Sage Palliative Medicine & Chronic Care

Sage Publications

Welcome to the official free Podcast site from SAGE Publications for Palliative Medicine & Chronic Care. SAGE is a leading international publisher of journals, books, and electronic media for academic, educational, and professional markets with principal offices in Los Angeles, London, New Delhi, and Singapore.

  1. 3 OCT

    A qualitative study exploring the perceptions and understandings of advance care planning by people with treatable but not curable cancer

    This episode features Professor Sheila Payne (International Observatory on End of Life Care, Health Innovation One, Lancaster University, Lancaster, UK).   What is already known about the topic? Advance care planning is considered good practice in palliative and end of life care and is promoted in health policy. There is no standardised approach to advance care planning in practice. There is recent debate about the utility and effectiveness of advance care planning in palliative care contexts.   What this paper adds Most patients did not recognise the concept of advance care planning and did not welcome conversations with health care providers about future planning despite many participants having done this prior to interview. Patients with treatable but not curable cancer live with uncertainty of prognosis in the context of ongoing and new treatment options, making advance care planning problematic. Most patients preferred to discuss future care, social and funeral arrangements within families, if at all.   Implications for practice, theory or policy The principles of future care planning can be introduced early in treatment without making them specifically about planning for the last days of life. Healthcare professionals in cancer and palliative care may need to ensure that future care planning discussions evolve over time, with decisions made being routinely revisited in light of changes in disease progression, treatment options and prognosis. Future policy guidance on advance care planning needs to take account of the changing treatment landscape for those with treatable but not curable cancer.     Full paper available from:     https://journals.sagepub.com/doi/full/10.1177/02692163251363752   If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu:  a.nwosu@lancaster.ac.uk

    6 min

  2. 18 AUG

    Enhancing the wellbeing of refugees living with advanced life-limiting illness in high-income resettlement countries: A systematic review

    This episode features Dr Heidi Merrington (School of Public Health, The University of Technology Sydney, Sydney, NSW, Australia) and Professor Angela Dawson (School of Public Health, The University of Technology Sydney, Sydney, NSW, Australia).   What is already known about the topic? In high-income countries, refugees experience barriers to accessing health care that may delay palliative care seeking. Refugees' cultural backgrounds and experiences of trauma, loss and grief during forced displacement shape health, wellbeing and expectations of care. Evidence is needed to inform palliative care services and approaches to supporting resettled refugees and their families.   What this paper adds This review demonstrates the dearth of research focused on resettled refugees living with advanced life-limiting illness and their families in high-income countries. The review highlighted the importance of assets such as resilience, sense of identity and belonging, community connections, social support and social capital, for enhancing the wellbeing of refugees and their families during end-of-life care and bereavement. Refugees' cultural identity, death literacy and experiences of grief influence engagement with palliative care staff and decision-making about end-of-life care approaches.   Implications for practice, theory or policy Community networks play an important role in end-of-life care and bereavement support for refugees and their families. Participation of diverse groups of refugees in co-designed research is needed to build an evidence base to inform palliative care service approaches and develop community-based end-of-life care interventions that strengthen assets that enhance refugee wellbeing. Future studies should focus on refugees as a distinct group compared to migrants and the general population in high-income resettlement countries.     Full paper available from:     https://journals.sagepub.com/doi/full/10.1177/02692163251338583   If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu:  a.nwosu@lancaster.ac.uk

    5 min

  3. 9 JUNE

    Asian family members' participation in advance care planning: An integrative review

    This episode features Jing-Da Pan (Department of Oncology, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong Province, China School of Nursing, Guangzhou Medical University, Guangzhou, Guangdong Province, China)   What is already known about the topic? Family members are crucial in advance care planning for patients with life-limiting illnesses, particularly in Asia, where cultural values stress family-centeredness and paternalism. No study so far has attempted to systematically synthesize this information within the Asian context and there is a lack of a model to describe Asian family members' involvement in advance care planning.   What this paper adds? Asian family members are willing to participate in advance care planning but face difficulties in translating this willingness into action. Barriers include inadequate legislation, insufficient public education, and influences from Confucianism or traditional beliefs. A culturally sensitive model with six dimensions was developed to illustrate Asian family members' participation in advance care planning.   Implications for practice, theory, or policy Asian governments should enact advance care planning legislation to ascertain its legal status and allocate more relevant resources to educate the public to overcome the barriers to Asian family members' participation in advance care planning. Future efforts in advance care planning in Asia should prioritize developing culturally sensitive models which align the willingness, beliefs, and actions of Asians and the proposed conceptual model should be verified by more advanced statistical tests, thus confirming its validity in different Asian regions. Due to the paradoxical impact of filial piety on advance care planning, a culturally specific intervention is needed to help family members understand that respecting dying patients' decisions is a filial act, ultimately improving their involvement in advance care planning.   Full paper available from:     https://journals.sagepub.com/doi/10.1177/02692163251317856   If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu:  a.nwosu@lancaster.ac.uk

