Media Watch ... 18 October Edition | Issue # 171 is distributed weekly to my colleagues who are active or have a special interest in hospice , palliative care and end-of-life issues – to help keep them abreast of current, emerging and related issues, and to also inform discussion and to Compilation of Media Watch 2008 , 2009, 2010 © encourage further inquiry. Compiled & Annotated by Barry R. Ashpole

Physician-patient interaction: Scroll down to Specialist Publications and 'Do patients want a choice and does it work?' (p. 7), for an analysis published in the British Medical Journal .

Canada

Parliamentar y Committee on Palliative & Com passionate Care

MP lauds Sault's palliative care program during fact -finding tour

ONTARIO | Sault Star – 16 October 2010 – NDP [New Democratic Party] MP Joe Comartin, co - chair of the all-party Parliamen tary Committee on Palliative & Compassionate Care , was in Sault Ste. Marie ... to gather information about improving palliative care in Canada. What he saw impressed him: the city is home to one of fewer than 10 residential hospices in Canada, "at a substantially lower cost and, in many cases, a higher level of care, " said Comartin. Ninety per cent of people prefer to spend their last days at home; the reality is that three -quarters end up dying in hospital, at a cost of approximately $1,300 a day. Hospice is estimated to cost between $300 and $400. http://www.saultstar.com/ArticleDisplay.aspx?e=2803595

Hospice House cuts ties with SELHIN [South East Local Health Integration Network]

ONTARIO | Bancroft This Week – 15 October 2010 – The board of directors of Hospice North Hastings is making a stand against the restraints of government funding that have been experienced in the organization , a bold statement against the South East Local Health Integration Network (S ELHIN). After receiving partial funding for 13 years from the SELHIN in order to provide different programs through the current Hospice House location, the Board has decided to refuse continuing on their funding agreement with the provincial body, losing a s a result $52,000 from their annual budget. http://www.bancroftthisweek.com/ArticleDisplay.aspx?e=2799955

Media Watch posted on Palliative Care Network-e Website

Palliative Care Network-e (PCN-e) promotes education amongst health care providers in places around the world where the knowledge gap may be wider than the technology gap ... to foster teaching and interaction, and the exchange of ideas, information and ma terials. http://www.pcn-e.com/community/

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Canadian researchers put a cost on where you die

NATIONAL POST | Onlin e report – 12 October 2010 – Researchers from the University of Alberta have found that when heart failure patients pass away in an acute care hospital the cost is more than double than for those who die elsewhere, such as at home or a palliative care faci lity. This is the first study to examine heal th -care costs – including inpatient, outpati ent, physician, and drug costs – at the end-of-life among heart failure patients in Canada. 1 "End-of-life is a big issue, not only in C anada but in the western world, " said researcher and epidemiologist Padma Kaul in a statement. http://news.nationalpost.com/2010/10/12/ new-canadian-study-puts-a-cost -on-where- you-die/

 ALBERTA | – 12 October 2010 – 'Hospitalization costs explode with termin al heart patients...' A new study examining the high cost of dying in Alberta 1 – the f irst of its kind in Canada – suggests the final weeks of the lives of terminal cardiac patients cost the health system more than five times the per -capita cost of health care in , most of it due to hospitalization. http://www.vancouversun.com/health/Hospitalization+costs+explode+with+terminal+ heart+patients+Alberta+study/3660964/story.html

1. ARCHIVES OF INTERNAL MEDICINE | Online article – 11 October 2010 – 'Resource use in the last 6 months of life among patients with heart failure in Canada. ' The authors conclude that resource use in the last six month s of life among patients with heart failure in Alberta is changing, with a reduction in hospitalizations, in-hospital deaths, and an increase in the use of o utpatient services. However, end of life costs are substantial and continue to increase. http://archinte.ama-assn.org/cgi/content/short/archinternmed.2010.365

Of related interest:

