BMJ Supportive & Palliative Care最新文献

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.

Itch is a common symptom faced in palliative care. In this case report, we present a patient in his 80s with a background of prostate and bladder cancer who fell and was subsequently immobile following a resultant vertebral fracture. He experienced persistent and distressing pruritis during his hospital stay. This case highlights the assessment and management of pruritis in a palliative care setting, eventually leading to a diagnosis of miliaria which was successfully treated with Propantheline.

Objective: During the period of caregiving, informal caregivers of incurably ill patients experience caregiving burden that is often overlooked since the focus is on the suffering of the care receiver. In Bangladesh, informal caregivers often cannot express their suffering as they are culturally obliged to take responsibility for sick family members. This cross-sectional study was conducted among 156 informal caregivers of patients with advanced cancer attending the Department of Palliative Medicine at Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.

Methods: The sample was chosen consecutively based on the inclusion and exclusion criteria. Face-to-face interviews were conducted using a well-designed questionnaire. A previously translated and validated Bangla version of the Zarit Burden Interview (ZBI) was used to assess the burden of the informal caregivers.

Results: The mean ZBI score of the informal caregivers was 28±11. The study found that caregiver burden was significantly associated with the relationship between the informal caregiver and the patient, as well as the caregiver's awareness of the patient's prognosis.

Conclusion: Currently, no facilities for informal caregivers are available in Bangladesh. As extended members of the patient's care team, the burden experienced by the caregivers needs to be given more attention and should be taken into account in healthcare.

Background: Cystic fibrosis (CF) is an incurable, progressive disease that affects multiple organs, causing burdensome symptoms. This study aimed to explore the palliative care needs in patients with CF, focusing on health-related quality of life (HRQOL), fatigue, anxiety and depression.

Methods: From October 2019 to March 2020, a cross-sectional questionnaire survey was conducted with outpatients with CF at the Infectious Medicine Clinic in a Danish University Hospital.

Results: 130 patients completed at least one questionnaire. Mean age was 35.5 years (SD 11.5), with 51.7% males. Charlson's comorbidity index mean score was 1.3 (SD 1.6). Patients with CF had significantly lower scores in general health, vitality, social functioning, role emotional and mental health compared with the Danish population. Mean fatigue score of patients was 50.9 (SD 16.2), with the highest scores in general fatigue, physical fatigue and reduced activity. Additionally, 33% indicated anxiety and 19.5% depression. 51.6% were treated with Tezacaftor/Ivacaftor or Lumacaftor/Ivacaftor.

Conclusion: This study found poor HRQOL and burdensome symptoms of fatigue, anxiety and depression in patients with CF compared with the general Danish population. The results suggest that systematic assessments and palliative care interventions should be integrated into routine CF care.

Objectives: Death occurs within the emergency department (ED) sadly not infrequently. There is limited evidence exploring the demographics of these patients and the experience they have in the ED when they die or are approaching the end of life (EOL).

Methods: A retrospective review of patients aged 18 years and over who died in our major trauma centre was conducted. Data collected included demographics, frailty scores, time of arrival, time of death, time of EOL decision, cause of death in the ED and who wrote do not attempt cardiopulmonary resuscitation (DNACPR) forms.

Results: From January to December 2023, 326 patients died in the ED. 76% of patients were aged 65 years or over, with 69% having a clinical frailty score of 5 or more. The average time from arrival to death was 5 hours 56 min, with the average time from EOL decision to death being 1 hour and 53 min. 60% of all patients had a DNACPR, with 75% of those being written by ED clinicians.

Conclusion: EOL is becoming ever more important in the ED. Further work is needed to see if our local experience matches other EDs.

Objective: Family caregivers are essential to the care and support of adult cancer patients yet they often experience caregiver strain, anxiety and depression. Despite the psychological and emotional burden they endure, formal assessments of their mental health needs are seldom conducted. This study aimed to determine the prevalence of caregiver strain, anxiety and depression among family caregivers of adult cancer patients at a tertiary hospital in the Philippines.

Methods: This study included 346 family caregivers chosen through purposive sampling at the cancer centre of a tertiary hospital in the Philippines. It used the Modified Caregiver Strain Index-Pilipino version to identify cases of caregiver strain, and the Hospital Anxiety and Depression Scale-Pilipino version to identify cases of anxiety and depression. Data were analysed using descriptive statistics in frequencies and percentages.

Results: Among the family caregivers of adult cancer patients undergoing outpatient treatment at the cancer centre of a tertiary hospital in the Philippines, the prevalence of caregiver strain was 10%. Moreover, the prevalence of anxiety was 33%, and the prevalence of depression was 30%.

Conclusion: Though the majority of family caregivers did not experience significant caregiver strain, anxiety or depression, a notable proportion still reported symptoms. These findings highlight the need for screening and monitoring of family caregivers so that targeted mental health interventions and support can be given to improve their well-being and caregiving capacity.

Objective: To investigate the impact of massage therapy on pain syndrome and shoulder function in women undergoing mastectomy, specifically those referred to oncology centres in Kerman.

Methods: This study was conducted as a randomised clinical trial, the convenience sampling method was employed, and the samples were randomly divided into two groups. The Swedish massage group (n=21) received Swedish hand massages for a duration of 3 weeks, with two sessions per week, each lasting 20 min. The sham group (n=21) underwent light stroking of the corresponding hand for the same duration and frequency. The data collection process involved gathering demographic and background information and utilising the Shoulder Pain and Disability Index. Data were collected prior to the intervention, immediately after the intervention and 1 month after the intervention.

Results: In the massage group, the mean pain syndrome score was 5.62, 1.89 and 5.42 before the intervention, immediately and 1 month after the intervention, respectively. In the sham group, the mean pain syndrome scores were 6.51, 4.94 and 6.32 before the intervention, immediately after the intervention and 1 month later, respectively. Shoulder dysfunction mean scores in the massage group were 3.84, 1.20 and 3.43 before the intervention, immediately after the intervention and 1 month later, respectively. In the sham group, the mean shoulder dysfunction scores were 3.73, 2.73 and 3.43 before the intervention, immediately after the intervention and 1 month later, respectively. The pain syndrome score and shoulder dysfunction decreased immediately after the massage compared with the sham group (p<0.05).

Conclusion: Swedish massage could effectively reduce pain syndrome and shoulder dysfunction in patients who underwent mastectomy surgery. Based on these findings, Swedish massage can be applied in clinical practice as a simple, low-cost and non-invasive complementary therapy to support pain relief and functional recovery in oncology and rehabilitation clinics.

Trial registration number: IRCT20221213056803N1; Iranian Registry of Clinical Trials on 8 January 2023. https://irct.behdasht.gov.ir/trial/67387; recruitment start date: 2023.