Roderick MacLeod

A randomised feasibility study of EPA and Cox-2 inhibitor (Celebrex) versus EPA, Cox-2 inhibitor (Celebrex), Resistance Training followed by ingestion of essential amino acids high in leucine in NSCLC cachectic patients - ACCeRT Study

BackgroundCancer cachexia is a syndrome of progressive weight loss. Non-small cell lung cancer patients experience a high incidence of cachexia of 61%. Research into methods to combat cancer cachexia in various tumour sites has recently progressed to the combination of agents.The combination of the anti-cachectic agent Eicosapentaenoic acid (EPA) and the cyclo-oxygenase-2 (COX-2) inhibitor celecoxib has been tested in a small study with some benefit. The use of progressive resistance training (PRT) followed by the oral ingestion of essential amino acids (EAA), have shown to be anabolic on skeletal muscle and acceptable in older adults and other cancer groups.The aim of this feasibility study is to evaluate whether a multi-targeted approach encompassing a resistance training and nutritional supplementation element is acceptable for lung cancer patients experiencing cancer cachexia.Methods/DesignAucklands Cancer Cachexia evaluating Resistance Training (ACCeRT) is an open label, prospective, randomised controlled feasibility study with two parallel arms. All patients will be treated with EPA and the COX-2 inhibitor celecoxib on an outpatient basis at the study site. In the experimental group patients will participate in PRT twice a week, followed by the ingestion of essential amino acids high in leucine. A total of 21 patients are planned to be enrolled. Patients will be randomised using 1:2 ratio with 7 patients enrolled into the control arm, and 14 patients into the treatment arm. The primary endpoint is the acceptability of the above multi-targeted approach, determined by an acceptability questionnaire.DiscussionTo our knowledge ACCeRT offers for the first time the opportunity to investigate the effect of stimulating the anabolic skeletal muscle pathway with the use of PRT along with EAA alongside the combination of EPA and celecoxib in this population.Trial registrationNetherlands Trial Register (NTR): ACTRN12611000870954

Recognition, reflection and role models: Critical elements in education about care in medicine.

OBJECTIVE Medical education can be described as a socialization process that has a tendency to produce doctors who struggle to convey to patients that they care. Yet, for people who are suffering, to enjoy the quality of life they are entitled to, it is important that they feel cared for as people, rather than simply attended to as patients. METHOD This article addresses how we teach medical students the art of caring for the person rather than simply treating the disease--a question particularly relevant to end-of-life care where, in addition to the physical needs, attention to the psychosocial, emotional, and spiritual needs of the patient is paramount. Following an overview of what it is to care and why it is important that patients feel cared for, we investigate how we learn to care and develop caring human relationships, describing the development and display of empathy in adulthood and the developmental impact of human interaction. RESULTS We outline evidence of situational barriers to effective education about care in medicine including role models, ward culture, and the socialization process. SIGNIFICANCE OF RESULTS We then propose a model for medical education based on patient contact, reflection, self-care, role model development, and feedback that will see students learn the art of human care as well as the science of disease management.

Perceived barriers and facilitators to physical activity in men with prostate cancer: possible influence of androgen deprivation therapy

While physical activity is beneficial for men with prostate cancer, too few perform sufficient activity for such benefit. This study examined perceptions of men with prostate cancer of their barriers and facilitators to physical activity, and how androgen deprivation therapy (ADT) may influence these perceptions. Two focus groups were conducted, involving six ADT and eight non-ADT patients respectively. Data were transcribed verbatim and themes developed using a general inductive thematic approach. Facilitators to physical activity common to both groups of cancer survivors included clinician and spousal involvement, with pre-existing co-morbidities and increased age cited as barriers by both groups. The ADT subgroup cited personal involvement as a facilitator to physical activity, with fatigue, reduced motivation and a relative lack of specific advice from their clinician as additional barriers. The non-ADT subgroup had no additional facilitators to physical activity but cited time constraints as a barrier. These results highlight the important role that cancer clinicians and spouses play in promoting physical activity for men with prostate cancer and how ADT may influence their other facilitators and barriers. As physical activity is beneficial for prostate cancer survivors, especially those on ADT, cancer clinicians should regularly discuss physical activity with their patients.

