Abstract
Best M, Butow P, Olver I. Palliative care specialists’ beliefs about spiritual care. Support Care Cancer 2016; 24: 3295–3306.
A previous survey of the Multinational Association of Supportive Care in Cancer (MASCC) members found low frequency of spiritual care provision. The authors hypothesized that physicians with special training in palliative medicine would demonstrate an increased sense of responsibility for and higher self-reported adequacy to provide spiritual care to patients than health professionals with general training. The authors surveyed members of the Australian and New Zealand Palliative Medicine Society (ANZSPM) to ascertain their spiritual care practices. They sent 445 e-mails on 4 occasions, inviting members to complete the online survey. Results demonstrated that 158 members (35.5%) responded. Physicians working primarily in palliative care comprised the majority (95%) of the sample. Significantly more of the ANZSPM than MASCC respondents had previously received training in spiritual care and had pursued training in the previous two years. There was a significant difference between the two groups with regard to interest in and self-reported ability to provide spiritual care. Those who believed that it was their responsibility to provide spiritual care were more likely to have had training, feel they could adequately provide spiritual care, and were more likely to refer patients if they could not provide spiritual care themselves. The authors conclude that training in spiritual care was more common in healthcare workers who had received training in palliative care, and that ANZSPM members gave higher scores for both the importance of spiritual care and self-reported ability to provide it than MASCC members.
Mularski RA, Hansen L, Rosenkranz SJ, et al. Medical record quality assessments of palliative care for intensive care unit patients. Do they match the perspectives of nurses and families? Ann Am Thoracic Soc 2016; 13: 690–698.
The aim of this study was to measure the quality of palliative care delivered in the ICU, using chart review-derived process quality measures of palliative care in critically ill patients, and to compare these measures with family and nursing perspectives on the quality of care provided in an effort to direct improvements. The authors developed and operationalized a comprehensive quality evaluation measure set from previously endorsed palliative care measure statements, using a rigorous multidisciplinary Delphi process focused on optimizing the validity and feasibility of chart review-derived metrics. Fourteen process measures assessed the quality of care delivered across established domains of palliative care for the ICU. The authors assessed the quality of care for ICU patients with ICU length of stay exceeding two days from three perspectives: medical record reviews, family satisfaction reports, and nurse ratings from those providing care in the ICU. Care was evaluated over a seven-month period. One-hundred fifty patients (mean age, 63.9 years [SD 13.4], average ICU length of stay, 7.5 days [SD 7.2]) were involved in the study. Overall, ICU patients received 53.1% of recommended palliative care. The family satisfaction with care in the ICU total scores from 136 family members (response rate, 91%) were high, 85.7 (SE 2.0) and 86.0 (SE 1.6), at the two sites, but not correlated with measured quality delivered. Nurses rated the quality of care higher than medical record review (mean, 77.3% [SD 13.4]; n = 135) and similarly correlation with chart-based process measures was poor. The authors conclude that delivering high-quality palliative care in the ICU requires assessing key patient-centered domains. However, assessments from different perspectives do not always agree with technical quality of care as measured through chart-based metrics. The authors found deficits across seven domains of technical quality that were not correlated with either nurse or family ratings. Despite care gaps, families were generally satisfied with the care delivered. The authors note that each measurement perspective provides an independent view that can guide quality improvement and innovation work as well as subsequent research.
De Vries K, Plaskota M. Ethical dilemmas faced by hospice nurses when administering palliative sedation to patients with terminal cancer. Palliat Support Care 2016; e-pub ahead of time, DOI: https://dx-doi-org.web.bisu.edu.cn/10.1017/S1478951516000419.
