CIAP Newsletter

National Palliative Care Week is an annual awareness raising week organised by Palliative Care Australia. Palliative Care Australia is the peak national body for palliative care and its website provides useful information and support for clinicians working in palliative care. This year, National Palliative Care Week will be held between 22-28 May.

CIAP provides many resources to support NSW Health staff in the delivery of evidence-based palliative care to patients of all ages. These resources provide medicines information, guidelines, details about diseases and conditions, a range of topic-specific journals and books, links to recommended websites and more.

A good place to start is with the Therapeutic Guidelines (eTG). There are three main ways of finding information in eTG: through the Index, via the Contents, or by using the search function (Text Find). You will note on the eTG home page that guidelines are listed by specialty area, one of which is Palliative Care. Selecting Palliative Care will display a comprehensive list of chapters, appendices, tables, key references and details about the expert group that compiled this content. Chapter topics include Principles of palliative care, Ethical issues, Supporting the patient and family, Bereavement, Managing medications, Pain, Fatigue and systemic symptoms. Click on List of tables, boxes and figures, for easy to read summaries on a range of subjects, such as Children’s concepts of death (Table 10.11), Dosing of medications commonly used in paediatric palliative care (Table 10.14) and Mucocutaneous paraneoplastic syndromes (Table 10.20).

For evidence-based systematic reviews on palliative care topics, browse BMJ Clinical Evidence (BMJ CE), Cochrane Library and the Joanna Briggs Institute through 'Evidence-Based Practice' in CIAPs left menu.

BMJ CE systematic reviews aim to summarise the current state of knowledge and uncertainty about interventions used to prevent and treat clinical conditions by using a rigorous process and teams of expert clinician authors. By searching and appraising world-wide literature, BMJ CE produces reviews of authoritative evidence on the benefits and harms of clinical interventions. One of these reviews focuses on the use of Opioids in people with cancer-related pain. The authors note, ‘Up to 80% of people with cancer experience pain at some time during their illness, and most will need opioid analgesics’. This review focuses on assessing how different opioid analgesics compare, in terms of both pain control and adverse effects, in people with cancer.

The Cochrane Library contains systematic reviews and a range of other resources including podcasts and the Cochrane Journal Club. While the Cochrane Library does not provide a specific palliative care section, many relevant reviews are contained within other topic sections. For example, selecting 'Blood Disorders' will offer 85 reviews on haematological malignancies, including:

The role of iron in the management of chemotherapy‐ induced anemia in cancer patients receiving erythropoiesis‐stimulating agents (Online Publication Date: February 2016)
Antibody therapies for lymphoma in children (Online Publication Date: January 2016)
Prognostic models for chronic lymphocytic leukaemia: an exemplar systematic review and meta‐analysis (Online Publication Date: January 2016)

Select your own specialty area of practice in the 'Browse by Topic' section located on the lower half of the Cochrane home page to explore the full range of reviews available.

PEDro is the Physiotherapy Evidence Database. It contains information for over 33,000 randomised trials, systematic reviews and clinical practice guidelines for physiotherapy. For palliative care specifically, it offers 1300 entries covering interventions, supportive and complementary therapies, exercise programs and emerging treatments including many on lymphedema and pain management.

A range of guidelines can be accessed on palliative care and related topics through Guidelines in CIAP's left menu. For example, links to the Agency of Clinical Innovation (ACI) and the National Health and Medical Research Council provide access to networks, models of care, reports, chart and checklists, guidelines, evidence reviews and consumer information.

Using the green Full List buttons in either Journals or Books & Dictionaries from CIAP's left menu, you can search and browse for journals and books that may be of interest. In the Browse books by publisher section, select Access Medicine Books to access a diverse range of eBooks with chapters on palliative and end of life care such as Chapter 33: Pain Management & Pediatric Palliative & End-of-Life Care in Current Diagnosis & Treatment: Pediatrics and Section I Chapter 11: Geriatrics & Palliative Care in Current Diagnosis & Treatment: Geriatrics.

Browse journals such as Journal of Palliative Care, BMC palliative care and International Journal of Palliative Nursing (the current issue includes: Meeting nutritional needs of palliative patients, and Yoga as Palliation in Women with Advanced Breast Cancer: A Pilot study).

To explore more resources available through CIAP, visit the Palliative Care Specialty Guide. To learn more about how to use CIAP resources, visit the Knowledge Centre where you will find user guides, video tutorials and other learning options to support your use of CIAP resources.

CIAP Update

New Features in the Therapeutic Guidelines (eTG)

A new web design is being released for the Therapeutic Guidelines (eTG). In May 2016, eTG complete will release a website update, featuring a new look, coupled with improved functionality and navigation. To view these changes and information about the new functions, take a look at the eTG Update user guide.

A new video tutorial is also available from CIAP’s Knowledge Centre in the Video Tutorials page.

Article in Focus

Conceptual foundations of a palliative approach: a knowledge synthesis

BMC Palliative Care 15(5): Published online January 2016

Abstract

The goal of this research was to delineate the key characteristics of a palliative approach found in the empiric literature in order to establish conceptual clarity. The authors synthesised the empirical peer-reviewed literature pertaining to 'palliative care' and 'chronic life-limiting conditions'.

The following three overarching themes were conceptualised to delineate a palliative approach: (1) upstream orientation towards the needs of people who have life-limiting conditions and their families, (2) adaptation of palliative care knowledge and expertise, (3) operationalisation of a palliative approach through integration into systems and models of care that do not specialise in palliative care.

Gems on CIAP

Opioid Preparations

The Therapeutic Guidelines (eTG) has a table of properties of commonly used opioid preparations. Type opioid into the search box, select opioids (see also individual drugs), then under clinical pharmacology select the Formulations and properties table. You’ll note other tables and info boxes that may also be of use, such as Adverse effects with long-term use, Paediatric palliative care, Relative dosing and Initiating modified-release opioid preparations.