Reference Example Setting Target population Abernethy AP, Arnold RM. (2006) PC-FACS: A Real-Time Evidence Resource for Busy Palliative Care Clinicians, Journal of Palliative Medicine, 9(1); 24

Description of PC-FACS – Palliative Care-Fast Article Critical Summaries for clinicians. PC-FACS is a new publication from the American Academy of Hospice and Palliative Medicine (AAHPM) developed to help busy clinicians stay up-to-date with clinical research relevant to palliative medicine practice. Clinician editors systematically review the most important and pertinent findings from more than 60 medical and scientific journals. The publication contains timely, concise summaries with commentaries, delivered to readers via electronic media. The database is designed for the practicing palliative care and hospice clinician.

University of NC, USA

Physicians

Abernethy AP, Currow DC, Hunt R, Williams H, Roder-Allen G, Rowett D, Shelby-James S, Esterman E, May F, Phillips PA. (2006) A pragmatic 2_2_2 factorial cluster randomized controlled trial of educational outreach visiting and case conferencing in palliative care-methodology of the Palliative Care Trial [ISRCTN 81117481], Contemporary Clinical Trials, 27; 83– 100

Evaluation of the Palliative Care Trial (PCT) that tests the ability of educational outreach visiting and case conferencing to improve patient-based outcomes such as performance status, patient functional status over time, pain intensity, and resource utilization. The study randomized patients and their general practitioners (GPs) to the following interventions: 1) A GP educational outreach visiting versus usual care, (2) Structured patient and caregiver educational outreach visiting versus usual care and (3) A coordinated palliative care model of case conferencing versus the standard model of palliative care.

Southern Adelaide Palliative Services, Australia

Patients needing palliative care

Abrams D, Albury S, Crandall L, Doka KJ, Harris R. (2005) The

The Florida Clergy End-of-Life Education Enhancement Project was a model program developed to provide an interdenominational and statewide model of clergy education on

Department of educational affairs, Florida, USA

Clergy

1

Florida Clergy End-of-Life Education Enhancement Project: A description and evaluation, American Journal of Hospice and Palliative Medicine, 22; 181

loss, grief, dying, and death. The project is described, including present data from the project’s evaluation. The project indicates that clergy both recognize the need for additional training and are anxious to improve their abilities to minister to the dying and bereaved, reporting higher levels of knowledge on end-of-life issues at the conclusion of the training.

Ahronheim JC, Morrison RS, Morris J, Baskin S, Meier DE. (2000) Palliative Care in Advanced Dementia: A Randomized Controlled Trial and Descriptive Analysis, Journal of Palliative Medicine, 3(3); 265

An RCT of palliative care in patients with advanced dementia (Functional Assessment Staging Tool [FAST] stage 6d-7f) who were hospitalized with acute illness. Intervention patients received recommendations by a palliative care team with the goal of enhancing patient comfort. Findings show difficulty for a palliative care research team to influence the care of advanced dementia patients in the acute hospital setting. There must be a re-examination of treatment approaches for this severely impaired group of patients.

Acute hospital setting, USA

Patients with Advanced Dementia

Aiken LS, Butner J, Lockhart CA, Volk-Craft BE, Hamilton G, Williams FG. (2006) Outcome Evaluation of a Randomized Trial of the Phoenix Care Intervention: Program of Case Management and Coordinated Care for the Seriously Chronically Ill, Journal of Palliative Medicine, 9(1); 111

Outcome evaluation and intervention of Phoenix-Care RCT. The intervention was intensive home-based care management provided by registered nurse case managers alongside usual care. Participants were 192 patients with chronic obstructive pulmonary disease (COPD) or chronic heart failure (CHF), who had an estimated 2-year life expectancy. The findings show that the model combined with greatly enhanced palliative care focused case management with ongoing MCO-based treatment was associated with improved functioning of chronically severely ill patients in the last years of life.

Hospice, USA Seriously chronically ill individuals also receiving managed care

Alexander SC, Keitz Evaluation of a short course to improve the communication skills University, USA Internal Medicine

2

SA, Sloane R, Tulsky JA. (2006) A Controlled Trial of a Short Course to Improve Residents’ Communication With Patients at the End of Life, Academic Medicine, 81(11); 1008

of health professionals when delivering “bad” news and eliciting patients’ preferences for end-of-life care. The course can improve the end-of-life communication skills of U.S. medical residents.

residents

Ann Hamilton: The Facilitation of Palliative Care Training for Social Work Residential Home Staff, South Lanarkshire, Scotland Ann.hamilton@lanarkshire.scot.nhs.uk

The project involves training care home staff, mainly carers and staff from day care centres for older people in the principles of palliative care, including the physical, psychological and spiritual needs of the residents and their families. The programme originated from the recognition that care home staff, and carers more specifically have limited experience of palliative care, while they require such. It emerged as collaboration between the Older People’s Service Manager at South Lanarkshire, Social Work, Residential Homes (initially 8 care homes and 4 day care centres) and the Care Home Liaison team. The team facilitates the implementation of the training pack “Foundations in Palliative Care” developed previously by Macmillan Nurses. The programme consists of 4 modules (1 per week), evaluations by participant, and adaptation. Implementation is planned to cover all Lanarkshire Care Home staff.

South Lanarkshire, Scotland

Carers, staff in care homes and day care centres for older people

Athina Vadalouca: Palliative Care Facts in Europe for 2005 Athinajv@ath.forthnet.gr

Description of Programme in Greece, No Evaluation – written up in an interview format

Greece Mostly cancer patients

Bakitas M, Stevens M, Ahles T, Kirn M, Skalla K, Kane N, Greenberg ER. (2004) Project ENABLE: A

Intervention to alleviate cancer symptoms and treatment side-effects, enhance clinician and patient/family communication, support for families, friends and other caregivers, address emotional and spiritual needs of dying people and provide conceptual and administrative structure to provide EOL care

Rural USA Patients with advanced cancer and poor prognosis.

3

mailto:Ann.hamilton@lanarkshire.scot.nhs.ukmailto:Ann.hamilton@lanarkshire.scot.nhs.ukmailto:Athinajv@ath.forthnet.gr

Palliative Care Demonstration Project for Advanced Cancer Patients in Three Settings, Journal of Palliative Medicine, 7(2); 363

consistent with patients’ values and preferences. Although patient symptom data is not yet available, other measures of success included improved access to hospice and palliative care services from the time of diagnosis and a sustained palliative care program at two of the three sites in which the program was implemented.

Basson B, Vassal P, Richard A, Gonthier R. (2002) Place d’une Unité Mobile d’Accompagnement et de Soins Palliatifs dans une structure d’hébergement gériatrique: à propos de 15 observations, INFOKara, 17; 52-57

A retrospective analysis to demonstrate the utility of a mobile unit of accompaniment and palliative care (MUAPC) in nursing homes and to determine whether hospitalizations of elderly patients can be avoided at the end of life. Pain was the main reason for calling MUAPC beside support of the caring team and of the family. 82% of the families, 73% of the caring teams and 75% of the treating physicians were fully satisfied with MUAPC interventions. MUAPC contributed significantly to avoid inappropriate hospitalizations and to actively support families and caring teams in their daily work.

Hospital, Paris, France

Nursing home patients & elderly

Becker S, Kruse A, Schröder J, Seidl U. (2005) The Heidelberg instrument for the assessment of quality of life in people suffering from dementia (H. I. L. DE.) – dimensions of quality of life and methods of operationalization, Zeitschrift für Gerontologie und Geriatrie, 38(2); 108–121

A research project aimed to develop and validate a comprehensive assessment of quality of life in nursing home residents’ suffering from dementia. First results from the H.I.L.DE.-study are used as an illustration of the potentials of such a comprehensive approach to the measurement of quality of life.

Heidelberg, Germany

Palliative care professionals

4

Bookbinder M, Blank AE, Arney E, Wollner D, Lesage P, McHugh M, Indelicato RA, Harding S, Barenboim A, Mirozyev T, Portenoy RK. (2005) Improving End-of-Life Care: Development and Pilot-Test of a Clinical Pathway, Journal of Pain and Symptom Management, 26(6); 529

The Palliative Care for Advanced Disease (PCAD) pathway includes a carepath, a daily flowsheet, and a physician order sheet with standard orders for symptom control. To evaluate the utility of PCAD, the clinical pathway was introduced on three hospital units (Oncology, Geriatrics, and an inpatient palliative care/hospice unit) as part of a quality improvement initiative and outcomes were compared to two general medical units receiving usual care. The results suggest that 1) a clinical pathway such as PCAD can serve as a managerial and educational tool to improve the care of the imminently dying inpatient; 2) a PCAD clinical pathway can be implemented on hospital units as a quality improvement initiative—a “PCAD intervention;” 3) a PCAD intervention can change outcomes in a positive direction, as measured using a chart audit tool; 4) a PCAD intervention can promote aggressive symptom assessment and treatment when goals of care are aimed at comfort; and 5) changes may occur in units that do not directly receive the intervention, a phenomenon that suggests the possibility of diffusion.