Estimating the need for palliative care at the population level: A cross-national study in 12 countries

Background: To implement the appropriate services and develop adequate interventions, detailed estimates of the needs for palliative care in the population are needed. Aim: To estimate the proportion of decedents potentially in need of palliative care across 12 European and non-European countries. Design: This is a cross-sectional study using death certificate data. Setting/participants: All adults (⩾18 years) who died in 2008 in Belgium, Czech Republic, France, Hungary, Italy, Spain (Andalusia, 2010), Sweden, Canada, the United States (2007), Korea, Mexico, and New Zealand (N = 4,908,114). Underlying causes of death were used to apply three estimation methods developed by Rosenwax et al., the French National Observatory on End-of-Life Care, and Murtagh et al., respectively. Results: The proportion of individuals who died from diseases that indicate palliative care needs at the end of life ranged from 38% to 74%. We found important cross-country variation: the population potentially in need of palliative care was lower in Mexico (24%–58%) than in the United States (41%–76%) and varied from 31%–83% in Hungary to 42%–79% in Spain. Irrespective of the estimation methods, female sex and higher age were independently associated with the likelihood of being in need of palliative care near the end of life. Home and nursing home were the two places of deaths with the highest prevalence of palliative care needs. Conclusion: These estimations of the size of the population potentially in need of palliative care provide robust indications of the challenge countries are facing if they want to seriously address palliative care needs at the population level.

Place of death in rural palliative care: A systematic review:

Background: There have been many studies on the actual and preferred place of care and death of palliative patients; however, most have been whole population surveys and/or urban focused. Data and preferences for terminally ill rural patients and their unofficial carers have not been systematically described. Aim: To describe the actual place of death and preferred place of care and/or death in rural palliative care settings. Method: A systematic mixed studies review using Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Data source: PubMed, PsychINFO, Scopus and CINAHL databases were searched (September to December 2014); eligible quantitative and qualitative studies included preferred and/or actual place of death/care of rural, regional or remote residents; rural data that are clearly identifiable; death due to palliative condition (malignant and non-malignant) or survey of participants with current or hypothetical life-limiting illness. Results: A total of 25 studies described actual place of death; 12 preferred place of care or death (2 studies reported both); most deaths occurred in hospital with home as the preferred place of care/death; however qualitative studies suggest that preferences are not absolute; factors associated with place are not adequately described as rurality was an independent variable; significant heterogeneity (rural setting and participants), however, many areas had a greater chance of home death than in cities; rural data are embedded in population reports rather than from specific rural studies. Conclusion: Home is the preferred place of rural death; however, more work is needed to explore influencing factors, absolute importance of preferences and experience of providing and receiving palliative care in rural hospitals which often function as substitute hospice.

Caregivers’ Estimations of Their Children's Perceptions of Death as a Biological Concept

Communication about death is often a sensitive topic in families with children. The present studied compared answers of 141 school children aged 5–7 to questions about death, and their caregivers’ predictions. Children were interviewed, and caregivers answered on paper, questions on inevitability, applicability, irreversibility, cessation, causation, and personal mortality. For causation, cessation, and irreversibility, children were significantly more correct than caregivers expected, and girls were more correct on applicability. Communicating with children about death may not always be as caregivers expect.

Perceptions of physically active men with prostate cancer on the role of physical activity in maintaining their quality of life: possible influence of androgen deprivation therapy

The primary aim of this study was to examine the perceptions of older men with prostate cancer regarding their quality of life and physical activity post‐diagnosis, and the potential benefits and risks associated with being physically active. A secondary aim was to gain some preliminary insight into how these perceptions may differ as a function of androgen deprivation therapy (ADT).

The Ability of Hospital Staff to Recognise and Meet Patients’ Spiritual Needs: A Pilot Study

