Palliative Medicine最新文献

Background: Grief experienced by parents following the death of their child is profound and places them at a higher risk of adverse health outcomes. Memory making practices intend to provide families the tools to meaningfully adjust and make sense of a child's death. Although memory making practices are established in end-of-life care, it remains uncertain how memory making interventions are experienced by families during bereavement.

Aim: This study aims to provide evidence-based insights into the memory making experiences of parents during neonatal and paediatric bereavement care.

Design: This is an exploratory descriptive mixed-methodology study using a Melbourne-based cross-sectional electronic-survey.

Setting/participants: Thirty-three bereaved parents participated in this study. All families were known to the Neonatal Intensive Care Unit and/or the Victorian Paediatric Palliative Care Program at The Royal Children's Hospital. This study captures the experiences of bereaved parents whose children died between 1 January 2018 and 31 December 2020.

Results: The majority of parents who took part in memory making activities had a positive experience. Parent responses came together across four themes: (1) Experiential memory making is emotionally challenging but rewarding, (2) Physical memory making keeps the child real and part of the family, (3) Regret over missed opportunities and (4) Catering to individual needs.

Conclusion: Personalised provisions of love and care were dignities parents could warmly reflect back on during their bereavement. Importantly, tailoring memory making practices to the unique needs of the family and the dying child ensures both have their needs acknowledged and met.

Background: Community Palliative Care Services, a limited resource, helps patients spend as much time at home as possible by managing their symptoms and supporting caregivers in the community.

Aim: To describe the characteristics of patients discharged alive from the Community Palliative Care Services and to determine the outcomes of those discharged alive, including overall survival, subsequent place of death, and health service use.Design, setting/participants:Linked administrative clinical data were analysed for all adults discharged from an Australian metropolitan Community Palliative Care Services in Sydney between July 2010 and September 2018. That data comprised death records, ambulance, emergency, and hospital admissions. Factors associated with 30-day re-presentation to these services after discharge from the Community Palliative Care Services were examined using logistic regression.

Results: Of 5270 community patients, 20% (n = 1095) were alive at discharge. The median follow-up after the first discharge was 259 (95% CI 214-287) days, with 40% (n = 454) of these having a subsequent community palliative care referral. Six hundred and sixty-four (61%) died within a year of discharge, and 45% (n = 495) died in the community. Patients who lived in private residences and who had a malignant disease had higher odds of 30-day hospital re-presentation.

Conclusion: As the demand for Community Palliative Care Services increases, delivering equitable and efficient services to patients with palliative care needs becomes challenging with limited resources. Factors associated with hospital readmission shortly after discharge from the Community Palliative Care Services should be further explored to determine interventions that may support patients and families in their illness trajectory.

Background: Palliative Care is concerned with relieving suffering and improving the quality of life of patients and their families. Currently, questions arise about how to provide patients with good end-of-life care. There has been increasing interest in the beneficial effects of using psilocybin-assisted therapy in patients with severe chronic illnesses near the end of their lives and who present symptoms of depression and/or anxiety.

Aim: Explore the role of psilocybin-assisted therapy in palliative care, synthesizing evidence from clinical trials and longitudinal studies.

Design: Systematic review.

Data sources: A bibliographic search was performed in April 2024 in B-on, PubMed, Web of Science, and Scopus. Eligible studies included peer-reviewed quantitative research (RCTs, longitudinal, and observational designs) with adult participants in palliative care settings, examining the efficacy and safety of psilocybin-assisted therapy. Reviews, gray literature, and studies outside the scope of palliative care were excluded.

Results: Of the 215 articles found, six studies (n = 74 participants; age range 22-75 years) met the inclusion criteria. Across randomized and open-label trials, psilocybin-assisted therapy produced clinically significant reductions in depression and anxiety, with 57-79% of participants achieving ⩾ 50% symptom reduction on standardized scales (e.g. HAM-D, HAM-A, BDI, STAI). Improvements were sustained for up to 6-8 months in most trials, and in one follow-up study, for up to 4.5 years. Reported adverse effects were generally mild and transient, including nausea, vomiting, and temporary increases in blood pressure and heart rate; no serious adverse events were observed.

Conclusions: Psilocybin-assisted therapy consistently demonstrated efficacy and safety in the reduction of depressive and anxiety symptoms. However, more studies exploring integrating psilocybin-assisted therapy into existing palliative care healthcare systems are needed. This includes investigating the feasibility, acceptability, and cost-effectiveness of integrating psilocybin-assisted therapy into routine clinical practice.

