|
Augment is produced quarterly and highlights some of the recent literature and web resources relevant to clinicians with an interest in palliative care in residential and community aged care.
Some of the articles or documents included in this newsletter may require a subscription to read in full. You can register to receive Augment via email or you can view previous editions on the Decision Assist website.
What’s New in the Literature?
What’s New on the Web?
Highlighting Decision Assist
What’s New in the Literature?
|
Ostherr K, Killoran P, Shegog R, Bruera E.
J Palliat Med. 2016 Apr;19(4):408-20.
Communication at the End-of-life (EOL) plays a critical role in ensuring that patients receive care concordant with their wishes and experience high quality of life. As the baby boomer population ages, scalable models of end-of-life communication will be needed to ensure that patients receive appropriate care. Information and communication technologies (ICTs) may help address the needs of this generation; however, few resources exist to guide the use of ICTs in EOL care.
The primary objective was to identify the ICTs being used in EOL communication. The secondary objective was to compare the effectiveness of different ICTs in EOL communication.
The authors conducted a systematic review, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. They systematically searched seven databases for experimental and observational studies on EOL communication between doctors and patients using ICTs, published in 1997–2013.
They identified 38 relevant articles. Eleven types of technology were identified: video, website, telephone, videoconferencing, e-mail, telemonitoring, Internet search, compact disc, fax, PalmPilot, and short message service (SMS) text messaging. ICTs were most commonly used to provide information or education, serve as decision aids, promote advance care planning (ACP), and relieve physical symptom distress.
The authors conclude the use of ICTs in EOL care is a small but growing field of research. Additional research is needed to adapt older, analog technologies for use in the digital age. Many of the interventions discussed in this review do not take full advantage of the affordances of mobile, connected health ICTs. The growing evidence base for e-health applications in related fields should guide future interventions in EOL care.
Reymond L, Cooper K, Parker D, Chapman M.
Aust Fam Physician. 2016 Jan-Feb;45(1):76-8
Due to the changing demographics of ageing and death in Australia, general practitioners (GPs) are caring for greater numbers of people with advanced chronic conditions that will soon lead to death. GPs play a pivotal role in proactively preparing these people for end-of-life.
This article introduces GPs to a framework of care, based on a palliative care approach, which supports proactive management of end-of-life care for older Australians living in the community.
Embedding the above framework into routine practice can help GPs deliver care, aligned with patients’ preferences, at the right time and in the right place. Experience has shown that implementing proactive management of end-of-life care can increase satisfaction with GP care and help GPs meet the clinical, legal and ethical challenges associated with caring for older patients with advanced progressive conditions.
Fleming J, Farquhar M, Cambridge City over-75s Cohort (CC75C) study collaboration, Brayne C, Barclay S.
PLoS One. 2016 Apr 5;11(4):e0150686.
Increasing longevity means more people will be dying in very old age, but little is known about the preferences of the 'oldest old' regarding their care at the end-of-life. This study aims to understand very old people's preferences regarding care towards the end-of-life and attitudes towards dying, to inform policy and practice.
The authors collected qualitative data for 42 study participants aged from 95 to 101 (88% women, 42% in long-term-care): topic-guided interviews with n = 33 participants and n = 39 proxy informants, most with both (n = 30: 4 jointly + separate interviews for 26 dyads).
The authors found that death was a part of life: these very old people mainly live day-to-day. Most were ready to die, reflecting their concerns regarding quality of life, being a nuisance, having nothing to live for and having lived long enough. Contrasting views were rare exceptions but voiced firmly.
Most were not worried about death itself, but concerned more about the dying process and impacts on those left behind; a peaceful and pain-free death was a common ideal. Attitudes ranged from not wanting to think about death, through accepting its inevitable approach to longing for its release. Preferring to be made comfortable rather than have life-saving treatment if seriously ill, and wishing to avoid hospital, were commonly expressed views. There was little or no future planning, some consciously choosing not to. Uncertainty hampered end-of-life planning even when death was expected soon. Some stressed circumstances, such as severe dependency and others’ likely decision-making roles, would influence choices. Carers found these issues harder to raise but felt they would know their older relatives’ preferences, usually palliative care, although we found two discrepant views.
