Benzodiazepine Use and Morbidity-Mortality Outcomes in a Geriatric Palliative Care Unit: A Retrospective Review

<b><i>Introduction:</i></b> Patients often experience delirium at the end of life. Benzodiazepine use may be associated with an increased risk of developing delirium. Alternate medications used in conjunction with benzodiazepines may serve as an independent precipitant of delirium. The aim is to understand the role of benzodiazepines in precipitating delirium and advanced mortality in palliative care population at the end of life. <b><i>Methods:</i></b> A retrospective medical chart review was conducted at a hospice and palliative care inpatient unit between the periods of June 2017–December 2017 and October 2017–November 2018. It included patients in hospice and palliative care inpatient units who received a benzodiazepine and those who did not. Patient characteristics, as well as Palliative Performance Scale score, diagnosis, and occurrence of admission, terminal, and/or recurrent delirium, were collected and analyzed. <b><i>Results:</i></b> Use of a benzodiazepine was not significantly associated with overall mortality nor cause-specific death without terminal delirium rate. However, it was significantly associated with higher cause-specific death with terminal delirium rate and a higher recurrent delirium rate. <b><i>Discussion:</i></b> This retrospective chart review suggests an association between benzodiazepine use and specific states of delirium and cause-specific death. However, it does not provide strong evidence on the use of this drug, especially at the end of life, as it pertains to the overall mortality rate. Suggested is a contextual approach to the use of benzodiazepines and the need to consider Palliative Performance Scale score and goals of care in the administration of this drug at varying periods during patient length of stay.

The Grief and Bereavement Experiences of Informal Caregivers: A Scoping Review of the North American Literature

Background Informal caregivers are a significant part of the hospice and palliative care landscape as members of the interdisciplinary care team. Despite this, little is known about the impact this responsibility has on informal caregivers’ experiences of grief and bereavement. To address this, a scoping review of the literature was conducted to explore the current state of knowledge toward grief and bereavement of informal caregivers of adult/geriatric patients in the hospice and palliative/end-of-life care realm within North America. Methods Using Arksey and O’Malley's 5-step framework, key electronic health care and social sciences databases (eg, CINAHL, MEDLINE, ProQuest Sociological Abstracts, PsycINFO) alongside gray literature sources were searched and screened against inclusion and exclusion criteria. A thematic content analysis was used to identify key themes. Results 29 articles met the final inclusion criteria with 3 central themes emerging: (1) mediators of grief, (2) grief experiences, and (3) types of grief. Discussion Informal caregivers encounter unique grief and bereavement experiences: The range of psychosocial outcomes, both negative and positive, can be affected by various mediators such as caregiver burden, demographics, disease type of the patient being cared for, etc. Bereavement interventions must be designed with the mediators of grief in mind. Conclusions Understanding the nuances of informal caregivers’ experiences with grief and bereavement will inform and advance practice, policy, and research. Practitioners/clinicians should be further educated on how to properly acknowledge the complexity of grief and bereavement for informal caregivers, specifically paying attention to mediators. Further research needs to consider the role of culture.

LGBTQ Older Adult Recruitment in the Midst of a COVID-19 Lockdown: Reminiscences of a Post-Doctoral Fellow

Within days of obtaining ethics approval for a qualitative study “Optimizing LGBTQ Engagement with Hospice and Palliative Care in the Island Health Region” our local Covid-19 lockdown began. It took several months to have new Covid-19 research protocols (Zoom Town Hall meetings/Zoom or telephone interviews) approved. Being impatient, I teamed with another group of researchers to launch “Covid-19: Your Current Experiences and Planning for the Future,” an online survey with a large qualitative component where we planned to oversample LGBTQ respondents. In time both projects were approved, and here I reflect on recruitment lessons learned. These include my perceptions how Zoom Town Hall meetings and interviews differ from those I’ve conducted in-person, reflections on how to use social media (including targeted Facebook advertising) to recruit participants, and sadly, how to manage anti-LGBTQ sentiment that resulted from even the most targeted advertising.

