The effects of animal-assisted interactions on quality of life in children with life-threatening conditions and their parents

Background: Children with advanced cancer and their primary caregivers may experience severe stress and anxiety in coping with their life-threatening condition. As a way to help reduce these stressors and increase overall quality of life, research suggests that animal-assisted interactions may be beneficial when integrated into palliative care. Aims: This pilot study aims to provide evidence for the feasibility and efficacy of a randomised clinical trial using animal-assisted interactions to help improve the quality of life for children with an advanced life-threatening condition and their primary caregivers. This protocol paper outlines the basis of the research, goals, experimental design and methodology.

Research Roundup

Synopses of a selection of recently published research articles of relevance to palliative care

Experience of internationally qualified nurses providing palliative care in a New Zealand aged residential care facility

Background: New Zealand is reliant upon internationally qualified nurses (IQNs) working within aged residential care (ARC), despite the fact that many of these nurses have limited or no ARC or palliative care experience before arriving in the country. Aims: To understand the issues faced by IQNs providing palliative care to people in ARC. To understand how the palliative aged residential care (PARC) specialist nurse team can best support IQNs. Methods: A thematic analysis was undertaken from five focus group interviews with IQNs (n=24) from ARC facilities in the Christchurch and Canterbury regions. Findings: Unfamiliarity with New Zealand 's palliative care and ARC systems, cultural differences and communication barriers caused internal struggles. Transitioning to a New Zealand approach to palliative care highlighted participants' adaptability and resilience. Consistent approaches to training and support by the PARC team and additional cultural training within New Zealand Competence Assessment Programmes (CAP) are required. Conclusion: Ongoing education, support and role modelling to develop confidence and reduce internal struggles are required for IQNs providing palliative care in ARC.

Oral care experiences of palliative care patients, their relatives/carers and healthcare professionals

Aim: To explore the oral care experiences of palliative care patients and of those who support or deliver oral care to these patients: nurses, doctors, dentists, their relatives and carers. Data Sources: An electronic search of the databases included: Embase, MEDLINE, DOSS, AMED and PsycINFO was performed. Data selection: Six articles were included in the final synthesis. Data extraction: Thematic analysis was applied by two researchers. Data synthesis: Three themes were identified: ‘performing oral care’, ‘effects on oral health’ and ‘challenges in palliative care’. Conclusions: Despite similarities of oral care experiences, this review identified some differences, crucially in terms of the wider impact of oral symptoms, namely social interactions with others and challenges to oral care. This confirms the need to investigate these topics further in relation to different stakeholders, such as nurses; and to have consistent guidance to facilitate the provision of effective oral care to palliative care patients.

Synthesis of health promotion concepts in children's palliative care

Background: Palliative care improves the health of children with a life-limiting condition and appears to draw implicitly on concepts shared with a model of health promotion. However, to date there has been no scrutiny about how this relationship may shape understanding about children's palliative care. Aim: To explore the influence of health promoting concepts on children's palliative care models, policies and guidelines. Data sources: Health and social care databases were searched for policies, models and guidelines published between 2000–2018. Additional searches of professional national and international healthcare websites, children's palliative care charities and UK and Ireland government websites were conducted. Methods: A best fit framework synthesis was used. Findings: A total of 55 policies and guidelines were reviewed for the framework synthesis. Eight themes were generated: (1) health promoting children's palliative care policy and guidelines; (2) planning ahead; (3) creating a supportive environment; (4) enabling coping and independence; (5) reorienting children's palliative care sectors; (6) the lengthening trajectory of need for support; (7) strengthening community engagement in children's palliative care; and (8) quality of life and value-based ideologies. Conclusion: The best fit framework synthesis confirmed a conceptual relationship between children's palliative care and health promotion. This is captured in a new model that will extend professionals' understanding.

Is it time to re-evaluate the inevitability of ulcers at the end of life?

Background: The prevention of pressure injuries/ulcers (PI/PUs) in patients at the end of life is achievable, albeit challenging. Objective diagnostic tools, such as sub-epidermal moisture (SEM) scanning, support healthcare practitioners' clinical judgment in preventing PI/PUs. Aim: A pragmatic study was conducted to assess the feasibility of preventing PI/PUs using SEM technology as an adjunct to routine care in a 22-bed inpatient hospice. Methods: Daily SEM scanning was introduced to support the device-trained practitioners' clinical judgment in detecting developing, non-visible PI/PUs. Preventive interventions were initiated by clinical judgment informed by Waterlow scores, visible, tactile skin and tissue assessments and scanner readings. Results: Prior to the study, the incidence of PI/PUs was 9%. The 6 month study period reported a 4.8% PI/PU incidence, 7/146 consenting patients developed a PI/PU, resulting in a 47% reduction in incidence rates. Conclusion: Preventing the development of PI/PUs is possible with clinical judgment aided by SEM data.

Understanding what is important to older people living with frailty in relation to advance care planning

Background: Advance care planning (ACP) provides opportunities for people to make decisions about future care. Internationally, the approach to this varies. Older people living with frailty could considerably benefit from discussing and undertaking advance care planning. However, this has not traditionally been a particular focus of their care. Aim: To provide recommendations to support nurses and health professionals to undertake ACP conversations with older people living with frailty through a review of contemporary literature. Methods: The following electronic databases were searched: CINAHL, British Nursing Index and the Cochrane Library. Information about the process and outcome of undertaking an ACP conversation with older people living with frailty was extracted and categorised in relation to care setting. Findings: A total of 69 papers were identified, of which eight met the inclusion criteria. The importance of preparation before starting an ACP conversation was highlighted, as well as key considerations when undertaking such a conversation. From these papers five clinical recommendations, one policy recommendation and two research recommendations are made. Conclusions: Maintaining and improving wellness is important to older people living with frailty. In order that conversations about ACP are acceptable and meaningful to older people living with frailty, they should include: the opportunity to discuss both ‘current’ and ‘future’ care; be focused on their goals of care; and, to be offered routinely to the older person

Women's lived experiences of advanced cervical cancer: a descriptive qualitative study

Aim: To explore the lived experiences of women with advanced incurable cervical cancer attending a palliative care service in Uganda. Methods: This qualitative and exploratory study was conducted at Mobile Hospice Mbarara in South Western Uganda. The target population was a convenience sample of all patients with a confirmed histological diagnosis of advanced cervical cancer; stage 2B to 4B, and clinically advanced disease. Demographic data were collected prior to conducting semi-structured audio-taped interviews. Transcripts were read and re-read, coded and codes were then abstracted into emergent broad-based meaningful themes by consensus. Results: A total of 10 participants, average age of 53.4, age range 40–71, cancer staging 2B to 4 and average duration of illness 3.5 years were interviewed. Six themes emerged from the data: socio-demographic profiles of the women; road to cancer diagnosis; effects of disease on women's quality of life; experiences with main stream medicine; adapting to having cancer and needs of the women. Conclusions: Living with advanced incurable cervical cancer is associated with significant disruptions in all domains of life. Good palliative care enables patients to achieve an optimal quality life. Poverty and a lack of knowledge about cervical cancer among women and health workers are the strongest predictors of a patient receiving a late advanced diagnosis.