BMJ Supportive & Palliative Care最新文献

Aim: This study aims to systematically evaluate the effects of palliative care on the quality of life, anxiety level, depression level, cardiac function, readmission rate and mortality rate among patients with advanced heart failure, in order to provide evidence-based support for further research in this area.

Methods: Randomised controlled trials of palliative care for patients with advanced heart failure were retrieved from CNKI, WANFANG DATA, CQVIP, SinoMed, CINAHL, Medline, PubMed, Web of Science and Embase, and references were traced. The search deadline was set as 17 July 2025. Two researchers independently screened literature, extracted data and evaluated the quality of included literature according to the Cochrane Handbook V.5.1.0. Meta-analysis was conducted using RevMan 5.3.

Results: A total of 20 references were included, involving 2165 patients with advanced heart failure. The results of the meta-analysis showed that palliative care can improve the quality of life (standardised mean difference (SMD)=1.12, 95% CI 0.28 to 1.97, p=0.009), alleviate anxiety (SMD=-1.27, 95% CI -1.89 to -0.65, P<0.0001) and depression (SMD=-1.33, 95% CI -1.95 to -0.71, p<0.0001)), improve cardiac function (MD=4.41, 95% CI 2.73 to 6.09, p<0.00001) and reduce readmission rates (relative risk (RR)=0.70, 95% CI 0.52 to 0.94, p=0.02), but did not show a significant reduction in mortality rate (RR=1.29, 95% CI 0.82 to 2.05, p=0.28). The certainty of evidence across the outcomes ranged from low to moderate based on the GRADE approach.

Conclusion: Palliative care can enhance the quality of life, alleviate anxiety and depression, improve heart function and reduce readmission rates for patients with advanced heart failure. However, it does not reduce the mortality rate. This article can provide a foundation for the widespread implementation of clinical palliative care. More high-quality and large-sample studies are needed in the future to further explore the impact of palliative care on patients with advanced heart failure.

Prospero registration number: CRD42023489277.

Background: Supportive care is a commonly provided health service for people with cancer, but less is known about how this model of care is implemented in populations with non-malignant, but life-limiting chronic conditions.

Methods: A search from 2000 to February 2024 was performed on four electronic databases targeting supportive care studies in adults living in Organisation for Economic Co-operation and Development Convention countries who had cardiovascular, respiratory, renal, hepatic, neurological or genetic (Huntington's disease and cystic fibrosis) chronic conditions. Data were extracted relating to the type of condition, the supportive care aim, whether the care was spiritual, psychological, social, informational or practical in nature and details relating to replication in a clinical setting.

Results: From 124 full text articles assessed for eligibility, 33 studies (39 reports) were included, representing 3701 participants. Supportive care was most described for people with neurological (n=10, 30%) and renal (n=10, 30%) conditions. The most common aims of supportive care studies related to symptom management (n=12, 36%), decision making (n=6, 18%) and reducing health service utilisation (n=5, 15%). The supportive care provided predominantly took the form of educational/informational (n=25, 76%), practical (n=21, 64%) or psychological care (n=20, 61%). Provision of spiritual care was described least often (n=7, 21%). Multidisciplinary teams commonly provided the service via face-to-face meetings or telephone calls.

Conclusions: This scoping review shows that a variety of supportive care interventions addressing a range of life-limiting chronic conditions exist, with a common focus on education and symptom management. Current gaps are indicated in the provision of social and spiritual support.

Objectives: The aim of this study was to map the use of palliative sedation (PS) in specialised palliative care (SPC) in Sweden and compare the results with a survey made 20 years ago.

Methods: A survey to all SPC units in Sweden was performed during the first quarter of 2025 as add-on questions to the Swedish Register of Palliative Care. The definition of PS was continuous sedation in the final stage of life with the aim of lowering the patient's consciousness due to intractable symptoms. Questions included whether the patient had received PS (yes/no), choice of drug and how long the sedation lasted.

Results: Of 2701 deaths in SPC during the study period, 2069 cases had answered the survey (response rate 77%). Of these, 208 had received PS (10%). The majority of patients had received midazolam as the main sedative, n=185 (89%). Other drugs used as main sedatives were levomepromazine, n=14 (7%); propofol, n=5 (2%); and haloperidol, n=2 (1%). The median duration of sedation was 2 days and 4% had sedation longer than 7 days.

Conclusions: PS is more common in Sweden today than 20 years ago, 10% compared to 1%. The vast majority received midazolam as a sedative.

Patients with cancer are often polysymptomatic due to significant disease and treatment-related morbidity. Vagus nerve stimulation (VNS), a type of neuromodulation, affects various physiological processes that are highly relevant to many cancer-related symptoms. It is an emerging therapy that uses the omnipotent nature of the nerve and is known to ameliorate conditions such as depression, epilepsy, gastrointestinal disorders and migraine. Given the evidence base for VNS and its proven utilisation outside of cancer, we suggest research and clinical application of this treatment modality in supportive oncology.

Objectives: Informal family caregivers are often the primary providers of care for patients with life-limiting illnesses. Although supporting these caregivers is a core component of palliative care, there is a notable lack of context-specific research on caregiver burden from Southeast Asia. This study aimed to examine the experience of caregiving in a tertiary hospital in Malaysia with consultative palliative care services, exploring both the burden experienced and the factors that mitigate or exacerbate it.

Methods: A qualitative-dominant mixed-method study using an explanatory sequential design was conducted in a Malaysian tertiary hospital. Sixteen informal family caregivers were purposively sampled. The 12-item Zarit Burden Interview (ZBI-12) was used to assess caregiver burden, followed by semistructured interviews. Data were thematically analysed, and findings from both phases were synthesised.

