Sharing Current Scottish Practice

A limited systematic review of the efficacy of the management of paraneoplastic sweating in palliative care populations

Author(s):Mullin J (Cicely Saunders Institute; NHS Lothian)

Background: Paraneoplastic sweating is a distressing symptom to both patients and carers, interrupting sleep and causing daytime hyper-somnolence, fatigue and mood disturbance. Various therapeutic approaches have been trialled but there are no published clinical guidelines in place.

Aims: To present and critically appraise the published literature regarding pharmacological and non-pharmacological treatments for paraneoplastic sweating.

Method: A literature search was performed on Health Management Information Consortium, International Pharmaceutical Abstracts, OvidMEDLINE®, Embase, EmbaseClassic and OvidNursing. Further papers were identified from the reference lists.

Results: Reports of reduced sweating were identified for 5 pharmacological and 2 non-pharmacological treatments:

1. Cannabinoids: 1 case series

2. Thioridazine: 2 un-controlled trials

3. Somatostatin anologues: One case report

4. Thalidomide: 3 case reports & a crossover study of 6 patients

5. Etanercept: Incidental finding in open-label pilot study

6. Gabapentin: One case series

7. YuPing FenSan: One prospective trial.

Conclusions: The evidence for each treatment largely relies upon case reports and under-powered, uncontrolled, unblinded trials. As such, the evidence is currently of insufficient quality to create guidelines for clinical practice. Moreover, the success of some individual drugs has been handicapped by the palatability of treatment, side-effects and financial constraints.

Audit of oxygen therapy in a specialist palliative medicine unit

Author(s):Simmons C; Welsh J (St Margaret of Scotland Hospice, Clydebank)

Introduction: We audited the use of normobaric hyperoxia against guidelines issues by the British Thoracic Society (BTS). These state that oxygen should be prescribed to achieve target oxygen saturation of 94-98% for most acutely ill patients or 88-92% for those at risk of hypercapnic respiratory failure. Moreover, the target saturation should be documented on the drug prescription chart.

Methods: Retrospective analysis of the drug charts for all in-patients throughout January 2013 (cycle1) and April 2013 (cycle 2) was performed by 2 clinicians in St Margaret of Scotland Hospice.

Results: Cycle 1: Four of twenty one patients (19%) required supplemental oxygen. All patients had oxygen prescribed (100%) but only 1 (25%) had oxygen prescribed with the correct target saturation documented.

Results were presented orally to medical staff and via posters, and formal presentation of standards issued. Anticipatory care prescription sheets were modified to include oxygen for all in-patients for administration at time of need.

Cycle 2: Three of twenty patients (14%) required supplemental oxygen and all of these (100%) had oxygen prescribed regularly and all (100%) with correct target saturation documented which represented an improvement.

Conclusion: After intervention there was improvement to 100% adherence to the standard required for oxygen prescription.

Audit of the efficacy of Snoezelen Therapy in a specialist palliative care unit

Author(s):McMillan J (St Margaret of Scotland Hospice, Clydebank)

Introduction: Snoezelen is a therapy developed in the seventies in an establishment caring for disabled people. It is a multisensory environment. The evidence suggests it is beneficial for use within a Specialist Palliative Care unit for promotion of relaxation and some anxiety and pain management within a supportive setting.

Aim: To explore the effectiveness of Snoezelen Therapy for patients with specialist palliative care needs.

Methodology: Retrospective analysis of participants. Evaluation was performed on 11 random participants after 1 or more session(s) in the Snoezelen with a set questionnaire focussing on the benefits and experience participants felt through the use of the Snoezelen room.

This Specialist Palliative Care unit has a dedicated Snoezelen room with state of the art equipment. Results were disseminated and presented to a Multi-professional Meeting.

Result:

Ÿ number of participants who enjoyed the session – 9

Ÿ number of participants who would like to experience further sessions – 11

Ÿ number of participants who experienced relaxation – 9.

Snoezelen Therapy for patients who have Specialist Palliative Care needs can be beneficial to patient care and quality of life through providing relaxation, enjoyment and a peaceful environment.

Better palliative care for heart failure patients, the Caring Together Programme

Author(s):Armstrong I; Millerick Y (British Heart Foundation; Marie Curie Cancer Care; NHS Greater Glasgow and Clyde)

Heart failure is a life-limiting condition affecting up to 100,000 people in Scotland. Compared with many cancer patients, heart failure patients have a worse prognosis , poorer quality of life, and limited access to social services and palliative care.

In the first two years of the programme (June 2011 and June 2013), over 230 heart failure patients with palliative care needs have been referred to the Caring Together. These patients have benefited from a holistic assessment, anticipatory care planning, identification of a care manager and appropriate onward referral to other services such as day therapies and benefits assessment.

Caring Together designed and developed six core components with the support of key stakeholders including patients and carers. These core components were implemented as part of integrated models in three pilot sites across NHS Greater Glasgow and Clyde to meet local patient needs and within existing healthcare resources and structures. These models of care and core components were refined over two action research cycles to ensure that the models meet patient, care and clinician needs.

A key outcome is that Caring Together patients are less likely to die in hospital and more likely to be cared for and die in their preferred place of care, home.