Place of Death for Adults Receiving Specialist Palliative Care in Their Last 3 Months of Life: Factors Associated With Preferred Place, Actual Place, and Place of Death Congruence

Objectives: Congruence between the preferred and actual place of death is recognised as an important quality indicator in end-of-life care. However, there may be complexities about preferences that are ignored in summary congruence measures. This article examined factors associated with preferred place of death, actual place of death, and congruence for a sample of patients who had received specialist palliative care in the last three months of life in Ireland. Methods: This article analysed merged data from two previously published mortality follow-back surveys: Economic Evaluation of Palliative Care in Ireland (EEPCI); Irish component of International Access, Rights and Empowerment (IARE I). Logistic regression models examined factors associated with (a) preferences for home death versus institutional setting, (b) home death versus hospital death, and (c) congruent versus non-congruent death. Setting: Four regions with differing levels of specialist palliative care development in Ireland. Participants: Mean age 77, 50% female/male, 19% living alone, 64% main diagnosis cancer. Data collected 2011-2015, regression model sample sizes: n = 342-351. Results: Congruence between preferred and actual place of death in the raw merged dataset was 51%. Patients living alone were significantly less likely to prefer home versus institution death (OR 0.389, 95%CI 0.157-0.961), less likely to die at home (OR 0.383, 95%CI 0.274-0.536), but had no significant association with congruence. Conclusions: The findings highlight the value in examining place of death preferences as well as congruence, because preferences may be influenced by what is feasible rather than what patients would like. The analyses also underline the importance of well-resourced community-based supports, including homecare, facilitating hospital discharge, and management of complex (eg, non-cancer) conditions, to facilitate patients to die in their preferred place.

Grasping a new approach to older persons' dignity: A process evaluation of the Swedish Dignity Care Intervention in municipal palliative care

AIM

Dignity in older persons is a goal of palliative care. This study aimed to perform a process evaluation of the Swedish Dignity Care Intervention (DCI-SWE) in municipal palliative care in Sweden, focusing on implementation, context, and mechanism of impact.

METHODS

This study had a process evaluation design. The Knowledge to Action framework supported the implementation of the DCI-SWE. The intervention was used by community nurses with older persons (n = 18) in home healthcare and nursing homes. Data were collected by focus groups- and individual interviews with community nurses (n = 11), health care professionals (n = 5) and managers (n = 5), reflective diaries, and field notes.

RESULTS

Grasping the DCI-SWE was challenging for some community nurses. Enhanced communication training and increased engagement from managers were requested. However, the DCI-SWE was perceived to enhance professional pride in nursing. In terms of fidelity, dose and reach the project was not fully achieved. Regarding mechanism of impact the DCI-SWE contributes to address older persons' loneliness and existential life issues, as it put conversations with older persons on community nurses' agenda.

CONCLUSIONS

The DCI-SWE provided opportunities to maintain older persons' dignity and quality of life. However, with refinements of design and the DCI-SWE, the sustainability in the context may increase.

Epidural Spinal Cord Stimulation for Spinal Cord Injury in Humans: A Systematic Review

(1) Background: Spinal cord injury (SCI) represents a major health challenge, often leading to significant and permanent sensorimotor and autonomic dysfunctions. This study reviews the evolving role of epidural spinal cord stimulation (eSCS) in treating chronic SCI, focusing on its efficacy and safety. The objective was to analyze how eSCS contributes to the recovery of neurological functions in SCI patients. (2) Methods: We utilized the PRISMA guidelines and performed a comprehensive search across MEDLINE/PubMed, Embase, Web of Science, and IEEE Xplore databases up until September 2023. We identified studies relevant to eSCS in SCI and extracted assessments of locomotor, cardiovascular, pulmonary, and genitourinary functions. (3) Results: A total of 64 studies encompassing 306 patients were identified. Studies investigated various stimulation devices, parameters, and rehabilitation methods. Results indicated significant improvements in motor function: 44% of patients achieved assisted or independent stepping or standing; 87% showed enhanced muscle activity; 65% experienced faster walking speeds; and 80% improved in overground walking. Additionally, eSCS led to better autonomic function, evidenced by improvements in bladder and sexual functions, airway pressures, and bowel movements. Notable adverse effects included device migration, infections, and post-implant autonomic dysreflexia, although these were infrequent. (4) Conclusion: Epidural spinal cord stimulation is emerging as an effective and generally safe treatment for chronic SCI, particularly when combined with intensive physical rehabilitation. Future research on standardized stimulation parameters and well-defined therapy regimens will optimize benefits for specific patient populations.

Involving patients and the public in nursing PhD projects: practical guidance, potential benefits and points to consider

BACKGROUND

Funders, academic publishers and governance bodies increasingly require research to involve patients and the public. This also enables nurse researchers to increase the visibility of scholarly nursing roles, which are poorly understood by the public. There are different approaches to involvement, and a wealth of guidance about how it can and should be implemented. Less is known about how it should be done in the context of a nursing PhD.

AIM

To discuss the experiences of the authors' nursing research group in involving patients and the public in PhD research, reflect on the benefits to be gained from doing so, and highlight considerations for those planning to involve patients and the public in their doctoral research projects. Discussion It is essential to decide in advance of a study who you will involve, how to reach them and why you are involving patients and the public. Some potential benefits of involvement are: more accessible documentation, refined methods and better research outputs created in collaboration with patients and the public.

CONCLUSION

Patients and the public should be involved in nursing PhD projects. Not only does this improve the quality of the research and raise the profile of nursing research, but it provides the opportunity for students to learn skills that they can develop further throughout their academic careers.

IMPLICATIONS FOR PRACTICE

Obtaining high-quality patient and public involvement is an important skill for nurse researchers. The first steps in acquiring this skill should be taken during research training.

Environmental impact of the supervised toothbrushing programme amongst children in Scotland

OBJECTIVES

To understand the environmental impact of providing a nationwide supervised toothbrushing programme (Childsmile) for 5-year-old children in Scotland.

METHODS

A life cycle assessment was conducted to assess the annual environmental effects of the supervised toothbrushing programme in early years childcare, as well as each dental procedure (dental restoration under local anaesthesia (LA), single tooth extraction under LA, and multiple teeth extraction under general anaesthesia) spanning from 2001/02 to 2009/10. The expected savings in annual carbon dioxide equivalent (CO2e) emissions for all combined dental treatments in subsequent years were calculated compared to those in 2001/02.

RESULTS

An overall decrease in CO2e emissions was evident in the Childsmile programme and across all dental procedures. The estimated reduction in emissions across all procedures varied from 102.5 tonnes in 2002/03 to 461.1 tonnes in 2009/10 when compared to 2001/02. Within three years, the expected emissions savings from all combined dental procedures surpassed the emissions generated by implementing the Childsmile programme.

CONCLUSIONS

Over time, there was a significant reduction in annual CO2e emissions for all combined dental treatments in children. In the eighth year of the Childsmile, emissions savings were more than 4.5 times greater than the emissions generated during its implementation.

CLINICAL SIGNIFICANCE

The study highlights the importance of educating public by individual dentists about the environmental impact of caries prevention programmes and paediatric dental treatments as this may influence patient choice. It also encourages commissioners of community dental programmes to support the implementation of supervised toothbrushing programmes in early years childcare.

Characteristics of symptoms and symptom change across different heart failure subtypes: a sex-stratified analysis

AIMS

To examine sex-stratified differences in the association of left ventricular ejection fraction-based heart failure (HF) subtypes and the characteristics and correlates of self-reported changes in HF symptoms.

