BMJ Supportive & Palliative Care最新文献

Background: End-of-life care among surgical patients is largely understudied and far fewer studies examine such care from the family perspective. To identify potential opportunities for improvement, we explored responses of family members of veterans who died following surgery using the Veterans Affairs (VAs) Bereaved Family Survey (BFS).

Methods: We examined data from the BFS open-text responses to explore insights into surgical patient's end-of-life care. Data were analysed iteratively using qualitative content analysis and clustered into domains based on content.

Results: We evaluated 936 open-text responses to the BFS for all decedents who underwent any high-risk surgical procedure across 124 VA medical centres from 2010 to 2019. This report focused on the following domains: patient needs, family/caregiver needs, clinical teams/personnel characteristics and facility/organisational characteristics. Key themes within patient needs included concerns about pain management, preservation of patient dignity and spiritual support. Within the family/caregiver domain, key themes included enhanced communication needs, assistance with logistics and displays of gratitude for the patient's military service. The clinical team's domain included the key themes of professionalism concerns and understaffing. Finally, key themes identified within the facility/organisation domain were the need for more robust support services and discomfort with the physical space.

Conclusions: Narratives from the family perspective provide valuable insight into end-of-life care among surgical patients. Our data demonstrate the critical need for preserving patient dignity and improved communication, which emphasises family involvement and shared decision-making. In addition, hospital systems can optimise nurse-to-patient ratios and intentionally design physical spaces to help improve end-of-life care for surgical patients.

Objectives: The use of herbal medicine is widespread among oncology patients, with potentially negative interactions with anticancer drugs. This study identified herbal products being used among a cohort of oncology patients, assessing the risk for an herb-drug interaction.

Methods: Herbal medicine use was examined among 42 oncology patients, identifying potential herb-drug interactions using four online sites. The risk for an interaction was scored using the Working Group on Pharmacotherapy and Drug Information of the Royal Dutch Association for the Advancement of Pharmacy (KNMP).

Results: Most patients (62%) reported herbal medicine use, with 70 products identified; 8 herbs and 13 herbal formulas with unidentified components; and 24 anticancer drugs. Herbal medicine use was more prevalent among female patients (p=0.038), with only nine potential herb-drug interactions identified on at least one site. A maximal KNMP Score of 1 (ie, incomplete published case report) was found with only one interaction.

Conclusions: The risk for interactions between herbal products and anticancer drugs is difficult to predict, with online search engines providing limited and inconsistent information. Clinical implications of herb-antitumor drug interactions need to be better understood, enabling patients and their oncology healthcare providers to make informed decisions regarding their care.

Objectives: To determine the distribution of prostate cancer (PCa) patients between physical activity and kinesiophobia, fatigue and quality of life, and to what extent PCa persists compared to healthy males.

Methods: Total of 118 males participated in the study. These participants were allocated into two groups: PCa group (n:59) and control group (n:59). The International Physical Activity Questionnaire Short Form was used to assess physical activity levels, Functional Assessment of Chronic Illness Therapy-Fatigue Questionnaire (FACIT-F) was used for measuring fatigue, kinesiophobia was evaluated with the Kinesiophobia Causes Scale, and Functional Assessment of Cancer Treatment-Prostate Version questionnaire (FACT-P) was used to assess quality of life.

Results: PCa had significantly lower scores in moderate activity (p=0.005) and total physical activity (p=0.010) compared with the control. Scores for kinesiophobia in both biological (p=0.045) and psychological subparameters (p=0.001), as well as the total kinesiophobia score (p=0.003), were higher in PCa. The FACIT-F (p<0.001) and total FACT-P (p<0.001) score were significantly lower in PCa than the control.

Conclusion: Kinesiophobia in PCa is significantly influenced by both biological and psychological factors. Kinesiophobia negatively affects patients' functional status and overall quality of life. Their well-being is shaped not only by their physical and emotional conditions but also by the quality of their family relationships. This multifaceted impact highlights the complex interaction between physical activity, functional abilities, emotional health and social dynamics in PCa. In addition to routine treatments for PCa patients, the development and implementation of a comprehensive rehabilitation programme may lead to significant improvements in their quality of life.

Purpose: To assess the prevalence of preoperative frailty in patients with oesophageal cancer and its impact on postoperative outcomes and overall survival.

Methods: A comprehensive computer-based search of the CNKI, Wanfang, VIP, CBM, PubMed, Embase, Cochrane Library, Web of Science and CINAHL databases was conducted for articles related to preoperative frailty in patients with oesophageal cancer. The search was carried out from the time of the construction of the database to 20 April 2024. Data related to the prevalence of preoperative frailty in patients with oesophageal cancer and their postoperative outcomes and overall survival were extracted.

Results: A total of 13 studies were included, including 12 cohort studies and 1 cross-sectional study involving 53 485 patients. Meta-analysis showed that the prevalence of preoperative frailty in patients with oesophageal cancer was 29.6% (95% CI 24.5% to 34.8%). Preoperative frailty increased the risk of postoperative mortality (HR 1.80, 95% CI 1.51 to 2.14, p<0.001), complications (HR 1.32, 95% CI 1.16 to 1.49, p<0.001) and 30-day readmission (HR 1.24, 95% CI 1.18 to 1.31, p<0.001), in patients with oesophageal cancer, but had no significant effect on overall survival (HR 1.28, 95% CI 0.97 to 1.68, p=0.08).

Conclusions: The prevalence of preoperative frailty is high in patients with oesophageal cancer, and preoperative frailty is strongly associated with increased adverse outcomes after surgery. Healthcare providers should identify preoperative frailty in patients with oesophageal cancer at an early stage and develop targeted intervention strategies to reduce the incidence of postoperative adverse outcomes.

