Annals of palliative medicine最新文献

Background and objective: Provider experience is critical to the acceptance and sustainability of palliative care delivery models. Compassion satisfaction and burnout make up key components of provider wellbeing and therefore serve as important targets for measurement. Exploring the impact of palliative care interventions on provider experience offers significant potential for innovation. This narrative review surveys existing literature regarding provider-wellbeing outcomes in palliative care delivery. Our primary objectives were to examine the factors and interventions that influence compassion satisfaction and burnout among palliative care providers, as well as explore provider wellbeing outcomes that have been previously measured for patient-centered palliative care interventions. We ultimately propose an underlying conceptual model founded in care ethics to guide further research.

Methods: We queried PubMed with additional articles found through backwards chaining. No publication timeframe was imposed. Non-English articles were excluded.

Key content and findings: Previous research has identified various factors associated with compassion satisfaction among palliative care providers, including self-care practices, supportive team dynamics, and organizational support. Moreover, a number of provider-centered interventions have shown potential for decreasing burnout, including professional development time and educational programs. However, relatively little research has explored how patient-centered interventions may affect providers. Prior studies exploring interventions such as targeted skills training, communication tools, and innovations in patient and caregiver end-of-life care education and discussion demonstrate that patient-centered improvements to palliative care delivery may also confer benefits to providers, including those without formal palliative care training.

Conclusions: Although compassion fatigue and burnout are well-documented among palliative care providers, research into how patient-centered palliative care interventions affect providers is limited. We propose a model of palliative care innovation that utilizes care ethics to understand the interdependent relationships among patients, caregivers, and providers. Future research should leverage existing tools measuring compassion satisfaction and burnout to better understand how interventions targeting one stakeholder might affect the experiences and outcomes of others. Such an approach may support sustainable adoption of palliative care interventions across multiple domains.

Background: Are signs and symptoms overlooked in patients who have cancer and who identify as transgender or nonbinary? Because clinicians seem unaware of hiccups and because patients who identify as transgender or nonbinary appear at especially high risk for having their medical signs/symptoms overlooked, this study focused on hiccups as a bellwether sign/symptom.

Methods: The medical records of 126 patients who had cancer and who identified as transgender or nonbinary were reviewed in detail. A literature-based, incidence rate of hiccups of 9% served as a benchmark.

Results: The median age was 42 years (range, 18-78 years). Fifteen self-identified as transgender men, 41 as transgender women, and 70 as nonbinary. Seven patients, or 6%, had hiccups (this observation was below the benchmark). The incidence of hiccups was 0% (0/15), 12% (5/41), and 3% (2/70) among transgender men, transgender women, and nonbinary individuals, respectively. In 3 patients, the hiccups appeared to go unaddressed.

Conclusions: These findings suggest signs/symptoms might be overlooked in gender diverse patients with cancer. Additionally, these findings should prompt efforts to identify and palliate signs/symptoms-including hiccups but, of course, others as well-in patients who have cancer and who identify as transgender or nonbinary.

Background: Delirium is common among patients with advanced illness. The prevention of delirium and management of its symptoms are important to the palliative care of patients with interstitial lung diseases (ILDs). We investigated the incidence of delirium among patients with terminally ill ILDs and risk factors for its development.

Methods: This retrospective observational study included patients with ILDs who were admitted to the National Hospital Organization (NHO) Kinki Chuo Chest Medical Center between April 2020 and September 2022 and died during hospitalization. The primary and secondary outcomes were the percentage of patients with delirium and risk factors associated with delirium.

Results: A total of 85 patients were included in this study. Delirium was present in 38 of these 85 patients (44.7%). Patients with dementia had a significantly higher risk of delirium compared to those without dementia [risk ratio, 2.38; 95% confidence interval (CI): 1.84-3.08], and patients who were physically restrained also had a higher risk of delirium compared to those without restraint (risk ratio, 2.32; 95% CI: 1.53-3.52).

Conclusions: Delirium is prevalent in terminally ill patients with ILDs. Dementia and physical restraint may be risk factors for delirium. Physicians should recognize the risk factors for delirium and prepare for its development in terminally ill patients with ILDs.

