Access to Specialist Palliative Care Services and Place of Death in Ireland

The aim of this report is to provide data, analysis and commentary to stimulate discussion on emerging trends in relation to the provision of specialist palliative care in Ireland. The report mines existing data from four key sources -- the Health Service Executive's (HSE) Minimum Data Set for Palliative Care; the National Cancer Registry; the Hospital Inpatient Enquiry, and HSE population records (2011) -- to compare and contrast administrative regions of the health service against national averages on a number of key indicators (number of hospice beds, waiting times for first assessment of patient, place of death, etc), and to examine the impact of varying levels of investment in palliative care on access to services and service activity. In particular, the report seeks to explore possible relationships between access to specialist palliative care services and place of death. It is clear from the data emerging from all four sources that there is a marked correlation between the availability or otherwise of hospice/palliative care services and where people die

Identifying and changing attitudes toward palliative care: an exploratory study

Research suggests that palliative care is poorly understood and often associated with imminent death (Canny, 2002). This, in turn, can negatively impact upon the transition to palliative care services. The aims of this three phase, multi-method study were to: (1) examine and compare the attitudes of health professionals toward palliative care; (2) examine and compare the attitudes and personal constructs of four key participant groups including patients receiving palliative care services, people living with cancer and the carers of both of these groups; and (3) to examine potential strategies for changing attitudes through education. Phase One involved a detailed assessment of health professionals’ attitudes toward, and understanding of, palliative care by means of a postal survey (182/700) and a small number of one-to-one interviews (n=5). Attitudes toward palliative care, as measured by the Health Professional Attitude Questionnaire (HPAQ), were explained by a number of key factors including: (1) knowledge of palliative care services; (2) relationship with the patient and family; and (3) personal reflection on mortality. Thematic analysis of the qualitative data further illuminated and developed this factorial model. Phase Two utilised one-to-one semi-structured interviews (n=30) and a battery of quantitative measures (n=75) to identify and compare attitudes toward, and experiences of, palliative care amongst patients receiving palliative care services (n=15), people living with cancer (n=25) and the carers of both of these groups (n=35). Repertory grids (n=12) were also used to explore and compare participants’ constructs of palliative care. Thematic analysis of the interview data revealed four key themes and associated subthemes that described patients’ and carers’ attitudes toward palliative care. Within each theme, different perspectives were adopted by each of the participant groups and these were explored and quantified by means of the repertory grid analysis. The findings from Phases One and Two were then used to inform the development of two health professional and patient interventions for Phase Three that aimed to: (1) provide information about palliative care services; (2) utilise the patient ‘voice’ and story; (3) focus on the health promoting benefits of palliative care; and (4) demystify hospice, palliative care and the dying process. The study adds to the relatively small pool of evidence in this area and the use of the repertory grid technique, in particular, offers an interesting psychological tool for investigating palliative care research and practice

Use of dependency and prioritization tools by clinical nurse specialists in palliative care: an exploratory study

Aims: The principal aim was to assess the utility of three needs assessment/dependency tools for use in community-based palliative care services. Specific objectives were to assess a sample of patients receiving specialist palliative care community nursing using these tools, to assess the predictive ability of each tool, and to explore the utility of prioritizing and measuring patient dependency from a clinical nurse specialist (CNS) perspective. Method: In phase 1, 22 community-based CNSs completed the Vale prioritization tool for all patients visited during a 3-month period (n=162). They also completed either the Graves and Payne (2007) or the Birch et al (1997) dependency tool after each visit. In phase 2 a focus group (n=8) and two one-to-one interviews with CNS participants explored the perceived utility of all three tools. Results: The Vale prioritization tool appeared to be the most useful for prioritizing patient need and managing workload. Statistical analysis highlighted minimal differences between the two dependency tools, neither of which predicted length of visit. Three themes were identified from phase 2: difficulties with routine administration, points of divergence between the two dependency tools, and workload concerns. Conclusion: While the Vale prioritization tool emerged as the most useful, the findings raise questions about the overall utility and practical application of these kinds of tools with community-based palliative care patients. Further research is needed to identify/develop, adapt, and evaluate appropriate, setting-specific dependency tools for use with this population

Use of dependency and prioritization tools by clinical nurse specialists in palliative care: an exploratory study

Aims: The principal aim was to assess the utility of three needs assessment/dependency tools for use in community-based palliative care services. Specific objectives were to assess a sample of patients receiving specialist palliative care community nursing using these tools, to assess the predictive ability of each tool, and to explore the utility of prioritizing and measuring patient dependency from a clinical nurse specialist (CNS) perspective. Method: In phase 1, 22 community-based CNSs completed the Vale prioritization tool for all patients visited during a 3-month period (n=162). They also completed either the Graves and Payne (2007) or the Birch et al (1997) dependency tool after each visit. In phase 2 a focus group (n=8) and two one-to-one interviews with CNS participants explored the perceived utility of all three tools. Results: The Vale prioritization tool appeared to be the most useful for prioritizing patient need and managing workload. Statistical analysis highlighted minimal differences between the two dependency tools, neither of which predicted length of visit. Three themes were identified from phase 2: difficulties with routine administration, points of divergence between the two dependency tools, and workload concerns. Conclusion: While the Vale prioritization tool emerged as the most useful, the findings raise questions about the overall utility and practical application of these kinds of tools with community-based palliative care patients. Further research is needed to identify/develop, adapt, and evaluate appropriate, setting-specific dependency tools for use with this population

