Palliative & Supportive Care最新文献

Objectives: Persons living with dementia (PLWD) and their caregivers (CG) face a complex disease trajectory, which includes a multitude of challenges related to identifying credible health resources, access to services, and securing emotional support. Scalable, sustainable interventions that guide recently diagnosed PLWD and CG are desperately needed to minimize unnecessary burden and improve quality of life. This article describes the feasibility and acceptability of an early virtual palliative care intervention (SUPPORT-D^TM) for use among PLWD with mild Cognitive Impairment or Alzheimer's disease and their CG.

Methods: Using a quasi-experimental design, this 6-week prospective feasibility study was conducted among 28 (PLWD/CG) dyads and 2 individual CG. Eligibility criteria for PLWD included those with mild cognitive impairment (FAST score ≥4). SUPPORT-D^TM comprises 4 main areas of guided support: 1) understanding the disease, 2) caring for myself, 3) caring for the caregiver, and 4) planning for the future. Outcome data were collected pre/post and during the intervention. Semi-structured interviews were conducted post intervention with 10 dyads. This study was approved by the Medical University of South Carolina IRB and data were collected from January 2023 to March 2024.

Results: Seventy-six percent (23/30) of enrolled dyads successfully completed the study. PLWD and CG scores on validated measures of acceptability, appropriateness, and feasibility indicated SUPPORT-D^TM was acceptable, appropriate, and feasible. Post-intervention interview feedback further evidenced the acceptability, appropriateness, and feasibility of SUPPORT-D^TM.

Significance of results: Delivery of this virtual nurse-led early palliative care intervention (a Program of SUPPORT-D^TM) was feasible for both PLWD and their CGs. A Program of SUPPORT-D^TM has potential as a feasible intervention to provide anticipatory guidance to community-dwelling PLWD and CG. Participants endorsed inclusion of additional content specific to physical activity, stress management, and social support as helpful refinements for future delivery.

Background: Patients with a life-threatening illness and their family caregivers are often affected by biopsychosocial factors that contribute to suffering and burden-sharing and affect quality-of-life.

Objectives: To compare anxiety and depression levels between patients with incurable cancer and caregivers, investigate the association between perceived burdensomeness and psychological outcomes over time, and evaluate factors associated with perceived burden.

Methods: Secondary analysis of a larger prospective, longitudinal study. Patients with incurable cancer and their family caregivers were interviewed every 3 months, from study enrollment to 12 months, to assess psychological factors. Anxiety and depression were measured with Hospital Anxiety and Depression Scale (HADS) and perceived of burden was assessed using distinct questions directed to patients and caregivers about feeling or perceiving caregiving as a burden. For the data analysis, generalized estimating equations were applied to assess the impact of patient and family caregiver related variables on HADS over time, considering anxiety and depression scores as binary variables.

Results: A total of 190 patient-family caregiver dyads were included. Anxiety was more frequent among family caregivers than patients across all follow-up moments. No significant difference was found in mean depression scores. Feeling like a burden to their family (32.6%) was significantly associated with higher anxiety [odds ratio (OR) = 4.45] and depression scores (OR = 2.73). Poor health perception increased the likelihood of anxiety and depression for patients (OR = 11.00; OR = 38.81) and FC (OR = 2.73; OR = 4.30). Family caregivers demonstrated higher psychological distress, with active employment reducing anxiety (OR = 0.54) and depression (OR = 0.43).

Significance of results: The perceived burden experienced by patients with advanced cancer and their family caregivers over time were factors relevant in the disease process. The feeling of being a burden and poor health perception were key factors contributing to psychological distress, underlining the need for specific interventions in palliative care.

Objectives: Futile treatment is defined as maintenance of organ function without achieving meaningful goals of care. Poland is characterized by low prevalence of introducing limitations of treatment in intensive care units (ICUs). The aim of the study was to conduct a questionnaire study to evaluate the approach of Polish medical personnel to futile treatment in the ICUs.

