palliative_care

End of life care for infants, children and young people with life limiting conditions: summary of NICE guidance

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Children and young people can have a wide range of life limiting conditions and may sometimes live with such conditions for many years. This guideline recommends that end of life care be managed as a long term process that begins at the time of diagnosis of a life limiting condition and entails planning for the future. Sometimes it may begin before the child’s birth. It is part of the overall care of the child or young person and runs in parallel with other active treatments for the underlying condition itself. Finally, it includes those aspects related to the care of the dying.

Combination drug shows promise for treating agitation in patients with Alzheimer’s disease

jamaA combination drug treatment can reduce agitation in patients with probable Alzheimer’s disease and is generally well tolerated, preliminary research published in JAMA has shown.

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The phase II double blind randomised clinical trial showed that patients who received the combination dextromethorphan hydrobromide and quinidine sulphate had lower occurrence and severity of agitation than patients who received placebo. This combination is approved in the United States and the European Union for treating pseudobulbar affect, a neurological disorder characterised by uncontrollable episodes of crying.

Being underweight in middle age is associated with raised dementia risk, large study finds

People who are underweight in middle age are at increased risk of developing dementia, while increasing weight and obesity offer protection against the condition, a large cohort study has found.

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A number of previous studies have looked at the association between weight and dementia, and most have found that the risk of dementia increased among adults who are overweight or obese, although some studies have found the opposite. Most of these studies have been small, which led the present researchers to conduct a much larger analysis of the link.

Terminally ill patients could benefit from stopping statins, study says

Discontinuing treatment with statins in patients with terminal illnesses is safe, could improve quality of life, and could reduce costs, US research published in JAMA Internal Medicine concludes.

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The pragmatic randomized trial looked at 381 patients with a mean age of 74.1 years. Half of the patients had cancer, and all had an estimated life expectancy of between one month and one year. The patients had been taking prescribed statins for three months or more for primary or secondary prevention of cardiovascular disease but had no recent active cardiovascular disease

NHS England: Revised funding approach for palliative care

NHS England has published a revised draft funding approach for NHS_Englandpalliative care featuring a ‘currency’ for ensuring services match patient needs, offer best value and that providers are reimbursed fairly. The revision is informed by feedback received through consultation, events and seminars since publication of the original document in October 2014.

Doctors’ and nurses’ views and experience of transferring patients from critical care home to die: A qualitative exploratory study

Authors: Maureen Coombs, Tracy Long-Sutehall, Anne-Sophie Darlington and Alison Richardson

Extract from Palliative Medicine

Background: Dying patients would prefer to die at home, and therefore a goal of end-of-life care is to offer choice regarding where patients die. However, whether it is feasible to offer this option to patients within critical care units and whether teams are willing to consider this option has gained limited exploration internationally.
Aim: To examine current experiences of, practices in and views towards transferring patients in critical care settings home to die.
Free full-text available

Report on public health approach to improve end-of-life care

Using a public health approach to improve end-of-life care: results and discussion of a health needs assessment undertaken in a large city in northern England

This extract was taken from BMJ Support Palliat Care doi:10.1136/bmjspcare-2014-000662

“A detailed health needs assessment (HNA) for end-of-life care (EoLC) services was led by public health in Leeds to inform a commissioning strategy. To answer the question: are we delivering the best possible EoLC services within the resources available? Mixed methods were used with three approaches: epidemiological, corporate and comparative” …

Read the full article at: http://spcare.bmj.com/content/early/2014/09/05/bmjspcare-2014-000662.abstract

 

Updates from NICE: Eyes on Evidence

This month in Eyes on Evidence

Acid-suppressive drugs and oesophageal adenocarcinoma in Barrett’s oesophagus
A systematic review and meta-analysis indicates that proton pump inhibitors reduce the risk of oesophageal adenocarcinoma and high-grade dysplasia in people with Barrett’s oesophagus.

Prescriptions for anxiolytics and hypnotics and risk of death
A population-based cohort study in UK primary care suggests that people who are prescribed anxiolytic and hypnotic drugs have a significantly increased risk of death from any cause over a 7-year period.

Assessment and treatment of dementia in older adults
A systematic review finds that brief cognitive assessment tools can adequately detect early dementia, but whether interventions for mild cognitive impairment or early dementia have a clinically significant effect is unclear.

