Palliative Care Support Research Articles

Early palliative/supportive care in acute myeloid leukaemia allows low aggression end-of-life interventions: observational outpatient study

ObjectivesEarly palliative supportive care has been associated with many advantages in patients with advanced cancer. However, this model is underutilised in patients with haematological malignancies. We investigated the presence and...

Neonatal Nurses' Report of Family-Centered Care Resources and Practices.

A paucity of studies describes the prevalence of family-centered care (FCC) practices and resources in US neonatal units. To identify US prevalence of FCC practices and resources and to identify the largest gaps in resource provision. Neonatal nurses completed an online survey through national conferences (eg, NANN educational conference), neonatal organization Web sites (eg, NANN research survey), and social media (eg, NANN and NPA Facebook). Nurses provided demographics and the National Perinatal Association Self-Assessment on Comprehensive Family Support, a 61-item checklist of FCC practices and resources from 6 categories: family-centered developmental care, staff education/support, peer support, palliative care, discharge education, and mental health support. Nurses (n = 103) reported lowest resources for Peer Support and Mental Health Support. About a third had a neonatal intensive care unit parent advisory committee (n = 39; 37.9%). Only 43.7% (n = 45) had necessary amenities for families to stay with their infants. Less than a third felt that mental health professionals were adequately staffed to provide counseling to parents (n = 28; 27.5%). Very few nurses had adequate training on providing parents psychological support (n = 16; 15.8%). More than half (n = 58; 56.3%) stated that all staff receive training in family-centered developmental care. Finally, less than half (n = 42; 40.8%) stated that staff see parents as equal members of the care team. We demonstrate a consistent and widespread lack of training provided to neonatal staff in nearly every aspect of comprehensive FCC support. Researchers need to identify unit/organizational interventions that increase adoption and implementation of FCC practices and resources.

On the issue of evaluation of quality and efficiency of intersectorial interaction under palliative medical care support

The article presents the original system of indices for comprehensive assessment of level of intersectorial collaboration in palliative medical care support of population. The system was developed on the basis of and considering requirements of normative legal acts of the Russian Federation. The proposed indices can be applied in analysis of functioning and subsequent optimization of medical institutions network and social service institutions in the subjects of the Russian Federation, including involvement of non-profit organizations and public associations.

EP.FRI.253 Outcomes of treatment of anal squamous cell carcinoma over a 10-year period

Abstract Background We evaluated our 10-year experience with the treatment and outcomes of patients with anal squamous cell carcinoma (ASCC). Patients and Method Clinical and pathological data of patients with ASCC were analysed between January 2011 and December 2019. All patients underwent the standard workup according to the anal cancer network guidelines and treated accordingly. Patients were followed up clinically and with imaging according to the network protocol. The outcome measures were clinicopathological characteristics, treatment modalities, recurrent disease, disease-free and overall survival. Results 117 patients were diagnosed with ASCC over the 10-year period. 14 patients with adenocarcinoma(11), melanoma(1), Paget disease(1) and carcinoid tumour(1) were excluded. Median age of 103 patients included was 68 (38-101) years with a Male to female ratio of 1:2. Four patients were HIV positive and 42.7% of the patients had AIN of varying degree of dysplasia. 66% (68/103) of the patients had radical chemoradiotherapy with curative intent while 9 patients with tumour ≤2cm underwent wide local excision. Six patients underwent palliative therapy and the remaining 20 were on supportive palliative care. 61.2% of the patients treated with radical chemoradiotherapy had complete response while 10.7% had partial response. Four patients with incomplete response underwent salvage APER. 13% (10/77) of the patients treated with curative intention developed recurrence. The overall mean survival time was 77.9 (95% CI 66.73-89.06) months with 5-year survival rate of 59%. The overall mortality rate was 42.7% and disease-specific mortality was 26.2%. Conclusion ASCC responds well to radical chemoradiotherapy with enhanced survival rate.

