Barriers to timely transitions to comfort care in cancer patients: a review.

IF 1.6 Q2 MEDICINE, GENERAL & INTERNAL
Annals of Medicine and Surgery Pub Date : 2025-07-22 eCollection Date: 2025-09-01 DOI:10.1097/MS9.0000000000003618
Tenzin Tamdin, Sadikshya Bhandari, Samikshya Bhandari, Matthew Barbery, Ravi Bajwa
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引用次数: 0

Abstract

Introduction: "Comfort care" is a holistic approach for patients with terminal conditions, such as cancer, who are not expected to recover. It focuses on managing pain, among other end-of-life symptoms, and providing support to both the patient and their family during the dying process, which can last unpredictably from hours to days. End-of-life care concepts are often shaped by personal judgment and culture and thus lack a single consensus. This can lead to ambiguity in the term "comfort care" itself as well as create confusion in medical communication and treatment, making the transition to comfort care more challenging. In this review, we strive to evaluate the barriers preventing the timely conversion of end-stage cancer patients to comfort care. We also discuss the possible measures to limit these sensitive barriers to avoid futility in treatment and to ensure an ambiguity-free transition to ensure the best possible outcome for the patient. In this paper, we aim to systematically identify and categorize the key barriers that delay comfort care transitions in terminal cancer patients and to propose actionable strategies grounded in current evidence to address these challenges.

Methodology: We conducted a literature search using PubMed and MEDLINE, covering studies published between January 2020 and March 2025. Search terms included a combination of MeSH terms and keywords such as "Palliative Care," "Terminal Care," "Hospice Care," "Communication Barriers," "Cultural Factors," "Cancer," and "Prognostic Uncertainty." Eligible studies were peer-reviewed, published in English, and focused on adult cancer patients receiving palliative or end-of-life care, with a clear emphasis on barriers to timely transitions to comfort care. Studies unrelated to cancer, lacking a focus on barriers, or published in non-English languages were excluded. A total of 156 articles were identified; titles and abstracts were screened for relevance, followed by full-text review based on inclusion criteria. Data from the selected studies were analyzed using a thematic synthesis approach, in which two authors independently categorized findings under three main themes: prognostic uncertainty, communication challenges, and cultural factors. Discrepancies were resolved through discussion.

Findings: Based on our extensive search, we classified the barriers for transition to comfort care into three main headings: Prognostic uncertainty, Challenges to Communication, and cultural factors. High levels of distress were observed in both patients and healthcare providers due to prognostic uncertainty, which complicates the prediction of illness trajectories, negatively affecting quality of life and delaying the transition to comfort care. Communication challenges, such as short consultations, language barriers, and difficult conversations about care goals, were also prevalent. The COVID-19 pandemic exacerbated these issues; there was lingering apprehension surrounding end-of-life discussions. Additionally, cultural factors play a significant role in shaping patients' perceptions of cancer, pain, treatment, and death. Family involvement in decision-making varies across cultures, and systemic inequalities in access to palliative care disproportionately affect racialized groups.

Conclusion: To overcome these barriers, the study emphasizes the need for effective policy-making to improve the quality of life for cancer patients during their care transition. It also becomes crucial to implement measures to improve communication protocols, validate culturally sensitive interventions, and routinely integrate palliative care in oncological practice early. We also need to work towards culturally appropriate interventions and strive to incorporate appropriate communication techniques to eliminate disparity for access to equitable palliative care.

癌症患者及时过渡到舒适护理的障碍:综述。
简介:“舒适护理”是一种针对晚期疾病患者的整体治疗方法,如癌症,他们预计不会康复。它的重点是控制疼痛,以及其他临终症状,并在死亡过程中为患者及其家属提供支持,这一过程可能持续数小时到数天。临终关怀的概念往往受到个人判断和文化的影响,因此缺乏单一的共识。这可能导致术语“舒适护理”本身的模糊性,并在医疗沟通和治疗中造成混乱,使过渡到舒适护理更具挑战性。在这篇综述中,我们努力评估阻止晚期癌症患者及时转向舒适护理的障碍。我们还讨论了限制这些敏感障碍的可能措施,以避免治疗无效,并确保无歧义的过渡,以确保患者的最佳结果。在本文中,我们旨在系统地识别和分类延迟晚期癌症患者舒适护理过渡的关键障碍,并根据现有证据提出可操作的策略来应对这些挑战。方法:我们使用PubMed和MEDLINE进行文献检索,涵盖2020年1月至2025年3月之间发表的研究。搜索词包括MeSH术语和关键词的组合,如“姑息治疗”、“临终关怀”、“临终关怀”、“沟通障碍”、“文化因素”、“癌症”和“预后不确定性”。符合条件的研究经过同行评审,以英文发表,重点关注接受姑息治疗或临终关怀的成年癌症患者,明确强调及时过渡到舒适护理的障碍。与癌症无关、缺乏对障碍的关注或以非英语语言发表的研究被排除在外。共查明156件物品;对标题和摘要进行相关性筛选,然后根据纳入标准对全文进行审查。使用主题综合方法对选定研究的数据进行分析,其中两位作者将研究结果独立分类为三个主题:预后不确定性、沟通挑战和文化因素。分歧通过讨论解决了。研究结果:基于我们广泛的研究,我们将过渡到舒适护理的障碍分为三个主要标题:预后不确定性,沟通挑战和文化因素。由于预后的不确定性,在患者和医疗保健提供者中观察到高度的痛苦,这使疾病轨迹的预测复杂化,对生活质量产生负面影响,并延迟向舒适护理的过渡。沟通方面的挑战,如短暂的咨询、语言障碍和关于护理目标的困难对话,也很普遍。COVID-19大流行加剧了这些问题;人们对生命终结的讨论一直心存疑虑。此外,文化因素在塑造患者对癌症、疼痛、治疗和死亡的看法方面发挥着重要作用。家庭对决策的参与因文化而异,在获得姑息治疗方面的系统性不平等对种族化群体的影响尤为严重。结论:为了克服这些障碍,本研究强调需要有效的政策制定来改善癌症患者在护理过渡期间的生活质量。实施措施以改善沟通协议,验证文化敏感干预措施,并在早期将姑息治疗常规地纳入肿瘤实践也变得至关重要。我们还需要努力采取符合文化的干预措施,并努力采用适当的沟通技术,以消除在获得公平的姑息治疗方面的差距。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Annals of Medicine and Surgery
Annals of Medicine and Surgery MEDICINE, GENERAL & INTERNAL-
自引率
5.90%
发文量
1665
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