Media Watch 552

Attached is the current issue of Media Watch (#552)

Of particular interest in this week's issue: 


Assessment and treatment considerations for post traumatic stress disorder at end of life

AMERICAN JOURNAL OF HOSPICE & PALLIATIVE MEDICINE | Online – 20 February 2018 – Post traumatic stress disorder (PTSD) may first emerge, re-emerge, or worsen as individuals approach end of life (EoL) and may complicate the dying process. Unfortunately, lack of awareness of the occurrence and/or manifestation of PTSD at EoL can lead to PTSD going unaddressed. Even if PTSD is properly diagnosed, traditional evidence-based trauma-focused treatments may not be feasible or advisable with this group as many patients at EoL often lack the physical and mental stamina to participate in traditional psychotherapy. This article reviews the clinical and empirical literature on PTSD at EoL, as well as discusses assessment and psychotherapy treatment issues with this neglected population. 


Palliative medicine: Has there been mission rift?

EUROPEAN JOURNAL OF PALLIATIVE CARE, 2018;25(1):6-8. With its new-found status, one of palliative medicine’s first challenges was to confront the prospect of evidence-based medicine. This new paradigm suggested tradition, anecdote and theoretical reasoning be replaced by evidence from high-quality randomised control trials and observational studies. In combination with “clinical expertise,” these were to provide clinicians with the knowledge to drive healthcare into the new millennium. Thirty years later, other specialties have amassed an evidence base that stands tall over that of palliative medicine (PM). However, somewhat contradictorily, PM is widely regarded as offering a standard of care second to none. Within this paradox lies the answer to what really matters to people. Evidence-based medicine has its limitations. It has become distorted by vested interests, uses surrogate outcomes to establish efficacy, is a poor fit for frailty and multi-morbidity, and there are huge problems with publication bias. Despite this, we have created a volume of research and guidelines that has left us at saturation point. Compulsive reliance on evidence has created a breed of clinician trained in following a template driven approach that stifles development of the subtleties of clinical expertise. What lies beyond evidence-based medicine?


A framework for complexity in palliative care: A qualitative study with patients, family carers and professionals

PALLIATIVE MEDICINE | Online – 19 February 2018 – Palliative care (PC) patients are often described as complex, but evidence on complexity is limited. We need to understand complexity, including at individual patient-level, to define specialist PC, characterise PC populations, and meaningfully compare interventions/outcomes. Semi-structured interviews [were conducted] across six U.K. centres with patients, family, professionals, managers and senior leads, sampled by experience, background, location and setting (hospital, hospice and community). Participants provided an understanding of complexity, which extended far beyond the commonly used physical, psychological, social and spiritual domains. Complexity included how patients interact with family/professionals, how services respond to needs and societal perspectives on care. “Pre-existing,” “cumulative” and “invisible” complexity are further important dimensions to delivering effective palliative and end-of-life care. The dynamic nature of illness and needs over time was also profoundly influential. Stakeholders found it acceptable to capture complexity at the patient-level, with perceived benefits for improving PC resource allocation.