End-stage organ disease–Healthcare utilisation: Impact of palliative medicine

ObjectivesAlthough patients living with end-stage organ disease (ESOD) suffer unmet needs from the physical and emotional burdens of living with chronic illness, they are less likely to receive palliative care.The...

Barriers to and Facilitators of Neonatal Palliative Care Among Neonatal Professionals in China.

This study investigated institutional and personal barriers to and facilitators of neonatal palliative care facing neonatal professionals in China. A cross-sectional questionnaire surveyed 231 neonatal clinicians employed in 5 neonatal intensive care units from 2 children's hospitals and 3 medical centers in China. The translated modified version of the Neonatal Palliative Care Attitude Scale was used to survey neonatal clinicians' attitudes and beliefs regarding neonatal palliative care. Findings highlight 4 facilitators and 5 barriers among participating clinicians. Participants gave contradictory responses regarding the relative importance of curative treatment versus palliative care in the NICU. Negatively traumatic feelings, cultural issues and moral distress may impact this contradictory response and discourage clinicians from providing neonatal palliative care. Additionally, neonatologists and nurses held differing attitudes on several topics (p < 0.05). Further research should address strategies to improve knowledge and attitudes and relieve moral distress in NICU clinicians. Neonatal clinicians providing neonatal palliative care should receive regular palliative care training addressing culture-specific issues and communication skills. Study findings will be beneficial to inform clinical education and practice. Regular interdisciplinary team training is needed to enhance support for palliative care and decrease clinicians' moral distress during end-of-life care.

664 BURDEN OF IN-HOSPITAL CARE IN OESOPHAGEAL CANCER: A NATIONAL POPULATION-BASED STUDY

Abstract Oesophageal cancer management requires extensive in-hospital care. This cohort study aimed to quantify in-hospital care for esophageal cancer patients in relation to intended treatment and to analyze factors associated with risk of spending a large proportion of survival time in hospital. Methods All patients with oesophageal cancer in three nationwide registers over a ten-year period, were included. In-hospital care during the first year after diagnosis was evaluated and the proportion of survival time spent in hospital, stratified for intended treatment (curative, palliative or best supportive care) calculated. Associations of relevant factors to a greater proportion of survival time in hospital was analyzed by multivariable logistic regression. Results In-hospital care was provided for a median time of 39, 26 and 15 days the first year after diagnosis of oesophageal cancer for curative, palliative and best supportive care groups respectively. Patients receiving curatively intended treatment spent a median of 12% of their survival time in hospital during the first year after diagnosis, while palliative or best supportive care patients spent 19% and 23% respectively. Factors associated with more in-hospital care included higher age, female sex, being unmarried and chronic obstructive pulmonary disease (COPD). Conclusion The burden of in-hospital care during the first year after diagnosis of oesophageal cancer was substantial. Important clinical and socioeconomic factors were identified that predisposed to a greater proportion of survival time spent in hospital.

Using the Delphi technique to achieve consensus on bereavement care in palliative care in Europe: An EAPC White Paper

Background: The WHO definition of palliative care includes bereavement support as integral to palliative care, yet a previous survey of bereavement support in palliative care in Europe has shown a range of service responses to loss. A rigorous approach to agreeing and implementing a palliative care bereavement framework was required. Aim: The aim of this study was to develop consensus on best-practice recommendations for bereavement care principles, structures, processes and delivery based on current practice and evidence. Design: In accordance with Guidance on Conducting and Reporting Delphi Studies, a consensus-building five-round Delphi technique was performed. A scoping review of research literature informed drafting of 54 statements by the EAPC Bereavement Task Force. Evaluation of the statements was performed by an expert panel using a 5-point Likert scale. ⩾80% agreement were defined as essential items and 75%–79% agreement were defined as desirable items. Items with a consensus rating <75% were revised during the process. Setting/participants: The Delphi study was carried out by an expert panel among membership organisations of the European Association for Palliative Care. Results: In total, 376 email requests to complete Delphi questionnaire were distributed with a response rate of 23% (n = 87) and a follow-up response-rate of 79% (n = 69). Of the initial 54 statements in six dimensions, 52 statements were endorsed with 26 essential statements and 26 desirable statements. Conclusions: The six dimensions and 52 statements agreed through this Delphi study clarify a coherent direction for development of bereavement services in palliative care in Europe.