Materials and methods: We conducted an anonymous questionnaire study during a national intensive care conference in April 2023. We collected data on participants' experiences with limiting futile treatment and their demographics. Statistical analysis comparing the responses between respondents with shorter (less than 10 years) or longer (10 years or more) work experience was conducted with a chi-squared test with residual analysis and Bonferroni correction.

Results: 354 respondents completed the questionnaire. Most participants (94.5%) found discussing end-of-life care with patients important. Additionally, 81.6% believed that the medical personnel should be more decisive than the patient's family regarding end-of-life care decisions. While 81% were aware of the existence of futile treatment protocol, only 35% used it regularly. Fear of legal consequences (61.9%) or family's reaction (55.6%) were the most common reasons for not adhering to existing guidelines. Improving hospital procedures (83.6%) and proper legislation (67.2%) were commonly suggested measures to improve end-of-life care. Respondents with shorter work experience more often reported no awareness of futile treatment protocol (28.7% vs. 6.9%, p < 0.001) as well as no experience discussing treatment limitations with patients (24.6% vs. 8.2%, p < 0.001) or their families (20.0% vs. 3.8%) compared to the clinicians with longer work experience.

Significance of results: Despite widespread recognition of the unethical nature of futile treatment, it remains controversial among Polish ICU clinicians. Improvement of legislation and hospital procedures could contribute to improvement of clinicians' and patients' well-being when facing end-of-life care decisions.

Objectives: There is a lack of family-based psychosocial support interventions in palliative care when a parent of children or youths has a life-threatening illness. One intervention that has shown positive effects is the family talk intervention (FTI). This study aimed to describe the influence of contextual factors on FTI sustainability, as perceived by healthcare professionals (HCPs), after a median of 18 months of implementation in clinical practice in cancer and palliative care when a parent of children or youths has a life-threatening illness.

Methods: Focus groups and individual interviews were conducted with 15 HCPs working with FTI. Data were analyzed using conventional qualitative content analysis.

Results: HCPs identified contextual factors that facilitated or hindered the use of FTI. The analysis resulted in 3 categories, Trying to prioritize FTI and coordinate families in a complex context is challenging, Working alone without FTI-educated colleagues hampers sustainability, the satisfaction of seeing families become stronger contributes to a receptiveness for change.

Significance of the results: This study shows that organizational support and resources, alongside the individual's facilitating factors, such as receptiveness for change, are crucial for sustainability after the initial implementation. Witnessing a positive impact is motivational and also supports the sustainability of an intervention despite contextual constraints.

Objectives: Existential distress is a debilitating condition in end-of-life cancer patients. The Psycho-existential Symptom Assessment Scale (PeSAS) was developed to screen psycho-existential symptoms in palliative care, but limited research has examined its use. This study aimed to implement the Italian version of the PeSAS in palliative care services and to evaluate changes in healthcare providers' (HCPs) competence after experiential training. It also aimed to estimate the frequency of psycho-existential symptoms and explore the scale structure using network analysis.

Methods: Two-hour experiential workshops were conducted in 5 Italian palliative care services by a clinical psychologist specialized in psycho-oncology and palliative care. Training covered psycho-existential distress, role-play, and feedback. Pre- and post-workshop questionnaires assessed clinicians' self-efficacy in evaluating physical, psycho-existential, and suicidal symptoms, managing distress, and providing psychosocial support. Patient cross-sectional data were analyzed with descriptive statistics, t-tests, chi-square tests, and exploratory graph analysis.

Results: One hundred one clinicians from 3 services participated. Significant results were found in HCPs' self-efficacy, with the largest effect in assessing suicidal symptoms (Cohen's d = 0.54), followed by managing distress (d = 0.47) and evaluating psycho-existential symptoms (d = 0.40). Of 210 patients screened, 194 were included. PeSAS scores were strongly associated with Hopelessness (strength = 1.30) and depression (1.18), while being trapped by illness (-1.64) and wishing to die (-1.12) had weaker associations.

Significance of results: The Italian PeSAS is feasible for integration into palliative care. Strong associations highlight targets for interventions, while weaker associations suggest the need for additional approaches. PeSAS enhances HCPs' ability to address the psycho-existential needs in end-of-life care.