METHODS AND RESULTS

We report a secondary data analysis from 528 hospitalized individuals diagnosed with HF characterised by a reduced, mildly reduced, or preserved ejection fraction [HF with reduced ejection fraction (HFrEF), HF with mildly reduced ejection fraction (HFmrEF), or HF with preserved ejection fraction (HFpEF)] who completed 12-month follow-up within a multicentre disease management trial. There were 302 men (71.1 ± 11.9 years, 58% with HFrEF) and 226 women (77.1 ± 10.6 years, 49% with HFpEF). The characteristics of self-reported symptoms measured by the Kansas City Cardiomyopathy Questionnaire (KCCQ) at baseline and 12-month were analysed. At baseline, shortness of breath and fatigue predominated; with key differences according to HF subtypes in bilateral ankle oedema (both sexes), walking problems (women) and depressive symptoms (men). At 12-month follow-up, most KCCQ scores had not significantly changed. However, 25% of individuals reported worse symptom. In women, those with HFpEF had worse symptoms than those with HFmrEF/HFrEF (P = 0.025). On an adjusted basis, women [odds ratios (OR): 1.78, 95% confidence interval (CI): 1.00-3.16 vs. men], those with coronary artery disease (OR: 2.01, 95% CI: 1.21-3.31) and baseline acute pulmonary oedema (OR: 1.67, 95% CI: 1.02-2.75) were most likely to report worsening symptoms. Among men, worsening symptoms correlated with a history of hypertension (OR: 2.16, 95% CI: 1.07-4.35) and a non-English-speaking background (OR: 2.30, 95% CI: 1.02-5.20).

CONCLUSION

We found significant heterogeneity (with potential clinical implications) in the symptomatic characteristics and subsequent symptom trajectory according to the sex and HF subtype of those hospitalized with the syndrome.

TRIAL REGISTRATION

ANZCTR12613000921785.

Memory making in critical care: A qualitative thematic synthesis

BACKGROUND

Caring for bereaved families is an important aspect of the nursing role in critical care. Memory making practices are one way in which dying, death and bereavement can be acknowledged and supported within critical care. Memory making was introduced into the care of stillborn babies and neonatal deaths to improve parents' experiences of bereavement, and has since become common practice in adult critical care.

AIMS

The aim of this qualitative thematic synthesis was to explore families' experiences of memory making in critical care, with a view of gaining greater understanding of the ways in which memory making impacts bereaved families.

METHODS

A systematic search strategy was developed, and five databases were searched (Medline, CINAHL, PsychINFO, Embase and ASSIA). Seven qualitative studies were included: four were conducted in adult and three in paediatric critical care settings in which memory making was initiated between 2014 and 2020. Memory making practices included, patient diaries, general keepsakes, word clouds and photography.

RESULTS

The thematic synthesis generated four main themes to describe families' experience of memory making in critical care: 'connection', 'compassion', 'engagement and creation' and 'continuation'.

CONCLUSIONS

Memory making is a meaningful activity for families whose loved one dies in critical care; it brings focus and meaning during a devastating process in a highly technical environment. Families rely heavily on nursing staff for support and guidance. The creation of memories and/or keepsakes can have a positive impact on the bereavement experience for families and can facilitate a continuing bond with their loved one.

RELEVANCE TO CLINICAL PRACTICE

Memory making is a worthwhile practice to support and guide family bereavement within critical care. It can provide structure and purpose during an emotionally challenging transition, by supporting families to focus on a meaningful activity during a devasting time.

Palliative sedation: autonomy, suffering, and euthanasia

PURPOSE OF REVIEW

This contemporary and novel review of palliative sedation explores some of the distinctive ethical problems associated with that intervention. It is timely in light of recent reviews of palliative care guidelines on the topic and given the current public debates around the related but distinct practice of euthanasia.

RECENT FINDINGS

The main themes discussed are patient autonomy, the nature of suffering and how to alleviate it, and the relationship between palliative sedation and euthanasia.

SUMMARY

First, palliative sedation poses a significant problem for patient autonomy, both in terms of securing informed consent and in terms of the ongoing effect on individual well-being. Second, as an intervention to alleviate suffering, it is appropriate only in limited cases and counterproductive in others, for example, where an individual values their ongoing psychological or social agency more than the relief of pain or negative experience. Third, people's ethical views about palliative sedation are often coloured by their understanding of the legal and moral status of assisted dying and euthanasia; this is unhelpful and occludes the interesting and urgent ethical questions raised by palliative sedation as a distinct end-of-life intervention.

Effectiveness of dignity therapy in the context of culturally competent care in people with palliative care needs: a systematic review of systematic reviews

PURPOSE OF REVIEW

This review aims to synthesise the evidence from systematic reviews and meta-analyses on the efficacy of dignity therapy (DT) in relation to psychosocial and spiritual outcomes in the context of person-centred and culturally competent care for people with supportive and palliative care needs.

RECENT FINDINGS

Thirteen reviews were found, including seven conducted by nurses. Most reviews were of high quality, including various study populations such as cancer, motor neurone disease and non-malignant conditions. Six psychosocial and spiritual outcomes were identified: quality of life, anxiety, depression, hopefulness, meaning and purpose in life, and suffering based on the cultural variations in the implementation of DT.

SUMMARY

DT has a positive impact on anxiety, depression, suffering, and meaning and purpose in life for people with palliative care needs, but the evidence is somewhat conflicted as to whether DT is effective in improving hope, quality of life and spiritual outcomes in the context of culturally competent care. Nurse-led DT seems desirable given its pivotal role when caring for people with palliative care needs. More randomised controlled trials should be conducted for people with different cultural backgrounds to provide person-centred, culturally competent supportive and palliative care.

Caring for people in prison with palliative and end-of-life care needs

PURPOSE OF REVIEW

The prison population is growing and ageing, and many people will die from natural causes while incarcerated. This article provides a contemporary review of key issues related to palliative and end-of-life care in prisons.

RECENT FINDINGS

Few countries have integrated prison hospices. Palliative care needs may go unrecognised in prison. Older offenders may not trust the prison to care for them and may benefit from segregation. Cancer remains a major cause of death. Training staff remains a priority, and technology can help facilitate this. The coronavirus disease 2019 (COVID-19) had a significant impact on prisons, less is known about its impact on palliative care. Compassionate release is underutilised, and the issue of medically assisted dying adds complexity to decisions around end-of-life care. Peer carers can provide reliable symptom assessment. Family members are often absent when someone dies in prison.

SUMMARY

Palliative and end-of-life care in prisons requires a joined-up approach, and staff must understand the challenges of both this and custodial care in general. The relational network both inside and outside of the prison should be involved, and when possible and appropriate, we should consider alternatives to dying whilst incarcerated, such as compassionate release.

An integrative literature review examining the key elements of bereavement follow-up interventions in critical care

PURPOSE OF REVIEW

The aim of this review is to examine bereavement follow-up intervention studies in critical care, with the purpose of integrating results on the timing, content, aims and outcomes of interventions. The impact of a death in critical care is well documented, and bereavement follow-up is recognised as an important topic, but there is limited research with little consensus on the content and structure of interventions.

RECENT FINDINGS

A total of 18 papers were selected; 11 are intervention studies, with only one randomised control trial. Six papers were from national surveys and are not the focus of this review. Bereavement follow-up mainly consisted of information giving, condolence interventions, telephone calls and meetings with families. The timing, content, aims and outcomes depended on the intervention and were influenced by the design of the study.

SUMMARY

Overall, bereavement follow-up is acceptable for relatives but outcomes are mixed. Calls for more research are valid, but how do we utilise the current research to better inform the critical care community? Researchers suggest that bereavement follow-up interventions need to be designed with specific aims and outcomes, in collaboration with bereaved families that are appropriate to the intervention.

Qualitative Research and Cancer Nursing: A Guide for Novice Researchers

OBJECTIVE

To introduce the cancer nurse to qualitative research.

