BMJ Supportive & Palliative Care最新文献

Objectives: Comprehensive understanding of the technical aspects of medical aid-in-dying (MAiD) including candidate selection, clinician prescribing decisions, and complications in the USA has been absent from clinical literature. This is due to limited scholarship and highly fractured data reporting methods across states. This study seeks to characterise the current landscape of MAiD practice and management by American providers to assess whether and how national standards of care are emerging across jurisdictions.

Methods: A digital survey tool recorded a series of quantitative and qualitative questions from 126 respondents practising in 10 jurisdictions and gathered 682 deidentified case reports of their patients who self-administered a MAiD prescription.

Results: Respondents had cared for an average of 102 patients and 73% reported an increase in patient volume over time. Providers declined 9% of MAiD requests. More than half had changed pharmacological regimens, but lacked consistent clinical justification for these changes. The drug combination known as DDMAPh is the current predominant prescribed MAiD regimen. More than half use alternate MAiD regimens, change dosages, or add agents like macrolide antibiotics, indicating DDMAPh functions as a backbone rather than a standard order set. Unanticipated complications occurred in 7% of cases. The addition of sweeteners did not reduce burning or bitter taste.

Conclusions: Although there are general trends among MAiD practice, primarily offered by two national organisations, US providers continue to pursue significant individual practice variation.

Objectives: To determine the frequency and timing of resuscitation plan (RP) documentation among medical oncology inpatients, and to identify factors affecting RP completion.

Methods: This retrospective review was conducted for all medical oncology inpatient admissions to an Australian cancer centre in October 2023. RP completion, timing (early or late) and authorship were reviewed. Associations between RP documentation and patient age, sex, disease stage (no disease, local or advanced), timing of admission (in hours or out of hours) and type of admission (planned or unplanned) were analysed.

Results: Of 121 inpatients, 78% had a RP documented during admission, and 51% had RP completion occur within 24 hours. Most RPs were documented by basic physician trainees. Younger patients were more likely to have early RP documentation (60% vs 36%, p=0.013) and completion by discharge (84% vs 66%, p=0.019). In-hours admissions more frequently had a RP completed early (62% vs 38%, p=0.009), with no difference in completion by discharge compared with those admitted out of hours (p=0.939). Planned admissions had higher rates of RP documentation than unplanned admissions (40% vs 19%, p=0.038).

Conclusions: Several patient and system-level factors affect RP documentation for medical oncology inpatients.

Objectives: To examine differences in quality of dying (QOD) between patients with cancer receiving no anticancer treatment (untreated group) and those receiving chemotherapy in the last 3 months of life (late chemotherapy group), and to explore socioeconomic characteristics by treatment status.

Methods: This observational study used data from a Japanese nationwide mortality follow-back survey, restricted to cancer decedents. Questionnaires were mailed to their bereaved family members. The primary outcome was family-reported QOD, and the exploratory outcomes included symptom burden, end-of-life (EOL) discussions and socioeconomic factors. Analyses were stratified by age (<60, 60-79, ≥80 years).

Results: Of 48 124 eligible responses, 12 563 were untreated. The proportion untreated increased with age (4.9%<60 years, 42.4% ≥80 years). Untreated patients had shorter survival times and more hepatobiliary or pancreatic cancer. The QOD was not poorer in untreated patients. Of untreated patients <60 years, 42.9% were free from physical distress versus 28.9% in the late chemotherapy group (difference: 14.0 points; 95% CI 5.5 to 22.5). Among untreated patients aged 60-79 years, 51.0% reported life completion versus 41.7% in the late chemotherapy group (difference: 9.3 points; 95% CI 6.9 to 11.7). More families of untreated patients reported EOL discussions with their physicians. Younger, untreated patients were more likely to be from lower-income households.

Conclusion: The absence of anticancer treatment was not associated with a poorer QOD in untreated patients. Socioeconomic disparities among younger patients highlight the need for equitable access to cancer care and support for value-based EOL decision-making.

Introduction: Providing nursing care is a challenging job which may lead to serious effects on sleep quality, thereby leading to lower work productivity and reduced job satisfaction. Therefore, it becomes increasingly important to adopt effective and adaptive coping strategies to deal with day-to-day stress and to improve sleep.

