What do young adults know about palliative care? A cross-sectional survey

OBJECTIVES

A public health approach to palliative care that reorientates care towards the public is advocated in global policy. The public are drivers in identifying care priorities and partners in finding solutions to care issues; however, a necessary prerequisite is that the public knows what palliative care is and what it can achieve. The aim of this study was to investigate what young adults, an important cohort of the public, know about palliative care and identify key predictors of knowledge.

STUDY DESIGN

This is a cross-sectional online survey.

METHODS

A cross-sectional online survey measured knowledge of palliative care using the Palliative Care Knowledge Scale (PaCKS), with young adults (aged 18-29 years) recruited from a university in the UK. Data relating to demographic characteristics and familiarity and experience of palliative care were collected, with descriptive, bivariate and multivariate analyses undertaken to determine respondents' knowledge levels and key predictors.

RESULTS

In total, 83% (n = 710) of respondents (n = 859) had heard of the term palliative care. The mean score on the PaCKS was 8.87 (standard deviation = 3.4, range = 0-13); men had lower levels of knowledge (P = 0.016). Most respondents were aware that palliative care is not specifically for those with cancer or exclusively for older populations. They were unsure of timing and other key aspects reporting significant levels of 'I don't 'know' responses. Linear regression analysis demonstrated that familiarity and experience of palliative care moderated demographic influences (age, gender, education level) on knowledge (β = 0.45, P < 0.001).

CONCLUSIONS

The findings suggest that despite high levels of awareness and familiarity with the term, significant numbers of respondents indicated a lack of knowledge of palliative care rather than inaccurate knowledge. This suggests the need for public health organisations to partner with palliative care sectors to develop and disseminate clear unequivocal messaging relating to the breadth of palliative care that both informs and engages young adults.

31 A multi-site retrospective case note review for clinical practices of constipation in specialist palliative care settings

Background

Constipation is a common symptom for patients receiving palliative care. Whilst national clinical guidelines are available on the management of constipation for people with advanced cancer in specialist palliative care (SPC) settings questions exist around clinical practice and the extent to which the guidelines are implemented in practice. This study examine current clinical practice for management of constipation for patients with advanced cancer in SPC settings.

Methods

A multi-site retrospective case-note review was conducted consisting of 150 patient case-notes from three SPC units across the United Kingdom between August 2016 and May 2017. Descriptive statistics were used to compare clinical practices to national policy guidelines for constipation.

Results

A physical exam and bowel history was recorded for 109 patients (73%). Whilst the Bristol Stool Chart was used frequently across sites (96%) involvement of the multidisciplinary team varied. Almost a third of patient charts (27%) recorded no evidence of non-pharmacological management strategies. Pharmacological management was recorded frequently with sodium docusate or senna as the preferred laxatives across all sites however 33% of patient charts recorded no information on the titration of laxatives. There were no consistent management strategies recorded for opioid induced constipation or bowel obstruction

Conclusion

Assessment and management of constipation in SPC settings is highly variable. Variations in assessment; limited use of non-pharmacological and preventative strategies and absence of consistent strategies for opioid induced constipation or bowel obstruction are evident. Further education is needed to equip HCPs with the necessary knowledge and skills to assess and manage constipation.

References

. Friedrichsen M, Erichsen E. The lived experience of constipation in cancer patients in palliative hospital-based home care. Int J Palliat Nurs [Internet] 2004;10(7):321–5. Available from: http://search.ebscohost.com/login.aspx?direct=true&profile=ehost&scope=site&authtype=crawler&jrnl?=13576321&A?N=13991056&h=XKMF4r08srZuhDY0j7C95oLLyYKNHUcvoeEuhyXNnsIM2BI%2BEhmcY1pPP%2BN1pvrMzQ9Bn9b5j45X6WzyBRydEA%3D%3D&crl=c [Accessed: 21 August 2017]

. Gilbert EH, et al. Chart reviews in emergency medicine research: Where are the methods?Annals of Emergency Medicine1996;27(3):305–8. Available at: http://www.ncbi.nlm.nih.gov/pubmed/8599488 [Accessed: 17 May 2018]

. National Clinical Effectiveness Committee. Management of constipation in adult patients receiving palliative care national clinical guideline No. 10November 2015.

