Palliative & Supportive Care最新文献

Objectives: Clinical pharmacists are increasingly recognized as essential members of multidisciplinary palliative care teams, yet their specific roles and impact have not been comprehensively summarized. This scoping review aimed to systematically map and synthesize published evidence on the clinical roles, interventions, and professional contributions of pharmacists within multidisciplinary palliative care services for patients with non-communicable diseases.

Methods: A scoping review was conducted by searching PubMed, Embase, Web of Science, and Scopus from January 2000 to May 2024. Eligible studies reported clinical pharmacist interventions in palliative care. Data were extracted on study characteristics, pharmacist activities, and clinical outcomes.

Results: Twelve studies were included, predominantly from the United States. Pharmacist-led interventions encompassed medication reconciliation (91.7%), symptom management (83.3%), adverse drug event prevention (75.0%), patient and caregiver education (58.3%), and policy-level contributions (33.3%). High physician acceptance rates (≥90%) were consistently reported. Outcomes included improved symptom control, reduced drug-related problems, and enhanced patient-reported quality of life.

Significance of results: This scoping review synthesizes current evidence on the roles of clinical pharmacists in palliative care teams. The findings highlight their essential contributions to medication safety, symptom management, deprescribing, and opioid stewardship, reinforcing the need for pharmacist integration into multidisciplinary palliative care models to improve patient-centered outcomes. Future research should focus on implementation models, cost-effectiveness analyses, and service expansion in community-based settings.

Objectives: Patients in the re-entry phase (that is, the first 18 months after curative cancer treatment) may use meaning-making to deal with existential concerns imposed by cancer and related changes in life. The purpose of the current study was to conduct a formative evaluation of an intervention aimed at supporting patients' meaning-making process and motivating them to pick up life during the re-entry phase.

Methods: Patients were included after finishing systemic treatment for breast cancer or melanoma. The intervention comprised a single one-hour conversation guided by a spiritual counselor who explored patients' sources of meaning, in order to support them in dealing with existential concerns and changes in life in the re-entry phase. The evaluation included semi-structured interviews concerning the intervention and questionnaires assessing mental adjustment to cancer, psycho-spiritual wellbeing and meaning in life.

Results: Qualitative interviews with 14 participants demonstrated an overall positive experience and appreciation of the intervention. Patients reported several benefits: reflection on existential concerns and sources of meaning, validation of sources of meaning, insights regarding the use of sources of meaning, and motivation to pick up life; and to a lesser extent: prioritizing, identifying meaningful goals, or undertaking specific action. Patients made suggestions on how to tailor the intervention more to their needs. Quantitative data showed increases on the subscales autonomy, goal-orientedness, and fairness of life with small effect sizes.

Significance of the results: This study showed that an intervention to support patients with breast cancer or melanoma in the process of meaning-making in the re-entry phase after systemic treatment was positively experienced and well appreciated. It supported meaning-making, particularly through reflection on, validation and utilization of sources of meaning, and supporting motivation to pick up life. The results of the current study can be used to optimize the intervention, which can be further evaluated in a multicenter study.

Objectives: Open communication between parents and adolescents and young adults (AYAs) with blood cancer is key to managing cancer together. However, parents avoid difficult conversations about cancer care and lack support in navigating them. To inform a communication skills intervention to help parents of AYAs navigate challenging conversations in caregiving, this mixed-method study sought to identify difficult topics and better understand psychosocial factors associated with avoidant communication.

Methods: Phase 1 involved 20 interviews with parents of AYAs with blood cancer (aged 15-29) to capture difficult conversations and factors that inform why they are challenging. Phase 2 surveyed 80 parents about openness, avoidance, and psychosocial outcomes.

Results: In Phase 1, parents identified 5 challenging conversation areas: (1) expressing negative feelings; (2) discussing disease/care-related information; (3) addressing sexual health; (4) navigating triadic clinical interactions; and (5) talking about mortality. Parents described 3 interrelated factors that informed why these conversations were difficult: (1) lifespan/human development; (2) emotional/psychological well-being; and (3) relational-caregiving dynamics. Quantitative results (Phase 2) confirmed the same challenging conversation areas and extended them with an additional topic parents avoid: caregiver burden. Overall avoidance of these topics was associated with lower clinical communication skills and competence, less openness between parents and AYAs, reduced willingness to communicate about cancer, and greater parental distress. Avoidance of discussing caregiver burden and sexual health with their AYA was associated with higher burden. Younger parents reported higher overall avoidance compared to older ones. Hispanic/Latino parents reported higher overall avoidance than non-Hispanic/Latino. Parents without a high school degree had higher scores for avoiding treatment discussions compared to parents with higher education levels.

Significance of results: Findings highlight the need for supportive care interventions that strengthen parent caregivers' communication skills. This study also provides a roadmap of key content to include, ensuring communication skills interventions are relevant and impactful.

Objective: Perinatal palliative care (PPC) offers holistic support to families of babies with life-limiting conditions, addressing emotional, psychological, and practical needs alongside ensuring dignity for the baby. While there is growing evidence to support its benefits, there remains inconsistent service provision, limited integration with maternity care, and regional disparities. This study explores parental experiences with perinatal hospice services to inform future care models.

Methods: The study was undertaken in the Northwest of England. Fourteen semi-structured interviews were undertaken with 17 parents (three joint interviews) who had experienced perinatal loss and had engaged with PPC services. Semi-structured interviews were used to gather insights into their perceptions of care they received, focusing on issues such as communication, the timing of referrals, and the emotional and practical support provided. Data was analyzed using a thematic analysis approach.

Ethical approval: The obtained REC reference: 22/YH/0028 Results Five key themes were identified: the significance of language used by healthcare professionals when discussing the baby's condition; the importance of timely introduction to hospice care; recognition that grief is a personal and evolving process; the role of shared experiences in building relationships; and the importance of creating lasting memories.

Significance of results: Findings highlight the importance of improving healthcare professionals' communication skills and integrating multidisciplinary palliative care services early in the care pathway. Parents expressed gratitude for the hospice support, particularly the opportunity to spend quality time with their baby and make lasting memories. However, a more consistent perinatal hospice care provision across the UK is needed.

Objectives: Communicating a cancer diagnosis to a child is a complex challenge for parents. This study aims to explore (1) the communication strategies and beliefs of parents with cancer when communicating with their children and (2) the needs of these parents.

Methods: Semi-structured interviews were conducted with parents with cancer being treated at an Italian comprehensive cancer center and their healthy partners, when present. The interviews were analyzed through a constructivist approach using reflexive thematic analysis. The number of parents to be interviewed was not predetermined, but the meaning saturation procedure was followed.

Results: Ten parents were interviewed, meaning saturation was reached at the seventh interview. Five themes were created: (1) the challenges parents faced at this sensitive time; (2) the emotions parents experienced; (3) the beliefs that may have influenced how they communicate the illness to their children; (4) the strategies parents used to communicate the illness to their children and (5) parents' perception of their children's understanding of the illness. Fifty-seven needs, often unmet, were also identified and were grouped into three categories: (1) "existential" needs; (2) support needs; and (3) needs related to continuing to be and act as parents.

Significance of results: This study provides important insights for healthcare professionals to consider in order to better support and care for these parents.