BMC Palliative Care最新文献

Objective: To investigate the effects of advance care planning (ACP) on patients with terminal cancer in primary hospitals.

Methods: Convenience sampling was used to select 60 patients with terminal cancer and their primary caregivers from primary hospitals. The control group received routine care, while the intervention group received routine care plus an ACP-based care intervention. Patients and their primary caregivers' anxiety and depression levels were assessed before and after the intervention. We compared several outcomes between the ACP intervention and routine care control group, including quality of life scores (EORTC QLQ-C30), frequency of intensive care unit (ICU) admissions, length of hospital stay within 30 days before death, and direct medical costs.

Results: Two weeks post-intervention, caregivers' anxiety and depression were significantly lower in the ACP group than in the control group (P < 0.05). The ACP group also showed significant improvements in quality of life, including role functioning, pain, nausea/vomiting, dyspnea, constipation, diarrhea. At 1 month post-intervention, both patients and caregivers had significantly reduced anxiety/depression in the ACP group (P < 0.05). All quality-of-life dimensions significantly improved with ACP (P < 0.05). There were also significant reductions in ICU admission frequency, length of hospital stay within 30 days before death, and direct medical costs in the ACP group relative to the control group (P < 0.05).

Conclusion: ACP intervention can be successfully implemented for patients with terminal cancer in primary hospitals when clinicians receive structured training and standardized documentation and family engagement protocols are followed. Furthermore, the findings suggest that ACP may help reduce anxiety and depression in patients and their caregivers, improve patients' quality of life, and has the potential to decrease ICU admissions, hospital stay length, and direct medical costs.

Background: Primary healthcare services provide care to patients and their relatives during the late palliative phase in the patients' home or in facilities such as nursing homes. Patients receiving palliative care may be vulnerable due to the total pain of the situation they are facing, which requires great expertise of healthcare professionals in meeting the patients' needs. The aim in this study was to explore patients' experiences of quality in palliative care and advance care planning in primary healthcare services.

Methods: This study has a qualitative design. Five patients in the late palliative phase in primary care from different municipalities in Norway participated. All participants had experiences across both primary and specialist care settings. Individual interviews were conducted between January 2022 and July 2023. The interviews were transcribed verbatim and analysed using content analysis. The study adheres to the checklist of the consolidated criteria for reporting qualitative research.

Results: The findings are described in terms of four main themes: (1) trust in supportive clinicians to ease their future path, (2) perceived quality of palliative care depended on the context, (3) advance care planning helped to tidy up important aspects of life, and (4) personalized family support and involvement eased burdens for patients and relatives.

Conclusion: Patients in late palliative phase and their experiences of palliative care highlight the need for information and support from healthcare professionals, but the organization of primary healthcare settings does not adequately address these needs. A key aspect of quality in care is comprehensive and individualized follow-up throughout the patient's illness trajectory. Another area that affects the quality of palliative care is the communication skills of healthcare professionals. Care plans for the end- of -life were developed through advance care planning, but the quality of implementation varied in home care. A huge concern for patients in the late palliative phase was if and how their relatives received the support they needed.

Introduction: Heart failure (HF) patients experience significant palliative care needs (PCN), which can be assessed using the Integrated Palliative Care Outcome Scale (IPOS). This study evaluates PCN in hospitalized HF patients and their association with patient characteristics and mortality.

Population and methods: A prospective observational study was conducted on 160 hospitalized HF patients in Vietnam. PCN were assessed using IPOS (17 questions, scored 0-4, none to severe). PCN was defined as ≥ 2 items scoring 4 or ≥ 3 items scoring ≥ 3. All-cause mortality was tracked post-discharge.  RESULTS: PCN were identified in 59.4% of patients, with shortness of breath (57.5%), weakness (51.9%), and pain (45.6%) being the most common symptoms at moderate severity. PCN correlated with longer HF duration, lower eGFR, and specific medication use (intravenous drugs, RAAS inhibitors, MRAs). PCN independently predicted higher post-discharge mortality (adjusted HR: 2.63, 95% CI 1.06-6.53, p=0.037).

Conclusion: PCN are prevalent in hospitalized HF patients and independently associated with increased mortality, underscoring the need for routine PCN assessment and early palliative care integration.

Background: Despite significant advances in the availability and quality of palliative care globally, health economics research to understand the value of palliative care in Australian settings remains scarce. To address knowledge gaps and foster evidence-informed policy, funding and practice, this paper presents a consensus-driven research agenda for the health economics of palliative care in Australia.

Methods: A panel of 27 Australian experts was convened, including health economists, palliative care clinicians/researchers, policy makers/government officials, and representatives from the national peak body for palliative care. Panel members completed a survey, participated in a forum and collectively drafted the research agenda.

