Palliative medicine reports最新文献

Psilocybin-assisted psychotherapy represents a promising addition to palliative care interventions, potentially improving quality of life by addressing existential distress. Despite its safety and effectiveness, this therapy remains limited in Canada, underscoring the need for improved access to ease suffering from life-threatening illnesses. However, important questions remain regarding how to integrate psilocybin-assisted psychotherapy into existing health care frameworks, navigate regulatory challenges, and ensure equitable access for all patients. These unanswered questions highlight the complexity of expanding access and the need for thoughtful, informed approaches to its implementation. To address this, the P3A team (Psilocybin at End of Life: Audacity, Acceptability, Access) held a forum on March 22, 2024, in Quebec, Canada, to explore actionable steps for the responsible use and equitable access to psilocybin-assisted psychotherapy. A total of 57 participants with knowledge in palliative care, including professional and patient associations, patients, health care professionals, researchers, and policymakers, attended the event, which featured presentations, a panel discussion, and small-group workshops. This report provides 16 recommendations across six previously identified key topics: (1) patient eligibility and equity, (2) regulatory framework and respect for autonomy, (3) logistical and organizational aspects, (4) professional education and training, (5) public awareness and information, and (6) research. The elements and recommendations discussed in this article could offer valuable insights for expanding access to psilocybin-assisted psychotherapy in other jurisdictions, particularly in global contexts where similar barriers to care exist.

Hiccups are caused by involuntary spasms of the diaphragm and external intercostal muscles. When persistent, they can significantly reduce the quality of life. However, comprehensive reviews of available treatments and their corresponding evaluation metrics remain scarce. This scoping review aimed to comprehensively map the interventions used to treat hiccups in adults and clarify the current state of outcome measures employed in existing research. We conducted a scoping review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) -ScR guidelines and the framework of Arksey and O'Malley. Using PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Ichushi-web databases, we identified studies published up to June 3, 2024. The search terms included "HICCUP," "HICCOUGH," and "SINGULTUS." A total of 3248 articles were identified, with 499 duplicates removed. After screening 2749 titles and abstracts, 2708 articles were excluded. Full-text reviews of 41 articles led to the exclusion of 18, resulting in 23 that met the inclusion criteria. Of these, 17 studies focused on pharmacological interventions, including baclofen, metoclopramide, methylprednisolone, and Shitei-to, while 6 studies examined nonpharmacological interventions, such as acupuncture, infrared therapy, rebreathing techniques, and cervical epidural block. Outcome measures were categorized into objective and subjective evaluations. Objective measures included complete cessation, partial cessation, frequency reduction, and time to complete cessation. Subjective measures assessed the distress caused by hiccups using patient-reported scales, such as the numerical rating scale. This scoping review identified 23 studies on hiccup interventions, including five randomized controlled trials on pharmacological agents and one study on a nonpharmacological approach. Studies included both Western and Eastern medicine, offering new perspectives on hiccup management. The outcome measures were primarily objective, with some patient-reported assessments. These findings provide a foundation for future research on hiccup treatment and evaluation methods.

Background: Team-based care is vital in palliative care, but there is limited interprofessional education (IPE) among health care providers, leading to siloed learning. This project addresses this gap by developing a workshop focused on the active dying process, promoting shared competencies among palliative medicine, geriatrics, nursing, and psychology subspecialty learners.

Objective: We aimed to design, implement, and evaluate an Interprofessional Education Exchange (IPEX) Death and Dying workshop to foster interdisciplinary collaboration and improve participants' comfort with palliative care competencies.

Design: A full-day, case-based workshop was developed using the Analysis, Design, Development, Implementation, Evaluation model, emphasizing experiential and collaborative learning.

Setting/subjects: Two workshops were held at a tertiary southeastern academic university in the United States (US) in 2022 (cohort 1) and 2023 (cohort 2). A total of 25 participants, including palliative medicine fellows, geriatric medicine fellows, advanced nurse practitioner students, and psychology residents, completed the workshops.

Measurements: Participants' comfort with palliative care competencies, perceptions of interprofessional collaboration, and qualitative feedback were assessed using post-workshop surveys.

Results: Participants' comfort in providing anticipatory guidance, addressing spiritual distress, and supporting grief and bereavement improved. Interprofessional collaboration and professional growth, particularly in communication and understanding each other's roles and responsibilities in caring for the actively dying, also increased.

Conclusions: The collaborative IPEX Death and Dying workshop has been shown to enhance competencies and foster interprofessional collaboration among palliative care subspecialty learners across four disciplines. This model holds potential for broader implementation across health care settings to improve care for the seriously ill patients.

