Palliative Care and Social Practice最新文献

Background: Emergency medical services (EMS) encounters with palliative care patients present unique operational challenges. As EMS providers increasingly care for individuals with life-limiting illnesses, understanding the intersection of emergency care and palliative medicine has become essential to optimizing healthcare delivery.

Objective: This study examines EMS operational metrics, resource allocation patterns, and clinical outcomes among palliative care patients in Thailand.

Methods: This retrospective analysis study investigated operational times, resource utilization, and clinical outcomes in palliative care patients utilizing EMS services, derived from electronic medical records and EMS documentation. This study was conducted at the Srinagarind Hospital EMS unit from October 2019 to September 2024. All patients diagnosed with palliative care (ICD-10 code Z51.5) who utilized EMS services were included.

Results: Palliative care patients represented 6.9% (N = 340) of total EMS utilization (N = 4520), with cases increasing from 51 patients (15.0%) in 2019-2020 to 89 patients (26.2%) in 2023-2024. The median age was 72 years, with 62.9% male patients. Palliative care patients demonstrated significantly prolonged EMS operational times: activation (1.51 min vs 1.27 min), response (10.21 min vs 9.35 min), and scene time (22.05 min vs 10.02 min, p < 0.001). Resource utilization showed higher rates of pain medication administration (30.88% vs 7.79%) and exclusive use of comfort-focused interventions. Patient outcomes revealed significantly higher discharge rates.

Conclusion: Palliative care patients utilizing EMS services represent a distinct population requiring specialized operational approaches. Extended scene times reflect appropriate symptom-focused care delivery rather than rapid transport protocols. Higher discharge rates validate the EMS role as a symptom management bridge.

Background: Māori people in Aotearoa New Zealand and Australia experience significant healthcare inequity as they age and towards the end of their lives. Compassionate community approaches to ageing and end-of-life care are increasing in popularity throughout the world. However, this approach has arisen from Eurocentric knowledge systems and not from First Nations people and their communities.

Objectives: This research aimed to gain insight into what the Compassionate Communities approach means for First Nations people and identify implications for Māori in Aotearoa New Zealand and Australia. A systematic literature review explored the intersection of Compassionate Communities and First Nations peoples' perspectives and needs. Addressing the overarching question of: What does the Compassionate Communities approach mean for older First Nations people?

Design: A Kaupapa Māori approach was used to answer the research question and to explore the literature retrieved.

Methods: The main literature search was conducted during 2020-2022, with subsequent searches in 2023 and a final search in 2025. The review was conducted in Covidence systematic review software following the PRISMA process. Screening was completed by two reviewers and assessed against the inclusion and exclusion criteria. Kaupapa Māori theoretical questions were applied to each full-text article, with a rating of positive, neutral or negative allocated to establish conceptual alignment. NVivo thematic analysis software was utilised to code and explore themes.

Results: Fifty papers were imported into Covidence, with 22 studies included in the final review.

Conclusion: The review found minimal discussion about how Compassionate Communities approaches are implemented in a way that includes First Nations knowledges of ageing and end of life. There is a greater need to understand the contribution First Nations peoples' wellness philosophies make to the Compassionate Communities approach. Evaluations of Compassionate Community initiatives need to be more inclusive of First Nation peoples and their knowledges. In Aotearoa New Zealand and Australia, more research is needed to understand pathways to well-being for older Māori people based upon existing community strengths to ensure flourishing futures. Addressing these knowledge deficits will support efforts to address the inequities experienced by First Nations people as they age and at the end of life.

Background: Knowledge about the structure and type of palliative psychological care is limited and heterogeneous in most countries. Due to the lack of legal regulations in Germany, it is unclear how psychologists are integrated into multiprofessional palliative care teams (MPCT).

Objectives: To describe how palliative psychology is organised in the various specialist palliative care settings for adults in Germany, how psychologists/psycho-oncologists assess their professional attitude and how satisfied they are with their work.

Design: Online survey with psychologists/psycho-oncologists working in specialist palliative settings in Germany.

Methods: The quantitative data was analysed descriptively and inferentially (correlations, group differences) using SPSS; category-based evaluation of free text comments.

