BMJ Supportive & Palliative Care最新文献

Objectives: More than 50% of people who die in England and Wales use an ambulance at least once in their last 3 months of life, and around 50% attend the emergency department (ED). In Bradford, an estimated 1000 patients a year are not recognised as being within the last year of life and do not access palliative care services. We aimed to improve access to palliative care and reduce hospital admissions and days spent in hospital during the last year of life.

Methods: We created the Responsive Emergency Assessment and Community Team (REACT), comprised of both ED palliative medicine in-reach and a community virtual ward. The virtual ward accepts patients as 'step-down' from the hospital and 'step-up' from primary care to avoid hospital admissions through intensive holistic support.

Results: Between June 2022 and March 2025, REACT received 1656 referrals. Within the last 12 months, 83% of referrals received face-to-face review. 64% of patients seen by the service had a non-cancer palliative diagnosis, and those seen by REACT were representative of the local population both by ethnicity and by deprivation index. By March 2025, patients known to REACT had a reduction in the number of days spent in hospital in the last year of life by 55%.

Conclusions: REACT has a valuable impact on patient care, autonomy, quality of life and reduces health inequity for patients with life-limiting illnesses. By reducing time spent in the hospital in the last year of life, the service creates additional capacity across the entire healthcare system.

Objective: This study describes and evaluates a comprehensive training programme to improve identification of patients for palliative care (PC) using the Supportive and PC Indicators Tool - Low Income Settings (SPICT-LIS).

Methods: The 2-day (3 hours each) training was for healthcare professionals (HCPs) working in a family medicine service unit, and it consisted primarily of didactic sessions on early identification of patients with PC needs using SPICT-LIS, case-based learning on its application, familiarisation with general PC principles and ongoing mentorship. The training was evaluated using structured questionnaires before and after the training programme.

Results: 58 HCPs were trained. The mean age was 35.55 years (SD=9.08), and the mean years of work in family medicine was 7.51 years. Before the training, only 33% were familiar with the SPICT-LIS, and 66% were confident in identifying patients with PC needs, which improved to 100% and 97% post-training, respectively. After the training, all participants agreed that using the SPICT-LIS in clinical practice is feasible.

Conclusions: Training HCPs in the family medicine setting to use SPICT-LIS is useful and can improve their confidence in the early identification of patients with PC needs. HCPs found SPICT-LIS a feasible tool for use in clinical practice.

Background: Dementia is a major global cause of death, with cases projected to rise from 57.4 million in 2019 to 152.8 million by 2050. As the disease progresses, individuals experience growing frailty, complex health needs and multiple comorbidities, requiring comprehensive support to maintain quality of care. Non-pharmacological physical interventions, targeting either the physical body or immediate environment, may help address these needs, especially in advanced dementia nearing end of life.

Aim: To map, appraise and synthesise evidence on the effectiveness of physical interventions for people with dementia nearing end of life.

Design: An umbrella review of systematic reviews on physical interventions, part of a broader palliative dementia care series.

Data sources: MEDLINE, Epistemonikos and ASSIA were searched for systematic reviews from 1980 to May 2024 involving people with dementia, carers or staff in health and social care settings. Physical interventions were defined as non-pharmacological approaches focusing on the body or physical environment.

Results: From 6052 records, 13 reviews met the inclusion criteria. Interventions grouped into two categories: (1) nutrition and hydration (including enteral feeding) and (2) physical activities (including exercise, massage and approaches to reduce care resistance). Evidence quality was generally low, with no conclusive findings on effectiveness. Most interventions addressed well-being and function, with limited evidence for carer support, holistic assessment or medical management.

Conclusion: Research has primarily targeted well-being and functional outcomes, leaving key gaps in carer support and holistic management, warranting further investigation.

Trial registration: PROSPERO CRD42020162887.

Objectives: To assess clinicians' travel burden in home-based palliative care (PC), identify factors improving the telemedicine (TM) applicability and assess its perceived feasibility.

Methods: This prospective, multicentre, real-world study analysed outpatient visits with oncological patients. It assessed travel and time burden, patient and visit characteristics, perception of both patients and clinicians regarding TM. Statistical analyses were performed to describe the data and evaluate associations between variables.