Aim: This study aimed to assess the sleep quality of nurses and the coping styles employed by them to deal with the stressors at the workplace.

Methods: This cross-sectional study included (n=125) nurses working across different wards and intensive care units in two cancer hospitals. The sleep quality was assessed using the Pittsburgh Sleep Quality Index, while brief COPE was used to assess the coping styles. Stress was assessed using a Likert scale.

Results: The results indicated that the majority of the nurses (59.2%) had poor sleep quality. However, most nurses employed problem-focused coping (70.4%) compared with emotion-focused (21.6%) and avoidant coping (8%). Poor sleep quality was found to have significant association with problem-focused coping (r=0.27), emotion-focused coping (r=0.25) and stress (r=0.42). A thematic analysis of the responses resulted in the emergence of eight major themes causing stress including management issues, novelty of job, family stress, health, work-life balance, workload, interpersonal relations and career growth.

Conclusion: Poor sleep quality was observed in more than half of the nurses who participated in this study. This can be attributed to several reasons mostly relating to work stress. Thus, it becomes increasingly important to address these issues and provide adequate support on an organisational level to improve their psychological well-being.

Objectives: Palliative surgery aims to relieve patients' symptoms and improve quality of life with surgical interventions. While a multidisciplinary approach has been found beneficial for critically ill patients, limited evidence supports this approach in palliative surgery. Here we sought to study whether palliative care consultations can improve outcomes among patients undergoing palliative surgery.

Methods: Consecutive patients undergoing palliative care at gastrosurgical wards in a tertiary Finnish university hospital during a 2-year study period were included. Outcomes of those undergoing surgery with or without palliative care consultation were compared. The main outcome measures were patients' functional status, postoperative morbidity and mortality.

Results: A total of 312 patients were included, of whom 173 underwent surgery, 77 endoscopic care and 62 were treated conservatively. Of the operated patients, 24 underwent multidisciplinary assessment while among the rest, the treatment decision was based on the surgeons' assessment. Multidisciplinary assessment was associated with a clinically significantly reduced morbidity (8.3% vs 23%, p=0.111), in-hospital mortality (8.3% vs 17%, p=0.051) and rate of hospital readmissions (8.3% vs 21%, p=0.052). There was no difference in median survival 49 (2-440) vs 45 (1-971) days (p=0.949). Of those undergoing conservative care, 44% could have undergone surgery.

Conclusions: The aim of the palliative surgery is to relieve symptoms among patients with no hope of being cured. While the involvement of the palliative care consultation into the surgical decision-making is likely to reduce unnecessary operations, it is likely to be even more important in improving quality of end-of-life care.

Objectives: Time is crucial for patients with metastatic breast cancer (MBC), and clinicians are expected to determine the optimal timing for best supportive care (BSC) transition but no evident marker has been established. We recently revealed that absolute lymphocyte count (ALC) was a prognostic marker for patients with MBC. Thus, we investigated whether ALC could be an indicator of the best timing for the BSC transition.

Methods: 101 patients with MBC were retrospectively investigated, and the relationship between clinicopathological factors, including ALC, and the duration of the last treatment was analysed.

Results: Mean ALC significantly gradually decreased during the last three systemic treatments towards BSC transition. Patients of younger age, with special histology type, hormone receptor-positive tumours and low ALC at the start of the last treatment had significantly shorter time-to-treatment-termination (TTT) for the last treatment. When ALC was classified into low and high, the mean TTT of the last treatment in the ALC-low group was significantly shorter (16.4 weeks) compared with that in the ALC-high group (30.2 weeks; p=0.004).

Conclusions: Our data suggest that ALC values, which decrease as MBC progresses, could serve as a potential indicator for determining the optimal timing of BSC transition.

This report focuses on the case of a woman in her 80s struggling with pruritus of a likely multifactorial cause within an inpatient unit at a hospice. Subcutaneous chlorphenamine 10mg twice daily, was used when the oral route was unavailable. Pruritus and associated rash resolved within 6 days of treatment being commenced. There was no further rash or pruritus after this. There is little literature about the use of subcutaneous chlorphenamine and this case report highlights its use can be effective for treatment of pruritus in palliative care and broaden therapeutic options. Further research is needed to support its use when administered subcutaneously.