Objectives: We conducted an online cross-sectional survey to determine the understanding of spirituality and spiritual care among clinical and non-clinical staff caring for people with chronic and terminal conditions. Background: As health care moves towards a more person-centred approach, spiritual care has become more important in patients’ care. Recent evidence shows positive associations between addressing patient spiritual needs and health outcomes. Methods: We administered an adapted Spirituality and Spiritual Care Rating Scale (SSCRS), used by the Royal College of Nursing, to hospital and community-care staff (n = 191) in Sydney, Australia. This survey examines perceptions of spiritual care and participant abilities to meet patients’ spiritual needs. Results: The response rate to the SSCRS survey was 84 of 191 eligible participants (44%). Agreement was high on items describing talking to and observing patients and their loved-ones to identify spiritual needs (mean – 90%). However agreement was low concerning items describing the use of data collection tools and talking with colleagues to identify patients’ spiritual needs (mean – 43%). Participants recognised patients’ spiritual needs (mean – 86%), but when asked if they were able to meet these spiritual needs, only 13% (n = 11) stated they were always able to do so. Hence, there was strong agreement on actions for guidance and support for staff dealing with patients’ spiritual and religious issues (n = 71, 85%) and that spiritual care education and training is required (n = 64, 76%). Conclusion: We have identified strong agreement of the importance of delivering spiritual care but uncertainty in the ability to recognise and meet spiritual needs of patients by clinical and non-clinical hospital staff. Our results also show that spiritual care training for hospital staff is now required. Therefore, evidence-based models of spiritual care education and training require further study.

Palliative care development in the Asia-Pacific region: an international survey from the Asia Pacific Hospice Palliative Care Network (APHN)

Background Although palliative care is an important public healthcare issue worldwide, the current situation in the Asia-Pacific region has not been systematically evaluated. Objectives This survey aimed to clarify the current status of palliative care in the Asia-Pacific region. Methods Questionnaires were sent to a representative physician of each member country/region of the Asia Pacific Hospice Palliative Care Network (APHN). The questionnaire examined palliative care service provision, information regarding physician certification in palliative care, the availability of essential drugs for palliative care listed by the International Association for Hospice and Palliative Care (IAHPC) and the regulation of opioid-prescribing practice. Results Of the 14 member countries/regions of the APHN, 12 (86%) responded. Some form of specialist palliative care services had developed in all the responding countries/regions. Eight member countries/regions had physician certifications for palliative care. Most essential drugs for palliative care listed by the IAHPC were available, whereas hydromorphone, oxycodone and transmucosal fentanyl were unavailable in most countries/regions. Six member countries/regions required permission to prescribe and receive opioids. Conclusions The development of palliative care is in different stages across the surveyed countries/regions in the Asia-Pacific region. Data from this survey can be used as baseline data for monitoring the development of palliative care in this region.

Developing Navigation Competencies to Care for Older Rural Adults with Advanced Illness

Les navigateurs aident les adultes ruraux âgés avec des maladies avancées, ainsi que leurs familles, de se connecter aux ressources, à l’information, et aux gens qui peuvent améliorer leur qualité de vie. Cet article décrit le processus utilisé pour engager des experts—en vieillissement en milieu rural, les soins palliatifs en milieu rural, et la navigation—ainsi que les intervenants dans les collectivités rurales, d’élaborer une définition conceptuelle d’une telle navigation et de délimiter les compétences pertinentes pour la prise en charge de cette population. Un document de discussion sur les considérations importantes pour la navigation dans cette population a été développé, suivi d’un processus Delphi en quatre étapes avec 30 membres invités experts. Les résultats de l’étude ont abouti à cinq compétences générales de navigation pour les fournisseurs de soins de santé qui prennent soin des personnes âgées rurales et de leurs familles à la fin de vie: la capacité de fournir le dépistage des patients / famille; à préconiser pour le patient / famille; de faciliter les relations avec la communauté; de coordonner l’accès aux services et aux ressources; et de promouvoir l’engagement actif. Les compétences particulières ont également été développées. Ces compétences constituent la base pour la recherche et le développement de programmes d’études en navigation.Navigators help rural older adults with advanced illness and their families connect to needed resources, information, and people to improve their quality of life. This article describes the process used to engage experts–in rural aging, rural palliative care, and navigation–as well as rural community stakeholders to develop a conceptual definition of navigation and delineate navigation competencies for the care of this population. A discussion paper on the important considerations for navigation in this population was developed followed by a four-phased Delphi process with 30 expert panel members. Study results culminated in five general navigation competencies for health care providers caring for older rural persons and their families at end of life: provide patient/family screening; advocate for the patient/family; facilitate community connections; coordinate access to services and resources; and promote active engagement. Specific competencies were also developed. These competencies provide the foundation for research and curriculum development in navigation.