Journal of palliative medicine最新文献

Background: Recent research indicates that psychedelic-assisted therapy (PAT) may be a safe and effective treatment for several psychiatric disorders, including those experienced by people with serious physical illness. Understanding health care workers' (HCWs') attitudes and knowledge about the clinical application of psychedelics for patients with serious illness is important in progressing research and identifying factors to consider in potential future implementation of PAT. Aim: The aim of this systematic review was to synthesize quantitative, qualitative, and mixed methods studies that explored HCWs' attitudes and knowledge about the role of psychedelics in treating psychological distress in patients with serious illness. Design: MEDLINE, PsycInfo, and CINAHL were searched for quantitative, qualitative, or mixed methods primary empirical studies, published in English from 2006 onward. Two reviewers independently screened articles for inclusion. The Joanna Briggs Institute (JBI) convergent approach to mixed methods systematic reviews guided synthesis of the findings of included studies. One reviewer extracted data from included studies which was checked for accuracy by another reviewer. Two reviewers independently critically appraised included studies using JBI critical appraisal tools. Results: The review included nine studies (seven qualitative, two quantitative) conducted in four countries. Five themes were developed: Polarized views about PAT for patients with serious illness; attitudes often informed by PAT research knowledge and heuristic methods; stronger evidence base needed to increase HCWs' confidence and support implementation of PAT; barriers may hinder PAT's potential integration into existing care models; and team-based approach and clinical education are essential to facilitate PAT. Conclusion: Although support for PAT varied, most HCWs perceived potential benefits in treating refractory distress, desired education about PAT, and called for further research to develop a stronger evidence base. Limitations of the review and included studies are discussed, along with implications of the findings and recommendations for future research.

Background: Since 2011, extended care paramedics in South Australia have collaborated with palliative care services to deliver successful palliative and end of life care. However, a gap in paramedic training was identified with a growing number of patients opting for home palliation, prompting the development of a 2021 education program by the South Australian Ambulance Service in partnership with Program of Experience in the Palliative Approach, to equip paramedics with enhanced skills and resources for effective palliative care in the community. Aim: To qualitatively evaluate the effectiveness of the education program provided to paramedics by exploring their subjective experience in providing palliative care within the community following the education program. Methods: The study was guided by an interpretative phenomenological approach to understand the impact an education training in palliative care has had on the practices of paramedics in South Australia. Setting/Participants: A purposive sample of nine South Australian paramedics from rural and metropolitan areas participated. Results: Four major themes were identified including: (1) benefits of the education program; (2) gaps in the education program; (3) responsibility for the education provision; and (4) suggestions for the improvement of the education program. Conclusions: Paramedics were integral to avoiding the transfer of palliative care patients to emergency departments. This was crucial for complying with a patient's wishes of not wanting to leave their own familiar surrounding at the end of their life. Palliative care education was shown to improve paramedic knowledge and skills. Specific knowledge gaps were highlighted by the participants to better manage palliative care patients in the community.

Background: Inpatient hospices (IHs) can alleviate distress and address economic burdens on patients with terminal cancer. However, there have been inconsistent findings regarding IHs in terms of cost savings and medication use. Objective: We aimed to examine cost savings associated with IHs, according to the timing of first hospitalization before death, and analyze their use of medication, among Korean patients with terminal lung cancer. Methods: Using the South Korean national health insurance claim database, we identified 31,139 patients with lung cancer who died between 2017 and 2020. Their daily hospitalization costs were analyzed using a generalized linear model stratified by time of first hospitalization before death. Medication use was examined using a negative binomial model. Results: IHs spent $134, and $21 less on patients during days 1-7, and 8-30 before death, but $18, $44, $36, and $54 more during days 31-60, 61-90, and 91-180, respectively, compared with non-IHs (all p < 0.05). However, total hospitalization costs in the year preceding death did not differ (relative risk: 0.990, 95% confidence interval [CI]: 0.972-1.007, p > 0.05). IHs used 2.103 times more opioid analgesics (95% CI: 1.980-2.233, p < 0.001). They also used more antiemetics, delirium medications, and antianxiety agents, as well as fewer antidepressive agents, systemic steroids, diuretics, total parenteral nutrition, and antibiotics (all p < 0.05). Conclusions: Patients with terminal lung cancer in IHs in Korea were more likely to receive symptom-oriented medications and experienced reduced hospitalization costs only during the 30 days preceding death.

Background: Caregivers are engaging in recreational travel with the neuro-oncology patients they care for, yet there is little scientific research on this phenomenon. Aim: The purpose of this study is to examine the experiences of recreational travel among caregiver-patient with brain cancer dyads from the perspective of the caregivers. Specifically, we examined (1) context (i.e., why and when) of recreational travel, (2) the caregiver's travel preparations, and (3) the impact of the travel on caregivers. Design: Descriptive thematic analysis was conducted on transcripts of unprompted caregiver discussion of recreational travel, defined as any trip or vacation taken by caregiver and patient with the purpose of recreation lasting at least overnight. Setting/Participants: Caregivers of patients with brain cancer enrolled in an eight-week support intervention at an NCI-designated Cancer Center (NCT04268979). Incidental discussion of recreational travel during weekly phone intervention sessions was identified from structured interventionist notes. Results: Fifteen caregivers discussed recreational travel. The context of travel was often to focus on quality of life upon treatment cycle completion. Preparation often included accommodating patients' needs. Care teams' practical support and validation for the trip were identified as useful resources. Caregivers most often described the emotional impact of travel, which was often complex and bittersweet. Conclusions: Travel with a patient with brain cancer may be an important goal for caregivers and could help create meaning and memories, but can also present challenges. Early and clear communication from the care team can play a role in supporting meaningful trips.

Background: The majority of hospice patients are over the age of 65, and the majority of hospice deaths occur in private homes. As a hospice patient's disease progresses, death becomes imminent and family and friends gather around to say good-bye. These private vigils are the culmination of the hospice experience and reflect both the strengths and the challenges surrounding hospice care. The purpose of this study was to explore the stories and experiences of hospice staff with death vigils, unveiling the secrets of home deaths and identifying barriers to a good death. Methods: Qualitative analysis of interviews with 25 hospice staff representing 11 different hospice agencies explored the emotions and challenges of directing and managing the vigil experience. Based on Erving Goffman's dramaturgical model, the experience is explored in depth to unveil a private experience in hopes of enlightening the public on what death in the home looks and feels like. Co-coding of stories and validation of findings by hospice nurses and physicians assure the trustworthiness of the data. Results: Hospice staff share narratives related to family and caregiver burden, challenges with symptom management, frustrations with staffing shortages, and administrative burdens surrounding the experience of death vigils. Conclusions: The family and hospice clinician's experiences with the final act of dying at home are sometimes challenged by the intermittent nature of home care during the final days.

Introduction: Methadone is used to treat intractable cancer pain when other opioid analgesics are ineffective. Methadone tablets may be difficult to administer in cases of gastrointestinal passage obstruction. However, changing the route of methadone tablet administration is possible. Case Description: The patient, diagnosed with esophagogastric junction cancer with multiple metastases, continued to receive methadone tablets even after not being longer able to take oral medication. Method: Methadone tablets were administered using a simple suspension method via gastrostomy. We measured the respiratory rate during sleep daily. We also measured weekly QTc values using a 12-lead electrocardiogram and methadone blood concentration periodically. No side effects were observed. Conclusion: Using a simple suspension method to administer methadone is a safe pain management method when accompanied by careful monitoring. To date, no study has examined the tube administration safety of methadone tablets. Thus, this case report is of important clinical significance.