Advance Care Planning in the Philippines: A continuing narrative of advocacy

This article discusses the current state of Advance Care Planning (ACP) in the Philippines, where the health system operates within a fragmented environment, with mixed private and public provisions. Despite some attempts to introduce legislation to foster ACP implementation, patient autonomy remains subordinate to family values and physician authority within the Southeast Asian culture. The article also highlights how the COVID-19 pandemic has challenged the norms of the global healthcare force and pushed Palliative Medicine specialists to take on stronger roles in the battle lines against health-related suffering. The Palliative Care Consultants, advocates along with Philippine Society of Hospice and Palliative Medicine (PSHPM) and Hospice Philippines Inc. have been playing a significant role in promoting and supporting ACP through education and training, advocacy, research and development, networking and collaboration.

The Knowledge of Palliative Care among Geriatric Home Staff in Jordan

Background

Palliative care in nursing homes (NHS) is a major challenge, because it gives the demands of the knowledge and skills of nursing staff to provide high-quality care.

Purpose

The purpose of this study was to assess the knowledge of palliative care among nursing home staff.

Methods

A descriptive study design was used, 124 nurses, aged over 30 years and most of them were male working in the nursing home in Jordan. Around 109 participants were responded to the questionnaire. All licensed nurses were included in the study, except of that will be excluded. The knowledge of palliative care was measured via the palliative care survey. knowledge scores were ranged 0-1, with higher scores indicate greater knowledge.

Results

Descriptive statistics was used. The Knowledge of palliative care issues is 0.21 in Jordan (95% confidence interval (CI) 0.19-0.24). Knowledge of physical aspects that can contribute to pain is 0.22 (95% CI 0.2-0.25), and knowledge of psychological aspects that can contribute to pain is 0.21 (95% CI 0.2-0.22).

Conclusion

Education for nursing staff needs to be enhanced to address the specific knowledge gaps. Additional studies with large sample size recommended to explore the effect of educational programs in regard of palliative care in nursing homes.

The impact of death and dying on the personhood of senior nurses at the National Cancer Centre Singapore (NCCS): a qualitative study

Background

A nurse’s role in caring for the dying is fraught with ethical, professional, and psychosocial challenges that impact how they perceive their roles as professionals. When unsupported, nurses caring for the dying experience burnout, career dissatisfaction and leave the profession. Better understanding of how caring for the dying affects the professional identity formation (PIF) of nurses will guide efforts to better support nurses.

Methods

Guided by new data on the subject, we adopt the theoretical lens of the Ring Theory of Personhood (RToP) to evaluate how caring for the dying impacts the values, beliefs, principles, professional identities and personhood of nurses. We employ Krishna’s Systematic Evidence-Based Approach (SEBA) to guide the design and piloting of the semi-structured interview tool.

Results

Analysis of interviews with eight senior nurses in Supportive, Palliative and Oncology care revealed three domains: Identity 1) Formation; 2) Conflict and 3) Refinement. Identity Formation occurs early in a nurse’s career, upon entering a new specialist field, and at the start of Supportive, Palliative and Oncology care. Identity Formation reveals significant changes to how self-concepts of professional identities are tied to individual concepts of personhood. Caring for the dying, however, resulted in Conflicts between values, beliefs, and principles within regnant concepts of personhood and their professional duties. These conflicts are captured as conflicts within (‘disharmony’) and/or between (‘dyssynchrony’) the rings of the RToP. These conflicts can result in changes to self-concepts of personhood and professional identities. Identity Refinement sees experience and timely support helping nurses attenuate the impact of difficult experiences. This reduces the risk of burnout and mitigates changes to their professional identities. Identity Refinement helps them develop a ‘rooted identity’ which remains relatively consistent in the face of adversity.

Conclusions

Ongoing Identity Construction amongst nurses, particularly in caring for the dying, underscore the host organisation’s role in ensuring structured, longitudinal, accessible, and personalised assessments and support of nurses, especially when they are prone to dyssynchrony and disharmony whilst caring for the terminally ill. Further study into assessment methods and the role of the environment is critical.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12904-022-00974-9.

Mentoring in palliative medicine in the time of covid-19: a systematic scoping review : Mentoring programs during COVID-19

INTRODUCTION

The redeployment of mentors and restrictions on in-person face-to-face mentoring meetings during the COVID-19 pandemic has compromised mentoring efforts in Palliative Medicine (PM). Seeking to address these gaps, we evaluate the notion of a combined novice, peer-, near-peer and e-mentoring (CNEP) and interprofessional team-based mentoring (IPT) program.

METHODS

A Systematic Evidence Based Approach (SEBA) guided systematic scoping review was carried out to study accounts of CNEP and IPT from articles published between 1st January 2000 and 28th February 2021. To enhance trustworthiness, concurrent thematic and content analysis of articles identified from structured database search using terms relating to interprofessional, virtual and peer or near-peer mentoring in medical education were employed to bring together the key elements within included articles.

