Article: Hydration and symptoms in the last days of life

At end of life, oral fluid intake is often reduced.  Consensus about the most appropriate management of this situation is lacking.  The objective of this Dutch study is to investigate to what extent the amount of fluid intake, preceding and during the dying phase is related to the occurrence of death rattle and restlessness.   371 patients were included in the study.  Death rattle was reported at least once in 149 (40%) of patients but not associated with the amount of fluid intake during the days before dying.  Terminal restlessness was reported in 96 (26%) of patients. It wasn't associated with a lower amount of fluid intake in the days before dying, however terminal restlessness during the last 24 hours of life was associated with a higher amount of fluid during 48 - 25 hours before death.  The authors conclude that a higher amount of fluid (>250mL/day) during 48 - 25 hours before death may be associated with the occurrence of terminal restlessness.

Lokkers, M. et al. 2019.  Hydration and symptoms in the last days of life.  BMJ Supportive & Palliative Care, epub ahead of print. August 2019/.

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Article: Clinical nurse specialist prescribing in a cancer centre supportive and palliative care team

The aim of this study was to provide insight into the prescribing practice of 3 independent nurse prescribers (INP) working in a district general hospital and a specialist tertiary cancer centre in the UK. A review of all consultations and prescribing activity was carried out over a 3 month period in 2018.  493 consultations were undertaken on 186 individual patients. 247 (50%) consultations resulted in changes to a prescription and 50% of these resulted in the prescribing of an opioid for moderate to severe pain.   The authors conclude this study demonstrated the potential for independent nurse prescribers in this setting to provide comprehensive symptom control.  It also led to the clinical nurse specialists (CNSs) practicing with a greater autonomy, leading to enhanced job satisfaction.  They encourage all CNSs to undergo INP training.

Hall, S. et al. 2019. Clinical nurse specialist prescribing in a cancer centre supportive and palliative care team.  BMJ Supportive & Palliative Care. epub ahead of print.  August 2019.

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Article: Delirium: non pharmacological and pharmacological management

Delirium is particularly common in palliative care, with up to 88% of patients developing delirium in the last weeks to hours of life.   This editorial provides overview of delirium including the diagnosis, identifying and reversing underlying causes if appropriate and management of the condition.

Boland, J. 2019. Delirium: non pharmacological and pharmacological management.  BMJ Supportive and Palliative Care.

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Article: Examining constipation assessment and management of patients with advanced cancer receiving specialist palliative care

Constipation is a common symptom for patients receiving palliative care.  This study looked at the clinical practice and management of constipation receiving specialist palliative care (SPC).  A multi-site retrospective case note review was carried out consisting of 150 patient case notes from 3 inpatient SPC's across the UK.   The findings showed that constipation management is driven by a pharmacological approach with little evidence of implementation of preventative and non pharmacological management.  The nurse plays a key co-ordinating role in assessment, however involvement and roles of the wider MDT varies.  They concluded further education is needed to equip healthcare professionals with the knowledge and skills to ensure consistency in assessment and implementation of preventative/non pharmacological strategies.

McIlfatrick, S. et al. 2019. Examining constipation assessment and management of patients with advanced cancer receiving specialist palliative care: a multisite retrospective case note review of clinical practice.  BMC Palliative Care. 

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Article: Group singing in bereavement: effects on mental health, self-efficacy, self-esteem and well-being

This UK study recruited 58 adults who had been bereaved due to cancer in the last 5 years were recruited and elected to join a choir (n=29) or participate in the non-intervention control group (n=29).  Joining a choir involved engaging in 90 minute weekly singing and social sessions for 12 weeks with a post intervention assessment at 24 weeks.  Participants who sang in a choir had more stable symptoms of depression and levels of well being as well as gradual improvements in in self-esteem.  In contrast, the control group showed gradual increases in depressive symptoms and reduction in levels of well-being.  The authors conclude weekly singing could be a promising mutual support intervention for people experiencing grief.

Fancourt, D. 2019. Group singing in bereavement: effects on mental health, self-efficacy, self-esteem and well-being.  BMJ Supportive & Palliative Care, epub ahead of print September 2019.

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Article: Interventions available to adolescents and young adults bereaved by familial cancer: a systematic review of the literature

This Australian study looked at the interventions available to adolescents and young adults (AYA's) between the ages of 15 and 25 bereaved by a parent or sibling's cancer.  A systematic review of the literature was carried out.  Twenty two interventions were identified that were available for bereaved young people, however only 3 were specific to young people bereaved by familial cancer and none were specific to AYA's.  Interventions primarily provided opportunities for participants to have fun, share their experiences and/or memorialise the deceased.  Psychoeducation about bereavement, grief and coping was less common. Only a small number of interventions had bene evaluated and overall the evidence was very limited.  The authors conclude it is unclear at present which interventions currently available would benefit AYA's and further development and evaluation is needed.

Ing, V. 2019. Interventions available to adolescents and young adults bereaved by familial cancer: a systematic review of the literature.  BMJ Supportive & Palliative Care, epub ahead of print. August 2019.

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Article: Registered nurse verification of expected adult death: a response to situational challenges.

A commentary piece answering a number of questions following the updated guidance from Hospice UK in February 2019 on verification of death.  It covers which deaths can be verified, the staff who can do this, assessment of competence, and training for students in the future.

