Palliative care

Care after Death delivered in SaTH (2022)

Posted on by

Type of publication:Service improvement case study

Author(s):*Debbie Snooke Project Lead, Swan EOLC Specialist Nurse *Jules Lewis, Swan EOLC Facilitator & Lead Nurse *Miriam Gilbert, Swan EOLC Specialist Nurse

Citation:SaTH Improvement Hub, October 2022

Abstract:To improve care delivered to our patients after death, the Palliative and End of Life Care team created a training video, checklist and prompt to ensure that care is delivered in line with the Trust Care after Death Policy.

Link to PDF poster [no password required]

Thrombolysis for pulmonary embolism in palliative care: a case report (2017)

Posted on by

Type of publication:Conference abstract

Author(s):Macfarlane M.; Gilhooley L.; *Griffiths T.; Frost S.; Willis D.

Citation:BMJ Supportive and Palliative Care. Conference: APM ASP Conference. Belfast United Kingdom. 7(Supplement 1) (pp A31-A32), 2017. Date of Publication: March 2017.

Abstract:Background Thrombolysis for pulmonary embolism (PE) in a patient with advanced cancer has never been reported in the literature. Whilst not an absolute contraindication, most clinicians would be wary of thrombolysing a patient with a limited life expectancy. A case is presented of a patient with advanced mesothelioma who received thrombolysis treatment with a resultant significant improvement in pleuritic chest pain and dyspnoea. History The patient was a 69 year old man who was diagnosed with epithelioid mesothelioma and received radiotherapy to his right chest followed by palliative chemotherapy. Subsequent CT scanning showed disease progression and the patient declined further chemotherapy. Thrombolysis The patient was admitted to hospital with sudden- onset shortness of breath and right sided chest discomfort which was felt to be due to disease progression. Three days later the patient developed new, severe left sided pleuritic chest pain and acute breathlessness. The patient was thrombolysed with alteplase (50 mg IV over 1 hour) on clinical suspicion of a PE. The pleuritic chest pain resolved completely and the acute severe dyspnoea improved significantly within two hours of treatment and a CTPA later confirmed acute-onchronic pulmonary thromboembolism as well as progressive mesothelioma. The patient was transferred to the hospice four days later for ongoing management and end-of-life care. Effect of Thrombolysis on Symptom Control On admission to the hospice, the patient continued to complain of mild to moderate dyspnoea but had no pain. He was commenced on regular immediate-release morphine (10 mg QDS) for breathlessness but only required one breakthrough dose of analgesia before his condition deteriorated. The patient died comfortably nine days after thrombolysis treatment. Conclusion Thrombolysis was very effective in controlling pleuritic chest pain and acute severe dyspnoea in this patient with PE and advanced cancer with a limited life expectancy.

Link to full-text [NHS OpenAthens account required]

Quality improvement project: improving junior doctors' confidence in prescribing at end of life for acute inpatients (2022)

Posted on by

Type of publication:Conference abstract

Author(s):*Dewhirst L.; *Hudson H.

Citation:BMJ Supportive and Palliative Care. Conference: Palliative Care Congress 1 Specialty: 3 Settings – Home, Hospice, Hospital. Telford United Kingdom. 10(Supplement 1) (pp A14), 2020. Date of Publication: March 2020