 ARCHIVES OF INTERNAL MEDICINE | Online article – 11 October 2010 – 'Resource use in the last 6 months of life among Medicare beneficiaries with heart failure, 2000-2007. ' Among Medicare beneficiaries with heart failure, health care resource use at the end of life increased over time with higher rates of intensive care and higher costs. However, the use of hospice services also increased markedly. http://archinte.ama -assn.org/cgi/content/short/archinternmed.2010.371

Assisted (or facilitated)ated) death

Representative sample of recent news media coverage:

 QUEBEC | – 15 October 2010 – 'Euthanasia is 'killing,' McGill ethicist tells Quebec hearings.' When religious values were more important in Quebec, it was easier to make the case against euthanasia, McGill University ethicist Margaret Somerville said ... before provincial hearings in Montreal. "Thou shalt not kill " was pretty much the end of the de bate, Somerville said. Now in a largely secular society, euthanasia and assisted suicide remain "mora lly wrong ." She prefers the term "killing," as she considers euthanasia and assisted suicide to be euphemisms. http://www.montrealgazette.com/health/kill+each+other+ethicist+tells+euthanasia+hearing/3672871 /story.html

 ONTARIO | – 12 October 2010 – 'Exit plans for those who 'don't want to linger. '' This was Canada's third "Safe Exit " meeting and workshop, where [euthanasia advocate] Dr. Philip Nitschke advises adults to develop an "exit plan" – and then offers specifics on end -of-life options. http://www.nationalpost.com/news/canada/Exit+plans+those+want+linger/3668854/story.html

Barr y R. Ash pole

My involvement in palliative and end -of-life care dates from 1985. As a communications specialist, I 've been involved in or responsible for a broad range of initiatives at the community, regional, provincial and national level. My work focuses primarily on advocacy, capacity building and policy development in addressing issues specific to those living with a life-threatening or terminal illness – both patients and families. In recent years, I've applied my experience and knowledge to education, developing and teaching on -line and in-class courses, and facilitating issue specific workshops, for frontline care providers.

pg. 2

U.S.A.

End-of-life care costs continue to climb upward

REUTERS HEALTH | Online report – 14 October 2010 – Health care costs at the end of life show no signs of leveling off, according to new research from the U.S. and Canada published in the Archives of Internal Medicine .1 But other trends over the past decade, including a sharp increase in use of hospice services, could point the way toward bringing these costs down while improving patient care. http://www.reuters.com/article/idUSTRE69C3KY20101014

 BLOOMBERG BUSINESS WEEK | Online report – 12 October 2010 – 'Earlier hospice care urged for terminal prostate cancer.' Most American men who are dying of prostate cancer are slow to take advantage of the end-of-life services available through hospice care, new research suggests. 1 Although about half of such patients do turn to hospice care eventually, the study team found that most wait ... – often just a week or two before their death – before enrolling in a hospice program. http://www.businessweek.com/lifestyle/content/healthday/644252.html

1. ARCHIVES OF INTERNAL MEDICINE | Online article – 11 October 2010 – 'Hospice use and high-intensity care in men dying of prostate cancer.' The authors sought to characterize hospice use by men dying of prostate cancer and to compare the use of high-intensity care between those who did or did not enrol in hospice. They concluded that the proportion of individuals using hospice is increasing, but the timing of hospice referral remains poor. Those who enrol in hospice are less likely to receive high-intensity end-of-life care. http://archinte.ama-assn.org/cgi/content/short/archinternmed.2010.394

Hospice dogs

MINNESOTA | Echo Press – 13 October 2010 – Hospice of Douglas County will add another facet of "compassionate care" to its program – therapy dogs. Registered therapy dogs can provide comfort, support and animal companionship to hospice patients and their families. It has been proven that the sight of a dog and the touch of their fur can often bring peace and joy to those patients whose life once included animals. The physical contact has a calming effect and dogs have the ability to bring diversion from physical discomfort, decrease anxiety and provide expanded opportunities for laughter and joy. http://www.echopress.com/event/article/id/78814/