Background: An increasing number of patients receive end-of-life care in the intensive care unit (ICU). Death often occurs in the ICU after a decision has been made to withdraw life-sustaining therapies. In 2016, Downar et al. published Canadian consensus guidelines to standardize practices for withdrawal of life-sustaining therapy in the ICU. In this study, we sought to understand the feasibility and acceptability of implementing an order set, nursing flowsheet, and nursing care plan based on these guidelines in two ICUs in Saskatchewan, Canada.

Methods: We used a hybrid effectiveness-implementation design, engaging a steering committee of ICU health care providers and leadership to guide implementation. We conducted a six-month pilot implementation. We collected data in the three months pre-implementation, during the six-month implementation period, and for three months post-implementation. To evaluate implementation outcomes, we used the Consolidated Framework for Implementation Research to develop semi-structured interviews and feasibility surveys. To measure effectiveness outcomes, bedside nurses completed Quality of Death and Dying surveys, and we performed a patient chart review.

Results: The intervention materials added to the burden of paperwork of bedside health care providers but helped them provide quality end-of-life care, meet the needs of patients and their families, and lessen ethical tensions between symptom control and hastening death. There was no difference in cumulative sedative dosing and time to death after extubation in the pre-implementation, implementation, or post-implementation periods. A significant increase in symptom assessment (pain, dyspnea, and agitation) using standardized tools was observed during the implementation and post-implementation periods. There was an improvement in holistic care outcomes post-implementation.

Conclusions: We implemented current Canadian best-practice guidelines for providing end-of-life care in the ICU using a multidisciplinary approach. This study offers insight into how standardized symptom assessment and medication titration can be incorporated into the complex ICU environment.

Background: Severely ill patients often express a desire to die, which can turn into suicidality. To support health professionals in managing this issue, we initially created a two-day face-to-face training to enhance self-confidence, knowledge, attitudes, and skills. Due to the increasing need for more accessible formats, we aimed to transition this training online and develop a complementary website.

Methods: Multimethod approach to develop and evaluate an online training and a website on dealing with the desire to die in palliative care in Germany. This involved: (1) reviewing literature on effective didactic elements, (2) digitalizing the face-to-face training and creating the website with ongoing expert feedback, and (3) piloting and evaluating these resources through online surveys.

Results: We retrieved suggestions for the development of online trainings and websites from n = 39 publications. Through these results and expert discussion, an online version of our training and a website were developed. For evaluation, we conducted two trainings (face-to-face (n = 8) and online (n = 19)) with multiprofessional participants. All improved significantly in self-confidence after the training without differences between online and face-to-face training. Website evaluation of usability, comprehension, information quality, presentation, and sustainability by n = 71 users yielded favorable feedback with improvement suggestions for structure and plain language.

Conclusions: Dealing with the desire to die can be taught not only face to face but also through online training and an educational website. This can ensure low-threshold access to scientifically sound information and training units for those health professionals confronted with the desire to die.

Background: Benefits of hospice care, such as improvement in quality of life and reduced costs, depend on duration of enrollment in hospice services, making timely hospice referral essential. Patient-, provider-, and system-level factors associated with hospice referral timing and length of stay (LOS) are unclear.^1-6.

Objective: To review existing hospice referral patterns to identify patient- and system-level factors associated with hospice LOS.

Methods: We performed a retrospective review of all adult patients referred from our institution (located in Rochester, Minnesota, USA) to a nonprofit hospice agency between 2013 and 2017. The primary dependent variable was hospice LOS. Patient-level variables included demographic characteristics, place of residence, and hospice diagnosis. System-level variables included referral setting and provider-specific variables, such as title and gender. Statistical analyses were performed using multivariate logistic regression.

Results: A total of 2072 patients were referred to hospice during the study period. Patient-level factors associated with LOS included hospice diagnosis and place of residence. Patients referred for cancer had a higher odds of a long LOS, while patients from long-term care facilities had a higher odds of a short LOS. System-level factors associated with LOS included provider gender and title. Referral by a female provider or by a physician, rather than an advanced practice provider, was associated with a lower odds of a short LOS.

Conclusion: Based on a review of hospice referral patterns, the integration of hospice care into subspecialty practices, long-term care facilities, and advanced practice education could be an effective strategy to improve hospice LOS.

Background: As the Japanese population continues to age, home health care provision has greater significance. However, the number of patients with terminal cancer receiving end-of-life care at home remains limited, and predicting the prognosis of patients with terminal-stage gastric cancer is challenging.

Objective: To analyze the real-world data of patients with terminal gastric cancer receiving end-of-life care at home to provide insights into their care and health outcomes.

Design: A two-center retrospective study.

Setting/subjects: This study focused on terminal patients with gastric cancer who died at home between 2021 and 2024 in Japan. A total of 27 participants (14 males and 13 females) were included in the study, with a median age of 78 years.

Measurements: First, we analyzed the detailed clinical course of the patients during home care. Second, we performed a comparative analysis by dividing the patients into two groups based on median overall survival (OS).

