BMC Palliative Care最新文献

Background: Patients with glioblastoma (GB) not only suffer from a life-threatening oncological disease but also present with severe neurological symptoms and high psychosocial distress. The unfavorable prognosis and the early decline in neurological functions and activities of daily living, such as mobility, lead to a significant deterioration in quality of life aspects. The need for palliative care (PC) therefore arises at an early stage and increases as the disease progresses but is often inadequately assessed and treated.

Methods: In this single-center, retrospective study, we investigated prognostic factors, survival outcomes and neuro-oncologically focused primary palliative care (nPPC) as well as specialized palliative care (SPC) interventions. Pearson's Chi-square test and an univariable and multivariable binary logistic regression analysis were used to test the independence between categorical variables and the correlation between SPC and tumor-specific therapy prior to death. The Kaplan-Meier method and a multivariable Cox regression analysis were performed to estimate the impact of SPC on survival.

Results: A cohort of 274 patients with GB was investigated, of whom 251 (91.6%) received nPPC and 210 (76.6%) SPC. Patients with SPC (p < 0.001; OR: 0.302; 95% CI: 0.157-0.584) and patients with methylation of the MGMT promoter region (p = 0.005; OR: 0.375; 95% CI: 0.190-0.739) were less likely to receive a tumor-specific therapy in the 30 days prior to death. Median overall survival was 16.9 months (95% CI: 14.5-19.3 months) for patients with SPC (n = 210) vs. 12.9 months (95% CI: 10.8-15.1 months) for patients without (n = 64) (p = 0.100; not significant). The Cox proportional hazards model demonstrated that SPC significantly correlates with longer overall survival (p = 0.017; HR: 0.707; 95% CI: 0.532-0.939).

Conclusion: This study revealed a broad availability of PC interventions for patients with GB. After adjustment of known prognostic factors, an association between SPC supply and prolonged OS was observed. Utmost efforts should be made to incorporate PC into the care of every patient within a standardized framework. Data on PC in patients with GB is still rare; therefore, further research should be made to improve PC in this highly burdened patient group.

Background: Families and medical professionals caring for traumatic brain injury (TBI) patients are often faced with decisions regarding the limitation of life-sustaining treatment (LLST). Considering difficulty of outcome prognostication and the resulting lack of objectivity, these decisions remain challenging. Although it is recognized that sex influences end-of-life care, research on sex differences in palliative care (PC) is scarce. To better understand the decision-making process at the end of life in TBI, we investigated potential sex-differences in the frequency of LLST and PC involvement, the extent of LLST, the timing of LLST and PC involvement, and the nature of the decisional authority that instigates the redirection of care.

Methods: In this systematic review and meta-analysis, we conducted a literature search in PubMed and EMBASE on March 10th, 2025. We included randomized, interventional, observational, prospective, and retrospective studies published in English on adult patients with TBI. Eligible studies provided data on sex-related differences in the frequency of LLST and PC involvement, the extent of redirection of care, the timing of LLST and PC involvement, and the nature of the decisional authority. We performed a random-effects meta-analysis to assess sex differences in frequency of LLST and PC involvement. Risk of bias was evaluated with funnel plots and the Newcastle-Ottawa-Scale.

Results: Of the 6'254 systematically and 38 manually identified records, 10 studies met the inclusion criteria. The meta-analysis on sex-related differences in the frequency of LLST, which included 6 studies referring to 367'304 patients, showed a higher likelihood for LLST for female TBI patients (risk ratio 2.16, 95%-CI 1.84-2.54, p < 0.001). The meta-analysis on PC-involvement, based on 4 studies referring to 46'220 patients, showed a higher likelihood of PC provision for female TBI patients (risk ratio 1.22, 95%-CI 1.03-1.43, p < 0.05).

Conclusions: Our results suggest that women with TBI are more likely to receive LLST and PC than men. This suggests that patient's sex plays a role in end-of-life decision-making. However, due to methodological limitations, our results must be interpreted with caution and highlight the need for further research.

