SAGE Palliative Medicine & Chronic Care SAGE Publications Ltd.

This episode features Dr Fiona Kenney and Koby Anderson, (Ottawa Hospital Research Institute, Ottawa, ON, Canada Bruyère Research Institute, Ottawa, ON, Canada)
 
What is already known about the topic?
Previous research demonstrates a high prevalence of severe grief symptoms up to a year post-death of a loved one among those who experienced bereavement during the COVID-19 pandemic. No previous study has assessed changes in the severity of grief more than a year after the death of a loved one during the COVID-19 pandemic.  
What this paper adds?
This prospective cohort follow-up study found the prevalence of severe grief reaction remained high (28.8%) at 12–18 months post- family member death. One-third (33.3%) of family members experienced persistently high or worsening grief symptoms at the time of their 12–18-month assessment compared to baseline 6–12-month assessment. Grief severity was associated with endotracheal intubation in the deceased, but not with the cause of death (e.g., COVID vs non-COVID illness) or physical presence/absence of the family member at the bedside in the final 48 h of life.  
Implications for practice, theory, or policy
There is a persistent, elevated risk of severe grief among family members who experience bereavement during the pandemic period, even up to 18 months post-death of the decedent. There is an urgent need for effective and scalable means of addressing severe grief in the wake of the COVID-19 pandemic.  
 
Full paper available from:    
https://journals.sagepub.com/doi/full/10.1177/02692163231223394
 
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

This episode features Sue-Ling Chang, (CHU de Québec-Université Laval Research Center, Oncology Division, Québec City, QC, Canada)
 
What is already known about the topic?
There is a growing interest in psilocybin-assisted therapy worldwide, particularly to treat existential distress at the end of life.  
What this paper adds?
In this study, we show that the social acceptability of psilocybin-assisted therapy to treat existential distress at the end of life is high in Canada and identify factors associated with favourable attitudes of the population towards it.  
Implications for practice, theory, or policy
Our findings may help mobilise resources to address barriers and challenges for implementing psilocybin-assisted therapy within palliative medicine and society. This could also have implications for policies regarding medical assistance in dying.  Full paper available from:    
https://journals.sagepub.com/doi/full/10.1177/02692163231222430
 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

This episode features Dr Carlos Seiça Cardoso (Faculty of Medicine, University of Coimbra, Coimbra, Portugal
CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal)
 What is already known about the topic?
The burden of chronic, progressive, incurable and life-threatening illness is increasing, highlighting the need to integrate palliative care into patients’ care plans. Data indicate that involving General Practitioners in the provision of palliative care may improve outcomes for patients and families, but the evidence on the effectiveness of interventions for patients with palliative care needs in primary care is still scarce.  What this paper adds?
We developed a training programme, from logistics to content, to be feasible for General Practitioners and to address the main topics in which they identified training needs. A two-tiered intervention was implemented, involving training and a new consultation model; this was shown to be feasible and effective in reducing the physical and emotional symptoms of patients with palliative needs managed in primary care. To the best of our knowledge, this is the first intervention involving General Practitioners, that assesses the impact on patients’ self-reported symptoms and demonstrates positive effects.  Implications for practice, theory, or policy
General Practitioners may test whether the intervention is applicable in their own setting, as there is potential for transferability to similar primary care settings elsewhere in the world.  
We successfully implemented and evaluated an intervention with a statistically and clinically important impact on patients, showing that research in primary palliative care can and must expand, as it may be key in the initial care of patients with palliative needs.   Full paper available from:    
https://journals.sagepub.com/doi/full/10.1177/02692163231219682
 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

This episode features Ellis Slotman (Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands)
 What is already known about the topic?
Potentially inappropriate end-of-life care in patients with cancer is still common. The COVID-19 pandemic has been shown to affect cancer diagnosis and treatment, but evidence on how the pandemic has affected end-of-life care is limited.   What this paper adds?
The COVID-19 pandemic was associated with less potentially inappropriate care at the end of life in patients with cancer.  The decline in potentially inappropriate end-of-life care was driven by fewer hospitalizations and intensive care unit admissions in the last month of life and fewer hospital deaths.   Implications for practice, theory, or policy
The findings of this study raise important questions as to which pandemic related changes in end-of-life care delivery and decision making might be able to contribute to appropriate end-of-life care for future patients.  Ensuring that awareness for triaging and advance care planning is maintained after the pandemic may be of great importance in this regard.  Full paper available from:    
https://journals.sagepub.com/doi/10.1177/02692163231217373
 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

This episode features Dr Vanessa Abrahamson, (Centre for Health Services Studies, University of Kent, Kent, UK).
 
What is already known about the topic?
Increasingly, people at end-of-life want to die at home but this relies heavily on family carers to support the patient. Many carers struggle with the practical and emotional burden of caring for a loved one at home. Services providing hospice care at home are highly rated by carers but access is limited and the model of care varies greatly between services, with little data on how this affects patient/carer experiences.  
What this paper adds?
Hospice-at-home services need to set clear expectations from the start so that families know exactly what the service can, or cannot, provide; this helps establish confidence in the service and build a strong relationship with the carer. Carers valued the expertise of hospice staff (in death and dying) and that they had time to care in a flexible and compassionate manner, which other services lacked. Carers felt ‘doubly’ bereaved when the person they cared for died and the hospice team immediately withdrew; existing bereavement services did not suit many carers, particularly younger families.  
Implications for practice, theory, or policy
Carers appreciated early contact with services but placing the onus on carers to trigger increased help when needed was not found supportive. There should be regular review of needs for the carer as well as for the patient and services available to address both their needs; services could consider options to increase volunteer contributions to hospice-at-home services. Hospice services could consider how to provide bereavement support that meets carer preferences.  
Full paper available from:    
https://journals.sagepub.com/doi/10.1177/02692163231206027
 
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

This episode features Dr Nivedita Ashok, (University College London, London, UK).
 
What is already known about the topic?
Individuals with intellectual disability or serious mental illness have high rates of mortality due to physical comorbidities. These populations have specific needs that should be met to provide optimum palliative care and maintain optimum mental healthcare at the end-of-life. While research exists describing the problems these populations face, little is known about how to improve care for them.  
What this paper adds?
By focusing on lived experiences of patients/service users, carers and healthcare professionals this paper synthesises existing evidence into multivoiced perspectives on what works, does not work, plus challenges and opportunities for improvement. Assumptions and misunderstandings about the role of mental capacity assessment to appropriately involve the patient in decision-making are common, while adapting training for palliative care staff to address concerns and beliefs about mental illness helps to avoid diagnostic overshadowing. Professionals need help to work across divides between physical and mental healthcare services, so people can receive palliative care in familiar locations and/or from familiar people.  
Implications for practice, theory, or policy
A significant research deficit exists regarding provision of optimal palliative care to people with psychosis, personality disorders, bipolar affective disorder and depression. Assessing capacity may be optimally achieved by involving professionals across specialities and organisations. Proactive identification of service arrangements for care needs of persons with serious mental illness will help optimise care.  
Full paper available from:    
https://journals.sagepub.com/doi/10.1177/02692163231175928
  
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