Palliative medicine reports最新文献

Introduction: Dyspnea, a common and debilitating symptom, affects over half of the patients with cancer, with increasing frequency and severity as the end of life approaches. It substantially affects the daily lives of patients by contributing to anxiety, depression, fatigue, and reduced physical activity, ultimately diminishing their quality of life. Although pharmacological treatments remain standard, nonpharmacological interventions, including psychotherapy, are increasingly recommended owing to their safety and accessibility. Psychotherapy is particularly relevant for alleviating psychological distress associated with dyspnea; however, research on its efficacy in managing dyspnea among patients with cancer is limited. This systematic review aims to synthesize evidence on the following four key psychotherapy techniques for managing dyspnea: mindful breathing, guided imagery, progressive muscle relaxation, and meditation. The review will assess the optimal delivery methods, evaluate the quality of existing studies, and provide clinical recommendations for implementing these interventions in cancer care.

Method and analysis: This review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocols. A systematic search will be conducted on some databases such as PubMed. Relevant studies will also be identified through reference lists and manual searches of key journals. The search terms will include keywords related to dyspnea and psychotherapeutic techniques. Four independent reviewers will screen and assess the articles, extracting data using a standardized charting form. The quality of the studies will be assessed using the Mixed Methods Assessment Tool. The results will be summarized via a psychotherapeutic technique, providing a comprehensive overview of the interventions and their applicability.

Purpose: This study aimed to clarify the types of nursing support provided by palliative care unit (PCU) nurses in Japan to manage nausea and vomiting in patients with cancer who have a prognosis of months or weeks.

Methods: This multisite cross-sectional study surveyed registered nurses from all 389 PCUs across Japan. Eligible participants were nurses providing direct care to patients. Data were collected via online surveys from October 2023 to March 2024. The frequency of 13 types of nursing supports for nausea and vomiting was evaluated using a five-point Likert scale, stratified by patient prognosis (months or weeks).

Results: Of the 389 PCUs invited, 162 (41.6%) consented to participate. A total of 2448 nurses were invited, of which 539 (22.3%) responded. The most frequently implemented nursing supports were "avoiding unpleasant odors," "providing shaved ice or ice chips," "providing fresh air," and "gargling with cold water." These were consistently practiced by many nurses, regardless of patient prognosis. Conversely, specialized supports such as "reiki," "acupressure," "guided relaxation exercises," "therapeutic touch," and "foot reflexology" were rarely or seldom used.

Conclusion: Noninvasive, simple nursing supports that do not require specialized knowledge or skills were frequently provided to patients with cancer who were experiencing nausea and vomiting, irrespective of their prognosis. However, nursing supports that require specialized knowledge and skills were rarely used. Further research is needed to evaluate the effectiveness of these nursing supports.

Background: In palliative care, investigating prognosis awareness is a milestone for effective and comprehensive patient intake care. The literature shows that over the past half-century, regarding prognoses, the data report less willingness to provide information, despite patients' wishes.

Objective: To investigate the varying degrees of awareness of prognosis of patients and their caregivers admitted to an Italian Palliative Home Based Care Service.

Design: A monocentric observational survey study with questionnaires created by the research team and completed by physicians, caregivers, and healthcare professionals (HCPs) during the intake. The assessment of any statistically significant differences was evaluated through McNemar's test.

Subjects: Forty patients (±75 years old, 60% females) with an estimated prognosis of more than 10 days, and for whom there was an opportunity to provide informed consent, who were intake at the Home Palliative Care Service of the Domus Salutis Clinic in Italy, from January 1 to June 30, 2022 were recruited.

Results: In total, 52% of patients were fully aware of their prognosis at the time of intake, although 75% had asked to be informed about their prognosis. Before death, the total percentage of patients who were aware of their prognosis was 72. Twenty percent of patients were informed of their prognosis during the course of treatment. The total number of patients aware of prognosis, from the caregiver's perspective before death, was 28 (71%). The postmortem questionnaire revealed that the team had discussed prognoses with 86% of patients.

Conclusion: Periodic re-evaluation of prognosis awareness during the course of care is essential, awareness increased significantly.

Background: The American Association of Colleges of Nursing introduced hospice/palliative/supportive care as a focus area for baccalaureate nursing and identified pre-licensure competency-based education as essential for a safe and effective entry-to-practice nurse workforce. Yet many nursing educators lack knowledge and skills to teach competency-based primary palliative care (PPC).