Palliative sedation is a method of symptom management frequently used in hospices to treat uncontrolled, refractory symptoms at the end of life. There is a substantial body of literature on the subject; however, there has been little research into the experiences of hospice nurses when administering palliative sedation in an attempt to manage the terminal restlessness experienced by cancer patients. In this study, semistructured interviews were conducted with a sample of seven hospice nurses who had cared for at least one patient who had undergone palliative sedation within the past year in a hospice in the south of England in the United Kingdom (UK). Results demonstrated that facilitating a “peaceful death” was the primary goal of the nurses, where through the administration of palliative sedation they sought to enable and support patients to be “comfortable,” “relaxed,” and “calm” at the terminal stage of their illness. Ethical dilemmas related to decision making were a factor in achieving this. These were medication decisions, “juggling the drugs,” “causing the death,” sedating young people, the family “requesting” sedation, and believing that hospice is a place where death is hastened. The authors conclude that hospice nurses in the UK frequently encounter ethical and emotional dilemmas when administering palliative sedation. Making such decisions about using palliative sedation causes general discomfort for them. Undertaking this aspect of care requires confidence and competence on the part of nurses, and working within a supportive hospice team is of fundamental importance in supporting this practice.
Brennan F. The pathophysiology of pruritus—A review for clinicians. Prog Palliat Care 2016; 24: 133–146.
Pruritus is a troubling and occasionally disabling symptom. The past decade has witnessed significant progress in the understanding of the complex pathophysiology of pruritus. Most of that literature has emerged in neurobiology, immunology, and experimental dermatology; little has appeared in the palliative care literature. This review synthesizes the current understanding of the mechanism of pruritus and argues that a well-informed knowledge of pathophysiology is necessary to both illuminate this area of clinical practice and enhance strategies of management.
Laird BJA, Fallon M, Hjermstad MJ, et al. Quality of life in patients with advanced cancer: Differential association with performance status and systemic inflammatory response. J Clin Oncol 2016; e-pub head of time, DOI: 10.1200/JCO.2015.65.7742.
Quality of life is a key component of cancer care; however, the factors that determine quality of life are not well understood. The aim of this study was to examine the relationship between quality-of-life parameters, performance status (PS), and the systemic inflammatory response in patients with advanced cancer. An international biobank of patients with advanced cancer was analyzed. Quality of life was assessed at a single time point by using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C-30 (EORTC QLQ-C30). PS was assessed by using the Eastern Cooperative Oncology Group (ECOG) classification. Systemic inflammation was assessed by using the modified Glasgow Prognostic Score (mGPS), which combines C-reactive protein and albumin. The relationship between quality-of-life parameters, ECOG PS, and the mGPS was examined. Results were available for 2520 patients; the most common cancers were GI (585 patients [22.2%]) and pulmonary (443 patients [17.6%]). The median survival was 4.25 months. Increasing mGPS (systemic inflammation) and deteriorating PS were associated with deterioration in quality-of-life parameters (p < 0.001). Increasing systemic inflammation was associated with deterioration in quality-of-life parameters independent of PS. The authors conclude that systemic inflammation was associated with quality-of-life parameters independent of PS in patients with advanced cancer. The authors also suggest that further investigation of these relationships in longitudinal studies and investigations of possible effects of attenuating systemic inflammation are now warranted.
Dawes JM, Angela V. Autoantibodies and pain. Curr Opin Support Palliat Care 2016; 10: 137–142.
Over the past 20 years, several neurological conditions have been identified that appear to be caused directly by autoantibodies targeting receptors, ion channels, and related proteins on neuronal or glial cells. Neuroimmune interactions are now accepted contributors to chronic pain conditions. Autoantibodies might be one such cause and the authors highlight their potential role in pathological pain. Recent studies have given more weight to the idea that autoantibodies can be directly related to pain; this is suggested by the success of immunotherapy in patients and preclinical studies in animal models. For example, in complex regional pain syndrome, plasma exchange or intravenous immunoglobulins have been successful in reducing pain scores. Similarly, immunotherapies reduce autoantibody levels and pain in neuromyelitis optica and voltage-gated potassium channel complex antibody-positive patients. Furthermore, animal studies show that IgG autoantibodies from patients with rheumatoid arthritis or complex regional pain syndrome can recapitulate pain phenotypes in mice. The authors conclude that there is growing evidence that some pain syndromes may be caused by autoantibodies to proteins that modify or exacerbate pain sensation, and that this has possible direct therapeutic advantages for these patients and possible wider implications for sufferers of chronic pain.