Media Watch 553

Attached is the current issue of Media Watch (#553).

Of particular interest in this week's issue:


Assessment of the wish to hasten death in patients with advanced cancer: A comparison of two different approaches

PSYCHO-ONCOLOGY | Online – 28 February 2018 – The Desire for Death Rating Scale (DDRS) and the short form of the Schedule of Attitudes toward Hastened Death (SAHD-5) are different approaches to assessing the wish to hasten death (WTHD). Both have clinical threshold scores for identifying individuals with a meaningfully elevated WTHD. However, the agreement between the two measures, and patient opinions about assessment of the WTHD, are unknown. The WTHD was assessed in 107 patients with advanced cancer using both the DDRS and SAHD-5. Patients were subsequently asked their opinion about this assessment. Correlation between scores on the SAHD-5 and the DDRS was moderate. The SAHD-5 identified 13 patients at risk of the WTHD, and the DDRS identified 6 patients with a moderate-high WTHD. Concordance between the DDRS and SAHD-5 in identifying individuals with an elevated WTHD was poor when using recommended cut-off scores..., but could be improved by using different thresholds. Only 4 patients regarded the assessment questions as bothersome, and 90.6% considered it important that healthcare professionals inquire about the WTHD.


The Liverpool Care Pathway for the Dying Patient: A critical analysis of its rise, demise and legacy in England

WELLCOME OPEN RESEARCH | Online – Accessed 27 February 2018 – The Liverpool Care Pathway for the Dying Patient (“the LCP”) was an integrated care pathway (ICP) recommended by successive governments in England & Wales to improve end-of-life care (EoLC), using insights from hospice and palliative care (PC). It was discontinued in 2014 following mounting criticism and a national review. The ensuing debate among clinicians polarised between “blaming” of the LCP and regret at its removal. The authors aimed to address three questions: 1) Why and how did the LCP come to prominence as a vehicle of policy and practice; 2) What factors contributed to its demise; and, 3) What immediate implications and lessons resulted from its withdrawal? The rapidity of transfer and translation of the LCP reflected uncritical enthusiasm for ICPs in the early 2000s. The subsequent LCP “scandal” demonstrated the power of social media in creating knowledge, as well as conflicting perceptions about end-of-life interventions. While the LCP had some weaknesses in its formulation and implementation, it became the bearer of responsibility for all aspects of National Health Service (NHS) EoLC. This was beyond its original remit. It exposed fault lines in the NHS, provided a platform for debates about the “evidence” required to underpin innovations in PC and became a conduit of discord about “good” or “bad” practice in care of the dying. It also fostered a previously unseen critique of assumptions within PC. In contrast to most observers of the LCP story who refer to the dangers of scaling up clinical interventions without an evidence base, the authors call for greater assessment of the wider risks and more careful consideration of the unintended consequences that might result from the roll out of new end-of-life interventions.