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.
Complementary therapy in palliative care: A synthesis of qualitative and quantitative systematic reviews
This episode features Dr Bridget Candy (Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK).
A systematic review of effectiveness data on aromatherapy, massage and reflexology in palliative care drew inconclusive conclusions. A systematic review of qualitative evidences shows palliative care patients highly value complementary therapy.
None of the aromatherapy, massage or reflexology trials included all key delivery components as outlined by palliative care patients. The five quality of life scales used in the trials failed to capture the range of perceived benefits from the complementary therapies and many included inappropriate or redundant items. This novel but simple method of integrating synthesised qualitative and quantitative reviews through matrices allows the reasons for inconclusive trial evidence to be explored.
This synthesis has highlighted a need for fully powered, robust trials of aromatherapy, massage and reflexology that are conducted with the key components described by people with palliative care needs. Outcome measures should be appropriate to capture the range of potential benefits highlighted by people with palliative needs. In the meantime, complementary therapies should continue to be offered as part of palliative care.
The pervasive relevance of COVID-19 within routine paediatric palliative care consultations during the pandemic: A conversation analytic study
This episode features Dr Katie Ekberg (School of Early Childhood and Inclusive Education, Queensland University of Technology, Australia) and Dr Anthony Herbert (School of Early Childhood and Inclusive Education, Queensland University of Technology, Australia).
The urgency of caring for children with complex and serious conditions ensures that care must continue during the Coronavirus Disease 2019 (COVID-19) pandemic.
As yet, guidelines for communication with families about the COVID-19 pandemic are not based on direct observational evidence of actual communication practices within palliative care during the pandemic. The current study provides evidence of the pervasive relevance of communication about the COVID-19 pandemic during clinician-family paediatric palliative care consultations.There was a pervasive relevance of serious and non-serious talk about the pandemic.
Topics typical of standard paediatric palliative care consultations often led to discussion of the pandemic, including medical discussions and psychosocial and lifestyle discussions.Clinicians (55%) and parents (45%) initiated talk about the pandemic.
Clinicians should expect and be prepared for the pervasiveness of talk about the COVID-19 pandemic within standard paediatric palliative care consultations, so that they can be flexible in how they respond to families.
Future guidelines should consider the pervasive and varied ways that conversations about a pandemic are raised within and across routine consultations.
My wife is my doctor at home’: A qualitative study exploring the challenges of home-based palliative care in a resource-poor setting
This episode features Dr Yakubu Salifu (International Observatory on End of Life Care, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, Lancashire, UK).
Caring for a family member with advanced prostate cancer in the home presents practical and emotional challenges, especially in resource-poor contexts, where there are increasing palliative cases without adequate palliative care institutions.
The study explored palliative and end-of-life care experiences of family caregivers and patients living at home in a resource-poor context in Ghana.
Men with advanced prostate cancer face complex issues, including lack of access to professional care and a lack of resources for homecare. Family caregivers do not have easy access to professional support; they often have limited knowledge of disease progression. Patients have inadequate access to medication and other practical resources for homecare. Caregivers may be overburdened and perform the role of the patient’s ‘doctor’ at home-assessing patient’s symptoms, administering drugs, and providing hands-on care.
In resource-poor contexts, there are significant challenges associated with home caregiver support. This study revealed the scale of challenges family caregivers, who lack basic training on aspects of caring, face in providing home care unsupported by healthcare professionals.
This is your golden time. You enjoy it and you’ve plenty time for crying after’: How dysphagia impacts family caregivers of people with amyotrophic lateral sclerosis – A qualitative study
This episode features Dr Dominika Lisiecka (Department of Nursing and Healthcare Sciences, School of Health and Social Sciences, Institute of Technology Tralee, Tralee, Ireland).
Amyotrophic lateral sclerosis causes multiple neurodegenerative symptoms including dysphagia, which impacts on person’s ability to eat and drink in a safe way and can contribute to chest infections, pneumonia and death. Family caregivers play an important role in managing a person with amyotrophic lateral sclerosis, but little is known about how dysphagia impacts on their own lives.
