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Concept: Hospice


The main objectives of this qualitative study were to describe the perceptions and needs of pediatric health care professionals (HCPs) taking care of children with palliative care needs and to develop a concept for the first Center of Competence for Pediatric Palliative Care (PPC) in Switzerland. Within two parts of the study, 76 HCPs were interviewed. The main interview topics were: (1) definition of and attitude toward PPC; (2) current provision of PPC; (3) the support needs of HCPs in the provision of PPC; and (4) the role of specialized PPC teams. HCPs expressed openness to PPC and reported distinctive needs for support in the care of these patients. The main tasks of specialized PPC teams in Switzerland would encompass the coaching of attending teams, coordination of care, symptom control, and direct support of affected families during and beyond the illness of their child. Conclusion: This study indicates the need for specialized PPC in Switzerland both inside and outside of centers providing top quality medical care (Spitzenmedizin). Specialized PPC teams could have a significant impact on the care of children and families with PPC needs. Whether hospices are an option in Switzerland remains unanswered; however, a place to meet other families with similar destinies was emphasized.

Concepts: Health, Healthcare, Hospice, Illness, Health care provider, Curative care, Medicine, Health care


Abstract Access to palliative care has been advocated as a human right by international associations, based on the right to the highest attainable standard of physical and mental health. It has been argued that failure to provide palliative care for patients facing severe pain could constitute cruel, inhuman, or degrading treatment. Yet the governments of many countries throughout the world have still not acknowledged a human right to access palliative care for all those who need it. The European Association for Palliative Care (EAPC), the International Association for Hospice and Palliative Care (IAHPC), and Human Rights Watch (HRW) discussed this at the EAPC congress in 2011 and formulated the Lisbon Challenge: Governments must: (1) put in place health policies that address the needs of patients with life-limiting or terminal illnesses; (2) ensure access to essential medicines, including controlled medications, to all who need them; (3) ensure that health care workers receive adequate training on palliative care and pain management at undergraduate levels; and (4) facilitate and promote the implementation of palliative care services as part of available health services.

Concepts: Palliative care, Hospice, Suffering, Illness, Health care provider, Human rights, Medicine, Health care


Background:Patients living with advanced heart failure (HF) require a palliative approach to reduce suffering. Nurses have described significant knowledge gaps about the disease-specific palliative care (PC) needs of these patients. An intervention is required to facilitate appropriate end-of-life care for HF patients.Aims:The purpose of this study was to develop a user-friendly, evidence-informed HF-specific practice tool for community-based nurses to facilitate care and communication regarding a palliative approach to HF care.Methods:Guided by the Knowledge to Action framework, we identified key HF-specific issues related to advanced HF care provision within the context of a palliative approach to care. Informed by current evidence and subsequent iterative consultation with community-based and specialist PC and HF nurses, a pocket guide tool for community-based nurses was created.Results:We developed the Heart Failure Palliative Approach to Care (HeFPAC) pocket guide to promote communication and a palliative approach to care for HF patients. The HeFPAC has potential to improve the quality of care and experiences for patients with advanced HF. It will be piloted in community-based practice and in a continuing education program for nurses.Conclusion:The HeFPAC pocket guide offers PC nurses a concise, evidence-informed and practical point-of care tool to communicate with other clinicians and patients about key HF issues that are associated with improving disease-specific HF palliative care and the quality of life of patients and their families. Pilot testing will offer insight as to its utility and potential for modification for national and international use.

Concepts: Human Development Index, Hospice, Nursing specialties, Communication, Suffering, Palliative medicine, End-of-life care, Palliative care


177Lu-EDTMP is currently being investigated as a potential agent for providing palliative care to the patients suffering from bone pain due to metastatic skeletal carcinoma. The present article describes the evaluation of 177Lu-EDTMP complex in four different canine patients with different types of primary and metastatic skeletal lesions with respect to its pharmacokinetic properties, dosimetry and therapeutic efficacy. The dogs were treated with a dose of ~44.4 MBq (1.2 mCi) per kg body weight of 177Lu-EDTMP, synthesized in-house with high radiochemical purity (98.8 ± 0.4 %) and excellent in vitro stability. The radiopharmaceutical showed favourable pharmacokinetic properties, such as, preferential accumulation at skeletal lesion sites and fast clearance from blood and other non-target organs through urinary route. The administered dose of the radiopharmacutical showed excellent therapeutic efficacy in case of a dog suffering from skeletal metastasis originating from primary tumor elsewhere. On the other hand, two of the remaining three patients with primary bone cancer showed stable disease intially with palliative effect. The fourth patient having metal implant induced osteosarcoma with severe limb oedema did not show any response to the treatment.

