Palliative & Supportive Care最新文献

Objectives: Patients' involvement in the decision-making process is essential for shared decision-making and optimal patient-centered care. However, when there are concerns about a patient's cognition and judgmen, the complexity of providing patient-centered care increases. It is often necessary to evaluate patients' decision-making capacity (DMC) to determine whether they are able to make a particular decision or whether to rely on their previously expressed wishes or the patient's caregivers.

Methods: In this article, we present a case of an older adult with colon cancer who presented to the emergency room.

Results: We describe how multidisciplinary care can enhance the evaluation of DMC and improve quality of care for older patients with advanced cancer.

Significance of results: Multidisciplinary discussions and good communication skills are essential for navigating these complex situations, reducing potential harm and maximizimizing quality of life.

Aim: This study aimed to explore the many roles of palliative care (PC) nurses in addressing the needs of patients with life-limiting illnesses in the acute inpatient setting in New Zealand.

Methods: A scoping review was undertaken, informed by the Joanna Briggs Institute guidelines and utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework. In December 2024, a comprehensive search using Pubmed, Scopus, and CINAHL was conducted for peer-reviewed articles published in English between the years 2014 and 2024, with full text available, that focused on PC nursing in the acute setting in New Zealand, Australia, Canada, Ireland, or the United Kingdom. These countries were chosen because their health care systems are similar. Citation searches were undertaken. Grey literature from New Zealand hospitals was also searched.

Results: After selection, 25 pieces of literature were eligible for the review. Nine key areas were found where PC nurses and teams play key roles in the ongoing management of patients and their coordination of care within the last months to last days of life in the acute inpatient setting. The areas were care-coordination, communication facilitation, decision-making, goals and expectations, discharge planning, physical symptom management, holistic symptom management, finances, environment, education, and rapid review. The findings suggest that PC nurses in the acute setting are no longer involved in single episodes of symptom management and ward-based end-of-life nursing, but are responsible for multiple facets of care, facilitated across several different services.

Significance of results: Understanding the complex roles involved in PC nursing can impact the health care outcomes of patients with a life-limiting illness. The scoping review can help inform future staffing requirements and the skill mix and knowledge levels required to provide timely and appropriate PC in the acute environment in New Zealand hospitals.

Background: An effective communication seemed to be crucial in all the cancer care phases, like diagnosis, prognosis, and treatment options.

Objectives: To analyze and interpret structured and open-ended questionnaire responses, focusing on the communication of bad news in onco-hematology: health care professionals' attitudes, communication methods, and perceived stress levels.

Methods: By employing a free Large Language Model, we identified and summarized the main emotions and perspectives shared by professionals.

Results: A total of 221 Italian nurses and physicians employed in onco-hematology field were enrolled. The analysis revealed key emotional themes, offering insights into the professionals' emotional states and coping mechanisms when delivering difficult news.

Significance of results: Data highlighted the duality of emotions experienced by nurses when delivering bad news - balancing professional composure with emotional distress, underscoring the critical role of empathy, team support, and adequate preparation in helping nurses navigate these challenging conversations.

Objectives: This study was conducted to examine the relationship between cancer patients' spiritual needs and their quality of life and depression levels.

Methods: This cross-sectional, exploratory study was conducted between March 2023 and November 2024. The study population consisted of cancer patients hospitalized in medical oncology departments at a university hospital in eastern Turkey. The sample consisted of 250 patients, determined by power analysis. To collect data, the "Demographic Information Form," "Spiritual Needs Assessment Scale," "EORTC QLQ-C30 Version 3.0 Quality of Life Scale," and "Beck Depression Scale" were used to evaluate the patients' sociodemographic characteristics and disease process.

Results: There was a weak, negative, statistically significant relationship between patients' spiritual needs and the subdimensions of the quality of life scale, specifically the general perceived health status (r = -0.297, p < 0.001), physical (r = -0.446, p < 0.001), role (r = -0.423, p < 0.001), emotional (r = -0.472, p < 0.001), cognitive (r = -0.458, p < 0.001) and social (r = -0.443, p < 0.001) functions, and finally, a weak positive correlation was found between the symptoms experienced (r = 0.376, p < 0.001) and depression levels. Additionally, a weak positive correlation between spiritual needs and depression level (r = 0.374, p < 0.001) was identified. Functional areas, depression, education level, diagnosis duration, and symptoms were identified as variables predicting spiritual needs.

Significance of results: In conclusion, it was determined that as the spiritual needs of cancer patients increased, their quality of life decreased and the severity of depression increased.

Objectives: Behavioral health needs are highly prevalent among individuals receiving long-term services and supports (LTSS), yet palliative care (PC) models in these settings often underemphasize psychiatric symptom management. This study explores interdisciplinary staff perspectives on behavioral health as a core domain of PC across nursing home and Program of All-Inclusive Care for the Elderly (PACE) sites.

Methods: We conducted a secondary analysis of a multi-site survey assessing PC needs across 13 LTSS sites within a large health system in New York State. We examined 5 survey items related to psychiatric symptom management, analyzing frequency, comfort, perceived benefit, and training interest. Multivariable logistic regression was used to assess associations between staff characteristics and behavioral health-related outcomes.

Results: Among 597 respondents, 60.5% reported that over half of their patients could benefit from psychiatric symptom management, and nearly half (49.2%) reported managing such symptoms weekly or more. Forty percent identified psychiatric symptom management as one of the top three ways PC specialists could help their patients, and 44.6% expressed interest in further behavioral health training as part of further PC training. Prior professional experience with PC was associated with greater recognition of behavioral health needs among patients (aOR 1.6), greater likelihood of managing psychiatric symptoms (aOR 2.0), and greater comfort doing so (aOR 1.5).

Significance of results: Behavioral health emerged as a salient and frequently encountered domain of serious illness care among LTSS staff, particularly in nursing home and PACE settings. Staff with prior PC experience were more engaged and confident in addressing psychiatric symptoms. Findings underscore the need for PC models in LTSS to better integrate behavioral health - through training, interdisciplinary collaboration, and care delivery redesign - to meet the complex needs of medically and psychiatrically vulnerable populations.

Objectives: Despite the increasing implementation of consultation-based hospice palliative care teams in tertiary hospitals of Korea, there is limited research on their impact on self-determination respect rates. Understanding this impact is crucial for improving end-of-life care practices and respecting patient autonomy. The aim of this study is to assess the trends in self-determination respect rates regarding advance care planning before and after the introduction of a consultation-based hospice palliative care team in a tertiary hospital.

Methods: A retrospective observational study was conducted using medical records from a tertiary hospital in Korea from March 2018 to December 2023. The study included all patients aged 19 years and older with medical records at a tertiary hospital during the specified period. We examined the characteristics of patients referred to the palliative care team, the effects of the consultation-based hospice palliative care team on the completion rates of advanced care planning, and changes in self-determination respect rates.

Results: Following the introduction of the consultation-based hospice palliative care team, 411 patients were referred. The proportion of patients with completed advance care planning increased from 27.0% to 60.6% (p < 0.001). The overall number of advanced care planning completions and the self-determination respect rate also showed a marked increase, particularly from 2021 to 2022, when the respect rate spiked from 27.6% to 43.2%.

Significance of results: Introduction of a consultation-based hospice palliative care team improved the respect for patient self-determination in end-of-life care decisions. These findings support the integration of hospice care teams in tertiary hospitals to enhance early and informed end-of-life decision-making.