. Tvistholm N, Munch L, Danielsen AK. Constipation is casting a shadow over everyday life? A systematic review on older people’s experience of living with constipation [Internet]. Journal of Clinical Nursing2017;26:902–14. Available from: http://doi.wiley.com/10.1111/jocn.13422 [Accessed: 21 August 2017]

. Wickson-griffiths A, et al.Revisiting retrospective chart review: An evaluation of nursing home palliative and end-of-life care research. Palliative Medicine Care2014;1(2):8. Available at: www.symbiosisonlinepublishing.com [Accessed: 23 November 2017]

32 Examining the key factors impacting on the implementation of an educational program on constipation in specialist palliative care

Introduction

Constipation is one of the most common symptoms in patients in specialist palliative care (SPC) settings and can cause considerable physical psychological and social suffering for the patient and their family. Due to the high variability in constipation assessment and management in SPC settings questions exist around how to implement an educational program in practice to address this clinical gap.

Aim

To develop and test the feasibility and acceptability of a novel educational intervention for HCPs to manage constipation experienced by people in SPC settings.

Method

Using the MRC framework for complex interventions and guided by the consolidated framework for implementation research an online resource was developed considering the content context and processes for implementation.

Results

Assessment prevention and management were identified as the core aspects. Six sessions with theoretical content application to practice and reflection through interacting with colleagues were developed in line with the best available evidence. Incentives including an educational bursary and alignment with revalidation and support from senior management champions and the research team were identified as key elements needed successful implementation. Funding IT infrastructure and attitudes to the content have been flagged as potential barriers to success.

Conclusion

A six week blended program covering the key concepts for assessment and management of constipation in palliative care has been created. Content evidence from the literature and empirical data on the preferred structure and method of delivery as well as key considerations of the contextual factors have been identified as key factors for implementation.

References

. Craig P, et al.Developing and evaluating complex interventions: The new medical research council guidance. BMJ Clinical Research Ed2008;337(October):a1655. Available at: http://discovery.ucl.ac.uk/168426/

. Damschroder LJ, et al. Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation Science2009;4(50).

. Friedrichsen M, Erichsen E. The lived experience of constipation in cancer patients in palliative hospital-based home care. Int J Palliat Nurs [Internet] 2004;10(7):321–5. Available from: http://search.ebscohost.com/login.aspx?direct=true&profile=ehost&scope=site&authtype=crawler&jrnl?=13576321&AN=13991056&h=XKMF4r08srZuhDY0j7C95oLLyYKNHUcvoeEuhyXNnsIM2BI%2BEhmcY1pPP%2BN1pvrMzQ9Bn9b5j45X6WzyBRydEA%3D%3D&crl=c [Accessed: 2017 August 21]

. Tvistholm N, Munch L, Danielsen AK. Constipation is casting a shadow over everyday life? A systematic review on older people’s experience of living with constipation [Internet]. Journal of Clinical Nursing2017;26:902–14. Available from: http://doi.wiley.com/10.1111/jocn.13422 [Accessed: 2017 August 21]

Exercise and nutrition interventions in advanced lung cancer: a systematic review

In this systematic review, we sought to evaluate the effect of physical activity or nutrition interventions (or both) in adults with advanced non-small-cell lung cancer (nsclc).

METHODS

A systematic search for relevant clinical trials was conducted in 6 electronic databases, by hand searching, and by contacting key investigators. No limits were placed on study language. Information about recruitment rates, protocol adherence, patient-reported and clinical outcome measures, and study conclusions was extracted. Methodologic quality and risk of bias in each study was assessed using validated tools.

MAIN RESULTS

Six papers detailing five studies involving 203 participants met the inclusion criteria. Two of the studies were single-cohort physical activity studies (54 participants), and three were controlled nutrition studies (149 participants). All were conducted in an outpatient setting. None of the included studies combined physical activity with nutrition interventions.

