Virtual reality technology for pain management in advanced cancer.

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: Primarily, to determine the effectiveness of a virtual reality (VR) intervention compared to an alternative or no intervention for people living with advanced cancer: on pain intensity, adverse events (AEs) and serious adverse events (SAEs); and secondarily, on additional pain properties (e.g.

Assessing the sensitivity and acceptability of the Royal Marsden Palliative Care Referral "Triggers" Tool for outpatients with cancer.

Purpose: To evaluate the use, acceptability, and experience of a seven-item palliative care referral screening tool in an outpatient oncology setting.

Methods: A two-phase convergent parallel mixed-methods study. Patient participants who met any of the "Royal Marsden Triggers Tool" criteria were compared with those who did not in terms of demographic data, palliative care needs (Integrated Palliative Outcome Scale, IPOS) and quality of life indicators (EORTC-QLQ-C30).

Methylphenidate Versus Placebo for Treating Fatigue in Patients With Advanced Cancer: Randomized, Double-Blind, Multicenter, Placebo-Controlled Trial.

Purpose: To compare effects and side effects of 6 weeks of individually dose-titrated methylphenidate or placebo on fatigue in palliative care patients with advanced cancer.

Methods: This is a randomized, double-blind, placebo-controlled, multicenter trial. Eligible patients had advanced incurable cancer and fatigue >3/10.

An Analysis of Healthcare Usage & Place of Death in England for All Adults Who Died in 2021/22.

Objective: We wanted to examine the healthcare use and non-elective activity in the UK population of expected deaths over an 1-year period to highlight and examine the reasons for variation. We did this to identify areas to focus interventions or resources on to reduce unnecessary emergency care use at the end of life.

Methods And Analysis: We assembled a data set of approximately 400 000 adults who died in England in the financial year 2021/22 (April 2021-March 2022).

Digitally Recording Comfort Observations in the Last Days of Life.

37.5% of deaths in our area occur in hospital. There are known high unmet needs of adult patients dying in hospital, this unmet need can be reduced by using an individualised care plan and specialist palliative care review.

Evaluation of Palliative Care Related Hospital Admissions in a Regional Centre.

Objectives: A significant proportion of adults admitted to hospital are in their last year of life. We evaluated admissions for these patients.

Methods: We identified ambulance callouts to patients known to the palliative care team.

What can you learn as a foundation doctor from analysing deaths in hospital?

Deaths in hospital represent a vital learning opportunity for both individual clinicians and the wider healthcare system. Many deaths are reviewed and discussed in morbidity and mortality meetings, with the Royal College of Physicians promoting Structured Judgement Review (SJR) methodology to support this discussion. An analysis of 1 year of SJRs in one hospital was undertaken, generating a toolkit to support junior doctors in evaluating in-hospital deaths.

Seeking Excellence in End of Life Care UK (SEECare UK): a UK multi-centred service evaluation.

Objective: To evaluate the care of patients dying in hospital without support from specialists in palliative care (SPC), better understand their needs and factors influencing their care.

Methods: Prospective UK-wide service evaluation including all dying adult inpatients unknown to SPC, excluding those in emergency departments/intensive care units. Holistic needs were assessed through a standardised proforma.

Patient-reported outcome measurement in palliative care: A hermeneutic narrative review.

Objectives: Recent years have witnessed the rise of patient-reported outcome measures (PROMs) in palliative care (PC), particularly those focused on the standardized measurement of symptom burden. These measures seek to evaluate the quality of PC through the quantification of various aspects of potential suffering (e.g.

Speaking up at conference question and answer sessions-disruptive behaviour typography and assessment scale.

Conferences can be a space to present new research, network, and provide an opportunity for learning. Delegates can meet field leaders, peers, top doctors, and international colleagues in various areas of expertise. Challenging behaviours, in particular in the question and answer session, but also during lectures themselves, may reduce overall enjoyment and learning.

Care of the dying - medical student confidence and preparedness: mixed-methods simulation study.

Objectives: Of all doctors, Foundation Year 1 trainees spend the most time caring for dying patients yet report poor preparation and low confidence in providing this care. Despite documented effectiveness of simulation in teaching end-of-life care to undergraduate nurses, undergraduate medicine continues to teach this subject using a more theoretical, classroom-based approach. By increasing undergraduate exposure to interactive dying patient scenarios, simulation has the potential to improve confidence and preparedness of medical students to care for dying patients.

How effective is virtual reality technology in palliative care? A systematic review and meta-analysis.

Background: The efficacy of virtual reality for people living with a terminal illness is unclear.

Aim: To determine the feasibility and effectiveness of virtual reality use within a palliative care setting.

Design: Systematic review and meta-analysis.

