BMC Palliative Care最新文献

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.

Background: Despite recent improvements, there is still stark inequity in the funding and provision of 24/7 end-of-life care for children, resulting in many families not receiving the support they need. To inform, plan and implement service changes it is important to take account of what works in current contexts and existing models of care, and to learn how professionals 'on the ground' are currently experiencing 24/7 care delivery.

Methods: The study aimed to explore professionals' perspectives of delivering 24/7 paediatric palliative care and their expectations and needs of a new service. This qualitative study used focus groups, and a thematic framework approach to analyse the data. Participants were healthcare professionals (HCPs) involved in the delivery of care to children (0-18 years) with palliative care needs and their families.

Results: Fifty-three healthcare professionals, (25 doctors, 19 nurses, 6 managerial/administration and 3 allied professionals), took part in 11 focus groups. Three themes with sub-themes were developed: (1) Working within a fragmented landscape (Responding to the need for 24/7 end-of-life care, Coordination across teams without infrastructure, Building 24/7 continuity through integration); (2) Constraints on choice: default not preferred choice? (Limits to family choice, Critical yet inconsistent provision of community nursing, Inequality of access to specialist support); and (3) The personal cost of making it work (Gaps in confidence and experience, The price of goodwill). Professionals navigated a disjointed system to deliver 24/7 care to families. They strived to offer care in families' preferred place; however, choice was constrained by the availability of local services. Professionals stretched themselves to provide around the clock care, often sacrificing their personal wellbeing and in doing so, inadvertently sustaining a broken system.

Conclusion: Stepping up to support families with 24/7 end-of-life care for their child, has resulted in an unsustainable physical and emotional toll on professionals. The impact of delivering care in an inequitable system is causing significant moral distress, and there is a growing realisation that their goodwill is masking current systemic shortcomings. Integrated Care Boards must work jointly to find economies of scale to establish equitable and sustainable models of delivery that meet national standards and to ensure all children have access to high quality 24/7 end-of-life care.

Background: Palliative sedation is considered an essential measure when other methods cannot provide sufficient symptom control in end-of-life. Prior research suggests that health care professionals find boundaries between palliative sedation, routine symptom management and euthanasia ambiguous. Appropriate implementation of palliative sedation depends on palliative care clinicians being confident in conceptual understanding of palliative sedation. The aim of this study was to understand specialist palliative care professionals' conceptualization of distinctions between symptom management, palliative sedation, and euthanasia; how perceived boundary ambiguities act as barriers to timely initiation of palliative sedation; and potential strategies to overcome these barriers.

Methods: This is an explorative qualitative phenomenological study, based on focus group interviews, utilizing reflexive thematic analysis. Four focus groups were interviewed at specialist palliative care departments across four Norwegian hospitals. Participants were 11 nurses and 12 physicians with at least one year of experience within specialist palliative care.

Results: Through thematic analysis two core themes were developed; the distinction between symptom management and palliative sedation, and the distinction between palliative sedation and euthanasia. Important sub-themes were definitional uncertainties, complexity of gradual medication titration, timing of sedation, indications for sedation, communication, and concerns about hastening death.

Conclusion: Even within specialist palliative care, different end-of-life treatment concepts are not experienced clear-cut. These conceptual ambiguities impede appropriate initiation of palliative sedation. Overcoming such barriers requires multi-level interventions: enhancing practitioners' definitional knowledge, fostering awareness of clinical intention during end-of-life treatment, promoting interprofessional dialogue, and developing more explicit clinical guidelines.

Background: In the final stages of life, patients discuss their wishes regarding their preferred location of death. However, this preferred location is not always the actual place of death. This study explores why palliative and terminal patients die in the hospital instead of their preferred location.

Methods: This is an exploratory retrospective record review of adult palliative and terminal patients who died in 2023 in Gelre Hospitals Apeldoorn, the Netherlands, while waiting for terminal care at home or in hospices. Data were retrieved from electronic patient records, after which the reasons for not dying at the preferred location were analysed.

Results: 74 patients were included, comprising 54.1% women, with a mean age of 78.2 years (SD 11.0). The most common reasons why patients did not die at their preferred location were sudden deterioration of health status (31%), hospice waiting lists (27%), and transfer delays (21%). Other reasons include uncertainty regarding the care location, failure to mark the terminal phase, and waiting for responses from preferred care locations. Delays in the transfer process due to the intervening weekend also seemed to play a role.

