Palliative medicine reports最新文献

Objectives: Although unfinished business is associated with psychological states in bereaved families of patients with cancer, no evaluation tools have been developed for such families in Japan. This study aimed to develop and examine the validity and reliability of an evaluation tool for unfinished business among families of terminally ill patients with cancer in Japan.

Methods: In August 2020, a cross-sectional online survey consisting of the Unfinished Business Scale for Families, Unfinished Business in Bereavement Scale (UBBS), Brief Grief Questionnaire (BGQ), and Patient Health Questionnaire-9 (PHQ-9) was conducted on bereaved families of patients with cancer, followed by a retest two weeks later.

Results: Responses from 206 bereaved families were analyzed using factor analysis. Three subscales (10 items) were identified: Talk, Action, and Message. The Unfinished Business Scale for Families had an overall Cronbach's α coefficient of 0.96, and the intraclass correlation coefficient in the test-retest examination was 0.74. The Unfinished Business Scale for Families was significantly moderately correlated with the UBBS (r = 0.46) and moderately correlated with the BGQ (r = 0.40) and PHQ-9 (r = 0.33). All p-values were <0.001.

Conclusions: Our findings suggest that the Unfinished Business Scale for Families is effective for evaluating unfinished business among families of terminally ill patients with cancer. In the future, it will be necessary to conduct bereaved family surveys using this scale to identify unfinished business among family members. This could lead to health care providers providing more appropriate and adequate care to families with unfinished business.

Background: The Palliative Care Outcomes Collaboration (PCOC), established in 2005 and funded by the Australian Government, is a national quality improvement initiative that integrates patient outcome measures into routine clinical practice. While PCOC supports services to improve patient care, implementation across diverse clinical settings presents challenges, with variation observed between similarly resourced services. Engaging services in continuous quality improvement proves difficult as the program grows.

Objectives: To identify factors associated with high-performing palliative care services and develop and evaluate an implementation framework and education program that supports continuous quality improvement.

Methods: Patient outcome data and case studies from established PCOC-participating services were analyzed to identify high-performing services and the factors enabling successful integration of outcome measures. Based on the findings, an implementation framework was developed. Improvement trends were assessed in 20 services participating pre-intervention (2016-2018) and 11 services participating post-intervention (2022-2024).

Results: Five key strategies and 25 enabling factors for successful integration were identified including, leadership and governance; education to improve data literacy; infrastructure for the meaningful management of data; and uptake of PCOC in quality systems. The post-intervention services started with higher benchmark performance and showed improvements within 6 months of implementation. Addressing patient's psychological/spiritual needs continues to be challenging.

Conclusion: Quality improvement involving outcome measurement and benchmarking in palliative care requires education and structured implementation with ongoing feedback. The PCOC initiative demonstrates that improving patient outcomes involves more than collecting and analyzing outcome measures and benchmarking-it requires integrated assessment models, education, and resources to support information-driven quality improvement.

Background: Although early palliative care (EPC) integrated into standard cancer care improves the quality of lives of patients with cancer and their caregivers, implementation strategies for EPC programs in individual clinical settings have not been established.

Objective: This pilot randomized controlled trial explored the feasibility, acceptability, and effectiveness of nurse-led EPC using a screening-based program that focused on the individual concerns of patients with advanced lung cancer and their caregivers.

Design: This pilot study was a parallel-group randomized controlled trial in which patients were randomly assigned (1:1) to receive either EPC using the care program or standard care alone.

Setting/subjects: At one university hospital in Japan, 32 patients with newly diagnosed stage IV lung cancer and their 27 caregivers participated.

Measurements: Feasibility was evaluated using recruitment and interview execution rates. Acceptability and effectiveness of the care program were also evaluated.

Results: The recruitment rate was 91%. The interview execution rates were 14/14 (100%) at baseline, 11/14 (79%) at 1 month, and 12/14 (86%) at 3 months for patients, and 10/11 (91%) at baseline, 6/11 (55%) at 1 month, and 7/11 (64%) at 3 months for caregivers. At 5 months, 55% of patients in the intervention group responded that the delivered care was valuable, while 88% of caregivers in the same group answered that it was valuable. The prevalence of severe concerns in patients and caregivers in the intervention group decreased after 1 month.

Conclusions: This pilot randomized controlled trial revealed that EPC using a screening-based program that focused on individual concerns in patients with advanced lung cancer and their caregivers was feasible and acceptable.

Background: In Canada, access to palliative care varies across jurisdictions. Many health care professionals lack core palliative care competencies. To help build capacities, a pilot education program was conducted at a community hospital in Southwestern Ontario (Canada). Using Pallium Canada's Learning Essential Approaches to Palliative Care (LEAP) Hospital course, generalist hospital physicians participated in this initiative. The purpose of this investigation was to explore the impact of the LEAP Hospital course on physician attitudes, comfort, and care delivery.

