Literature Review

[UK] Multiple points of system failure underpin continuous subcutaneous infusion safety incidents in palliative care: A mixed methods analysisPalliative Medicine; Amy Brown, Sarah Yardley, Ben Bowers, Sally-Anne Francis, Lucy Bemand-Qureshi, Stuart Hellard, Antony Chuter, Andrew Carson-Stevens; 10/24 About 25% of palliative medication incidents involve continuous subcutaneous infusions. Complex structural and human factor issues make these risk-prone interventions. Primary incidents (most proximal to patient outcomes) leading to inappropriate medication use (including not using medication when it was needed) were underpinned by breakdowns in three major medication processes: monitoring and supply ... administration ... and prescribing ... Recurring contributory factors included discontinuity of care within and between settings, inadequate time, inadequate staffing and unfamiliarity with protocols. Psychological harms for patients and families were identified. System infrastructure is needed to enable timely supply of medication and equipment, effective coordinated use of continuous subcutaneous infusions, communication and continuity of care.

[United Kingdom] After tragedy, NJ doctor finds renewed purpose working — and living — at a hospice My Central Jersey - NorthJersey.com; by Scott Fallon; 11/14/24 Even though she was on hospice care for terminal cancer at a New York hospital, Sandy Cattani’s last days were marred with pain and suffering. At one point, she began flailing so much in her hospital bed that her husband, Dr. Charles Vialotti, and other family members had to help hold her arms and legs down. This is not how any patient should die, Vialotti thought. He ought to know, having helped pioneer hospice care at three New Jersey hospitals. About a year after Sandy's death, Vialotti took the unusual step of moving into the Villa Marie Claire hospice in Saddle River, where he has spent 14 years attending to the terminally ill.

[UK] Large language models for mental health applications: Systematic reviewZhijun Guo, Alvina Lai, Johan H Thygesen, Joseph Farrington, Thomas Keen, Kezhi Li; 10/24The study identifies several issues: the lack of multilingual datasets annotated by experts, concerns regarding the accuracy and reliability of generated content, challenges in interpretability due to the "black box" nature of LLMs [large language models], and ongoing ethical dilemmas. These ethical concerns include the absence of a clear, benchmarked ethical framework; data privacy issues; and the potential for overreliance on LLMs by both physicians and patients, which could compromise traditional medical practices. As a result, LLMs should not be considered substitutes for professional mental health services. However, the rapid development of LLMs underscores their potential as valuable clinical aids, emphasizing the need for continued research and development in this area.

[England] Woman doing race for hospice that helped husband BBC News; Lorna Bailey and Andrew Dawkins; 11/4/24 A woman is taking part in a 120km (75-mile) race over four days through the deserts of Jordan for a hospice that helped care for her husband. Charlotte Rochenard-Taylor, from Warwick, said running became a way for her to cope with grief, after Jamie died from a brain tumour in June last year. She is participating in the Marathon des Sables to raise money for Myton Hospice, which has sites in Coventry, Warwick and Rugby. Ms Rochenard-Taylor said it was "just a way to keep alive, if that makes sense, getting again out of my comfort zone to just feel like fully alive". One of her husband's last wishes was to die at home, stated the runner, who made it her "mission for this to happen". She added: "Thanks to the Myton Hospice, the at-home team... that was made possible." ... "I [found] that running actually became for me a way to cope with the grief, just to get out there and just get the rage out and just... mental wellbeing really." Ms. Rochenard-Taylor, who broke her pelvis a few years ago, said the charity was close to her heart, and the race starting on Tuesday was an ideal way to support it.

Europe funeral products and services market size, share & trends analysis report by type (funeral products, funeral services), by country (UK, Germany, France, Italy, Spain), and segment forecasts, 2025 - 2030 Grand View Research; 10/31/24 ... [There] is a rising demand for biodegradable coffins, urns made from natural materials, and shrouds crafted from organic fabrics. For instance, Ecoffins UK LLP offers eco-friendly coffins made from pandanus, willow, and pine. These products are designed to decompose naturally without leaving harmful residues, aligning with the eco-conscious values of many Europeans. Furthermore, natural burial grounds, which avoid embalming chemicals and concrete grave liners in favor of simple, green burials, are gaining popularity. This has spurred the growth of new services offering eco-friendly plots and personalized, sustainable burial plans. Moreover, the COVID-19 pandemic significantly impacted Europe's market. ...Editor's note: This trend for eco-friendly funerals continues to grow in the U.S. 

[UK] Symptom management for people with advanced dementia who are receiving end of life careCurrent Opinion in Supportive and Palliative Care; Maria Drummond , Bridget Johnston; 10/24Recent studies indicate that people with advanced dementia often experience significant unmet palliative care needs, particularly regarding symptom management. Palliative care for people with advanced dementia is currently inadequate due to a lack of tailored interventions, poor symptom management, and disjointed care systems. Enhancing training for caregivers, fostering interdisciplinary collaboration, and focusing on integrated care approaches across home and institutional settings are crucial to improving quality of life and symptom control for people with advanced dementia.