Laverty, D. et al. 2019. Registered nurse verification of expected adult death: a response to situational challenges.  International Journal of Palliative Nursing, 25 (7) p 354 - 355.

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Article: Sleep assessment and interventions for patients living with cancer from the patients' and nurses' perspective

Although sleep disorders are common, it is an overlooked problem in cancer care. 129 patients with cancer and 113 registered nurses working with cancer patients were recruited to this study.  The majority of patients (69.8%) reported having poor sleep quality and the majority of nurses (86.7%) reported they had never screened patients with cancer for any sleep problems.  Only 8% of patients who reported having problems sleeping to a nurse received interventions to promote better sleeping.  The authors concluded assessment of sleep disturbances in patients with cancer should be unified using a comprehensive valid tool, as well as providing evidence-based interventions according to patients needs.

Khater, W. et al. 2019.  Sleep assessment and interventions for patients living with cancer from the patients' and nurses' perspective.  International Journal of Palliative Nursing, 25 (7) p 316 - 324.

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Article: Use of pain scales and observational pain assessment tools in hospital settings

The complex and dynamic nature of pain makes its assessment and management challenging for healthcare professionals. This article discusses the various pain scales and observational pain assessment tools that are available, and the evidence to support their use.

Gregory, J. 2019. Use of pain scales and observational pain assessment tools in hospital settings.  Nursing Standard, 34 (9) p 70 - 74.

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Article: Assessment and management of chronic pain

Chronic pain can have significant physical, psychological and social effects on a person's life, as well as their family and friends. This article outlines the biomedical and psychosocial factors that can influence an individual's pain experience that should be considered as part of the assessment and management of chronic pain.  It also discusses the management options, including neural blockade and analgesics as well as non -pharmacological approaches.

Howarth, A. & Poole, D. 2019.  Assessment and management of chronic pain.  Nursing Standard, 34 (9) p75 - 81.

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Article: Prevention and management of urinary catheter blockages

This article details evidence-based recommendations for the assessment and diagnosis of catheter blockages, as well as the identification of risk factors.  It explains the interventions that can be used to prevent and manage catheter blockages.  The article includes a test your knowledge quiz.

Paterson, C. 2019. Prevention and management of urinary catheter blockages in community settings.  Nursing Standard, 34 (9) p 59 - 65.

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Article: Development of an eHealth information resource for family carers supportive a person receiving palliative care in Ireland

Many people receiving palliative care wish to die at home, however carers often report feeling underprepared to undertake this role. This paper describes the process of developing a consensus and evidence-based website to provide core information to help support carers/family members.     Content was developed by a Virtual Reference Group (VRG) comprising of patients, carers and professionals, along with subject exerts and a web developer. Nineteen systematic reviews  identified nine areas of core information required by carers.  These included a description of palliative care, prognosis and treatment of the condition, medication and pain management, personal care, specialist equipment, local support services, what to do in an emergency, nutrition, and support for the carer. 

Scott, D. 2019.  Development of an eHealth information resource for family carers supportive a person receiving palliative care in Ireland.   BMC Palliative Care:

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Article: The use of digital legacies with people affected by motor neurone disease

The aim of this study was to investigate the views and experiences of people living with motor neurone disease (MND) creating a video based digital legacy to pass on to a family member.   The study consisted of 4 people living with the disease, and 3 young people who had been bereaved and had access to the legacy. The study found the creation of the legacy provided a sense of purpose for people with MND and for the bereaved family member a sense of comfort, once they had reached an appropriate place within their grief journey.

Clabburn, O. et al. 2019.  The use of digital legacies with people affected by motor neurone disease for continuing bonds: an interpretive phenomenological analysis study.

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Article: Patient safety incidents in advance care planning for serious illness: a mixed-method analysis.

Advance care planning (ACP) is essential for patient centred care in the last phase of life.  This study characterises and explores patient safety incidents arising from the ACP process reported in the National Reporting and Learning System.  Searching over a 10 year period - 2005 - 2015 the study found 70 reports in which an ACP caused a patient safety incident across 3 areas: ACP's not completed despite being appropriate (23%); ACP completed but not accessible or miscommunicated between professionals (40%); and ACP completed and accessible but not followed(37%).  Reasons for this included lack of staff knowledge, lack of confidence, and trust in prior documentation to create or enact the ACP.  The authors conclude that staff related causes  should be explored in local contexts along side system development for ACP documentation.

Dinnen, T. et al. 2019. Patient safety incidents in advance care planning for serious illness: a mixed-method analysis.  BMJ: Supportive and Palliative Care. epub ahead of print. August 2019

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Article: In what ways might group clinical supervision affect the development of resilience of hospice nurses

This research comprising of a survey and focus group interviews looked at how clinical supervision might improve resilience in hospice nurses.  Clinical supervision was found to help work confidence, regulating emotions, offering a coping strategy, managing expectations and developing self-awareness.   This was dependent however upon individual preference and experience, the local organisational context and wider social and political factors.  The study provides a number of recommendations for practice.

Francis, Amy & Bulman, C. 2019. In what ways might group clinical supervision affect the development of resilience of hospice nurses.  International Journal of Palliative Nursing, 25 (8) p387 - 396.

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