Hospital setting, NYC, USA

Terminally ill patients

Braun KL, Zir A, Crocker J, Seely MR. (2005) Kokua Mau: A Statewide Effort to Improve End-of-Life Care, Journal of Palliative Medicine, 8(2); 313

Evaluation of Kokua Mau, a community–state partnership to improve EOL care in Hawaii funded by The Robert Wood Johnson Foundation (RWJF). Change was measured through counting the number of legislative policies that were modified by the coalition as well as indicators of hospice utilization, advance directive (AD) completion, support for physician-assisted death, and place of death. The findings suggest that programs based on innovation-diffusion theory can increase EOL awareness and help develop the change agents and role models needed to affect community-wide change over the long term.

Hawaii, USA with multi-level organizations

Terminally ill patients with EOL care needs

Brechling BG, Kuhn D. (1989) A Specialized Hospice for Dementia Patients and their Families, American

Reports the development of a small pilot program and briefly describes its activities. The Alzheimer's Family Care Hospice has provided services to eight terminally ill dementia patients and their families in a pilot project sponsored jointly by the Rush Alzheimer's Disease Center and the Chicago Area Chapter of the

Alzheimer's Hospice, USA

Patients with dementia

5

Journal of Hospice Care, 6(3); 27-30

Alzheimer's Association.

Bruera E, Fornells H, Perez E, Tattangelo M, Neumann CM. (1998) Bus rounds for medical congresses on palliative care, Support Care Cancer, 6; 529–532

Bus rounds by a group of medical specialists were organised as part of a congress in Argentina to promote patient-based education of physicians and nurses. Patients were visited at home and in acute hospitals. To save time the cases were presented and journal articles read during the bus journey. On average five cases were presented during each round. Patients and medical specialists were highly satisfied with bus rounds. They provided an opportunity for intensive exposure to patient-based learning both in hospitals and at home. The limited time spent in each home/hospice causes minimal patient and family disruption.

Buses during a medical conference, Argentina

Physicians

Bruera E, Selmser P, Pereira J, Brenneis C. (1997) Bus rounds for palliative care education in the community, Canadian Medical Association, 157(6); 729

Evaluation of bus rounds as a means of providing continuing education for physicians and medical students in various settings where palliative care takes place. Bus rounds provide an opportunity for intensive exposure to community-based learning for physicians, nurses and students and are highly satisfactory from the participants’ perspective.

Bus rounds, Edmonton Canada

Palliative care physicians and nurses, family physicians, specialty and family medicine residents and medical students.

Brumley RD, Enguinados S, Cherin DA. (2003) Effectiveness of a Home-Based Palliative Care Program for End-of-Life, Journal of Palliative Medicine, 6(5); 715

Evaluated the effectiveness of a palliative program for end-of-life care. Intervention of The Kaiser Permanente Palliative Care Project, a multidisciplinary care management approach for home-based end of life care and treatment. Palliative care patients had increased satisfaction with services at 60 days after enrolment and significantly fewer emergency department visits, hospital days, skilled nursing facility days, and physician visits than those in the comparison group. Those enrolled in palliative care averaged a 45% decrease in costs as compared to usual care patients.

Non-profit health maintenance orgs in Hawaii and Colorado, US

Homebound terminally ill patients with less than a year’s life expectancy

6

Brumley RD, Enguinados S, Jamison P, Seitz R, Morgenstern N, Saito S, McIlwane J, Hillary K, Gonzalez J. (2008) Increased Satisfaction with Care and Lower Costs: Results of a Randomized Trial of In-Home Palliative Care, Journal of American Geriatrics Society, 55; 993

An RCT to determine whether an in-home palliative care intervention for terminally ill patients can improve patient satisfaction, reduce medical care costs, and increase the proportion of patients dying at home. The intervention was in-home palliative care plus usual care delivered by an interdisciplinary team providing pain and symptom relief, patient and family education and training, and an array of medical and social support services. The intervention patients reported greater improvement in satisfaction with care at 30 and 90 days after enrolment, were more likely to die at home than those receiving usual care and were less likely to visit the emergency department or be admitted to the hospital than those receiving usual care, resulting in significantly lower costs of care for intervention patients.

Non-profit health maintenance orgs in Hawaii and Colorado, US

Homebound terminally ill patients with less than a year’s life expectancy

Byock I, Twohig JS, Merriman M, Collins K. (2006) Peer–Professional Workgroups in Palliative Care: A Strategy for Advancing Professional Discourse and Practice, Journal of Palliative Medicine, 9(4); 934

Staff at the national program office of Promoting Excellence in End-of-Life Care convened eight disease-based, specialty-based or issue-based workgroups (the selected workgroup topics were amyotrophic lateral sclerosis, cost accounting, critical care, end-stage renal disease, human immunodeficiency virus/acquired immune deficiency syndrome [HIV/AIDS] disease, Huntington’s disease, paediatric care, and surgical palliative care). The goal was to establish research and practice agendas to integrate palliative care within selected fields and health care settings, and to expand delivery of palliative care to special patient populations that have been underserved by palliative care.

USA Hospitals Physicians

Catherine MacDonald: Bethesda Care Home and Hospice bethesdahospice@hotmail.com www.bethersdahospice.co.uk

This project integrates hospice into care home facility. It is a small project (4 hospice single bedrooms and 21 care home beds). Liverpool Care Pathway is being used here. Non-cancer patients are included. 1192-2007, 15 years, 594 patients benefited from the hospice, 150 from the care home facility.

Hospice, care home, Scotland

Registered nurses, nursing assistants, palliative care specialists

7

mailto:bethesdahospice@hotmail.commailto:bethesdahospice@hotmail.comhttp://www.bethersdahospice.co.uk/http://www.bethersdahospice.co.uk/

Christine Reddall: Stock Drugs in Care Homes for Palliative Care Christine.reddall@nhs.net

Pilot programme initiated to help nursing homes to keep a limited stock of drugs for use in palliative care of residents. Also aimed to provide care homes in Warwickshire with a stock of drugs for palliative care use, ensure selection of palliative care drugs available and to reduce unnecessary transfer to hospital.

Macmillan nurse at Myton Hospice Warwick, UK

Nursing home residents

Ciemins EL, Stuart B, Gerber R, Newman J, Bauman M. (2006) An Evaluation of the Advanced Illness Management (AIM) Program: Increasing Hospice Utilization in the San Francisco Bay Area, Journal of Palliative Medicine, 9(6); 1401

Intervention and Programme evaluation, measuring the impact of the AIM program on the discharge disposition of participating home health patients. Participants were selected based on a life expectancy of 6 months or less and additionally matched on prognosis of current episode of illness and symptom status. The AIM program was successful at increasing hospice utilization through a targeted intervention focused on palliative and end-of-life care, increased patient education and decision making, and a dynamic treatment approach. The finding of increased utilization by African Americans, a population traditionally reluctant to use hospice, was particularly noteworthy.

SF Hospice, USA Hospice services and policy makers

Clarke A, Sanders C, Seymour JE, Gott M and Welton M. (2009) Evaluating a peer education programme for advance end-of-life care planning for older adults: The peer educators’ perspective, nternational Journal of Disability and Human Development, 8, 33-41

Evaluation of a peer education programme for advance end-of-life care planning for older adults in the hope of refining and extending. The project had an ongoing evaluation, conducted to facilitate the cycles of action and reflection necessary in action research to inform project progress. Phase 1 recruited participants from community groups, care homes and extra care housing facilities and cancer networks. We have wide ranging data relating to views, experiences and information needs in end of life care. Phases 2-3 adapted an existing peer education programme for training volunteers. Findings suggest that a feasible intervention for community education in end of life care has been developed; but show that not all volunteers wish to sustain a role in community education of this type.

UK Community groups, care homes, extra care housing facilities, cancer networks

Clarke A, Seymour JE, et al. (2006) Listening to

Report describes findings from a collaborative venture between Help the Aged and a team of researchers from the Universities of

Sheffield and Nottingham, UK

Older people from diverse communities

8

mailto:Christine.reddall@nhs.netmailto:Christine.reddall@nhs.net

Older People: Opening the door for older people to explore end of life issues. London: Help the Aged.

Sheffield and Nottingham to run four listening events around the UK. These aimed to offer older people the opportunity to express their views about the end of life, while also supporting them with advice and information to help meet their concerns. Report shows there is a real appetite amongst older people for an opportunity to discuss death and dying, to share experiences and consider options. Report also brings out some key areas for improvement around the end of life experience.

Cohen-Mansfied J, Libin A, Marx MS. (2007) Nonpharmacological Treatment of Agitation: A Controlled Trial of Systematic Individualized Intervention, Journal of Gerontology: MEDICAL SCIENCES, 62A(8); 908–916

A placebo-controlled study to examine the efficacy of a systematic algorithm for providing individualized, non-pharmacological interventions for reducing agitated behaviours in nursing home residents with dementia. The study was conducted in 12 nursing home buildings in Maryland; 6 were used as treatment facilities, and 6 as control facilities. Interventions were tailored to the individual profiles of agitated participants using a systematic algorithm that considered type of agitation and unmet needs. Personalised, non-pharmacological interventions resulted in statistically significant decreases in overall agitation in the intervention group relative to the control group from baseline to treatment In addition, implementation of individualized interventions for agitation resulted in statistically significant increases in pleasure and interest.