Conclusions: Sudden health deterioration and waiting lists at hospices seem to be the main reasons why patients die in the hospital instead of at their preferred location. The findings provide a starting point for formulating potential solutions to honour patients' wishes more often and enhance the quality of end-of-life care in our hospital-and potentially in other hospitals as well.

Background: Acute myeloid leukemia (AML) remains an aggressive malignancy, despite advancements in diagnosis and treatment. Early integration of palliative care has been shown to alleviate symptom burden and enhance quality of life among patients and their caregivers. However, palliative care remains underutilized, especially in hematologic malignancies. This study aims to determine the rate of inpatient palliative care utilization among hospitalized patients with AML and to identify predictors of inpatient palliative care utilization.

Methods: This retrospective study utilized data extracted from the National Inpatient Sample database from 2016 to 2020. Adult patients diagnosed with acute myeloid leukemia (AML) and recipients of palliative care services were identified through the International Classification of Diseases, 10th Revision (ICD-10) coding system. Sociodemographic, hospital-related, and clinical characteristics were summarized using frequencies and percentages. Binary logistic regression analysis was performed to determine independent predictors of inpatient palliative care utilization.

Results: There were 121,892 hospital admissions of patients with a primary diagnosis of AML. Of these, 460 patients (0.3%) received inpatient palliative care services. Among those receiving palliative care, most were aged ≥ 65 years (59.8%), male (53.3%), White (83.1%), and privately insured (40.2%). In multivariable analysis, older age (OR 1.57; 95% CI 1.23-2.01; p < 0.001), private insurance (OR 1.43; 95% CI 1.33-1.53; p < 0.001), receipt of chemotherapy or stem cell therapy (OR 4.13; 95% CI 3.28-5.20; p < 0.001), and inpatient mortality (OR 8.80; 95% CI 6.86-11.28; p < 0.001) were independently associated with increased palliative care utilization. While non-White race (OR 0.70; 95% CI 0.61-0.81; p < 0.001), treatment in certain hospital regions (OR 0.75; 95% CI 0.67-0.83; p < 0.001), and shorter length of stay (OR 0.60; 95% CI 0.47-0.76; p < 0.001) were associated with lower utilization.

Conclusion: Inpatient palliative care remains markedly underutilized among patients with acute myeloid leukemia. Sociodemographic, economic, hospital, and clinical factors significantly influence its utilization. Addressing these disparities through targeted interventions and institutional policies may enhance palliative care integration, potentially improving symptom management, quality of life, and overall care outcomes for patients with AML.

Background: High-quality person-centred communication for those living with serious illness benefits patients, families, and health care professionals (HCPs). However, research suggests that HCPs often find it challenging to engage in these discussions. The purpose of this study is to assess the effectiveness of the 'All providers Better Communication Skills' (ABCs), an online blended learning program delivered over three months. The ABCs program seeks to complement existing programs by adopting an interprofessional and person-centred educational philosophy, teaching core communication skills that can be utilized by any clinician across many conversations and healthcare settings, and investigating outcomes focused on clinician's skill acquisition and behavior change.

Methods: We will conduct a Canada-wide prospective stepped-wedge randomized controlled trial with interprofessional HCPs. All participants will receive the intervention, however, there will be a delay in the intervention for those randomly assigned to the control group. Our study will measure change in pre and post intervention scores for all participants. The primary outcome consists of external expert rater assessments of participants' video-recorded Standardized Patient (SP) encounters using the validated Assessment of Clinical Encounters - Communication Tool. Secondary outcomes include: participant self-assessments on self-efficacy using the validated Self-Efficacy-12 measure, as well as competence using the Patient and Family-Centered Communication subscale from the validated End-of-Life Professional Caregiver Survey; and SP ratings using the validated Questionnaire on the Quality of Physician-Patient Interaction and Feeling Heard and Understood measures. Learning experience and perceived usability of the program will also be assessed through the validated Blended Learning Usability Evaluation - Questionnaire and semi-structured interviews following program completion.

Discussion: This study is a national trial evaluating the effectiveness of a communication program for interprofessional HCPs. This research will generate evidence on ways of improving conversations about serious illness. With improved communication skills, clinicians can better support patients and families in their illness understanding, deliver care that better aligns with their patients' goals and values, improve care-related outcomes and experiences, and optimize healthcare resources - all of which can support health system strengthening.

Trial registration: https://clinicaltrials.gov/study/NCT06606470 .