Palliative medicine reports最新文献

Background: Depression is a common yet under-recognized condition among palliative care patients, often affecting their psychological well-being and quality of life. Coping strategies used by these patients may influence their mental health outcomes and overall adaptation to illness.

Objective: To assess the presence of depression and identify coping strategies among palliative care patients attending a tertiary teaching hospital in Karachi, Pakistan.

Setting/subjects: This cross-sectional study was conducted at Aga Khan University Hospital, Karachi, Pakistan, over six months (June to December 2023). A total of 81 adult patients receiving palliative care for at least one month were enrolled in the study. Depression was assessed using the Patient Health Questionnaire-9, while coping strategies were evaluated using the Brief COPE Inventory. Descriptive and inferential statistics were applied using SPSS v. 21.

Results: Depression was present in majority of participants, with 30% showing minimal, 18% mild, 19% moderate, 22% moderately severe, and 11% severe symptoms. The coping styles used were problem-focused (2.65 ± 0.65), emotion-focused (2.18 ± 0.32), and avoidant coping (1.74 ± 0.34). Female participants were more likely to employ emotion-focused coping compared to male participants (p = 0.012). A weak inverse correlation was observed between education level and depression severity (r = -0.213, p = 0.056).

Conclusion: Depression is highly prevalent among palliative care patients in this context. Most patients adopt adaptive coping strategies, particularly emotional support and religious coping. These findings highlight the need for integrated psychological care as a routine component of palliative treatment.

Background: Women appear to be underrepresented in heart failure and palliative care research. Given this underrepresentation, their unique characteristics, needs, and outcomes require further investigation.

Methods: A secondary analysis of baseline data of the Educate, Nurture, Advise, Before Life Ends Comprehensive Heartcare for Patients and Caregivers study, a randomized clinical trial of Deep South patients ≥50 years of age with advanced HF. Differences in sociodemographics and measures of quality of life and mood between female and male patients were examined using bivariate tests and effect-size measures.

Results: Statistically significant gender differences were observed with females reporting poorer quality of life-The Kansas City Cardiomyopathy Measure (49.55 ± 20.04 vs. 55.37 ± 21.52, d = 0.28, p-adj = 0.01), Patient-Reported Outcome Measurement Information System (PROMIS) Global Mental Health (44 ± 8.02 vs. 46.53 ± 9.01, d = 0.30, p-adj = 0.007), and PROMIS Global Physical Health (37.37 ± 7.65 vs. 39.2 ± 8.20, d = 0.23, p-adj = 0.034) and Hospital Anxiety and Depression Scale anxiety (6.9 ± 4.38 vs. 4.72 ± 3.89, d = 0.53, p-adj = 0.003) compared with men at baseline.

Conclusion: Further investigation of gender differences is necessary to improve outcomes and inform the refinement of PC-HF interventions for females.

Background: Nursing students often encounter emotional challenges when facing death during their clinical training, which can negatively impact their academic performance and mental well-being. As they provide crucial support to patients and their families, this responsibility can induce significant stress.

Objective: This study aims to examine nursing students' attitudes toward death and dying and to identify the demographic and educational factors influencing their preparedness for end-of-life care in the United Arab Emirates context.

Methods: In March 2025, a cross-sectional study was conducted using a convenience sample of 122 nursing students (senior and junior) enrolled in clinical placements at a university in the United Arab Emirates. Data collection utilized the validated Death Attitude Profile-Revised (DAP-R) and Frommelt Attitudes Toward Care of the Dying (FATCOD) scales as assessment tools.

Results: The study showed that nursing students typically hold neutral attitudes toward caring for patients nearing the end of life. There are statistically significant correlations between age, education level, grade point average, clinical scores, and overall scores on the DAP-R scale, as well as the FATCOD Scale, among the participants.

Conclusions: While many students showed some acceptance of death, high degrees of fear, avoidance, and escape acceptance had a significant impact on their views about end-of-life care. The findings indicate that emotional distress and insufficient training may act as impediments to compassionate treatment. Furthermore, the comparatively low FATCOD ratings indicate a need for better integration of palliative care instruction within the nursing curriculum. Structured clinical exposure, psychological coping mechanisms, and reflective learning opportunities could all be used to help students gain the essential confidence and emotional resilience.

