Palliative Medicine最新文献

{"title":"Shared Decision making aids in palliative care: A systematic review & meta-analysis of randomized controlled trials.","authors":"Joe El Khoury, Rachel Garofalo, Molly M Kilpatrick, Arya B Mohabbat, Maisha T Robinson, Carolyn Mead-Harvey, Zaheera Lukman, Larry J Prokop, Abd Moain Abu Dabrh","doi":"10.1177/02692163261464375","DOIUrl":"10.1177/02692163261464375","url":null,"abstract":"<p><strong>Background: </strong>Shared Decision Making in palliative care encompassing patient-clinician collaboration has shown potential for improved patient outcomes. However, the impact of decision aids intended to support palliative care decision making discussions across clinical care settings remains uncertain.</p><p><strong>Aim: </strong>To assess the impact of shared of decision aids on decision making, clinical outcomes, and quality of life for patients with palliative care needs and their caregivers.</p><p><strong>Design: </strong>Systematic review and meta-analysis of randomized controlled trials, reported according to PRISMA, with overall evidence quality assessed using GRADE.</p><p><strong>Data sources: </strong>Ovid MEDLINE (all segments), EMBASE, Cochrane CENTRAL, Cochrane Database of Systematic Reviews, and Scopus, from inception through September 20, 2024, without restrictions on publication date, sample size, or language. Eligible studies were randomized controlled trials that included adult patients with palliative care needs or their caregivers, using any form of decision aids. Outcomes encompassed decision-related, clinical, and quality of life measures.</p><p><strong>Results: </strong>Sixteen randomized controlled trials were included. Participant ages ranged from 44 to 85 years. Predominant decision aids were videos or printed materials addressing goals of care and treatment options, with aims that included improving understanding of prognosis and supporting values clarification. Decision aids significantly improved decision-related knowledge (SMD: 0.40, 95% CI: 0.14-0.67, <i>p</i> = 0.003) and lowered preference for cardiopulmonary resuscitation (OR: 0.28, 95% CI: 0.20-0.40, <i>p</i> < 0.001). They showed no significant impact on decisional conflict, satisfaction, or regret.</p><p><strong>Conclusion: </strong>Evidence regarding the effectiveness of decision aids in palliative care decision making is limited and of low overall quality, with observed improvements primarily in patient knowledge and changes in stated treatment preferences rather than established improvements in decision quality or values-concordant care. Future research should prioritize integration into comprehensive shared decision making frameworks, cultural adaptations, and larger-scale studies to enhance patient-centered outcomes.</p>","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":" ","pages":"1229-1254"},"PeriodicalIF":6.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13612879/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148606210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Digital legacy in palliative care: A concept analysis with Walker and Avant's approach.","authors":"Anne Meißner, Jennifer Pengel, Björn Steinführer","doi":"10.1177/02692163261455491","DOIUrl":"10.1177/02692163261455491","url":null,"abstract":"<p><strong>Background: </strong>The increasing digitalization of everyday life means that digital artifacts persist after death, presenting unique and complex challenges in palliative care. Lacking clear conceptualization, digital legacy raises clinical, ethical, and legal uncertainties. Conceptual clarity is crucial to support palliative care teams in addressing digital legacy issues at the end of life.</p><p><strong>Aim: </strong>To examine and clarify the concept of digital legacy in palliative care.</p><p><strong>Design: </strong>A concept analysis was conducted using Walker and Avant's eight-step method.</p><p><strong>Data sources: </strong>Seven electronic databases (CINAHL, Embase, Medline, PsycInfo, Scopus, Web of Science, CareLit) were searched in May 2025, with no time restrictions and relevant English- and German-language publications were reviewed. Given the conceptual focus, no formal study quality appraisal was conducted.</p><p><strong>Results: </strong>From 373 records, 46 articles were included. Digital legacy comprises the totality of digitally encoded artifacts that endure after an individual's death, manifesting as multidimensional, dynamically reconfigurable formations shaped by varying degrees of purposefulness, curation, meaning, media dependency, and access. Consequences include a broad range of emotional responses, ongoing support needs, transgenerational transmission, and potential risks of misuse.