[Canada] Aerobic physical activity and depression among patients with cancer-A systematic review and meta-analysisJAMA Network Open; Matthew Kulchycki, MD; Henry Ratul Halder, MSc; Nicole Askin, MLIS; Rasheda Rabbani, PhD; Fiona Schulte, PhD; Maya M. Jeyaraman, MD; Lillian Sung, MD, PhD; Deepak Louis, MD; Lisa Lix, PhD; Allan Garland, MD, MA; Alyson L. Mahar, PhD; Ahmed Abou-Setta, PhD; Sapna Oberoi, MD, MSc; 10/24A cancer diagnosis increases the risk of anxiety, depression, and emotional distress among patients. Depression prevalence among patients with cancer ranges from 13% to 27%, which is 2 to 3 times higher than the general population. In this systematic review and meta-analysis, APA [aerobic physical activity]was associated with modest short-term and long-term reductions of depression among adults with cancer. Future studies should discern the effectiveness of APA in combination with other strategies for managing depression across various populations of patients with cancer.

Janey Godley says it's important to 'talk about death' in hospice update STV News; 10/8/24 Janey Godley has said it is important to “talk about death” as she shared an update on her condition from her hospice.The Scottish comedian is currently receiving end-of-life care after receiving the news that her cancer had spread, after initially being diagnosed with ovarian cancer in 2021. She shared the “devastating news” in September after cancelling her upcoming autumn tour, adding that her “chemo ran out of options” and she couldn’t take anymore. In a video from the hospice, Godley thanked everybody as she confirmed she has had some issues with sickness – and said it is “hard” to speak about death but these are conversations we “all have to have.”

[Sweden] Reconciliation in palliative care: A concept analysisPalliative and Supportive Care; Margareta Karlsson, Andrea Uhlman, Benedict Kämper, Britt Hedman Ahlstrom; 9/24Terminal illnesses affect almost all aspects of life and being close to death may lead to a need for reconciliation. The end of life is stressful on an existential level for both patients and relatives. It can therefore be of relevance for palliative care nurses to understand the meaning of reconciliation. We conclude that reconciliation is a concept of importance when caring for patients in end-of-life care. A broader and deeper understanding of the concept facilitates conversations about the meaning of reconciliation in palliative care and can enable patients who strive to achieve reconciliation to be more easily identified and supported.

Dame Judi Dench paints watercolour to aid hospice BBC, United Kingdom; by Joshua Askew; 10/2/24 A watercolour painted by Dame Judi Dench has helped raise funds for a local hospice that is struggling financially. The Oscar-winning actress' painting of a Scottish landscape - titled Early Sunset Wester Ross - was used to create £150 hand-signed prints. The artworks are being sold in aid of the St. Catherine's Hospice in Crawley, which provides end-of-life care in Sussex and Surrey. "I am thrilled," said Dame Judi. "All the money raised from these limited-edition prints will help provide care for local people." ... Dame Judi is a long-term resident of Outwood in Surrey, which sits in the hospice's catchment area.

[The Netherlands] The focus on life-prolonging anticancer treatment hampers shared decision-making in people with advanced cancer: A qualitative embedded multiple-case studyPalliative Medicine; Daisy Jm Ermers, Maartje J van Geel, Yvonne Engels, Demi Kellenaers, Anouk Sj Schuurmans, Floortje K Ploos van Amstel, Carla Ml van Herpen, Yvonne Schoon, Henk J Schers, Kris Cp Vissers, Evelien Jm Kuip, Marieke Perry; 9/24Implementing shared decision-making in oncology practice is often limited, particularly integrating the patient's context into decision-making. Four themes were identified [in this study]: shared decision-making is a dynamic and continuous process (1), in which the medical oncologist's treatment recommendation is central (2), fuelled by the patients' experience of not having a choice (3), and integrating the patient's context into shared decision-making was considered important but hampered (4), for example, by the association with the terminal phase. The prevailing tendency among medical oncologists and persons with advanced cancer to prioritize life-prolonging anticancer treatments restricts the potential for shared decision-making.

[Ghana] A qualitative study on the experiences of family caregivers of children with End Stage Kidney Disease (ESKD)BioPsychoSocial Medicine; Edward Appiah Boateng, Mabel Baaba Bisiw, Rosemary Agyapomah, Isaac Enyemadze, Joana Kyei-Dompim, Samuel Peprah Kumi, Dorothy Serwaa Boakye; 8/24Family caregivers, mostly parents, are greatly involved in the care of their children with end stage kidney disease (ESKD) globally. Yet, the experiences of these caregivers and the demands placed on them by the caregiving role have not been explored or documented in Ghana. The majority of the family caregivers experienced anxiety, fear, uncertainty, and hopelessness in response to the children's diagnosis and care ... [and] ... the thought of the possibility of the children dying was deeply traumatizing for our participants. Most participants reported bodily pains and physical ailments because of lifting and caring for the children. Financial constraint was also a key issue for all the family caregivers. All the family caregivers had their psychological well-being compromised as a result of the challenges they encountered physically, socially, and spiritually.

[United Kingdom] 'Cuts to hospice care are a tragedy' BBC News, United Kingdom; by Helen Drew and James W. Kelly; 9/22/24 A south London hospice has made several staff redundant and cut services because funding levels are failing to meet rising operating costs, its chief executive has said. Nick Stevens said St Raphael's Hospice's operating costs have risen by £1m over the last four years but only received a £140,000 uplift from the NHS, which provides a quarter of the charity's funding. Among the cuts was the disbandment of the "hospice at home" service which serves the local area. ... Mr. Stevens said they have had to reduce their clinical nurse community team by 20%. "That is a real tragedy. We've lost members with decades of expertise and experience who have supported hundreds of people through the last stages of their lives," he said. Mr. Stevens described such staff as "irreplaceable" and their loss will have a "detrimental impact" on the services offered by the hospice. Editor's Note: This trend continues to grow throughout the United Kingdom, with huge fundraisers to help pay costs. What implications might it have for the United States, or not?