Bedtime schedules and children’s cognition and behaviour
Two analyses of 7-year-olds in the UK Millennium Cohort Study suggest that not having a regular bedtime is associated with impaired cognition in girls and behavioural difficulties in both girls and boys.

Trained glycaemia alert dogs for people with type 1 diabetes
A small UK intervention study suggests that trained glycaemia alert dogs may be able to notify people with type 1 diabetes during blood glucose variations.

NICE opens consultation on the NICE Accreditation Process Manual Update
NICE is inviting comments on its proposals to update the NICE Accreditation Process Manual.

Evidence Updates
NICE has recently published Evidence Updates on:

  • Physical activity and the environment
  • Autism in adults
  • Opioids in palliative care

Divided in dying

This report highlights the need for better advance care planning at the end of life and the urgent need to put in place workable guidance to replace the Liverpool Care Pathway as soon as possible. The report found that almost half of those who have lost someone close to them through a short or long illness, feel their loved one died badly (45%). In cases where the dying person had recorded their end of life wishes, relatives and friends are more likely to report that they had a good death (58%).
Compassion in Dying 

Care of the dying patient in the community

BMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f4085 (Published 3 July 2013)
Cite this as: BMJ 2013;347:f4085
 CME
General practice / family medicine
End of life decisions (ethics)
End of life decisions (geriatric medicine)
Extract from BMJ:The consensus from international studies of patient preferences is that, given adequate support, most people would prefer to die at home. However, more than half of all deaths in the United Kingdom occur in hospital, with only 18% of people dying in their own home. Suggested reasons for this include a lack of anticipatory care planning, poor coordination between healthcare agencies, and insufficient community resources. National and local policies now focus on facilitating home deaths, and recently there has been a small increase in the proportion and absolute number of people dying at home.

The demographics of deaths across Europe are changing with the ageing population, with deaths from dementia, cancer, and chronic diseases becoming more common.  Caring for such patients in hospital will probably become unsustainable in terms of capacity, cost, and patient satisfaction. The focus of end of life care is therefore shifting to the community—to homes and care homes—where the role of the general practitioner, with support from the community palliative care team, is key. The onus is on all health and social care professionals to work collaboratively across settings to enable patients to receive high quality end of life care in the place of their choice.

LCP Independent report

This report sets out recommendations regarding the Liverpool Care Pathway and end of life care following an independent review of the LCP chaired by Baroness Julia Neuberger.

The recommendations include:

  • unless there is a very good reason, a decision to withdraw or not to start a life-prolonging treatment should not be taken during any ‘out of hours’ period
  • an urgent call for the Nursing and Midwifery Council to issue guidance on end of life care
  • a new system-wide approach to improving the quality of care for the dying

End of Life Journal – Summer issue

endoflife_logoThe Summer 2013 issue of the free journal for nurses caring for dying people at home, in hospitals and care homes is now available online.  This issue is mobile-friendly making it easier to read on your mobile device or tablet.  Articles include:

CLINICAL PRACTICE DEVELOPMENT

CLINICAL SKILLS

RESEARCH

PERSONAL REFLECTIONS

CLINICAL SKILLS

CLINICAL RESEARCH/AUDIT

End of Life Journal – Spring Issue 2013

End of Life Journal is the free, online, peer-reviewed, quarterly journal that publishes articles on all aspects of nursing practice relating to end-of-life care.   It is primarily aimed at generalist nurses working in hospital, community and care home settings. However, many articles will also be of interest to the specialist palliative care nursing audience as well as members of the wider multidisciplinary team.   The journal focuses on care for patients with both malignant and non-malignant disease and their family and friends.

Articles include:endoflife_logo

CLINICAL REVIEW

CLINICAL SKILLS

CLINICAL PRACTICE DEVELOPMENT

ETHICAL/LEGAL DISCUSSIONS

NURSING CASE REVIEW

NATIONAL END OF LIFE CARE PROGRAMME UPDATE

Is educating community nurses about end-of-life care a waste of resources?

Brian Nyatanga, British Journal of Community Nursing, Vol. 18,
                          Iss. 2, 01 Feb 2013, pp 77

The health system-and palliative care in particular-are facing difficult financial times due to spending cuts. It seems that when times are this hard one of the first things to go is staff education, which is disturbing considering that it takes years to train community palliative care nurses to function at specialist level.