Various nursing homes in the USA

Nursing home residents with dementia

Cotterel P, Lynch C, Peters D. (2007) Bridging the Gap: Can a Link Nurse Initiative Influence Palliative Care in an Acute Hospital? International Journal of Palliative Nursing, 13(3); 102

Evaluation of a palliative care link nurse initiative (PCLN) in an NHS acute hospital, identifying key factors that affect link nurses’ ability to influence palliative care practice. This qualitative study used semi-structured interviews and a focus group to show the anticipated and actual influence of link nurses on practice. Findings suggest that link nurses had increased knowledge and skills in palliative care due to education provided. Link nurses were seen to have an influence on the presence and quality of palliative care practice in hospital wards. Factors that could help link nurses to have greater influence are reported, as are difficulties in providing care and accessing

NHS hospitals, UK Nurses

9

training. Currow DC, Abernethy AP, Shelby-James TM, Phillips, P. (2006) The impact of conducting a regional palliative care clinical study, Palliative Medicine, 20; 735-743

Intervention and evaluation of a large scale, randomized control trial of service-based interventions in a regional palliative care service, and its impact on palliative care research, service delivery and health policy. The evaluated interventions included: case conferences, general practitioner education, and patient education, with performance status, pain intensity, and resource utilisation as the main outcomes.

University and Hospital, South Australia

Agencies involved in health-care delivery, research and policy.

Curtis JR, Treece PD, Nielsen EL, Downey L, Shannon SE, Braungardt T, Owens D, Steinberg KP, Engelberg RA. (2008) Integrating palliative and critical care - Evaluation of a quality-improvement intervention, American Journal of Respiratory and Critical Care Medicine, 178(3); 269-275

Single-hospital, before-after study of a quality-improvement intervention to improve palliative care in the ICU. Consecutive patients who died in the ICU were identified pre- (n= 253) and post-intervention (n=337). The findings showed no significant improvement in family-assessed quality of dying or in family satisfaction with care, but significant improvement in nurse-assessed quality of dying and reduction in ICU length of stay with an intervention to integrate palliative care in the ICU. It was concluded that to improve family ratings, interventions that have more direct contact with family members may be required.

Teaching hospital, USA

Families and Clinicians

Daley A, Mathews C, Williams A. (2006) Heart failure and palliative care services working in partnership: report of a new model of care, Palliative Medicine, 20; 593-601

Three-year collaboration between community-based heart failure nurse specialists and existing specialist palliative care services. In the model of care that has evolved, the heart failure nurses remain key workers throughout the illness. They run a regular support group for patients and carers in the setting of a hospice day therapy unit, referring patients for other palliative care involvement as necessary. Activity data and the results of patient interviews are presented. These suggest that the model is a cost effective, sustainable way of providing high quality care for people with heart failure.

NHS Bradford, UK Specialist heart failure services

10

http://apps.isiknowledge.com/OneClickSearch.do?product=UA&search_mode=OneClickSearch&db_id=&SID=S2mBb5fNblLgnJLh98M&field=AU&value=Curtis%20JR&ut=000258162000009&pos=1http://apps.isiknowledge.com/OneClickSearch.do?product=UA&search_mode=OneClickSearch&db_id=&SID=S2mBb5fNblLgnJLh98M&field=AU&value=Treece%20PD&ut=000258162000009&pos=2http://apps.isiknowledge.com/OneClickSearch.do?product=UA&search_mode=OneClickSearch&db_id=&SID=S2mBb5fNblLgnJLh98M&field=AU&value=Nielsen%20EL&ut=000258162000009&pos=3http://apps.isiknowledge.com/OneClickSearch.do?product=UA&search_mode=OneClickSearch&db_id=&SID=S2mBb5fNblLgnJLh98M&field=AU&value=Downey%20L&ut=000258162000009&pos=4http://apps.isiknowledge.com/OneClickSearch.do?product=UA&search_mode=OneClickSearch&db_id=&SID=S2mBb5fNblLgnJLh98M&field=AU&value=Shannon%20SE&ut=000258162000009&pos=5http://apps.isiknowledge.com/OneClickSearch.do?product=UA&search_mode=OneClickSearch&db_id=&SID=S2mBb5fNblLgnJLh98M&field=AU&value=Braungardt%20T&ut=000258162000009&pos=6http://apps.isiknowledge.com/OneClickSearch.do?product=UA&search_mode=OneClickSearch&db_id=&SID=S2mBb5fNblLgnJLh98M&field=AU&value=Owens%20D&ut=000258162000009&pos=7http://apps.isiknowledge.com/OneClickSearch.do?product=UA&search_mode=OneClickSearch&db_id=&SID=S2mBb5fNblLgnJLh98M&field=AU&value=Owens%20D&ut=000258162000009&pos=7http://apps.isiknowledge.com/OneClickSearch.do?product=UA&search_mode=OneClickSearch&db_id=&SID=S2mBb5fNblLgnJLh98M&field=AU&value=Steinberg%20KP&ut=000258162000009&pos=8http://apps.isiknowledge.com/OneClickSearch.do?product=UA&search_mode=OneClickSearch&db_id=&SID=S2mBb5fNblLgnJLh98M&field=AU&value=Engelberg%20RA&ut=000258162000009&pos=9

Dr Alberto Cella: The Palliative home care service of Galliera, Genoa Alberto.cella@galliera.it

Geriatric outreach schemes: 1) community-based home care assistance 2) hospital-based service. Adopted palliative approach for relieving suffering from terminal conditions. Concluded their palliative home care service provides effective relief of symptoms as well as the possibility of dying at home by means of a special unit in place for terminal care.

Genoa, Italy Elderly patients

Dr Bernadette Klapper and Prof. Michael Ewers: “Palliative Praxis” Bernadette.klapper@bosch-stiftung.de

An interdisciplinary curriculum for raising the standards of palliative care in dementia by training professionals how to implement the integrated PC approach in nursing homes and out-patient care in Germany. It is based on an action-oriented and practice-oriented learning.

Nursing homes, Out-patient care Germany

Carers, general practitioners, head of the nursing service

Dr Boris Hait: “Implementation of the palliative care practice in a care home, St Katharinen Hospital, Unna, Germany hait@katharinen-hospital.de

The project aims to achieve better symptom control for older people in care homes who suffer from multiple conditions, often disabling, chronic diseases; to support family and friends of older people living in care homes; includes education and training for the team of the care home. The project involves consultation, regular contacts and hotline, with members of the team of the Department of PC in the hospital, i.e. PC physician, specialist nurses, who provide service for the care home.

Care home, Germany

Care home staff, hospital unit of palliative care

Dr Jochen Steurer: Workshop: Implementing palliative care in nursing homes praxis@steurer-online.de

Workshop: Implementing palliative care in nursing homes. The project PWI is run by MediAcion as a service aiming to strengthen the knowledge and implement palliative care in nursing homes through education of staff (nurse and service manager). The programme has taken place in Germany since 2006 over 4 provinces.

Nursing homes, Germany

Nurse, Service manager

Dr Juliet Spiller: NHS Lothian Integrated Do Not Attempt Resuscitation (DNAR)

NHS Lothian implemented first fully integrated DNAR policy and documentation for use across all healthcare settings including the community. Number of benefits found for healthcare staff, patients and their families in the Lothian area

Lothian, Scotland Healthcare staff, patients, patients families

11

mailto:Alberto.cella@galliera.itmailto:Bernadette.klapper@bosch-stiftung.demailto:Bernadette.klapper@bosch-stiftung.demailto:hait@katharinen-hospital.demailto:hait@katharinen-hospital.demailto:praxis@steurer-online.demailto:praxis@steurer-online.de

Policy and documentation Juliet.spiller@mariecurie.org.uk

since the implementation.

Dr Lourdes Rexach Cano: Integral Plan of Palliative Care in the region of Madrid, Spain Lrexach.hrc@salud.madrid.org

Plan established to improve palliative care, aimed to ensure high quality end of life care at every level of the health system. Activity in hospital consultation units has grown steadily, each unit now caring for 30 patients a month, 75% of them being 70 years or older.

Hospital Consultation Units, Madrid, Spain

Clinicians, professional carers, education and training professionals, patients, families

Dr Mirjana Adzic: Gerontology Institute, Republic of Macedonia skopje@suerydercare.org.mk

The Gerontology Institute represents a modern institution with a 50 year tradition of organized provision of health and social care for the elderly. The main strategic objective that all services function as an integrated and coordinated and cohesive network, has been achieved and represents a great benefit for the patients and their families.

Gerontology Institute, Republic of Macedonia

Elderly patients

Dr Sing-hung Lo: A retrospective review of a new service to patient with end-stage renal failure on conservative treatment in Tuen Mun Hospital Losh1@ha.org.hk

Retrospective review of a new service model to patient with end-stage renal failure on conservative treatment in Tuen Mun Hospital. Initiated Renal Palliative Care (RPC), aimed at offering palliative care to patients with renal failure. Findings showed decisions related to initiation or withdrawal of dialysis are often related to personal beliefs and sentiments. Concluded a feasible service model in providing palliative care to patients with end-stage renal disease.