Dealing with Family Conflicts in Decision-making in End-of-Life Care of Advanced Cancer Patients.

The family plays a significant role in end-of-life care and decision-making with advanced cancer patients. This non-systematic review aims to summarize the family role and possible emerging conflicts and problems related to family involvement in decisions with advanced cancer patients. Four important domains were identified: (1) discordance between patients and caregivers' understanding of prognosis and goals of care; (2) internal family conflicts; (3) cultural differences regarding the role of the family in end-of life decision-making; (4) the burden on caregivers through caring for cancer patients. Based on the findings, we formulated some implications to consider for clinical practice. We suggest to involve the family in decision-making, to ascertain patients' wish for family involvement and if necessary, taking a mediator role between patients and their caregivers; to be aware of "invisible" family influence on patients' decisions; to assess systematically family burden and needs; to provide timely information, psychological support interventions and palliative care.

Access and Attitudes Toward Palliative Care Among Movement Disorders Clinicians.

Neuropalliative care is an emerging field for those with neurodegenerative illnesses, but access to neuropalliative care remains limited. We sought to determine Movement Disorder Society (MDS) members' attitudes and access to palliative care. A quantitative and qualitative survey instrument was developed by the MDS Palliative Care Task Force and e-mailed to all members for completion. Descriptive statistics and qualitative analysis were triangulated. Of 6442 members contacted, 652 completed the survey. Completed surveys indicating country of the respondent overwhelmingly represented middle- and high-income countries. Government-funded homecare was available to 54% of respondents based on patient need, 25% limited access, and 21% during hospitalization or an acute defined event. Eighty-nine percent worked in multidisciplinary teams. The majority endorsed trigger-based referrals to palliative care (75.5%), while 24.5% indicated any time after diagnosis was appropriate. Although 66% referred patients to palliative care, 34% did not refer patients. Barriers were identified by 68% of respondents, the most significant being available workforce, financial support for palliative care, and perceived knowledge of palliative care physicians specific to movement disorders. Of 499 respondents indicating their training in palliative care or desire to learn these skills, 55% indicated a desire to gain more skills. The majority of MDS member respondents endorsed a role for palliative care in movement disorders. Many members have palliative training or collaborate with palliative care physicians. Although significant barriers exist to access palliative care, the desire to gain more skills and education on palliative care is an opportunity for professional development within the MDS. © 2021 International Parkinson and Movement Disorder Society.

Operationalizing legal rights in end-of- life decision-making: A qualitative study

Background: For a patient’s legal right to make end-of-life treatment decisions to be respected, health care practitioners, patients and their substitute decision-makers must know what rights exist and how to assert them (or support others to assert them). Yet very little is known about what enhances or obstructs the operationalization of legal rights from the perspective of patients, family members and substitute decision-makers. Aim: To explore barriers and facilitators to the operationalization of rights in end-of-life decision-making from the perspectives of terminally-ill patients and family members and substitute decision-makers of terminally ill patients in Australia. Design: Semi-structured interviews (face to face and telephone) with patients, family or substitute decision-makers experienced in end-of-life decision-making completed between November 2016 and October 2017. A thematic content analysis of interview transcripts. Setting/participants: Purposive sampling across three Australian states provided 16 terminally-ill patients and 33 family and/or substitute decision-makers. Results: Barriers and facilitators emerged across three overlapping domains: systemic factors; individual factors, influenced by personal characteristics and decision-making approach; and communication and information. Health care practitioners play a key role in either supporting or excluding patients, family and substitute decision-makers in decision-making. Conclusion: In addition to enhancing legal literacy of community members and health practitioners about end-of-life decision-making, support such as open communication, advocacy and help with engaging with advanced care planning is needed to facilitate people operationalizing their legal rights, powers and duties. Palliative care and other support services should be more widely available to people both within and outside health systems.