Method: We piloted an educational intervention for baccalaureate nursing faculty in developing a competency-based PPC learning activity. The intervention consisted of workshops during which pre- and posttest data were collected. Intervention materials included an open-access PPC faculty resource Guide and a Learning Activity Template developed by the first author.

Results: Paired samples t tests demonstrated significant knowledge gains and changes in attitudes post-intervention in 17 of 20 areas assessed including "I am confident in my ability to teach nursing students about end-of-life care." There was a statistically significant increase in the total palliative care score (all 20 areas assessed) from pretest (M = 70.25, standard deviation [SD] = 9.54) to posttest (M = 80.40, SD = 10.10), t (39) = 9.18, p < 0.001 [two-tailed]). The Cohen's d statistic (1.45) indicated a large effect size. Additionally, over half of the participants created unique learning activities (n = 22) for teaching competency-based PPC.

Conclusion: This intervention addresses a faculty need in the context of new accreditation expectations. The open-access intervention materials shared in this article can be used to create course learning activities aligned with nursing needs for competency-based PPC. Future research should focus on effective faculty teaching interventions and reliable and valid assessment tools for faculty needs and student competency.

Objectives: This study aimed to assess the effects of high-resolution natural sound with inaudible high-frequency components (HNIH) on healing, symptoms, sleep satisfaction, and autonomic nerve function among terminally ill cancer patients.

Methods: We conducted a single-arm, open-label study of 4-hour HNIH for 20 terminally ill cancer patients. We evaluated the healing state, symptoms (Japanese version of the Edmonton Symptom Assessment System-Revised, ESAS-r-J), global impression, and heart rate variability at 30 minutes (T2) and 4 hours (T3) after starting HNIH and sleep satisfaction the next morning (T4).

Results: A total of 18 participants were evaluated (mean age: 69.4 years; 33.3% female). Post-intervention, there was a nonsignificant increase in Healing Scale scores at T2 (mean difference: 5.3, 95% confidence interval [CI]: -1.2 to 11.8, p = 0.106), but a significant increase at T3 (mean difference: 6.6, 95% CI: 1.0 to 12.3, p = 0.024). Specific ESAS-r-J scores demonstrated significant improvements in anxiety (mean difference at T2: -1.2, 95% CI: -1.99 to -0.34, p = 0.008; T3: -1.2, 95% CI: -1.99 to -0.34, p = 0.008), tiredness (mean difference at T2: -0.6, 95% CI: -1.18 to -0.04, p = 0.037), and shortness of breath (mean difference at T2: -1.0, 95% CI: -1.72 to -0.28, p = 0.010). Moreover, 66.7% of participants reported improved general conditions at T2 and T3, whereas 50% reported enhanced sleep satisfaction at T4. Heart rate variability analysis revealed a decreased low-frequency/high-frequency ratio in 55.6% of participants at T2 and 44.4% at T3.

Conclusions: The present single-arm study showed that HNIH potentially enhanced healing, alleviated symptoms such as anxiety, tiredness, and shortness of breath, and improved sleep satisfaction in terminally ill cancer patients.

Background: Many individuals prefer to pass away in the comfort of their own homes, yet logistical obstacles often result in their admission to hospitals for end-of-life care. Objectives: To measure the effectiveness, as assessed by relatives and staff, of end-of-life care according to the acute basic palliation concept (ABPC) for patients discharged from an emergency department. Methods: An observational study of 40 consecutive actively dying patients who were discharged from Aalborg University Hospital, Denmark, using the ABPC. Effectiveness of end-of-life care was measured by questionnaires to relatives, discharging doctors and nurses, and municipality health staff. The ABPC comprised a physician checklist, instructions for medical professionals, a medication template to be personalized, an added standardized text to discharge papers, information pamphlets for patients and relatives, and a box of medicine and utensils. Results: Among the 40 included patients (mean age 84, standard deviation [SD] 7.7), four experienced improvements at home and resumed active treatment. The patients who died had an average survival time of 3.8 days (SD 7.5). According to relatives, 90% of patients died a dignified death without suffering. Municipality nurses rated the usefulness of the ABPC at 96 (interquartile range 88; 100) on a 0-100 scale, and all health care staff wanted to use the ABPC again. Conclusion: The ABPC showed great potential as a tool for discharging dying patients without specialized palliative needs to good-quality end-of-life care at home. The ABPC was widely accepted by relatives and all health staff. The ABCP is ready for large-scale testing with patient subgroups and economic analysis.

