Media Watch 551

Attached is the current issue of Media Watch (#551).


Of particular interest in this week's issue:

How to achieve the desired outcomes of advance care planning in nursing homes: A theory of change

BMC GERIATRICS | Online – 14 February 2018 – The authors created a Theory of Change map that describes how and in what circumstances advance care planning (ACP) should be implemented and organised in nursing homes to achieve its desired long-term outcomes. They explicitly state which intervention components should be part of this ACP intervention. The Theory of Change map provides the first comprehensive rationale of how ACP is expected to work in nursing homes, something that has not been shown by research before, but for which repeated calls have been made. We will use these insights in the further design of the ACP intervention and its evaluation to explore in greater depth how, why and in what circumstances ACP works best in routine nursing home care in Belgium. 

Research involving dying persons: Time to reconsider?

COLLEGIAN (Australian Journal of Nursing Practice, Scholarship & Research), 2018;25(1):1-2. Using research to generate evidence to inform clinical practice is a position adopted almost universally in healthcare, with health care organisations, policymakers and clinicians using research evidence to improve the quality of care. Yet, when it comes to palliative and end-of-life (EoL) care, the situation may be different. Research involving the dying, whether conducted in palliative care settings or elsewhere, is often considered ethically challenging and controversial. This is because of concern about the actual or potential vulnerability of persons approaching the EoL and whether the dying person can or should be involved in research. Yet, the caution associated with research participation for those who are dying, might need to be reconsidered. Despite concern from ethical review boards, researchers, clinicians and consumers that research involving dying persons might be intrusive, inappropriate or unethical, the research evidence suggests that dying persons who have participated in research did so with very good reason. 

A moment for compassion: Emerging rhetorics in end-of-life care

Medical Humanities | Online – 10 February 2018 – “Compassion” has become the flagship concept to be fostered in the delivery of end-of-life care (EoLC), and a rallying call for social action and public health intervention. The authors examine the emerging rhetorics of compassion as they relate to EoLC and offer a critique of the expanding discourse around it. They argue, even where individuals “possess” compassion or are “trained” in it, there are difficulties for compassion to flow freely, particularly within Western society. This relates to specific sociopolitical structural factors that include the sense of privacy and individualism in modern industrialised countries, highly professionalised closed health systems, anxiety about litigation on health and safety grounds, and a context of suspicion and mistrust within the global political scenario. We must then ask ourselves whether compassion can be created intentionally, without paying attention to the structural aspects of society. One consequence of globalisation is countries in the global South are rapidly trying to embrace the features of modernity adopted by the global North. The authors argue unrealistic assumptions have been made about the role of compassion in EoLC and these idealist aspirations must be tempered by a more structural assessment of potential. Compassion that is not tied to to realistic action runs the risk of becoming empty rhetoric.