Identificación de los pacientes con necesidades paliativas en el ámbito de la atención primaria de un área de salud de Extremadura

Primary objective. Knowing what the identification of patients with palliative needs in primary health care (PHC) services of the chosen health area. Secondary objectives. Assessing the level of knowledge PHC teams have about the interventions of palliative care support teams (PCST) and their referral criteria. Material and method. A descriptive cross-sectional and prospective study carried out through anonymous ad hoc surveys to PHC professionals. The study period was from April to June 2020. Participants are: Physician, nurses, physician and nurse resident who are working at PHC teams of the chosen health area. Results. 102 responses have been received. Almost 90% of PHC professionals have identified their patients with chronic disease in an advanced stage. Most respondents affirm that know the criteria for referral to the PCST and they have requested them. Conclusions. Although the majority of respondents know what their patients have suffered from an advanced chronic disease, only 25% of them have registered these patients with a specific code. Although most respondents understand what the criteria for referral to the PCST are, the number of patients referred to these teams is much lower than expected. Most respondents believe it is necessary to increase their training in palliative care and the coordination between the different levels of care.

Revisiting Combination Chemotherapy as a Single Modality Palliative Therapy for Advanced Anaplastic Thyroid Carcinoma-a Single Institution Experience.

Anaplastic thyroid carcinoma (ATC) is an aggressive malignancy with dismal outcome especially in metastatic setting. Consensus for ideal treatment of advanced and metastatic ATC remains elusive. This study aimed to analyze the impact of palliative chemotherapy versus supportive care on overall survival in patients with metastatic anaplastic thyroid carcinoma. Patients diagnosed with ATC between the period January 2018 and December 2019 were prospectively followed. The patients opting for palliative chemotherapy received 3 weekly Paclitaxel (175 mg/m2) and Carboplatin (AUC-5). Out of the 31 patients diagnosed with ATC, clinicopathological profile of 29 patients was analyzed (2 patients who underwent upfront surgical resection with curative intent were excluded), out of which 20 patients were included in the survival analysis. The median age of presentation was 55.8 years with male:female ratio 1.9:1. Seventeen out of the total 29 patients presented with anaplastic transformation in long-standing goiter. Nineteen out of 20 (95%) patients presented with distant metastasis with lungs being the most common site. Nodal metastasis was present in all patients. Invasion of the strap muscles (90%) and trachea (80%) was the most common peri-thyroidal tissue invasion followed by invasion of the esophagus (40%), internal jugular vein (30%), and carotid artery (5%). Twelve out of the 20 patients opted for palliative chemotherapy. Overall, median survival from the time of diagnosis was 2.6 months, with median survival in patients receiving chemotherapy 3.1 months and those opting for supportive care 1.6 months (p=0.004). Out of all the factors analyzed, male sex (HR 6.521, 95% CI 1.143-37.206, p value 0.03) and vascular invasion (HR 0.066, 95% CI 0.009-0.499, p value 0.008) were poor prognostic indicators. Palliative chemotherapy showed increased survival benefit in patients with metastatic ATC. Male sex and vascular invasion were found to be significant factors associated with poor outcomes on Cox regression analysis.

Exploring the Impact of Different Types of Do-Not-Resuscitate Consent on End-of-Life Treatments among Patients with Advanced Kidney Disease: An Observational Study.

