Journal of palliative medicine最新文献

Background: Children who lose a sibling often receive inadequate attention, leading to lasting psychological and emotional challenges. Health care providers recognize the importance of comprehensive bereavement support but may lack knowledge for effective delivery. Aim: This study sought to analyze and synthesize primary research on children bereaved by a sibling to gain insight into their actual grieving experiences. Methods: A systematic review of qualitative studies was conducted following the Joanna Briggs Institute (JBI) methodology. The review protocol was registered on PROSPERO (CRD42022289604). Electronic databases including MEDLINE, CINAHL, PsycInfo, Scopus, and Igaku Chuo Zasshi were searched from inception to April 15, 2024. Critical appraisal was performed using the JBI Critical Appraisal Checklist for Qualitative Research. Results: Twenty-three articles met inclusion criteria, synthesizing experiences of 466 children. Four synthesized findings were generated: Children recognized internal and external changes in themselves after losing their siblings; children found it hard to believe their sibling had died, experienced feelings of loss and fear of death, and sometimes hid their emotions; various types of grief work allowed children to find their place after the loss, but ineffective grief work led to prolonged grief; and children's relationships with others were either strengthened or weakened depending on others' understanding and reactions to the loss. Conclusions: This review highlights the complex nature of sibling grief in children. It emphasizes the importance of recognizing children's unique grief experiences, facilitating effective grief work, and providing appropriate support from family, friends, and health care professionals. The findings suggest a need for tailored grief support programs for children who have lost siblings, considering their cultural backgrounds. However, the low ConQual score of the synthesized findings indicates that recommendations should be considered with caution.

Background: Patients with advanced cancer often have emotional problems such as inadequate coping, fear of new metastases, or the prospect of enduring physical suffering. Some will need professional emotional support to cope with these problems. Accurately identifying these patients requires a thorough understanding of their characteristics. Aim: To assess the need for emotional supportive care in patients with advanced cancer who have emotional problems, and their associated sociodemographic, disease-related, clinical, and psychosocial characteristics. Design: Prospective multicenter observational study on experienced quality of care and quality of life in patients with advanced cancer and their relatives. Setting/Participants: Baseline data were used of 892 patients with advanced cancer who had emotional problems. Results: In total, 92% of the patients with advanced cancer had emotional problems and 33% of these had emotional supportive care needs. Most patients without emotional supportive care needs had contact with an oncology nurse (70%), while a minority received additional psychosocial support. Our multivariable logistic regression analysis shows that fatigue (odds ratio [OR]: 2.65, 95% confidence interval [CI]: 1.82-3.86), pain (OR: 1.50, 95% CI: 1.07-2.12), and less social support (OR: 0.95, 95% CI: 0.91-0.99) were associated with having emotional supportive care needs. Conclusions: One-third of patients with advanced cancer who have emotional problems in the eQuiPe study report emotional supportive care needs. Oncologists and oncology nurses should be aware that emotional supportive care needs are more common in patients with advanced cancer who experience increased pain, fatigue, or decreased social support in addition to their emotional problems. The eQuiPe study is registered as NTR6584 in the Netherlands Trial Register.

Introduction: The National Institute for Health and Care Excellence (NICE) recommends an individualized approach to end-of-life care (EOLC), including an individualized record of care, which supports shared decision-making and timely rationalization of futile observations and medications. Aim: To assess the impact of the individualized record of care in supporting patients at the end of life at a UK tertiary cancer center. Method: In May 2024, we audited the case notes of 100 consecutive patients who received EOLC at our center. Data regarding clinical decision-making and rationalization were collected. Outcomes for those supported by an individualized record of care were compared to those who were not. Results: A total of 98 patient records were analyzed. 97.3% with an individualized care record had their observations rationalized compared to 75% without, and 74.3% versus 41.7% for medications, respectively (p < 0.01). Certain medications, e.g., prophylactic low molecular weight heparin (LMWH), were less likely to be rationalized. Evidence of discussion about rationalization of observations and medications was present in approximately half of the case notes and often occurred after the rationalization had taken place. Conclusion: The presence of an individualized end-of-life record of care improved rates of review and rationalization of observations and medications. Future qualitative work is needed to identify challenges regarding these conversations, including examining the role of shared decision-making on rationalization versus patients' refusal.

Background: Early advance care planning (ACP) is associated with improved outcomes in pediatrics, yet few rigorously developed curricula exist to train interprofessional clinicians in ACP communication. Objectives: To develop, pilot and evaluate an evidence-based virtual clinician training in a pediatric serious illness communication program (PediSICP) to facilitate ACP. Primary outcomes were learner self-assessment of skills attainment and training program satisfaction. Methods: We developed an interactive, skills-based three-hour synchronous online clinician training program using Kern's Six-Step Curriculum Design, incorporating didactic and simulated patient encounters with a trained actor. Specific, measurable cognitive and behavioral learning objectives were to improve knowledge of the evidence-based benefits of ACP, to describe the PediSICP framework, and to improve practice by demonstrating a simulated ACP conversation using a goals and values approach. Sub-objectives include responding to emotion and sharing prognosis using "wish/worry" statements. Results: We conducted 10 virtual trainings from April to December 2021, each with 2-8 participants (n = 40), including 27 physicians, 7 nurse practitioners, 5 nurses, and 1 respiratory therapist from critical care, cardiology, pulmonary, and complex care; 62.5% reported no prior formal ACP communication training. Following training, 97% of participants were highly satisfied with training quality, and 100% endorsed that they would recommend it to colleagues. Additionally, clinician self-reported comfort discussing fundamental elements of ACP significantly increased following the training. Conclusion: Teaching ACP communication virtually to pediatric interprofessional clinicians is both feasible and acceptable, with improvements described in self-reported knowledge and comfort discussing elements of ACP. Future research will test the efficacy of PediSICP to facilitate longitudinal ACP.

Context: The growing field of palliative care emphasizes the need for high-quality research, yet the contributions of nonphysician palliative care specialists to studying patient outcomes remain underexplored. Methods: This national observational study aims to identify barriers to conducting research among chaplains, nurses, pharmacists, and social workers in palliative care settings. An anonymous online survey was conducted across various disciplines. Results: A total of 173 participants reveal significant differences in research engagement and perceived barriers, with chaplains and pharmacists more likely to have research requirements and training, respectively, but face obstacles including insufficient time and article preparation. Nurse practitioners and social workers reported lower research involvement and higher perceived barriers in study design and mentorship. Conclusion: The study highlights the need for tailored interventions, including targeted training, mentorship, and financial support to enhance research engagement among nonphysician palliative care specialists. Addressing these barriers through institutional support and interprofessional collaboration is crucial for advancing palliative care research and practice.