This episode features Dr Fiona Kenney and Koby Anderson, (Ottawa Hospital Research Institute, Ottawa, ON, Canada Bruyère Research Institute, Ottawa, ON, Canada)

What is already known about the topic?

• Previous research demonstrates a high prevalence of severe grief symptoms up to a year post-death of a loved one among those who experienced bereavement during the COVID-19 pandemic.
• No previous study has assessed changes in the severity of grief more than a year after the death of a loved one during the COVID-19 pandemic.

What this paper adds?

• This prospective cohort follow-up study found the prevalence of severe grief reaction remained high (28.8%) at 12–18 months post- family member death.
• One-third (33.3%) of family members experienced persistently high or worsening grief symptoms at the time of their 12–18-month assessment compared to baseline 6–12-month assessment.
• Grief severity was associated with endotracheal intubation in the deceased, but not with the cause of death (e.g., COVID vs non-COVID illness) or physical presence/absence of the family member at the bedside in the final 48 h of life.

Implications for practice, theory, or policy

• There is a persistent, elevated risk of severe grief among family members who experience bereavement during the pandemic period, even up to 18 months post-death of the decedent.
• There is an urgent need for effective and scalable means of addressing severe grief in the wake of the COVID-19 pandemic.

Full paper available from:    

https://journals.sagepub.com/doi/full/10.1177/02692163231223394

If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu: 

[email protected]

This episode features Sue-Ling Chang, (CHU de Québec-Université Laval Research Center, Oncology Division, Québec City, QC, Canada)

What is already known about the topic?

• There is a growing interest in psilocybin-assisted therapy worldwide, particularly to treat existential distress at the end of life.

What this paper adds?

• In this study, we show that the social acceptability of psilocybin-assisted therapy to treat existential distress at the end of life is high in Canada and identify factors associated with favourable attitudes of the population towards it.

Implications for practice, theory, or policy

• Our findings may help mobilise resources to address barriers and challenges for implementing psilocybin-assisted therapy within palliative medicine and society. This could also have implications for policies regarding medical assistance in dying.

 Full paper available from:    

https://journals.sagepub.com/doi/full/10.1177/02692163231222430

 If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu: 

[email protected]

This episode features Dr Carlos Seiça Cardoso (Faculty of Medicine, University of Coimbra, Coimbra, Portugal CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal)

 What is already known about the topic?

• The burden of chronic, progressive, incurable and life-threatening illness is increasing, highlighting the need to integrate palliative care into patients’ care plans.
• Data indicate that involving General Practitioners in the provision of palliative care may improve outcomes for patients and families, but the evidence on the effectiveness of interventions for patients with palliative care needs in primary care is still scarce.

 What this paper adds?

• We developed a training programme, from logistics to content, to be feasible for General Practitioners and to address the main topics in which they identified training needs.
• A two-tiered intervention was implemented, involving training and a new consultation model; this was shown to be feasible and effective in reducing the physical and emotional symptoms of patients with palliative needs managed in primary care.
• To the best of our knowledge, this is the first intervention involving General Practitioners, that assesses the impact on patients’ self-reported symptoms and demonstrates positive effects.

 Implications for practice, theory, or policy

• General Practitioners may test whether the intervention is applicable in their own setting, as there is potential for transferability to similar primary care settings elsewhere in the world.

• We successfully implemented and evaluated an intervention with a statistically and clinically important impact on patients, showing that research in primary palliative care can and must expand, as it may be key in the initial care of patients with palliative needs.

  Full paper available from:    

https://journals.sagepub.com/doi/full/10.1177/02692163231219682

 If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu: 

[email protected]

This episode features Ellis Slotman (Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands)

 What is already known about the topic?

• Potentially inappropriate end-of-life care in patients with cancer is still common.
• The COVID-19 pandemic has been shown to affect cancer diagnosis and treatment, but evidence on how the pandemic has affected end-of-life care is limited. 

 What this paper adds?

• The COVID-19 pandemic was associated with less potentially inappropriate care at the end of life in patients with cancer. 
• The decline in potentially inappropriate end-of-life care was driven by fewer hospitalizations and intensive care unit admissions in the last month of life and fewer hospital deaths. 

 Implications for practice, theory, or policy

• The findings of this study raise important questions as to which pandemic related changes in end-of-life care delivery and decision making might be able to contribute to appropriate end-of-life care for future patients. 
• Ensuring that awareness for triaging and advance care planning is maintained after the pandemic may be of great importance in this regard. 