Background: Patients with advanced kidney disease have a symptomatic and psychological burden which warrant renal supportive care or palliative care. However, the impact of do-not-resuscitate consent type (signed by patients or surrogates) on end-of-life treatments in these patients remains unclear. Objective: We aim to identify influential factors correlated with different do-not-resuscitate consent types in patients with advanced kidney disease and the impact of do-not-resuscitate consent types on various life-prolonging treatments. Methods: This was a retrospective observational study. We included patients aged 20 years and over, diagnosed with advanced kidney disease and receiving palliative and hospice care consultation services between January 2014 and December 2018 in a tertiary teaching hospital in Taiwan. We reviewed medical records and used logistic regression to identify factors associated with do-not-resuscitate consent types and end-of-life treatments. Results: A total of 275 patients were included, in which 21% signed their do-not-resuscitate consents. A total of 233 patients were followed until death, and 32% of the decedents continued hemodialysis, 75% underwent nasogastric (NG) tube placement, and 70% took antibiotics in their final seven days of life. Do-not-resuscitate consents signed by patients were associated with reduced life-prolonging treatments including feeding tube placement and antibiotic use in the last seven days (odd ratio and 95% confidence interval were 0.16, 0.07–0.34 and 0.33, 0.16–0.69, respectively) compared to do-not-resuscitate consents signed by surrogates. Conclusions: Do-not-resuscitate consent signed by patients and not by surrogates may reflect better patients’ autonomy and reduced life-prolonging treatments in the final seven days of patients with advanced kidney disease.

Prostate Cancer with Bone Metastases: Addressing Chronic Pain from the Perspective of the Radiation Oncology Nurse Practitioner.

To discuss the symptom burden experienced among patients with castrate-resistant prostate cancer and bone metastases and the role of the oncology nurse practitioner in evaluation for palliative radiotherapy. These include PubMed, international consensus documents, and clinician experience. Men with advanced prostate cancer may live for several years after diagnosis of bone metastases; however, pain and other difficult symptoms are problematic. Pain is effectively treated with palliative radiotherapy, but careful assessment and intervention of other difficult symptoms must be addressed over time. Nurse practitioners in radiation oncology should be well-versed in the disease trajectory of this patient population. Careful symptom inquiry and comprehensive physical examination is a key responsibility. Palliative radiotherapy, alongside analgesics and supportive care measures, can effectively reduce symptoms and improve quality of life in men with prostate cancer metastatic to bone.

A good death in the child with life shortening illness: A qualitative multiple-case study

Background: Understanding what makes a ‘good death’ in the child with life shortening illness is important, as it informs appropriate and effective end-of-life care. Above play, peer contact and opportunities for assent, prior literature review found meeting needs and managing control were critical. The influence of disease types, location of death and palliative care support remains unclear. Aim: Explore how a good death for children can occur in the real-world context and identify factors influencing it. Design: A qualitative multiple-case study. The case was defined as family and professional caregivers of children who died, stratified across disease categories (cancer or non-cancer) and palliative care contact. Data collection included (1) interviews, (2) artefacts, (3) clinical notes. Framework Analysis facilitated in-depth within and cross-case analysis. Setting/participants: Singapore health-care context. Respondents included bereaved parents, health and social care providers from hospital, and a community palliative care service. Results: Five cases were constituted, with eight parents and 14 professionals as respondents. Eight common themes were identified, sub-categorised under three domains and interpreted theoretically: (1) Antecedents: Letting go, Acknowledging the child, Closure (2) Determinants: Suffering, Control, Systems and processes (3) Attributes: Comfort, Dying not prolonged. These factors were consistent across all cases, regardless of individual diagnoses, place of care and palliative care access. Conclusions: Elements that universally influence a good death are revealed within an ecologically sound and holistic conceptual framework. The impact of attitudes among healthcare professionals, and service delivery at systems level highlighted in this study have immediate applications in practice and policy.