Results: One hundred and five of 210 respondents worked in a predominantly specialist palliative setting, mainly on palliative care units (137/210), mostly in combination with other settings (158/210), with a small proportion working in specialist palliative home care (29/210), palliative care support team within a hospital (28/210) or a hospice (16/210); the professional attitude did not differ between the predominantly and less palliative setting or the levels of professional experience. A high level of satisfaction with integration into and perceived appreciation by the MPCT, perceived effectiveness, supervision/intervision/exchange within the MPCT and overall job satisfaction was reported; when dissatisfaction was mentioned, the most common reasons given were a lack of resources, unfavourable structures or communication deficits; the predominantly palliative setting had a positive effect on satisfaction with integration into the MPCT, perceived effectiveness and overall satisfaction; a higher level of professional experience also showed a positive influence on perceived effectiveness.

Conclusion: Although psychologists/psycho-oncologists were present in all palliative settings, they were not regularly a core member of the MPCT. Besides structural differences in palliative psychological care, there was also heterogeneity in the qualifications of the psychologists/psycho-oncologists. These results make the structure of psychological care in palliative care facilities in Germany more transparent and could be used to promote palliative psychology expertise as an integral part of multiprofessional care.

Background: The growing number of patients diagnosed with advanced cancer increases the pressure on health systems, especially in lower-middle-income countries. Telemedicine palliative care consultation is innovative in providing quality cancer care while reducing costs. However, there is a lack of randomized controlled studies that evaluate the effects of digital consultations in the palliative treatment of cancer patients. This study aims to investigate the efficacy of telemedicine consultation in outpatient palliative care settings.

Methods/design: During an 18-month recruitment period, participants recently diagnosed with advanced cancer who are not already receiving palliative care are invited to participate in a randomized controlled trial. Eligible participants are randomized to the intervention group (telemedicine) or the control group (face-to-face) consultations. Patients have monthly scheduled consultations (three such consultations), and unscheduled consultations as needed, provided through telemedicine or face-to-face visits. The primary outcomes are patients' quality of life assessed monthly using the EORTC-QLQ-C30 Questionnaire, changes in self-reported symptom control measured at every visit through the mean changes in distress score on the IPOS Questionnaire, and patients' satisfaction assessed monthly using the FAMCARE P16 Questionnaire. Secondary outcomes are eHealth Literacy, the domain of intervention, number of patients satisfied with physician communication, patients' experiences with the care, number of emergency room visits, number of unscheduled visits, adherence to intervention, changes in medication adherence, number of completed telemedicine scheduled visits, and physician's ability to evaluate a patient through telemedicine.

Discussion: This is one of the first randomized controlled trials investigating virtual palliative care. Our data will determine whether telemedicine is appropriate for outpatient palliative care.

Trial registration: ClinicalTrials.gov Identifier: NCT06538350.

Background: There is a growing need for psychosocial oncology and palliative care training among nurses in Cameroon and other low-resource settings, where formal education in these domains remains limited. The Psychosocial Oncology and Palliative Care Training (POPCaT) program was developed to address this gap by providing a blended, contextually relevant training to nurses working in some healthcare settings in Cameroon.

Objective: To evaluate the implementation, outcomes, and participant experiences of the POPCaT training pilot delivered across six health facilities in Cameroon.

Methods: This was a pilot evaluation conducted immediately following a 4-day intensive POPCaT training. The course combined didactic lectures, interactive group work, clinical case discussions, role-plays, and a supervised visit to a palliative care unit. Fifty-two nurses purposively selected from six health facilities participated in the training, and 48 voluntarily completed the post-training evaluation. Quantitative data were collected via a structured survey containing closed-ended Likert scale questions assessing course satisfaction, content relevance, learning outcomes, and likelihood of practice implementation. Descriptive statistics were used to summarize responses. Qualitative data were collected through open-ended questions exploring motivations, course experiences, perceived strengths, limitations, and post-course intentions. Thematic analysis was applied to analyze open-text responses.