DATA SOURCES

A search of published literature including articles and books was conducted to inform the article using University libraries (University of Galway and University of Glasgow) and CINAHL, Medline, and Google Scholar databases using broad terms, including qualitative research, qualitative methods, paradigm, qualitative, and cancer nursing.

CONCLUSION

It is important for cancer nurses wishing to read, critically appraise, or undertake qualitative research to understand the origins and different methods employed in qualitative research.

IMPLICATIONS FOR NURSING PRACTICE

The article is of relevance for cancer nurses globally who wish to read, critique, or undertake qualitative research.

Formal health care costs among older people in Ireland: methods and estimates using The Irish Longitudinal Study on Ageing (TILDA)

Background: Reliable data on health care costs in Ireland are essential to support planning and evaluation of services. New unit costs and high-quality utilisation data offer the opportunity to estimate individual-level costs for research and policy. Methods: Our main dataset was The Irish Longitudinal Study on Ageing (TILDA). We used participant interviews with those aged 55+ years in Wave 5 (2018) and all end-of-life interviews (EOLI) to February 2020. We weighted observations by age, sex and last year of life at the population level. We estimated total formal health care costs by combining reported usage in TILDA with unit costs (non-acute care) and public payer reimbursement data (acute hospital admissions, medications). All costs were adjusted for inflation to 2022, the year of analysis. We examined distribution of estimates across the population, and the composition of costs across categories of care, using descriptive statistics. We identified factors associated with total costs using generalised linear models. Results: There were 5,105 Wave 5 observations, equivalent at the population level to 1,207,660 people aged 55+ years and not in the last year of life, and 763 EOLI observations, equivalent to 28,466 people aged 55+ years in the last year of life. Mean formal health care costs in the weighted sample were EUR 8,053; EUR 6,624 not in the last year of life and EUR 68,654 in the last year of life. Overall, 90% of health care costs were accounted for by 20% of users. Multiple functional limitations and proximity to death were the largest predictors of costs. Other factors that were associated with outcome included educational attainment, entitlements to subsidised care and serious chronic diseases. Conclusions: Understanding the patterns of costs, and the factors associated with very high costs for some individuals, can inform efforts to improve patient experiences and optimise resource allocation.

Multimorbidity, disease count, mortality and emergency care use in persons attending the emergency department: a cross-sectional data-linkage study

Background

Multimorbidity (two or more concurrent chronic conditions) is associated with poorer health outcomes and increased healthcare utilisation in primary care and general populations. Less is known about the prevalence of multimorbidity in emergency department attenders, or its association with poor outcomes in this population.

Aim

This study sought to explore the relationship between multimorbidity, mortality and health-care utilisation in a large urban cohort of persons attending emergency departments.

Methods

Validated algorithms for the identification of 28 chronic conditions from ICD-10 codes were deployed on a cross-sectional sample of patients attending emergency departments in Glasgow, Scotland between April 2019 and March 2020. Analysis was conducted on complete cases (n=63,328) and compared with results from data with imputed missing values (n=75,723). Models adjusted for age, sex, deprivation and ethnicity were fitted to test for the association between (i) multimorbidity, (ii) complex multimorbidity, (iii) disease count and the following outcomes: admission to hospital, reattendance at 30 and 90 days, and death during admission.

Results

Multimorbidity, complex multimorbidity and disease count were significantly associated with hospital admission and emergency department reattendance. Those with 1-3 conditions were at increased risk of inpatient mortality.

Conclusion

This study further evidences the impact of multimorbidity and disease burden on health-care use, and mortality to a lesser extent. Deployed algorithms were sufficiently sensitive to detect associations, despite limited access (21 months) to secondary-care data. This should allow for the construction of more robust models to prospectively identify persons at risk of poor outcomes in similar populations.

A mixed-methods systematic review of nurse-led interventions for people with multimorbidity

AIMS

To identify types of nurse-led interventions for multimorbidity and which outcomes are positively affected by them.

DESIGN

Mixed-methods systematic review following the Joanna Briggs Institute (JBI) methods for convergent-integrated reviews.

PROSPERO ID

CRD42020197956.

DATA SOURCES

Cochrane CENTRAL, CINAHL, Embase and MEDLINE were searched in October 2020. Grey literature sources included OpenGrey, the Journal of Multimorbidity and Comorbidity and reference mining.

REVIEW METHODS

English-language reports of nurse-led interventions for people with multimorbidity were included based on author consensus. Two reviewers performed independent quality appraisal using JBI tools. Data were extracted and synthesized using a pre-existing taxonomy of interventions and core outcome set.

RESULTS

Twenty studies were included, with a median summary quality score of 77.5%. Interventions were mostly case-management or transitional care interventions, with nurses in advanced practice, support to self-manage conditions, and an emphasis on continuity of care featuring frequently. Patient-centred outcomes such as quality of healthcare and health-related quality of life were mostly improved, with mixed effects on healthcare utilization, costs, mortality and other outcomes.

CONCLUSION

Interventions such as case management are agreeable to patients and transitional care interventions may have a small positive impact on healthcare utilization. Interventions include long-term patient management or short-term interventions targeted at high-risk junctures. These interventions feature nurses in advanced practice developing care plans in partnership with patients, to simplify and improve the quality of care both in the long and short-term.

IMPACT

This is the first mixed-methods review which includes all types of nurse-led interventions for multimorbidity and does not focus on specific comorbidities or elderly/frail populations. Using adapted consensus-developed frameworks for interventions and outcomes, we have identified the common features of interventions and their overall typology. We suggest these interventions are of value to patients and healthcare systems but require localization and granular evaluation of their components to maximize potential benefits.

The influence of anastomotic techniques on postoperative anastomotic complications: Results of the Oesophago-Gastric Anastomosis Audit

BACKGROUND

The optimal anastomotic techniques in esophagectomy to minimize rates of anastomotic leakage and conduit necrosis are not known. The aim of this study was to assess whether the anastomotic technique was associated with anastomotic failure after esophagectomy in the international Oesophago-Gastric Anastomosis Audit cohort.

METHODS

This prospective observational multicenter cohort study included patients undergoing esophagectomy for esophageal cancer over 9 months during 2018. The primary exposure was the anastomotic technique, classified as handsewn, linear stapled, or circular stapled. The primary outcome was anastomotic failure, namely a composite of anastomotic leakage and conduit necrosis, as defined by the Esophageal Complications Consensus Group. Multivariable logistic regression modeling was used to identify the association between anastomotic techniques and anastomotic failure, after adjustment for confounders.

RESULTS

Of the 2238 esophagectomies, the anastomosis was handsewn in 27.1%, linear stapled in 21.0%, and circular stapled in 51.9%. Anastomotic techniques differed significantly by the anastomosis sites (P < .001), with the majority of neck anastomoses being handsewn (69.9%), whereas most chest anastomoses were stapled (66.3% circular stapled and 19.3% linear stapled). Rates of anastomotic failure differed significantly among the anastomotic techniques (P < .001), from 19.3% in handsewn anastomoses, to 14.0% in linear stapled anastomoses, and 12.1% in circular stapled anastomoses. This effect remained significant after adjustment for confounding factors on multivariable analysis, with an odds ratio of 0.63 (95% CI, 0.46-0.86; P = .004) for circular stapled versus handsewn anastomosis. However, subgroup analysis by anastomosis site suggested that this effect was predominantly present in neck anastomoses, with anastomotic failure rates of 23.2% versus 14.6% versus 5.9% for handsewn versus linear stapled anastomoses versus circular stapled neck anastomoses, compared with 13.7% versus 13.8% versus 12.2% for chest anastomoses.

CONCLUSIONS

Handsewn anastomoses appear to be independently associated with higher rates of anastomotic failure compared with stapled anastomoses. However, this effect seems to be largely confined to neck anastomoses, with minimal differences between techniques observed for chest anastomoses. Further research into standardization of anastomotic approach and techniques may further improve outcomes.

