Literature Review

Hospice funding crisis: an urgent message ehospice, UK Edition; by Helen Simmons, Chief Executive of St. Christopher's; 8/14/24 Growing numbers of people need hospice support – in the last year alone the number of home visits completed by our teams at St. Christopher’s increased by 10%. But many hospices – one in five – are either cutting specialist palliative and end of life services in the last year or plan to do so. Fortunately, we are not one of those at the moment. ... NHS funding has failed to keep up with the increase in demand and expenditure. We are increasingly relying on people leaving gifts in wills, running marathons and donating clothes to deliver our core services. The model is breaking. ... At St. Christopher’s we receive 34% of our income from the NHS – for the remaining 66% we rely on the generosity of the community. Hospices should not have to rely on the generosity of the community to provide essential healthcare services. ... Editor's Note: St. Christopher's is the first hospice of the modern hospice movement, pioneered by Dame Cicely Saunders in London, UK, in 1967.

[Italy] A transitional care program in a technologically monitored in-hospital facility reduces the length of hospital stay and improves multidimensional frailty in older patients: a randomized clinical trialAging Clinical and Experimental Research; Alberto Pilotto, Wanda Morganti, Marina Barbagelata, Emanuele Seminerio, Simona Morelli, Romina Custureri, Simone Dini, Barbara Senesi, Camilla Prete, Gianluca Puleo, Carlo Berutti Bergotto, Francesco Vallone, Carlo Custodero, Antonio Camurri, PRO‐HOME Project Investigators Group; 8/24Multidimensional frailty is a reversible condition that can be improved by reduced LOS [length of stay]. Longer length of hospital stay (LOS) negatively affects the organizational efficiency of public health systems and both clinical and functional aspects of older patients. Data on the effects of transitional care programs based on multicomponent interventions to reduce LOS of older patients are scarce and controversial. The PRO-HOME transitional care program reduces LOS and multidimensional frailty in hospitalized older patients.

First Swiss hospice for terminally and critically ill children closes a gap in care NZZ; by Erich Aschwanden, Reidbach near Bern, Switzerland; 8/12/24 As many as 10,000 children and young people in Switzerland live with life-shortening illnesses. Because the state does not help support efforts to care for them in special facilities, private organizations are stepping in. ... Switzerland's first children's hospice is located in a converted farmhouse in Riedbach, a small hamlet on the outskirts of Bern. As idyllic as these surroundings may be, the fate of the children and their families who are taken in by the Allani Foundation is bitter. These are children and young people with life-shortening illnesses such as cancer, genetic defects or neurological diagnoses.

Paramedics treating patients’ palliative needs at home benefits everyone[Canada] The Conversation; 8/5/24In a medical system that seems to be under constant bombardment — economic, pandemic, demographic — it’s refreshing to see solid evidence to support a new idea that improves care while saving valuable time and money. It’s exactly what has been happening in several Canadian provinces that have been implementing innovative palliative programs to improve paramedic support to patients with palliative care needs. The idea is that paramedics, with some extra training, can provide patient-centred care in the homes of people living with cancer and other life-limiting conditions. It is intended to make patients as comfortable as possible as they spend their last days at home, which is where most Canadians say they’d prefer to die.

Doctors could opt out of assisted dying for religious reasons, says peer behind proposed law The Telegraph, United Kingdom; by Kamal Ahmed and Camilla Tominey; 7/26/24 Lord Falconer is launching a bill to make assisted dying legal but which includes a 'conscience clause' to factor in people's faiths. Doctors will be able to opt out of supporting assisted dying in England and Wales if they believe it clashes with their religious beliefs under a new attempt to legalise terminally ill people being able to end their lives.

Assisted dying bill introduced in Parliament BBC News; 7/26/24 A bill which would allow terminally ill adults with six months or fewer to live to get medical help to end their own lives has been introduced in the House of Lords, by former Labour Justice Secretary Lord Falconer. He told the BBC his bill would apply only to people "mentally able to make the decision." Their choice would also need to be approved by two doctors and the high court. Private members' bills introduced in the Lords rarely become law. However, Lord Falconer says he hopes a backbench MP will introduce a similar bill in the Commons, where it will have a greater chance of success.

“At home, even the walls help”: Exploring the palliative care needs, experiences, preferences, and hopes of older people with serious illness in Ukraine (July 2024) OCHA Services; by HelpAge; 7/24/24 Older Ukrainians living with serious illness face significant concerns and challenges within the political, environmental, and social context of the ongoing armed conflict, according to a new report published by HelpAge International, in partnership with HelpAge USA. ... The report highlights an innovative project funded by GlobalGiving which provides palliative care services in Ukraine. It underscores the profound challenges faced by older people due to the combined toll of disease and the ongoing war, and offers key recommendations to enhance their care and support. “Our findings reveal the unimaginable burden faced by older people living with serious illnesses in the midst of war. We are deeply grateful for the generous support of GlobalGiving, which has allowed us to highlight these issues and work to ensure that older people’s needs and preferences are included in healthcare system planning during humanitarian crises,” said Cindy Cox-Roman, CEO and president of HelpAge USA.