Methods: Within a Plan-Do-Study-Act framework, a mixed-methods design summarized post-course evaluations, commitment to change (CTC) statements, and interviews with learners and hospital staff. Participants completed pre-course knowledge and post-participation surveys. Group and individual interviews were conducted with learners and staff who practiced alongside LEAP learners. Descriptive statistics were completed for aggregate survey data. Thematic analysis was conducted to summarize learner and staff experiences.

Results: Twenty-nine physicians completed the LEAP Hospital course. Ninety-six CTC statements identified improvements in symptom management and communication. Sixteen participants participated in interviews. Learners and hospital staff noted the impact courses had on symptom and disease management and enhanced communication when discussing goals of care. Learners valued case-based learning and connecting with peers who are often siloed in practice. Participants also noted the inclusion of allied health for greater collaboration.

Conclusions: LEAP Hospital courses enhanced knowledge and skills and incorporated a greater palliative approach to care. Establishing a community of practice to address educational needs and strategies should be considered while supporting the inclusion of new graduates and hires.

Background: Collaborative methods are necessary to meet patient palliative care (PC) needs because of the inadequate supply of PC specialists.

Objective: This study aimed to conduct a needs assessment and determine primary care, emergency, and hospital physicians' general attitudes about primary PCs, confidence in managing common PC scenarios, and preferences for interaction with specialty PCs.

Design: A sequential mixed-methods study design was used, whereby individual qualitative interviews informed the content of a quantitative survey. Semistructured telephone interviews were conducted by a member of the study team with expertise in qualitative research methods.

Setting/subjects: The quantitative survey, delivered to primary care, emergency, and hospital physicians across four distinct geographic locations of a large health system, solicited impressions on common clinical PC scenarios that might pose challenges.

Measurements: Survey data included demographic information, clinician confidence levels, preferences for support in managing PC scenarios, and likelihood to refer to PC.

Results: The quantitative survey was completed by 126 physicians (response rate, 13.9%). Overall mean (standard deviation) confidence levels were lowest for a scenario about handling pain (5.57 [2.35] out of 10) and highest for goals-of-care conversations with the patient (7.80 [2.02]). Spearman correlations between mean confidence and likelihood to refer to PC demonstrated weak to moderate inverse correlations. Respondents with previous training in PC had higher mean confidence in managing symptoms and goals-of-care conversations.

Conclusions: Continuing efforts are needed to help improve physicians' confidence in primary PC skills and develop innovative methods to provide collaborative support of specialty PCs across various specialties and PC needs.

Background and aims: Palliative radiotherapy practice patterns have been reported to vary widely, with a notable underutilization of single fraction treatment schedules. This study aims to investigate the outcomes and care patterns among patients receiving palliative radiotherapy for advanced cancer at a high-volume institution in Saudi Arabia.

Materials and methods: Electronic records were used to identify patients receiving palliative radiotherapy for advanced cancer between 2018 and 2023. Univariate analyses were used to assess tumor and patient factors potentially associated with single fraction use, including primary tumor, target site, sex, age, admission status, and geographical remoteness from the center. Survival outcomes were analyzed using Kaplan-Meier curves.

Results: A total of 792 patients receiving 990 radiotherapy courses were identified. 60% of patients were female and 40% were male. The median age was 56.5 years (16.4 standard deviation [SD]). The most common primary histology was breast (34%), followed by gastrointestinal (13%). Single fraction treatment schedule represented 28.7% of all treatments and were most commonly used for extremities (p < 0.05). Multiple-fraction treatment schedule was more likely to be used for breast, chest, head-and-neck, pelvis, and spine (p < 0.05). The median survival was 6.9 months (SD = 8.9 months) and 25% of patients died within 30 days following radiotherapy. Median survival was shorter for male gender, admitted patients and those who did not complete their course of treatment (log-rank p < 0.05).

Conclusion: Single fraction radiotherapy is underutilized in the management of advanced cancer patients, particularly those with bone metastases. Further research is warranted to develop clinical decision-making tools that enhance adherence to clinical guidelines and optimize treatment outcomes.

Background: Advanced breast cancer patients often require palliative care (PC) to manage significant symptoms, relying heavily on nurses' competence.

Objective: Evaluate whether a structured PC training program can enhance nurses' competence in breast cancer care.

Methods: After an online announcement at Zhejiang Hospital, nurses enrolled in the PC training program. Due to the imbalance in trained and untrained nurses post-training, stratified randomization was applied, forming untrained (n = 34) and trained (n = 24) groups. The primary outcome, nursing competence, was assessed using Competency Inventory for Nursing Students at baseline and three months post-training. Subsequently, patients were recruited and assigned to different study groups based on the nurses providing their care. The untrained group (n = 167) and trained group (n = 106) received three months of inpatient PC care. European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 and Family Caregiver Satisfaction Scale-2, as secondary outcomes, were assessed at baseline and three months post-care to evaluate the training's impact on care quality.