Tuen Mun Hospital, Hong Kong

Renal failure patients

Dr Vasile Musteata: Needle acupuncture – an effective palliative care option for cancer patients vmusteata@yahoo.co.uk

Applied needle acupuncture to 12 newly diagnosed oncologic patients with a poor performance status. Patients underwent 10-12 procedures of acupuncture. Findings showed significant pain and chemotherapy/radiotherapy-induced nausea relief, in marked decrease of fatigue and anorexia. Acupuncture considerably improved the quality of life of cancer patients, sustaining the

Institute of Oncology, Moldova

Oncology patients

12

mailto:Juliet.spiller@mariecurie.org.ukmailto:Juliet.spiller@mariecurie.org.ukmailto:Lrexach.hrc@salud.madrid.orgmailto:Lrexach.hrc@salud.madrid.orgmailto:skopje@suerydercare.org.mkmailto:skopje@suerydercare.org.mkmailto:Losh1@ha.org.hkmailto:vmusteata@yahoo.co.uk

individuals’ families. Concluded the management of pain, nausea and anorexia enforces an interdisciplinary and multiprofessional approach to balance the individual risk-benefit ratio of any therapeutic intervention.

Dr Vito Curiale: Palliative drugs for terminal heart failure in the oldest old curiale@libero.it; vito.curiale@galliera.it

Adopted in an 18 bed Acute Care for Elders Unit, a palliative care approach for relieving suffering from terminal heart failure. With this approach, the oldest old patients reach an acceptable symptom control in the dying process due to heart failure.

Acute Care for Elders Unit, Genova, Italy

Patients, care givers

Duong PH, Zulian GB. (2006) Impact of a postgraduate six-month rotation in palliative care on knowledge and attitudes of junior residents, Palliative Medicine, 20; 551

A six-month clinical rotation in a palliative care centre of junior medical residents (trainees) followed by a questionnaire to measure improvement of medical knowledge, knowhow, communication skills and personal attitudes in coping with end-of-life issues; apprehension and fear, priorities, tuition support, utility, and recommendations. The aim is to assess opinions about the training experience. The rotations consists of daily morning ward round with nurses, weekly round with chief resident, monthly round with a consultant, afternoon notes round and admissions with chief resident; four hours per week of teaching in general internal medicine, geriatrics and palliative care; free access to library and on-line databases.

University hospital, Geneva, Switzerland

Junior medical residents.

Edes T, Shreve S, Casarett D. (2007) Increasing Access and Quality in Department of Veterans Affairs Care at the End of Life: A Lesson in Change, Journal of the American Geriatrics Society, 55; 1645–1649

Evaluation of a coordinated plan to increase access to hospice and palliative care services. This addressed policy development, program and staff development, collaboration with community hospices, outcomes measurement, and proving value to the organization. To determine progress and monitor resource allocation, workload and outcome measures were established in all settings. Through a multifaceted strategic plan and a mission of honouring veterans’ preferences for care at the end of life, the VA has made rapid progress in improved access to palliative care services for inpatients and outpatients.

Health Admin, USA Managed care facilities such as veteran affairs hospitals

13

mailto:curiale@libero.itmailto:vito.curiale@galliera.it

Ellison NM, Radecke MW. (2005) An Undergraduate Course on Palliative Medicine and End-of-Life Issues, Journal of Palliative Medicine, 8(2); 354

Evaluation of an educational course aimed to demystify aging, illness and death; increase awareness and tolerance for cultural and religious differences; enhance empathy and teach compassion; provide communication skills that could be used in many difficult situations; and provide a caring and mutually beneficial relationship for the elderly and students in our community. The group comprised 7 physicians, 3 nurses, 1 chaplain, and 2 individuals participating in volunteer community activities for the elderly and infirm. Overall, student and faculty comments about the course were quite positive. Every student believed that it was a very worthwhile course, but 4/18 would not sign up for it again and would not recommend it to a friend.

University, USA Health personnel and clergy involved in EOL care

Eng C. (2002) Future Consideration for Improving End-of-Life Care for Older Persons: Program of All-Inclusive Care for the Elderly (PACE), Journal of Palliative Medicine, 5(2); 305

Evaluation of programme of all inclusive care for the elderly (PACE)

NGO (On Lok, SF), USA

The frail elderly

Ersek M, Grant MM, Kraybill BM. (2005) Enhancing End-of-Life Care in Nursing Homes: Palliative Care Educational Resource Team (PERT) Program, Journal of Palliative Medicine, 8(3); 556

Education and Evaluation-of a comprehensive palliative care expertise PERT programme to enhance EOL care Development and evaluation of a comprehensive curriculum “Palliative Care Educational Resource Team (PERT)” aimed at enhancing end-of-life (EOL) abilities and palliative care expertise of staff working in nursing homes.

Nursing homes, USA

Nursing home staff - care workers and nurses

Ferrell BR, Borneman T. (2002) Community

National Cancer Institute funded training project to improve end of life through implementation of a palliative care curriculum.

Home care agencies, LA, USA

Homecare health professionals

14

Implementation of Home Care Palliative Care Education, Cancer Practice, 10(1); 20

Home care Outreach for Palliative care Education (HOPE) programme implemented to improve EOL care in home healthcare professionals. Agency nurses knowledge on end of life issues rose from 84.6% pre-education to 89% post-education.

Fineberg IC, Wenger NS, Forrow L. (2004) Interdisciplinary Education: Evaluation of a Palliative Care Training Intervention for Pre-professionals, Academic Medicine, 79(8); 769

Development and evaluation of an interdisciplinary educational programme in palliative care to promote interdisciplinary exchange and understanding as essential components of palliative care. The intervention consisted of participation in a series of training sessions over 4 weeks of 3rd and 4th year medical students and social work students (second year of masters degree), compared to the control group of students who received written materials after the study. Outcomes from the intervention include increased understanding of perceived role understanding, and maintained gains in perceived role understanding at 3 month follow up.

University, USA 3rd and 4th year medical students

Fischer GS, Arnold RM. (2007) Feasibility of a Brief Workshop on Palliative Care Communication Skills for Medical Interns, Journal of Palliative Medicine, 10(1); 19

Description of a 3-hour workshop on delivering bad news and discussing end-of-life goals of care for internal medicine residents, and its effect on the interns’ attitudes, knowledge, and confidence in discussing these topics with patients. The workshop involves role-playing, teaching core knowledge, skills, and attitudes associated with delivering bad news and discussing goals of care at the end of life. Evaluation of the educational intervention indicates a high degree of satisfaction with the workshop, increase in knowledge and confidence. No change in interns’ attitudes was detected.

Pittsburgh Medical School, US

Internal Medicine Residents

Fischer SM, Gozansky WS, Kutner JS, Chomiak A, Kramer A. (2003) Palliative Care Education: An Intervention to Improve Medical Residents’ Knowledge and

Testing a curriculum designed to improve medical trainee knowledge and to lessen anxiety around end-of-life care. The intervention had no significant effect on residents’ attitudes towards or knowledge of end-of-life care. Prior palliative care experience affects baseline scores, which is why continued research is needed for an effective curriculum for end-of-life education, with a focus on clinical experience in palliative care.

Teaching hospital, USA

Medical residents

15

Attitudes, Journal of Palliative Medicine, 6(3); 391 Fleming S, Brown I. (1983) The Impact of a Death Education Program for Nurses in a Long-Term Care Hospital, The Gerontologist, 23 (2); 192-195.

Assessed the impact of a death education program for nursing staff of a long-term care institution. Analysis of nurses' chart entries (problem-oriented record format — POR) revealed a statistically significant increase from pre- to post-course in charting of patients' subjective state. While the entries in the Subjective section of the POR changed from pre- to post-test, there was no evidence that these observations were implemented (i.e., no significant changes were found for the Objective, Assessment, and Plan sections of the POR).

Long-term care hospital Canada

Nurses and Nurse Assistants

Frank Kittelberger: Life until the end – Palliative Care in the Older People and Nursing Homes of the ‘Inneren Mission Muenchen’ fkittelberger@im-muenchen.de

Training programme for professionals in nursing homes to raise the standard of PC. The programme started in 2001 across 7 nursing homes in and around Munich (a nursing home in Germany is typically for 150 people). The project now is being implemented all over Bavaria. The programme involves training of nurses and other professionals in the principles of palliative care, ethical counseling, changes in the habits and organization of the care home.

Nursing homes, Germany

Nurses and other professionals in nursing homes, cooperation with external professions, e.g. doctors, churches, hospice groups, palliative care units in hospitals).

Frogatt K. (2000) Evaluating a palliative care education project in nursing homes, International Journal of Palliative Nursing, 6(3); 140

Provision of palliative care education for nursing home staff to improve the care for dying residents. Evaluation of the project’s impact on the care of residents and their relatives, on the participating staff groups and the degree to which the organizational practices of the nursing homes changed. The initiative raises questions about the effectiveness of education as an agent of organizational change.