Results: Participants were mostly female (83.3%) with a mean age of 38.2 years and varying levels of clinical experience. Most (64.5%) held a nursing diploma, while only 31.3% had prior oncology training. Overall course satisfaction was high, with 77.1% rating the program as "very good" and 93.8% reporting a strong likelihood to implement learning in practice. Participants praised the course content, relevance, interactive methods, and facilitator expertise. Key strengths included clinical exposure, bilingual delivery, and group learning. Areas for improvement included calls for expanded content on breaking bad news, cultural and spiritual care, sexuality, survivorship, and practical service implementation.

Conclusion: The POPCaT training was positively received, enhanced nurses' confidence and knowledge, and generated actionable post-course plans across individual, clinical, and institutional levels. Findings support the relevance and scalability of this model for strengthening palliative and psychosocial oncology care in low-resource settings. Future iterations should incorporate suggested enhancements and explore long-term impacts on practice and patient outcomes.

Grief is universal, yet very isolating. Every culture has rituals, every family its stories of loss, and every individual their private struggles with absence. Very often, grief is treated as something to be repaired, resolved, replaced, or moved beyond. Yet what the bereaved most need is not solutions, but companionship-someone willing to notice, listen, and stay present. This article reflects on bereavement companionship through stories shared during monthly workshops that I lead. The narratives-a child mourning a lost pen that symbolised her absent father, a woman grieving the death of a neighbourhood cat dismissed as "just an animal," and a husband given the gift of a final private conversation with his deceased wife-highlight the many forms grief can take. They remind us that grief is not confined to death, but is interwoven with everyday losses, symbols of love, and the fragile bonds that give life meaning. The lessons from these stories reflects what participants in the Bereavement Companionship Program repeatedly affirm: grief is personal, unique, and never small. What helps is steady presence, emotional support, and space to grieve. What harms is dismissal, rushed condolences, or attempts at replacement.

Background: Patients with advanced non-small-cell lung cancer (NSCLC) frequently experience severe symptoms and functional decline, underscoring the need for early end-of-life (EOL) care discussions to improve care quality. Additionally, enhancing patients' death literacy may strengthen these discussions. However, how patient characteristics influence death literacy in this population is largely unknown.

Objective: This cross-sectional study explored baseline levels of death literacy and examined associated patient characteristics in advanced NSCLC.

Design: A cross-sectional study was conducted.

Methods: A total of 103 patients aged ⩾18 years with stage IIIB or higher NSCLC who had completed at least first-line cancer treatment were recruited using convenience sampling. Data were collected between June 2024 and June 2025 using structured questionnaires assessing sociodemographic, medical conditions, prior EOL care experience, and death literacy (using the traditional Chinese version of the Death Literacy Index, score range = 29-145). Descriptive statistics, Pearson's correlation, independent t test, and stepwise regression were used to analyse associations between patient characteristics and death literacy.

Result: The mean participant age was 61.62 ± 10.86 years, and the mean Karnofsky Performance Score was 67.57 ± 12.48. Many had prior experience of EOL care provision (58%) and had lost a relative (90%), but few had discussed EOL care with a physician (29%). Overall, death literacy was moderate (94.08 ± 16.45). Higher death literacy was significantly associated with experience of EOL care (β =  13.390, p < 0.001), having had an EOL care discussion with a physician (β =  10.901, p < 0.001), and being a women (β = 8.671, p = 0.001). These factors explained 37.1% of the variance in death literacy (F = 21.030, Adjusted R ² = 0.371).

Conclusion: Healthcare providers should recognize patients' lived experiences as important contributors to fostering open conversations around EOL care preferences. Interventions such as the Life Journey Tea House or broader public health strategies may help stimulate reflection and encourage dialogue.

Background: Community-based palliative care (CBPC) shows promise for supporting patients with advanced noncommunicable diseases, yet implementation remains inconsistent. Most research focuses on organizational and provider perspectives, with limited understanding of patient and caregiver views on service acceptability and implementation.

Objectives: To understand barriers and facilitators to implementing CBPC services from the perspectives of patients with advanced congestive heart failure, chronic obstructive pulmonary disease and end-stage renal failure, and their primary caregivers.

Design: Qualitative study using focused open-ended interviews conducted over four-monthly intervals. Data were analysed using reflexive thematic analysis within a critical realist paradigm.

