Palliative medicine reports最新文献

Background: Data from other countries have indicated that palliative care physicians are more opposed to assisted dying compared with other physicians. However, little is known about reasons for support/opposition among palliative care physicians.

Objectives: To explore Norwegian palliative care physicians' attitudes toward assisted dying, with focus on filling knowledge gaps regarding reasons for support/opposition.

Methods: The study is a cross-sectional descriptive survey. All 285 members of the Norwegian Association for Palliative Medicine were invited by e-mail to participate. To allow comparison with previous data, most questions and response alternatives were similar to a 2024 study of Norwegian physicians.

Results: Among the 117 respondents opposition toward assisted dying was observed with 85 (73%) strongly disagreeing and 14 (12%) somewhat disagreeing with legalization of physician-assisted suicide for patients with short life expectancy. There was a clear pattern of less support for assisted dying if indications were wider, with only one respondent partially agreeing that assisted dying should be legalized for patients without severe illness who are tired of life and want to die. The most common reason for opposition was assisted dying representing a breach with professional ethics (88 subjects). The most common reason for support was that legalization could provide a safety for patients and next of kin that suffering could be avoided (14 subjects).

Discussion: A large majority of Norwegian palliative care physicians reject the legalization of assisted dying. Among the small minority who support assisted dying, most believe it should be limited to patients with a short life expectancy.

Opioid conversion, particularly from high-dose intravenous (IV) fentanyl (>120 mg/day oral morphine-equivalent daily dose per referenced Japanese guidelines) to IV hydromorphone, presents clinical challenges due to inconsistent conversion ratios and lack of robust evidence. Specific approaches used in Japan may require careful evaluation. This report details two advanced cancer patients experiencing inadequate pain control after switching from high-dose IV fentanyl to IV hydromorphone. Conversions were based on calculations reflecting common Japanese practice. In both cases, pain worsened significantly, necessitating reversion to the original fentanyl regimen to regain acceptable analgesia. Conventional fentanyl-to-hydromorphone conversion ratios applied in Japan may underestimate the required hydromorphone dose when switching from high fentanyl baselines, risking therapeutic failure. These cases highlight the need for caution, consideration of potentially higher initial hydromorphone doses, close monitoring, and individualized strategies, including reverting to the prior opioid, for this specific rotation, especially in high-dose scenarios.

Objective: International literature suggests that patients with hematological diseases are frequently referred to palliative care (PC) at a late stage. This study aims to explore the attitudes of a hemato-oncology care team toward referring patients to the PC in a fourth-level hospital in Bogotá, Distrito Capital.

Methods: This exploratory qualitative study was conducted through in-person focus groups between May 2024 and October 2024 at Clínica Universitaria Colombia in Bogotá, Colombia. Data were analyzed thematically using framework analysis, an analytical approach that structures qualitative data around predefined themes aligned with the research question.

Results: This study identified key factors influencing the referral of patients with hematological malignancies to PC. These include symptom management, interdisciplinary collaboration, and perceived barriers such as misconceptions about PC, emotional attachment, and limited formal training among health care professionals.

Conclusion: While the hematology team acknowledges the value and benefits of PC, barriers such as prognostic uncertainty, emotional attachment, and insufficient training continue to hinder its early integration into the management of patients with hematological malignancies.

Background: Treatment with antihypertensives in patients with advanced cancer is often continued until very late in the disease trajectory, despite a considerable risk of hypotension.

Objectives: The aim of this study was to investigate the time of deprescribing of antihypertensive agents in patients with cancer receiving palliative care during their last year of life. The monitoring of blood pressure (BP) during treatment was also studied.

Design: Retrospective cohort study.

Setting/subjects: Medical records of all patients admitted during a three-year period to a home care unit in Stockholm, Sweden, and now deceased were screened for antihypertensive agents. To create a homogenous cohort, only agents of the renin-angiotensin system (ATC-code C09) were included.

Measurements: Data for time of deprescribing and monitoring of BP were collected.