Nursing home, UK Nursing home staff

Garfinkel D, Zur-Gil S, Ben-Israel J. (2007) The war against Polypharmacy: A New

Intervention to improve drug therapy and minimize drug intake in nursing departments. The intervention was associated with a substantial decrease in the cost of drugs. Application of the geriatric-palliative methodology in the disabled elderly enables

Nursing home, Israel The elderly taking a large number of drugs

16

mailto:fkittelberger@im-muenchen.demailto:fkittelberger@im-muenchen.de

Cost-Effective Geriatric-Palliative Approach for Improving Drug Therapy in Disabled Elderly People, Israel Medical Association Journal, 9; 430–434

simultaneous discontinuation of several medications and yields a number of benefits: reduction in mortality rates and referrals to acute care facilities, lower costs, and improved quality of living.

Gillian Davies: Australian Palliative Residential Aged Care Project (APRAC) Gillian@pallcare.org.au

APRAC established in response to recognition that there was a critical need for a palliative care approach in residential aged care. Guidelines for a Palliative Care Approach in Residential Aged Care involved an extensive consultation process that included both the palliative and aged care sectors. These Guidelines have been well received.

Care homes, Australia

National guidelines – clinicians, professional carers, education and training professionals, patients

Grady A, Travers E. (2003) Hospice at home 2: evaluating a crisis intervention service, International Journal of Palliative Nursing, 9(8); 326

Evaluation of a rapid-response crisis intervention service, hospice at home (H@H), for patients with advanced cancer. The service was able to prevent admission to, or facilitate discharge from, institutional care on 62 occasions. The evaluation found significant improvements in some areas of pain and symptom management. High levels of satisfaction were recorded by all service users. A partial cost analysis revealed that the medical and nursing support costs for the H@H service were greater than for traditional hospital/hospice based care. However, the additional cost of H@H would have been substantially reduced if throughput had been higher. A valuable lesson learned from the project was the importance of involving all key players from the outset when determining the requirements of a new service initiative.

Hospice at home, Scotland, UK

NHS (Funding organizations) and hospices.

Gutierrez JB, Elustondo SG, de Miguel Sanchez C, Sanchez FV, Gutierrez IM, Garcia CF. (2004)

A before-and-after study examining the effects of a bioethics course and a checklist on the concordance in number of ethical problems identified in the care of terminally ill patients between the members of a home care support team and a group of experts. The study found that the intervention, i.e. the bioethics course

ESAD, Madrid, Spain.

Members of home care support team

17

mailto:Gillian@pallcare.org.au

Effectiveness of a Training Course in Bioethics and of the Introduction of a Checklist to Detect Ethical Problems, Atencion Primaria, 34(1); 20-25

and the introduction of a checklist, helped professionals who were not experts in bioethics to identify ethical problems in treating terminally ill patients.

Han PKJ, Keranen LB, Lescisin DA, Arnold RM. (2005) The Palliative Care Clinical Evaluation Exercise (CEX): An Experience-Based Intervention for Teaching End-of-Life Communication Skills, Academic Medicine, 80(7); 669

A pilot intervention to test the “Palliative Care Clinical Evaluation Exercise (CEX)”: an experience-based intervention to improve the skills of health care professionals in communicating bad news to palliative care patients and their families. The findings suggest that there is potential value in refining the intervention, in exploring its feasibility in other settings as an educational and assessment tool.

National Cancer Institute MD, USA and Uni of Pittsburgh

First-year Internal Medicine Residents

Hanks GW, Robbins M, Sharp D, Forbes K, Done K, Peters TJ, Morgan H, Sykes J, Baxter K, Corfe F, Bidgood C. (2002) The imPaCT study: a randomised controlled trial to evaluate a hospital palliative care team, British Journal of Cancer, 87; 733-739

An RCT, comparing full- Palliative Care Team and limited telephone advice, to assess the effectiveness of a hospital PCT on physical symptoms and health-related quality of life; patient, family carer and primary care professional reported satisfaction with care; and health service resource use. The data reflects a high standard of care of patients dying of cancer and other chronic diseases in an acute hospital environment, but do not demonstrate a difference between the two models of service delivery of specialist palliative care.

Bristol Trust Hospital, UK

Terminally ill patients

Hannan EL, O’Donnell JF. (1984) An

Evaluation of the use of hospice care within New York state's Hospice Demonstration Program. Twelve hospice programs,

Hospices, New York State, USA

Hospice patients

18

Evaluation of Hospices in the New York State Hospice Demonstration Program, Inquiry, 21(4); 338-348

each providing one of three different models of hospice care, were studied. The community-based programs were found to be considerably less costly than both the hospital-based scattered-bed programs and the hospital-based autonomous-unit programs. The costs of all three programs, however, were less than the costs of conventional terminal care. Although satisfaction with all three models was high, it was higher for both kinds of hospital-based programs than for the community-based programs.

Hanson LC, Reynolds KS, Henderson M, Pickard CG. (2005) A Quality Improvement Intervention to Increase Palliative Care in Nursing Homes, Journal of Palliative Medicine, 8(3); 576

A quality improvement (QI) intervention was tested in nursing homes to examine whether it increases hospice, pain management, and advance care planning. The intervention included recruitment and training of Palliative Care Leadership Teams in each facility, followed by six technical assistance meetings for team members. A quality improvement intervention was effective in increasing hospice enrolment, pain assessment, non-pharmacologic pain treatment, and advance care planning discussions.

Nursing homes, USA

Nursing home residents

Harris D, Hillier LM, Keat N. (2007) Sustainable Practice Improvements: Impact of the Comprehensive Advanced Palliative Care Education (CAPCE) Program, Journal of Palliative Care, 23(4); 267

Development and evaluation of a Comprehensive Advanced Palliative Care Education (CAPCE) programme designed to improve palliative care practice through the development of workplace hospice palliative care resources and its impact on knowledge transfer and longer term changes to clinical practice. Positive effects from the intervention include enhanced pain and symptom management, staff education and development of care policies and guidelines.

Ontario Canada University

Registered Nurses or Palliative Care Nurses primarily from Long Term Care Facilities

Howell D, and Prestwich C, Laughlin E, Giga N. (2004) Enhancing the Role of Case Managers With

An educational programme for case managers of palliative patient populations in the home care setting. Case managers in this model do not provide direct care or treatment, but are responsible for resource and service allocation to patients and families in the home setting, using internal policy and guided by

Teaching hospital, Canada

Registered nurses

19

Specialty Populations Development and Evaluation of a Palliative Care Education Program, Lippincott’s Case Management, 9(4); 166–174

government legislation. The curriculum for case managers aims to improve the quality of palliative home care by increasing the case managers’ knowledge and skills necessary to coordinate services and to allocate resources according to the care needs of palliative patient populations. The curriculum is based on learning needs assessment, case-based problem solving, comfort and confidence in performing the role; principles and practice of palliative care; burdens of caring at the end of life; communication; psychosocial, spiritual, grief and bereavement issues; ethical and legislative issues; resource allocation.

Hudson P, Quinn K, Kristjanson L, Thomas T, Braithwaite M, Fisher J, Cockayne M. (2008) Evaluation of a psycho-educational group programme for family caregivers in home-based palliative care, Palliative Medicine, 22; 270

This programme, developed by a group in Victoria (Australia), prepares family caregivers to support someone with advanced cancer at home. The three weekly 1½-hour group sessions involve a mix of presentations, group work and question and answer sessions. Caregivers found that this helped to prepare them for the caring role, and the majority reported positive changes in their lives. The programme makes efficient use of available multi-disciplinary specialist palliative staff, and can be readily integrated into practice with minimal extra resources. The approximate time commitment for the facilitator for an intervention is one day a week for five weeks. The programme is currently being evaluated in London, UK.

University hospitals, Victoria, Australia

Family caregivers of those with advanced cancer

Hudson P, Quinn K, Kristjanson L, Thomas T, Braithwaite M, Fisher, J Cockayne M. (2008) Evaluation of a psycho-educational group programme for family caregivers in home-based palliative

Evaluation of the utility of a group family caregiver psycho-educational programme focused on preparing primary family caregivers for the role of supporting a relative with advanced cancer at home. The education programme consisted of three consecutive weekly sessions presented in a group format, conducted at six home-based palliative care services across metropolitan and regional Victoria (Australia). Participating caregivers were required to complete a set of self-report questionnaires measuring caregiver competence, preparedness,

Various sites, metropoitan Victoria, Australia

Family care givers of patients with advanced cancer

20

care, Palliative Medicine, 22; 270

optimism, rewards, social support, burden and information needs, at three time points: commencement of the programme (T1), upon completion (T2) and 2 weeks later (T3). Caregivers were also asked to report on the relevance, acceptability, and content of the programme, as well as any barriers to access. This study demonstrated that a group education programme to prepare family caregivers for the role of supporting a dying relative at home was accessible, applicable and effective.

Hudson PL, Aranda S, Hayman-White K. (2005) A Psycho-Educational Intervention for Family Caregivers of Patients Receiving Palliative Care: A Randomized Controlled Trial, Journal of Pain and Symptom Management, 30(4); 329

Psycho-educational support for family caregivers of patients dying of cancer at home. The findings indicate that it is possible to increase caregiver rewards despite being immersed in challenging circumstances that often yield considerable negative psychosocial sequelae. In addition, it is feasible for health professionals to discuss emotive topics, such as impending death, with caregivers without adverse effects.