Methods: Twenty-five patients (11 male, 14 female; 13 CHF, 8 ESRF, 4 COPD) and 9 caregivers (1 male, 9 female) were recruited from the Segamat district in Malaysia. Participants met inclusion criteria using the Supportive and Palliative Care Indicators Tool. One-on-one open-ended qualitative interviews using the reflexive thematic analysis approach explored experiences of living with advanced illness, perceived needs and perspectives on establishing CBPC services.

Results: Four key themes emerged: "What they offer is not what we need" revealed skepticism towards new healthcare services based on negative past experiences; "Supportive relationships over support services" demonstrated preference for care from trusted community members rather than outsiders; "The myriad cares of family" highlighted the valued role of family caregivers in providing companionship and maintaining patient identity; and "How to care for us" identified unmet needs including transportation, financial support and social connection. Participants emphasized that trust-building through community engagement must precede service implementation.

Conclusion: Successful CBPC implementation requires fundamental shifts from expert-driven service delivery towards relationship-centred, community-engaged approaches. Services must be co-developed with communities, prioritize trust-building and address social determinants of health alongside clinical needs. Traditional "build it and they will come" approaches are insufficient for achieving community acceptance and sustainable implementation.

Background: Advance care planning (ACP) is crucial for ensuring quality end-of-life care, yet its implementation remains limited in Thailand.

Objectives: To understand the attitudes and preferences of older Thai adults towards ACP in primary care settings.

Design: A cross-sectional study was conducted using structured interviews. Data on demographics, health status, attitudes, and preferences towards ACP were collected. Multivariable analysis was performed to identify factors associated with ACP attitudes and preferences.

Setting/subjects: Participants aged 60 years or older at the Primary Care Unit of Songklanagarind Hospital, Thailand, between June and December 2022.

Results: Among 250 participants, 60% had high comorbidity levels (Charlson Comorbidity Index >3). While most participants demonstrated high attitude levels towards ACP, over 40% did not want to make an ACP, and 37.2% wanted to postpone it. Higher educational levels (adjusted OR (aOR) = 2.17, 95% CI: 1.16-4.06) and prior ACP discussions (aOR = 4.08, 95% CI: 1.38-12.08) were significantly associated with high attitude levels. Participants with high attitude levels showed greater odds of desiring to engage in ACP (aOR = 2.81, 95% CI: 1.45-5.42). Those with higher education (aOR = 2.09, 95% CI: 1.1-3.98) and family members who received life-sustaining treatment (aOR = 1.9, 95% CI: 1.02-3.55) were more likely to prefer ACP engagement.

Conclusion: Tailored education and repeated ACP discussions are needed to bridge the gap between attitudes and engagement among older Thai adults.

Background: Nowadays, effective communication has become indispensable with the increasing prevalence of advanced life-limiting diseases. Goals of care discussion (GOCD) align care with patients' preferences and improve care quality.

Objectives: This paper probes deep into the dilemmas and summarizes strategies of medical staff conducting GOCD from the viewpoint of human-environment interaction.

Design: Qualitative study comprising semi-structured in-depth interviews.

Methods: Eighteen medical staff (6 doctors, 12 nurses) were recruited from five palliative care units in Guangzhou, China, from December 2023 to March 2024. Data were analyzed by carrying out Braun and Clarke's thematic analysis and guided by Bourdieu's theory of practice.

Results: Three themes and 11 sub-themes emerged: (1) The palliative care environment as a complex and sensitive field characterized by highly sensitive life-related issues, intricate ethical dilemmas, and ambiguous role responsibilities; (2) Multiple forms of capital employed in communication, including informational capital, economic capital, social capital, symbolic capital, and emotional capital; (3) Common communication habitus, including risk aversion, euphemistic expression, emotional restraint.

Conclusion: By drawing on Bourdieu's theory of practice, this study offers revolutionary standpoints on the dilemmas in GOCD within palliative care, which underscores the significance of both individual and environmental factors. Grounded in these insights, we recommend implementing the following strategies: fostering a positive ethical climate and a conducive environment for open dialogue; enhancing ethical awareness and sensitivity through tailored training programs; clarifying relational frameworks to bolster team collaboration; improving communication approaches by leveraging diverse forms of capital; and proactively confronting implicit biases that persist in clinical settings.