Symptom Burden, Palliative Care Needs, and Patient-Provider Communication Among Chronic Myeloid Leukemia Survivors

Background: Chronic myeloid leukemia (CML) patients are living longer, yet can be challenged by disease complications, adverse effects of treatment, and lifelong drug therapy. CML symptoms and treatment side effects (SEs) are often chronic, and patients may need care from a multidisciplinary team of specialists. The study objectives were to examine CML patients' symptom burden, palliative care needs, and experiences with health care team (HCT) communication.Methods: 310 people diagnosed with CML enrolled in the Cancer Support Community's Cancer Experience Registry and completed questions about CML history, treatment, and symptoms. Participants rated the extent to which 19 symptoms and SEs interfered with daily life (0= not at all ; 4= very much); ratings were summed into a symptom burden score (α=.89). Participants also rated 10 items assessing quality of patient-provider communication about SEs (0 = strongly disagree; 4 = strongly agree); items were summed into a SEs communication quality total score (α=.83). Bivariate associations between communication quality and sociodemographic, symptom history, and symptom burden variables were examined; significant variables were included in multiple linear regression analysis predicting SEs communication quality.Results: Participants were 68% female, 89% White; mean age was 56 years (SD=12); mean time since diagnosis was 5 years (SD=6). 65% reported hematologic remission, 42% cytogenic remission, 64% molecular remission; <1% had not yet had a response to CML treatment; 3% had an initial response but were no longer responding. 88% indicated more than one health care provider manages their CML; of those, 72% were satisfied with care coordination. Respondents reported the following symptoms interfered (somewhat to very much) with daily life: fatigue (70%), muscle aches (57%), sleep disturbance (46%), loss of concentration/memory (42%), sexual or intimate relation problems (38%), bone pain (37%), rash or skin issues (35%), anxiety (34%), diarrhea (32%), sadness/depression (32%), nausea (31%), water retention around the eyes (31%), appetite change (29%), constipation (27%), hand/foot swelling (22%), infection (15%), sores not healing (12%), heart problems (7%), and excess lung fluid (7%). 52% believed their HCT prepared them to manage treatment SEs. 67% felt confident in their ability to cope or get help with treatment SEs. 41% reported that potential SEs at least somewhat affected treatment choice. 51% wished they had received more help with managing short-term SEs, and 59% with managing long-term SEs. 81% reported being satisfied with HCT communication about CML treatment, yet only 65% were satisfied with communication about treatment SEs, and 40% did not report the full extent of their symptoms/SEs to their HCT. 74% indicated it was “somewhat” to “very easy” to contact their HCT with questions or concerns, and 76% believed their HCT takes enough time to address concerns. Regression analysis indicated that three predictors explained 51% of the variance in SEs communication quality (R2 = .51, F (3,268) = 93.68, p <.001). Poorer SEs communication quality was associated with less confidence in coping with SEs (semipartial r=.33, p <.001), more holding back from telling the HCT about SEs (semipartial r=−.34, p <.001), and wanting more help managing long-term SEs and symptoms (semipartial r=−.21, p <.001). Greater symptom burden was associated with poorer SEs communication quality in bivariate analysis (r=−.41, p <.001) but the relationship was only a trend in the multivariate model (semipartial r=−.07, p=.10).Conclusion: People with CML experience significant symptom burden and want more support with managing symptoms and side effects. Importantly, those reporting less satisfaction with health care team communication about side effects tended to report greater symptom burden, less confidence in coping with side effects, and greater desire for support in managing symptoms. The results from this study indicate the need for more comprehensive symptom management as part of CML survivorship care, including increased attention to symptom burden during health care team conversations and access to palliative and other supportive care services. DisclosuresMauro:Bristol-Myers Squibb: Consultancy. Buzaglo:Pharmacyclics, Inc: Research Funding; Pfizer Oncology: Research Funding; Novartis: Research Funding; Janssen Biotech, Inc: Research Funding; Genentech, Inc: Research Funding; Eli Lilly and Company: Research Funding; Celgene Corporation: Research Funding; Bristol-Myers Squibb: Research Funding; Boehringer Ingelheim: Research Funding; Bayer: Research Funding; Amgen Corporation: Research Funding; AbbVie: Research Funding; Takeda Oncology: Research Funding.