Trial registration: International prospective register for systematic reviews (PROSPERO; registration number CRD42025615274).

Introduction: Family conferences (FC) are a structured and therapeutic tool in palliative care, promoting effective communication between the healthcare team, patient and family. They are especially relevant for patients with high clinical complexity, both in hospital settings and in primary care.

Objective: To evaluate caregivers' perceptions of the impact of FC on patients cared for by palliative care teams and/or primary healthcare clinicians (PHC). This included measuring quality of care, communication effectiveness, interprofessional collaboration, successful implementation of care strategies, clarity of information received, and overall satisfaction and confidence. Secondary objectives were to assess caregivers' perceptions of the importance of FCs for their knowledge and attitudes/skills, and to evaluate their perception of the overall quality of care provided to the patient, including the concordance between desired and actual place of death as an indicator of effective end-of-life planning.

Methods: Observational, analytical and cross-sectional study, with application of a specific questionnaire to caregivers of patients followed by a community palliative care team and a family health team. Sociodemographic and clinical variables and perceptions of the impact of FC on the understanding of the disease and its trajectory, on satisfaction and on the feeling of security and trust were analysed.

Results: The total sample included 38 caregivers, of whom 20 were accompanied by a team specialized in palliative care and 18 by a family health team. There was a high percentage of female caregivers (78.9%), with a mean age of 58.1 years, and the mean age of patients was 80.7 years. FC was associated with improved perception of communication (9.36 ± 0.65), collaboration (9.50 ± 0.86) and implementation of care strategies (9.45 ± 0.83). The presence of professionals such as social workers and psychologists in the FC of the palliative care team associated with greater family participation (p = 0.002) and greater perceived support (p = 0.001). Among the patients who died, there was a significant correspondence between the desired and actual place of death (p = 0.007), demonstrating FC as a potential effective instrument for planning. The presence of more family members in the FC correlated with greater hospital use in the previous month (p < 0.001) and with greater case complexity.

Discussion: Despite being an exploratory study with inherent limitations, FCs were perceived as effective in improving communication, planning and aligning care with patient and family preferences. Their regular implementation, especially in PHC, should be promoted with multidisciplinary teams and specific training.

Background: Studies have shown that needs and expectations concerning palliative and hospice care differ in relation to patients' diversity characteristics. Patients from minority groups may encounter various barriers that can prevent them from using or receiving appropriate, high-quality care. While corresponding measures and approaches exist that aim to address the diversity of patients, it is currently unclear, to what extent they are utilized by German palliative and hospice care facilities.

Methods: To examine the current state of sensitivity or responsiveness to diversity of German palliative and hospice care providers, a mixed-mode cross-sectional survey was conducted using a random sample (n = 1901) of German hospices, palliative care units in hospitals, outpatient hospice services, specialized palliative care teams (so-called 'SAPV teams'), and other service providers listed in the online guide of hospice and palliative care services of the German Association for Palliative Medicine (DGP).

Results: Among the respondents (n = 346, response rate = 18.2%), the majority perceived diversity responsiveness as a development that is gaining importance but did not necessarily consider addressing it in their facility. While a majority of facilities (56.9%) considered diversity in their mission statement, dedicated activities to promote diversity responsiveness - like diversity trainings for staff members (35.3%), designated diversity commissioners (4.6%), or dedicated internal working groups (4.3%) - were less common. Similarly, written materials and services depending strongly on communication were not generally available. Barriers to implementing such services were mostly related to organizational difficulties (31.8%), missing knowledge on how to implement corresponding measures (28.3%), and decision makers not being convinced of the necessity (25.7%). Furthermore, 25.1% of respondents reported lacking financial resources.

Conclusions: The surveyed palliative and hospice care facilities often did not address patient diversity sufficiently. Although a larger share of the respondents was generally aware of the need for diversity-sensitive care to improve patient orientation, corresponding structures and services were not commonly available. To address existing barriers, efforts to further raise awareness, as well as support measures to help facilities implement diversity-sensitive concepts are necessary.