Palliative Care Digest - January 2010

This digest is designed to highlight journal articles and news stories of interest to those working in specialist and generalist palliative care. The digest will be updated on a monthly basis.  If you would like to be informed when the digest is updated, please email hospice.info@hje.org.uk.   

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Spiritual Care Beliefs and Practices of Special Care and Oncology RNs at Patients’ End of Life

Link to article

Source: Journal of Hospice & Palliative Nursing

Author: Murray, Reinette Powers

Issue: Volume 12(1), January/February 2010, pp 51-58

Abstract Summary: The need for nurses to address patients' spiritual care practices and needs at the end of life was the focus of this study. A descriptive comparative study was done between 33 intensive care and oncology RNs, addressing their personal spiritual beliefs and practices caring for patients at the end of life. The nursing framework for the study was the "Comfort Theory" (Kolcaba). The RNs from these two units participated by completing the Demographic and Spiritual Beliefs and Practices surveys. Results showed a nonsignificant difference between nurses who worked on the two units. The RNs from both units felt a strong belief in the need to assess their patients' spirituality at the end of life. Despite indicating the need to address spiritual care needs in their daily practice, data revealed a great inconsistency in nurses addressing these needs and a desire for education in addressing spirituality issues with their patients and family members. Results of this study support previous research identifying the need for greater support of the RN in identifying and assessing spiritual care concerns of their patients.

Chronic Palliative Care: Specific practices for Alzheimer's disease sufferers

Link to article

Source: Journal of Palliative Care

Authors: Mino, Jean-Christophe and Frattini, Marie-Odile

Issue: Winter 2009. Vol. 25, Iss. 4;  pg. 257

Abstract Summary: With Alzheimer's disease, the chronic palliative care phase takes place between the stimulation phase - during which cognitive rehabilitation (and possibly medication) is used in an attempt to limit the evolution of the disease - and the terminal palliative care pahse. Issues related to that middle phase raise many questions among the professionals we met. Their points of reference are not as clear as they are during the stimulation and terminal phases, and their practices remain formalized.

Out-of-hours palliative care provided by GP co-operatives: availability, content and effect of transferred information

Link to article

Source: BMC Palliative Care

Authors: Bart PM Schweitzer, Nettie Blankenstein, Luc Deliens, and Henriette van der Horst

Issue: Volume: 8:17, November 2009

Abstract Summary: Out-of-hours GP care in England, Denmark and the Netherlands has been reorganised and is now provided by large scale GP co-operatives. Adequate transfer of information is necessary in order to assure continuity of care, which is of major importance in palliative care. We conducted a study to assess the availability, content and effect of information transferred to the GP co-operatives. Method - Cross-sectional exploratory study of all palliative care phone calls during a period of one year to a GP co-operative. The total number of phone calls about patients who needed palliative care was 0.75% of all calls to the GP co-operative. Information was transferred by GPs on 25.5% of palliative care patient calls, and on 12% of palliative care patient calls from residential care homes. For terminally ill patients the number of information transfers increased to 28.9%. When information was transferred, the content consisted mainly of clinical data. Information about the diagnosis and current problems was transferred in more than 90% of cases, information about the patient's wishes in 45% and information about the patient's psychosocial situation in 30.5% of cases. A home visit was made after 53% of the palliative care calls. When information was transferred, fewer patients were referred to a hospital. GPs frequently fail to transfer information about their palliative care patients to the GP co-operatives. Locums working at the GP co-operative are thus required to provide palliative care in complex situations without receiving adequate information. GPs should be encouraged and trained to make this information available to the GP co-operatives.

What progress has been made towards implementing national guidance on end of life care? A national survey of UK general practices

Link to article

Source: Palliative Medicine

Authors: Philippa M Hughes, Peter A Bath, Nisar Ahmed, Bill Noble

Issue: Volume 24(1), January 2010: 68-78

Abstract Summary: The objectives of this study were to establish the extent to which UK primary care has adopted recommended practices on supportive and palliative care of adults with cancer, and to relate this to participation in national initiatives. We conducted a cross-sectional postal questionnaire survey of a random sample of UK general practices. In total, 60.0% of practices (2096 of 3495) responded to the survey: 61.5% reported involvement with the Gold Standards Framework (GSF); 24.4% with the Liverpool or other End of Life Care Pathway; 12.3%, with the Preferred Place of Care (PPC) initiative; and 8.4% with Advance Care Planning (ACP). Participation in GSF contributed most to the variance in practice organization scores; and practice organization scores contributed most to the variance in clinical care scores. Participation in ACP or PPC, and higher clinical care scores were associated with an increased likelihood of reported high rates of death at home for cancer patients. Our findings appear to support the role of national initiatives in improving the quality of end-of-life care delivery in general practice. A population-based study would be required to assess the effect of end of life care on clinical outcomes and patient or carer experience.