How much do consumers consider sustainability when purchasing a toothbrush? A discrete choice experiment

Introduction A recent resurgence of sustainability in healthcare has resulted in huge progress towards more 'eco-aware' products and their incorporation into everyday life, with home oral hygiene products being not far behind. However, it is unclear which components of sustainability consumers value or how much they are willing to pay for these.Aim To use a discrete choice experiment (DCE) to evaluate preferences for attributes such as recyclable handle materials and recyclable packaging of low-cost disposable manual toothbrushes, along with the willingness to pay (WTP) for said attributes.Methods Design and implementation of the DCE were informed by best practice guidelines. A multi-method approach was used for attribute identification and refinement. Participants were recruited through an online survey platform. Conditional logistic regression model was used to estimate participant preferences for the attributes. WTP for attributes was estimated using the ratio of the coefficient of a given attribute level to the product cost coefficient.Results A total of 326 participants took part in the survey, of which 169 were women (52%). The median age was 35 years of age. The three most influential attributes were: bamboo handles (= 0.486 and WTP = £4.85 [€5.79]), recyclable plastic handles (= 0.338, WTP = £3.37 [€4.02]) and recyclable packaging (= 0.191,WTP = £2.32 [€2.77]).Conclusion Sustainable attributes dominated consumer preference when considering the purchase of a manual disposable toothbrush. This could perhaps be due to new environmental initiatives from influential oral hygiene companies or activism.

Communicating with young children who have a parent dying of a life-limiting illness: a qualitative systematic review of the experiences and impact on healthcare, social and spiritual care professionals

Background

Healthcare professionals play a key role in interacting with children who have a parent with a life-limiting illness. While playing such a role can be challenging, not much is known about how such interactions impact these professionals and affect their ability to render support.

Methods

Four databases were searched with the intention to conduct a qualitative systematic review. Articles were selected based on pre-determined inclusion and exclusion criteria. Their quality was assessed using the tool "Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields”. Findings were analysed using thematic analysis techniques outlined by Thomas and Harden as well as Sandelowski and Barroso. Review was registered with the Review Registry database.

Results

Three themes emerged – healthcare professionals’ discomfort; their assumptions and actions; and potentiating workplace factors. The discomfort had several dimensions: fear of making a situation worse, concern of not being able to cope with emotionally charged situations, and internal conflict that arose when their values clashed with family dynamics.

Conclusion

Healthcare professionals’ sense of discomfort was very pronounced. This discomfort, together with their assumptions, could impact their ability to support children. The organisation played an important role, which was reflected in the work culture, workflow and ability to collaborate with other agencies involved in supporting children. The discomfort was mitigated by having more professional experience, workplace support systems and training on communicating with children. It was apparent that the individual professional did not work alone when supporting children but alongside others within an organisation. As such, issues raised in this review will benefit from multi-faceted solutions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12904-022-01007-1.

Cutting through the intersections to care for caregivers: Secondary data analysis of a carers support service in Glasgow, Scotland

As the number of people living longer with life-limiting conditions grows, so too does the number of caregivers and the complexity of the caring role. To understand more about the role and how caregivers can be supported, local and national registers have been created that collect data on caregivers. Our objective was to undertake comparative analysis of female and male adult caregiver assessments from a caregiver database created from a carers support service running in Glasgow, Scotland. Assessments were carried out over a 12-month period (01/04/17-29/03/18). We aimed to identify the prevalence of negative consequences of caring through descriptive statistical, comparative analysis. Seven hundred and eighty-three assessments were eligible for inclusion. In our dataset, 69% were female (n = 552), and 29% were male (n = 231). Female caregivers were more likely to be of working age but unemployed (p = 0.03) and experiencing mental ill-health (p = 0.011). Male caregivers were more likely to be retired (p < 0.001), caring for a parent (p = 0.017) and living with heart disease (p = 0.0004), addiction issues (p = 0.013) or diabetes (p = 0.042) than female caregivers. For caregivers using this support service, female and male caregivers experienced, recognised or reported negative impacts from caring on their personal identity, social life, ability to self-care and relationships similarly. Furthermore, a caregiver whose relationships had been negatively impacted was 13.8 times more likely (p > 0.00) to report a reduction in psychological well-being. Sex disaggregated data are an important consideration for caregiver research due to socio-political influences that impact caring roles and expectations. Disaggregating data by sex allow researchers to understand how the caring role differs between subsets and allow for the development of more targeted, sensitive support.

Dignity Therapy - past, present and future journey: Beyond end of life cancer care. Responding to Grassi et al

This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Views of Care at End of Life: A Secondary Analysis of Online Feedback Using Care Opinion

Although there are studies on the use of social media and palliative and end-of-life care (PEOLC), there are no studies specifically investigating the content of online public feedback about PEOLC services. This study sought to understand experiences of end-of-life care provided in hospitals in the West of Scotland by exploring the main themes within the content of stories posted on a nationally endorsed nonprofit feedback online platform, Care Opinion, within a 2-year period. We used “Appreciative Inquiry” as a theoretical framework for this study to determine what works well in end-of-life care, while also identifying areas for further improvement. Of the 1428 stories published on “Care Opinion” from March 2019 to 2021 regarding hospitals in the West of Scotland, 48 (3.36%) were related to end-of-life care, of which all were included in data analysis. Using the software package NVivo and thematic analysis, we identified 4 key themes. We found that people overwhelmingly posted positive feedback about their experiences with end-of-life care. People reported positively about staff professionalism in providing compassionate and person-centered care to meet their loved ones needs at end of life. Other experiences of care related to challenges facing healthcare services, particularly during the COVID-19 pandemic. Quality appraisal of staff responses highlighted areas for improving feedback. This study can add to the aim of improving staff response to people’s concerns about end-of-life care. This study has provided a novel perspective of patients’ experiences of end-of-life care in hospitals in the West of Scotland. Novel insights were the appreciation of quality of care, staff professionalism, effective communication, and meeting patient’s needs at end-of-life particularly by nursing staff.

Textbook outcome following oesophagectomy for cancer: international cohort study

Background

Textbook outcome has been proposed as a tool for the assessment of oncological surgical care. However, an international assessment in patients undergoing oesophagectomy for oesophageal cancer has not been reported. This study aimed to assess textbook outcome in an international setting.

Methods

Patients undergoing curative resection for oesophageal cancer were identified from the international Oesophagogastric Anastomosis Audit (OGAA) from April 2018 to December 2018. Textbook outcome was defined as the percentage of patients who underwent a complete tumour resection with at least 15 lymph nodes in the resected specimen and an uneventful postoperative course, without hospital readmission. A multivariable binary logistic regression model was used to identify factors independently associated with textbook outcome, and results are presented as odds ratio (OR) and 95 per cent confidence intervals (95 per cent c.i.).

Results

Of 2159 patients with oesophageal cancer, 39.7 per cent achieved a textbook outcome. The outcome parameter ‘no major postoperative complication’ had the greatest negative impact on a textbook outcome for patients with oesophageal cancer, compared to other textbook outcome parameters. Multivariable analysis identified male gender and increasing Charlson comorbidity index with a significantly lower likelihood of textbook outcome. Presence of 24-hour on-call rota for oesophageal surgeons (OR 2.05, 95 per cent c.i. 1.30 to 3.22; P = 0.002) and radiology (OR 1.54, 95 per cent c.i. 1.05 to 2.24; P = 0.027), total minimally invasive oesophagectomies (OR 1.63, 95 per cent c.i. 1.27 to 2.08; P &lt; 0.001), and chest anastomosis above azygous (OR 2.17, 95 per cent c.i. 1.58 to 2.98; P &lt; 0.001) were independently associated with a significantly increased likelihood of textbook outcome.