RESULTS

Fifteen thousand one hundred twenty one abstracts were reviewed, 557 full text articles were evaluated, and 92 articles were included. Four themes and categories were identified and combined using the SEBA's Jigsaw and Funnelling Process to reveal 4 domains - characteristics, mentoring stages, assessment methods, and host organizations. These domains suggest that CNEP's structured virtual and near-peer mentoring process complement IPT's accessible and non-hierarchical approach under the oversight of the host organizations to create a robust mentoring program.

CONCLUSION

This systematic scoping review forwards an evidence-based framework to guide a CNEP-IPT program. At the same time, more research into the training and assessment methods of mentors, near peers and mentees, the dynamics of mentoring interactions and the longitudinal support of the mentoring relationships and programs should be carried out.

Introduction to Special Issue on Advanced Cancer Care and Palliative Care Integration

Palliative care is uniquely positioned to optimize the care of the oncology patient through exploring unmet needs and utilizing interdisciplinary care. The studies presented here highlight some of the ways this can be done which includes: identifying patients at risk or in need; providing solutions to those requiring community supports; addressing psychological and existential concerns; managing symptoms over the course of a disease; communicating prognosis effectively and with compassion; exploring goals of care and advance directives; and facilitating conversations regarding goals, preferences, and values.

Clinician Perspectives on Group Visits for Advance Care Planning Among Caregivers and Older Adult Patients With Heart Failure

BACKGROUND

Advance care planning (ACP) is critical for older adults with heart failure; however, patient-level and clinician-level barriers exist. Although a group visit (GV) approach to engage patients in ACP has proven effective among general geriatric populations, little is known about clinician perceptions/likelihood of referral.

METHODS

Qualitative study to understand clinician perspectives on GVs for ACP among older adult patients with heart failure and caregivers. Twenty physicians and advance practice providers participated in telephone-based interviews guided by a semistructured research protocol. Transcripts were analyzed using a grounded theory approach.

RESULTS

Results highlight variability in clinician engagement in ACP but greater agreement around the factors that prompt discussions. Qualitative themes included (1) inherent properties of GVs (characteristics that make GVs ideal for most but less ideal for some, risk-to-benefit ratio); (2) purpose of GVs (general education, "priming the pump" for subsequent discussions, providing tools for action); and (3) format and procedures for GVs (inclusion/exclusion considerations, organizing by unifying characteristic, link back to clinicians).

CONCLUSIONS

This is the first study to gain clinician insights into ACP GVs specific to patients and caregivers affected by heart failure. Results shed light on an important topic and suggest key considerations for conducting GVs for ACP.

End-of-Life Care of Hospitalized Children with Advanced Heart Disease

BACKGROUND

Despite improvements in palliative care for critically ill children, the characteristics of end-of-life care for pediatric patients with advanced heart disease are not well-known. We investigated these characteristics among hospitalized children with advanced heart disease in a tertiary referral center in Korea.

METHODS

We retrospectively reviewed the records of 136 patients with advanced heart disease who died in our pediatric department from January 2006 through December 2013.

RESULTS

The median age of patients at death was 10.0 months (range 1 day-28.3 years). The median duration of the final hospitalization was 16.5 days (range 1-690 days). Most patients (94.1%) died in the intensive care unit and had received mechanical ventilation (89.7%) and inotropic agents (91.2%) within 24 hours of death. The parents of 74 patients (54.4%) had an end-of-life care discussion with their physician, and the length of stay of these patients in the intensive care unit and in hospital was longer. Of the 90 patients who had been hospitalized for 7 days or more, the parents of 54 patients (60%) had a documented end-of-life care discussion. The time interval from the end-of-life care discussion to death was 3 days or less for 25 patients.

CONCLUSION

Children dying of advanced heart disease receive intensive treatment at the end of life. Discussions regarding end-of-life issues are often postponed until immediately prior to death. A pediatric palliative care program must be implemented to improve the quality of death in pediatric patients with heart disease.

Ethical Dilemmas at the Beginning and End of Life: A Needs-Based, Experience-Informed, Small-Group, Case-Based Curriculum for Pediatric Residents

INTRODUCTION

Pediatric residents are faced with ethical dilemmas in beginning- and end-of-life situations throughout their training. These situations are innately challenging, yet despite recommendations that residents receive training in ethics and end-of-life domains, they continue to report the need for additional training. To address these concerns, we developed an interactive and reflective palliative care and medical ethics curriculum including sessions focusing on ethical dilemmas at the beginning and end of life.

METHODS

This module includes a trio of case-based, small-group discussions on artificial nutrition and hydration, futility, and ethical considerations in neonatology. Content was developed based on a needs assessment, input from local experts, and previously published material. Trainees completed assessments of comfort and understanding before and after each session.