    4 min

  4. 9 JUNE

    The experience of nurses when providing care across acts that may be perceived as death hastening: A qualitative evidence synthesis

    This episode features Victoria Ali  (Lancaster University, Lancaster, UK. Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK)   What is already known about the topic? Nurses deliver care for patients and those important to them across acts that may intentionally or potentially hasten death, navigating this care within the boundaries of healthcare systems and professional regulation. The increase in permissive legislation relating to assisted dying is challenging healthcare professionals to consider how an assisted death sits alongside accepted or 'traditional' healthcare practices at the end of life. Providing care in these situations can be challenging and requires emotional labour to navigate.   What this paper adds? This review allows recognition of how the emotional labour involved in providing care, and its subsequent impact, is often better recognised within assisted dying than for other acts that may be perceived as death hastening. The 'normalising' of care, and consequently dying, within acts that may be perceived as hastening death limits the recognition of the emotional labour required for nurses to provide care in these circumstances. When supporting a patient through an assisted death, nurses focus on optimising the experience for the patient, whereas in other acts that may hasten death, nurses' primary focus is on the experience of those present with the patient.   Implications for practice, theory, or policy The impact on nurses' emotional well-being due to the expectation to engage in significant emotional labour, in all care that may be perceived as death hastening, should be considered in daily practice, policy and organisational structure. The provision of emotional support should be considered for nurses when involved in the delivery of care that may hasten death, either through intentional acts (an assisted death) or unintended consequence of the care. Normalising care that may be perceived as death-hastening can impact nurses' feelings of agency within care delivery and may need to be considered in jurisdictions with permissive assisted dying legislation as these practices embed within organisations.     Full paper available from:     https://journals.sagepub.com/doi/full/10.1177/02692163251331162   If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu:  a.nwosu@lancaster.ac.uk

    5 min

  5. 27 FEB

    Changes in perception of prognosis in the last year of life of patients with advanced cancer and its associated factors: Longitudinal results of the eQuiPe study.

    This episode features Moyke Versluis (Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands Graduate school of Social and behavioral sciences, Tilburg University, Tilburg, The Netherlands).   What is already known about the topic? Patients who are aware of their limited prognosis are more likely to be actively involved in advance care planning. Many patients with advanced cancer are unaware of their limited prognosis.   What this paper adds? More patients with advanced cancer become aware of their limited prognosis during their last year of life. Some patients do not want to know their prognosis, and their wish to not know their prognosis is persistent during their last year of life.   Implications for practice, theory, or policy It is important for physicians to recognise that the patients' perception of prognosis may change as the disease progresses and to invite patients to discuss their needs and wishes regularly. Although some patients may prefer not to know their prognosis, it remains important to respectfully explore their preferences and wishes for end-of-life care.   Full paper available from:     https://journals.sagepub.com/doi/full/10.1177/02692163241301220   If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu: a.nwosu@lancaster.ac.uk

    4 min

  6. 27 FEB

    Components of home-based palliative and supportive care for adults with heart failure: A scoping review

    This episode features Dr Madhurangi Perera (Cancer and Palliative Care Outcomes Centre, School of Nursing and  Australia Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia)   What is already known about the topic? Providing palliative and supportive care in the home setting for people with heart failure is advantageous because care can be provided in accordance with an individual's way of life. Home-based palliative and supportive care for people with heart failure has the potential to improve person and caregiver outcomes and reduce healthcare costs.   What this paper adds? The components of home-based palliative and supportive care are symptom management; expert communication; multidisciplinary team involvement; continuity of care; education; end-of-life discussions; and caregiver support. While initiation of care, the services provided in the home-setting and health care approaches provided differed across the reported studies, in all included studies, nursing staff were strategically placed to provide a wide range of services in the home-setting. Continuous and early liaison between cardiology, palliative care and primary care providers is needed to provide continuous, non-fragmented care.   Implications for practice, theory, or policy The detailed findings of this review which highlight the components of home-based palliative and supportive care can provide guidance to enable health care providers to tailor care for this population. Future research into the perspectives of people with heart failure on each of the identified components and their implementation will assist service providers to gain a better understanding of how to enable home-based palliative and supportive care for persons with heart failure.   Full paper available from:     https://journals.sagepub.com/doi/full/10.1177/02692163241290350   If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu:  a.nwosu@lancaster.ac.uk

