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What is a cookie?
A cookie is a small file of letters and numbers that we store on your browser or the hard drive of your computer if you agree. Cookies contain information that is transferred to your computer's hard drive.
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In the October digest, we explore challenging clinical and ethical issues: why gastrostomies often harm patients with severe dementia, how to overcome barriers to pain relief, and what holds palliative care together amid a catastrophic shortage of funding and staff. We also share practical insights on protecting carers and providing spiritual support to patients when no chaplain is on staff.
If you wish to continue any of the topics listed below through a discussion or webinar, please contact us at info@paced.org.uk.
In the October digest, we explore challenging clinical and ethical issues: why gastrostomies often harm patients with severe dementia, how to overcome barriers to pain relief, and what holds palliative care together amid a catastrophic shortage of funding and staff. We also share practical insights on protecting carers and providing spiritual support to patients when no chaplain is on staff.
If you wish to continue any of the topics listed below through a discussion or webinar, please contact us at info@paced.org.uk.
If you are a palliative care professional from Central Asia, the South Caucasus, Eastern Europe, or the Baltic States, or if you work to develop palliative care in these regions, we warmly invite you to join our community chat on Telegram. Please complete this form.
Tube or Spoon? Clinical Consequences and Risks of Artificial Nutrition in Dementia
A review of clinical data confirms that, contrary to international guidelines, staff continue to place feeding tubes and gastrostomies in patients with severe dementia. However, artificial nutrition neither extends their life nor improves its quality, while sharply increasing the risks of aspiration pneumonia, pressure ulcers, and physical restraint. Savings on professional carers are thus wiped out by the costs of treating complications. The authors remind us that natural feeding remains the standard of care for such patients. The burden on relatives can be eased through simple measures—ranging from high-contrast tableware and music to training in safe feeding techniques. Doctors must help families make choices that prioritise a person's comfort and avoid unnecessary invasive procedures.
A review of clinical data confirms that, contrary to international guidelines, staff continue to place feeding tubes and gastrostomies in patients with severe dementia. However, artificial nutrition neither extends their life nor improves its quality, while sharply increasing the risks of aspiration pneumonia, pressure ulcers, and physical restraint. Savings on professional carers are thus wiped out by the costs of treating complications. The authors remind us that natural feeding remains the standard of care for such patients. The burden on relatives can be eased through simple measures—ranging from high-contrast tableware and music to training in safe feeding techniques. Doctors must help families make choices that prioritise a person's comfort and avoid unnecessary invasive procedures.
Equity in Palliative Care: Three Steps to Bridging the Gap
Racial, economic, and geographical barriers still determine whether a seriously ill person receives timely pain relief and qualified care. At the same time, habitually assessing palliative care solely through the lens of ‘cost-cutting’ only exacerbates this divide. In a new guideline, researchers propose a three-step strategic plan for healthcare administrators: from mass training of non-specialist doctors in basic communication skills to a complete overhaul of financial and organisational care models.
Racial, economic, and geographical barriers still determine whether a seriously ill person receives timely pain relief and qualified care. At the same time, habitually assessing palliative care solely through the lens of ‘cost-cutting’ only exacerbates this divide. In a new guideline, researchers propose a three-step strategic plan for healthcare administrators: from mass training of non-specialist doctors in basic communication skills to a complete overhaul of financial and organisational care models.
System Crisis and Community Strength: A Qualitative Review of Palliative Care in Ethiopia
In low-income countries, up to 86% of people in need of palliative care do not receive it. A systematic review using Ethiopia as an example illustrates the drivers of this systemic crisis: a lack of national standards, a shortage of basic analgesics, educational failures, and cultural taboos around death. At the same time, the study highlights the main pillars that sustain patient care in the country: the personal dedication of medical specialists and volunteers, support from private and religious organisations, and strong community ties.
In low-income countries, up to 86% of people in need of palliative care do not receive it. A systematic review using Ethiopia as an example illustrates the drivers of this systemic crisis: a lack of national standards, a shortage of basic analgesics, educational failures, and cultural taboos around death. At the same time, the study highlights the main pillars that sustain patient care in the country: the personal dedication of medical specialists and volunteers, support from private and religious organisations, and strong community ties.
‘Invisible Patients’: What Barriers Families of Seriously Ill People Encounter
A review of 17 studies shows that relatives caring for palliative patients at home or in inpatient settings most often lack clear information about prognosis, basic caregiving skills, and respite opportunities. The authors emphasise that loved ones' emotional and physical exhaustion directly worsens the patient's quality of life. To support families, researchers suggest regularly assessing their burden, developing digital support services, and giving carers time to rest.
A review of 17 studies shows that relatives caring for palliative patients at home or in inpatient settings most often lack clear information about prognosis, basic caregiving skills, and respite opportunities. The authors emphasise that loved ones' emotional and physical exhaustion directly worsens the patient's quality of life. To support families, researchers suggest regularly assessing their burden, developing digital support services, and giving carers time to rest.
Spiritual Support Without Chaplains: How to Organise Palliative Care Amid Staff Shortages
In countries without professional chaplains, spiritual support in palliative care often falls outside the care system or is delivered haphazardly. To address this, researchers have developed the S.P.I.R.I.T. model—a practical framework for end-of-life care. The authors suggest training doctors and nurses in the basics of the model, engaging volunteers and local community representatives, and grounding these practices in scientific evidence. This approach helps meet patients' needs while accounting for local culture and staff shortages.
In countries without professional chaplains, spiritual support in palliative care often falls outside the care system or is delivered haphazardly. To address this, researchers have developed the S.P.I.R.I.T. model—a practical framework for end-of-life care. The authors suggest training doctors and nurses in the basics of the model, engaging volunteers and local community representatives, and grounding these practices in scientific evidence. This approach helps meet patients' needs while accounting for local culture and staff shortages.
DIGEST