Abstract
Boerner K, Kim K, Kim Y, et al.: Centenarians' end-of-life thoughts and plans: Is their social network on the same page? J Am Geriatr Soc 2018; [Epub ahead of print]; DOI: org/10.1111/jgs.15398.
The objective of this population-based study was to explore how centenarians think about and plan for the end of life (EOL) and to what extent their primary contacts (proxy informants) are aware of these thoughts. The study had a defined geographical region ∼60 km around Heidelberg, Germany. Participants were a subsample drawn from a larger study of centenarians (n = 78) with data on centenarians' EOL thoughts from the centenarian and the proxy informant. In this study centenarians reported on their thoughts about the EOL, perception of the EOL as threatening, longing for death, engagement in any EOL planning, and type of EOL plan (will, living will, healthcare surrogate) in place. Proxy respondents answered the same set of questions based on what they thought the centenarians' perspective was. Results demonstrated that in nearly half of cases, proxies misjudged whether the centenarian thought about EOL. Although only few centenarians perceived the EOL as threatening, and approximately one-quarter reported longing for death, proxies overestimated centenarians' reports on the former and underestimated the latter. Proxies reported more centenarian EOL planning than centenarians themselves. The authors conclude that even though enrolled proxies were mostly persons very close to the centenarian, many of them did not seem to be well informed about centenarians' thoughts and plans regarding the EOL, suggesting a lack of communication between centenarians and social network members in this respect. The authors suggest that healthcare professionals should be aware that, even for very old adults approaching the end of their lives, discussions about EOL and EOL planning may need to be actively encouraged and supported.
Wentlandt K, Toupin P, Novosedlik N, et al.: Language used by healthcare professionals to describe dying at an acute care hospital. J Pain Symptom Manage 2018; [Epub ahead of print]; DOI: org/10.1016/j.jpainsymman.2018.05.013.
The purpose of this study was to understand the language used to describe the deterioration and death of patients in an acute academic tertiary care center, and to identify whether patient diagnoses or palliative care (PC) involvement was associated with clearer descriptions of this process. The authors conducted a retrospective chart review of the final admission of 150 patients who died on an inpatient internal medicine unit. Conventional and summative content analysis was performed of the language used to describe, either directly or indirectly that the patient's death was imminent. Results demonstrated that of the 150 deaths, the median age was 79.5 (range 22–101), 58% were male, and 69% spoke English. A total of 45% of deaths were from cancer, and 66% occurred with prior PC team involvement. There was no documentation of the dying process in 18 (12%) of charts. In the remainder, clinicians' documentation of imminent death fell into three categories: (1) identification of the current state using specific labels, for example, “dying” (24.7%), or “end of life” (15.3%), or less specific language, “unwell” or “doing poorly” (6.0%); (2) predicting the future state using specific or more vague predictions: for example, “hours to days” (7.3%) or “poor or guarded prognosis” (26.0%); and (3) using care provided to the patient to imply patient status: for example, PC (49.3%) or comfort care (28.7%). PC involvement, but not a malignant diagnosis, was associated with more frequent use of specific language to describe the current or future state. The authors conclude that death and dying in hospital is inadequately documented and is often described using unclear and vague language. PC involvement is associated with clearer language to describe this process.
Nouvet E, Sivaram M, Bezanson K, et al.: Palliative care in humanitarian crises: A review of the literature. Int J Humanitarian Action 2018;3:5. DOI: org/10.1186/s41018-018-0033-8.
This article presents findings from a systematic review of the literature (2005–2017) on PC in humanitarian crises (e.g., disasters, armed conflicts, epidemics). The review set out to describe PC needs, practices, barriers, and recommendations in humanitarian crisis settings. Analysis of 95 peer-reviewed and gray literature documents revealed a scarcity of data on PC needs and interventions provided in crises, challenges of care provision particularly due to inadequate pain relief resources and guidelines, a lack of consensus on the ethics of providing or limiting PC as part of humanitarian healthcare response, and the importance of contextually appropriate care. The authors conclude that these findings suggest that more research and open discussion on PC in humanitarian crises are needed.
Prentice TM, Gillam L: Can the ethical best practice of shared decision-making lead to moral distress? J Bioeth Inq 2018 [Epub ahead of print]; DOI: org/10.1007/s11673-018-9847-8.