Results: The panel recommended 16 health economics research priorities across four key areas: (1) person-centred outcomes; (2) costs; (3) economic evaluation; and (4) data and metrics. Specific priorities included: comprehensively capturing the benefits of palliative care for people with life-limiting illnesses and their informal carers; understanding the diversity of preferences for palliative care across the population; capturing informal caring costs within economic evaluations; embedding economic evaluation within clinical trials and health services studies; and quantifying the extent and location of unmet palliative care needs.

Conclusions: This paper outlines high-priority research actions to generate the economic evidence required for appropriate funding and resource allocation in palliative care. The research agenda serves as a strategic tool to help researchers address gaps without duplicating efforts. By focusing on these priorities, we aim to support the development of more effective, equitable and sustainable palliative care services across Australia.

Background: This qualitative study was undertaken to obtain feedback from informal carers about their experiences of involvement in a cluster randomised trial of clinically-assisted hydration in the last days of life ("CHELsea II trial").

Methods: Informal carers that had taken part in the trial post-bereavement postal survey, and had expressed an interest in taking part in further research, were approached about this post-bereavement qualitative study. Interviews were conducted remotely, using a semi-structured interview schedule that asked about the impact of the research on patient / their end-of-life care, the impact of the research on the informal carer, and the informal carers views on research at the end-of-life. The interview transcripts were thematically analysed.

Results: Fifteen informal carers took part in the study prior to thematic saturation. Invariably informal carers reported that there was no negative impact on the patient or themselves, and were positive about taking part in future end-of-life research (if the situation occurred). The analysis generated three themes: (a) Purpose, helping, and no disruption; (b) Preparing for what was to come; and (c) Timing of research at the end-of-life.

Conclusions: This study confirms that research can be undertaken in patients at the end-of-life without negatively impacting the experience. Moreover, patients and their informal carers want to take part in such research, as it provides them with purpose during this time, and gives them the chance of helping future patients.

Trial registration: ISRCT Registry (registry number - ISRCTN65858561) - registered 14/09/2021.

Background: Nurses play an important role in caring for patients in palliative care and they need sufficient palliative care competence. Additionally, the need for palliative care is increasing. Therefore, palliative care and end-of-life care is one of the fields where nurses' specialisation education is needed the most. The aim of this study was to assess the effect of postgraduate specialist education on nurses' palliative care competence and the association between participants' age or work experiences and changes in their palliative care competencies.

Methods: The data were collected through electronic surveys at the beginning and at the end of specialisation education in 17 universities of applied sciences in Finland. The survey was conducted using the Nurses' Core Competence in Palliative Care (NCPC) instrument. The survey response rate was 89% (pre-training) and 69% (post training). Of 286 nurses, 143 completed both the pre- and post-survey. The data were analysed using nonparametric tests. The level of statistical significance was set at p ≤ 0.05.

Results: After the education participants' self-assessed core competencies in palliative care increased compared to before the education, indicating that their knowledge and skills increased in all five domains. Knowledge in Symptom Management, Systematic Use of the Edmonton Symptom Assessment System (ESAS), Teamwork Skills and Interpersonal Skills increased statistically significantly (P < 0.001). Likewise, Life Closure Skills increased statistically significantly (P = 0.044) after the education. Some associations were found, those who had five years or less of work experience in palliative care or end-of-life care reported a greater increase in Interpersonal Skills compared to those with more than ten years of work experience (P = 0.002). Also, those aged 40 or younger reported a greater increase in Interpersonal Skills than those aged 41-50 (P = 0.017).

Conclusion: This study shows that palliative care specialist education increased nurses' palliative care competence. No statistical association was found between work experience in healthcare and changes in competence; the competence of all participants increased during the education. Palliative care specialist education improves nurses' self-assessed competence in palliative care and may indirectly improve the quality of palliative care.

Background: The aging population and rising prevalence of chronic illnesses emphasize the importance of palliative care (PC), which focuses on enhancing patients' quality of life (QoL) while supporting their families and caregivers. PC integrates multidisciplinary interventions to alleviate the physical, psychological, social, and spiritual suffering of individuals facing serious or terminal illnesses. Concurrently, Artificial Intelligence (AI) advancements have been transforming the healthcare sector, particularly through Clinical Decision Support Systems (CDSS). Leveraged by advanced algorithms and machine learning (ML), these tools analyze large volumes of data to support diagnostics, personalized treatments, and early interventions. In PC, AI has demonstrated potential to enhance early diagnosis, identify support needs, and personalize end-of-life care. ML algorithms help predict symptoms and complications, enabling timely and effective interventions. However, challenges remain, including data privacy concerns, integration into clinical workflows, and ethical implications of AI in sensitive care contexts.