Improved quality of care and reduced healthcare costs at the end-of-life among older people with dementia who received palliative home care: A nationwide propensity score-matched decedent cohort study

Background: While palliative home care is advocated for people with dementia, evidence of its effectiveness is lacking. Aim: To evaluate the effects of palliative home care on quality and costs of end-of-life care for older people with dementia. Design: Decedent cohort study using linked nationwide administrative databases and propensity score matching. Setting/participants: All home-dwelling older people who died with dementia between 2010 and 2015 in Belgium (N = 23,670). Exposure: Receiving palliative home care support for the first time between 360 and 15 days before death. Results: Five thousand six hundred and thirty-seven (23.8%) received palliative home care support in the last 2 years of life, of whom 2918 received it for the first time between 360 and 15 days before death. Two thousand eight hundred and thirty-nine people who received support were matched to 2839 people who received usual care. After matching, those using palliative home care support, in the last 14 days of life, had lower risk of hospital admission (17.5% vs 50.5%; relative risk (RR) = 0.21), undergoing diagnostic testing (17.0% vs 53.6%; RR = 0.20) and receiving inappropriate medications, but were more likely to die at home (75.7% vs 32.6%; RR = 6.45) and to have primary care professional contacts (mean 11.7 vs mean 5.2), compared with those who did not. Further, they had lower mean total costs of care in the last 30 days of life (incremental cost:−€2129). Conclusions: Palliative home care use by home-dwelling older people with dementia is associated with improved quality and reduced costs of end-of-life care. Access remains low and should be increased.

Support interventions provided during palliative care to families with dependent children when a parent has terminal illness: a scoping review protocol.

The objective of this scoping review is to identify and map support interventions provided during palliative care to families with dependent children when a parent has a terminal illness. For dependent children, losing a parent through terminal illness can be one of the most traumatic experiences they will face. Without age-appropriate information and support, parental death can lead to unresolved grief, post-traumatic stress, and longer-term negative social, emotional, educational, and behavioral consequences. Support from health care professionals is provided, but challenges within hospice and community palliative care mean the needs of dependent children may not be addressed. Greater emphasis is often placed on children's and families' bereavement needs as opposed to their pre-bereavement needs. The status of pre-bereavement support in palliative care for these families has not been documented. We will include studies of support interventions provided to families with dependent children when a parent has a terminal illness that are delivered during palliative care and in settings including, but not limited to, hospices, hospitals, and the community (including family and care homes). Empirical, peer-reviewed studies based on qualitative, quantitative, or mixed methods data, and gray literature, reporting any stage of intervention development will be included. This review will follow the JBI approach for scoping reviews. Multiple database searches will be conducted. Two authors will independently review full-text articles and extract data. Interventions will be mapped in terms of characteristics, evaluation methods, and implementation challenges. Data will be presented in tables, diagrammatic form, and narrative summary.

Palliative care competencies and education needs of nurses and healthcare assistants involved in the provision of supportive palliative care

This paper investigates the palliative care competencies (knowledge, behaviours, attitudes) and education needs of nurses and healthcare assistants (HCAs) who provide supportive (Level 2) palliative care. A mixed-methods study using a sequential exploratory design was used, with findings integrated across sources. Qualitative focus groups were conducted in 2018 with a sample of staff (n=11, all female; nurses=4; HCAs=7) providing supportive palliative care in a single service setting. A quantitative survey, also conducted in 2018, explored the issue with a wider sample within the same setting (n=36; nurses=18; HCAs=18; female=32). Qualitatively, communication was highlighted as an important domain of the competence framework, with many participants acknowledging that the ability to communicate effectively is essential. Quantitatively, participants scored in the lower range for competency variables. A significant difference was observed between HCAs and nurses on measures of knowledge (t= -2.718; df=30; p<.05) and behaviour (t=-3.576; df=30; p<.05), with HCAs scoring significantly higher than nurses. In relation to education, while some participants report being indecisive regarding engaging in education/training, others highlighted the benefit of education, especially its ability to impact on their current practice. This research contributes to understanding palliative care competencies among nurses and HCAs working in palliative care, and has important implications for the education and training of nurses and HCAs working in Level 2 palliative care in Ireland.