Results: Based on 311 recorded visits in July 2025, travel time reaching patients' home was 7071 min, visit time was 14 177 min, distance travelled was 4411.85 km. The agreement between clinicians and patients on TM feasibility had a concordance rate of 76.20% (κ=0.55). In these cases, the potential savings were 1493 min on travel time, 2353 min of visit time and 984.6 km in distance. First-time and unscheduled visits were significantly longer than follow-up (p<0.001). Visit time was also significantly longer with uncontrolled symptoms (p=0.0419), higher median PERSONS score or significant therapeutic changes (p<0.001). Multivariate analysis confirmed that expected clinical complexity, type of visit, presence of significant symptoms and target symptom (only for clinicians) were the strongest predictors of TM practicability.

Conclusions: TM could reduce travel burden, but it is feasible in selected cases. Future efforts should focus on identifying patient subgroups for whom TM could safely and effectively replace in-person home visits. Stratifying patients may help optimise resource allocation and guide personalised care models in home-based PC.

A man in his 90s was frail, symptomatic of heart failure and dependent on a pacemaker inserted decades prior for third-degree atrioventricular block. He requested his cardiologist to deactivate the pacemaker so he could die naturally of his underlying cardiac pathology. After 135 days of consultations and advice, the pacemaker was deactivated in a hospice in England. After deactivation, the patient developed bradycardia and hypoxia but remained comfortable and conversant, then gradually became unconscious. Opioid and benzodiazepine were administered at deactivation and later in response to mild symptoms. He died peacefully 18 hours after the capacitous, legal withdrawal of cardiac pacing treatment.

Objectives: Unnecessary hospital admissions for palliative emergencies strain resources and may not meet patients' end-of-life preferences. This study evaluates the impact of a 3-year partnership between Macmillan Cancer Support and the Scottish Ambulance Service (SAS), launched in 2022, to strengthen community-based palliative care and establish alternative referral pathways.

Methods: A retrospective comparative analysis of SAS call data linked to emergency department (ED) outcomes was conducted for 2022 and 2023. We assessed changes in key metrics: acute-care hospital admissions, ambulance conveyance rates and 7-day mortality using χ² and two-proportion z-tests. Costs were estimated using NHS data and scenario modelling of patient length of stay.

Results: A statistically significant 5.47% reduction in hospital conveyances was observed, equating to over 1600 fewer incidents conveyed to hospital. Estimated ambulance service savings totalled £570 871, with ED-related cost reductions from £3.6 to £5.6 million. A modest increase in 7-day mortality was noted, consistent with increasing acuity of patients managed in the community.

Conclusions: The SAS-Macmillan collaboration demonstrates that targeted education, alternative referral pathways and integrated community care can reduce avoidable hospital admissions and improve efficiency. The initiative offers a scalable model to enhance patient-centred, community-based palliative and end-of-life care, aligned with patient preferences.

Objective: The purpose of this study was to investigate the postoperative course of pancreatoduodenectomy (PD) and distal pancreatectomy (DP) by examining body composition, physical function, physical activity and total intake to 1 month postoperatively, and to compare the two groups.

Study design: This study is a retrospective observational study investigating.

Methods: Forty-nine patients for whom preoperative and postoperative evaluation was possible were included. Measurements included operative time, intraoperative blood loss, body weight, body fat mass, skeletal muscle mass index (SMI), grip strength, lower limb muscle strength, walking speed, physical activity, oral intake, total intake, sarcopenia and complications. Body weight, body fat mass, SMI, grip strength, muscle strength of the lower limb, walking speed and sarcopenia were measured preoperatively and 1 month postoperatively.

Results: Weight, SMI, body fat mass and grip strength were significantly lower in both groups at 1 month postoperatively compared with preoperatively (p<0.05). The per cent change in body weight, SMI, body fat mass and grip strength between preoperative and 1 month postoperatively for each group was all significantly lower for PD compared with DP (p<0.05). Postoperative activity and oral intake were significantly lower in the PD group compared with the DP group (p<0.05). The incidence of sarcopenia increased significantly in PD at 1 month postoperatively (p<0.05).

Conclusions: The present study suggests that PD is associated with lower postoperative body composition, physical function and activity than DP. Rehabilitation intervention that takes into account postoperative physical function, physical activity and nutritional status is required, especially for the PD group.