Concepts: Hospice, Pain, Pharmacokinetics, Palliative care, Chemotherapy, Suffering, Oncology, Cancer


Palliative care research is relatively diverse and prioritizing research in this field is dependent on multiple factors such as complex ethical decisions in designing and conducting the research; access to participants who may be deemed “vulnerable” and an increasingly medically focused approach to care. The aim of this study was to inform organizational decision-making and policy development regarding future research priorities for a hospice service in New Zealand.

Concepts: Implementation, Cicely Saunders, Hospice, Palliative care


Following a review of organisational culture in 2013, Schwartz Centre Rounds (SCR) were introduced to Marie Curie Hospice Hampstead (MCHH). Aiming to promote a ‘one hospice’ ethos, the SCR were chosen as an evidence-based tool to address psychological issues felt by staff managing the increasingly complex physical and emotional burden of palliative care delivery. Unlike in NHS hospitals in which SCR are usually conducted, which have large numbers of staff, MCHH is a hospice with a relatively small pool of staff. Consequently, there were reservations about the Rounds being effective in this setting, and initially trepidation from staff concerned about sharing and exposing their emotions.

Concepts: Emotion, Cicely Saunders, Palliative care, Marie Curie, Psychology, Cancer, Hospice


Hospice palliative care volunteer work-being with dying persons and their often distraught family members-has the potential to take an emotional toll on volunteers. The aim of this review article is to examine the types of stressors hospice palliative care volunteers typically experience in their work and how they cope with them. The results of this literature review suggest that hospice palliative care volunteers do not generally perceive their volunteer work as highly stressful. Nonetheless, a number of potential stressors and challenges were identified in the literature, along with some strategies that volunteers commonly employ to cope with them. The implications for volunteers and volunteer training/management are discussed.

Concepts: Volunteer, Volunteering, Cicely Saunders, Hospice, Palliative care


Background:Advance care planning is the process of discussing and recording patient preferences concerning goals of care for patients who may lose capacity or communication ability in the future. Advance care planning could potentially improve end-of-life care, but the methods/tools used are varied and of uncertain benefit. Outcome measures used in existing studies are highly variable.Aim:To present an overview of studies on the effects of advance care planning and gain insight in the effectiveness of different types of advance care planning.Design:Systematic review.Data sources:We systematically searched PubMed, EMBASE and PsycINFO databases for experimental and observational studies on the effects of advance care planning published in 2000-2012.Results:The search yielded 3571 papers, of which 113 were relevant for this review. For each study, the level of evidence was graded. Most studies were observational (95%), originated from the United States (81%) and were performed in hospitals (49%) or nursing homes (32%). Do-not-resuscitate orders (39%) and written advance directives (34%) were most often studied. Advance care planning was often found to decrease life-sustaining treatment, increase use of hospice and palliative care and prevent hospitalisation. Complex advance care planning interventions seem to increase compliance with patients' end-of-life wishes.Conclusion:The effects of different types of advance care planning have been studied in various settings and populations using different outcome measures. There is evidence that advance care planning positively impacts the quality of end-of-life care. Complex advance care planning interventions may be more effective in meeting patients' preferences than written documents alone. More studies are needed with an experimental design, in different settings, including the community.

Concepts: Cultural studies, Evidence-based medicine, Effectiveness, Hospital, Palliative medicine, Hospice, End-of-life care, Palliative care


Despite the huge focus on reducing 30-day readmission rates, a majority of hospitals are still getting penalized. But, in many cases, the penalties may be too small to justify big expenditures for new programs and staff. Case management leaders should work with the hospital administration to redesign the way that care is delivered in order to succeed as the healthcare market changes. Hospitals need to have a handle on their own readmission data including number of patients readmitted within 7, 14, and 30 days, the top 10 conditions of readmitted patients, and where readmitted patients went after their initial discharge. Case managers should take the time to thoroughly assess patients for healthcare literacy, social issues, family support, and educate them on their conditions, their prognosis, and palliative and hospice care if appropriate.

Concepts: Patient, Cicely Saunders, Palliative care, Management, Hospice, Hospital


To measure how care needs, health and length of stay in permanent residential aged care differs by assessed need for palliative care.

Concepts: Curative care, Hospice, Nursing specialties