The authors demonstrate people aged over 95-years are willing to discuss dying and end-of-life care but seldom do. Formal documentation of wishes is extremely rare and may not be welcome. Although being “ready to die” and preferring a palliative approach predominated, these preferences cannot be assumed.
Elsayem AF, Elzubeir HE, Brock PA, Todd KH.
World J Clin Oncol. 2016 Apr 10;7(2):227-33.
Although visiting the emergency departments (EDs) is considered poor quality of cancer care, there are indications these visits are increasing. Similarly, there is growing interest in providing palliative care (PC) to cancer patients in EDs. However, this integration is not without major challenges. In this article, the authors review the literature on why cancer patients visit EDs, the rates of hospitalisation and mortality for these patients, and the models for integrating PC in EDs. Opportunities and barriers such integration will bring to the quality of cancer care and resource utilization of resources are discussed.
The authors found that the most common reasons for ED visits by cancer patients are pain, fever, shortness of breath, and gastrointestinal symptoms. The majority of the patients are admitted to hospitals, about 13% of the admitted patients die during hospitalisation, and some patients die in ED. Patients who receive PC at an ED have shorter hospitalisation and lower resource utilization. Models based solely on increasing PC provision in EDs by PC specialists have had modest success, while very limited ED-based PC provision has had slightly higher impact. However, details of these programs are lacking, and coordination between ED based PC and hospital-wide PC is not clear. In some studies, the objectives were to improve care in the communities and reduce ED visits and hospitalisations.
The authors conclude that as more patients receive cancer therapy late in their disease trajectory, more cancer patients will visit EDs. Integration of PC with emergency medicine will require active participation of ED physicians in providing PC to cancer patients. PC specialist should play an active role in educating ED physicians about PC, and provide timely consultations. The impact of integrating PC in EDs on quality and cost of cancer care should be studied.
Choosing Wisely Australia
Choosing Wisely Australia is helping healthcare providers and consumers start important conversations about improving the quality of healthcare by eliminating unnecessary and sometimes harmful tests, treatments, and procedures.
Clinical Practice Guidelines and Principles of Care for People with Dementia
Guideline Adaptation Committee. Clinical Practice Guidelines and Principles of Care for People with Dementia. Sydney. Guideline Adaptation Committee; 2016.
These new clinical guidelines highlight the importance of early and intentional assessment, communication, recognition and management of symptoms, supporting living positively and actively, and medication considerations. Carer support and the need for training of health professionals were also acknowledged.
Clinical Practice Guidelines and Principles of Care for People with Dementia - Recommendations (freely accessible 463kb pdf)
PA Toolkit New Careworker Resources
The PA Toolkit Project has released new resources for careworkers. These resources include four short videos and their companion factsheets:
Highlighting Decision Assist
|
The Decision Assist Website – Fast Tracking Busy Clinicians to Quality Evidence
‘…Sourcing evidence based and best practice information to train my staff was vital. Finding one dedicated source proved this a much needed site.’ Registered Nurse
For many patients living with a life-limiting illness, healthcare professionals (HPs) working in primary care are well placed to deliver their care. Processes enhancing timely access to information are critical to the delivery of high quality palliative care. One of the Decision Assist project aims was to develop convenient and ready access to evidence-based advice relating to palliative care through the engagement of new web-based technologies.
It is clear that many good quality Australian texts already exist to guide HPs in delivering good palliative care. This project aimed to connect HPs with existing resources, through a web portal, rather than develop a suite of new resources.
Initially, a working party identified and prioritised medicines information and clinical care resources for inclusion as a core guidance documents. Information was organised using a system of structured queries to progressively pinpoint the issue and direct the HP to the most appropriate guidance.
This web-based tool provides flexible support for HPs to meet the needs of people living with a life-limiting illness and their family caregivers. In addition, it provides a foundation for all project activities and that training and use of the site has been provided to those answering the telephone line and to those involved in developing educational resources.
Web statistics demonstrate consistent traffic to the clinical information pages, indicating the site has become a frequently used resource to support HPs working in primary care. Frequently accessed pages include:
Decision Assist’s webpage clinical links page can be found here. In addition, the Decision Assist Phone Advisory Line is available on 1300 668 908 while the palliAGED smartphone app, can be downloaded, for those who need information on the run.
More information: www.decisionassist.org.au
|
