NAHH Article of the Month

Article of the Month

October 2019

Management of hiccups in palliative patients. (BMJ 2018)

A hiccup, also known as Singullus is classified based on the duration: Hiccup bouts (up to 48 hours), Persistent hiccups (48 hours – 1 month) and Intractable hiccups (more than 1 month). Within Palliative Care suffering from hiccups can have a very negative impact on the patient’s quality of life.

The prevalence of patients suffering from hiccups is not well known, however it is thought that 1%-9% of patients with advanced cancer complain of persistent or intractable hiccups.

The paper’s authors are based in the USA and this may be a limitation to their work. They state that there are currently no clear guidelines for the treatment of persistent or intractable hiccups in a palliative care setting and the aim of the paper is to carry out a literature review with an objective to suggest an evidence-based guideline.

They conclude by stating that all non-pharmacological methods are explored with the patient first. They state that even after the literature review that persistent and intractable hiccups remains a diagnostic and therapeutic challenge, however limited research findings have established the benefits of newer agents.

These newer agents include Baclofen or hiccups of a predominantly central type and Metoclopramide or Proton Pump inhibitors for patients with peripheral causes.

Finally, the authors suggest further research for this area of care.  

Please click here to view the full artical.

September 2019

What do patients and family-caregivers value from hospice care? A systematic mixed studies review.

The paper acknowledges the growing demands for Palliative Care both within the bedded units but also within the community. The authors state that there is increased complexity with the service users with a recognised limited resource. The limited resource is leading to frequent service redesign.

This paper carries out an evidence review on what the patients and family’s value about the palliative care that they receive as well as capturing data on experience. The study is limited to use of adult hospice services only.

The authors used a 3-stage mixed-method systematic review and found;

Equity in the provision of support is an essential value to ensure patients and their family caregivers are receiving timely interventions day or night.

Carers appeared to place high value on bereavement support, but the reactive nature of the service resulted in carers foregoing support.

Carers appeared to place high value on proactive support, but they did not always consistently receive it.

Choice was a consistent value to patients thus creating a need for a wide range of activities.

Carers valued the provision of social opportunities and could therefore benefit from access to official social support networks.

The authors did acknowledge the limitation on their study and the need for further research.

Click here to read the article.

August 2019

This is a relevant and interesting article for all Hospice at Home services who are reviewing and extending their services. The research confirms that the demand for Hospice at Home services continues to grow and is unable to meet that demand in some areas. The focus is still dominated by cancer referrals and more affluent areas. Accessing ethnic minority populations and rural areas remains a challenge and are under-represented in most areas. The article is a reminder that, although H@H services have facilitated the need for services to allow people to die at home, they still have much to do to enable equity of access to their services.

Click here to read the full article

July 2019

What do patients and family-caregivers value from hospice care?  A systematic mixed studies review. 

Click here to read the full atricle.

June 2019

Two thirds of nurses struggle to provide good care to dying patients due to staff shortages

There is up to date research article on how nurses struggle to give good care to dying patients due to staff shortages and find not only the physical constraints but the emotional responsibility to care for the patient and the family is extremely challenging.

We all like to think we can give the precious gift of time but in reality there many barriers that prevent us from doing so and staff shortages is one of them.

Click here to read the full article

May 2019

This article highlights the importance of maintain identities for patients with dementia through clothing and accessories – in particular the importance of a handbag!

Handbags hold all sorts of important items that can stimulate memories and help patients to maintain their dignity through providing them with a focus or a reminder when they are struggling.

Click here to view Handbags and glad rags: preserving identity in dementia.

April 2019

This article is from the King's Fund that helped to explain how Primary Care Networks (PCNs) may/will work ovber the next few years.

Click here and here to to read more

March 2019

Advance care planning is encouraged to ensure patient choice and person centred care. It is often those caring for patients at home that are faced with discussing difficult and sometimes frightening conversations for patients.

This article , Advance Care Planning in general practice – does policy match reality? Are findings from a freedom of Information request by Compassion in Dying to Clinical commissioning groups, and explores how patients often reflect that GPs and other health care professionals are reluctant to discuss and record advance wishes.

Click here to read

February 2019

Mobile Health Technology and Home Hospice Care: Promise and Pitfalls 
Phongtankuel V, Adelman RD, Reid MC.
Prog Palliat Care. 2018;26(3):137-141. doi: 10.1080/09699260.2018.1467109. Epub 2018 Apr 26.

Mobile smart phone technology is an area where there has been rapid growth and where technology has enabled smarter processes and care to go further.

This article outlines the pros and cons of incorporating technology into existing Hospice at Home Services. 
Click here to read the article.

January 2019

Commissioning of Specialist Palliative Care Services in England
Lancaster H, Finlay I, Downman M, Dumas J.
BMJ Support Palliat Care. 2018 Mar;8(1):93-101. doi: 10.1136/bmjspcare-2016-001119. Epub 2017 Feb 28.

This article looks at the disparity between CCGs across England – with allocated budget for EOLC  ranging from  £52 to £2300 per patient per annum.

This highlights the need for EOLC services to be specific about the cost of caring for a patient when discussing resource with CCGs. Although collation of the data takes time, it would be time well spent in the longer term, if it means that CCGs recognised the cost savings by keeping patients out of acute services.

Click here to read more

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