Palliative medicine reports最新文献

Objectives: Restrictive blood transfusion policy has been shown to be effective in managing anemia. However, treatment of anemia in palliative (PC) and end-of-life (EOL) care remains understudied. The aim of this study was to examine Finnish PC physicians' attitudes and practices in the management of anemia.

Methods: A structured questionnaire asking clinicians about how they treat anemia in PC was developed with a focus on blood transfusion. In addition, a previously published collection of clinical case scenarios was included. Physician's recall of their use of red blood cell (RBC) transfusions in 2021 was also asked. The questionnaire was first delivered at an annual meeting of the Finnish Association for Palliative Medicine in 2022 and subsequently, a Webpropol form was emailed to the members of the society.

Results: A total of 94 (28%) doctors at an average age of 46.5 years responded. Of these 80% were specialists and 75% had a special competence in palliative medicine. RBC transfusions were given in less than 25% of patients, average hemoglobin was b ≤ 78 g/L. Transfusions were given for clinical symptoms such as fatigue, angina, and weakness without systematic measurement of symptom severity. Hematinic levels were investigated, but iron was given seldom. Clinical scenarios were answered similarly as previously in the UK. National guidelines for anemia in early PC or EOL care are lacking but would be deemed to be helpful by one-third of those who completed the questionnaire.

Conclusion: Physicians apply the restrictive policy in blood transfusions for PC patients in Finland. Other treatments for anemia are not often used. Both prospective studies and national guidelines are needed.

Background: The need for palliative care (PC) is increasing due to the growing number of chronic diseases and an aging population. As such, the requirement to ensure the provision of PC is evident. This calls for PC competence for nurses working in nonspecialist PC settings.

Objective: The aim was to describe the views of Finnish health care professionals relating to PC competencies and the development needs for continuing education in nonspecialist PC settings.

Design: A qualitative study design.

Setting/subjects: The data were compiled via an e-survey from health care professionals working in nonspecialist PC settings in Finland; 281 participants answered the open question: "Tell us what you think about the competencies in palliative care."

Measurements: The data were analyzed using inductive content analysis.

Results: The description of PC competence was categorized into four main categories, including 64 subcategories. The main category containing the largest number of reduced expressions (f = 303) was "Perceived level of PC competence and development needs." The competence in PC was also identified as "Perceived need for continuing education in different palliative care competencies" (f = 243), "Building the foundations of one's own competence" (f = 133), and "Factors related to the work organization and connected to the competence enhancement" (f = 84).

Conclusion: The health care professionals in nonspecialist PC settings recognize the importance of ensuring competence and the need for continuous and regular education. The results of this study can be utilized in the planning of continuing education and in targeting it correctly.

Background: Cancer-related fatigue (CRF) is a distressing symptom in patients with terminal cancer. It is often under-assessed or remains unrecognized among health care professionals due to difficulties in identifying symptoms. However, fatigue ratings have not been studied extensively in incurable, terminally ill cancer patients with palliative intent or in nurses who provide daily care in palliative care teams or units.

Objective: This study examined the agreement between nurses' assessments and terminally ill cancer patients' self-assessments of CRF.

Methods: The correlation between patients' scores on the Cancer Fatigue Scale (CFS) and nurses' scores on the Japanese version of the Support Team Assessment Schedule (STAS-J) was matched in patient-nurse pairs. Paper versions of the questionnaires were answered by the patients and nurses at the time of the temperature check.

Results: Twenty-eight participants in 14 pairs with valid responses were included. There were 10 cases (71.4%) of agreement between the patients' and nurses' assessments of fatigue via the CFS and STAS-J, respectively. Among the four cases (28.6%) of incongruence, two (14.3%) were underestimated, and two were overestimated. Significant correlations were observed between the STAS-J and physical fatigue (rs = 0.66, p < 0.01), but total fatigue (rs = 0.47, p = 0.09), affective fatigue (rs= -0.09, p = 0.75), and cognitive fatigue (rs = 0.52, p = 0.06) showed no significant correlation.

Conclusion: Differences were primarily observed in affective fatigue; therefore, nurses must carefully consider affective fatigue when assessing fatigue in patients with terminal cancer.

Background: Because of the limitations of pharmacological therapy, nonpharmacological therapies including intervention procedures are also important for quality of cancer pain management.

Objective: To clarify the availability of, number performed, barriers to performing, and educational practices of four interventional procedures (celiac plexus neurolysis/splanchnic nerve neurolysis, phenol saddle block, epidural analgesia, and intrathecal analgesia) in designated cancer hospitals.

Design: Cross-sectional survey.

Setting: Designated cancer hospitals certified by the Japanese Government.

Methods: We administered self-administered questionnaires to collect general information about the facility and interventional procedures for refractory cancer pain between January and April 2021.