[Australia] Methadone versus other opioids for refractory malignant bone pain: a pilot randomised controlled studySupportive Care in Cancer; Merlina Sulistio, Alexandra Gorelik, Hoong Jiun Tee, Robert Wojnar, David Kissane, Natasha Michael; 7/24Refractory cancer-induced bone pain (CIBP) affects a patient's functional capacity and quality of life, but there is limited evidence to guide opioid choice. We assessed the feasibility, tolerability and possible efficacy of methadone rotation (MR) compared to other opioid rotations (OOR) in this cohort. Of 51 eligible participants...both groups displayed significant reduction in average...and worst pain...and total pain interference score. Oral morphine equivalent daily dose was reduced significantly in MR compared to the OOR group (d = - 0.8, p = 0.05). The incidence of opioid-related adverse events following MR was unchanged but lower in the OOR group. There were no within-group or between-group differences in satisfaction with analgesia at the end of the study.

Hospice heart appeal in memory of teenager BBC News, West Midlands, United Kingdom; by Andy Giddings; 7/16/24 A mother has shared the story of her "totally remarkable" daughter's final days in a hospice as she helps launch a fundraising campaign inspired by the 17-year-old. While Hannah Debney was cared for at Acorns Children's Hospice in Walsall, she made a heart shaped sculpture as a keepsake for her mother, Christine Debney. The hospice is appealing to the public to dedicate a metal heart to the memory of someone they have lost, which will form part of a display. Ms Debney said the hospice was "amazing" and added: "They allowed us as a family to be together during her final days. ... “Hannah said she wanted to tell the doctors to stop," Ms Debney said. "No-one should have to make decisions like that. It was Hannah who said she wanted to go to Acorns Children’s Hospice and to be transferred there.” Christine described her daughter as "the bravest person" she had ever known. Hannah died 15 days after she arrived, but while she was at Acorns she made keepsakes for her family. They included a cast of her hand in the shape of the heart for her mother, and that symbol inspired the Hannah’s Hearts Appeal.

Employment protection for assisted dying medics BBC, Isle of Man; by Ashlea Tracey; 7/9/24 The employment rights of healthcare staff on the Isle of Man[] who choose to be part of any potential assisted dying service will be protected under new proposed laws. Members of the House of Keys previously ensured similar rights for conscientious objectors during a previous debate on the Assisted Dying Bill 2023. The Isle of Man is a self-governing British Corwn Dependency in the Iris Sea, between Great Briatin and Ireland. 

Successful use of propofol after failed palliative sedation in patients with refractory symptoms[Spain] Journal of Palliative Medicine; Eduardo Garcia Romo, Bernadette Pfang, Beatriz Valle Borrego, Marta Lobo Antuña, Antonio Noguera Tejedor, Silvia Rubio Gomez, Victoria Galindo Vazquez, Blanca Prieto Rios; July 2024Propofol is a general anesthetic used in multiple clinical scenarios. Despite growing evidence supporting its use in palliative care, propofol is rarely used in palliative sedation. Reluctance toward the adoption of propofol as a sedative agent is often associated with fear of adverse events such as respiratory arrest. We aimed to describe efficacy and safety of palliative sedation in refractory sedation with propofol using a protocol based on low, incremental dosing. Conclusion: A protocol for palliative sedation with propofol based on low, incremental dosing, with the option of administering an initial induction bolus, shows excellent results regarding adequate levels of sedation, without observing apnea or respiratory depression. Our results promote the use of propofol to achieve palliative sedation in patients with refractory symptoms and risk factors for complicated sedation at the end of life.Publisher's Note: An interesting study on palliative sedation, although findings would need to be put into an American context.

[United Kingdom] Hospices on the brink of financial meltdown warn of service cuts and mass redundancies Daily Express, United Kingdom; by Giles Sheldrick; 7/7/24 The growing crisis engulfing the hospice sector has led to another major facility closing beds and warning of widespread redundancies. Hospiscare, which helps those with terminal illnesses in Devon, has been forced to change its end-of-life service in response to “insufficient funding and rising costs.” It  is the latest to act on an emergency that is having a major impact on the families it helps. The hospice has already taken drastic steps, including slashing the number of beds on its ward in Exeter. It is now having to change how it delivers part of its at-home care for patients during the last days of their lives, which is likely to result in staff redundancies. ... Most facilities providing end-of-life care are operating in the red and look set to follow suit in a crisis that would flood the NHS. Toby Porter, chief executive of Hospice UK, said: “We’ve recently seen the worst financial results for the sector in 20 years, with hospices facing a collective deficit of £77million.