Objectives: To evaluate admission reasons, referral sources, and patient outcomes among hospice inpatients, and to explore factors contributing to a reduced average length of stay observed locally.

Methods: A retrospective audit of all hospice inpatient admissions between September and December 2024 was undertaken. Data included referral source, diagnosis, reason for admission, length of stay and outcomes. Findings were compared with previous local and national data. A re-audit in March 2025 assessed whether trends persisted.

Results: A total of 130 patients were admitted during the initial audit period. Most referrals (74%) originated from the hospital, with 30% from the emergency department; 75% of this subgroup died within 72 hours. Overall, 54% of patients had non-malignant conditions. Among hospital referrals, non-malignant diagnoses were predominant (70%), while among community referrals, most (93%) had cancer. The average length of stay was 4.7 days, markedly shorter than the national average of 1-2 weeks. During admission, 82% of patients died, and 18% were discharged. The reaudit confirmed the persistence of these trends.

Conclusion: Hospice inpatient care is shifting towards hospital referrals, non-malignant diagnoses and shorter stays. Models of care must adapt to support patients with unpredictable disease trajectories and crisis admissions.

Background: Transcranial magnetic stimulation (TMS) is a non-invasive neurostimulation technique currently approved by the Food and Drug Administration for the treatment of depression, migraines with aura and obsessive-compulsive disorder. While there is ample evidence supporting the safety and efficacy of TMS in treating these conditions, there is limited exploration of the application of TMS in the context of palliative care. Methods: In the wake of a preliminary study of 'accelerated' repetitive TMS promising symptomatic improvement in depression and anxiety in palliative care patients, we evaluated the use of TMS in addressing a broad spectrum of palliative care-focused symptoms based on the Edmonton Symptom Assessment System (ESAS) in numerous studies. Results: Positive effects were observed in modulating depression, anxiety, sleep, dyspnoea, appetite, peripheral neuropathy, non-neuropathic pain, fatigue and feelings of well-being. Although cachexia and nausea are symptoms classified under the ESAS, our literature search yielded no search results regarding TMS treatment. Conclusion: Larger-scale clinical studies with diverse samples are warranted, and future exploration is necessary to discover additional methodologies for TMS therapy. In this narrative review article, we discuss the current studies to analyse the supporting data, efficacy, safety, mechanisms and the therapeutic potential of TMS use across various conditions within palliative care.

Objectives: The study evaluates the fifth cohort of the palliative care cancer treatment centres (CTC) educational programme in India with the aim of refining the course on the basis of participant feedback thereby improving palliative care services at cancer centres.

Methods: The intervention included participation in the CTC 5 teaching and training programme, which encompassed foundation course, refresher course, access to palliative care training modules, clinical training and mentorship under palliative care experts. The feedback was taken from all 57 participants (29 doctors and 28 nurses) of CTC 5 programme representing 14 hospitals across nine regions in India. The assessment tools included Likert scale ratings and free-text comments. 3-point and 5-point Likert scale ratings were used to gauge the usefulness of course topics, quality of content and delivery. A mixed methods approach was used for a comprehensive evaluation by taking both quantitative measures of participant inputs and qualitative insights into their experiences and suggestions. The knowledge gained by the participants was analysed using pre-training and post-training assessments.

Results: The feedback obtained from the participants highlighted both strengths and scope for improvement. The foundation course received positive feedback for its sessions, especially on communication skills and pain management. The refresher course received positive feedback for team presentations but lacked sufficient case discussions. The interactive nature of sessions was well-received. Following the CTC 5 programme, participants showed a 30.38% knowledge gain. Overall, the programme exceeded expectations for 62% of participants, highlighting its impact on personal development and clinical practices in palliative care.

Conclusion: The study provides useful insights for designing future palliative care educational courses to address the needs of health professionals. The CTC programme has promising potential to bring about positive changes in both the personal and professional development of participants ultimately improving palliative care services across India.