Dignity therapy interventions for young people in palliative care: a rapid structured evidence review.

BACKGROUND: Dignity therapy is becoming established in adult settings, with research supporting its effectiveness. AIMS: This article aims to summarise and synthesise the research that has explored dignity therapy and related meaning-making interventions in palliative care with young people. METHODS: A rapid structured review was undertaken. Quality appraisal was based on the randomised control trial or cohort study Critical Appraisals Skills Programme (CASP) tool. RESULTS: Four studies met the inclusion criteria; one focused on young people (7-17 years), the other three included young people but mean ages were 50-70 years. Dignity therapy was found to improve aspects of wellbeing for the patient and was perceived as helpful for the family. CONCLUSIONS: Dignity therapy is well received, with improvements in measures of wellbeing. However, few studies have included young people (24 years and below). This highlights a clear gap in the literature, suggesting the need to develop and evaluate a dignity therapy or related meaning-making intervention to support young people.

The Effectiveness of Pharmacological and Non-Pharmacological Interventions for Improving Glycaemic Control in Adults with Severe Mental Illness: A Systematic Review and Meta-Analysis.

People with severe mental illness (SMI) have reduced life expectancy compared with the general population, which can be explained partly by their increased risk of diabetes. We conducted a meta-analysis to determine the clinical effectiveness of pharmacological and non-pharmacological interventions for improving glycaemic control in people with SMI (PROSPERO registration: CRD42015015558). A systematic literature search was performed on 30/10/2015 to identify randomised controlled trials (RCTs) in adults with SMI, with or without a diagnosis of diabetes that measured fasting blood glucose or glycated haemoglobin (HbA1c). Screening and data extraction were carried out independently by two reviewers. We used random effects meta-analysis to estimate effectiveness, and subgroup analysis and univariate meta-regression to explore heterogeneity. The Cochrane Collaboration's tool was used to assess risk of bias. We found 54 eligible RCTs in 4,392 adults (40 pharmacological, 13 behavioural, one mixed intervention). Data for meta-analysis were available from 48 RCTs (n = 4052). Both pharmacological (mean difference (MD), -0.11mmol/L; 95% confidence interval (CI), [-0.19, -0.02], p = 0.02, n = 2536) and behavioural interventions (MD, -0.28mmol//L; 95% CI, [-0.43, -0.12], p<0.001, n = 956) were effective in lowering fasting glucose, but not HbA1c (pharmacological MD, -0.03%; 95% CI, [-0.12, 0.06], p = 0.52, n = 1515; behavioural MD, 0.18%; 95% CI, [-0.07, 0.42], p = 0.16, n = 140) compared with usual care or placebo. In subgroup analysis of pharmacological interventions, metformin and antipsychotic switching strategies improved HbA1c. Behavioural interventions of longer duration and those including repeated physical activity had greater effects on fasting glucose than those without these characteristics. Baseline levels of fasting glucose explained some of the heterogeneity in behavioural interventions but not in pharmacological interventions. Although the strength of the evidence is limited by inadequate trial design and reporting and significant heterogeneity, there is some evidence that behavioural interventions, antipsychotic switching, and metformin can lead to clinically important improvements in glycaemic measurements in adults with SMI.

Is regular systemic opioid analgesia associated with shorter survival in adult patients with cancer? A systematic literature review.

Opioids are important in the management of pain in patients with cancer. Clinicians and patients are sometimes concerned about the effect of opioids on survival, which might decrease opioid prescription, compliance, and symptom control. We wanted to determine whether opioid analgesia was associated with shorter survival in adult patients with cancer. We systematically searched for studies that assessed the effect of regular systemic opioid analgesia on survival. We identified 526 unique records, with 20 articles meeting inclusion criteria. Thirteen end-of-life studies, including 11 very low-quality retrospective studies, did not find a consistent association between opioid analgesic treatment and survival; this evidence comes from low-quality studies, so should be interpreted with caution. Seven longer-term studies, including three randomised controlled trials and two prospective studies, were included. Six of these studies indicated that opioids were likely to be associated with a shorter survival. None of these studies were powered to assess the effect of opioids on survival as a primary endpoint. In view of this, no definitive conclusions can be made as to whether opioids affect survival in patients with cancer. These data suggest that while opioid analgesia does not affect survival at the end of life, in the context of longer-term treatment, higher-quality studies, with survival as a primary endpoint, are needed to confirm an independent association between opioid analgesia and shorter survival. An important limitation of research in this field is that the relationship between greater analgesic requirements and shorter survival may be mediated by painful progressive cancer.