</p><p><strong>Conclusions: </strong>The concept of digital legacy in palliative care offers insights into its attributes, antecedents, and consequences. It clearly demonstrates that digital legacy is a complex, multidimensional phenomenon that extends far beyond technical data storage as an integral component of palliative care. Further research is needed to investigate the dynamics of digital legacy in palliative care.</p>","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":" ","pages":"1347-1362"},"PeriodicalIF":6.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors influencing deprescribing in community-dwelling patients with palliative needs in primary care: A qualitative systematic review.","authors":"Jesse F van Weelderen, Ankie C M Hazen, Alexa M M Mulder, Eric C T Geijteman, Saskia C C M Teunissen, Dorien L M Zwart, Matthew P Grant","doi":"10.1177/02692163261465769","DOIUrl":"10.1177/02692163261465769","url":null,"abstract":"<p><strong>Background: </strong>Patients with palliative needs often use potentially inappropriate medications, leading to adverse health outcomes. Deprescribing remains poorly enacted in primary care. Understanding the factors influencing deprescribing is essential for successful implementation into clinical practice.</p><p><strong>Aim: </strong>To explore factors influencing deprescribing in community-dwelling patients with palliative needs in primary care from the perspectives of patients, their caregivers and primary healthcare practitioners.</p><p><strong>Design: </strong>Qualitative systematic review using thematic synthesis, registered in PROSPERO (CRD42024620219).</p><p><strong>Data sources: </strong>MEDLINE, Embase, CINAHL, and PsycINFO were searched from 2000 to January 2025, directed by the Palliative cAre Literature rEview iTeraTive mEthod (PALETTE) framework. Studies were included if they reported on independently living adults with palliative care needs.</p><p><strong>Results: </strong>23 studies were included. Four themes were established: (i) initial stance towards deprescribing: shaped by values, general perceptions of (de)prescribing, and competencies. This served as the premise for (ii) the deprescribing conversation: characterised by an individualised deliberation, shared decision-making, and tailored communication and practical strategies. During this conversation, (de)prescribing was reconsidered in the context of the individual patient, informing final decisions. Whether and how these conversations occurred was dependent on (iii) organisational factors, including systematic work processes and interprofessional collaboration. All factors operated within and interacted with (iv) the context of care, containing system-level prerequisites.</p><p><strong>Conclusions: </strong>Deprescribing in community-dwelling patients with palliative needs in primary care can be optimised by employing a multidimensional strategy that includes patient-centredness, shared decision-making, education, collaboration within the multidisciplinary care team, and systematic work processes, ultimately aiming to improve quality of life.</p>","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":" ","pages":"1270-1288"},"PeriodicalIF":6.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13612883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148631210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advance Care Planning in structurally vulnerable populations: A scoping review of barriers, facilitators, and interventions.","authors":"Andrew Jeong, Brian C M Li, Rachel Z Carter","doi":"10.1177/02692163261465882","DOIUrl":"10.1177/02692163261465882","url":null,"abstract":"<p><strong>Background: </strong>Individuals experiencing structural vulnerabilities experience greater rates of serious illness and face barriers to accessing healthcare, including advance care planning. However, evidence to understand relevant barriers, facilitators, and effective interventions for advance care planning engagement among different structurally vulnerable populations remains fragmented.</p><p><strong>Aim: </strong>To inform advance care planning interventions for structurally vulnerable patients by reviewing: barriers and facilitators to advance care planning; and advance care planning interventions.</p><p><strong>Design: </strong>Scoping review.</p><p><strong>Data sources: </strong>We searched MEDLINE, Embase, CINAHL, and PsycINFO for studies published between January 2003 and October 2024. Eligible studies examined advance care planning for those experiencing housing instability, poverty, racialization of Black or Indigenous race, serious mental illness, or substance use disorders.