Teaching hospital, Australia

Family caregivers

Hughes PM, Parker C, Payne S, Ingleton MC, Noble B. (2006) Evaluating an education programme in general palliative care for community nurses, International Journal of Palliative Nursing, 12(3); 123

Evaluation of a palliative care education programme on the self-reported knowledge and confidence of 72 community nurses. The programme succeeded in raising standards of knowledge, professional development and confidence in practice.

University, UK Community Nurses

Jack BA, Gambles M, Saltmarsh P, Murphy D, Hutchison T, Ellershaw JE. (2004)

Development of the palliative care network nurse programme to educate and skill generalist nurses in the care of the dying patient within the acute hospital setting. It developed at the request of nurses who had been involved in the piloting of the Liverpool

Hospitals and University, UK

Generalist nurses in acute care settings

21

Enhancing hospital nurses knowledge of palliative care: a network nurse programme, International Journal of Palliative Nursing, 10(10); 502

Care of the Dying Pathway. The programme consists of a monthly meeting that encompasses an educative component and networking opportunities. In a preliminary evaluation of the programme, a questionnaire was sent to the network nurses, who reported the programme to be beneficial in providing them with increased palliative care knowledge. Support and networking opportunities were also identified. This article discusses the programme, the evaluation findings and makes suggestions for further research.

Jackson WC, Connor PD and Tavernier L. (2002) Antemortem care in an afternoon: A successful four-hour curriculum for third-year medical students, American Journal of Hospice and Palliative Care, 19; 338

A palliative medicine curriculum for medical students to help increase students’ competence and confidence, to encourage interest in hospice clinical experience, and to enhance knowledge in palliative medicine.

University, USA Medical Students

Jan Aimer: ‘Supporting Palliative Care Education in Care Homes’, Fife jaimer@nhs.net

Evaluation of three year lottery funded project completed in 2007. Aim to enhance and develop general palliative care practice by an educational strategy and consistent programme of knowledge and skills. 3 year project was run in conjunction with 44 care homes in Fife. A total of 249 staff participated in the projects program. On completion, staff were not only empowered with knowledge and skills in using the palliative care approach but also recognized that people may have needs which are physical, social, psychological or spiritual or a combination.

Fife, Scotland Palliative care professionals

Jerant AF, Azari RS, Nesbitt TS, Edwards-Goodbee A, Meyers FJ. (2006) The palliative care in assisted living (PCAL) pilot

Results of a pilot intervention Palliative Care in Assisted Living, comparing two interventions for improving the PC of elderly assisted living residents in Sacramento, California. Both interventions are based on a model, which views palliative care as “Timely and Team-oriented, Longitudinal, and Collaborative and Comprehensive”, TLC. The less intensive intervention

UC Davis, University, CA

Nursing home residents

22

mailto:jaimer@nhs.net

study: Successes, shortfalls, and methodological implications, Social Science & Medicine, 62; 199–207

involved one assessment followed by a PC improvement recommendation letter to the resident, family member, primary provider, and facility staff. The other, more intensive intervention involved assessments and letters every three months. The study found no significant differences in recommendation adherence between the more and the less intensive groups, and no significant changes in physical and mental scores within or between groups. However, a loved one’s attendance of the baseline assessment was associated with improved physical scores. Interventions based on the TLC model might allow delivery of timely palliative care to assisted living residents not eligible for hospice care.

John Ellershaw: The Liverpool Care Pathway for the Dying Patient (LCP) John.ellershaw@mariecurie.org.uk

Liverpool Care Pathway been established for 12 years with aim of improving care for dying patients and their families. Template for best practice, designed to transfer principles of care from hospice to more generic healthcare settings.

Liverpool Terminally ill patients.

Jordhøy MS, Fayers P, Saltnes T, Ahlner-Elmqvist M, Jannert M, Kaasa S. (2000) A palliative-care intervention and death at home: a cluster randomised trial, The Lancet, 856; 888

Development of an intervention programme in Trondheim, Norway with the aim to enable patients to spend more time at home at the end of life, and to die there if they prefer. The programme was based on close cooperation with the community health-care professionals, who acted as the principal formal caregivers, and a multidisciplinary consultant team coordinated the care. A cluster randomised trial was used to assess the intervention’s effectiveness compared with conventional care. The palliative-care intervention enabled more patients to die at home. More resources for care in the home (palliative care training and staff) and an increased focus on the use of nursing homes are necessary, however, to increase time at home and reduce hospital admissions.

University hospital, Trondheim, Norway

Incurable malignant disease; expected survival of 2-9 months

Karamouzis MV, Ioannidis G, Rigatos G.

Evaluate quality of life (QoL) parameters in patients with metastatic breast cancer (MBC) and assess the potential

St. Savvas Anticancer-

Metastatic breast cancer patients

23

mailto:John.ellershaw@mariecurie.org.ukmailto:John.ellershaw@mariecurie.org.uk

(2007) Quality of life in metastatic breast cancer patients under chemotherapy or supportive care: a single-institution comparative study, European Journal of Cancer Care, 16(5); 433-438

differences between patients receiving chemotherapy and those undergoing supportive care interventions. Quality of life was found to be statistically better in MBC patients receiving chemotherapy than those under only supportive care. Findings suggest that chemotherapy in MBC patients with good performance status is the more rational therapeutic approach in terms of QoL improvement.

Oncologic Hospital, Greece

Kaufman J, Forman WB. (2005) Hospice and palliative care: An educational intervention for healthcare professionals in a rural community, American Journal of Hospice and Palliative Medicine, 22; 415

An educational intervention to increase the awareness and availability of hospice and EOL care among health care professionals in rural communities. It involved nurses, physicians, and allied healthcare professionals. The nurses and allied health professionals received a half-day seminar. The physicians attended a grand round about hospice and palliative care led by the local hospice medical director. The intervention is inexpensive, locally run, and effective (increase in hospice referrals).

University, USA Rural health care professionals - docs, nurses, social workers etc

Keay TJ, Alexander C, McNally K, Crusse E, Eger RE. (2003) Nursing Home Physician Educational Intervention Improves End-of-Life Outcomes, Journal of Palliative Medicine, 6(2); 205

Evaluate an educational intervention designed for nursing home physicians to improve the quality of dying for nursing home residents. The intervention was a half-day adult educational outreach program, including audit and feedback, targeted at opinion leaders, and quality improvement suggestions. Findings show important terminal care outcomes can be significantly improved by targeting key nursing home physicians with an adult educational program that includes audit and feedback, and quality improvement suggestions.

Diverse nursing facilities, USA

Nursing home physicians

Kenny LJ. (2003) An evaluation-based model for palliative care education: making a

Multi-phase evaluation project to investigate the effectiveness of palliative care education provided by a hospice education network in the north west of England. Effective palliative care education requires responding to the changing individual needs

Hospice Education Centre UK

Nursing students

24

difference to practice, International Journal of Palliative Nursing, 9(5); 189

of participants, competent teaching in theory and practice, and enabling students to make a difference to practice.

Klaristenfield DD, Harrington DT, Miner TJ. (2007) Teaching Palliative Care and End-of-Life Issues: A Core Curriculum for Surgical Residents, Annals of Surgical Oncology, 14(6); 1801–1806

A pilot curriculum in palliative surgical care designed for surgical residents in three 1-hour sessions. Sessions included group discussion, role-playing exercises, and instruction in advanced clinical decision making. Participants completed pre-test, post-test, and 3-month follow-up surveys to measure the programme’s effect. Surgical residents consider that understanding palliative care is a useful part of their training. This view remains valid at 3 month follow up.

Brown University, USA

Surgical Residents

Knight CF, Knight PF, Gellula MH, Holman GH. (1992) Training our Future Physicians: A Hospice Rotation for Medical Students, American Journal of Hospice Care, 9(1); 23-28

Development of a 16 hour hospice clinical rotation as part of a medical student family practice clerkship. The study examines the effect of the hospice rotation on student beliefs and attitudes towards the care of dying patients. The rotation was found to positively affect students’ attitudes about a hospice rotation, and beliefs concerning palliative care.

Hospice and University

Family practice medical students

Koffman J, Higginson IJ. (2005) Assessing the Effectiveness and Accessibility of Interprofessional Palliative Care Education, Journal of Palliative Care, 21(4); 262-269

These courses (MSc, Postgraduate Diploma and Certificate in Palliative Care) have been designed to develop future leaders in palliative care. Participants from all over the world develop the skills necessary to appraise research and evidence on palliative care, and to improve clinical practice and lead services. The course has a strong emphasis on non-cancer and includes sessions on palliative care in nursing homes. A follow-up of career trajectories on completion of the course found increased involvement in a wide range of clinical, research and service development activities, including: research; needs assessment; quality assurance and policy development. Participants felt that

University, UK Former students in M.Sc. Course in Palliative Care

25

the course helped develop lateral thinking; challenged misconceptions; enhanced teamwork opportunities and professional networking; increased confidence; and improved their chances of promotion. Those completing the course often continue to train others in their countries and regions, spreading skills and knowledge in palliative care more widely. The costs of running the course include a half-time course coordinator, a half-time course administrator and fees for visiting lecturers. Participants have to pay fees to attend, but charities or governments could provide bursaries.

