Journal of palliative medicine最新文献

Purpose: This study was undertaken to determine the nature of the relationship between psychological resilience and spiritual well-being (SWB) among family caregivers (FCs) of patients with terminal cancer. Methods: This multicenter cross-sectional study included 173 FCs from nine inpatient hospice care units. SWB was assessed using the Functional Assessment of Chronic Illness Therapy-Spiritual well-being questionnaire, and various psychosocial variables, including psychological resilience, were also measured. Factors associated with SWB were identified by multivariate regression analysis adjusted for potential covariates. Results: Various factors were found to be associated with the SWB of FCs as determined by total FACIT-Sp-12 scores and the scores of its three domains. FC resilience was significantly associated with SWB as determined by total FACIT-Sp-12 scores and scores of the meaning and peace domains. Conclusion: Assessing FC psychological resilience would help palliative care providers improve their SWB.

Background: Population-based methods to identify patients with serious illness are necessary to provide equitable and efficient access to palliative care services. Aim: Create a validated algorithm embedded in the electronic medical record (EMR) to identify hospitalized patients with serious illness. Design: An initial algorithm, developed from literature review and clinical experience, was twice adjusted based on gaps identified from chart review. Each iteration was validated by comparing the algorithm's results for a subset of patients (approximately 10% of the populations screened in and screened out on a given day) with the expert consensus of two independent palliative care physicians. Settings/Subjects: The final algorithm was run daily for nine months to screen all hospitalized adults at our academic medical center in the United States. Results: Compared with the gold standard of expert consensus, the final algorithm for identifying hospitalized patients with serious illness was found to have a sensitivity of 89%, specificity of 82%, positive predictive value of 80%, and negative predictive value of 90%. At our hospital, an average of 284 patients a day (54%) screened positive for at least one criterion, with an average of 38 patients newly screening positive daily. Conclusions: Data from the EMR can identify hospitalized patients with serious illness who may benefit from palliative care services, an important first step in moving to a system in which palliative care is provided proactively and systematically to all who could benefit.

Background: Oral disorders (ODs) in palliative care (PC) are highly prevalent and significantly impact patients' quality of life (QoL). Nevertheless, evidence-based management recommendations are lacking. Several natural products are safe, well-accepted, and effective for mucosal conditions. Objective: The study aimed to evaluate the efficacy of a propolis-based product combined with basic oral hygiene in preventing and treating ODs. Design: A prospective, open-label, single-center phase II study was performed. Adult patients in PC with cancer or noncancer diagnoses, who were conscious, able to swallow, with a life expectancy of more than one week, were recruited. Results: ODs' improvement or maintenance of oral health was observed in 89.6% of cases. Severity of ODs significantly decreased (p < 0.001), along with reductions in oropharyngeal pain (p = 0.002) and dysgeusia (p < 0.001). Meal comfort, completion, and QoL improved; acceptability was excellent. Conclusions: The protocol was safe, well-accepted, and effective for ODs in adult patients in PC. Study registration: The study protocol was prospectively registered at ClinicalTrials.gov: NCT04911335.

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.

Background: Seriously ill older adults are admitted for post-acute care in skilled nursing facilities (SNFs) for curative, rehabilitative treatments, yet experience high rates of re-hospitalization, and death. The primary palliative care in post-acute care (PPC-PAC) intervention is an evidence-based approach designed to help people with serious illness align treatment plans with goals of care, optimize quality of life, and improve satisfaction with their care. Objectives: To conduct a preliminary study and evaluate the feasibility of implementing the PPC-PAC intervention in the post-acute care SNF setting. Design: Two-group, multisite feasibility pilot pragmatic clinical trial with a non-equivalent design. Measurements: Primary outcome measures-eligibility, enrollment, and data collection rates; consultation satisfaction; and fidelity. Effectiveness outcome measure-quality of life using the Palliative Outcomes Scale version 2. Results: Close to 70% of those who were eligible and approached by the study team (45/65) enrolled in the trial throughout 12 SNFs in the Northeast and Mid-Atlantic United States. Thirty-five were enrolled from intervention sites; 10 were enrolled from control sites (usual care). Most participants (80%) expressed general satisfaction with PPC-PAC, and 90% of clinicians implemented the PPC-PAC intervention as intended. At 21 days follow-up, there were no significant differences in effectiveness outcomes. Conclusion: Implementation of the PPC-PAC intervention proved to be feasible and acceptable among older adults and clinicians. Future research should focus on testing the effectiveness of PPC-PAC and explore strategies for optimal intervention implementation and SNF staff engagement in the post-acute care setting.

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.