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BackgroundDecision-making in palliative care usually involves both patients and family caregivers. However, how concordance and discordance in decision-making manifest and function between patients and family caregivers in palliative care is not well understood.ObjectivesTo identify key factors and/or processes which underpin concordance and/or discordance between patients and family caregivers with respect to their preferences for and decisions about palliative care; and ascertain how patients and family caregivers manage discordance in decision-making in palliative care.MethodsA systematic review and narrative synthesis of original studies published in full between January 2000 and June 2021 was conducted using the following databases: Embase; Medline; CINAHL; AMED; Web of Science; PsycINFO; PsycARTICLES; and Social Sciences Full Text.ResultsAfter full-text review, 39 studies were included in the synthesis. Studies focused primarily on end-of-life care and on patient and family caregiver preferences for patient care. We found that discordance between patients and family caregivers in palliative care can manifest in relational conflict and can result from a lack of awareness of and communication about each other’s preferences for care. Patients’ advancing illness and impending death together with open dialogue about future care including advance care planning can foster consensus between patients and family caregivers.ConclusionsPatients and family caregivers in palliative care can accommodate each other’s preferences for care. Further research is needed to fully understand how patients and family caregivers move towards consensus in the context of advancing illness. more...

ObjectivesTo examine current practices, attitudes and levels of confidence related to advance care planning (ACP) in patients with chronic obstructive pulmonary disease (COPD) among healthcare professionals working in Ireland. This will inform future clinical guidance development.MethodsA cross-sectional survey of healthcare professionals.ResultsThere were 143 participants (109 general practitioners, 25 nurses, 7 physiotherapists and 2 consultant physicians). The majority (82%, n=117) cared for patients with COPD weekly, but only 23% (n=33) had initiated ACP with a patient with COPD over the previous 6 months. Overall, 59% (n=85) answered ≥6 of 8 general knowledge questions correctly. Participants demonstrated positive attitudes towards ACP (mean score 3.6/5.0), but confidence levels were low (2.2/4.0). Most thought ACP was appropriate for patients with severe or very severe COPD (71%, n=101%, and 91%, n=130, respectively) but were unsure or felt that it was not appropriate for those with mild–moderate COPD. However, almost all participants (97%, n=139) stated that if a patient expressed a desire to have ACP discussions, they would comply. Topics most likely to be discussed related to diagnosis and treatment options. Death and end-of-life issues were rarely discussed. The death of a family member or friend and participation in support groups were identified as new ‘triggers’ for initiating ACP.ConclusionsTargeted education to improve general knowledge and confidence levels among healthcare professionals, together with initiatives to increase public awareness of ACP so that patients themselves might be more inclined to start the discussion, may help increase the uptake of ACP for this patient group. more...

The aim of the study was to review current psychological and psychotherapeutic approaches for people with MND used by therapists in Ireland and to gain an insight into approaches used elsewhere. We used a qualitative study collecting data from eight therapists in Ireland and two therapists in the UK and Italy using semi-structured interviews and analysed the results using principles of grounded theory. Therapists' approaches included supporting the person in the 'here and now' by providing a 'fine focus' on what they can still do, re-affirming the person in their ability to have an active role in their life and supporting the person in exploring their emotions. The desired outcome was to provide the person with space to talk, express feelings and be able to self-direct. In conclusion, there is no consensus about a specific approach, due to the complexity of the disease and the variety of presentations. Different approaches may be required during disease progression. The findings indicate that therapists would benefit from having experience of MND, the limitations in mobility, communication and cognitive processing. more...

The quadruply bonded chiral anion [Re2Cl7PBzMePh]− (Bx = Ch2Ph) was synthesized and its crystal structure was determined. It crystallized in space group P1 with unit cell dimensions a = 10.677(2), b = 12.220(2), c= 18.220(4) A, α = 85.66(2), β = 75.98(2) and γ = 80.07(2)°. The ReRe distance was 2.2196(8) A. The average twist angle χ was 11.6°. The δ-bond energy was determined by molecular modelling to be 9 kcal mol−1 and 5% greater than the energy required to eclipse [Re2Cl8]2−. more...