Results: At baseline, there were no significant differences in nursing competence or patient quality of life between the trained and untrained groups. Trained nurses showed significant improvements in general clinical skills, critical thinking, and ethics compared to untrained nurses. Patients cared for by trained nurses also demonstrated improved quality of life and higher family caregiver satisfaction.

Conclusion: Structured training improves nursing competence, patient quality of life, and family caregiver satisfaction.

Background: Training in spirituality and spiritual care is limited in medical education. A potentially novel approach for addressing these gaps in medical training is an immersive, experiential internship focused on patient spirituality and spiritual care based on pedagogical approaches adapted from clinical pastoral education (CPE).

Methods: Mixed method analyses were undertaken of participants pre- and post-program surveys and comments to assess the first five years of the six-week Spirituality And Health Summer Internship Program, modeled on a unit of CPE, for first-year medical students.

Results: On a 5-point Likert scale (1 = poor/strongly disagree, 5 = excellent/strongly agree) participants rated the educational value (4.7, standard deviation [SD] = 0.3) and overall quality (4.4, SD = 0.35) of the internship highly and strongly endorsed they would recommend the internship to peers (4.48, SD = 0.36). Participants strongly valued (4.58, SD = 0.35) the opportunity to visit and have conversations with patients as a core activity of the internship. Following the internship, participants reported significant (p = 0.013 to p < 0.0001) increases in their (1) awareness of how spirituality influences their lives, (2) knowledge of the potential impact of spirituality on the patient experience, and (3) knowledge of the role of spirituality in the lives of health care providers. Significant increases were also noted in participants' comfort in (1) talking to patients, (2) talking about spirituality, and (3) talking to patients about spirituality.

Conclusions: A medical student summer internship focused on patient spirituality and spiritual care modeled after CPE provides a level of immersion in this content not obtainable in typical medical school curricula.

Background: In recent years, the palliative care (PC) paradigm is evolving from a prognosis-based approach to one centered on complexity, also in response to the aging population and the increase in chronic diseases. It is therefore necessary to strengthen PC networks with effective management of the specialist resources available. The use of tools such as the spanish Diagnostic Instrument for Complexity in Palliative Care (IDC-Pal) can help evaluate the complexity of PC needs, thus guiding the clinical care response. The aims of this study were the translation and the cultural adaptation of the IDC-Pal tool to the Italian language.

Methods: The methodology proposed by Beaton et al. and Sousa et al. was used for the translation and cultural adaptation of the IDC-Pal tool. Phase 1: a forward-backward translation with linguistic and cultural adaptation of the tool by two native Spanish translators and two native Italian translators, including two PC professionals and two nonprofessionals, was performed. Phase 2: the translation was evaluated by a panel of 12 Italian PC experts, who assessed the comprehensibility of the translated instrument, and proposed changes to the text, which was found to be incomprehensible to at least 20% of them. Phase 3: this version of the tool was proposed to a sample of the Italian target population (93 professionals including general practitioners, nurses, and hospital doctors at 9 Italian PC networks tested it on 168 patients in home and hospital settings), to evaluate its comprehensibility and usability. At the end of the experimental phase, a semi-structured interview was organized with the main researcher of each network, with the aim of receiving information about the comprehensibility of the tool. Finally, a definitive version was developed.

Results: The translation and adaptation were achieved without major problems.

Conclusions: A conceptually, culturally, and linguistically equivalent italian version of the original IDC-Pal was obtained.

Background: Few studies examine palliative care consultations (PCC) in acute decompensated heart failure (ADHF) admissions. Prior data suggest that 6% of admitted patients are referred for PCC. This study evaluates the effect of a best practice alert (BPA) embedded in the electronic record on PCC utilization and outcomes.

Methods: Patients admitted between May 1, 2020, and June 30, 2022, with ADHF were included. BPA was triggered at admission for patients with ≥3 ADHF admissions in 6 months or PCC during prior admission. Subjects were divided into early PCC (less than three days of admission), late PCC (more than three days), and no PCC. Demographics, BPA utilization, length of stay (LOS), and cost were compared between groups.

Results: Of 684 patients, 18% received PCC: 13.1% had early PCC, 5.12% late PCC, and 81.6% no PCC. Early PCC patients were older with more comorbidities. Patients receiving PCC had lower ejection fraction (p = 0.04). Median LOS was longest in the late PCC group (12 days, p ≤ 0.01) and similar in early and no PCC groups (six and five days, respectively) and remained significant in multivariate analysis. White patients were more likely to receive PCC compared with Black and other races. The late PCC group had the lowest readmission rate at 5.7%; 28 of the 35 patients changed their goals of care to hospice, "do not re-hospitalize," or "do not intubate/do not resuscitate."

Conclusions: PCC may influence therapy for patients with ADHF and reduce the readmission rate. Clinician biases remain despite the utilization of BPA, with a modest effect on PCC utilization.