From Media Watch dated 26 April 2010:

 BRITISH COLUMBIA | Vancouver Sun – 20 April 2010 – 'Four legs, a tail and nothing but love.' Some working dogs are bred to carry packs: Poppy's burden is weightier. She shoulders grief. http://www.vancouversun.com/life/Four+legs+tail+nothing+love/2927348/story.html

Terminally ill get cancer screenings, despite lack of benefit

NATIONAL PUBLIC RADIO | Online report – 12 October 2010 – All those reflexive pap smears, mammograms, and prostate cancer screening tests are controversial enough these days. But, one thing's pretty clear: They don't really help patients already dying of other cancers. That's the conclusion of a report just out from the specialists at Memorial Sloan-Kettering Cancer Center in New York. The reasons for continued screening varied, according to the article published in the Journal of the American Medical Association.1 The strongest predictor of who got screened post- cancer diagnosis was if they had a history of screening tests before diagnosis. It's a matter of habit. http://www.npr.org/blogs/health/2010/10/12/130516480/screening-for-new-cancers-doesn-t- help-terminally-ill

1. JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION , 2010;304(14):1584-1591. 'Cancer screening among patients with advanced cancer.' A sizeable proportion of patients with advanced cancer continue to undergo cancer screening tests that do not have a meaningful likelihood of providing benefit. http://jama.ama-assn.org/cgi/content/abstract/304/14/1584

pg. 3

Dealing with death: An interfaith approach

MASSACHUSETTS | GateHouse News understand is religion does not preclude nor Service – 11 October 2010 – After decades inoculate us from suffering," he said. visiting hospices around the world, Rabbi http://www.wickedlocal.com/weston/features Earl Grollman says the question terminally ill /x1722969031/Dealing-with-death-An- patients ask most often is "Why me? It's interfaith-approach more than a question. It's a cry of pain," said the rabbi emeritus of Temple Beth El in Belmont. "They want to know 'How could Specialist Publications God do this to me?"' Grollman said hospice patients often feel torn between religion's Of particular interest: promises of redemption and the harsh realities of pain, lost control and uncertainty. 'Use of spiritual life maps in a hospice setting' "Many people feel their faith provides divine (p.9), published in the Journal of Religion, Spirituality & Aging protection. But the important thing to

International

Palliative care units soon in 17 medical colleges

INDIA | The Hindu – 16 October 2010 – point of time, around 2.5 million people Palliative care units will be started at 17 in the country suffer from cancer. government medical colleges in the State. http://timesofindia.indiatimes.com/city/pu The first such unit was inaugurated at ne/Only-04-cancer-patients-avail-of- palliative-care- Government General Hospital on Friday [15 Expert/articleshow/6738392.cms October 2010]. "This is the first step towards establishing a palliative care policy for the State. A policy that would take cancer care From Media Watch dated 2 August 2010: to beyond medical management and move on to taking care of people who have a India worst in end-of-life care terminal condition," Health Secretary V.K. Subburaj said. He said the initial step of TIMES OF INDIA | Online report – 16 July 2010 – setting up units in the medical college India doesn't just have a poor quality of life, as hospitals was sensible as it was the tertiary reflected in its poor human development index, it care hospital that attracted a large number also has a particularly poor 'quality of death.' That's the depressing message from a new index of people with cancer and later in need of developed by the Economist Intelligence Unit palliative care. The units will avail of the [EIU] to measure end-of-life care services in 40 existing services in the cancer ward of the countries. 1http://timesofindia.indiatimes.com/India various hospitals. Morphine will be provided /India-worst-in-end-of-life- free. http://www.thehindu.com/news/states/ta care/articleshow/6174380.cms mil-nadu/article832712.ece 1. The Quality of Death: Ranking End of-life-care Across the World ,EIU, July 2010. Of related interest: http://graphics.eiu.com/upload/QOD_main_final_edition _Jul12_toprint.pdf  TIMES OF INDIA | Online report – 13 October 2010 – 'Only 0.4% cancer N.B. The EIU study was commissioned by the Lien patients avail of palliative care: Foundation: http://www.lienfoundation.org/ , and Expert.' While educating citizens about publication of the Quality of Death Index was reported how palliative care can provide relief to on in detail in the editions of Media Watch dated 26 July cancer patients, medical director of (p.2) and 19 July 2010 (pp.1,2 & 3). Cipla Palliative Care & Training Centre Priyadarshini Kulkarni said that ... at any