Conclusion

Textbook outcome is achieved in less than 40 per cent of patients having oesophagectomy for cancer. Improvements in centralization, hospital resources, access to minimal access surgery, and adoption of newer techniques for improving lymph node yield could improve textbook outcome.

Textbook outcome following oesophagectomy for cancer: international cohort study

BACKGROUND

Textbook outcome has been proposed as a tool for the assessment of oncological surgical care. However, an international assessment in patients undergoing oesophagectomy for oesophageal cancer has not been reported. This study aimed to assess textbook outcome in an international setting.

METHODS

Patients undergoing curative resection for oesophageal cancer were identified from the international Oesophagogastric Anastomosis Audit (OGAA) from April 2018 to December 2018. Textbook outcome was defined as the percentage of patients who underwent a complete tumour resection with at least 15 lymph nodes in the resected specimen and an uneventful postoperative course, without hospital readmission. A multivariable binary logistic regression model was used to identify factors independently associated with textbook outcome, and results are presented as odds ratio (OR) and 95 per cent confidence intervals (95 per cent c.i.).

RESULTS

Of 2159 patients with oesophageal cancer, 39.7 per cent achieved a textbook outcome. The outcome parameter 'no major postoperative complication' had the greatest negative impact on a textbook outcome for patients with oesophageal cancer, compared to other textbook outcome parameters. Multivariable analysis identified male gender and increasing Charlson comorbidity index with a significantly lower likelihood of textbook outcome. Presence of 24-hour on-call rota for oesophageal surgeons (OR 2.05, 95 per cent c.i. 1.30 to 3.22; P = 0.002) and radiology (OR 1.54, 95 per cent c.i. 1.05 to 2.24; P = 0.027), total minimally invasive oesophagectomies (OR 1.63, 95 per cent c.i. 1.27 to 2.08; P < 0.001), and chest anastomosis above azygous (OR 2.17, 95 per cent c.i. 1.58 to 2.98; P < 0.001) were independently associated with a significantly increased likelihood of textbook outcome.

CONCLUSION

Textbook outcome is achieved in less than 40 per cent of patients having oesophagectomy for cancer. Improvements in centralization, hospital resources, access to minimal access surgery, and adoption of newer techniques for improving lymph node yield could improve textbook outcome.

Risk factors associated with poorer experiences of end-of-life care and challenges in early bereavement: Results of a national online survey of people bereaved during the COVID-19 pandemic

BACKGROUND

Experiences of end-of-life care and early bereavement during the COVID-19 pandemic are poorly understood.

AIM

To identify clinical and demographic risk factors for sub-optimal end-of-life care and pandemic-related challenges prior to death and in early bereavement, to inform clinical practice, policy and bereavement support.

DESIGN

Online national survey of adults bereaved in the UK (deaths between 16 March 2020 and 2 January 2021), recruited via media, social media, national associations and organisations.

SETTING/PARTICIPANTS

711 participants, mean age 49.5 (SD 12.9, range 18-90). 628 (88.6%) were female. Mean age of the deceased was 72.2 (SD 16.1, range miscarriage to 102 years). 311 (43.8%) deaths were from confirmed/suspected COVID-19.

RESULTS

Deaths in hospital/care home increased the likelihood of poorer experiences at the end of life; for example, being unable to visit or say goodbye as wanted (p < 0.001). COVID-19 was also associated with worse experiences before and after death; for example, feeling unsupported by healthcare professionals (p < 0.001), social isolation/loneliness (OR = 0.439; 95% CI: 0.261-0.739), and limited contact with relatives/friends (OR = 0.465; 95% CI: 0.254-0.852). Expected deaths were associated with a higher likelihood of positive end-of-life care experiences. The deceased being a partner or child also increased the likelihood of positive experiences, however being a bereaved partner strongly increased odds of social isolation/loneliness, for example, OR = 0.092 (95% CI: 0.028-0.297) partner versus distant family member.

CONCLUSIONS

Four clear risk factors were found for poorer end-of-life care and pandemic-related challenges in bereavement: place, cause and expectedness of death, and relationship to the deceased.

Communication strategies and persuasion as core components of shared decision-making for children with life-limiting conditions: A multiple case study

BACKGROUND

Families and professionals caring for children with life-limiting conditions face difficult healthcare decisions. Shared decision-making is promoted in many countries, however little is known about factors influencing these processes.

AIM

To explore the communication strategies used in shared decision-making for children with life-limiting conditions.

DESIGN

A longitudinal, qualitative, multiple-case study. Cases were centred around the child and parent/carer(s). Most cases also included professionals or extended family members. Data from interviews, observations and medical notes were re-storied for each case into a narrative case summary. These were subject to comparative thematic analysis using NVivo11.

SETTING/PARTICIPANTS

Eleven cases recruited from three tertiary hospitals in England. 23 participants were interviewed (46 interviews). Cases were followed for up to 12 months between December 2015 and January 2017. 72 observations were conducted and the medical notes of nine children reviewed.

FINDINGS

Strategies present during shared decision-making were underpinned by moral work. Professionals presented options they believed were in the child's best interests, emphasising their preference. Options were often presented in advance of being necessary to prevent harm, therefore professionals permitted delay to treatment. Persuasion was utilised over time when professionals felt the treatment was becoming more urgent and when families felt it would not promote the child's psychosocial wellbeing.

CONCLUSIONS

Communication strategies in shared decision-making are underpinned by moral work. Professionals should be aware of the models of shared decision-making which include such communication strategies. Open discussions regarding individuals' moral reasoning may assist the process of shared decision-making.

Mixed methods systematic review: Factors influencing research activity among nurses in clinical practice

AIM

This study aimed to identify, evaluate and summarise current evidence in relation to the factors that influence the conducting of research by nurses in clinical practice.

DESIGN

This study used mixed methods systematic review.

DATA SOURCES

CINAHL, EMBASE, MEDLINE, Scopus and ASSIA, with dates limited from 2015 to 2020, were used to conduct a systematic search of the literature.

REVIEW METHODS

The Joanna Briggs Institute approach was followed, with results reported according to the Preferred Reporting System for Systematic Reviews and Meta-Analyses. The associated checklist for systematic reviews was also used. A standardised data extraction tool was then used, with quality appraisal guided by the Mixed Methods Appraisal Tool, with a subsequent convergent qualitative synthesis.

RESULTS

Sixteen papers were identified for inclusion, nine quantitative, six qualitative and one mixed methods. Four themes were identified: research competence and culture, proactive research mentorship, research resources and making a difference. These were critically discussed in relation to barriers and enablers to the conduct of research by nurses in clinical practice. Commonly cited barriers included a lack of research knowledge, confidence and access to resources, particularly protected time, while enablers such as educational partnerships, identifying research-motivated clinical nurses and access to research role models were also apparent in the literature.

CONCLUSIONS

Globally, nurses in clinical practice are clearly motivated to engage in the research process despite apparent barriers that have a significant impact on productivity. Nevertheless, there are also enablers to building research capacity apparent that offer methodological and structural approaches to empower this group to conduct research.

Exploring the Dilemma of Ethical Issues Using the Lens of Seedhouse Can Help Oncology Nurses to Gain a Different Perspective on Caring for Older Adults with Cancer

OBJECTIVE

To explore ethical issues associated with older adults with cancer and the people who matter to them.

DATA SOURCES

A scoping review of the literature was conducted to inform the article using CINAHL, Medline, and Google Scholar databases using broad terms, older adults, geriatrics, cancer, and ethics.

CONCLUSION

Older adults with cancer experience ageism, which stems from a range of uncertainties on best practice in care and treatment. By employing an ethical lens, decision-making by oncology nurses can be aided by creating and promoting autonomy through impeccable communication. Best interests for individual older adults with cancer can also be served by oncology nurses working in a way that serves needs first and acts in the best interests of the person and their family.