Translation, cultural adaptation, and validation of the mindful self-care scale among Brazilian palliative care providers

Objective This study aimed to translate, culturally adapt, and validate the Mindful Self-Care Scale (MSCS, 33-item) in a Brazilian hospice and palliative care context. Method This was a cross-sectional study with a sample of 336 Brazilian hospice and palliative care providers. The European Organisation for Research and Treatment of Cancer — Quality of Life Group Translation Procedure protocol was used for the translation and the cultural adaptation process. Psychometric properties supporting the use of the MSCS were examined through confirmatory factor analysis (CFA) and correlation analysis with other instruments to assess congruence to related constructs (resilience and self-compassion). The reliability of the Brazilian-Portuguese version of the MSCS was assessed using Cronbach's α and composite reliability coefficients. Results The six-factor (33-item) model showed a good fit to the data, with satisfactory reliability indices and adequate representation of the scale's internal structure. Further validity is evidenced in the significant, positive correlations found between the MSCS, and similar well-being constructs, namely the Self-Compassion and Resilience scales. Significance of results The findings reveal that the MSCS (33-item) is a valid, reliable, and culturally appropriate instrument to examine the practice of mindful self-care by hospice and palliative care providers in Brazil. More broadly, it represents a promising instrument for future research into self-care practices and well-being among Brazilian healthcare providers.

A Goal-Directed Model of Collaborative Decision Making in Hospice and Palliative Care

Hospice and palliative care teams face numerous barriers to the meaningful involvement of patients and families in medical decision making, which limits opportunities for exploration of the very values, preferences, and goals that ideally inform serious illness care. Researchers who develop and test interventions to address these barriers have noted the complementary utility of two existing models in supporting collaborative relationships between hospice and palliative care teams and the patients and families they serve: (1) the social problem-solving model, and (2) the integrative model of shared decision making in medical encounters. This paper describes the integration and extension of these two highly synergistic models, resulting in a goal-directed model of collaborative decision making in hospice and palliative care. Directions for practice innovation and research informed by the model are discussed at length.

How did Music Therapy Contribute to Patients’ Quality of Life in a Hospice and Palliative Care Setting?

<p>This qualitative research explores how I, as a student music therapist, contributed to patients’ quality of life (QoL) in a hospice and palliative care setting. The study principally focuses on the different music therapy and personal approaches that I used and which seemed to contribute to patients’ QoL. The research was carried out at a hospice in New Zealand and I had sessions with in-patients, day hospice patients and out-patients who were all at varying stages of illness. In this research, secondary analysis of data is used to answer my research question. The data used in this study are the clinical notes and reflexive journals that I gathered while working with 67 patients in a total of 194 sessions. Because QoL is a broad complex concept, I have chosen to use a conceptual framework suggested by music therapy theorist Even Ruud (1997) to put a structure to answering my research question. In thematic analysis, the data were both deductively and inductively analysed. The findings describe music therapy methods, activities, strategies and techniques as well as personal approaches I employed which seemed to promote a sense of affective awareness, agency, belonging and meaning, and coherence of life in patients receiving hospice and palliative care. This study indicated that Ruud’s (1997) framework has particular meaning in the context of hospice palliative care and that the framework could be extended for use in hospice and palliative care. The clinical vignette further provide an exploratory view of the use of music therapy techniques and the quality of relationships, and how both of these contributed to increasing a patient’s QoL. In the discussion, the findings are further explained in the light of other studies. In particular, ‘being with’ patients underpinned all of the musical and personal approaches that I made in working with hospice patients and this is evaluated as an overarching point. Although Ruud’s (1997) idea of QoL was a good fit in my study, the study may suggests how his model could address ways in which affective awareness, agency, belonging and meaning and coherence of life can be supported with various music and personal approaches in the context of music therapy in hospice and palliative care settings.</p>