Background: Specialist palliative care provides holistic care for individuals with health-related suffering and those close to them. Historically this included people with advanced cancer, however, people living beyond cancer also have significant unmet needs. Specialist palliative care could potentially provide support, but evidence for their role is limited.

Aim: To generate consensus opinion among European experts about the role of specialist palliative care for people living beyond cancer.

Design: The PRiSM project (Specialist Palliative care's Role in Cancer Survivorship Model) was an electronic Delphi study. Participants provided anonymous feedback on statements across three rounds. Consensus was pre-defined as ⩾75% within each group. Spearman's Rank Order Correlation determined stability and the Chi square test for goodness of fit compared group outcomes.

Setting/participants: European professional experts and patient advocates were invited via email, forming two groups undertaking simultaneous processes: specialist palliative care (86 experts representing 19 countries/regions) and oncology (54 experts representing 17 countries/regions).

Results: Eighty specialist palliative care and 49 oncology experts completed the process. Outcomes were achieved about the general core functions of specialist palliative care and areas requiring education, and their potential role for people living beyond cancer. Sixty statements reached stable consensus in both groups. Comparing other outcomes, 16 statements reached consensus in only one group, nine with a significant difference.

Conclusions: European specialist palliative care and oncology experts reached consensus that specialist palliative care should have a role in supporting people living beyond cancer, specifically in pain management. Results will inform a new care model.

Background: Specialised palliative care providers face complex challenges when caring for patients with life-limiting diseases. Despite this, a low prevalence of burnout has been observed among physicians in Danish palliative care compared to other Western countries. Given the multidisciplinary nature of palliative care, an expanded investigation was warranted.

Aim: To assess burnout and its associations with demographic variables and workplace factors among all professions in Danish palliative care.

Design: Cross-sectional survey study using the Copenhagen Burnout Inventory, the Danish Psychosocial Work Environment Questionnaire, and the Warr-Cook-Wall Job Satisfaction Scale.

Participants: All 12 palliative care units in the Central Denmark Region participated. Of 288 invited professionals, 151 (52%) completed the survey. Respondents comprised nurses (n = 88), physicians (n = 17), other healthcare specialists (n = 12), and non-healthcare professionals (n = 34) from six hospices and six palliative care teams.

Results: The prevalence of burnout was 23% overall; 28% in hospices and 14% in palliative care teams. Professionals in palliative care teams reported more weekly working hours (38 vs 34, p < 0.001), less shift work (40% vs 73%, p < 0.001), and higher meaningfulness at work (85 vs 76, p < 0.001) compared to hospice professionals. Adjusted analyses showed higher burnout among respondents with young age (p = 0.01), children living at home (p = 0.02), and shift work (p < 0.03). Low burnout was associated with high meaningfulness at work (p < 0.001), collegial trust (p < 0.001), and job satisfaction (p < 0.001).

Conclusion: Burnout is a relevant concern in Danish palliative care, especially at hospices. The identified links to organisational and psychosocial factors suggests areas for further research and organisational attention.

Background: Palliative care-while overlapping with but distinct from end-of-life care-involves multidisciplinary teams providing medical, psychosocial, and existential support to patients and families facing serious illness. While prior research has examined professional identity in palliative care, the existential dimensions of identity formation-what it means to be a palliative care professional-remain largely underexplored.

Aim: To explore the lived experiences of palliative care professionals, focussing on how their professional identity is constructed through the existential notion of "being," and to identify implications for advancing international education and workforce policy.

Design: Semi-structured interviews were analysed using Interpretative Phenomenological Analysis (IPA). Reflexivity, peer debriefing, thick description, and an audit trail were applied to ensure rigour and transparency.

Setting/participants: Fourteen Italian palliative care professionals from diverse disciplines (nursing, medicine, allied health) working primarily in community-based services.

Results: One Group Existential Theme emerged: Being, encompassing four subthemes-Meaning of Being, Ways of Being, Being Present for Others, and Reasons for Being Present. Across these, participants framed their identity not only around technical competence but also around emotional presence, relational depth, and ethical commitment to dignity in dying.

Conclusions: This study advances existing literature by integrating the existential dimensions of "being" into professional identity theory. Findings highlight the need for international education and workforce strategies that embed reflective practice, emotional competence training, and peer-support structures alongside technical instruction, to sustain professionals in death-related work.