IMPLICATIONS FOR NURSING PRACTICE

The article is of relevance to practicing oncology globally nurses because the framework can be easily used in clinical practice.

Postoperative outcomes in oesophagectomy with trainee involvement

BACKGROUND

The complexity of oesophageal surgery and the significant risk of morbidity necessitates that oesophagectomy is predominantly performed by a consultant surgeon, or a senior trainee under their supervision. The aim of this study was to determine the impact of trainee involvement in oesophagectomy on postoperative outcomes in an international multicentre setting.

METHODS

Data from the multicentre Oesophago-Gastric Anastomosis Study Group (OGAA) cohort study were analysed, which comprised prospectively collected data from patients undergoing oesophagectomy for oesophageal cancer between April 2018 and December 2018. Procedures were grouped by the level of trainee involvement, and univariable and multivariable analyses were performed to compare patient outcomes across groups.

RESULTS

Of 2232 oesophagectomies from 137 centres in 41 countries, trainees were involved in 29.1 per cent of them (n = 650), performing only the abdominal phase in 230, only the chest and/or neck phases in 130, and all phases in 315 procedures. For procedures with a chest anastomosis, those with trainee involvement had similar 90-day mortality, complication and reoperation rates to consultant-performed oesophagectomies (P = 0.451, P = 0.318, and P = 0.382, respectively), while anastomotic leak rates were significantly lower in the trainee groups (P = 0.030). Procedures with a neck anastomosis had equivalent complication, anastomotic leak, and reoperation rates (P = 0.150, P = 0.430, and P = 0.632, respectively) in trainee-involved versus consultant-performed oesophagectomies, with significantly lower 90-day mortality in the trainee groups (P = 0.005).

CONCLUSION

Trainee involvement was not found to be associated with significantly inferior postoperative outcomes for selected patients undergoing oesophagectomy. The results support continued supervised trainee involvement in oesophageal cancer surgery.

Understanding the use of heart failure online health forums: a qualitative study

AIMS

Heart failure is a major public health challenge and is described as an epidemic. Many people resort to the internet as a source of health information and online health forums have become an increasingly common way to obtain information and support regarding health-related issues. This study aims to explore what information people concerned about heart failure seek from online health forums, and how this shapes decision-making, trust, and interactions with healthcare professionals.

METHODS AND RESULTS

Widely available internet search engines (Google, Yahoo, and Bing) were used to identify online health forums, accessed by people seeking information on heart failure. Comments posted between 2016 and 2019 were screened, downloaded, and analysed thematically. Normalization Process Theory provided the underlying conceptual lens to inform analysis. Ten online health forums were identified, and 204 individual posts analysed. Three themes were identified [(information and support needs; online diagnosis; and relationship with healthcare professionals (HCPs)]. The most common purpose for using online health forums was to plug information/knowledge gaps surrounding diagnosis or treatments (e.g. discussion of results, medication/health insurance queries). They were used as a tool to aid decision-making regarding, (i) whether to seek further medical attention and (ii) lifestyle choices, medications, and other advice surrounding concerns. Negative experiences with HCPs were discussed, and sometimes online health forums appeared to promote distrust with HCPs.

CONCLUSION

Online health forums offer a supportive platform and help fill key informational gaps. However, online forums may amplify distrust with HCPs.

Implementing technology to support the deteriorating patient in acute care: evaluating staff views

BACKGROUND

Early warning scores (EWS) have been widely used to aid in the detection of deterioration. The use of technology, alongside EWS, may improve patient safety and lead to improvements in the accuracy of documentation.

AIM

The aim of this service evaluation was to understand nurses' and healthcare support worker views around the implementation of handheld electronic devices for documenting care related to the deteriorating patient.

METHODS

Before the implementation of an electronic handheld device, in-depth semi-structured interviews with nursing staff and healthcare support workers were undertaken to explore the context for improvement. The Consolidated Framework for Implementation Research was used to analyse, organise and present data, to ensure systematic inquiry across the range of potential facilitators and challenges perceived by staff. In all, 11 interviews were undertaken across three speciality areas (four wards).

FINDINGS

Challenges to the use of new technology included staff apprehension around training and education needs and the uncertainty of technological reliability in the clinical setting. Potential facilitators to support the implementation of this technology were: the potential for improved communication across the individual ward and hospital setting and the potential for more streamlined processes for escalation of concerns.

CONCLUSION

Three main recommendations for practice emerged. First, nurses should be involved in the development of the systems. Appropriate time is required to embed the technology in practice. Finally, thought must be given not just to the absolute number of devices required and their reliability, but also how new technology interacts in each individual context.

Palliative care research promotion in policy and practice: a knowledge exchange process

In palliative care, as in many areas of medicine, there is a considerable amount of research conducted that makes sound recommendations but does not result consistently in improved care. For instance, though palliative care has been shown to benefit all people with a life-threatening illness, its main reach continues to be for those with cancer. Drawing on relational models of research use, we set out to engage policy-makers, educators, clinicians, commissioners and service providers in a knowledge exchange process to identify implications of research for Scottish palliative care priorities. First, we mapped the existing palliative care research evidence in Scotland. We then organised evidence review meetings and a wider stakeholder event where research producers and users came together to coproduce implications of the evidence for policy, education and practice. We used questionnaires and key stakeholder feedback meetings to explore impacts of this process on research uptake and use immediately after the events and over time. In this paper, we reflect on this knowledge exchange process and the broader context in which it was set. We found that participation fostered relationships and led to a rich and enthusiastic exploration of research evidence from multiple perspectives. Potential impacts relating to earlier identification for palliative care, education and need-based commissioning ensued. We make suggestions to guide replication.

An analysis of the diagnostic accuracy and peer-to-peer health information provided on online health forums for heart failure

AIMS

To examine the accuracy of diagnostic responses and types of information provided on online health forums.

DESIGN

Qualitative descriptive study.

METHODS

This paper reports the findings of a thematic analysis of peer responses to posts included on heart failure online health forums, to understand the quality and types of information provided. Responses posted between March 2016 and March 2019 were screened, collected and analysed thematically using Braun & Clarke. Themes were conceptually underpinned by Normalization Process Theory. Responses were assessed for quality against the NICE and SIGN guidelines to determine whether they were evidence based or not.

RESULTS

The total number of responses collected for analysis was 639. Five main themes were identified: diagnostic, experiential, informational, peer relations and relationships with healthcare professionals. Out of 298 diagnostic responses, 5% were guideline evidence-based and 6% had information that were partly evidence-based. Non-evidence based and potentially dangerous responses were 10%. Experiential responses were 10%; 23% included advice that was not supported with any clinical evidence; and 46% signposted users to other online references/healthcare professionals.

CONCLUSION

Online health communication largely focuses on provision of experiential responses to assist those in need of pre- or post-diagnosis advice and support. However, there is evidence of inaccurate information provision which suggests the use of a moderator would be beneficial.

IMPACT

This study suggests heart failure online health forums are a source of support, however, there are potential risks. Increasing nurses and other health care professional's awareness of online health forums will be important. Additional training is needed to help them learn more about patient's use of online health forums, to gain a better understanding about the types of information sought, and how best to address such knowledge deficits. Healthcare systems must ensure sufficient time and resources are available to meet information needs for people with heart failure.

Mortality from esophagectomy for esophageal cancer across low, middle, and high-income countries: An international cohort study

BACKGROUND

No evidence currently exists characterising global outcomes following major cancer surgery, including esophageal cancer. Therefore, this study aimed to characterise impact of high income countries (HIC) versus low and middle income countries (LMIC) on the outcomes following esophagectomy for esophageal cancer.