pg. 4

Coroner's concern at increase The state's leading palliative care advocate in "old and alone" deaths has revealed how the situation has reached breaking point with the level of funding now U.K. (WALES) | BBC News – 14 October so low it is unable to meet demand. Despite 2010 – Concerns have been raised about two reports commissioned by Queensland the number of pensioners dying alone at Health ... recommending changes to the home and laying undiscovered for weeks. A service, the Government has failed to act. coroner spoke out at an inquest into the Queenslanders are left suffering from death of a 70-year-old woman whose body preventable pain in the weeks before their was belatedly found by neighbours at her death, with others forced to die in a general home in Dolgellau, Gwynedd. He called it a hospital ward instead of in the comfort of "sad reflection on society." Ruth Marks, their own home. John-Paul Kristensen ... of Older People's Commissioner for Wales, Palliative Care Queensland, said ... funding said that "companionship and support" were had not increased for at least 10 years, important for older people. The inquest ... while demand for services had soared by heard Joan Easterbrook lived alone, did not 25% a year in some areas. socialise and had not visited her doctor for http://www.couriermail.com.au/news/queensl years when she died in March. and/queensland-health-funding-shortfall- http://www.bbc.co.uk/news/uk-wales- leaves-the-sick-left-to-die-in-pain/story- 11526737 e6freoof-1225937853889

From Media Watch dated 12 July 2010: Media Watch Online  PALLIATIVE MEDICINE | Online article – 9 July 2010 – 'Older people living The weekly report can be accessed at several alone at the end of life in the U.K.' websites, among them: The paper focuses on the U.K., given recent policy and service development Canada

initiatives there which emphasize home Ontario | Hamilton Niagara Haldimand Brant Hospice as a place of support and care; the Palliative Care Network: promotion of independence; ensuring http://www.hnhbhpc.net/Resources/UsefulLinks/Media choice and decision making; and, equity. Watch/tabid/97/Default.aspx These initiatives do not acknowledge diversity in the older population and Ontario | HPC Consultation Services: make little provision to meet the specific http://www.hpcconnection.ca/newsletter/inthenews.html needs that older people living alone may Ontario | Mississauga Halton Palliative Care Network have as they approach the end of life. http://www.mhpcn.ca/Physicians/resources.htm The authors identify three broader social (Scroll down to 'Newsletters/Media Updates') factors that influence whether older people who live alone can remain at U.S.A. home until the end of their lives. http://pmj.sagepub.com/cgi/content/abstr Prison Terminal : act/0269216310373165v1 http://www.prisonterminal.com/news%20media%20wat ch.html

Queensland Health funding shortfall International leaves the sick left to die in pain Global | Palliative Care Network Community: AUSTRALIA (QUEENSLAND) | Courier Mail http://www.pcn- e.com/community/search/?tag=Media+Watch – 13 October 2010 – Terminally ill patients are being left to die in Queensland hospitals U.K. | Omega, the National Association for End of Life because the Bligh Government is failing to Care: http://www.omega.uk.net/news.htm adequately fund community palliative care...