Background: Uncertainty about the future is commonly experienced by older adults with advanced multimorbidity, impacting multiple life domains and frequently causing anxiety. Communicating about future uncertainty affects patient satisfaction, quality of decision-making and opportunities for future planning. Patient, carer and healthcare professional experiences of future uncertainty communication have been little studied to date.

Aim: In the context of older adults with advanced multimorbidity, to explore patient, carer and healthcare professional experiences and preferences for communication of uncertainty about their future.

Design: Multi-method qualitative research utilising in-depth interviews and focus groups with reflexive thematic analysis.

Setting/participants: Older adults with advanced multimorbidity (n = 15), their nominated informal carers (n = 3), and community and inpatient healthcare professionals working with this population (n = 17).

Results: Participants' experiences of uncertainty communication were influenced by their acceptance or avoidance of addressing future unknowns. Patients and their informal carers expressed a range of information needs: they prioritised open and honest dialogue with healthcare professionals, tailored to their unique circumstances and supported by reassurance and proactive plans, even when medical options were limited. Healthcare professionals acknowledged the importance of addressing uncertainty: they expressed a lack of experience and confidence and feared upsetting patients or losing their trust. As a result, opportunities for timely and personalised communications may be missed.

Conclusions: To support patients and carers navigate the inherent uncertainties of advanced multimorbidity, healthcare professionals would benefit from tailored communication training designed to increase their experience of undertaking honest and open dialogue about future uncertainties, informed by patients' individual context and preferences.

Introduction: Evidence around pressure injuries in palliative care settings is limited and fragmented.

Aim: To synthesize systematic review evidence regarding prevalence, risk factors, prevention and treatment of pressure injuries in non-acute care settings, and evaluate implications for specialist palliative care.

Design: A rapid overview of reviews following the Cochrane guidance for overviews.

Data sources: We searched four databases (MEDLINE, Cochrane Database of Systematic Reviews, JBI EBM Reviews, and CINAHL) from inception to October 2024. We included systematic reviews on adult patients in inpatient Palliative Care Units or settings likely involving end-of-life care.

Results: Seventeen systematic reviews incorporating 149 unique studies (n = 5,856,293) were included. Thirteen of the reviews were high quality. Only one low-quality review specifically addressed palliative care, focusing on prevalence and risk factors. Interventions were categorized into nutritional, physical (e.g. repositioning, tilt strategies), topical/dressing-based, electrical stimulation and organizational approaches. Frequent repositioning and certain nutritional interventions may reduce incidence or surface area of pressure ulcers; however, certainty remains very low. Frequent repositioning, specific tilt strategies and specific nutritional interventions may help reduce the incidence of pressure injuries and decrease injury surface area; however certainty is very low. Other interventions have limited and inconclusive evidence and were rated low to very low certainty according to GRADE criteria due to poor trial design and population and setting variations.

Conclusions: The evidence base remains weak and largely indirect, offering insufficient guidance for clinical practice in palliative care. High-quality, targeted research is needed to inform effective pressure injury prevention and management in this population.

Background: Many patients in the last phase of life use anticoagulants. There is little evidence on the benefits and risks of (dis)continuation of anticoagulant therapy in this phase, leaving healthcare professionals with a complex clinical dilemma.

Aim: To gain an in-depth understanding of the experiences, perspectives, and preferences of healthcare professionals regarding decision-making about anticoagulant therapy in the last phase of life.

Design: Semi-structured in-depth interviews were conducted and analyzed using a thematic content analysis.

Setting/participants: This study was performed in the Dutch Federation of Anticoagulation Clinics, two hospitals, two hospices, and two palliative home care groups in the Netherlands. Thirty-two healthcare professionals regularly involved in care for patients in the last phase of life were interviewed.

Results: Healthcare professionals experienced decision-making regarding anticoagulant therapy in the last phase of life as difficult and multifactorial, due to a lack of knowledge on the incidence of events after (dis)continuing therapy, the uncertain risk trade-off between events with major consequences, the variety of indications for therapy, the variety of comorbidities and patient characteristics, and prognostic uncertainty. As a result, healthcare professionals act defensively when considering discontinuation, due to concerns about being held accountable for potential thrombotic events. Uncertainty in decision-making results in reactive decision-making in response to triggers such as active bleeding, low performance score, recognition of the dying phase, and patient's preference.

Conclusions: This study highlighted the complexity of decision-making regarding anticoagulant therapy in the last phase of life. This results, in practice, in reactive instead of proactive decision-making.