Medical student anxiety in caring for dying patients and their family: a cross-sectional study.

Objectives: To investigate the level of medical student anxiety in caring for a dying patient and their family and identify influencing factors.

Methods: We conducted a cross-sectional survey in a UK medical school to measure medical student anxiety using a validated Thanatophobia Scale questionnaire.

Results: In total, 332 questionnaires were completed.

Seeking Excellence in End of Life Care (SEE Care): A Multi-Centered Acute Hospitals Service Evaluation.

Context: A proportion of UK hospital inpatients have palliative care needs but do not access specialist services.

Objectives: To contemporaneously evaluate the significance of unmet specialist palliative care needs within the hospital inpatient population.

Methods: Prospective multi-centered service evaluation was conducted through 4 snapshots across 4 acute NHS hospital trusts.

The Potential of Personalized Virtual Reality in Palliative Care: A Feasibility Trial.

Background: Virtual Reality can help alleviate symptoms in a non-palliative care population. Personalized therapy can further alleviate these symptoms. There is little evidence in a palliative care population.

Emotional intelligence in palliative medical education.

The death of a patient is one of the most stressful situations a healthcare professional can face for the first time at work or during training. Palliative and end of life care education aims to impart appropriate awareness and understanding of key issues arising at the end of life, but also to develop learners' interpersonal skills in leadership, communication and management of their own emotional load. There is a pressing need to be explicit around death, dying and care at the end of life and to equip clinical staff with the ability to manage the emotions that are experienced by their patients, their teams and themselves.

Care of the dying person before and during the COVID-19 pandemic: A quality improvement project.

The current COVID-19 pandemic has necessitated the redeployment of NHS staff to acute-facing specialties, meaning that care of dying people is being provided by those who may not have much experience in this area. This report details how a plan, do, study, act (PDSA) approach was taken to implementing improved, standardised multidisciplinary documentation of individualised care and review for people who are in the last hours or days of life, both before and during the COVID-19 pandemic. The documentation and training produced is subject to ongoing review via the specialist palliative care team's continuously updated hospital deaths dashboard, which evaluates the care of patients who have died in the trust.

Opioid-induced constipation in patients with cancer: a "real-world," multicentre, observational study of diagnostic criteria and clinical features.

The aim of this study was to investigate opioid-induced constipation (OIC) in a large cohort of "real-world" patients with cancer; the objectives were to determine the prevalence of OIC, the utility of a simple screening question, the accuracy of the Rome IV diagnostic criteria, the clinical features of OIC (physical and psychological), and the impact of OIC (quality of life). One thousand patients with cancer were enrolled in the study, which involved completion of the Rome IV diagnostic criteria for OIC, the Bowel Function Index, the Patient Assessment of Constipation Quality of Life questionnaire, and the Memorial Symptom Assessment Scale-Short Form. Participants also underwent a thorough clinical assessment by an experienced clinician (ie, "gold-standard" assessment of OIC).

Hospital deaths dashboard: care indicators.

Objectives: We wanted to create a medical/nursing led data collection tool to allow for an ongoing audit of the quality of deaths in a teaching hospital. We wanted to be able to produce a visual summary to monitor our involvement, use of PRN medication, recognition of death, treatment escalation plans and communication aspects. We feel these are good surrogate indicators for quality end-of-life care.

Palliative care training in undergraduate medical, nursing and allied health: a survey.

Objectives: Impending death is poorly recognised. Many undergraduate healthcare professionals will not have experience of meeting or caring for someone who is dying. As death can occur in any setting, at any time, it is vital that all healthcare students, regardless of the setting they go on to work in, have end-of-life care (EOLC) training.

Online training improves medical students' ability to recognise when a person is dying: The ORaClES randomised controlled trial.

Background: Recognising dying is a key clinical skill for doctors, yet there is little training.

Aim: To assess the effectiveness of an online training resource designed to enhance medical students' ability to recognise dying.

Design: Online multicentre double-blind randomised controlled trial (NCT03360812).

The Second Conversation project: -Improving training in end of life care communication among junior doctors.

Junior doctors describe a need for greater support and training in end of life care (EoLC) communication skills. The Second Conversation project was designed by a multi-professional steering group as a workplace based training intervention for junior doctors to improve their skills and confidence in undertaking EoLC conversations. Qualitative interviews were carried out with 11 junior doctors and five senior doctors across two sites who took part in, or facilitated, a 'second conversation'.

The (un)availability of prognostic information in the last days of life: a prospective observational study.

Objectives: The aims of this study were (1) to document the clinical condition of patients considered to be in the last 2 weeks of life and (2) to compare patients who did or did not survive for 72 hours.

Design: A prospective observational study.

Setting: Two sites in London, UK (a hospice and a hospital palliative care team).