Prospero registration number: CRD42024541051.

Despite rapid advances in the field of rheumatology, many patients with rheumatoid arthritis suffer from chronic and debilitating systemic disease, with a high symptom burden and limited life expectancy. In this paper, we demonstrate an approach to managing a patient with rheumatoid arthritis with life-limiting illness for the palliative care physician. In particular, we focus on the systemic nature of rheumatoid arthritis and nuances around medication management towards the end of life. It is our hope that this paper can serve as a guide for the palliative care clinician to decrease end-of-life morbidity from rheumatic disease and rheumatic medications.

Objective: Fan therapy is widely acknowledged as an essential component in the management of dyspnoea with numerous studies supporting its efficacy in alleviating dyspnoea among patients with chronic illnesses. However, there is limited evidence regarding the effectiveness of fan therapy in reducing dyspnoea in patients with respiratory failure undergoing continuous oxygen therapy. This study aimed to assess the efficacy of fan therapy in mitigating dyspnoea in this specific patient population through a randomised controlled trial.

Methods: Participants meeting the inclusion criteria were randomly assigned to either an experimental group or a control group. In the experimental group, a handheld fan (HHF) was directed at the face, while in the control group the fan was aimed at the legs. Both interventions were conducted at a distance of 15-30 cm for 10 min. Key physiological and subjective measures, including heart rate, respiratory rate, blood pressure, blood oxygen saturation, facial skin temperature and Visual Analogue Scale (VAS) scores, were recorded immediately after fan therapy.

Results: The experimental group demonstrated a statistically significant reduction in VAS scores (p<0.05) compared with the control group indicating that fan therapy effectively alleviates dyspnoea in patients with respiratory failure receiving continuous oxygen therapy.

Conclusion: HHFs are affordable, widely accessible and highly effective in relieving dyspnoea with minimal risk. Therefore, fan therapy should be considered as a complementary treatment for patients with respiratory failure and incorporated alongside standard therapeutic interventions for the condition.

Introduction: The National Audit of Care at the End of Life reports the quality of care provided to people dying in hospital. This paper reports the bereavement (quality) survey data about the families' view of care provided to the patient and support provided to the family.

Methods: Anonymised summary data were retrieved from 'Key findings for patients and carers on the quality of end of life care in acute and community hospitals' reports 2019-2022 and the summary report 2018.

Results: 9089 respondents provided feedback about care received. In more than 70% of the cases, care provided to the dying person was described as good, excellent or outstanding. At least 66% of respondents reported that care provided to them was good, excellent or outstanding. At least 76% of respondents felt that staff communicated sensitively, and more than 70% felt they were happy with the level of involvement in decisions about the patient's care.

Conclusion: The voices of dying patients and those at the bedside are critical in helping understand and improve care at the end of life. Co-ordinating our ask and focusing on agreed key outcomes are important to achieve the pragmatic principle of 'one death one review'.

Context: Pharmacogenomics (PGx) is an area of expanding research, which could indicate whether an individual is likely to benefit from a symptom control medication. Palliative and supportive care (PSC) could be an area that benefits from PGx, however, little is known about the current evidence base for this.

Objective: To determine how PGx can be applied in PSC, whether there is any evidence of benefit, and to understand the extent and type of evidence that supports the use of PGx in PSC.

Methods: A search of six databases up to July 2024. Reference snowballing from review articles and screened papers was used to identify any missed articles.

Results: 11 articles were reviewed. A total of 550 patients had a PGx test across 8/11 studies. Up to half of the patients had an actionable PGx result, and in one study there were 4.6 drug-gene interactions per patient. Implementation of PGx was found to be feasible. Clinician adherence to advice given was under-reported. No studies reported health economics analysis, or was designed to definitively answer whether PGx was better than standard care.

Conclusions: It is both feasible and acceptable to conduct PGx testing in a supportive and palliative care setting. Many supportive care medications are amenable to PGx. Clinician adherence to recommendations is variable and there is no clear evidence that PGx enhances palliative/supportive care patient outcomes. Prospective, clinical trials are needed to establish whether PGx can improve symptom management for people receiving PSC.

Importance: Limb spasticity is a common issue among stroke patients. Transcutaneous electrical acupoint stimulation (TEAS) is recommended as an alternative therapy for managing upper limb spasticity after stroke; however, its potential effects and feasibility remain uncertain.

Objective: To investigate the potential effects and feasibility of TEAS on motor function in patients with upper limb spasticity after stroke.

Methods: This randomised controlled, double-blined pilot study was conducted in two phases. All the patients were randomly divided into two groups: the TEAS group and the sham TEAS group. The intervention period for both TEAS and sham TEAS was 6 weeks, with each session lasting 30 min and conducted thrice weekly. The outcomes measured were the Fugl-Meyer Assessment-Upper Extremity (FMA-UE) score, the effective improvement rate, the modified Ashworth Scale (MAS), the Wolf Motor Function Test (WMFT), the visual analogue scale (VAS), the Barthel index (BI) and the surface electromyography (sEMG).

Results: All participants completed the course of therapy. Baseline characteristics were comparable across the two groups. Compared with the sham TEAS group, the TEAS group showed significant increases in FMA-UE score (P value=0.013), WMFT score (P value=0.001) and BI score (P value=0.008) at week 6. For integrated electromyogram (p=0.048) and root mean square of the biceps (p=0.033), lower scores were identified in the TEAS group compared with the sham TEAS group with a significant difference at week 6.

Conclusion: TEAS was acceptable and feasible in participants with upper limb spasticity after stroke. A pivotal study of this therapy is justified.