But how does it develop? Adopting a sociocultural lens to the development of intergroup bias among children

We argue that adopting a sociocultural lens to the origins of intergroup bias is important for understanding the nature of attacking and defending behavior at a group level. We specifically propose that the potential divergence in the development of in-group affiliation and out-group derogation supports the authors’ framework but does indicate that more emphasis on early sociocultural input is required

Shifting gears versus sudden stops: qualitative study of consultations about driving in patients with cognitive impairment

Objective General practitioners (GPs) report finding consultations on fitness to drive (FtD) in people with cognitive impairment difficult and potentially damaging to the physician–patient relationship. We aimed to explore GP and patient experiences to understand how the negative impacts associated with FtD consultations may be mitigated. Methods Individual qualitative interviews were conducted with GPs (n=12) and patients/carers (n=6) in Ireland. We recruited a maximum variation sample of GPs using criteria of length of time qualified, practice location and practice size. Patients with cognitive impairment were recruited via driving assessment services and participating general practices. Interviews were audio-recorded, transcribed and analysed thematically by the multidisciplinary research team using an approach informed by the framework method. Results The issue of FtD arose in consultations in two ways: introduced by GPs to proactively prepare patients for future driving cessation or by patients who urgently needed a medical report for an expiring driving license. The former strategy, implementable by GPs who had strong relational continuity with their patients, helped prevent crisis consultations from arising. The latter scenario became acrimonious if cognition had not been openly discussed with patients previously and was now potentially impacting on their right to drive. Patients called for greater clarity and empathy for the threat of driving cessation from their GPs. Conclusion GPs used their longitudinal relationship with cognitively impaired patients to reduce the potential for conflict in consultations on FtD. These efforts could be augmented by explicit discussion of cognitive impairment at an earlier stage for all affected patients. Patients would benefit from greater input into planning driving cessation and acknowledgement from their GPs of the impact this may have on their quality of life.Road Safety Authority of Irelan

Conflicting perspectives mediate the relation between parents’ and preschoolers’ self‐referent mental state talk during collaboration

We examined the relations between the referent of parents and preschoolers’ mental state talk during a collaborative puzzle‐solving task (N = 146 dyads; n = 81 3‐year‐olds, n = 65 4‐year‐olds). The results showed that parents’ references to their own knowledge and beliefs (self‐referent cognitive talk), and references to their child’s knowledge and beliefs (child‐referent cognitive talk) were both related to children’s (primarily self‐referent) cognitive talk. We then tested whether any of the observed relations could be explained by the presence of conflicting perspectives within the collaborative interaction. Mediational analyses revealed that conflicting perspectives mediated the positive relation between parents’ production of self‐referent cognitive talk and child cognitive talk. By contrast, the positive relation between parents’ production of child‐referent cognitive talk and child cognitive talk did not depend on the presence of this type of conflict. These findings highlight an important mechanism through which parents’ references to their own mind might promote children’s developing mental state talk in collaborative contexts

A bacterial carbohydrate links innate and adaptive responses through Toll-like receptor 2

Commensalism is critical to a healthy Th1/Th2 cell balance. Polysaccharide A (PSA), which is produced by the intestinal commensal Bacteroides fragilis, activates CD4+ T cells, resulting in a Th1 response correcting the Th2 cell skew of germ-free mice. We identify Toll-like receptors as crucial to the convergence of innate and adaptive responses stimulated by PSA. Optimization of the Th1 cytokine interferon-γ in PSA-stimulated dendritic cell–CD4+ T cell co-cultures depends on both Toll-like receptor (TLR) 2 and antigen presentation. Synergy between the innate and adaptive responses was also shown when TLR2−/− mice exhibited impaired intraabdominal abscess formation in response to B. fragilis. Commensal bacteria, using molecules like PSA, potentially modulate the Th1/Th2 cell balance and the response to infection by coordinating both the innate and adaptive pathways

‘We practise every day’: Parents’ attitudes towards early science learning and education among a sample of urban families in Ireland

Educational policies increasingly emphasise early childhood science engagement. As key influencers in children’s early learning, parents (n=85) attending a science workshop in three urban schools in Ireland were surveyed regarding their attitudes towards science. Seventy per cent of parents believed that science education should begin in the pre-school years, before the age of four. Despite high levels of education, at least half of the parents expressed some lack of confidence in talking about, and in doing science with, their young children. Parents who reported less confidence in doing science activities with their children also reported reduced frequency of activities for five out of the seven science learning opportunities listed. Mothers, compared to fathers, reported less confidence in doing science activities with their children. Findings indicate that parents’ confidence in science may impact early science experiences and highlight parents as a key support for increasing early science engagement

Parents’ beliefs about their influence on children’s scientific and religious views: Perspectives from Iran, China and the United States

Parents in Iran, China and the United States were asked 1) about their potential influence on their children's religious and scientific views and 2) to consider a situation in which their children expressed dissent. The Iranian and US parents endorsed their influence on children's beliefs in both domains. By contrast, Chinese parents claimed more influence in the domain of science than religion. Most parents spoke of influencing their children via Parent-only mechanisms in each domain (e.g., discussion, teaching), although US parents did spontaneously note Multiple sources for the transmission of religious views (e.g., church, other influential adults). Parents proposed a similar stance towards children’s dissenting religious and scientific views. Chinese and US parents were more likely to express Supportive approaches and Iranian parents were more likely to express a Directive approach by comparison. The present research informs our understanding of the cultural transmission of views about science and religion