Media Watch 560

Attached is the current issue of Media Watch (#560).

Of particular interest in this week's issue:

Increasing information dissemination in cancer communication: Effects of using “palliative,” “supportive,” or “hospice” care terminology

JOURNAL OF PALLIATIVE MEDICINE | Online – 20 April 2018 – When attempting to share information about comfort-oriented care, many use “palliative,” “supportive,” and “hospice” care terminology interchangeably, but we lack evidence about the effects of using these different terms. This experimental study was conducted at a major U.S. hospital serving a diverse population. Patients visiting a cancer clinic encountered opportunities to learn more about cancer care. They were offered health materials that were described as reporting on “palliative,” “supportive,” or “hospice” care and the primary outcome was whether a patient decided to select or reject each. As a secondary outcome, the study measured the patient’s level of interest in receiving each. In this study, the terminology used had a large effect and, compared with alternatives, the information labeled as being about “supportive” care was significantly more likely to be selected. If these effects are supported by additional research, there may be low-cost, highly feasible changes in language choice that increase the dissemination of relevant health information. 


Medical assistance in dying: A paediatric perspective

PAEDIATRICS & CHILD HEALTH, 2018;23(2): 125-130. In June 2016, [Canada’s] Bill C-14 was enacted, allowing medical assistance in dying (MAiD) for an eligible adult whose death is “reasonably foreseeable.” An independent report on the status of “mature minors” (who are currently excluded under federal legislation), with focus on their potential eligibility for MAiD, was required by the 2016 Act and is expected to be presented to Parliament by December 2018. Ensuring that newborns, children and youth receive the highest possible standard of care as they are dying is a privilege and a responsibility for physicians and allied professionals. Bringing a thoughtful, respectful and personal approach to every end-of-life situation is an essential and evolving duty of care, and the process should meet each patient’s (and family’s) unique social, cultural and spiritual needs. This statement describes the current Canadian legal and medical context of MAiD and articulates a paediatric perspective that has emerged from – and been informed by – the broad, structured consultation process unfolding in Canada and elsewhere. Although “mature minors” are the only youth currently mandated for further legislative consideration in Canada, the need to examine requests for and attitudes around MAiD for minors of all ages remains compelling for two main reasons: Canadian health care professionals are increasingly being approached by the parents of “never-competent” infants and children, including those too young to make a reasoned decision, and by youth themselves, to discuss MAiD related issues; and, the discussion of MAiD policy in Canada has been framed as much by the issue and context of suffering as by considerations of autonomy. While current legislation clearly prohibits MAiD for incapable persons at the request of any other person, it is possible that parents may request MAiD on behalf of their dying child. 

Extract from the Paediatrics & Child Health article: The role of palliative care

Palliative care (PC) and medical assistance in dying (MAiD) provide philosophically and clinically distinct – though interconnected – medical services. Some parents and clinicians fear PC as being focused on death rather than on life, and education around PC often involves explaining its essential role in optimizing quality of life for as long as possible. If PC physicians were also to engage in the MAiD process, some practitioners believe that fear and apprehension might intensify. At the same time, however, PC practitioners have acquired invaluable wisdom and experience caring for individuals and families living with advanced illness. Requests for MAiD may still arise in the context of excellent PC, and the expertise and experience of PC specialists must remain available to families considering MAiD. Furthermore, paediatric PC physicians may also wish to participate in MAiD, if and when legislative changes extend MAiD to some paediatric patients. Irrespective of personal beliefs, access to high quality PC must be seamless for those in need, whatever end-of-life options are being contemplated.


The involvement of cancer patients in the four stages of decision-making preceding continuous sedation until death: A qualitative study

PALLIATIVE MEDICINE | Online – 18 April 2018 – Professional guidelines emphasize that the decision to initiate continuous sedation should be made in accordance with the wishes of the dying person and be preceded by their consent. Interviews were conducted with 26 physicians, 30 nurses and 24 relatives caring for 24 patients with cancer who received continuous sedation until death in Belgium, the U.K. and The Netherlands. The authors distinguished four stages of decision-making: initiation, information exchange, deliberation and the decision to start continuous sedation until death. There was wide variation in the role the patient had in the decision-making process. At one end of the spectrum (mostly in the U.K.), the physician discussed the possible use of sedation with the patient, but took the decision themselves. At the other end (mostly in Belgium and The Netherlands), the patient initiated the conversation and the physician’s role was largely limited to evaluating if and when the medical criteria were met. The authors recommend building into clinical practice regular opportunities to discuss the goals and preferences of the person who is dying for their future medical treatment and care.