BMC Palliative Care最新文献

Background: The number of older individuals in need of care is projected to increase in the coming years. As support from family members is becoming increasingly limited, often due to geographical distance, non-kin caregivers, such as neighbours, friends, and acquaintances, are assuming an increasingly significant role in providing support. The present scoping review aimed to identify, describe and synthesise existing evidence on the experiences, individual capacities and support needs of informal non-kin caregivers of patients at the end of life, as well as the support services available to them.

Methods: The review followed the methodological framework of Arksey and O'Malley. A search was conducted in four electronic databases (CINAHL, PsycInfo, PubMed, Web of Science Core Collection) on 10 October 2022 using a highly sensitive search strategy, and updated on 8 January 2025. Reference lists of the included studies were also hand-searched.

Results: Two authors independently reviewed the titles and abstracts of 2,931 articles and screened 128 full texts. Seven articles met the inclusion criteria, and a further three articles were identified through hand searching. The analysis revealed seven overarching themes: (1) the duration and extent of non-kin caregiving, (2) caregiving relationships, (3) enabling care at home, (4) support wishes and needs, (5) modes of support, (6) non-kin caregivers as 'hidden' caregivers and (7) caregiving burden. Notable research gaps were identified, particularly regarding the low visibility of friends and neighbours in informal care, the lack of clear differentiation from family caregivers and the limited access to appropriate support and palliative care services.

Conclusions: The findings showed that informal non-kin caregivers of seriously ill patients at the end of life remain under-recognised, despite the significant responsibilities they undertake. Future research is needed to improve access to tailored support and to distinguish their experiences from those of family caregivers.

Background: During the COVID-19 pandemic, face-to-face volunteer support for patients and families was not possible, making it necessary to explore alternative ways of reducing distress. New technologies emerged as a valuable resource, facilitating communication and information exchange, and supporting volunteer tasks.

Objective: To explore the perceived usefulness of new technologies in volunteering among different stakeholders (patients, relatives, professionals, and volunteers), and to examine how these perceptions relate to participants' technological profiles.

Design: A cross-sectional mixed-methods study was conducted to explore attitudes and preferences toward new technologies. Quantitative data were analyzed descriptively and through regression models, while qualitative data were examined using thematic analysis.

Methods: Participants were recruited through consecutive non-probabilistic sampling and included patients, relatives, healthcare professionals, and volunteers from various care settings. Quantitative measures assessed perceptions of usefulness, benefits, barriers, and satisfaction with volunteering, alongside the TechPH tool to profile technological attitudes. Qualitative data were collected through interviews and focus groups using open-ended questions to explore the perceived usefulness of new technologies in palliative care volunteering. Quantitative analysis involved descriptive statistics, Pearson correlations, ANOVA, and multiple linear regression. Qualitative data were analyzed using thematic analysis.

Results: A total of 402 individuals participated: 50 patients, 45 relatives, 136 professionals and 171 volunteers. Perceived usefulness of new technologies varied: 50% of patients, 63.6% of relatives, 77.8% of professionals, and 78.2% of volunteers found them beneficial. Three themes emerged from qualitative analysis: difficulties in new technologies use (mainly among patients), perceived benefits (e.g., enhanced communication), and the need for volunteer training in digital skills.

Conclusions: All stakeholder groups recognized new technologies as useful for volunteer support in palliative care, with the highest perceived usefulness among professionals and volunteers. However, professionals were the least involved in volunteer support. Patients reported the lowest acceptance, preferring a hybrid model in which technology complements, but does not replace, in-person support.

Background: The increasing incidence of patients requiring palliative care warrants holistic care approaches for patients where caregivers play vital roles. Understanding caregiver resilience and its determinants is crucial for developing targeted interventions to strengthen care for both patients and their caregivers.

Objective: To assess resilience levels among caregivers of palliative care patients and identify associated factors using the Connor-Davidson Resilience Scale (CD-RISC).

Methods: A cross-sectional study was conducted in five palliative care centers in Nepal from 2023 to 2024 including 422 family caregivers of palliative care patients identified using the Supportive and Palliative Care Indicator Tool for Low-Income Settings (SPICT-LIS). Data were collected via demographic questionnaires and the validated Nepalese version of the CD-RISC. Resilience scores were reported as median and interquartile range. Associations were examined using non-parametric tests (Mann-Whitney U and Kruskal-Wallis H), and effect sizes (epsilon-squared) were calculated for significant findings. Statistical significance was set at p-value < 0.05 and 95% confidence intervals and data analysis were performed in SPSS version 20 with effect size calculation in R-software.