Methods: We conducted a scoping review to map and analyze AI applications on PC. Articles published until May 2024 were identified in two electronic databases. From 542 records, 57 studies met the inclusion criteria. The review explored trends, benefits, and limitations of AI applications, highlighting tools for diagnostic and prognostic support, symptom tracking, shared decision-making, and communication with patients and families.

Results: The findings highlight how digital technologies and AI are revolutionizing communication, care coordination, and symptom control in PC, unlocking remote care options. The review identified key advancements in symptom management, communication, decision support, telemedicine and education areas, while addressing barriers like ethical, legal, and accessibility concerns.

Conclusions: By compiling evidence on AI use in PC, we aimed to empower professionals, researchers, and policymakers to promote more effective, ethical, and person-centered strategies. Ultimately, we provide insights for developing new technologies and establishing protocols that support the safe, equitable, and person-centered implementation of AI in palliative care, and highlight the need to prioritize early identification of patient needs, promote integration between hospital and community care, and establish protocols.

Background: At the end of life, patients frequently experience distressing symptoms. When they become refractory, sedating medications and palliative sedation (PS) may be used to alleviate suffering. PS is mainly practised in specialist settings, as it requires defined procedures and guidelines. Little is known, however, about how registered nurses (RNs) and healthcare assistants (HCAs) manage refractory symptoms and unbearable suffering in nursing homes and how sedating medications are used in this non-specialist setting. This study explored how RNs and HCAs in Swiss nursing homes recognise, assess, and alleviate unbearable suffering, the challenges they face, and the strategies they employ to alleviate residents' suffering by using sedating medications and PS.

Methods: This qualitative study involved 22 RNs and six HCAs from nursing homes in German-speaking Switzerland. Seven semi-structured focus group interviews were conducted between October 2023 and January 2024, transcribed verbatim, and analysed using a grounded theory approach.

Results: The core category, 'Navigating palliative sedation in nursing homes - tension between alleviating suffering and over-sedating', was identified, with three subcategories: (1) recognising suffering, (2) assessing suffering, and (3) alleviating suffering. Challenges included distinguishing residents' suffering from that perceived by relatives or healthcare professionals, negotiating assessments with relatives and general practitioners (GPs), and uncertainties in the use of sedating medications - particularly morphine and midazolam. Strategies to address these challenges included 'double-checking' to validate symptom recognition, shared decision-making to 'get everyone on the same page' and align treatment goals, and the reliance on internal and external 'safety nets' (experienced colleagues and specialised palliative care services). Resource constraints such as personnel and financial resources, as well as beliefs and attitudes were reported to influence the management of unbearable suffering and the use of sedating medication.

Conclusions: RNs and HCAs in nursing homes face complex challenges when recognising, assessing and alleviating suffering with sedating medications. Ensuring safe and ethical practice requires sufficient staffing, adequate training, clear protocols, and access to specialised palliative care support. Without sufficient expertise, interprofessional collaboration, and shared decision-making, residents risk either inadequate relief of suffering or inappropriate sedation.

Background: Serious illness communication with racial and cultural discordance can be challenging for both patients and providers. Furthermore, patients with serious neurologic conditions may have deficits that affect communication and medical decision-making. We aimed to explore strategies for effective culturally-tailored communication and interpersonal relationship-building that multidisciplinary healthcare providers use to facilitate serious illness conversations with patients of diverse cultural backgrounds.

Methods: Using non-stratified purposive and snowball sampling, we conducted semi-structured interviews with 17 multidisciplinary providers, recruited from an academic tertiary care center, a Veterans Affairs hospital, and an academia-affiliated county hospital, who provide care for patients with serious neurologic conditions. We used inductive and deductive content analysis methods with dual review. We used inductive and deductive content analysis methods with dual review.

Results: We describe six strategies providers used to establish trust and rapport with diverse patients and families. Theme 1: Recognize and check personal biases about race and culture. Theme 2: Create sufficient time and space to build connection with patients and families. Theme 3: Ask direct, open-ended questions to gather clear information about lived experiences and establish rapport. Theme 4: Repeat information as necessary to ensure understanding and bi-directional engagement. Theme 5: Understand family structure and dynamics and involve family members in communication and decision-making. Theme 6: Partner with palliative care teams, interpreters and other hospital staff as well as individuals from outside the healthcare system.

Conclusions: High-quality care involves culturally-sensitive and tailored communication, which can be challenging for patients with neurocognitive deficits and limited abilities in communication and decision-making. Our study highlights six ways on how to establish rapport and improve cross-cultural serious illness communication with these diverse patients and families.