CONCLUSIONS

Our systematic review suggests that exercise and nutrition interventions are not harmful and may have beneficial effects on unintentional weight loss, physical strength, and functional performance in patients with advanced nsclc. However, the observed improvements must be interpreted with caution, because findings were not consistent across the included studies. Moreover, the included studies were small and at significant risk of bias. More research is required to ascertain the optimal physical activity and nutrition interventions in advanced inoperable nsclc. Specifically, the potential benefits of combining physical activity with nutrition counselling have yet to be adequately explored in this population.

Attitudes to cancer and cancer prevention: what do people aged 35-54 years think?

The aim of this study was to explore the knowledge, attitudes and behaviours of people in mid-life towards cancer prevention. The study was undertaken in Northern Ireland between 2003 and 2007. This was a mixed methods study using a sequential exploratory design. The theoretical framework was the Theory of Planned Behaviour and the methodology was based on Sutton's framework. There were three methodological stages in the study using focus groups, a large cross-sectional survey and a volunteer sample survey. This paper focuses on the findings of the cross-sectional survey relating to the attitudes of people in mid-life towards cancer and cancer prevention. Findings are considered in relation to the respondents' level of knowledge, age, gender, level of educational attainment and socio-economic status. Evidence from this study shows that attitudes towards cancer and cancer prevention are associated significantly with level of knowledge about cancer, gender, socio-economic status and level of educational attainment. In conclusion, the evidence from this study shows that men, those with a lower level of education, those with a lower level of knowledge and those in a lower socio-economic group were more likely to hold negative attitudes about cancer and cancer prevention.

The role of community nurses and residential staff in supporting women with intellectual disability to access breast screening services

BACKGROUND

Women with intellectual disability (ID) are surviving to the age group at greatest risk of developing breast cancer (50-69 years). These women are more likely to experience a greater number of risk factors placing them at an advanced threat of developing breast cancer. However, as a result of cognitive deficits and communication difficulties these women are dependent upon staff to support them to attend the breast screening clinics.

AIM

The aim of this paper was to examine how community nurses and residential staff support women with ID to access breast screening services.

METHODOLOGY

Six focus groups were held with community nurses and residential staff who work in the field of ID in one region of the UK. The focus groups were tape recorded and the transcriptions were subjected to a thematic content analysis.

FINDINGS

Although many of the participants recognised the risk factors and signs/symptoms of breast cancer, there was still a deficit of knowledge. Both positive and negative experiences of women with ID attending for breast screening were reported; however, greater discussion focused on the latter. The participants identified 'a lack of health educational material' and also negative 'emotions, attitudes and physical barriers' as inhibiting factors for attendance.

DISCUSSION

This paper highlights the need for developing a health promotion programme for women with ID focusing on breast awareness and information on screening, and also healthier lifestyles. Breast awareness via visual checks was identified for women with ID who refused to attend the breast clinics; however, issues of informed 'consent' and 'vulnerability' were raised for staff and also family carers having to undertake these checks. Development of user-friendly health educational literature using 'pictures, symbols, signs' and simplified words should be accessible to all ID staff, healthcare staff, and also women with ID.

Exploring the ethical issues of the research interview in the cancer context

This paper sets out to reflect on ethical issues in the context of a study exploring cancer patients', relatives' and nurses' experience of a day hospital chemotherapy service. Interviewing can be considered as a well-used approach within qualitative methodology, yet little attention has been paid to a many of the ethical deliberations that are inherent when adopting this approach, particularly in the context of cancer. It is the intention of the authors that this paper might raise awareness of these issues, contribute to the ongoing debate about conducting research interviews on sensitive topics and provide a 'real-world' application of these principles. It is considered that the article potentially raises more questions that answers and illustrates that there are not always quick-fix solutions for the 'real-world' problems qualitative researchers' experience.