</p><p><strong>Results: </strong>From 70 included articles, 13 barriers, 13 facilitators, and 6 targets of intervention were identified. Barriers and facilitators were commonly experienced between multiple structurally vulnerable populations. The most common barriers include low advance care planning literacy, discomfort with conversations around mortality, personal, cultural and/or spiritual beliefs, and familial and social isolation. Common facilitators include trusted provider relationships, provider training and empowerment, social support, and tailored advance care planning content and delivery. We identified 27 interventions, most commonly involving advance care planning education and outreach or guided advance care planning.</p><p><strong>Conclusions: </strong>Structurally vulnerable patients share many barriers and facilitators to advance care planning, which can inform interventions for underserved populations. Interventions targeting advance care planning education and outreach or guided advance care planning show promise if providers can incorporate advance care planning facilitators.</p>","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":" ","pages":"1322-1346"},"PeriodicalIF":6.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13612880/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148631223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of tools for identifying palliative care needs and supporting advance care planning: A scoping review of barriers and facilitators in hospital settings.","authors":"Tóra Róin, Jahan Shabnam, Stine G Roikjær, Vibeke Ø Steenfeldt, Cecilie L Egholm, Heidi M Bergenholtz","doi":"10.1177/02692163261465770","DOIUrl":"10.1177/02692163261465770","url":null,"abstract":"<p><strong>Background: </strong>Implementing tools to identify and support palliative care needs remains challenging in hospitals, requiring a clear understanding of implementation determinants. This study defines tools as clinical resources for palliative care identification, needs assessment, and advance care planning support.</p><p><strong>Aim: </strong>This scoping review aimed to identify and categorise the barriers and facilitators influencing the implementation of tools in hospital settings.</p><p><strong>Design: </strong>Following the Arksey and O'Malley framework with PRISMA-ScR reporting, we employed a hybrid analysis combining inductive thematic coding with deductive mapping onto the Consolidated Framework for Implementation Research. Studies in English, Danish, Norwegian, or Swedish were considered eligible for inclusion.</p><p><strong>Data sources: </strong>In May 2024, the databases MEDLINE, Embase, Scopus, CINAHL, SocINDEX, and PsycINFO were searched for studies focusing on tool implementation by healthcare professionals in hospital settings.</p><p><strong>Results: </strong>From 4032 records screened, 25 studies were included. Determinants were identified across all five Consolidated Framework for Implementation Research domains, though primarily concentrated within the Inner Setting and Individuals. Key barriers included time constraints, lack of training, and fragmented communication. Facilitators comprised strong leadership support, clinical champions, multidisciplinary collaboration, and a supportive organisational culture.</p><p><strong>Conclusion: </strong>This scoping review identifies determinants that can inform the selection of implementation strategies for tools in hospitals. Our findings suggest that tool implementation likely requires multi-faceted strategies capable of addressing barriers across multiple levels, from individual training to organisational leadership and culture. Future research should focus on evaluating tailored strategies that account for the unique complexities of different hospital contexts to ensure sustainable adoption.</p>","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":" ","pages":"1255-1269"},"PeriodicalIF":6.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Goal-concordant care for older adults with advanced heart failure: A retrospective cohort study.","authors":"Sarah Godfrey, Maryjane Farr","doi":"10.1177/02692163261464366","DOIUrl":"10.1177/02692163261464366","url":null,"abstract":"<p><strong>Background: </strong>Older adults with advanced heart failure experience significant morbidity and mortality and face higher complication rates from advanced therapies. Ensuring these therapies match patients' values is essential for patient-centered care, and palliative care can be instrumental in clarifying patients' goals.