Journal of palliative medicine最新文献

Background: Historically, there have been perceptions that engagement with palliative care (PC) services may preclude potentially curative but high-risk operations. As such, we sought to investigate the relationship between specialty PC consultation and the care trajectory of surgical patients. We hypothesized that PC consultation would be associated with increased frequency of nonoperative treatments being chosen among surgical inpatients. Design: All general surgery and general surgery subspecialty patients receiving PC consultation at a single tertiary academic medical center from 2020 to 2021 were identified. Surgical operations were stratified as "elevated risk" in accordance with 2014 American Heart Association guidelines. Retrospective chart review was performed, and comparisons were made with univariable statistics. Results: We identified a total of 729 patients who received specialty PC consultation, 159 of whom were admitted to a surgical service. PC was actively involved in consultation for surgical decision making in 27% (43/159) of these encounters. PC assistance with surgical decision making was associated with a greater incidence of elevated-risk operative procedures during admission compared with patients without presurgical PC consultation (OR 3.29 [2.51, 7.16]). There was no association between PC involvement with surgical decision making and odds of discharge to hospice (OR 0.42 [0.18, 1.51]) nor death during admission (OR 0.66 [0.21, 2.10]). Conclusions: We found that specialty PC involvement in surgical decision making does not preclude the pursuit of disease-directed surgical treatment. Contrary to our hypothesis, our single institutional data demonstrate that early PC consultation can be synergistic with surgical disease management and does not preclude elevated-risk operative care.

Background: The debate over legalizing medical assistance in dying (assisted dying) is ongoing, also in Nordic countries such as Sweden where assisted dying is illegal. A 2020 survey by the Swedish Medical Association highlighted varied perspectives, with 41% of physicians supporting and 34% opposing legalization. Professionals in palliative care were more negative toward it. Objective: To assess attitudes toward the legalization of, and the need for education about, assisted dying among Swedish palliative care professionals. Study Design: A survey with 19 closed- and 2 open-ended questions was administered to the participants of the 2023 Swedish National Conference on Palliative Care (including physicians, nurses, assistant nurses, administrators, and researchers). Results: Of the 866 conference participants who were invited, 444 (51%) participated. Predominantly, the cohort comprised women (89%); 60% were nurses and 17% physicians. The results showed that 38% opposed euthanasia, 36% supported it, and 26% remained undecided, with similar findings regarding physician-assisted suicide. There was a significant trend of increasingly negative attitudes with age and experience in palliative care (p < 0.01). Physicians emerged as the group most opposed to euthanasia (80%), whereas assistant nurses were the most positive, with 13% opposing legalization, and 33% of the nurses opposed euthanasia. The open-ended questions revealed thoughts regarding the complexity of the issue and the need for further discussion and education. Conclusion: In Sweden, where euthanasia and physician-assisted suicide is illegal, more than one-third of palliative care professionals were in favor of legalizing these practices while one-fourth were undecided, these proportions differed markedly between professions. Further, we uncovered a significant need for further discussion and education.

Introduction: There is limited understanding of critical care (CC) and specialist palliative care (SPC) professionals' perceptions regarding the role and utility of SPC for patients on extracorporeal membrane oxygenation (ECMO). Methods: An 18-item survey was distributed via convenience sampling and snowballing strategies to CC and SPC attendings working with veno-venous ECMO patients. Results: A total of 75 surveys were completed. Many CC professionals indicated that SPC consultation was not routinely helpful (5% vs. 71%, p < 0.05). Responses varied on the appropriateness of discussing SPC with patients/families prognosis (81% SPC vs. 47% CC, p < 0.05), end-of-life preferences (100% vs. 62%, p < 0.05), goals of care (95% vs. 58%, p < 0.05), and code status (76% vs. 43%, p < 0.05). Conclusion: Most respondents indicated that psychosocial support and multidisciplinary team collaborations were within the SPC scope. CC professionals were less likely to indicate that discussion of the care trajectory with patients/families was within SPC scope.

Background: Formal assessment of What Matters in end-of-life care is often done in medical settings through legal forms. Past research indicates that Native Hawaiians are less likely to complete these forms than Whites. The purpose of this study was to explore health care preferences among Native Hawaiian elders and to identify cultural themes that may impact quality care at end of life. Objective: To explore What Matters to Native Hawaiian elders, as culture likely impacts health care and end-of-life preferences. Design: A secondary analysis of qualitative data collected through a multiyear interview project in Hawai'i. Setting/Participants: Twenty participants age 60+ living in rural Hawai'i. Measurement: Deductive coding was informed by guidelines on What Matters according to the Institute of Healthcare Improvement's 4Ms Framework. Inductive coding identified themes specific to Native Hawaiian elders as part of their culture. Results: Themes suggest the criticality of: (1) incorporating cultural traditions into health care routines; (2) involving family in health and end-of-life decisions; (3) supporting home-based care at the end of life; and (4) building strong patient-provider relationships. Conclusion: Although findings parallel preferences expressed in other populations, the data provide additional insights into the preferences of Native Hawaiian elders anticipating end-of-life care. Recommendations for culturally competent care include: (1) develop relationships with Native Hawaiian patients well before end-of-life care is needed to facilitate discussions of care preferences; (2) work collaboratively with the patient and the patient's defined family; (3) ask about cultural practices and engage traditional healers as directed by the patient; and (4) provide services in patients' homes and communities.

The field of Hospice and Palliative Medicine (HPM) has its roots in the principles, promulgated by Dame Cicely Saunders, that patient and family are the unit of care and that comprehensive integration of physical, psychological, social, and spiritual care is necessary to address suffering in all its dimensions. Although we aspire to provide comprehensive care for our patients, most hospice and palliative care (HPM) physicians lack basic competencies for identifying and managing patients with psychological distress and mental health distress and disorders, a growing segment of our clinical population. In this article, I argue that we are not living up to the founding values of our field in how we practice, how we educate our trainees, our research, and in how we pursue our own professional development as faculty. The history of our field, the nature of our clinical workforce, the culture of PC, and our educational programs all contribute to our current practice model, which is not adequate to meet the mental health needs of our patients. I propose strategies to address these challenges focused on enhancing integration between psychiatry/psychology and HPM, changes in fellowship education and faculty development, addressing the stigma against people with mental health diagnoses, and addressing system and cultural challenges that limit our ability to provide the kind of comprehensive, integrative care that our field aspires to.

Background: Palliative care (PC) is essential to improve quality of life for individuals with life-limiting acute neurological conditions, particularly in resource-limited settings. In Latin America and the Caribbean (LAC), there is limited health care professional training and education on PC. Objective: We reviewed the peer-reviewed literature discussing end-of-life care, withdrawal of life-sustaining treatments (WOLST), and PC in the acute inpatient setting. Methods: We searched 10 databases, including peer-reviewed published conference abstracts and articles published until May 22, 2024, and included literature describing goals-of-care discussions or availability of PC services in an inpatient setting in LAC countries. Results: We identified 34 articles that highlighted end-of-life discussions, WOLST, and PC utilization in inpatient settings in LAC. We identified several themes across literature as follows: limitations to PC referrals, hospice/end-of-life care, and the role of advanced directives in LAC. Our review found that several articles highlight the limitations of PC usage in LAC and inadequate access to treatments, including gastrostomy and tracheostomy tube placement. Conclusions: Our review demonstrates a need to improve PC knowledge and access to end-of-life care resources. Regional educational efforts are needed to improve PC knowledge among health care providers who care for patients with acute neurological conditions in LAC.