    4 min

  7. 6 FEB

    Multiple points of system failure underpin continuous subcutaneous infusion safety incidents in palliative care: A mixed methods analysis

    This episode features Amy Brown (Marie Curie Research Centre, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK. Swansea University Medical School, Swansea University, Swansea, UK)   What is already known about the topic? The third World Health Organization Global Patient Safety Challenge 'Medication without harm', emphasises the need for improved infrastructure through better reporting practices and cross-organisational learning from adverse events and near misses. Medication is implicated in one-fifth of serious palliative care patient safety incidents, with approximately 25% of these incidents involving continuous subcutaneous infusions. Inadequate analysis of continuous subcutaneous infusions as safety-critical, risk-prone interventions dependent on complex structural and human factor issues is a lost opportunity for learning.     What this paper adds? Continuous subcutaneous infusion incidents occur across all settings including the home, hospices and hospitals and particularly after the transfer of patients between settings with harm present in nearly three-quarters of reports. Multiple points of system failure were identified in continuous subcutaneous infusion incident reports including monitoring and supply (405, 31%), administration (383, 29%) and prescribing (268, 20%); recurring contributory factors included discontinuity of care within and between care settings, inadequate time, inadequate staffing and unfamiliarity with protocols. Narrative descriptions of psychological and social harm, alongside physical harm risk, are not being adequately recognised or responded to through existing approaches to measure harm in palliative care, hindering learning in practice   Implications for practice, theory, or policy The structural changes needed to minimise harm and maximise safety in palliative care are likely to be replicated in other parts of the world where patient safety reporting practices are less well established, for example, shifting from focussing on lack of experience and competency at an individual practitioner-level to addressing deficits in working environments and infrastructures for care provision. When patients move between care locations, more attention should be given to the timeliness and effective transfer of medication management (e.g. if someone is discharged from hospital to a care home that rarely uses continuous subcutaneous infusions for palliative care, this needs to be preceded by refreshing staff skills and ensuring they can access further community support if needed). Professional training and further research are needed to increase quality of reporting of psychological and social harms (including for families and other stakeholders involved) to facilitate organisational learning and pinpoint precise targets for further improvement.     Full paper available from:     https://journals.sagepub.com/doi/full/10.1177/02692163241287639  If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu:  a.nwosu@lancaster.ac.uk

    5 min

  8. 4 FEB

    Definition and recommendations of advance care planning: A Delphi study in five Asian sectors

    This episode features  Dr Masanori Mori (Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan)   What is already known about the topic? As in Western countries' health-care systems, advance care planning is being increasingly implemented in Asian ones, but consensus on its definition and recommendations based on Asian culture are lacking. In high-context, Confucian-influenced Asian societies, explicit conversations about end-of-life care with patients are not always the norm. Family involvement is crucial in decision-making. Health-care providers in Asia uncommonly involve patients in advance care planning, partly due to their lack of knowledge and skills in advance care planning, personal uneasiness, fear of conflicts with families and their legal consequences, and the lack of a standard system for advance care planning.   What this paper adds? A key domain not previously highlighted in Western Delphi studies is "a person-centered and family-based approach" that facilitates families' involvement to support an individual's engagement in advance care planning and the attainment of the individual's best interest through shared decision-making. Treatment preferences in Asian contexts are often shaped by relationships and responsibilities toward others, with families and health-care providers supporting individuals to meaningfully participate, even in the presence of physical or cognitive impairments.   Implications for practice, theory, or policy Our definition and recommendations can guide clinical practice, education, research, and policy-making in advance care planning, not only in the Asian sectors included in our study, but also in regions with Asian residents and other areas where implicit communication and family-centered decision-making are valued. Our findings, combined with the existing evidence, will help future investigations to develop culturally sensitive advance care planning interventions, identify appropriate outcomes, and build an infrastructure where Asian individuals receive care consistent with their values, goals, and preferences.   Full paper available from:     https://journals.sagepub.com/doi/full/10.1177/02692163241284088   If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu:  a.nwosu@lancaster.ac.uk

    5 min
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Welcome to the official free Podcast site from SAGE Publications for Palliative Medicine & Chronic Care. SAGE is a leading international publisher of journals, books, and electronic media for academic, educational, and professional markets with principal offices in Los Angeles, London, New Delhi, and Singapore.

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