This paper reports on undergraduate students' evaluation of a new hospice-based interprofessional practice placement (IPP) that took place in the voluntary sector from 2008 to 2009. Ward-based interprofessional training has been successfully demonstrated in a range of clinical environments. However, the multidisciplinary setting within a hospice in-patient unit offered a new opportunity for interprofessional learning. The development and delivery of the IPP initiative is described, whereby multidisciplinary groups of 12 students provided hands-on care for a selected group of patients, under the supervision of trained health care professionals. The placement was positively evaluated and students reported an increased understanding of both their own role and that of other professionals in the team. The evaluation also suggests that additional learning opportunities were provided by the in-patient palliative care unit. The results of this evaluation suggest that the in-patient unit of a hospice caring for patients with life-limiting illness provides a suitable environment to demonstrate and learn about interprofessional practice.

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When discussions around end-of-life choices do occur, carers generally appear to agree with the patients' preferences around end-of-life treatment, and preferred place of death.

background Annually, across the world a substantial number of dependent children experience the death of a parent through lifelimiting illness. Without support, this has longterm implications for children's emotional, social and physical well-being, impacting on health and social care services globally. Limited information exists on how service providers are meeting family needs when a parent with dependent children is dying. Aim To determine the bereavement support provided to families with dependent children by UK hospices before and after a parent's death. Design A 23-item, cross-sectional, web-based survey of adult UK hospices. Closed and openended questions were asked about the features of support provided; open-ended response was sought to a question about the challenges faced by hospices in delivering support. Descriptive and non-parametric statistics and framework analysis were used to analyse the data. results 197 hospices were invited to participate. Response rate was 66% (130/197). More types of support were provided after, than before, parental death (mean 6.36/5.64, z=−5.767, p<0001). Twenty-two per cent of hospices reported no formal processes for asking or documenting the presence of dependent children. Volunteers were an underused resource before parental death. Four themes characterised challenges in delivering support for families: emotional difficulties for families; practical and social difficulties for families; funding/resources; and staff training/numbers. conclusions Family needs are not consistently being met when a parent is dying. Areas for development include: enhanced systems to record when patients have dependent children; flexible approaches to support vulnerable families; staff training to help communication with families and management of their own fears of making the situation worse. Effective educational interventions and service developments to better support staff, parents and children are needed.on July 10, 2020 by guest. Protected by copyright.

We were interested to read the paper by Atkinson and Kirkham 1 on the use of unlicensed medication in their palliative care unit, as we have just completed a similar study on the inpatient palliative care unit at the Royal Marsden Hospital, Sutton. The methodology of our study was very similar to that employed in the paper. However, we classified our drugs as either having a product licence for the specific indication (PLI), having a product licence for an alternative indication (PLNI), having a clinical trial exemption certificate (CTX) or doctors' and dentists' exemption certificate (DDX). We also classified the drugs as either having a product licence for the route of use, or no product licence for the route of use. Our study was carried out over a 6-month period between October 1998 and April 1999, and involved 120 consecutive admissions to the palliative care unit. Of the 1004 drugs prescribed, 146 (14.5%) did not have a PLI, but did have a PLNI. These results are remarkably similar to those reported by Atkinson and Kirkham. A further 19 (2%) of drugs were being used under a CTX or DDX. We also observed that 115 (11.5%) of the drugs were given by an unlicensed route. The main differences between our results and those reported in the paper are the routes of use (20% of the drugs in our study were given subcutaneously, as compared to 36% in the earlier study), and the type of drugs used-co-analgesics were prescribed more frequently in our study. These differences may reflect different populations of patients with cancer, or different patterns of clinical practice. Although we agree that clinical trials can be difficult in patients with advanced cancer, we feel that it is essential to confirm the efficacy (and tolerability) of drugs in this group of patients. This is especially true of drugs that do not have a PLI. In view of the regulations governing the licensing of drugs, the onus of performing such clinical trials is likely to remain with clinicians.

BackgroundProviding care for our patients during the COVID-19 pandemic required a rapid shift to video consultations (VCs). A service evaluation was performed to capture hospice professionals’ (HPs) and patients’ experiences of VC.MethodsOnline or postal surveys were sent to HPs and patients, who had participated in VC between March and July 2020, focusing on their experience and satisfaction with the service.Results31 responses from HPs were received. 19 (61.3%) rated their experience of VC as good, despite 29 (93.5%) having no prior VC experience. One-third of HPs had undertaken potentially sensitive consultations, including resuscitation discussions. 23 (74.2%) undertook a VC that included a family member and 18 (58.1%) had included an external healthcare professional. 25 (80.6%) wanted to offer VC as an option going forward. Well-being staff successfully provided multiple group support sessions via video. 26 responses from patients (23) and carers (3) were received. 22 (84.6%) had access to a smartphone. 8 (30.8%) included a family member in their consultation. All patients/carers reported satisfaction with their VC, although 10 (38.5%) expressed a preference for face-to-face consultations. 22 (84.6%) patients would be happy to receive care via VC going forward and 21 (80.8%) stated they would recommend the use of VC to others.ConclusionPatients reported VC to be an acceptable way to receive support from a hospice service and HPs would like to continue to offer VC in the future. VC can be offered as an alternative to face-to-face consultations with the potential to continue and improve access to a wide range of hospice services.

Our objective was to assess the impact of methicillin-resistant Staphylococcus aureus (MRSA) infection in palliative care. The study was conducted at three hospices in south London, totalling 118 beds, and the following two methods were used. Firstly, a retrospective review of the notes of patients who were known to be MRSA positive at admission or were subsequently found to be MRSA positive was taken. Secondly, a prospective study of factors influencing bed occupancy in one hospice was conducted. The proportion of admissions who were MRSA positive ranged from 4% to 8% in the three hospices. Seven of the 43 patients who had MRSA suffered clinically significant infections. Risk factors for colonization and bacteraemia were similar to the general population. Sites of infection were variable and multiple and treatment regimes for eradication were variable, with varying outcomes. MRSA infection appeared to delay admission because of the need for single rooms, of which there are few Time spent cleaning rooms after discharge or death also reduced the number of available beds. It was concluded that MRSA infection is associated with significant morbidity in a small number of palliative care patients. Beds unavailable because of MRSA should be considered in bed occupancy figures, otherwise bed occupancy may appear artificially low. The psychological and financial impact of the infection in palliative care patients needs further evaluation.

Findings suggest that the European Certificate in Essential Palliative Care improves confidence in palliative care and that this is sustained over time with evidence of confidence in symptom control, communication and a holistic approach in clinical practice.