Kristjanson LJ, Cousins K, White K, Andrews L, Lewin G, Tinnelly C, Asphar D, Greene R. (2004) Evaluation of a night respite community palliative care service, International Journal of Palliative Nursing, 10(2); 84

Development and evaluation of a community night respite palliative care service for patients and family carers. An assessment tool to identify those most in need of night respite was developed and tested. The tool was reliable and feasible for use in practice. Care aides were trained to provide night respite. Fifty-three patients participated over 11 months. Findings revealed the types of patients and families most in need of night respite, the amount of respite needed, and location of death. There is evidence that patients who would have been transferred to an inpatient setting for end-of-life care were able to die at home with the support of the night respite service. Families appreciated the service and a limited cost comparison suggested costs were lower than if patients had been transferred to hospital and/or inpatient hospice care. Recommendations for practice are offered.

Western Australia Patients and family caregivers of terminally ill.

Kwak J, Salmon JR, Acquaviva KD, Brandt K, Egan KA. (2007) Benefits of Training Family Caregivers on Experiences of Closure During End-of-

Evaluation of the effectiveness of Caregiving at Life’s End (CGLE), a program for family caregivers caring for someone during the last years of life that focuses on the emotional, spiritual, and practical aspects of life and relationship completion and closure. This study evaluated the effectiveness of CGLE in improving three key outcomes: comfort with caregiving, closure, and caregiver gain. The programme length made a difference for

Hospice, Florida, US.

Caregivers of terminally ill patients

26

Life Care, Journal of Pain and Symptom Management, 33(4); 434

improvement in comfort with caregiving and closure but not in caregiver gain. Caregivers who are caring for someone during the last years of life benefit from a programme that focuses on the life-changing or transformative aspects of caregiving in the last years of life, as well as practical aspects of caregiving. The ability to support caregivers in this relatively low impact intervention can be used in hospice and non hospice settings.

Kwekkeboom KL, Vahl C, Eland J. (2006) Impact of a Volunteer Companion Program on Nursing Students’ Knowledge and Concerns Related to Palliative Care, Journal of Palliative Medicine, 9(1); 90

The development and evaluation of a volunteer Palliative Care Companion programme for undergraduate nursing students to provide them with a learning opportunity by spending time with dying patients and their families. The programme took place at a university with an affiliated hospital-based palliative care service. The intervention did not produce significant improvements in knowledge and concerns, however companion students described their participation as a meaningful learning experience.

University, USA Nursing Students

Kyriaki Mystakidou: Pain Relief and Palliative Care Unit, Areteion University Hospital, Greece mistakidou@yahoo.com

A year long prospective study to explore patient’s functional ability, cognitive performance, psychological distress, malnutrition, and prevalence of polypharmacy before and after receiving treatment in the Pain Relief and Palliative Care Unit.

Areteion University Hospital, Greece

Clinicians, researchers, education and training professionals, patient groups

Ladislav Kabelka: St. Joseph’s Hospice and Pain Centre, Rajhrad, Czech Republic kabelkal@seznam.cz

Management of medical team at St Joseph’s Hospice and pain centre, the centre of palliative care education activities in Czech Republic. It is one of the largest hospice facilities. Employs holistic model of care and empathic communication to older people.

Rajhrad, Czech Republic

Older people in the hospice

Landmark B, Wahl AK, Bøhler A. (2004) Competence

Evaluation of competence development in palliative treatment, nursing and care in students on a two-year postgraduate education programme in palliation. Competence levels are

Teaching hospital, Norway

Post-graduate medical students

27

mailto:mistakidou@yahoo.commailto:kabelkal@seznam.cz

development in palliative care in Norway: A description and evaluation of a postgraduate education program in palliative care in Drammen, Norway, Palliative and Supportive Care, 2; 157–162

reported to have risen during the course.

Landmark B, Wahl AK, Bøhler A. (2004) Group supervision to support competency development in palliative care in Norway, International Journal of Palliative Nursing, 10(11); 542

Development and evaluation of a supervision model to provide continuous support to students during a 2-year postgraduate education course in palliative care. The model offers an opportunity for in-depth reflection of medical practice through group meetings and discussions facilitated by tutors. Situations discussed in supervision include challenges students face when tackling ‘bad news’; differences of opinion regarding treatment; ethical dilemmas; and difficulties related to the suffering of patients’ family.

University, Norway Post-grad Medical students specializing in palliative care

Lapid MI, Rummans TA, Brown PD et al. (2007) Improving the quality of life of geriatric cancer patients with a structured multidisciplinary intervention: A randomized controlled trial, Palliative and Supportive Care, 5(2); 107-114

An RCT examining the potential impact of elderly age on response to participation in a structured, multidisciplinary quality-of-life (QOL) intervention for patients with advanced cancer undergoing radiation therapy. The intervention consisted of eight 90-min sessions designed to address the five QOL domains of cognitive, physical, emotional, spiritual, and social functioning. The geriatric participants who completed the intervention had higher QOL scores at baseline, at week 4 and at week 8, compared to the control participants. The results demonstrate that geriatric patients with advanced cancer undergoing radiation therapy will benefit from participation in a structured multidisciplinary QOL intervention.

Cancer centre, USA Geriatric patients

Lapid MI, Rummans An RCT to examine the potential impact of elderly age on Hospital, USA Patients undergoing

28

TA, Brown PD, Frost MH, Johnson ME, Huschka MM, Sloan JA, Richardson JW, Hanson JM, Clark MM. (2006) Improving the quality of life of geriatric cancer patients with a structured multidisciplinary intervention: A randomized controlled trial, Palliative and Supportive Care, 5; 107–114

response to participation in a structured, multidisciplinary quality-of-life intervention for patients with advanced cancer undergoing radiation therapy. The intervention consisted of eight 90-min sessions designed to address the five QOL domains QOL was measured at baseline and weeks 4, 8, and 27.Geriatric patients with advanced cancer undergoing radiation therapy were shown to benefit from participation in a structured multidisciplinary QOL intervention. Therefore, geriatric individuals should not be excluded from participating in a cancer QOL intervention, and, in fact, elderly age may be an indicator of strong response to a QOL intervention.

radiation treatment in oncology wards.

Li YQ, Zhang MX, Fu GX, Zhao LH, Li WY, Li H, Zhang CX, Fany Y, Wang ZH, Peng L. (2006) Effect of hospice care on the quality of life and psychological state of aged mortal inpatients Zhong Nan Da Xue Xue Bao Yi Xue Ban, Journal of Central South University Medical Sciences, 31(4); 538-42 liyanqun@xysm.net

Study of how hospice care influences the life quality and psychological state of aged mortal inpatients. The intervention group received hospice care, while the control group was treated with conventional nursing. Outcome measures included quality of life, social support, degree of satisfaction, anxiety, and depression. The study concludes that hospice care can improve patients’ quality of life and psychological state, while lowering anxiety and depression.

Department of Gerontology, Second Xiangya Hospital, Central South University, China

Elderly Patients in hospice

Liao S, Amin A, Rucker, L. (2004) An Innovative, Longitudinal Program to Teach

An elective home hospice rotation where medical residents (internal medicine) served as primary care physicians for patients at the end of life over a one-year period. Residents followed patients through their entire hospice experience and learned

University, CA, USA

Third year medical residents.

29

mailto:liyanqun@xysm.net

Residents about End-of-Life Care, Academic Medicine, 79(8); 752

through case vignettes, quarterly meetings, textbook reading, and individual projects.

Lindner SA, Davoren JB, Vollmer A, Williams B, Landefeld CS. (2007) An Electronic Medical Record Intervention Increased Nursing Home Advance Directive Orders and Documentation, Journal of the American Geriatrics Society, 55; 1001–1006

Prospective before–after intervention trial to develop an electronic medical record intervention to improve documentation of patient preferences about life-sustaining care, detail of resuscitation and treatment-limiting orders, and concordance between these orders and patient preferences. The electronic medical record was modified so that an admission order would specify resuscitation status. Additionally, the intervention alerted the primary clinician to complete a template advance directive discussion note for documentation of life-sustaining treatment preferences. The findings showed that a targeted electronic medical record intervention increased completion of advance directive.

VA nursing home, USA

Nursing home residents

Loftus LA, Thompson E. (2002) An evaluation of a palliative care course for generic nurses, International Journal of Palliative Nursing, 8(7); 354

Evaluation of a generic palliative nursing course using the Palliative Care Quiz for Nurses, and more subjective evaluation of changes in practice through a short questionnaire which was sent out to participants 3 months after completion of the course. The need for educators and clinicians to develop more evaluation models based on clinical evidence is highlighted.

University, Scotland, UK

Generic nurses

London MR, McSkimming S, Drew N, Quinn C, Carney B. (2005) Evaluation of a Comprehensive, Adaptable, Life- Affirming, Longitudinal (CALL) Palliative Care Project, Journal of Palliative Medicine,

A prospective observational study evaluating a Comprehensive, Adaptable, Life-Affirming, Longitudinal (CALL) intervention to patients with life-threatening cancer, cardiac illness, respiratory conditions or dementia. Participants reported improved pain and symptom management. Fewer than one third were hospitalized (29%), and 7% had a critical care admission while enrolled. In addition, participants had high use of hospice (48% of those who died), and were likely to die at home (38% of those who died). CALL Care is an effective interdisciplinary intervention approach to individualise care for people living with life-

Various sites- hospitals and medical centres USA

Patients with life-threatening cancer, cardiac illness, respiratory conditions or Dementia.