82 IN VITRO SURVIVAL OF PORCINE BLASTOCYSTS VITRIFIED USING THE CRYOLOGIC VITRIFICATION METHOD

Porcine embryo cryopreservation is an important technology for the storage and transport of valuable genetic material. With many of the current vitrification and storage systems, such as the open pulled straws and microdrops, there is direct contact between the medium containing the embryos and the liquid nitrogen. This represents a possible contamination risk. One system with which there is no direct contact between the embryos and liquid nitrogen during the vitrification process is the Cryologic Vitrification System (CVM; Lindemans et al. Reprod. Fertil. Dev. 16, 174) which uses solid surface vitrification. Microdrops of vitrification medium containing the embryos are placed in contact with a metal block that has been precooled by partial submersion in liquid nitrogen, resulting in very rapid cooling rates. Blastocysts were collected surgically on day 5 of pregnancy from mature sows, and the embryos were randomly divided into two groups; each group was then vitrified and warmed with either of two previously published protocols except that the CVM replaced the open pulled straws plunged into liquid nitrogen in both protocols. The first method (OPS/CVM) was based on the open pulled straw method (Cuello et al. Theriogenology 61, 843-850), and used DMSO and ethylene glycol as cryoprotectants and TCM-199 as the basic medium. The second method (EG/CVM) used HEPES-buffered NCSU23 as the basic medium; the blastocysts were centrifuged prior to vitrification in ethylene glycol and polyvinylpyrrolidone (PVP) and the zona pellucida was removed immediately after warming (Cameron et al. Theriogenology 61, 1533-1543). Embryos were then cultured in NCSU23 +10% fetal bovine serum for 48 h at 38.5�C in an humidified atmosphere of 5% CO2, 5% O2, and 90% N2. Embryos that had reformed the blastocoel and continued to expand were considered to have survived. These were stained with Hoechst 33342 and the nuclei counted using fluorescence microscopy. There was no difference between the OPS/CVM or EG/CVM methods in either the survival rates (27/29; 93%, and 24/27; 89%, respectively) or the number of cells (mean � SEM; 109 � 6 and 112 � 6, respectively). The survival rates are comparable to previously published rates using these two methods and open pulled straws. These data suggest that the CVM can successfully replace the open pulled straws in these two protocols. However, transfer of vitrified and warmed embryos into recipients would be needed to confirm the viability of the surviving embryos.

Intensive care nurses' experiences of caring for dying patients: a phenomenological study

The experience of nurses working in end-of-life care, particularly those caring for cancer patients in the hospice setting, have been well researched. Yet despite the fact that intensive care units (ICUs) are frequently the site of patient death, studies of the nurses working in these units are uncommon. This study was designed to provide qualitative data to explore the experiences of intensive care nurses caring for patients who are dying. Semi-structured interviews were conducted with ten nurses who had experience of caring for dying patients in ICUs in two teaching hospitals in Taiwan. Data were analysed using a phenomenological descriptive approach. Participants' descriptions revealed the following core themes: considering nurses' attitudes to caring for the dying, stressors associated with this care and coping strategies that intensive care nurses adopt. The study concludes that education for ICU nurses must address these issues to facilitate better care of dying patients in the ICU.

District nurses' perceptions of palliative care services: part 2

The overall aim of this study was to examine district nurses' (DNs') perceptions of palliative care services within the community setting. A questionnaire which focused on the key areas of defining palliative care, perception of roles, communication, service provision and the education and training needs of DNS was used. This was designed following a review of the literature and combined with data from phase one of the study (Vol 5(5): 215-222), which involved focus group interviews with DNs. The questionnaire was distributed to district nursing sisters (n = 66) within two community trusts in Northern Ireland. Findings suggest that the physical 'doing' aspects of care continue to dominate DNs' perceptions of palliative care and their educational needs. However, the supportive element of the DN's role was also identified alongside the potential role as coordinator. Palliative care service provision was considered adequate and the main services that nurses identified as useful related to the provision of 24-hour care. The main factors identified by nurses as influencing service provision related to organizational issues such as inadequate staffing levels, limited resources and a lack of time.