Managing progressive dysphagia can be a huge challenge for caregivers of people with amyotrophic lateral sclerosis and can lead to multiple psycho-social consequences. Caregivers may be extremely concerned about the safety of a person with amyotrophic lateral sclerosis during meals and fearful of choking. Dysphagia transforms caregivers’ perception of food. The caregivers’ approach to dysphagia may depend on the duration of caregiving and the caregiver’s relationship with the person with amyotrophic lateral sclerosis.
Caregivers of people with amyotrophic lateral sclerosis need support from professionals to manage dysphagia at home. In particular, advice should be provided in relation to managing adverse episodes, such as choking at home. Professionals delivering services for dysphagia should find ways to recognise and address the needs of the caregivers of people with amyotrophic lateral sclerosis rather than focusing on the person with amyotrophic lateral sclerosis alone.
Does the carer support needs assessment tool cover the established support needs of carers of patients with chronic obstructive pulmonary disease? A systematic literature search and narrative review
This episode features Kerry Micklewright and Dr Morag Farquhar (School of Health Sciences, University of East Anglia, Norwich, UK).
Informal carers play a vital role in supporting patients with chronic obstructive pulmonary disease (COPD). COPD carers may have unidentified support needs that could be a target for intervention by clinicians. The Carer Support Needs Assessment Tool (CSNAT) is an evidence-based tool to enable identification of carer support needs. Initially developed mainly with carers of patients with end-stage cancer, it is unclear if it encompasses all the potential support needs of COPD carers.
Knowledge relating to COPD carer support needs from published literature was synthesised, including needs carers felt were met, needs carers felt were unmet and supportive inputs carers considered helpful. The identified support needs were then mapped to the CSNAT, and this exercise suggested that the addition of a question encompassing relationship management issues may be required to make CSNAT more comprehensive for COPD carers.
Many of the support needs of COPD carers are unmet: particular areas of concern relate to prolonged social isolation, accessing services, emotional support and information needs. COPD carers would benefit from a comprehensive, person-centred assessment of their needs and appropriate response to these needs by clinicians. The CSNAT is a promising approach to identifying COPD carer support needs, though it may require an additional question on relationship management to ensure it fully encompasses the potential needs of this group.
Nursing competencies across different levels of palliative care provision: A systematic integrative review with thematic synthesis
This episode features Minna Hökkä (Research Unit of Nursing Science and Health Management, Medical Department, Oulu University, Oulu, Finland).
Palliative care is provided across a wide range of healthcare settings, from tertiary hospitals to primary care. It has been recognized that palliative care services should be delivered in at least two or three levels (i.e., palliative care approach, generalist palliative care, specialist palliative care).
All healthcare professionals should have the appropriate education and competencies to provide high-quality palliative care. Nurses have an important role in the provision of palliative care in all levels.
This systematic integrative review is the first to focus on empirical studies defining the core competencies of palliative care nursing aligned with the different levels of palliative care provision.
The results show that both the distinct levels of palliative care provision and corresponding palliative care nursing competencies are rarely defined.
Rather than describing which core nursing competencies are the most related to each level of palliative care, previous research has concentrated on identifying the diverse competencies necessary for different specific settings and how they can be categorized in different aspects of nursing (e.g., competencies related to patient–nurse relationship).
Nurses with a specialized or advanced nurse practitioner role in palliative care have extended clinical competencies, which include the ability to provide informal education and guidance to colleagues.
Nursing competencies in palliative care, especially the ones that are more relevant to each level of palliative care provision, should be better outlined to enhance palliative care development, education and practice.
Further research that addresses how nursing competencies differ across the levels of palliative care provision is needed.
Full paper available from: https://journals.sagepub.com/doi/10.1177/0269216320918798
If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu: firstname.lastname@example.org