Full paper available from:    

https://journals.sagepub.com/doi/10.1177/02692163231217373

 If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu: 

[email protected]

This episode features Dr Vanessa Abrahamson, (Centre for Health Services Studies, University of Kent, Kent, UK).

What is already known about the topic?

• Increasingly, people at end-of-life want to die at home but this relies heavily on family carers to support the patient.
• Many carers struggle with the practical and emotional burden of caring for a loved one at home.
• Services providing hospice care at home are highly rated by carers but access is limited and the model of care varies greatly between services, with little data on how this affects patient/carer experiences.

What this paper adds?

• Hospice-at-home services need to set clear expectations from the start so that families know exactly what the service can, or cannot, provide; this helps establish confidence in the service and build a strong relationship with the carer.
• Carers valued the expertise of hospice staff (in death and dying) and that they had time to care in a flexible and compassionate manner, which other services lacked.
• Carers felt ‘doubly’ bereaved when the person they cared for died and the hospice team immediately withdrew; existing bereavement services did not suit many carers, particularly younger families.

Implications for practice, theory, or policy

• Carers appreciated early contact with services but placing the onus on carers to trigger increased help when needed was not found supportive.
• There should be regular review of needs for the carer as well as for the patient and services available to address both their needs; services could consider options to increase volunteer contributions to hospice-at-home services.
• Hospice services could consider how to provide bereavement support that meets carer preferences.

Full paper available from:    

https://journals.sagepub.com/doi/10.1177/02692163231206027

If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu: 

[email protected]

This episode features Dr Nivedita Ashok, (University College London, London, UK).

What is already known about the topic?

• Individuals with intellectual disability or serious mental illness have high rates of mortality due to physical comorbidities.
• These populations have specific needs that should be met to provide optimum palliative care and maintain optimum mental healthcare at the end-of-life.
• While research exists describing the problems these populations face, little is known about how to improve care for them.

What this paper adds?

• By focusing on lived experiences of patients/service users, carers and healthcare professionals this paper synthesises existing evidence into multivoiced perspectives on what works, does not work, plus challenges and opportunities for improvement.
• Assumptions and misunderstandings about the role of mental capacity assessment to appropriately involve the patient in decision-making are common, while adapting training for palliative care staff to address concerns and beliefs about mental illness helps to avoid diagnostic overshadowing.
• Professionals need help to work across divides between physical and mental healthcare services, so people can receive palliative care in familiar locations and/or from familiar people.

Implications for practice, theory, or policy

• A significant research deficit exists regarding provision of optimal palliative care to people with psychosis, personality disorders, bipolar affective disorder and depression.
• Assessing capacity may be optimally achieved by involving professionals across specialities and organisations.
• Proactive identification of service arrangements for care needs of persons with serious mental illness will help optimise care.

Full paper available from:    

https://journals.sagepub.com/doi/10.1177/02692163231175928

If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu: 

[email protected].uk

This episode features Caitlin Spooner (Marie Curie Palliative Care Research Department, University College London, London, UK).

 What is already known about the topic?

- Currently, there is no gold standard for evaluating how different methods of prognosticating in advanced cancer impact on patient care.

- Prognostic models are principally evaluated by their statistical performance, determining their discrimination and calibration. However, before any prognostic model can be recommended for use in clinical practice, it is necessary to demonstrate whether or not it has a beneficial impact on patient care.

- There is a lack of consensus among stakeholders about how to assess the impact of prognostication in advanced cancer, with prognostic studies varying in the outcomes they select.

 What this paper adds?

- We identified a wide variety of outcomes and measures used in published studies, which makes inter-study comparability problematic.

- Our findings highlight the widespread effect that prognostication in advanced cancer has on patients and informal caregivers.

- The lived experiences of patients and informal caregivers regarding prognostication in advanced cancer are not always represented in the outcomes quantitative prognostic studies measure.

 Implications for practice, theory, or policy

- Further research is needed to identify and prioritise outcomes to measure the impact of prognostication in advanced cancer.

- Patients’ and informal caregivers’ experiences and perspectives should always be incorporated when evaluating the impact of prognostication.

- Outcome selection in prognostication studies needs to be more consistent and standardised.