Results: Of 1501 deceased patients, 353 had been treated with agents of the renin-angiotensin system for hypertension and had a primary diagnosis of cancer. BP was measured before deprescribing in 169 patients (47.9%). In 102 patients (28.9%), antihypertensive treatment continued up to the last seven days of life. For 27 patients (7.6%), the treatment had not been deprescribed. In 184 patients (52, 1%), BP was not followed up despite continued antihypertensive treatment. All 27 patients whose treatment was never deprescribed were in this group.

Conclusions: This study shows that antihypertensive treatment is often deprescribed late or not at all in patients with advanced cancer. Monitoring BP in patients treated with antihypertensives in palliative care may facilitate making the decision to deprescribe them in time.

Airway obstruction is a distressing and potentially life-threatening complication in patients with advanced head and neck cancers, particularly squamous cell carcinoma (SCC) of the pharynx. This case highlights the clinical, ethical, and interdisciplinary complexities involved in managing airway compromise in the context of progressive disease and limited treatment options. A 75-year-old man with recurrent SCC of the soft palate, nasopharynx, oropharynx, and hypopharynx, recently initiated on pembrolizumab and radiation therapy, presented with dysphagia, stridor, and intermittent tumor bleeding. Imaging revealed a large pharyngeal mass causing critical airway narrowing. Plans for tracheostomy to manage anticipated radiation-induced edema were aborted following the patient's acute neurological deterioration, with imaging confirming bilateral carotid artery occlusions and a new stroke. With poor prognosis and elevated risk of carotid blowout syndrome (CBS), further disease-directed treatments were deemed inappropriate. A multidisciplinary team, including palliative care, oncology, and ENT, facilitated a transition to comfort-focused care, emphasizing symptom control, airway management, and emotional support. The patient was transferred to inpatient hospice for end-of-life care. This case underscores the multifactorial nature of airway obstruction in advanced pharyngeal SCC, including tumor burden, treatment-related edema, and vascular complications. It highlights the importance of risk stratification for tracheostomy, especially in the setting of stroke, bleeding risk, and impending CBS. Symptom management was pivotal in maintaining comfort. Nonpharmacologic strategies and psychosocial-spiritual support further contributed to comprehensive end-of-life care. Individualized, multidisciplinary, and patient-centered approaches are essential when curative therapies are no longer appropriate in advanced head and neck cancer. Prioritizing comfort, clear communication, and integrative symptom management can optimize quality of life and support dignity at the end of life.

Objectives: Palliative Care provision is a key competency for all physicians. Junior doctors are actively involved in the delivery of end-of-life care in hospitals despite often feeling unprepared to do so. There has been a recent shift toward competency-based education in palliative care. The primary aim of this study was to assess the impact of a novel competency-based workshop on interns' perceived preparedness in providing generalist palliative care at end of life.

Methods: A novel competency-based education workshop was designed by a multidisciplinary team including a medicine for the elderly consultant, the director of the intern training program, the hospital end of life coordinator, junior doctors and a palliative care consultant. The workshop consists of five interactive sessions delivered to interns over a three-week period by a member of the multidisciplinary team. The Palliative Care Competence Framework Questionnaire was administered pre and post completion of the workshop to examine the impact of the workshop on attitudes, behaviors, and knowledge.

Results: Prior to the intervention, 86% (n = 38) of participants reported feeling inadequately prepared to manage death and dying to the level required in their role. Overall, there was a significantly positive improvement in attitudes (p = 0.0314), behavior (p ≤ 0.0001), and knowledge (p ≤ 0.0001) following the competency-based workshop among participants who completed the pre- and post-intervention questionnaires.

Conclusions: The findings from this study suggest a novel competency-based workshop improved interns' perceived preparedness in providing generalist palliative care at end of life. Future initiatives will focus on validating the findings of this study.

Introduction: Conducting studies in palliative care can be challenging. It has been highlighted that the interprofessional team may have their own reasons for not engaging in research projects. We aimed to identify barriers and facilitators to the involvement of palliative care team members in research projects.