RESULTS

The module was attended and assessed by an average of 27 trainees per session, including residents and medical students. Knowledge of ethical considerations improved after individual sessions, with 86% of trainees reporting understanding ethical considerations involved in the decision to withdraw or withhold medically provided nutrition and hydration and 67% of trainees reporting understanding the use of the term futility. Trainee comfort in providing counseling or recommendations regarding specific ethical issues demonstrated a trend toward improvement but did not reach statistical significance.

DISCUSSION

We successfully implemented this innovative module, which increased trainees' comfort with end-of-life care and ethical conflicts. Future studies should focus on the trainees' ability to implement these skills in clinical practice.

International variations in clinical practice guidelines for palliative sedation: a systematic review

OBJECTIVES

Palliative sedation is a highly debated medical practice, particularly regarding its proper use in end-of-life care. Worldwide, guidelines are used to standardise care and regulate this practice. In this review, we identify and compare national/regional clinical practice guidelines on palliative sedation against the European Association for Palliative Care (EAPC) palliative sedation Framework and assess the developmental quality of these guidelines using the Appraisal Guideline Research and Evaluation (AGREE II) instrument.

METHODS

Using the PRISMA criteria, we searched multiple databases (PubMed, CancerLit, CINAHL, Cochrane Library, NHS Evidence and Google Scholar) for relevant guidelines, and selected those written in English, Dutch and Italian; published between January 2000 and March 2016.

RESULTS

Of 264 hits, 13 guidelines-Belgium, Canada (3), Ireland, Italy, Japan, the Netherlands, Norway, Spain, Europe, and USA (2) were selected. 8 contained at least 9/10 recommendations published in the EAPC Framework; 9 recommended 'pre-emptive discussion of the potential role of sedation in end-of-life care'; 9 recommended 'nutrition/hydration while performing sedation' and 8 acknowledged the need to 'care for the medical team'. There were striking differences in terminologies used and in life expectancy preceding the practice. Selected guidelines were conceptually similar, comparing closely to the EAPC Framework recommendations, albeit with notable variations.

CONCLUSIONS

Based on AGREE II, 3 guidelines achieved top scores and could therefore be recommended for use in this context. Also, domains 'scope and purpose' and 'editorial independence' ranked highest and lowest, respectively-underscoring the importance of good reportage at the developmental stage.

Caregivers Like Me: An Education Intervention for Family Caregivers of Latino Elders at End-of-Life

INTRODUCTION

End-of-life (EOL) care delivery to Latinos is a well-documented challenge. The majority of caregivers for Latino patients are family relatives, but because Latino caregivers may spend more hours in the caregiving role than other ethnic groups and are less likely to use additional available health care, caregivers can experience an increased burden. This can result in Latino elders being more vulnerable to receiving aggressive care. "Caregivers Like Me" was created as a source for nonprofessional caregivers to improve their knowledge about Latino caregiving of elders at end-of-life (EOL). This resource aims to educate about caregiver stress and to improve attitudes towards the utilization of EOL services.

METHODS

"Caregivers Like Me" is a bilingual education intervention that includes a video soap opera, or telenovela. The video is followed by discussion of hospice, palliative care, and caregiver stress definitions and ends with an explanation of services available for caregivers (i.e., social services, support groups, adult day care, chore workers, home care with or without palliative care, and respite care under hospice).

RESULTS

"Caregivers Like Me" has been demonstrated to improve Latino family caregivers' openness to receiving professional help while caring for their loved ones. Participants in a multisite cross-sectional pilot study among nonprofessional Latino caregivers (N = 145) reported active learning from the intervention and high satisfaction with the overall educational experience.

DISCUSSION

This tool provides an education format that is culturally and literacy-sensitive to Latino caregivers and effective in changing their attitude toward EOL care. It may be used by professional caregivers to educate Latino caregivers about EOL care.

Does simulation have a role in palliative medicine specialty training?

Simulation training has been adopted by other industries, particularly aviation, for many years. With patient safety on every agenda, more recently there has been considerable interest and investment in its use for the acute medical specialities. Evidence in palliative medicine, for the use of simulation is mainly limited to advanced communication skills but little is described about its use in developing acute clinical skills. This article describes how in the Yorkshire and Humber Deanery a simulation training day was set up for Palliative Medicine specialty trainees, to assess their knowledge and develop the skills required to deal with acute medical emergencies, as described in the specialty training curriculum for palliative medicine. Scenarios included opioid toxicity, acute left ventricular failure, anaphylaxis, hypoglycaemia and massive haemorrhage. The set up and scenarios are described, along with the mechanisms for delivering feedback. This method of training received positive feedback from trainees and facilitators. The advantages, limitations and potential future role for high-fidelity simulation training for medical trainees and the wider multidisciplinary palliative care team are discussed.