METHOD

This international multi-center prospective study across 137 hospitals in 41 countries included patients who underwent an esophagectomy for esophageal cancer, with 90-day follow-up. The main explanatory variable was country income, defined according to the World Bank Data classification. The primary outcome was 90-day postoperative mortality, and secondary outcomes were composite leaks (anastomotic leak or conduit necrosis) and major complications (Clavien-Dindo Grade III - V). Multivariable generalized estimating equation models were used to produce adjusted odds ratios (ORs) and 95% confidence intervals (CI95%).

RESULTS

Between April 2018 to December 2018, 2247 patients were included. Patients from HIC were more significantly older, with higher ASA grade, and more advanced tumors. Patients from LMIC had almost three-fold increase in 90-day mortality, compared to HIC (9.4% vs 3.7%, p < 0.001). On adjusted analysis, LMIC were independently associated with higher 90-day mortality (OR: 2.31, CI95%: 1.17-4.55, p = 0.015). However, LMIC were not independently associated with higher rates of anastomotic leaks (OR: 1.06, CI95%: 0.57-1.99, p = 0.9) or major complications (OR: 0.85, CI95%: 0.54-1.32, p = 0.5), compared to HIC.

CONCLUSION

Resections in LMIC were independently associated with higher 90-day postoperative mortality, likely reflecting a failure to rescue of these patients following esophagectomy, despite similar composite anastomotic leaks and major complication rates to HIC. These findings warrant further research, to identify potential issues and solutions to improve global outcomes following esophagectomy for cancer.

Florence Nightingale's legacy for clinical academics: A framework analysis of a clinical professorial network and a model for clinical academia

BACKGROUND

Clinical academic nursing roles are rare, and clinical academic leadership positions even more scarce. Amongst the United Kingdom (UK) academia, only 3% of nurses who are employed within universities are clinically active. Furthermore, access to research fellowships and research grant funding for nurses in clinical or academic practice is also limited. The work of Florence Nightingale, the original role model for clinical academic nursing, is discussed in terms of how this has shaped and influenced that of clinical academic nurse leaders in modern UK healthcare settings. We analysed case studies with a view to providing exemplars and informing a new model by which to visualise a trajectory of clinical academic careers.

METHODS

A Framework analysis of seven exemplar cases was conducted for a network of Clinical Academic Nursing Professors (n = 7), using a structured template. Independent analysis highlighted shared features of the roles: (a) model of clinical academic practice, (b) infrastructure for the post, (c) capacity-building initiatives, (d) strategic influence, (e) wider influence, (f) local and national implementation initiatives, (g) research area and focus and (h) impact and contribution.

FINDINGS

All seven of the professors of nursing involved in this discourse were based in both universities and healthcare organisations in an equal split. All had national and international profiles in their specialist clinical areas and were implementing innovation in their clinical and teaching settings through boundary spanning. We outline a model for career trajectories in clinical academia, and how leadership is crucial.

CONCLUSION

The model outlined emphasises the different stages of clinical academic roles in nursing. Nursing as a discipline needs to embrace the value of these roles, which have great potential to raise the standards of healthcare and the status of the profession.

Health system foundations for Sláintecare implementation in 2020 and beyond - co-producing a Sláintecare Living Implementation Framework with Evaluation: Learning from the Irish health system's response to COVID-19. A mixed-methods study protocol

All over the world, health systems are responding to the major shock of the COVID-19 pandemic. The virus is causing urgent and fast-paced change in the delivery of health and social care as well as highlighting pre-existing deficiencies and inequalities in the health system and broader society. In Ireland, COVID-19 is occurring during the second full year of Sláintecare’s implementation – Ireland’s 10-year plan for health reform to deliver universal access to timely, integrated care.

This research will coproduce a Living Implementation Framework with Evaluation (LIFE) linking evidence, policy and practice that feeds into real-world Sláintecare implementation. In partnership with senior leadership in the Sláintecare Programme Implementation Office, the Department of Health and the HSE, the researchers will scope, document, measure and analyse the Sláintecare relevant COVID-19 responses using qualitative and quantitative methods.

The LIFE will initially take the form of a live spreadsheet which contains the COVID-19 responses most relevant to Sláintecare. For each response, 3-4 indicators will be collected which enables monitoring overtime. The spreadsheet will be accompanied by a series of rapid reviews, narrative descriptions of multiple case studies, research papers, stakeholder engagement and formative feedback. These collectively make up the ‘LIFE’, informing dialogue with the project partners, which is happening in real time (living), influencing health policy and system decision-making and implementation as the project progresses. The LIFE will inform health system reform in Ireland in the months and years after the emergence of COVID-19 as well as contributing to international health systems and policy research.

Caring, sharing, preparing and declaring: how do hospices support prisons to provide palliative and end of life care? A qualitative descriptive study using telephone interviews

BACKGROUND

Older adults in prison have complex healthcare needs, and many will need palliative care before their sentence ends. Compared with prison-based hospices, little is known about the role played by community-based hospices in providing palliative care to people in prison.

AIM

To describe the roles Scottish hospices have adopted to support prisons to provide palliative care, and to discuss the international relevance of these findings in addressing the knowledge gap around community hospices supporting people in prison.

DESIGN

A qualitative descriptive study using semi-structured telephone interviews.

SETTING/PARTICIPANTS

Representatives from all Scottish adult hospices were invited to take part in a short telephone interview and all (N = 17) participated.

RESULTS

Four roles were identified: caring, sharing, preparing and declaring. Most hospices employed different combinations of roles. Five (30%) hospices were engaged in caring (providing direct care at the prison or the hospice). Eleven (65%) hospices were engaged in sharing (supporting the prison by sharing knowledge and expertise). Eleven (65%) hospices were engaged in preparing (making preparations to support prisons). All seventeen hospices were described as declaring (expressing a willingness to engage with prisons to provide care).

CONCLUSIONS

There are differences and similarities in the way countries provide palliative care to people in prison: many are similar to Scotland in that they do not operate prison-based hospices. Variations exist in the level of support hospices provide. Ensuring that all people in prison have equitable access to palliative care will require close collaboration between prisons and hospices on a national level.

Sláintecare implementation status in 2020: Limited progress with entitlement expansion

The Sláintecare report developed by political consensus sets out a ten year plan for achieving Universal Health Care (UHC) in Ireland. This paper evaluates the design and progress of the report to mid 2020, but with some reflection on the new COVID 19 era, particularly as it relates to the expansion of entitlements to achieve UHC. The authors explore how close Sláintecare is to the UHC ideal. They also review the phased strategy of implementation in Sláintecare that utilises a systems-thinking approach with interlinkages between entitlements, funding, capacity and implementation. Finally the authors review the Sláintecare milestones against the reality of implementation since the publication of the report in 2017, cognisant of government policy and practice. Some of the initial assumptions around the context of Sláintecare were not realised and there has been limited progress made toward expanding entitlements, and certainly short of the original plan. Nevertheless there have been positive developments in that there is evidence that Government's Implementation Strategy and Action Plans are focussing on reforming a complex adaptive system rather than implementing a blueprint with such initiatives as integrated care pilots and citizen engagement. The authors find that this may help the system change but it risks losing some of the essential elements of entitlement expansion in favour of organisational change.

A mixed methods systematic review of the effects of patient online self-diagnosing in the 'smart-phone society' on the healthcare professional-patient relationship and medical authority

BACKGROUND

As technology continues to advance, the internet is becoming increasingly popular. Self-diagnosis and health information seeking online is growing more common and it will be important to understand the influence this may have on the patient-healthcare professional relationship.

METHODS

A mixed-method systematic review of quantitative, qualitative and mixed method studies concerning the public and healthcare professionals' perceptions of online self-diagnosis and health information seeking and how this can impact the patient-healthcare professional relationship. We searched MEDLINE, EMBASE, CINAHL, ACM & SCOPUS between 2007 and 2018. Relevant data were extracted, and a thematic analysis was conducted and conceptualised using the Normalisation Process Theory framework.