Results: Questionnaires were sent to 402 facilities, and we received 199 valid responses (49.5%). Regarding availability, 36.7%-59.8% of the designated cancer hospitals reported that each procedure was available. Regarding the frequency of these procedures performed in the past 3 years, medians ranged from 1 to 4 times for each procedure. Among designated cancer hospitals, 44.7-65.8% reported the presence of barriers. Barriers such as "no/few physicians technically able to perform the procedure," "inability to follow-up after the procedure is implemented," and "the facilities to which patients may be referred after implementation are limited" were particularly pronounced. Training and treatment practice were provided by 30.7-55.8% of designated cancer hospitals for the procedures. Moreover, 12.6%-15.6% of designated cancer hospitals educated physicians and nurses responsible for cancer care in the region about pain treatment for the procedures.

Conclusions: Our findings suggest that designated cancer hospitals need to improve the availability, training, and education of interventional procedures.

Background: Burnout is common among palliative care clinicians caring for patients with a serious illness. Contemplative medicine is an emerging approach that aims to utilize Buddhist concepts of mindfulness, insight, and compassion to address unspoken suffering in clinicians.

Objectives: To introduce and share contemplative medicine practices with Hospice Palliative Medicine (HPM) fellows participating in two academic programs in New York.

Methods: Pilot educational sessions in contemplative medicine were conducted following a Contemplative Medicine Fellowship's relationship-centered and cohort-based curriculum. A short survey assessing HPM fellows' attitudes toward core competencies in contemplative medicine was administered to seven HPM fellows.

Results: Participants agreed that being present with those who are suffering are healing acts by themselves and that contemplative medicine can complement HPM fellows' skillsets when providing care to patients with serious illnesses. Common themes like "being awake" and "low self-compassion" were discussed by participants during the sessions. Techniques like pausing and mindful breathing were found helpful to practice throughout a busy workday.

Discussion: Incorporating contemplative medicine practices into an HPM fellowship may provide opportunities to (1) promote learner emotional development and (2) teach learners self-awareness of how difficult emotions can affect communication with patients.

Background: Little is known about the public perception of palliative care during and after the pandemic. Assuming that analyzing online language data has the potential to collect real-time public opinions, an analysis of large online datasets can be beneficial to guide future policymaking.

Objectives: To identify long-term effects of the COVID-19 pandemic on the public perception of palliative care and palliative care-related misconceptions on the Internet (worldwide) through natural language processing (NLP).

Design: Using large language model NLP analysis, we identified public attitudes, opinions, sentiment, and misconceptions about palliative care on the Internet, comparing a corpus of English-language web texts and X-posts ("tweets") (02/2020-02/2022) with similar samples before (02/2018-02/2020) and after the pandemic (03/2022-02/2024).

Setting: The study is a statistical analysis of website and social media data, conducted on six large language corpora.

Results: Since the COVID-19 pandemic, palliative care situations are more often portrayed as frightening, uncertain, and stressful, misconceptions about the activities and aims of palliative care occur on average 44% more frequently, especially on the social media platform X.

Conclusions: The impact of the COVID-19 pandemic on public discussion on social media continues to persist even in 2024. Insights from online NLP analysis helped to determine the image of palliative care in the Internet discourse and can help find ways to react to certain trends such as the spread of negative attitudes and misconceptions.

Background: The option of intentional sedation to relieve intolerable suffering from treatment-refractory symptoms may elicit a feeling of safety for patients and informal caregivers as a last resort if the situation becomes unbearable. Many health care professionals feel uncomfortable and insecure in conducting intentional sedation due to specific challenges. We developed a complex intervention to support best practice use of sedative drugs in specialist palliative care in Germany based on previously published recommendations. This article aims at reporting the development of the intervention.

Methods: The development of the intervention was based on theory and existing evidence with active stakeholder participation and patient and public involvement, following the updated Medical Research Council (MRC) Framework on complex interventions. A "Theory of Change," drawing on expert-approved best practice recommendations and applying user-centered methods, fostered the development. The process encompassed study preparation, development of the elements of the intervention, and designing the multimodal intervention. For reporting, we adhere to the Guidance for Reporting Intervention Development framework.

Results: The intervention is aimed at health care professionals working in specialist palliative care (inpatient and homecare settings) and consists of several components: (1) a screening tool, (2) the individual elements of the intervention, and (3) educational material for health care professionals to support them using the intervention. Additional information material was developed for patients and informal caregivers. Despite the benefits of stakeholder involvement, we faced some barriers due to limited health care staff and time resources and reservations regarding research in general.

Discussion: A pilot study is planned for testing the overall feasibility of the intervention and exploring possible benefits for health care professionals to inform a subsequent fully powered implementation study. To deal with the challenges, we stayed in contact with the health care teams, maintained transparency, and provided opportunities for active participation.