Background: Cancer-related fatigue (CRF) is a common symptom affecting patients with the majority of cancers with a significant impact on the overall quality of life. CRF has a complex and multifactorial origin, making it difficult to pinpoint specific causes, as they are interlinked with each other. The given scoping review aims to identify and explore the recent clinical updates related to screening, diagnosis, and management.

Methods: Databases including PubMed, Embase, Cochrane, and Medline were used for our search, and the articles from January 2020 to March 2025 were screened. Studies that documented adult cancer patients who experienced CRF in palliative care were included. PRISMA-ScR guidelines were followed to carry out the scoping review. Articles underwent titles and abstracts screening, followed by full text screening by 2 independent reviewers. The extracted data was analysed thematically.

Results: A total of 4,444 articles were identified through database searches. After screening titles, abstracts, and full texts, 53 articles were included in the scoping review. The themes that were identified included screening and assessment, pharmacological, non-pharmacological and complementary therapies for the diagnosis and management of CRF. Exercise, cognitive behavioural, mindfulness-based, psychosocial, and sensory therapies were found to be effective non-pharmacological methods for CRF management. Furthermore, pharmacological agents like corticosteroids and psychostimulants were proven beneficial in patients experiencing CRF when other techniques were insufficient in alleviating symptoms. Complementary therapies including acupressure (AS), acupuncture (AT), Tai Chi or Qigong, yoga, and massage were efficacious adjunctive therapies for CRF reduction in palliative care settings.

Conclusions: In palliative care settings, CRF is a multifaceted symptom that affects the physical, mental and psychological well-being. It is essential to raise awareness, promote training, and support research in diverse palliative care settings to integrate CRF into routine cancer care. Work up algorithm must be integrated for CRF at every oncology visit for early and prompt detection. There should be an amalgamation of the pharmacological, non-pharmacological and complementary interventions into a comprehensive treatment pathway that should be able to cater to the majority of cancer patients experiencing CRF.

Pancreatic cancer is an aggressive disease and often presents at an advanced stage with no curative options. The disease is often characterized by rapid progression, limited or short-lived responsiveness to standard therapies, and a profound impact on patients' quality of life. Despite advances in targeted therapies and immunotherapy, curative outcomes remain elusive for the majority of patients with advanced or high-grade disease with a 5-year survival rate of less than 10%. Treatment goals must evolve beyond prolonging survival to include alleviating suffering, optimizing function, and preserving dignity. This is where palliative care assumes a vital and indispensable role. Even patients who initially present with resectable disease are at a high risk of recurrence in the future. Pancreatic cancer carries a high symptomatic burden from pain, poor nutrition, malabsorption, jaundice, fatigue as well as depression. Given the overall poor prognosis, early integration of palliative care is essential to address the physical, emotional and spiritual needs of patients and provide patients and families guidance in complex decision-making. Early palliative care involvement has proven time and time again to improve symptoms control, reduce hospitalization and may even improve survival. Palliative care should be provided concurrently with active treatment before becoming the main focus of care for patients with advanced stages of disease.

Background: Methadone is a valuable drug for pain management but his use in palliative care settings is still challenging. The primary objective of this study was to take an in-depth look at the clinical use of methadone in specialized palliative care settings in Italy.

Methods: A register of all active hospices in Italy at the time of the study was created by consulting the websites of the National Agency for Regional Health Services (Agenas) and the Italian Federation of Palliative Care (Federazione Cure Palliative). A telephone survey composed of an 18-item questionnaire was then carried out with a member of staff of each facility about the period between January and August 2023. A descriptive, non-statistical comparison was made between the results of the present survey and those obtained from a similar survey carried out in 2013.

Results: Of the 275 hospices active at the time of the telephone survey, 160 (58%) responded to the questionnaire and 81 of them (51%) confirmed using methadone in their clinical practice. Questionnaire responses revealed that the perception of operators with regard to methadone has gradually shifted towards a greater appreciation of its strengths compared to the potential difficulties encountered in its use. In fact, the use of methadone increased over a 10-year period from 28% in 2013 to 51% in 2023.

Conclusions: The results of the present study highlighted a considerable variability in the use of methadone in clinical practice, in line with literature data. Its use has substantially increased in recent years, but appropriate training of palliative care professionals is still needed to ensure its safe and effective management.