Purpose: This study investigated the frequency with which nursing support for constipation is provided for patients with cancer during the prognostic months and weeks.

Methods: An online cross-sectional survey was conducted anonymously among registered nurses in palliative care units across Japan. The frequencies of providing six types of nursing support (abdominal massage with essential oils, abdominal acupressure, auricular acupressure, self-management education, abdominal massage, and warm compresses) were surveyed.

Results: Data were obtained from 539 nurses (response rate: 22.3%) from 162 facilities. The most frequently provided support was warm compression; the least frequently provided supports were auricular acupressure, abdominal massage with essential oils, and abdominal acupressure. In the prognostic weeks only, self-management education followed these support types.

Conclusion: The investigation found that the six types of support were rarely implemented for relieving constipation in patients with cancer. Future research should investigate the factors hindering the provision of these supports.

Background: Serious illness communication (SIC) competency is essential for health care professionals. However, many clinicians receive little-to-no SIC training, and there is little evidence as to which teaching method is most feasible to incorporate into postgraduate curricula. Two e-modules were created to adapt high-yield knowledge to deliver asynchronous, time-efficient, standardized communication skills teaching. This project evaluated SIC e-module teaching feasibility, learner and faculty perceptions toward e-module learning on this topic, as well as learner confidence and skill usage post-completion.

Methods: Family Medicine residents and palliative care fellows from two training sites were invited to asynchronously complete the e-modules on their own time and complete a survey to assess attitudes, perceptions, and needs toward them and impact on SIC skills immediately and 1-month post-completion. Faculty from the main site were also invited to view the e-modules and complete a survey immediately afterward assessing attitudes, perceptions, and feasibility on SIC e-module learning.

Results: In total, 19/50 (38%) learners completed the e-modules and post-training survey and 14/19 (73%) of those learners completed the 1-month follow-up survey. In total, 13/60 (22%) faculty completed the survey. Participants liked the structure and design of the e-modules and felt they were appropriate for their learners' level of training, were effective, time-efficient, and provided relevant SIC information. Case-based video demonstrations were identified as the most useful teaching method. Most learners intended to use new skills in clinical practice, rewatched both e-modules within 1 month of initial viewing, and reported using learned skills in practice.

Conclusion: E-module training provides a standardized method to scale postgraduate SIC skills teaching asynchronously and was well liked by learners and faculty. Barriers exist to completing them outside of a core curriculum. Early data suggest e-modules can be used iteratively and further research is needed to determine how their use impacts communication confidence and competency.

Background: Family caregivers (FCs) need to provide regular assistance and good quality care to patients to prevent the deterioration of chronic heart failure (CHF); therefore, they may have physical and mental distress. However, physical and mental distress in FCs of patients with CHF in Japan is unclear.

Objective: This study aimed to clarify the quality of life (QoL), anxiety/depression, and associated factors in patients with CHF and their FCs.

Design: We conducted a multicenter cross-sectional survey using a questionnaire between 2016 and 2017 among patients with CHF and their FCs. Demographic data were extracted from medical records. Health-related QoL and anxiety/depression were assessed using the Short Form-12 and the Hospital Anxiety and Depression Scales, respectively.

Results: Of 286 patients and FCs (response rate 57.2%), the physical component summary and mental component summary (MCS) scores of FC were higher than those of patients (p < 0.001 and p = 0.047, respectively). The incidence of anxiety and depression in patients with CHF was 7.0% and 10.8%, respectively, whereas that in FC was 10.1% and 12.6%. In multivariable analysis, the MCS score of FC was associated with the MCS score of patients (β = 0.22, p < 0.001). Anxiety in FC was associated with anxiety (β = 0.30, p < 0.001) in patients, respectively.

Conclusions: It is necessary to carefully monitor the physical and mental condition of patients with CHF and provide palliative care in collaboration with the palliative care team as needed. Stabilizing the patient's physical and mental condition through palliative care may also help alleviate the suffering of FC.