Results: The median OS during home care was 22 days. The patients were divided into two groups: long OS (OS-L) and short OS (OS-S). Strong opioid use and home oxygen therapy were recorded in 22 and nine patients, respectively. In the OS-S group, oral intake was significantly reduced (25.0% vs. 66.7%, p = 0.032). There was a notable difference in serum albumin levels between the two groups (2.8 vs. 2.4 mg/dL, p = 0.038). The neutrophil-to-lymphocyte ratio (NLR)/albumin was significantly higher in the OS-S group compared to the OS-L group (1.0 vs. 2.3, p = 0.032).

Conclusions: Oral intake, serum albumin level, and NLR/albumin were important prognostic factors in end-of-life care at home of patients with terminal gastric cancer.

Background: Family caregivers of people with dementia in nursing homes may need support from healthcare providers, especially when death is approaching.

Objective: To increase our understanding of family caregivers' experiences in their relative's last week of life before and during the pandemic, their needs for emotional, practical, and spiritual support, and the extent to which those needs are accommodated by healthcare providers.

Design: Survey among bereaved family caregivers of people with dementia recruited from six nursing homes in the Netherlands in 2018-2019 and 2020-2022.

Results: The questionnaire was completed by 165 family caregivers (response rate: 55%). Most respondents (79%) rated the overall care they received as "excellent," "very good," or "good." More respondents reported a need for emotional (74%) and practical (64%) support than for spiritual support (37%). Emotional and practical support were more commonly "always" or "most of the time" provided (63% and 51%, respectively) than spiritual support (22%). Differences existed in the presence of practical, emotional, and spiritual support needs (p < 0.001) and the frequency in which those support types were provided when there was a need (p < 0.001). The overall care that was received was more likely to be rated as "excellent" or "very good" when a higher frequency of emotional (p < 0.001), spiritual (p < 0.002), or practical (p < 0.001) support was reported. Before and during the pandemic, family caregivers' responses were mostly similar.

Conclusion: Family caregivers had support needs that were not always met, which was especially the case for spiritual support needs. Healthcare providers should be trained to accommodate support needs and refer to appropriate support services when necessary.

Background: Patients with multiple myeloma (MM) frequently endure a range of disease-related and treatment-related symptoms that significantly impact their quality of life. The Quality of Life Questionnaire Multiple Myeloma Module 20-item (QLQ-MY20) questionnaire developed by European Organization for Research and Treatment of Cancer (EORTC) was to evaluate the quality of life in patients with myeloma. However, it had not been evaluated in China. This study aimed to validate the Chinese version of the EORTC QLQ-MY20 questionnaire in terms of its reliability, validity, and sensitivity.

Methods: The EORTC QLQ-MY20 questionnaire was translated into Chinese and was completed by 140 Chinese patients with MM. The analysis included assessing content validity using the scale-level content validity index, evaluating construct validity through exploratory factor analysis, and calculating reliability statistics.

Results: The scale-level content validity index/unanimity was 0.875, and the scale-level content validity index/average was 0.915. Through exploratory factor analysis, the Chinese version of QLQ-MY20 demonstrated a test-retest reliability of 0.857. The Cronbach's α coefficient was 0.887, with the three dimensions having coefficients of 0.879, 0.809, and 0.786, respectively. The Kaiser-Meyer-Oklin value was 0.927, and the eigenvalues for the three common factors were 10.127, 2.831, and 1.124, respectively. The overall variance contribution rate was 74.112%.

Conclusions: The Chinese edition of the EORTC QLQ-MY20 is deemed a reliable and valid instrument for evaluating the quality of life in Chinese patients with MM.

Abstract: Palliative care focuses on providing relief from the stress and symptoms of serious illness. Obstetrician gynecologists (OBGYNs) manage a variety of complex clinical situations ranging from delivering a cancer diagnosis to caring for a neonatal demise to symptom management, all of which fall within the realm of palliative care. Palliative care is relevant to the practice of OBGYNs, yet residents rarely receive formal primary palliative care training. We sought to design, implement, and evaluate a dedicated curriculum on palliative care for OBGYN residents.

Abstract: We performed a needs assessment of an OBGYN residency at a single institution. This information was used to develop a multidisciplinary palliative care curriculum. Post-curriculum surveys were distributed and analyzed. Descriptive statistics were utilized.

Abstract: Our needs assessment identified a lack of knowledge and competency in palliative care concepts and skills. Using this information, we created a multidisciplinary palliative care curriculum, including clinical experiences, chalk talks, and online didactics. Post-curriculum surveys revealed a marked improvement in both knowledge base and perceived competence. Feedback was overwhelmingly positive; residents indicated that the curriculum was both a valuable use of time and would impact their provision of care in the future.

Abstract: A dedicated palliative care curriculum is an impactful addition to OBGYN training.