When healthcare professionals feel constrained from acting in a patient's best interests, moral distress ensues. The resulting negative sequelae of burnout, poor retention rates, and ultimately poor patient care are well recognized across healthcare providers. Yet an appreciation of how particular disciplines, including physicians, come to be “constrained” in their actions is still lacking. This article will examine how the application of shared decision making may contribute to the experience of moral distress for physicians and why such distress may go under-recognized. Appreciation of these dynamics may assist in crossdiscipline sensitivity, enabling more constructive dialog and collaboration.
Bellido-Perez M, Crespo I, Wilson KG, et al.: Assessment of the wish to hasten death in patients with advanced cancer: A comparison of 2 different approaches. Psychooncology 2018;27:1538–1544.
The Desire for Death Rating Scale (DDRS) and the short form of the Schedule of Attitudes toward Hastened Death (SAHD-5) are different approaches to assessing the wish to hasten death (WTHD). Both have clinical threshold scores for identifying individuals with a meaningfully elevated WTHD. However, the agreement between the two measures and patient opinions about assessment of the WTHD are unknown. In this study, the authors attempted to compare the DDRS and SAHD-5 and to analyze patient opinions about assessment of the WTHD. The WTHD was assessed in 107 patients with advanced cancer using both the DDRS and SAHD-5. Patients were subsequently asked their opinion about this assessment. Results demonstrated that correlation between scores on the SAHD-5 and the DDRS was moderate. The SAHD-5 identified 13 patients (12.1%) at risk of the WTHD, and the DDRS identified 6 patients (5.6%) with a moderate–high WTHD (p > 0.05). Concordance between the DDRS and SAHD-5 in identifying individuals with an elevated WTHD was poor when using recommended cutoff scores, but could be improved by using different thresholds. Only four patients (3.8%) regarded the assessment questions as bothersome, and 90.6% considered it important that healthcare professionals inquire about the WTHD. The authors conclude that the SAHD-5 and DDRS appear to be appropriate methods for assessing the WTHD and could provide complementary information in clinical practice: the SAHD-5 to screen for risk of the WTHD and the DDRS as a clinical interview to explore it in greater detail.
Bowman PN, Slusser K, Allen DH, et al.: Collaborative practice model: Improving the delivery of bad news. Clin J Oncol Nurs 2018;22:23–27.
Ideal bad news delivery requires skilled communication and team support. The literature has primarily focused on patient preferences, impact on care decisions, healthcare roles, and communication styles, without addressing systematic implementation. This article describes how an interdisciplinary team, led by advanced practice nurses, developed and implemented a collaborative practice model to deliver bad news on a unit that had struggled with inconsistencies. Using evidence-based practices, the authors explored current processes, role perceptions and expectations, and perceived barriers to developing the model, which is now the standard of care and an example of interprofessional team collaboration across the healthcare system. The authors suggest that this model for delivering bad news can be easily adapted to meet the needs of other clinical units.
Daudt H, d'Archangelo M, Duquette D: Spiritual care training in healthcare: Does it really have an impact? Palliat Support Care 2018 [Epub ahead of print]; DOI: org/10.1017/S1478951517001134.
Spiritual care has formed an integral part of PC since its inception. People with advanced illnesses, however, frequently report that their spiritual needs are not attended to by their medical care team. This study examined and described the impact of a spiritual care training program on practice and cultural change in our Canadian hospice. A qualitative case study approach was adopted to gather feedback from hospice staff and volunteers using purposive sampling. In-depth interviews were conducted, transcribed, and analyzed using thematic (semantic and latent) analysis. Results demonstrated that the program had a profound personal impact on attendees and contributed to a slight shift in practice patterns in the authors' organization. Using a program not specifically tailored to their local and organizational cultural contexts resulted in some unanticipated challenges, such as the range of tensions between personal and cultural boundaries. The authors further note that although some people criticized parts of the program or questioned the program's value, a general agreement suggests that the program had a positive impact and meaningfully benefited our hospice. “What will happen next?” was the question most frequently voiced by interviewees. The authors conclude that while the program may not have been a perfect fit for their organization, its use instigated a process of cultural change. They also conclude that the present study suggests that a systematic approach to spiritual care training that includes the concepts of workplace spirituality and sensitive practice offer useful frameworks for the development and implementation of spiritual care training in other institutions.