During Sunday’s Nursing Year in Review: Palliative Care Across the Lifespan, a panel of experts discussed the most up-to-date science related to palliative care, including consideration of needs across illness trajectory with representation for both neonatal/pediatric and adult patients, as well as for caregivers themselves.
Christine A. Fortney, PhD, Ohio State University, began the presentations with a review of recent literature related to neonatal palliative care, including the emerging field of neonatal neuropalliative care that focuses on the specific needs of infants with neurologic illness and their families.
“Many neurologic conditions are first diagnosed in the prenatal and immediate newborn periods, and the lives of affected infants can be shortened or severely altered,” Dr. Fortney said. “These infants are also at risk for under-recognition of pain and irritability.”
She cited a recently published topical review that explored the four core domains of neuropalliative care, which are family-centered communication, prognostication, decision-making, and pain and symptom management.
“Specific guidance for clinicians includes frequent and consistent communication with families, a focus on acknowledging and reducing prognostic uncertainty, engagement in shared decision-making with families, and becoming familiar with symptom control strategies related to pain, irritability, secretions, seizures, withdrawal, and sleep disruption,” she said.
The goal, she said, is to provide longitudinal, tailored support for infants and families.
“Best practices for many areas in neonatal palliative care have not been established,” Dr. Fortney said. “Prospective, longitudinal, multi-site, multi-informant research is desperately needed, along with the development of improved symptom assessment tools and novel interventions.”
Jennifer Burgher Seaman, PhD, RN, CHPN, University of Pittsburgh School of Nursing, followed with a discussion of symptom management strategies in palliative care.
“The prevalence of delirium can be as high as 80 percent among ICU patients, and is responsible for excess mortality, functional and cognitive decline, and increased hospital costs,” Dr. Seaman said. “While the mechanisms of onset are not well understood, the use of sedatives does appear to be associated with delirium occurrence.”
She cited a study that looked at the relative efficacy and safety of pharmacological and non-pharmacological interventions to prevent delirium in critically ill patients. Among the findings, the investigators reported that, compared with benzodiazepine sedation, dexmedetomidine and sedation reduction strategies may reduce delirium occurrence.
“No pharmacological interventions, however, impacted mortality or arrhythmia,” she said. “And while multi-component non-pharmacological delirium prevention programs are effective for hospitalized patients, they have not been shown to be effective in the ICU population.”
Jill Lynn Guttormson, MS, PhD, RN, Marquette University, discussed recent advances in symptom management in acute and critical illness, including a recently published systematic review looking at evidence for virtual reality interventions for hospitalized adolescent patients.
The authors reviewed data from four randomized controlled trials and four single-case reports in which VR was used for distraction from burn pain, pain and anxiety during chemotherapy and during venipuncture, preoperative anxiety, and well-being during palliative care. In the trials, the control group received standard care or distraction, such as music, television, or books.
“In most of the studies, there were significant reductions in pain or anxiety with VR compared to control,” Dr. Guttormson said. “And they received positive feedback from adolescents, who found the VR fun and engaging.”
In the final presentation of the session, Natalie Susan McAndrew, PhD, RN, ACNS-BC, CCRN, University of Wisconsin-Milwaukee, talked about palliative interventions for family caregivers, including a study that looked at meaning-centered psychotherapy for cancer caregivers.
“Family caregivers experience existential distress, and this is one of few interventions to address this aspect of the caregiver experience,” Dr. McAndrew said. “Meaning in life and meaning in caregiving can buffer adverse outcomes.”
Continued testing of MCP-C is needed to determine caregiver outcomes, she said, but the intervention could potentially extend beyond cancer to include caregivers for patients with dementia, chronic diseases such as heart failure, COPD, and ILD, as well as various critical illnesses.