BMC Palliative Care最新文献

Background: Globally, evidence indicates that most people prefer to receive care and die at home, provided high-quality care is available. However, systemic and logistical challenges often prevent this outcome. Palliate is a nurse-led intervention aiming to address these barriers, supporting lay-carers in administering end-of-life subcutaneous medications to their loved ones, through training, written guidance, and documentation.

Aim: To explore the perceptions and experiences of patients, carers, and healthcare professionals regarding the acceptability of the Palliate intervention, using the Theoretical Framework of Acceptability (TFA), including perceived barriers and opportunities to its implementation.

Methods: A qualitative study was conducted using semi-structured interviews with healthcare professionals, patients, carers, and policy-makers, informed by the TFA. Data were analysed thematically using deductive analysis.

Results: Thirty participants, including people with a diagnosis of advanced illness, carers, and a range of healthcare professionals involved in end-of-life care, provided perspectives on the acceptability of the intervention in end-of-life care. Participants described potential benefits, including improved symptom management, reduced waiting times for medication, and increased empowerment for families to support care at home. Concerns were raised about carer burden, emotional responsibility, and the need for professional oversight. Some participants spoke from direct experience of administering or supporting the intervention in practice, providing insights into both its practical value and the challenges of implementation.

Conclusion: While the Palliate intervention was generally viewed as acceptable and potentially beneficial, its broader implementation requires careful consideration. Its acceptability was conditional on carers receiving clear training, ongoing professional support, and being able to participate voluntarily. These findings offer new insights into the boundaries of lay caregiving and have implications for the implementation of family-administered end-of-life care within health systems. Further research is needed to evaluate its safety, impact, and feasibility in diverse contexts before wider adoption can be recommended.

Background: Hospice is specialized medical care that strives to provide comfort to dying patients. To our knowledge, no study has examined the percentage of young adult LGBTQ + patients with cancer who enrolled in hospice and circumstances that surround enrollment/non-enrollment.

Methods: A single healthcare system, 4000 + self-reported LGBTQ + database of patients with cancer identified young adult decedents (18-39 years old at death) to report the percentage who died with hospice, the conversations that preceded hospice enrollment, time-on-hospice, and circumstances that surrounded the deaths of those not enrolled.

Results: From the database, 43 decedents were identified with a median age at death (range) of 33 years old (20, 39 years). Twenty had self-identified as gay/lesbian, and 23 as bisexual. Twenty-nine decedents (67% (95% CI: 51, 81%)) were enrolled in hospice (3 not enrolled and died unexpectedly; 11 with unknown hospice outcome). Conversations that preceded enrollment discussed (1) limited cancer therapeutic options with worsening end-of-life symptoms and how hospice could help ("discussed… decline and how patient would not want to die hooked up to machines"); (2) medical staff's acknowledgement of same sex spouse/life partners ("[She] is here with her wife"); (3) the inclusion of the birth family in end-of-life discussions, especially if the decedent had been single ("Her father met us… this was difficult news for him to hear."). Four of 18 decedents with known date of hospice enrollment died 3 or fewer days after enrollment.

Conclusions: Most young adult LGBTQ + decedents with cancer receive hospice services with thoughtful and inclusive conversations that precede enrollment. For some, time-on-hospice appears limited.

Background: Pain identification and treatment are important for managing the neuropsychiatric symptoms of dementia and improving quality of life in people with the condition. Quantitative clarification of facilitators and barriers to pain identification and treatment is warranted for multi-component programme implementation. This study aimed to identify the factors related to pain identification and treatment in both care recipients and providers, through the implementation of a multi-component dementia care programme for managing neuropsychiatric symptoms.

Methods: This study used longitudinal data from naturalistic long-term care settings between April 2022 and March 2025 in Tokyo, Japan. A total of 1,282 care recipients with 3,497 evaluations was included. Care professionals from community and residential care providers participated in a multi-component programme for managing neuropsychiatric symptoms associated with dementia. They provided information concerning care recipients using a web-based tool. Care professionals held interdisciplinary discussion meetings to evaluate neuropsychiatric symptoms, identify their underlying causes and establish an action plan to address the identified causes. We conducted a multilevel binomial regression analysis using pain identification and treatment as dependent variables. The independent variables included sex, type of dementia and type of provider at the between-person level. Within-person-level variables included the types of caregivers involved in the meetings, prescribed medications, the number of identified causes other than pain and the levels of neuropsychiatric symptoms per evaluation.

Results: Of the 3,497 evaluations, 1,617 (46%) identified pain, and 517 (32% of evaluations with pain identified) targeted pain in the action plans. Pain identification was more likely to occur in individuals with greater number of identified causes underlying neuropsychiatric symptoms, fewer symptoms of apathy and those in residential care providers compared to home care management agencies or individual home care providers. Pain treatment was significantly more likely to appear in action plans that included care managers in interdisciplinary discussion meetings, in individuals with fewer identified causes underlying neuropsychiatric symptoms, fewer symptoms of hallucinations, and in those receiving care from residential care providers rather than home care management agencies.