(Continued next column)

pg. 5

Palliative care has an ima ge problem

Care allows a dignified death

THE AUSTRALIAN | Online report – 12 October 2010 – Research undertaken by Palliative Care Victoria suggests palliative care has an image problem. Many in the community think that if a person is referred to palliative care, it means there is no hope for them and they are about to die. Not only is this a perception of the community, but many health professionals still regard death as a medical failure, meaning they may be loath to refer a person who may benefit from palliative care. http://www.theaustralian.com.au/news/opinion/care-allows-a-dignified-death/story-e6frg6zo- 1225937348840

For the latest in funeral trends, look to eco-friendly caskets

CANADA | National Post – 12 October 2010 – From recycled newspaper coffins that resemble space-age mummies to sea-salt urns that dissolve in hours if floated out to sea, green burial options will be among the most innovative products on the trade-show floor at the National Funeral Directors Association convention in New Orleans. While interest in green funeral options is growing rapidly ... funeral directors say this trend is really a throwback to centuries past. http://www.nationalpost.com/life/latest+funeral+trends+look+friendly+caskets/3660317/story.html

Of related interest:

 U.K. (WALES) | Western Mail – 11 October 2010 – 'Grave concerns over the increasing costs of dying.' Research by the Western Mail has revealed that the basic cost for excavation of a grave can vary by hundreds of pounds between local authorities. But a move by Ceredigion County Council to almost double the cost of being buried in one of its cemeteries could be followed by other councils in the months to come. http://www.walesonline.co.uk/news/wales- news/2010/10/11/grave-concerns-over-the-increasing-costs-of-dying-91466-27444861/

Assisted (or facilitated) death

Representative sample of recent news media coverage:

 U.K. | PRESS ASSOCIATION – 17 October 2010 – 'Attack over 'legal euthanasia' call.' A writer from a leading think-tank has attacked the "chattering classes" who she said were calling for the legalisation of assisted dying. Cristina Odone, from the Centre for Policy Studies, warned legalising euthanasia could lead to the elderly, frail and vulnerable being viewed as an expendable burden. The legalisation of assisted dying would lead to a new category of "less than perfect" citizens, she argued. http://www.google.com/hostednews/ukpress/article/ALeqM5j4k0MaQdr9LJjJN98NslFubvcM PQ?docId=N0315161287311355841A

 NEW ZEALAND HERALD | Online report – 14 October 2010 – 'Banned suicide ad to be aired...' Provisional approval has been granted to screen on New Zealand television an advert "promoting suicide" that is banned from Australian and Canada airwaves. The script, by Australian-based pro- euthanasia group Exit International, was approved this week, by the Commercial Approvals Bureau. http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10680553

 LUXEMBOURG | Lux Mag – 13 October 2010 – 'Euthanasia is more acceptable in Luxembourg.' Luxembourg became the third European country to legalise euthanasia for terminally ill people in 2008, after Holland and Belgium. Despite considerable opposition at the time ... it would appear that the population is largely accepting of the moral issues around assisted suicide. http://www.station.lu/?p=edito&a=external&id=76889

 VENEZUELA | El Universal – 11 October 2010 – 'Criminal bill gives green light to euthanasia in Venezuela.' A person with terminal cancer may request his doctor to help him die and the physician will be able to meet his request, without any legal liability ... provided the draft Organic Criminal Code ... is passed. The bill legalizes euthanasia in Venezuela. http://english.eluniversal.com/2010/10/11/en_pol_art_criminal-bill-gives_11A4591773.shtml

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Specialist Publications (e. g., in-print and online journal articles, re ports, etc. )

Withdrawin g life-sustainin g treatment

Moral fictions and medical ethics

BIOETHICS , 2010;24(9):453-460. Conventional medical ethics and the law draw a bright line distinguishing the permitted practice of withdrawing life-sustaining treatment from the forbidden practice of active euthanasia by means of a lethal injection. When clinicians justifiably withdraw life-sustaining treatment, they allow patients to die but do not cause, intend, or have moral responsibility for, the patient's death. In contrast, physicians unjustifiably kill patients whenever they intentionally administer a lethal dose of medication. The authors argue that the differential moral assessment of these two practices is based on a series of moral fictions – motivated false beliefs that erroneously characterize withdrawing life-sustaining treatment in order to bring accepted end-of-life practices in line with the prevailing moral norm that doctors must never kill patients. http://onlinelibrary.wiley.com/doi/10.1111/j.1467-8519.2009.01738.x/abstract

Do patients want a choice and does it work?