Patients with advanced malignancies often end up receiving aggressive interventions which are not aligned with their preferences especially during terminal stages. Discussing and documenting the goals of care (GOC) early in the course of the illness will help patients receive interventions based on their preferences. In resource-constrained settings such as our institution, a regional cancer center in India, a lower-middle socioeconomic country, this also enables effective utilization of life-saving equipment and Intensive care unit care. Since we did not have a standard GOC discussion and documentation process, we initiated a quality improvement (QI) project. This QI initiative was done using the A3 methodology between September 2023 to May 2024 and it was followed up till March 2025. For this project, we chose patients with advanced pancreatic and colorectal cancer with a life expectancy of less than one year. We followed various steps of the QI project such as defining the problem, setting SMART goals, process mapping, root cause analysis, identifying key drivers and interventions to solve the problem, and also planned sustainability measures. As a result of this QI project, we were able to increase the rates of GOC documentation from 0% to 92% in patients with advanced pancreatic and colorectal cancer. Root cause analysis revealed that the absence of a standard operating procedure/document and limited awareness about GOC were the main barriers for which we derived key drivers and interventions. Though creating awareness help to increase the number of patients referred for GOC discussion, our goal was achieved after we created a color-coded GOC document. Introducing a standardized, color-coded GOC documentation process through a QI initiative significantly improved discussion and documentation rates in patients with advanced cancer. Such QI initiatives are feasible in low- and middle-income settings and help align care with patient preferences and save resources.

Background: Asians in the United States receive less palliative care and enter hospice less than Whites, disproportionately receive more invasive mechanical ventilation, and report less involvement in decision-making with physicians than they would like. Despite the growing literature addressing serious illness in diverse patient populations, communication with Asians is understudied. This study aimed to explore U.S. physician perceptions of clinical interactions with Asian patients with serious illness and barriers and facilitators to physician-patient communication.

Methods: This is an exploratory qualitative descriptive study using semistructured interviews with U.S. physicians who cared for Asian patients with serious illness. We used an inductive content analysis approach to identify themes related to facilitators and barriers to communication between Asian patients, their families, and physicians.

Results: We conducted 10 physician interviews between February and April 2024. Of participants, 50% were White and 50% were Asian, the majority were male, and 50% specialized in palliative care. Three major themes arose: (1) trust cannot be assumed; (2) understanding and honoring the role of family are key; and (3) honoring the patient's preferences for communication can build trust.

Conclusion: This study is a step in illustrating how a cross-cultural approach to communication needs to align physicians, patients, and families on the process of communication and shared decision-making and not only on the goals for care. Moving toward a cultural adaptive approach can empower clinicians to engage in a trust-building process of inquiry, observation, and understanding of how sociocultural factors impact patient preferences for health care.

Background: Patients with non-English Language Preference are at risk of adverse health outcomes, particularly at end of life and during serious illness. Medical interpreters often feel unprepared to interpret conversations about serious illness. Best practice guidelines recommend a pre-encounter huddle between clinician and interpreter to better prepare both providers. The CHECK-IN (Check in for Exchange of Clinical and Key Information) guide is a simple communication tool designed to facilitate this pre-encounter huddle. We describe the results of a pilot feasibility study of the CHECK-IN guide performed in a simulation environment. The primary objectives of the study were to evaluate the feasibility, acceptability, and preliminary performance of the CHECK-IN guide.

Methods: This U.S.-based study is a single-center simulation-based nonblinded randomized pilot feasibility study. Participating clinicians were randomized to usual practice (control) vs. introduction to the CHECK-IN guide (intervention). Clinicians completed pre- and post-session surveys. Participating clinicians were evaluated using the Faculty Observation Rating Scale (FORS), Interpreter Scale (IS), and Interpreter Impact Rating Scale (IIRS).

Results: Participants had a highly favorable opinion on the acceptability, appropriateness, and feasibility of the CHECK-IN tool; 91% of participants agreed/strongly agreed on the acceptability of the tool, 91% agreed/strongly agreed on the appropriateness of the tool, and 100% agreed/strongly agreed on the feasibility of the tool. There were no statistical differences between control and intervention groups for the IS, IIRS, and FORS scores.

Conclusion: The CHECK-IN guide is a promising tool to guide a pre-encounter huddle between clinician and interpreter, thereby improving interpreter-mediated communication when having conversations about serious illness.

Background: Early advance care planning (ACP) has been widely recommended, but overall uptake remains low. Most efforts to improve formal ACP adoption, namely living will (LW) and health care agent (HCA) documentation, focus on medical settings targeted at older adults with serious or chronic illness, while community-based ACP campaigns are limited.

Objectives: Describe the development and implementation of a community-based campaign (2017-2021) aimed at increasing ACP adoption and evaluating its outcomes at both the community level and across subgroups by race, ethnicity, and age.

Setting: Howard County, Maryland, United States.

Design: Nonexperimental study design.

Measures: A mixed-mode, representative survey of 2000+ county residents was conducted biennially between 2016 and 2021 (one survey was delayed due to COVID-19). Main outcome measures were self-attestation to completing LW and HCA documentation.