RESULTS

Of 6107 records identified, 25 articles met the review eligibility criteria which included 16 qualitative, 8 quantitative and 1 mixed method study. The findings indicated that patients found the internet as a complementary information source alongside healthcare professionals. Health care professionals were perceived to be the most reliable and valued information source. People feel responsible for their own health and find the internet to be a source that provides information rapidly with accessibility at their convenience. Most healthcare professionals agreed on the importance of collaboration with patients and the need to develop a partnership and shared decision-making process but struggled to find time in the consultation to do so efficiently. Some healthcare professionals felt that the internet was advantageous for patients looking after their own health, while others felt it was due to a lack of trust in their expertise. Patients tended to present information to the healthcare professional to support the therapeutic relationship rather than to challenge it and to become more involved in the decision-making process of their healthcare.

CONCLUSION

The results of this review suggests that patients value healthcare professionals as a source of medical advice more than the internet. While health professionals' views were mixed our findings indicate that online health information seeking can potentially improve the patient-healthcare professional relationship as patients reported they usually conducted an online search to form a partnership with the healthcare professional as opposed to trying to prove them wrong.

COVID-19 and Hospital Palliative Care - A service evaluation exploring the symptoms and outcomes of 186 patients and the impact of the pandemic on specialist Hospital Palliative Care

BACKGROUND

Patients hospitalised with COVID-19 have increased morbidity and mortality, which requires extensive involvement of specialist Hospital Palliative Care Teams. Evaluating the response to the surge in demand for effective symptom management can enhance provision of Palliative Care in this patient population.

AIM

To characterise the symptom profile, symptom management requirements and outcomes of hospitalised COVID-19 positive patients referred for Palliative Care, and to contextualise Palliative Care demands from COVID-19 against a 'typical' caseload from 2019.

DESIGN

Service evaluation based on a retrospective cohort review of patient records.

SETTING/PARTICIPANTS

One large health board in Scotland. Demographic data, patient symptoms, drugs/doses for symptom control, and patient outcomes were captured for all COVID-19 positive patients referred to Hospital Palliative Care Teams between 30th March and 26th April 2020.

RESULTS

Our COVID-19 cohort included 186 patients (46% of all referrals). Dyspnoea and agitation were the most prevalent symptoms (median 2 symptoms per patient). 75% of patients were prescribed continuous subcutaneous infusion for symptom control, which was effective in 78.6% of patients. Compared to a 'typical' caseload, the COVID-19 cohort were on caseload for less time (median 2 vs 5 days; p < 0.001) and had a higher death rate (80.6% vs 30.3%; p < 0.001). The COVID-19 cohort replaced 'typical' caseload; overall numbers of referrals were not increased.

CONCLUSIONS

Hospitalised COVID-19 positive patients referred for Palliative Care may have a short prognosis, differ from 'typical' caseload, and predominantly suffer from dyspnoea and agitation. Such symptoms can be effectively controlled with standard doses of opioids and benzodiazepines.

Reliability of studies published as SR/MA on nutrition in cancer prevention - a systematic survey

Background

In several fields of medicine, the quality of studies published as systematic reviews/meta-analyses (SR/MAs) is low. Similar problems may exist for SR/MA on nutrition in cancer prevention. We aimed to assess overall quality and risk of bias (RoB) of studies published as SR/MA on nutritional interventions in cancer prevention with two instruments: AMSTAR 2 ('a measurement tool to assess systematic review 2') and ROBIS ('Risk of Bias in Systematic Reviews') respectively.

Methods

Following a systematic search in 3 databases we included studies identified as SR/MA published between 2010 and 2018 assessing any nutritional interventions in cancer prevention in the general population or among people with cancer risk (Protocol in PROSPERO CRD42019121116). All the steps of study selection and data extraction were done by two independent reviewers with conflicts solved by discussion or by the third reviewer.

Results

We focused on a subsample of 101 SR/MA randomly selected from 737 included SR/MA. Included SR/MA on average searched 2 databases with Medline in 98% and included cohort studies (93%). They focused on specific food (36%), specific nutrients (27%) or beverages (24%, mostly tea and coffee). The assessment using AMSTAR 2 tool indicated that 93% of SR/MA had no pre-specified methodology, in 77% - research questions and inclusion criteria did not include the components of PICO, RoB assessment of primary studies was not used or did not contain all elements (87%) and RoB was not accounted for in the interpretation of the results (75%). Overall, the quality of 97% of studies was assessed as critically low. In the ROBIS tool for 97% of included studies, the overall high risk of bias was detected. The most important methodological flaws in ROBIS were similar to identified in AMSTAR tool.

Conclusions

Poor quality of SR/MA due to flawed methodology may lead to many concerns and mislead public media and consumers.

Key messages

Poor quality of SR/MA due to flawed methodology may lead to many concerns and mislead public media and consumers. The studies published as SR/MAs addressing nutrition for cancer prevention have major flaws, which limit the reliability of their conclusions.

An Investigation of the Characteristics of Edentulous Patients Who Choose or Refuse Implant Treatment

PURPOSE

To investigate whether pretreatment patient satisfaction, oral health-related quality of life, or diagnostic complexity are predictive of a decision to choose implant treatment.

MATERIALS AND METHODS

Edentulous patients requesting dentures were enrolled in a prospective observational study. All subjects were provided with conventional dentures and then given the option to proceed with the placement of two mandibular implants and to have their prosthesis modified into an implant overdenture. Subjects were classified according to the Prosthodontic Diagnostic Index (PDI-CE) and asked to complete a Denture Satisfaction Questionnaire and the Oral Health Impact Profile for edentulous patients (OHIP-EDENT) at pretreatment, following the provision of new dentures, and following modification to overdentures.

RESULTS

Of the 125 subjects who had conventional dentures, 15 proceeded with implant treatment. The subjects who decided to have implants were not significantly different in terms of diagnostic complexity or level of satisfaction. Those who chose implants were significantly younger, had newer dentures, and had higher OHIP-EDENT scores at baseline. The most common reason for not being satisfied with dentures but avoiding implants was fear of surgery.

CONCLUSION

The majority of subjects in this study were satisfied with conventional denture treatment, despite registering its limitations. Subjects who were more anatomically compromised were not more likely to choose implant treatment. It remains to be shown whether fear of surgery can be overcome in order to increase the uptake of implant treatment and improve patient outcomes.

Differential Diagnosis Decision Support Systems in Primary and Out-of-Hours Care: A Qualitative Analysis of the Needs of Key Stakeholders in Scotland

BACKGROUND

Differential Diagnosis Decision Support Systems (DDDSS) and other forms of clinical decision support systems may have a role in supporting clinicians and the public in making decisions about differential diagnosis and accessing health care services. The aim of this qualitative, focus group study was to explore the needs of out-of-hours and primary care clinicians, and members of the public in relation to DDDSS.

METHODS

Twenty-nine participants (comprising 13 advanced nurse practitioners [ANPs], 7 general practitioners [GPs], 2 allied health professional advanced practitioners [AAPs], and 7 members of the public) took part in 1 of 6 focus groups. Data were audio-recorded, transcribed, and analyzed thematically.

RESULTS

Four themes were identified: (1) Current Practice, (2) Attitudes to DDDSS, (3) Implementation Considerations, and (4) Desirable Characteristics of DDDSS.

DISCUSSION

There may be a role for differential diagnosis decision support systems in supporting clinicians and members of the public; however, it is important that the needs of these groups are considered when designing or implementing any clinical decision support system in primary or out-of-hours care. More research is needed into how these systems could be used within clinical practice.