Highlighted Reviews

August 2019

Hanna JR, McCaughan E, Semple CJ. Challenges and support needs of parents and children when a parent is at end of life: A systematic review. Palliat Med. 2019 Jun 27:269216319857622. doi: 10.1177/0269216319857622.
This review examines the challenges and support needs of parents and dependent children when a parent is at the end of their life. Twenty seven qualitative studies were included and all participants were from a middle class, two parent family. The review found that protecting children from the truth about their parent’s impending death may be a natural parenting instinct but children who are less prepared for the death of a parent have shown increased hostility, resentment and guilt than those who were better prepared. Knowing how much information to share with a child was a challenge for parents and it is not always easy given the uncertainty around the trajectory of illness.
A factor in preparing children was spending time together before the death of their parent. Identifying networks inside and outside the family to provide support to the child was also beneficial for both the child and the dying parent. Knowing that someone would be available to care for their child when they were no longer able to, was comforting to the dying parent. Children responded to positive social support mechanisms such as maintaining routines like going to school or spending time with friends and peers.
More research is needed to reflect the experiences of more diverse families, such as divorced families or those affected by life-limiting illness other than cancer. Implications for health care professionals include the need to provide realistic information about prognosis to support families and to assist parents to openly communicate to their children.

Dias N, Hendricks-Ferguson VL, Wei H, Boring E, Sewell K, Haase JE. A Systematic Literature Review of the Current State of Knowledge Related to Interventions for Bereaved Parents. Am J Hosp Palliat Care. 2019 Jul 3:1049909119858931. doi: 10.1177/1049909119858931. [Epub ahead of print]
Supporting a parent who has lost a child can be challenging and this review sought to identify interventions for bereaved parents. Nine studies were included in the review, which were of varying quality. The authors noted the difficulty of finding research studies examining interventions for this specific group and they identified the need for more robust and focused research in this area. Of the interventions discussed in the paper those that provided a positive outcome for participants were intentional touch therapy, mindfulness therapy and intensive group therapy. The authors acknowledged the difficulty in recruiting participants into bereavement research projects and in particular the difficulty of recruiting grieving parents. While the authors are unable to make recommendations based on their review of the literature they have made some suggestions regarding design requirements for future studies which may be useful for researchers in this area.

Barker MM, Beresford B, Bland M, Fraser LK. Prevalence and Incidence of Anxiety and Depression Among Children, Adolescents, and Young Adults With Life-Limiting Conditions: A Systematic Review and Meta-analysis. JAMA Pediatr. 2019 Jul 8. doi: 10.1001/jamapediatrics.2019.1712. [Epub ahead of print]
This systematic review and meta-analysis sought to estimate the prevalence of anxiety and depression in children, adolescents and young adults (aged 5 to 25 years) with life-limiting conditions. Thirty seven studies were included, 19 reported the prevalence of anxiety while 36 reported the prevalence of depression. A higher rate of anxiety and depression was found in children, adolescents and young adults with life limiting illnesses compared with the same age groups in the general population. Anxiety was estimated at 19.1 per cent in those with life-limiting illnesses compared to 3 percent in the general population in the United States and 7.2 percent in the United Kingdom. Depression was also higher in the targeted group with 14.3 per cent of those with life limiting illnesses compared to 2.1 percent in the United Stated and 8.1 per cent in the United Kingdom. The researchers acknowledged that there was a reporting variation in the studies reviewed depending on the type of assessment tool used, with interviews yielding higher rates of anxiety and self-report tools providing higher rates of depression. While this review does have some limitations, in that only English language studies were reviewed and many studies had small sample sizes, there are some implications which can be drawn. This paper adds to the case in support of routinely screening younger patients for anxiety and depression. It also highlights the evidence gap in relation to younger people with life-limiting illness’ and their mental health needs, and the need for larger scale research in this area.

July 2019

Huang CW, Lee MJ, Wang LJ, Lee PT, Tu YK, Hsu CW, et al. Comparative efficacy and acceptability of treatments for restless legs syndrome in end-stage renal disease: a systematic review and network meta-analysis. Nephrol Dial Transplant. 2019 Jun 3. pii: gfz097. doi: 10.1093/ndt/gfz097. [Epub ahead of print]
Restless legs syndrome, or Wills-Ekbom disease occurs in approximately 6 to 50 per cent of patients with end stage renal disease and is characterised as a compulsion to move the limbs, mostly the legs. In this context it is known to be associated with increased risk of depression, anxiety, impaired quality of life, insomnia, and discontinuation of dialysis. This systematic review and network meta-analysis of 12 RCTs examining the efficacy of interventions at treating the syndrome included 498 patients. Of the nine interventions examined, Gabapentin provided the greatest alleviation of symptoms with an acceptable risk of side effects. Dopamine agonists when combined with exercise therapy was more effective than vitamin C, vitamin E or both given in combination. While iron supplementation also proved beneficial at reducing symptoms it did not have sustained effects. The authors of this review note that all the RCTs reviewed were of short duration and they did not consider the baseline severity of symptoms when comparing treatment outcomes.

Jess M, Timm H, Dieperink KB. Video consultations in palliative care: A systematic integrative review. Palliat Med. 2019 Jun 12:269216319854938. doi: 10.1177/0269216319854938. [Epub ahead of print]
Telehealth is a growing area of health care and video consultations are one aspect of this burgenoning practice. This systematic review examined the evidence for the use of video consultations in general and specialised palliaitive care. A total of 39 studies were included, with studies using mixed method (n = 14), qualitiative (n = 10) and quantitative (n = 10), covering 2345 patients, 549 relatives and 252 health care professionals particiapting in 1631 video consultations. Seven of the studies were conducted in the Australian setting. A majority of the research studies focused on terminally ill cancer patients, from high-income countries recieiving specialised palliative care services, which limits the applicability of the findings. There is some evidence to support that most patients and carers found video consultations a positive experience, some of the health care professionals felt that an in person encounter was beneficial to establishing a therapeutic relationship. Video consultations respresent a new form of practice for health care providers but this review, while outlining some advantages and disadvantages to the practice, was unable to establish where it might be best placed in the care of patients receiving pallaitive care. Differences between patient and health care professional responses highlights the importance of seeking input from both perspectives.

Parisi A, Sharma A, Howard MO, Blank Wilson A. The relationship between substance misuse and complicated grief: A systematic review. J Subst Abuse Treat. 2019 Aug;103:43-57. doi: 10.1016/j.jsat.2019.05.012. Epub 2019 May 23.
Complicated grief is a prolonged bereavement disorder which can adversley affect a person both physically and psychologically. The authors of this systematic review examined the relationship between complicated grief and substance misue. With 12 research papers included, covering 1749 patients, the authors examined a total of seven studies, both qualitative and quantitative. The review found evidence of a correlation between complicated grief and substance misuse, with people sufering from one condition being highly vulnerable to  developing the other. The authors examined potential risk factors for people with both conditions and these were female gender, unemployment, low levels of education and social support, a history of incarceration, the loss of a sibling or a husband and the traumatic circumstances of the death. Given the low number of studies, the limitiations in methodologies  and the heterogeneity  of the included research these results should be viewed with some caution.

Last updated 05 August 2019