Barry Ashpole Media Watch #495

Barry Ashpole Media Watch

The latest issue of Media Watch, compiled and annotated by Barry R. Ashpole (Ontario, Canada) can now be downloaded here. More reports can be found at IPCRC.NET

International news:

Mobile team offers comfort care to homeless at life’s end

WASHINGTON STATE | Kaiser Health News – 12 January 2017 – The pilot project run, by Seattle/King County Health Care for Homeless Network and UW Medicine’s Harboview Medical Center, is the first U.S. program that sends mobile teams to provide palliative care to homeless people facing terminal illness. The team connects clients with medical care, paid for through Medicaid or hospital charity, and then makes sure they follow up. They help patients evaluate complicated treatment options, and, when the time comes, they may be with them when they die.So far, for patients enrolled in the program for six months, the Seattle project has reduced hospital stays by 25 percent and emergency room visits by half, according to a June report. https://goo.gl/s2fTKp

 Specialist publications:

Patient versus health care provider perspectives on spirituality and spiritual care: the potential to miss the moment

ANNALS OF PALLIATIVE MEDICINE | Online – Accessed 1 March 2017 – Spiritual care is well recognized as an important component of patient care particularly for those with advanced illness. To provide such care, however, it is important that we understand both patient and Health Care Professional (HCP) perspectives on spirituality and spiritual distress and how these perspectives both align and differ. This study was originally designed to develop a screening question to allow ready identification of spiritual distress by front line HCP’s but what emerged instead, was a number of important areas of concordance and discordance in how patients and HCP’s viewed both spirituality and the care of spiritual distress. This  study strongly reinforces the need to listen openly, being guided by the patient, to allow them to explore what is important to them, which in turn may help to alleviate their spiritual distress. https://goo.gl/CNpp7d

Managing ‘shades of grey’: a focus group study exploring community-dwellers’ views on advance care planning in older people

BMC PALLIATIVE CARE | Online – 13 January 2017 – Community-dwelling consumers of healthcare are increasing, many aging with life-limiting conditions and deteriorating cognition. However, few have had advance care planning(ACP) discussions or completed documentation to ensure future care preferences are acted upon. This study examines the awareness, attitudes, and experiences of advance care planning amongst older people and unrelated offspring/caregivers of older people residing in the community. This study also highlights that ACP programs for community-dwelling older people(OP) and offspring/caregivers requires accommodation of OP’s variable and often fluctuating cognitive capacities and competency spectrums. Specific concerns in ACP may arise when OP enter the capacity ‘grey zone’, with fluctuating yet overall declining cognition and executive functioning (reasoning and understanding decisional consequences), and increasing frailty. Educational interventions such as written memory aids may be needed to help these vulnerable OP to better understand the value of ACP and future planning. https://goo.gl/J0hI3U

Treatment targeted at underlying disease versus palliative care in terminally ill patients: a systematic review

BMJ OPEN | Online – 6 January 2017 – The most concerning decision for patients and families alike following diagnosis of terminal illness relates to the choice of medical strategy of either opting for active treatment targeted at underlying disease (TTD) which can potentially be life-prolonging or curative, versus palliative care (PC) where the primary focus is on providing symptomatic relief and improving quality of life (QOL). The US Medicare regulations recommend PC for patients with terminal illness, ideally in hospice setting, if the expected survival is <6 months; conversely, PC or referral to hospice is considered inappropriate if expected survival is <6 months. However, findings from several studies show that around 40% of patients with advanced lung cancer continued aggressive therapy through the final month of life and over 60% of patients with cancer receive aggressive TTD within the past 3 months of life. https://goo.gl/OmKdPx

After the DNR: Surrogates who persist in requesting cardiopulmonary resuscitation

THE HASTINGS REPORT | Online – 11 January 2017 – At some hospitals, the procedures are articulated in policies about life-sustaining treatment. Sometimes called unilateral do-not-resuscitate (DNR) policies, these guidelines have been the subject of debate among experts and professional associations connected to questions about medical futility, resource allocation, and patient autonomy. The nineteen cases studied, suggest that although the majority of surrogates will eventually accept a decision not to offer CPR, there are some surrogates who will persist in their request for CPR that medical providers consider inappropriate. https://goo.gl/4CyvmX

Poverty reduction in India through palliative care: A pilot project

INDIAN JOURNAL OF PALLIATIVE CARE, 2017;23(1):41-45. This article concerns a study by the UK NGO EMMS International and Indian NGO Emmanuel Hospital Association(EHA), to assess whether palliative care reduces household poverty. EHA staff had noticed that many patients spend a lot on ineffective treatment before joining palliative care, many families do not know their entitlement to government healthcare subsidies or government pensions, and many bereaved widows and children are disinherited. Convinced that palliative care can address these, EMMS and EHA implemented PRIPCare – a pilot project. https://goo.gl/HFAUtd

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