Abstract:Background Junior doctors are often at the forefront of prescribing for acute inpatients. It is imperative that they are equipped with the knowledge and confidence to prescribe appropriately for patients at the end of their life. We felt that there was reduced awareness of the need for individualised prescribing for patients with relatively common chronic diseases such as Parkinson's disease and epilepsy. Recognising that prescribing end of life medications for patients with such diseases can differ, we looked to improve symptom management by focussing on improving end of life prescribing. Methods A pre-intervention questionnaire was used to assess subjective confidence levels in prescribing anticipatory medications, syringe drivers, and individualised prescribing for patients with Parkinson's disease, end-stage renal disease, epilepsy, end-stage heart failure, and diabetes mellitus. Based on these findings a prescribing handbook was produced, incorporating consultant advice from relevant specialities. Teaching sessions were carried out using case-based discussions alongside the handbook content. A local press release facilitated dissemination of the handbook. A post-intervention questionnaire was then distributed to reassess prescribers' confidence levels. Results Twenty-five allied health professionals (mainly foundation doctors) completed the questionnaires. The preintervention questionnaire found that the majority were confident in prescribing anticipatory medication but were significantly less confident in prescribing syringe drivers and in individualised prescribing. Following formal education and release of the prescribing handbook, higher confidence levels were reported throughout all themes of the questionnaire. Conclusions This quality improvement project has significantly increased prescribers' confidence levels in end of life prescribing. It has also increased awareness of the need for alternative approaches to prescribing for certain individuals and diseases at the end of life. It was stressed that the handbook is to be used as a guide and should not replace the need to escalate concerns to the relevant specialities and the in-house palliative care team.

Link to full-text [NHS OpenAthens account required]

Clozapine toxicity: a cautionary palliative care tale (2020)

Posted on by

Type of publication:
Journal article

Author(s):
*Macfarlane, Michael; Shahab, Julita; *Willis, Derek

Citation:
BMJ Supportive & Palliative Care; Sep 2020; vol. 10 (no. 3); p. 312-313

Abstract:
OBJECTIVE: This case report presents an unusual case of clozapine toxicity secondary to reduced smoking habit mimicking a patient approaching end of life. METHODS: It is a cautionary tale for palliative care specialists, perhaps unaware of the effect of cigarette smoke on metabolism of this antipsychotic, to be aware of. RESULTS: Following specialist advice and change of antipsychotic medication, this patient's condition improved to the point that he was discharged from the hospice. CONCLUSION: Palliative care specialists should be aware that reducing cigarette consumption can alter metabolism of clozapine, potentially causing drug accumulation and toxicity with features which mimic deterioration towards end of life. Specialist advice should be sought in such a situation.

The impact of the introduction of a palliative Macmillan consultant radiographer at one UK cancer centre (2016)

Posted on by

Type of publication:
Journal article

Author(s):
Goldfinch R., Allerton R., *Khanduri S., *Pettit L.

Citation:
British Journal of Radiology, 2016, vol./is. 89/1065(no pagination)

Abstract:
Objective: The UK radiotherapy (RT) workforce needs novel strategies to manage increasing demand. The appointment of a palliative RT (PRT) consultant radiographer (CR) offers a potential solution to enhance patient pathways providing timely RT. This article examined the impact of one such appointment. Methods: Two prospective audits were completed 1 year apart. All patients receiving PRT for bone metastases between 01/01/2014-31/03/2014 (Audit 1) and 01/01/2015-31/01/2015 (Audit 2) were included. Data collected included demographics, treatment site, dose, fractionation, treatment indication and professionals who planned the PRT. The patient pathway from decision to treat (DTT) to commencement of PRT was scrutinized. Results: 97 patients were identified for Audit 1 and 87 patients for Audit 2. Demographics were similar. Figures relate to Audit 1 and in brackets Audit 2. Indications for treatment: pain 55% (61%), metastatic spinal cord compression 41% (38%) and other neurological symptoms 4% (1%). The CR independently planned 13% (60%), being supervised for 36% (3%). Consultant clinical oncologists planned 43% (31%), with 7% (6%) planned by specialist registrars (SpRs). The pathway was enhanced in Audit 2, with 85% of patients treated within 14 days compared with 73% of patients treated in Audit 1. Conclusion: A CR has the potential to impact on the patient pathway, enabling quicker times from DTT to treatment. Continued audit of the role is required to ensure that it complements SpR training. Advances in knowledge: Increasing longevity and improved systemic therapies have led to greater numbers of patients living longer with metastatic disease. The appointment of a CR offers a potential solution to the capacity difficulties faced by UK RT services.