12/6/18 Declaration of conflict of interest Review author with the Cochrane Consumer and End of Life Communication Group Henderson A, Ryan R, Henderson S, Young J, Bradford NK, Bothroyd JI, Herbert A. Interventions for interpersonal communication about end of Amanda Henderson life care between health practitioners and affected people. Cochrane Associate Professor Database of Systematic Reviews 2018, Issue 9. Art. No.: CD013116. DOI: University of the Sunshine Coast, Australia 10.1002/14651858.CD013116. The conversation End of Life (EoL) “The period when a patient is living with, and “Death, dying and bereavement are all an integral impaired by, a fatal condition, even if the trajectory is part of life; however, reflecting on, and discussing ambiguous or unknown. This period may be years in death, can be profoundly confronting and difficult. the case of patients with chronic or malignant Open and frank discussion of death and dying disease, or very brief in the case of patients who including end of life care options, approach to futile suffer acute and unexpected illnesses or events, such treatment, caring and bereavement should be as sepsis, stroke or trauma” encouraged within the profession and in the wider community” (ACSQHC, 2015, p.33) (AMA, 2014, p.1) Context Communication “The WHO identified that, globally, palliative care needs are very high, with an estimated 20 million “a purposeful, planned and formalised people needing end-of-life care each year” strategy associated with a diverse range of intentions or aims, including to inform, (AIHW , 2014, p.2) educate, communicate with, support, skill ... engage and seek participation of people.” Death is common to all, however, the process and experience of dying and the health care systems (Hill, 2011, p.30) and environments in which this happens, are not the same for everyone 1
12/6/18 EoL Communication A consumer perspective Communication could be related to physical, psychological, Only by being involved from the “other spiritual or the cultural needs of patients, families and carers; side”, as the patient or their family/carer, relief of symptoms or suffering; pain management; care can the impact of the EoL conversation, or directives; dying; and death… its omission, be fully appreciated An exploratory study conducted with pediatric practitioners confirmed that evidence-based interdisciplinary interventions A consumer (patient/family/carer) are needed to support EoL discussions (Henderson et al., 2017) perspective provides a very different lens General guidelines exist, but they do not necessarily use for reflecting on this EoL conversation rigorous evidence related to the effectiveness of specific EoL communication interventions Communication Our Cochrane review • Interventions for interpersonal communication What levels of evidence about end of life care between health What interventions exist to confirm the practitioners and affected people. exist for the EoL Amanda Henderson interventions used for conversation? Rebecca Ryan EoL conversations? • Cochrane Database of Systematic Reviews Simon Henderson 2018, Issue 9. Art. No.: CD013116. DOI: Jeanine Young 10.1002/14651858.CD013116. Natalie Bradford Josephine Bothroyd • Intervention review : benefits and harms of Anthony Herbert What research still Are EoL research/ interventions used in healthcare and health needs to be undertaken interventions co- policy to support this critically created with important area? consumers? • Nominated as one of five priority reviews for the Consumer and Communication Group EoL review objective Why is it important to the review? “To assess the effects of interventions Improved and designed to improve verbal interpersonal more effective • help practitioners address gaps in care communication about EoL care between communication • improve outcomes such as distress and health practitioners and people affected by poor quality of life associated with poor between health EoL.” communication practitioners and • lay groundwork that will allow patients and people affected (Henderson et el., 2018, p.4) others affected by EoL events to participate by EoL has the in decisions about treatment and care potential to: (Henderson et al., 2018. p.4) 2
12/6/18 EoL communication intervention EoL intervention where a patient is likely to die within Method: 12 months and must include a health practitioner Randomised and cluster randomised Types of controlled trials (RCTs) that evaluate studies the effects of interventions for Verbal: in-person, telephone, videoconferencing, communicating with patients and remote video links, Internet-enabled verbal discussions families or carers about EoL care Specifically related to one or more EoL elements: • Quasi-RCTs (defined as a trial attempting, but not achieving, random allocation of physical, psychological, spiritual, cultural, relief of participants) symptoms or suffering, pain management, care directives, dying and death Method: Method: Knowledge and understanding about what might Patients with a life limiting illness Outcome happen (prognosis), or what to do, or options Types of expected to die within 12 months, any age measures participants from birth Evaluation of the communication - positive Patient, family Family or carers of a patient with a life- constructs (e.g. satisfaction, calmness or and/or carer confidence about ability to manage the future) limiting illness outcomes Evaluation of the communication - negative Health care professionals could include: constructs (e.g. fear, anxiety, distress) doctors, nurses, midwives, allied health practitioners, social workers, government Discussions of EoL care/EoL (e.g. frequency, health care workers, health care team, length, type, participants) interdisciplinary team, or a group of health care providers, lay health workers, Any adverse outcomes or harms other community providers or volunteers RCT Classifier Covidence: import citations, Search Data Selection of screening titles, abstracts, full • The Cochrane • Experts in the Electronic searches Searching other resources methods collection studies text Central field, research Register of reference lists Controlled of relevant Trials studies, grey • Screened 5752 citations (CENTRAL) literature, • The Cochrane World • Approx. 100 studies for full Library PalliativeCare review (still have some • MEDLINE Alliance To date • EMBASE conflicts to be considered) • PsycINFO • CINAHL 3
12/6/18 A complex review Consumer Consumer groups, industry and/or government agencies involvement Outcome of our review: It’s impossible to know No idea! (Yet) Without everything—pooled the data there is only knowledge opinion… The protocol received feedback from a consumer as part of standard CCCG editorial processes 2016 Impact Factor for The Cochrane Consumer Cochrane Database of and Communication Systematic Reviews is Cochrane consumer network editorial team… 6.124 Finally… Potentially a Cochrane living review EoL care discussions are of interest to everyone. A systematic review which is continually updated, incorporating relevant new evidence as it becomes available No matter who you are, where you live, or how it happens, there are two experiences that every living person has in common—they were Underpinned by continual, active monitoring of the evidence (i.e. born, and one day they will die. This is a monthly searches) universal and indiscriminate truth for all people. Immediately include any new important evidence (meaning data, studies or information) that is identified References Australian Institute of Health and Welfare. 2014. Palliative care services in Australia. http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129548892 Australian Medical Association. 2014. AMA position statement on end of life care and advance care planning. https://ama.com.au/sites/default/files/documents/AMA_position_statement_on_end_of_life_care_and _advance_care_planning_2014.doc_1.pdf Australian Commission on Safety and Quality in Health Care. 2015. National consensus statement: essential elements for safe and high quality end-of-life-care. Commonwealth of Australia . https://www.safetyandquality.gov.au/publications/national-consensus-statement-essential-elements- for-safe-high-quality-end-of-life-care/ Henderson, A., Ryan, R., Henderson, S., Young, J., Bradford, N.K., Bothroyd ,J.I., Herbert ,A. Interventions for interpersonal communication about end of life care between health practitioners and affected people. Cochrane Database of Systematic Reviews 2018, Issue 9. Art. No.: CD013116. DOI: 10.1002/14651858.CD013116. Henderson, A., Young, J., Herbert, A., Bradford, N., Pedersen, L. 2017. Preparing paediatric healthcare professionals for end-of-life care discussions: An exploratory study. Journal of Palliative Medicine , 20(6), 662-666. doi: 10.1089/jpm.2016.0367 Hill S. (ed). 2011. The Knowledgeable Patient: Communication and Participation in Health . Chichester, UK: Wiley Blackwell. [Other: http://au.wiley.com/WileyCDA/WileyTitle/productCd-1444337173.html] 4
Recommend
More recommend