BRITISH MEDICAL JOURNAL | Online Patient surveys show an unmet demand for article – 14 October 2010 – "Nothing about greater involvement in treatment decisions me without me" was the guiding principle that has persisted over the past eight years. adopted by 64 participants from 29 countries http://www.bmj.com/content/341/bmj.c4989. at a 1998 Salzburg global seminar convened extract to develop ideas for improving the quality of health care by involving patients. The catchphrase has now resurfaced in the Implementing shared coalition government's new plan for the NHS decision making in the NHS [National Health Service] in England, which sees patient choice and shared decision BRITISH MEDICAL JOURNAL | Online article – 14 October 2010 – Policies to promote shared making as key mechanisms to create a decision making are becoming prominent in the patient centred and quality focused NHS. U.S., Canada, and U.K. This is partly because of Many people have argued passionately for a recognition of the ethical imperative to properly and against the policy on the basis of their involve patients in decisions about their care and expectations of its effects, but research partly because of the accruing evidence that the evidence to confirm or refute these approach has benefits. Shared decision making assumptions is only now beginning to respects patient autonomy and promotes patient emerge. In contrast, evidence about the engagement. http://www.bmj.com/content/341/bmj effects of engaging patients in treatment .c5146.extract choices has accumulated over some time, but the findings have been largely ignored.

Of related interest:

 CLINICAL MEDICINE (Royal College of Physicians), 2010;10(5):468-471. 'The decision to engage in end-of-life discussions: A structured approach for doctors in training.' Engaging in end-of-life discussions is a major source of anxiety for doctors in training. The authors propose the use of a decision-making model to assist trainees and their clinical supervisors in such situations. http://www.ingentaconnect.com/content/rcop/cm/2010/00000010/00000005/art00013

 JOURNAL OF PARTICIPATORY MEDICINE | Online article – 13 October 2010 – 'Barriers to achieving shared understanding and shared decision making with patients.' The study sheds light on the barriers to shared understanding and decision making at both micro and macro levels from the physicians' perspective, and has implications for efforts to improve patient participation. http://www.jopm.org/evidence/research/2010/10/13/physician-communication-barriers-to-achieving- shared-understanding-and-shared-decision-making-with-patients/

Cont. pg. 7

 PATIENT EDUCATION & COUNSELLING , 2010;81(2):251-256. 'What can people approaching death teach us about how to care?' This study sought to hear what patients approaching death had to say about doctor-patient interactions and care in order that doctors can learn how to demonstrate care more effectively so that each patient feels cared for as an individual. The psychological and physical suffering that results from allowing stereotypical assumptions and behaviours to shape doctor-patient interaction was clear. http://www.pec-journal.com/article/S0738- 3991(10)00042-X/abstract

Perceptions of terminally ill patients and family members regarding home and hospice as places of care at the end of life

EUROPEAN JOURNAL OF CANCER CARE | Online article – 5 October 2010 – To enable demand-based palliative care, it is important to know the perceptions of terminally ill patients and their family members regarding home and hospice as places of care at the end of life. This paper provides further insight in the patient perspective in palliative care. The results reveal that a cohabiting partner seems an important prerequisite for terminally ill patients to stay at home. For spouses it is an obvious choice to facilitate the patients' stay at home, even when it becomes too demanding, something not discussed between spouse and patient. When sufficient care at home seems impossible and the negotiation between patients and family members results in the opinion that living at home is no longer an option, it is decided that the patient moves to a hospice. http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2354.2010.01228.x/full

Of related interest:

 COMMUNITY CARE JOURNAL (U.K.) | Online report – 13 October 2010 – [Care Services Minister] 'Burstow announces £4.4m boost for carers' support.' Care Services Minister Paul Burstow [has] revealed details of targeted measures to improve awareness of carers among frontline professionals and give charities ... the means to provide training themselves. http://www.communitycare.co.uk/Articles/2010/10/13/115558/exclusive-burstow-announces-4.4m- boost-for-carers-support.htm

