BMC Palliative Care最新文献

Background: Out-of-pocket health expenditure (OOPE) is a significant public health concern in India, with an estimated 55 million individuals pushed into poverty due to healthcare expenses. Evidence on the burden and patterns of OOPE among older adults requiring palliative care, and the financial strain faced by them, is limited.

Methods: Data from the Longitudinal Ageing Study in India (LASI) identified 2903 older adults aged 60 years and more with palliative care needs using the Supportive and Palliative Care Indicator Tool for Low-Income Settings (SPICT-LIS). Annual healthcare expenditure and OOPE were estimated separately for outpatient care and hospitalisation. At the household level, OOPE and Catastrophic Healthcare Expenditure (CHE) were calculated for the last month. CHE prevalence was mapped across India's states. The Kruskal-Wallis test and Multivariate logistic regression were used to assess differences in mean expenditure and identify household factors associated with CHE, respectively.

Results: The mean annual health expenditure for older adults with palliative care needs was ₹5002 for outpatient care and ₹36,263 for hospitalisation. OOPE accounted for 94% of outpatient and 82% of hospitalisation costs. Significant hospitalisation costs were associated with cancers (₹267,797), heart diseases (₹93,003), and stroke/neurological illnesses (₹54,913). Distress financing methods, such as liquidating savings (24.4%) and taking loans (26.5%), were standard. Nearly one-third of household health spending was attributed to older adults in need of palliative care, with 21.6% of these households facing CHE.

Conclusion: The healthcare needs of older adults requiring palliative care are predominantly funded out of pocket. One in five households with older adults needing palliative care faces catastrophic healthcare expenses, highlighting the need for expanded palliative care programs and health insurance to alleviate economic hardships.

Background: Meaningful and proactive end-of-life conversations are crucial for achieving person-centered care and supporting the concept of a "good death". However, death-related taboos and family-centered values continue to hinder such conversations in East Asian societies. Innovative and culturally sensitive strategies are needed to encourage early reflection and dialogue on end-of-life care preferences among healthy older adults.

Aim: This study describes the development and preliminary feasibility of a culturally grounded end-of-life conversation game, Tree of Peaches, designed to facilitate discussions about what matters most at the end of life and related care preferences.

Methods: The development of Tree of Peaches followed a two-phase design process, including synthesizing literature and consulting with a panel of experts to identify and validate culturally relevant attributes associated with a good death and hospice care. An exploratory descriptive study was then conducted to assess the game's feasibility among 16 healthy older adults residing in a senior community in northern Taiwan. Each small-group session involved self-reflection, prioritization of values, and group discussion. Quantitative data on card selection and weighting were analyzed descriptively; qualitative data were analyzed using qualitative content analysis.

Results: The game engaged participants in reflective dialogues on values and preferences for end-of-life care. Participants prioritized values related to dignity, followed by family emotional protection, physical comfort, and the desire to die at home. Factors discouraging hospice care included self-sacrifice reassurance to preserve family hope, optimistic beliefs, and unfamiliarity with hospice services. The findings highlight how participants navigated tensions between personal values, family love, and cultural expectations in shaping their end-of-life care preferences.

Conclusions: This study suggests that Tree of Peaches, through the integration of gamification and culturally sensitive design, offers a structured platform that may facilitate reflective and value-based discussions about end-of-life preferences among healthy older adults. The findings provide insights into the interplay between personal values and family concerns, contributing to a deeper understanding of how autonomy, interdependence, and a "good death" are negotiated within Taiwanese culture. This tool shows potential for adaptation in broader contexts to support proactive end-of-life conversations, which warrants further evaluation in future studies.

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).