Background: In the Netherlands, overtreatment at the end of life and the high incidence of in-hospital death have led to discussions on how to improve advance care planning.

Objectives: To investigate in-hospital deaths at the Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands in 2019 and 2022 of patients previously diagnosed with at least one life-threatening disease, who received symptom-oriented treatment within seven days of admission.

Design: Retrospective study.

Measurements: Characteristics of the patient population and their final hospital admission were analyzed.

Results: In the Canisius-Wilhelmina Hospital, 216 and 180 patients died in 2019 and 2022, respectively, who were treated for at least one life-threatening disease and who received symptom-oriented treatment within seven days of admission. Most of these patients were referred to the emergency room from home. They were admitted for median three days before their in-hospital death. Advance care was documented in 1% and 2% of cases in 2019 and 2022, respectively.

Conclusion: A significant number of in-hospital deaths at the Canisius-Wilhelmina Hospital in 2019 and 2022 could be considered expected deaths. Furthermore, advance care planning was rarely documented in these cases. Whether improvement of advance care planning could reduce the number of deaths occurring in-hospital should be the subject of further investigation.

Background: Palliative care has been shown to be effective for patients with advanced cancer; however, the best approach to deliver palliative care needs to be considered. We hypothesized that a combination of palliative care via video telemedicine (TMD) and usual outpatient treatment would improve patients' quality of life (QOL) and ameliorate depression and prognosis.

Methods: Patients with advanced cancer who terminated treatment with chemotherapy were enrolled. Patients who could perform videoconferencing were assigned to the TMD group and those who could not perform were assigned to the (no TMD; control) group. The primary endpoint was QOL, which was evaluated using the difference in the Functional Assessment of Cancer Therapy-General (FACT-G) scores between baseline and one-month follow-up. Secondary endpoints included depression, measured using the Center for Epidemiological Studies Depression (CES-D) scale, overall survival, and patient satisfaction.

Results: Fifty patients were included in this study (25 in each group). A comparison of measures of QOL at one month showed that the TMD group maintained a better QOL. FACT-G decreased by 0.21 and 5.96 points in the TMD and no TMD groups, respectively (p = 0.047). The TMD group maintained better QOL. There were trends suggesting improvements in depression and survival which did not reach significance. CES-D increased by 0.92 and 3.50 points in the TMD and no TMD groups, respectively (p = 0.26). Median survival time was 7.82 (3.30-14.59) and 6.37 (2.33-11.04) months in the TMD and no TMD groups, respectively. The results of the Patient Satisfaction Questionnaire suggest that video TMD could be a feasible tool in palliative care.

Conclusion: Video TMD is effective in maintaining the QOL of patients with advanced cancer and is feasible based on patient satisfaction. It is desirable to further evaluate the usefulness of palliative care using video TMD and evaluate its clinical applications.

Background: Community-based palliative care (CBPC) is only available in large cities in mainland China and little is known about who utilizes it.

Objectives: This study examined the characteristics, outcomes, and factors associated with place of death (PoD) among inpatient CBPC patients.

Design: This was a multicenter retrospective cohort study.

Settings/subjects: All patients admitted to the inpatient CBPC unit in four community health centers in 2021 in Shanghai, China, were included.

Methods: Characteristics and outcome data were extracted from electronic health records and paper version notes between September 4 and December 29, 2022. PoD was followed up on May 12, 2023. Data were analyzed using descriptive analysis and categorized using two-step clustering. Decision tree analysis was used to identify factors associated with PoD.

Results: The cohort admitted in 2021 included 290 participants (Age: 75.7 ± 12.7 years; Male: n = 155, 53.4%) including two children, with a mortality rate of 59.0% and a median length of stay (LoS) of 14 days upon December 29, 2022. The primary diagnosis for 80.3% of participants was tumor. Two clusters were identified. Cluster 1 was smaller than Cluster 2 (n = 45, 15.5% vs. n = 245, 84.5%) and dominated by noncancer participants (n = 37, 82.2%), whereas Cluster 2 included 91.8% (n = 225) tumor patients. Greatest significant differences in age, sex, marital status, education level, awareness of diagnosis and/or prognosis, mortality, LoS, and costs were found between the clusters. In total, 265 deaths derived from the cohort upon May 12, 2023, occur in inpatient CBPC units (75.5%), at home (18.9%), and in hospital wards (5.7%), influenced largely by participants' marital status and age.

Conclusions: Establishing contextualized inpatient CBPC services in more places nationwide that are tailored to different characteristics between cancer patients (i.e., younger and shorter inpatient stay) and noncancer patients (i.e., older and longer stay) is essential to maintain that more dying patients remain in their community.