Conclusions: The involvement of care managers in interdisciplinary discussion meetings may facilitate pain treatment to address the neuropsychiatric symptoms of dementia. Educational strategies are warranted to help front-line care workers improve their pain management skills.

Background: A serious illness conversation elicits a patient's wishes, goals and values in the setting of advancing illness. Patients living with structural vulnerabilities and substance use disorders encounter barriers to these conversations and therefore often experience less than ideal deaths. This study aims to understand the needs and preferences of these patients during serious illness conversations in the acute hospital setting and to inform best practice recommendations for serious illness conversations with this patient population.

Methods: We performed a qualitative research study using interpretive description methodology at a single tertiary care inner-city hospital in Vancouver, British Columbia, Canada. Data was collected from 16 hospitalized participants living with structural vulnerability, substance use disorder and chronic illness. Semi-structured interviews were recorded, transcribed and analyzed iteratively by our research team using thematic analysis.

Results: Participants had unmet basic needs and therefore unique priorities during serious illness conversations. Participants frequently had previous negative healthcare experiences which resulted in them guarding their feelings from healthcare providers. Hope was emphasized as an important component of serious illness conversations. Participants also outlined specific preferences and recommendations for healthcare providers engaging in these conversations.

Conclusions: Our findings offer several important considerations for engaging in serious illness conversations with patients living with structural vulnerabilities and substance use disorders that, if implemented, should improve the quality of conversations and care.

Background: The capacity to recognize, label, comprehend, manage, and apply emotions, known as Emotional Intelligence (EI), is pivotal for health outcomes, especially within the emotionally charged context of end-of-life (EOL) care. Although a growing body of research examines EI within the realm of EOL care, a comprehensive synthesis of the results has yet to be conducted.

Aim: This scoping review synthesizes evidence to explore the role of EI in EOL care by healthcare professionals, focusing on its associated factors and the effectiveness of interventions aimed at enhancing EI.

Objectives: (1) To synthesize evidence on the predictors and outcomes associated with healthcare professionals' EI in EOL care, (2) the effect of interventions on improving EI in the EOL setting.

Methods: Following PRISMA-ScR guidelines, the study searched six databases (PubMed, MEDLINE, Cochrane Library, Scopus, CINAHL, and Web of Science) for studies published between 2014 and 2024.

Results: Of 256 articles screened, 12 studies were included. In the EOL context, these studies demonstrated significant influence of EI on attitudes towards EOL care, learning satisfaction, coping styles, death anxiety, fear of death, empathy, perception of palliative care, attitudes towards death, self-efficacy and EOL care ability. The differences in position, degree, and EOL training status significantly affect EI levels. Additionally, EOL simulation and EOL psychodrama interventions were proven effective in enhancing EI.

Conclusions: This review summarizes the influencing factors and intervention effects of EI among hospice healthcare professionals. The included studies indicate that EI is associated with multidimensional variables such as attitudes, mental states, professional competence, cognitive levels, and learning coping behaviors. Furthermore, specific interventions targeting hospice care demonstrate the malleability of EI and provide practical pathways for enhancing clinical outcomes related to EI. These findings point to future research directions: developing specialized EI training to improve the EI levels of hospice healthcare professionals and optimize their capabilities in palliative care.

Background: The support of family caregivers is vital in home-based palliative care, ensuring quality care for patients with palliative care needs. In their commitment to prioritising the well-being of their loved ones, caregivers often neglect their own physical and emotional health, leading to varying degrees of caregiving burden. This study aims to estimate the prevalence of caregiver burden and identify the key factors associated with it among family caregivers of patients receiving services from a palliative care institution in Thiruvananthapuram district, Kerala.

Methods: This cross-sectional study included 270 family caregivers aged 18 years and above, providing care for three months to less than a year to patients registered at the selected palliative care institution between September 2023 and August 2024. Data was collected telephonically using a structured interview schedule and the burden level was assessed using the Achutha Menon Centre-Caregiver Burden Inventory. The distribution of burden levels was analysed and associations with study variables were examined using Chi-square test. Binary logistic regression was performed to identify significant predictors of moderate-to-high caregiver burden. A 95% confidence interval was used and a p value of ≤ 0.05 was considered to be statistically significant.

Results: Findings revealed that 54.8% of caregivers experienced moderate levels of burden. Factors associated with moderate to high burden included being employed, spending full time with the patient, experiencing a career break and perceiving that caregiving impacted their family's future plans. Caregivers who faced difficulty in seeking help, struggled to balance work and home responsibilities, had existing diseases or experienced emotional and physical challenges in the past four weeks were more likely to report moderate-high burden. Lack of breaks, limited support, poor social connections outside home, insufficient time for self-care, deteriorating health post-caregiving and inadequate sleep also contributed to higher burden.

Conclusion: Findings emphasise the multifaceted challenges caregivers face, reinforcing the need for the implementation of comprehensive support mechanisms including emotional and psychosocial support, accessible respite care services and flexible workplace policies to reduce burden and enhance caregiver well-being.