30

8(6); 1214 threatening illness. Lucy Sutton: Setting up a unit to identify practical policy solutions for meeting the palliative and end of life needs of an ageing population across the range of conditions and settings of care l.sutton@ncpc.org.uk

Policy Development - Setting up a unit to identify practical policy solutions for meeting the palliative and end of life care needs of an ageing population across the range of conditions and settings of care. Estimated some 5,000 organisations have benefitted from the work of the policy unit and approximately 60,000 people.

National Council for Palliative Care, UK

Policy makers

Lynne Millar/Joan Ferguson: Better Practice through User Involvement lynne.millar@mariecurie.org.uk

Better Practice through user involvement – using interviews to as part of the clinical leadership programme. Patients and carers talked about the care they had or were receiving and an action plan was formulated for each area. Three main themes – continuity of care, communication and different levels of knowledge and expertise within the team.

Marie Curie Nursing Service, Dalmally Scotland

Patients and clinicians at the hospice.

Macfarland KF, Rhoades DR. (2006) End-of-Life Care: A Retreat Format for Residents, Journal of Palliative Medicine, 9(1); 82

Educational curriculum for physicians to enhance focus on patient values, goals and preferences for care at the end of life; ways to communicate bad news, discussion of patient preferences, management of symptoms, and prescribing opiates. The initiative involves daylong retreat utilized case presentations and problems for presenting scientific content and the film Wit to convey information related to communication, whole-patient assessment, and the palliative care approach.

University, USA Internal medicine residents

MacLeod RD, Parkin C, Pullon S, Robertson G. (2003) Early clinical exposure to people who are dying: learning to care at the end of life. Journal of Medical Education, 37;51–58

Development of a programme designed for medical students in their first clinical year to spend time with a person who is dying and their family. The initiative involves a portfolio assignment that includes a personal reflection of the experience, exploring the student’s and the patient’s understandings of spirituality; meanings of the encounter, and ways to care more effectively for people who are dying.

University, NZ Medical students

31

mailto:l.sutton@ncpc.org.ukmailto:lynne.millar@mariecurie.org.ukmailto:lynne.millar@mariecurie.org.uk

Magnani JW, Minor MA, Aldrich JM. (2002) Care at the End of Life: A Novel Curriculum Module Implemented by Medical Students, Academic Medicine, 77(4); 292

Development of an end-of-life (EOL) care curriculum module by medical students. The curriculum includes case-based educational module to teach EOL communication skills to medical students commencing clinical training. Faculty members with national and local experience with EOL and palliative care reviewed the curriculum. Twelve members of the faculty were introduced to the curriculum and then taught it in pairs to groups of 12 to 16 medical students. The curriculum develops skills, attitudes, and knowledge relevant for communicating bad news and establishing treatment options in the EOL setting by utilizing videos, group discussion, role plays, and case discussions.

University USA First year medical students

Marcel Arcand: Comfort Care at the end of life for person’s with Alzheimer’s disease or other degenerative diseases of the brain: a guide for caregivers marcel.arcand@usherbrooke.ca

A follow-up of qualitative research about the perspective of family caregivers in end-of-life decision making in dementia and a response to the identified need of families for information and emotional support in this situation. Booklet developed in accordance with recent literature and current expert opinions. A pilot study done in a Montreal Nursing Home suggests that it is generally well accepted by multi-ethnic staff and may improve family satisfaction with care.

University of Sherbrooke, Quebec, Canada

Directed at Caregivers

Mc Clement SE, Care D, Dean R, Cheang M. (2005) Evaluation of Education in Palliative Care: Determining the Effects on Nurses’ Knowledge and Attitudes, Journal of Palliative Care, 21(1); 44-48

Evaluation of a pilot course in palliative nursing care aimed at improving practicing nurses’ knowledge regarding cancer pain management and attitudes towards care of the dying patients. The course involved 12 weeks of systematic classroom instruction for registered nurses, and a one-day observation on a designated palliative care unit. Results indicate that nurses’ attitudes improved significantly from the first to the last day of the course and that this improvement was maintained three months later.

University, Manitoba, Canada

Nurses

McMillan SC, Small BJ. (2007) Using the

Testing an intervention for hospice caregivers designed to help them better manage symptoms experienced by patients with

University with hospice centre, USA

Hospice homecare patients and workers

32

mailto:marcel.arcand@usherbrooke.camailto:marcel.arcand@usherbrooke.ca

COPE Intervention for Family Caregivers to Improve Symptoms of Hospice Homecare Patients: A Clinical Trial, Oncology Nursing Forum, 34(2); 313

cancer. Three groups: a control, standard care, standard care plus friendly visits, standard care plus the COPE intervention. Symptom distress, a measure that encompasses patient suffering along with intensity, was significantly decreased in the group in which caregivers were trained to better manage patient symptoms. The COPE intervention is effective and immediately translatable to the bedside for hospice homecare patients with advanced cancer.

assisting them.

Menten J, Desmedt M, Lossignol D, Mullie A. (2002) Longitudinal Follow-up of TTS-Fentanyl Use in Patients with Cancer-Related Pain: Results of a Compassionate-Use Study with Special Focus on Elderly Patients, Current Medical Research and Opinion, 18(8); 488-498

Longitudinal study evaluated tolerability, ease of use and applied doses of transdermal fentanyl in adult patients with cancer-related pain requiring strong opioid analgesia. Concluded TTS-fentanyl can be applied as long-term therapy to patients with cancer-related pain, including the elderly.

University hospital, Gathuisberg, Belgium

Elderly patients needing pain relief

Mikhael J, Baker L, Downar J. (2008) Using a Pocket Card to Improve End-of-life Care on Internal Medicine Clinical Teaching Units: A Cluster-randomized Controlled Trial, Journal of General Internal Medicine, 23(8); 1222-1227

A cluster-randomized controlled trial to establish the effectiveness of a cheap, portable, and easily implemented pocket reference for improving medical residents’ knowledge and comfort level in dealing with pain and symptom management on the medical ward in three academic hospitals in Toronto, Canada. Residents at 1 hospital received a pocket reference including information about pain and symptom control, as well as 1–2 didactic end-of-life teaching sessions per month normally given as part of the rotation. Residents at the other 2 hospitals received only the didactic sessions. The concise pocket reference is a feasible, economical, and educational intervention that improves resident comfort level and knowledge in delivering end-of-life

Medical Clinical Teaching Units, Toronto, Canada

All medical residents

33

care. Molloy DW, Guyatt GH, Russo R et al. (2000) Systematic Implementation of an Advance Directive Program in Nursing Homes: A Randomized Controlled Trial, Journal of the American Medical Association, 283(11); 1437-1444

An RCT examining the effect of systematically implementing an advance directive in nursing homes on patient and family satisfaction with involvement in decision making and on health care costs. The intervention, LetMeDecide, was an advance directive program included educating staff in local hospitals and nursing homes, residents, and families about advance directives and offering competent residents or next-of-kin of mentally incompetent residents an advance directive that provided a range of health care choices for life-threatening illness, cardiac arrest, and nutrition. The data suggests that systematic implementation of a program to increase use of advance directives reduces health care services utilization without affecting satisfaction or mortality.

Nursing homes, Canada

Nursing home residents

Montagnini M, Varkey B, Duthie E. (2004) Palliative Care Education Integrated into a Geriatrics Rotation for Resident Physicians, Journal of Palliative Medicine, 7(5); 652

Geriatric Rotation - To improve resident physicians’ knowledge and skills in palliative care, a structured clinical/educational experience was integrated into an existing required geriatrics rotation for senior medicine residents. The integration of a structured clinical/educational experience into an existing geriatrics rotation for senior medicine residents aimed at improving their knowledge and skills in palliative care. The rotation involves two residents per month, on a simultaneous basis. The curricular elements of palliative care include prognostication, assessment and management of pain and non-pain symptoms in end-of-life care. The geriatrics component consists of mechanisms of aging, patho-physiology of common geriatric diseases, clinical pharmacology and psychosocial aspects of geriatric care. Teaching methods include direct patient care, bedside teaching rounds, lectures, and multidisciplinary and family meetings. Residents indicated significant knowledge improvement in all palliative care domains taught during the programme.

Medical College WI, USA

Senior Medical Residents

Morita T, Fujimoto K, A study exploring nurses’ self-reported practices, confidence, Medical School, Nurses

34

Imura C, Nanba M, Fukumoto N, Itoh T. (2006) Self-reported Practice, Confidence, and Knowledge About Palliative Care of Nurses in a Japanese Regional Cancer Center: Longitudinal Study After 1-Year Activity of Palliative Care Team, American Journal of Hospice and Palliative Medicine, 23(5); 385

and knowledge about palliative care in five different areas, i.e. pain, dyspnoea, delirium, communication, and the dying-phase, as well as changes in these parameters after a 1-year educational and clinical programme of a palliative care team.

Japan

Morita T, Murata H, Hirai K, Tamura K, Kataoka J, Ohnishi H, Akizuk