BMC Palliative Care最新文献

Background: Mainland China's end-of-life care system remained underdeveloped marked by underutilization of hospice care services. Physicians-initiated end-of-life communication is likely to result in immediate enrollment in hospice care. However, there is a lack of empirical evidence on how physicians in China undertake end-of-life communication in advanced cancer. This qualitative study aimed to explore physicians' experiences on discussing end-of-life matters and facilitating hospice care transition within families of patients with advanced cancer.

Methods: A descriptive qualitative study was conducted. Using the purpose sampling, physicians were recruited from 8 hospitals in Shanghai, China. Physicians were eligible if they had experiences in treating patients with advanced cancer and were ineligible if they did not directly participate in end-of-life discussions with patients/families. Semi-structured interviews were conducted from August 2022 to February 2023. Qualitative data were analyzed by content analysis approach.

Results: Among 18 physicians, three major themes emerged regarding barriers to effective end-of-life communication at physician, family, and system levels: (1) Physician avoidance in disclosing terminal prognosis: Prognostic uncertainty, Skill deficiency, Emotional burden, Concerns about therapeutic hope, and Systematic avoidance; (2) Family priority in end-of-life decision-making: Complex family dynamics, Cultural stigma, and Unstructured family coping; (3) Systematic fragmentation in hospice care integration: Limited awareness and understanding, Ineffective referral mechanisms, and Insufficient leadership support.

Conclusion: End-of-life communication in Shanghai is hindered by physician challenges, cultural norms favoring family decisions, and systemic gaps. Targeted training for non-hospice physicians, balanced approaches to patient autonomy and family roles, and strengthened referral/reimbursement policies are needed to improve hospice transitions.

Background: Perinatal palliative care (PPC) provides essential support for families and healthcare providers at the end-of-life. Despite clear global need, structured PPC programs are not widely established.

Aim: To develop a PPC program that supports families confronted with a severe perinatal diagnosis for their (unborn) child, with a focus on evidence-based development of such program, ensuring care is effective, consistent, and aligned with best practices.

Methods: We systematically designed a PPC program following a 7-step method, using Bleijenberg's extended Medical Research Council framework. We conducted a qualitative interview study with 22 healthcare providers and 18 bereaved parents from six hospitals to identify care gaps alongside an integrative review study of international programs. These combined findings informed the development of a PPC prototype program, intended to be integrated in routine practice. Subsequently, we refined the program, identified barriers to implementation, and explored opportunities for contextual tailoring through six participatory workshops involving both healthcare providers and bereaved parents at three hospitals. In these sessions we reviewed the preliminary care components, identified practical challenges, and adapted the model to align with local workflows, staffing realities, and documentation systems.

Results: Five core components were developed: 1. Dedicated fixed PPC Team with care coordinators 2. Formal/Specialized 1,5 day training covering essential PPC aspects 3. Stepwise PPC Approach with a structured PPC plan including individualized care pathways and centralized resources and information sharing 4. Proactive psychological support for both families and staff 5. Structured Team Debriefings Key barriers to implementation included fragmented documentation systems, limited staffing and time resources, and challenges in cross-departmental coordination.

Discussion: We developed a PPC program based on existing international evidence and current PPC practices. This approach ensured both relevance and practical applicability. The program design is a strength, as it is grounded in evidence and shaped through active involvement of parents and healthcare providers, with attention to contextual tailoring. The program is now ready for pilot testing to assess feasibility and acceptability in clinical practice. Future implementation will require institutional support, contextual adaptation, and ongoing evaluation to ensure sustainable integration into perinatal care.

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.