Highlighted Reviews

The following selected systematic reviews have been reviewed by the CareSearch team to highlight the relevance of this research to palliative care practice and the Australian context where appropriate.  For the full list of new reviews added to the CareSearch Systematic Review collection visit the Latest Reviews page.

5 June 2020

Examining the Support Needs of Older Male Spousal Caregivers of People With a Long-Term Condition: A Systematic Review of the Literature

Fee A, McIlfatrick S, Ryan A. Examining the support needs of older male spousal caregivers of people with a long-term condition: A systematic review of the literature. Int J Older People Nurs. 2020 May 4:e12318.

The proportion of male caregivers is increasing, and in some countries among those aged 85 years and older they are the majority. Should this prompt a change in how support for carers is provided? To answer this a systematic review of 11 articles has summarised insights gained from male carers who are caring for a chronically ill spouse/partner at home. Two major themes were revealed, male caregivers need to maintain masculinity and they often feel isolated in a “feminised landscape of care”. The first of these is often expressed by professionalising care through application of their work-life skills to take charge and protect their partner. However, this sense of duty and a wish to avoid formal care ‘taking over’ can delay requests for help. The authors suggest simple ways of working with male carers to maintain a sense of involvement with their partner and influence over their lives, while ensuring delivery of effective and timely care.

5 June 2020

Symptoms of Malignant Fungating Wounds and Functional Performance Among Patients With Advanced Cancer: An Integrative Review From 2000 to 2019

Tilley CP, Fu MR, Van Cleeve J, Crocilla BL, Comfort CP. Symptoms of Malignant Fungating Wounds and Functional Performance among Patients with Advanced Cancer: An Integrative Review from 2000 to 2019. J Palliat Med. 2020 Jun;23(6):848-862.

Malignant fungating wounds (MFW) affect up to 15% of people with advanced cancer and typically occur in the last 6-12 months of life. An understanding of MFW symptoms and the impact of this at the individual level is needed to provide person centred support. This review of 12 studies provides a detailed insight into the many symptoms of MFW, of which pain was the most frequent but malodor the most distressing. It also provides evidence from qualitative studies on how some of these symptoms impact functional performance including mobility, activities of daily living, and social interactions. Health professionals can use this knowledge of both clinical and broader impacts of MFW on quality of life to help affected people maintain their sense of dignity and connection at the end of their life.       

5 June 2020

Measuring the Prevalence of Sleep Disturbances in People With Dementia Living in Care Homes: A Systematic Review and Meta-Analysis

Webster L, Costafreda Gonzalez S, Stringer A, Lineham A, Budgett J, Kyle S, et al. Measuring the prevalence of sleep disturbances in people with dementia living in care homes: a systematic review and meta-analysis. Sleep. 2020 Apr 15;43(4):zsz251.

Sleep disturbances among people with dementia can be disruptive for the person and other residents in a care home setting. However, despite numerous studies and the fact that responses to sleep disturbances often involving pharmacological intervention with psychotropics it has not been examined in detail. This review addresses this by examining 55 studies of sleep disturbances in people with dementia and residing in care homes. A detailed meta-analysis demonstrates that how sleep disturbances are measured has a strong influence on reported prevalence, and ultimately can lead to potentially incorrect measures being taken. Varying between a prevalence of 20% when assessed with validated questionnaires to 70% using a wrist accelerometer, the review discusses in detail whether these approaches are measuring the same thing, and the implications of this for residents and their families. While the authors recommend use of questionnaires at this stage, care providers should be aware of the strengths and weaknesses of all approaches.  

7 May 2020

Triggered Palliative Care Consults: A Systematic Review of Interventions for Hospitalized and Emergency Department Patients.

Kistler EA, Stevens E, Scott E, Philpotts LL, Greer JA, Greenwald JL. Triggered Palliative Care Consults: A Systematic Review of Interventions for Hospitalized and Emergency Department Patients. J Pain Symptom Manage. 2020 Feb 12:S0885-3924(20)30074-9. doi: 10.1016/j.jpainsymman.2020.02.001. Epub ahead of print.

How do we identify who would benefit from a palliative care consultation? This review of 20 studies with more than 17,000 patients examined the trigger tools commonly employed to make this decision when patients present to an emergency department or have been admitted to hospital. Approximately 40% of patients were identified as likely to benefit. The most common categories included in the tools were the presence of advanced or life-limiting disease such as cancer or chronic comorbidities, readmission risk, and goals of care discussions. In total 20 categories were identified but no category was present in all studies, while expert opinion and local observation were the basis of most tools. The authors discuss this heterogeneity and propose a base set of categories that might inform development of a standardised tool.  This is important in terms of improving identification of those who might benefit, and because not all care settings have experts and experience to guide local tool development.

7 May 2020

The use of olanzapine as an antiemetic in palliative medicine: a systematic review of the literature.

Saudemont G, Prod'Homme C, Da Silva A, Villet S, Reich M, Penel N, Gamblin V. The use of olanzapine as an antiemetic in palliative medicine: a systematic review of the literature. BMC Palliat Care. 2020 Apr 22;19(1):56. doi: 10.1186/s12904-020-00559-4.

Nausea is a common symptom towards the end of life and the use of antiemetics to manage this is well established. However, the appropriateness of medications also depends on the individual person’s tolerance and capacity for different drugs and routes of administration. Having a range of options helps to accommodate this while maintaining good symptom management. Keeping up with the evidence base underpinning these options is part of best practice care and alerts us where new practices or research is required.  This detailed review of 13 articles examined the evidence for use of the antipsychotic olanzapine as an antiemetic in palliative care. Currently recommended for chemotherapy induced nausea and vomiting, the authors provide a useful review of olanzapine relative to other antiemetics and discuss the evidence for its efficacy and applicability in palliative care. Overall the available studies support use of olanzapine but the evidence base in the context of palliative care is very low. This article shows how emerging evidence for new treatments can be clearly presented within the context of current practice. It also demonstrates how knowledge of the evidence level influences whether changes in practice are needed.

7 May 2020

Medication use in aged care residents in the last year of life: A scoping review.

Aitken C, Boyd M, Nielsen L, Collier A. Medication use in aged care residents in the last year of life: A scoping review. Palliat Med. 2020 Apr 14:269216320911596. doi: 10.1177/0269216320911596. Epub ahead of print.

People increasingly approach old age and end of life with multiple chronic conditions. This makes striking a balance between prescribing for the chronic illness and for end of life symptom management difficult as the number of medications increases. This is particularly so in residential aged care facilities (RACF) where many of the residents are physically and cognitively frail as they approach their end of life. This scoping review of 30 studies examined the characteristics of medication use in the last year of life within RACF. Some common findings were apparent such as the use of opioids and non-opioid analgesics as death approached, although people with dementia were less likely to receive these.  A high level of preventative medication prescribing in the last year of life was also common as was the practice of deprescribing as the person neared the end of life. Overall the authors provide a useful discussion of polypharmacy in the RACF context and suggest that it is more complex than the number of medications. Indeed more studies reported on the appropriateness of medications rather than number, although as highlighted here currently available tools to measure this use different criteria and can give very different rates. Future systematic review of studies within a common health and aged care system can now build on this insight to provide the detail required to inform practice.