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New version of end of life care quality assessment tool launched

 

Extract from National End of Life Care Programme website

endoflifeThe National End of Life Care Intelligence Network (NEoLCIN) has released the new version of its End of Life Care Quality Assessment (ELCQuA) tool, which is now structured around the NICE quality standard for end of life care for adults.

ELCQuA is a free, online self-assessment tool designed to support local service improvement and the commissioning of end of life care services. It can be used by any organisation caring for people at the end of life, across the health, social care, voluntary and private sectors. This includes commissioners, local authorities, acute hospitals, primary care, community, palliative care and ambulance services.

Read more about it by following the link at the top of this post.

Opioid prescribing for cancer pain

Opioid prescribing for cancer pain during the last 3 months of life: associated factors and 9-year trends in a nationwide United Kingdom cohort study

Posted: 10 Dec 2012 12:00 AM PST

Source: Journal of Clinical Oncology

Purpose: To determine time trends and characteristics associated with opioid analgesic prescribing to patients with cancer who are approaching the end of life.

Patients and Methods: This population-based cohort study used data on 29,825 patients diagnosed with five common cancers – lung (34.2%), colorectal (19.9%), female breast (21.6%), prostate (19.1%) and head and neck (5.2%) – in the United Kingdom General Practice Research Database (GPRD) who died between 2000 and 2008.  Opioid prescription rates in the last 3 months of life were described.  Characteristics associated with opioid prescribing were investigated by using generalised estimation equation models. Results: In the last 3 months of life, 43.6% (95% CI, 43.0% to 44.2%) of patients received at least one prescription of opioids: morphine (33.4%; 95% CI, 32.8% to 33.9%), diamorphine (11.6%; 95% CI, 11.2% to 11.9%) and fentanyl family (10.2%; 95% CI, 9.8% to 10.5%).  Over time, prescription rates …

Helping GPs to support people to live and die well

National End of Life Care Programme (NEoLCP)

Find your 1%: helping GPs to support people to live and die well
This resource pack has been developed to be a practical tool to help GPs identify those patients who may be in their last year of life and talk to them about their preferences. It contains information on: identifying people at the end of life; having end of life care conversations; putting plans in place; managing and co-ordinating care; and space for GPs to include local information such as the telephone numbers of hospices, palliative care teams and pharmacies which stock palliative care drugs.

BMJ articles: End of Life Care Pathways

Kirsty Boyd and Scott Murray
Rosemarie Anthony-Pillai

Newsletter for End of Life care

The National End of Life Care Programme newsletter has published its August newsletter.
From NHS Networks
The National Council for Palliative Care (NCPC) has launched a toolkit to empower local people to push for the right end of life care services following reform of the health and social care system.

Improving communication between GPs and palliative care patients

The ACA training programme to improve communication between general practitioners and their palliative care patients: development and applicability

Source: BMC Palliative Care June 2012

Follow this link for the full text

Publication type: Web article

In a nutshell:  This article describes the development of a new training programme on GP-patient communication in palliative care, and the applicability to GPs and GP Trainees. This ‘ACA training programme’ focuses on Availability of the GP for the patient, Current issues that should be raised by the GP, and Anticipating various scenarios. Evaluation results indicate the ACA training programme to be applicable to GPs and GP Trainees. The ACA checklist was appreciated by GPs as useful both in practice and as a learning tool, whereas GP Trainees mainly appreciated the list for use in practice.

Length of publication: 16 pages

End of Life Journal : St Christopher’s Hospice

Summer 2012 Vol 2 Issue 2

End of Life Journal is free, online, peer-reviewed, quarterly journal that publishes articles on all aspects of nursing practice relating to end-of-life care.

It is primarily aimed at generalist nurses working in hospital, community and care home settings. However, many articles will also be of interest to the specialist palliative care nursing audience as well as members of the wider multidisciplinary team.

The journal focuses on care for patients with both malignant and non-malignant disease and their family and friends.

End of life journal ISSN 2047-6361 (online)

READ MORE ABOUT THIS ISSUE

 

via End of Life Journal | End of Life Journal.