Oncolo gy

Compassionate honesty

JOURNAL OF PALLIATIVE MEDICINE , 2010;13(10):1187-1191. There are advantages to both the patient and physician to being honest and forthright, even if the truth is disappointing or frightening. Honest communication of clinical reality allows patients to make better informed decisions regarding treatment options, fully prepare for eventualities, have worthwhile discussions with loved ones, and not miss opportunities to do whatever is important to them with their remaining time. There are patients who may not welcome such openness, but most do appreciate knowing what lies ahead. Learning how to impart such information in a sensitive and compassionate manner requires not only good intentions, but strong communication skills ... and the discipline to do what will serve the patient best, rather than what is easiest or feels good. By providing stories of personal reflection as well as guidelines and practical advice, Art of Oncology promotes lifelong learning which enhances the practice of oncology for both our patients and ourselves. http://www.liebertonline.com/doi/pdfplus/10.1089/jpm.2010.9777

From Media Watch dated 11 October 2010:

 THE CANCER JOURNAL , 2010;16(5):488-492. 'Working with a palliative care team.' Barriers can complicate ... easy integration into the hospice team as patients often remain at home. There may be philosophical or clinical practice differences between oncology and palliative care at first glance. http://journals.lww.com/journalppo/Abstract/2010/09000/Working_With_a_Palliative_Care_T eam.11.aspx

N.B. This special issue of the journal focuses on the oncologist's role in delivering palliative care. Contents page: http://journals.lww.com/journalppo/pages/currenttoc.aspx

pg. 8

Specifying WHO recommendation: Moving toward disease-specific guidelines

JOURNAL OF PALLIATIVE MEDICINE , 2010;13(10):1273-1276. The World Health Organization (WHO) explicitly recommends the integration of palliative care (PC) early in the disease trajectory as part of the WHO definition of PC. The authors' comprehensive cancer center decided: 1) to include this recommendation in the administrative directives for principles of cancer care; and, 2) to establish a PC hospital support team. The evaluation of this approach revealed that patients with lung cancer still received PC rather late in the course of the disease. Therefore, they decided to additionally develop disease-specific standard operating procedures (SOPs) to try to overcome these deficiencies. This SOP for the first time presents disease-specific guidelines for PC integration into comprehensive (lung) cancer therapy by: 1) defining "green flags" for early integration of PC; and, 2) recommending PC parallel to initiation of anticancer therapy. Furthermore, clear definitions are provided to delineate PC assignments. Such disease-specific algorithms should be helpful to further reduce uncertainty about the way PC can be integrated early in the course of the disease. http://www.liebertonline.com/doi/abs/10.1089/jpm.2010.0016

Of related interest:

 PALLIATIVE MEDICINE | Online article – 15 October 2010 – 'Living and coping with Parkinson's Disease [PD]: Perceptions of informal carers.' A review of the literature highlights the important role informal carers play in the provision of palliative care in the community. Stereotypes of the meaning and timing of palliative care were common with many [of the informal caregivers interviewed] viewing it as being synonymous with cancer and not applicable to a person with PD. http://pmj.sagepub.com/content/early/2010/10/14/0269216310385604.abstract

Use of spiritual life maps in a hospice setting

JOURNAL OF RELIGION, SPIRITUALITY & AGING , 2010;22(4):254-270. This qualitative study evaluated the introduction, demonstration, and use of spiritual life maps in a hospice setting. Focus groups with hospice chaplains and social workers were conducted to assess hospice professionals' definitions of spiritual care and their responses both before and after hands-on training in the use of spiritual life maps as a tool in end of life care. Results suggest the need for ongoing training and support in addressing spiritual needs at the end of life, and several barriers to the use of new tools. Implications for research, training, and practice are discussed. http://www.informaworld.com/smpp/content~db=all~content=a927855965~frm=abslink