Results: In total, 6037 respondents over three years completed the survey. χ² analysis showed that the prevalence of ACP adoption increased overall by over 10% (p < 0.001) since 2016. While upward trends in ACP adoption were observed across all racial groups, statistically significant increases were found among only White and Hispanic residents (p < 0.001). Logistic regression analysis found that increased odds of ACP adoption were associated with the community campaign for residents ≤65 years of age, White residents, married individuals, and those with a regular health care provider after controlling for confounding factors (e.g., odds ratios = 1.35, p < 0.001).

Conclusions: Community-based ACP campaigns can result in increased ACP awareness and adoption in the general adult population, though more work is needed to encourage ACP adoption in diverse communities.

Background: Terminally ill cancer patients often experience pain and delirium. However, opioids administered for pain management may exacerbate patients' delirium.

Objectives: To explore the real-world symptom trajectory associated with pharmacological interventions, including opioids and antipsychotics, in patients with cancer pain and terminal delirium.

Design: A secondary analysis of a multicenter prospective observational study.

Setting/subjects: Adult patients admitted to inpatient hospice or palliative care units in Japan. Participants were eligible if they had cancer pain (Integrated Palliative care Outcome Scale: IPOS ≥2) and delirium at the time that their Palliative Performance Scale had declined to ≤20 (day 1, immediately before death).

Measurements: Pharmacological strategies, pain levels (using the IPOS), and delirium symptoms (using the Memorial Delirium Assessment Scale, item-9).

Results: Among a total of 1896 patients, 1396 were assessed for eligibility on day 1, and 137 met the inclusion criteria for analysis. A total of 86 (63%) patients had agitated delirium (hyperactive or mixed) with a median survival time of three days. Regarding pharmacological strategies, 32 (23%) received opioid initiation/dose escalation and 94 (69%) received regular administration of antipsychotics. These figures also included 25 (18%) patients who received both opioid initiation/dose escalation and antipsychotics. Approximately 55% of all patients had persistent cancer pain (IPOS for pain ≥2) on day 2. Among those with agitated delirium, 79% continued to exhibit agitation symptoms on day 2.

Conclusion: Despite specialized palliative care, the combined distress of cancer pain and delirium in the last days of life remains complex and refractory.

Background: Stress due to a child's serious medical condition affects the entire family. The cumulative stress burden ("allostatic load") has deleterious health and economic effects.

Objective: Demonstrate adequate caregiver willingness to disclose health care utilization and work/school attendance.

Setting/subjects: We enrolled caregivers of well children (WC), children with medical complexity (CMC), and children receiving palliative care (PC) (N = 15; 5 per group) in a midwestern United States pediatric hospital.

Measurements: A novel allostatic load questionnaire and the Family Appraisal of Caregiving Questionnaire for Palliative Care were used.

Results: All caregivers (100% female) completed the study, with 9% of data missing. PC participants reported greater child health care appointments and admissions compared with WC and CMC.

Conclusions: Caregivers will disclose sensitive information for health care research, providing evidence for subsequent, adequately powered studies to inform policy-making. While underpowered for between-group analyses, results suggest pediatricians should routinely assess caregiver burden even at well-child visits.

Background: Compared with non-Chinese adults in high-income countries, ethnically Chinese patients are more likely to encounter palliative care (PC) closer to death and in hospital settings. Yet, Chinese families' experiences and perception of inpatient PC remain unknown.

Objective: Identify barriers and facilitators to culturally respectful PC for Chinese immigrant inpatients and their caregivers.

Design: Prospective, exploratory qualitative design involving phenomenological interviews.

Setting/subjects: We consecutively recruited (n = 15) Chinese immigrant patients and their caregivers (n = 14) referred to PC at one Canadian academic teaching hospital. We collected participant self-reported sociodemographics and Suinn-Lew acculturation level and conducted semi-structured interviews (n = 10) in Mandarin and/or English. The interviews were recorded, transcribed, translated, and thematically analyzed using Tan's Health Communication framework.

Results: Patients were older-aged (mean = 73.5 ± 16.2 years), 53.3% female, 60% college-educated, 66.7% nonreligious, and 93.3% diagnosed with cancer and had low acculturation (mean = 1.8 ± 0.9/5.0). Caregivers were middle-aged (mean = 50.6 ± 15.5 years), 78.6% children, 57.1% female, 85.7% college-educated, and 71.4% nonreligious and had moderate acculturation (mean = 2.5 ± 1.2/5.0). We identified four themes from post-consultation interviews: abandonment and alienation mark past experiences with serious illness care; emphasizing expertise and symptom relief may help overcome initial ambivalence toward PC; PC brokers competing priorities within the family unit; and PC alleviates time-related distress by addressing illness understanding.

Conclusion: Chinese patients and caregivers may prefer a PC approach that is sensitive to historical mistrust, leverages expertise in symptom management to inspire confidence, and accommodates the information and care preferences of the family unit. Further research is needed to examine the impact of these PC strategies on clinical outcomes for Chinese families.