 Full paper available from:   

https://journals.sagepub.com/doi/full/10.1177/02692163231191148

 If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu:

[email protected]

This episode features Dr Amara Nwosu (Lancaster Medical School, Lancaster University, Lancaster, UK; Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK; and Marie Curie Hospice Liverpool, Liverpool, UK). The podcast is an overview of a published editorial on telehealth in palliative care. Dr Nwosu highlights the unrealised potential of palliative care telehealth, and discusses the opportunities and challenges associated with telehealth. Finally, Dr Nwosu describes the next steps needed for research evaluating palliative care telehealth.

Full paper available from:   

https://journals.sagepub.com/doi/full/10.1177/02692163231182461

If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu:

[email protected]

Title

"Hospital-service use in the last year of life by patients aged ⩾60 years who died of heart failure or cardiomyopathy: A retrospective linked data study"

Description

This episode features Dr Gursharan K Singh (Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia).

What is already known about the topic?

- Evidence based guidelines recommend palliative care for individuals with advanced heart failure, yet there is limited data on acute hospital and palliative care service use prior to death, to inform care planning and end-of-life services.

What this paper adds?

- Patients were generally aged ⩾80 years old and experienced repeat acute hospitalisations in the year preceding death.

- Over half died in hospital, without a hospitalisation for palliative care recorded.

- For those who had a hospitalisation for palliative care recorded, this mostly occurred in the last 7 days of life.

Implications for practice, theory, or policy

- Improving access to palliative care services in the outpatient or community setting is needed to reduce avoidable hospitalisation

- Improving access to timely palliative care, including end-of-life care, for patients with heart failure is needed.

Full paper available from:   

https://journals.sagepub.com/doi/full/10.1177/02692163231180912

 If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu:

[email protected]

This episode features Hannah May Scott (Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King’s College London, London, UK).

What is already known about the topic?

- Although spiritual concerns are recognised as a core component of palliative care for children, there is a paucity of primary data.

- Self-report data from children is rare, and existing evidence is largely proxy data from parents or health and social care professionals and mainly focused on the religious aspect of spiritual care for cancer patients.

What this paper adds?

- Specific spiritual concerns among children with a range of life-limiting and life-threatening conditions and their families (parents and siblings) included: living life to the fullest, meaning of life and leaving a legacy, uncertainty about the future, determination to survive, accepting or fighting the future and role of religion.

- This work broadens understanding of the spiritual domain for these children beyond religious needs to existential and value-based spiritual concerns.

- Recognition of the way in which children conceptualise spirituality and being able to identify their spiritual concerns is essential for child- and family-centred holistic palliative and end-of-life care.

Implications for practice, theory, or policy

- Professionals can optimise children and family’s wellbeing through identification of the things that provide meaning for them, and working together to set goals and actions towards achieving them.

- Such concerns must be assessed beyond religious considerations.

- Simple tools and training to support professional may be useful in implementing this.

 Full paper available from:   

https://journals.sagepub.com/doi/full/10.1177/02692163231165101

 If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu:

[email protected]

This episode features Dr Jenny Lau (Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada; Division of Palliative Care, University Health Network, Toronto, ON, Canada) and Dr. Daniel Buchman (Everyday Ethics Lab, Centre for Addiction and Mental Health, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; University of Toronto Joint Centre for Bioethics, Toronto, ON, Canada)

What is already known about the topic?

•             Communicable disease epidemics and pandemics, such as the COVID-19 pandemic, intensify the healthcare inequities encountered by people who use drugs.

•             Pandemics are expected to increase the demand for palliative care resources.

•             People who use drugs with life-limiting illnesses experience inequities in access to palliative care.

•             There is limited evidence beyond the HIV/AIDS context to guide decision-makers on the provision of palliative care for people who use drugs during communicable disease epidemics and pandemics.

What this paper adds?

•             This paper demonstrates that there is limited knowledge about how to provide palliative care for people who use drugs during epidemics and pandemics other than HIV/AIDS.

•             We identified enablers and barriers to equitable palliative care access, which include organizational barriers, issues related to stigma and structural inequity, and access to opioids and other substances

•             Our findings build on past research that seeks to integrate the premises of health equity within palliative care so health systems can be better prepared for future epidemics and pandemics.

Implications for practice, theory, or policy

•             The findings from our scoping review provides accessible and relevant evidence for healthcare professionals and decision-makers (e.g. policy makers, administrators) that can be applied to the COVID-19 pandemic response efforts and potentially future epidemics and pandemics.

•             More research is needed about palliative care access, policies, and programs for people who use drugs during communicable disease epidemics and pandemic beyond the HIV/AIDS context.

 Full paper available from:   

https://journals.sagepub.com/doi/10.1177/02692163221143153

 If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu:

[email protected]