Method: We used a cross-sectional online survey with qualitative and quantitative components to identify barriers and facilitators encountered by palliative care health professionals. Participants were physicians, nurses, nurse assistants, physiotherapists, dieticians, and occupational therapists working in the Division of Palliative Medicine of the Geneva University Hospitals in Switzerland. Data were analyzed using descriptive statistics and content analysis for the open-ended questions.

Results: A total of 107 questionnaires were sent, and 51 participants (48%) provided responses, of whom 75% expressed an interest in research, although only 47% had previously taken part in a research project. The most cited barriers were a lack of training on how to conduct studies, a lack of time, and a lack of funding. The main facilitators were the recognition that research enhances the quality of care and the belief that patients should be respected in their autonomy and given the opportunity to participate in research projects.

Conclusion: The interprofessional palliative care team would benefit from time, funds, and training in order to enhance a research culture within the team. The establishment of an interprofessional network to guide and share experiences would also be a good way to promote this culture.

Background: Community Access to Palliative Care via Interprofessional Teams Improvement (CAPACITI) is a virtual educational program designed to support primary care providers in delivering a palliative approach to care. This study evaluated whether expert-facilitated sessions result in greater self-rated competency than a self-directed format across three CAPACITI modules: Identification and Assessment, Communication, and Ongoing Management.

Methods: We conducted a randomized controlled trial where 566 interprofessional primary care team members were randomized to facilitated or self-directed delivery of the CAPACITI program. Participants completed two validated surveys at baseline and after each module: the End-of-Life Professional Caregiver Survey and the CAPACITI Competencies survey. These assessed self-rated comfort and competency in providing palliative care.

Results: Of the 566 participants randomized, 378 completed Module 1, and 270 and 192 completed Modules 2 and 3, respectively. Participants in both study arms demonstrated significant improvements in self-assessed comfort and competency following each module. No significant differences were observed between the facilitated and self-directed groups across either survey instrument.

Conclusion: Participants in both the facilitated and self-directed study arms reported significant increases in self-rated comfort and competency in providing a palliative approach to care. CAPACITI demonstrates that a relatively large, intensive, and feasible training program can be implemented virtually across diverse care settings. These results support the broader application of structured, scalable educational interventions in primary care, particularly those grounded in practical content and adult learning principles.

Trial registration number: ClinicalTrials.gov NCT05120154. Date registered: Oct 15, 2021. The authors affirm that this trial was registered prior to enrolling any participants.

Background: Goals of care (GOC) discussions align medical care with patients' wishes. Many physician-associated barriers to GOC discussions have been identified, but there is little understanding of the lived experiences of patients and their nominated health care spokespersons (NHSs) who have participated in the discussion.

Objectives: We aimed to describe the lived experience of participants of GOC discussions conducted during acute inpatient care and identify the features of well-conducted GOC discussions.

Methods: We conducted a qualitative enquiry based on grounded theory, employing a social-constructivist approach and interpretivist research paradigm. Participants were purposively sampled from the medical oncology, geriatric, and palliative medicine departments of a tertiary hospital in Singapore. Data was gathered using semi-structured interviews.

Results: A total of 24 interviews (16 NHS, 8 patients) were conducted. All participants were patients or NHS of patients who lived with a life-limiting illness (15 Cancer, 9 Non-cancer). The analysis yielded 2 major themes-Preconceived health perceptions and Desired communications skills-and 6 subthemes-Elusive knowledge, Emotional undertones, Existential struggles, Explicit clarity, Embracing empathy, and Enhancing autonomy. Well-conducted GOC discussions occurred when the participants' health perceptions were satisfied by a complementary communication skill employed by the physician, based on the model "Communicating to the Intellect, Heart, and Person."

Conclusions: Well-conducted GOC discussions that facilitated consensus were discussions where the physician engaged the participant at three levels-the Intellect, Heart, and Person. Our model advocates for person-centered conversations where the views of the participant are heard and will provide insights to improve the conduct of GOC discussions.