Ethics and end-of-life care for adults in the intensive care unit

THE LANCET , 2010;376(9749):1347-1353. – 9 October 2010 – The intensive care unit (ICU) is where patients are given some of the most technologically advanced life-sustaining treatments, and where difficult decisions are made about the usefulness of such treatments. The substantial regional variability in these ethical decisions is a result of many factors, including religious and cultural beliefs. Because most critically ill patients lack the capacity to make decisions, family and other individuals often act as the surrogate decision makers, and in many regions communication between the clinician and family is central to decision making in the ICU. Elsewhere, involvement of the family is reduced and that of the physicians is increased. End-of-life care is associated with increased burnout and distress among clinicians working in the ICU. Since many deaths in the ICU are preceded by a decision to withhold or withdraw life support, high-quality decision making and end-of-life care are essential in all regions, and can improve patient and family outcomes, and also retention of clinicians working in the ICU. To make such a decision requires adequate training, good communication between the clinician and family, and the collaboration of a well functioning interdisciplinary team. http://www.thelancet.com/journals/lancet/article/PIIS0140- 6736(10)60143-2/fulltext

pg. 9

Worth Re peatin g

Nurturing humanism through teaching palliative care

ACADEMIC MEDICINE , 1998;73(7):763-765. The discipline of So long as appropriate palliative care promises to be a rich source of learning and emotional support is provided growth for physicians-in-training. Teaching about palliative for learners, the immediacy care affirms two essential but vulnerable dimensions of the and rawness of the emotions practice of medicine – the importance of relationship-centered surrounding death for patients, families, and care and the value of doctoring as a source of meaning and physicians can allow learning growth for physicians. In addition to fostering fundamental to take place at a deep level. humanistic learning, palliative medicine is an excellent vehicle Caring for the dying can also for teaching basic but often neglected clinical competencies, help young physicians learn including pain and symptom control, communication, and to tolerate a degree of working as part of a health care team. intimacy and personal http://journals.lww.com/academicmedicine/Abstract/1998/070 engagement that other 00/Nurturing_humanism_through_teaching_palliative.12.aspx aspects of medical training may subvert and undermine.

Media Watch: Editorial Practice

Each listing in Media Watch represents a condensed version or extract of what is broadcast, posted (on the Internet) or published; in the case of a journal article, an edited version of the abstract or introductory paragraph, or an extract. Headlines are as in the original article, report, etc. There is no editorializing ... and, every attempt is made to present a balanced, representative sample of "current thinking" on any given issue or topic. The weekly report is issue-oriented and offered as a potential advocacy tool or change document.

Distribution

Media Watch is distributed at no cost to colleagues active or with a special interest in hospice, palliative care and end of life issues. Recipients are encouraged to share the weekly report with their colleagues. The distribution list is a proprietary one, used exclusively for the distribution of the weekly report and occasional supplements. It is not used or made available for any other purpose whatsoever – to protect the privacy of recipients and also to avoid generating undue e-mail traffic.

Links to Sources

1. Links are checked and confirmed as active before each edition of Media Watch is distributed. 2. Links often remain active, however, for only a limited period of time. 3. Access to a complete article, in some cases, may require a subscription or one-time charge. 4. If a link appears broken or inactive, try copying/pasting the URL into the address bar of your browser or, alternatively, Google the title of the article or report, and the name of the source. 5. Due to its relevance, an article may be listed but for which a link is not available; access, therefore, may only be possible directly from the source (e.g., publication) or through the services of a library.

Somethin g Missed or Overlooked?

If you are aware of a current report, article, etc., relevant to hospice, palliative care or end-of-life issues not mentioned, please alert this office (contact information below) so that it can be included in a future issue of Media Watch. Thank you.

Barry R. Ashpole 'phone: 905.563.0044 Beamsville, Ontario CANADA e-mail: [email protected]

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