Results: ZBI-12 scores indicated low to moderate burden: 50% low, 31% moderate and 19% high. Eight key themes emerged. The four contributing factors were impact on personal life and identity, emotional and psychological strain, physical challenges due to direct care responsibilities and financial burden with resource limitations. Protective factors included coping strategies and resilience, having support systems, access to training and resources, and spiritual coping. Caregivers reporting lower burden levels demonstrated more protective than contributing factors.

Conclusion: Informal family caregivers of palliative care patients often experience significant caregiving burden due to multiple contributing factors. The presence of protective factors can help mitigate its effects. Interventions that enhance caregiver training, provide psychosocial support and improve access to resources may help reduce this burden.

Objectives: To investigate why residents of residential aged care homes (RACH) are transferred to hospital for end-of-life care (EoLC).

Methods: We audited electronic health records at one tertiary referral centre hospital (New South Wales, Australia) from 1 June 2021 to 30 May 2023.

Results: Over a 2 year period, there were 2535 presentations to the emergency department (ED) from RACH, of which 45% were transferred back to RACH, 9% died in ED and 46% were admitted to hospital. Only 17% of those admitted were referred to palliative care, with an average delay of 3 days. The most common reasons for admission were falls, shortness of breath and sepsis. Most patients were in extremis at the time of referral, with an average time to death of 3 days; this was the most common barrier to returning patients to RACH (48%). In other cases (30%), the desired place of care was hospital or there was an urgent reason for admission, for example, fracture requiring surgery.

Conclusions: Once RACH patients are admitted to hospital for EoLC, there is little time to influence the trajectory of care. Future efforts should focus on supporting care in RACH and providing EoLC in situ.

Background: Uncertainty around a patient's prognosis at the end of life remains a major barrier to timely palliative-care involvement and alignment of treatments with patient goals. Artificial intelligence (AI)-based tools have recently emerged to provide structured mortality predictions and identify patients at risk of deterioration to support clinical decision-making.

Objective: This mini-review summarises recent literature evaluating AI-based prognostic and decision-support tools in end-of-life and palliative care, focusing on predictive accuracy, early implementation outcomes, communication effects and ethical considerations.

Methods: A set of peer-reviewed articles published between 2020 and 2025 was identified through a targeted narrative search of major medical databases. Included studies examined prognostic model validation, early-warning systems, implementation outcomes, communication impacts and ethical analyses.

Results: AI-based models consistently produced more accurate short-term mortality predictions than traditional scoring systems or clinician judgement. Early evidence also suggests that integrating AI decision support into clinical workflows can increase identification of patients and initiation of appropriate palliative care, including within generalist settings. However, data are limited regarding the impact of AI-based prognostic tools on treatment intensity or chemotherapy use. Preliminary qualitative work indicates that AI-generated summaries may assist communication among healthcare teams, though concerns persist regarding transparency, bias and over-reliance on algorithms.

Conclusions: AI-driven prognostic models show promise in improving risk identification and facilitating earlier engagement with palliative care. Nonetheless, the current evidence base is preliminary. Future research should include prospective trials and strengthened ethical frameworks to ensure that the integration of AI-based prognostic tools into end-of-life decision-making is both safe and equitable.

Introduction: This article presents a narrative review of psilocybin-assisted psychotherapy as a promising intervention for addressing anxiety, depression and psycho-existential distress in patients with advanced cancer. This group of disorders, often resistant to conventional treatments, significantly impacts patients' quality of life and autonomy, as well as illness trajectories. Psilocybin, when administered in high doses within a structured therapeutic framework, seems to alleviate these symptoms safely and effectively, with potential additional benefits on pain and systemic inflammation.

Methods and analysis: A targeted literature search was conducted across major scientific databases-including PubMed, Scopus, PsycINFO, Cochrane Library and Embase-supervised by experts from various relevant disciplines to identify sources of particular importance.

Results: The process also led to the acquisition of highly cited scientific works to compose a coherent theoretical framework through which to interpret the evidence initially collected. Emerged key themes include: the complex and treatment-resistant nature of psycho-existential disorders in cancer; the importance of set, setting and peak experiences for psilocybin efficacy, as well as the consequent therapeutic value of integrated approaches that include psychotherapy; and the methodological limitations in more recent experimental trials. The article also identifies palliative care as a uniquely appropriate context for psilocybin-assisted psychotherapy.

Conclusion: psilocybin-assisted psychotherapy is a compelling therapeutic option warranting further investigation through rigorous, interdisciplinary research to promote an anthropologically/ethically grounded implementation in palliative settings, even beyond the oncology field.

Objectives: This study aimed to assess illness perception and symptom burden in cancer patients, focusing on how demographic and clinical factors influence these perceptions.

Methods: A cross-sectional study was conducted with 102 cancer patients aged 18 years or older. Participants were assessed using the Brief Illness Perception Questionnaire (BIPQ) to measure illness perception, alongside sociodemographic data. Statistical analyses were performed to identify associations with gender, age, cancer stage and cancer type.

Results: The sample consisted of 68 women (67%) and 34 men (33%), with a mean age of 46 years. Half of the patients were between 40 and 60 years of age. Metastatic cancer was the most common stage (61%), and 100% received chemotherapy. A significant proportion of women (35%) reported high or very high perceptions of their illness compared with 2% of men (p=0.03). Patients aged 40-60 years and those with metastatic cancer also reported higher illness perceptions (p=0.04 and p=0.05). Breast cancer patients had the highest perception scores across all domains (p=0.01).

Conclusion: Illness perception varies by gender, age, cancer stage and type. These findings emphasise the need for personalised psychosocial interventions and educational strategies. Tailored approaches are essential to improve coping and treatment adherence.