist challenging, incorporating end-users’ priorities and preferences through the application of co-design principles in the planning and designing of out-of-hours palliative care service can help align care to the needs and values prioritised by patients and their families. 

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Notable: The last Media Watch supplement was published on November 15, 2022. The last update to the Prison Hospice: Backgrounder was published on August 1, 2022.


What Is the Minimally Effective Dose of Palliative Care? 

E Bruera. J Palliat Med 2022; 25(11). Published online October 27, 2022. DOI: 10.1089/jpm.2022.0432

This short commentary cites research showing that “specialist-driven interdisciplinary teams improve physical symptoms, psychosocial and spiritual distress, quality of life, and even cost of care.” Noting, however, that “clinical and academic leaders have failed to establish robust structures and processes, even in many of the elite cancer centers in our nation,” worsening patient outcomes and increasing burnout among medical staff. “One possible approach to the lack of investment in palliative care would be to ‘give a lower dose’ and see if it works the same.” It goes on to describe what that could look like, citing a study showing the difference a nursing intervention made.

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Satisfaction with Care Provided by Home-Based Palliative Care Service to the Cancer Patients in Dhaka City of Bangladesh: A cross-sectional study

J Biswas, M Faruque, PC Banik, N Ahmad, SR Mashreky. Health Sci Reports 2022; 5(6): e908. DOI: 10.1002/hsr2.908

A majority (88.2%) of the 51 patients in this study were satisfied with services by the home care team, including assessment of symptoms (70.6%), pain management (70.6%), inclusion of the family in decision-making (76.5%), coordination of care (76.5%), and availability of doctors, nurses, and palliative care assistants (84.3%). The median duration of services was 4 months.

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