Results: The caregivers had a mean age of 38.03 years (SD ± 12.3), with 51.2% being male. The resilience scores ranged from 13 to 100 (median 70.5). Caregiver resilience was significantly associated with perceived health status (p < 0.001) and patient diagnosis (p = 0.002). Caregivers with "very good" or "good" perceived health demonstrated higher resilience scores (median 74 and 73, respectively). Those caring for patients with cardiopulmonary conditions presented the highest resilience (median 75), whereas chronic kidney disease caregivers presented the greatest variability in resilience scores.

Conclusions: The patient's diagnosis and the caregivers' perceived health status were important determinants of caregiver resilience in Nepal's palliative care context. These results emphasize that routine palliative treatment in Nepal and other low and middle income countries should incorporate routine caregiver health assesments and support. Educational initiatives and support groups tailored to a particular diagnosis can assist caregivers in overcoming the burden of care and build resilience. In addition to community based programs that honor cultural caregiving roles, training healthcare staff to recognize and support caregiver needs may reduce caregiver burden and improve the sustainability of care.

Background: Patients with cancer experience a variety of needs at every stage of their illness. Many of these needs can be addressed with palliative care. Cancer patients' palliative needs should therefore be proactively identified and managed. This study aimed to identify the needs of oncology patients receiving out-patient cancer treatment at a Portuguese cancer center.

Methods: A cross-sectional study was undertaken of consecutive patients presenting to an outpatient cancer clinic over the course of 5 days for cancer treatments. The primary outcome measure was the validated Portuguese version of the Integrated Palliative Care Outcome Scale (IPOS). "Unmet needs" were defined as symptoms/needs rated as greater than 2 out of 4.

Results: Of 211 patients registered for clinic visits, 167 were potentially eligible and 113 (67.7%) completed the questionnaire. Cancers of the breast (31%), colorectum (18%), and lung (14%) were the most common, and 52% were stage IV cancers. Functional levels as assessed by the Eastern Cooperative Oncology Group (ECOG) were 31.8% (ECOG 1), 54.9% (ECOG 1) and 12.4% (ECOG 2). Almost all patients (99%) reported at least one symptom or need regardless of severity; 76%, 57% and 16% reported at least one, two to four, and five or more severe symptoms/needs, respectively. The most frequently reported physical "unmet" symptoms were pain (12%), poor mobility (12%) and weakness (11%). The psychological and social needs included anxiety (18%), depression (11%), difficulty sharing feelings (25%), information needs (23%), and family concerns (47%). The prevalence of unmet needs increased notably if moderate-intensity needs (2 out of 4) were included as "unmet" needs. Female sex and higher ECOG scores were associated with higher (worse) IPOS scores.

Conclusions: A high burden of unmet needs was identified among ambulatory cancer patients at this center, particularly among female patients and patients with poorer ECOG. Quality improvement initiatives are needed to improve the systematic screening of patient needs and integrate a palliative care approach earlier to help address them.

Background: With advances in technology, digital technology has played an important role in various fields. In palliative care, the application of digital technology interventions has provided new methods for managing symptoms for patients and their families, as well as for the provision of services for healthcare workers.

Objectives: To conduct a scoping review of the literature on the application of digital technology interventions in palliative care and to provide a reference for digital technology interventions and related research.

Methods: A systematic search of studies on the application of digital technology interventions in palliative care in China National Knowledge Infrastructure (CNKI), Wanfang, VIP, PubMed, Web of Science, and the Cochrane Library was conducted, with the search period from the establishment of the databases until June 18, 2025.

Inclusion criteria: Chinese or English, patients, caregivers, and healthcare workers as target populations, and the combination of digital technology intervention in palliative care, digital tools are primarily designed for web-based platforms, applications, wearable devices, virtual reality (VR), and Artificial intelligence (AI) decision tools.

Results: Twenty-one articles were included in the analysis. In palliative care, digital technology interventions mainly include short videos, web-based platforms, and VR. The content of the intervention included health education, symptom management, and relaxation experience, and the main outcome indicators were mood, quality of life, pain, symptom-related system, and family social support. The application effect is concentrated on psychological and emotional support, quality of life, symptom improvement, and social, medical, and nursing aspects.

Conclusions: Technology has significant positive effects on the application of palliative care, such as alleviating negative emotions, improving quality of life, and enhancing social support. However, in the application of digital technology in palliative care, the aspects of technology that assist in the guidance of personnel and the support of social funds should be strengthened, so that the application of technology in palliative care can have broader application potential.