</p><p><strong>Aim: </strong>To examine the relationship between advanced heart failure patients' expressed goals of care and their subsequent clinical outcomes and circumstances of death.</p><p><strong>Design: </strong>In this retrospective cohort study, electronic medical records were reviewed for demographic information, advanced therapy evaluation outcomes, and quality-of-death metrics. Goals of care were identified from palliative consult notes and compared with outcomes to assess goal-concordance.</p><p><strong>Setting/participants: </strong>This single-center study included adults who were referred to both advanced heart failure and palliative care specialists from 2012 to 2022.</p><p><strong>Results: </strong>Of 212 patients, 91 (42.9%) underwent evaluation for advanced therapies, though few received a heart transplant (16, 7.5%) or left ventricular assist device (32, 15.1%). Most (148, 69.8%) had only one palliative physician visit. One hundred thirty-nine (65.6%) died, often in the hospital (55, 40%) and with life-sustaining therapy in the last 24 h (73, 52.5%). Most (167, 78.8%) received goal-concordant care, with the main reasons for discordance being the desire for advanced therapy (33, 15.6%) and complications post-implantation affecting quality of life (9, 4.2%).</p><p><strong>Conclusions: </strong>Few older adults received advanced therapies, and palliative care was underutilized, with many patients seeing palliative care only once. Most received goal-concordant care, but decisions were often made late, highlighting the need for earlier, longitudinal palliative care for these vulnerable patients.</p>","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":" ","pages":"1388-1393"},"PeriodicalIF":6.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148437561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term grief experiences of parents who lost a child to cancer - Results from a multicenter cross-sectional study.","authors":"Peter Francis Raguindin, Eddy Carolina Pedraza, Anna Katharina Vokinger, Eva De Clercq, André Oscar von Bueren, Katrin Scheinemann, Eva Maria Tinner, Eva Bergstraesser, Gisela Michel","doi":"10.1177/02692163261465772","DOIUrl":"10.1177/02692163261465772","url":null,"abstract":"<p><strong>Background: </strong>Childhood cancer deaths may be associated with persistent parental grief. Evidence on grief symptoms beyond ten years post-loss remains limited.</p><p><strong>Aims: </strong>We described grief symptoms, identified grief profiles, and examined associations between grief intensity and sociodemographic, cancer-related characteristics, and time since death.</p><p><strong>Design: </strong>This multicenter cross-sectional survey was conducted in Switzerland (July 2022-July 2023). We used PG-13. Items were rated on a 5-point scale (1-5). We calculated the sum score to assess grief intensity (range 11-55). We employed descriptive statistics, latent profile analysis, and linear regression analyses.</p><p><strong>Setting/participants: </strong>Eligible parents had a child diagnosed with cancer (⩽18 years), who had received treatment at one of three participating Swiss pediatric oncology centers and had died ⩾1 year prior to study participation. Participants were identified via the Swiss Childhood Cancer Registry and invited by the child's former treatment facility.</p><p><strong>Results: </strong>Of 388 identified cases, 103 parents of 81 deceased children participated. Mean grief intensity was 23.3 (SD = 9.0); <i>yearning</i> represented the most prominent symptom (mean = 3.2), while <i>reminder avoidance</i> was least prominent (mean = 1.3). Latent profile analysis revealed three grief profiles: low (56%), moderate (32%), and high grief (12%). High poverty risk (β = 11.04, p<0.001) and death in healthcare facility (β = 3.82, <i>p</i> = 0.024) were associated with higher grief intensity, while longer time since death was associated with lower grief intensity (β = -5.46, <i>p</i> = 0.041).</p><p><strong>Conclusions: </strong>Parental grief symptoms can persist long after the death of a child to cancer. Integrated palliative care, anticipatory guidance, and multidisciplinary collaboration may identify at-risk parents early, and ensure sustained support within the community.</p>","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":" ","pages":"1408-1419"},"PeriodicalIF":6.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148762330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integration of palliative care in a multidisciplinary head and neck cancer clinic: A prospective cohort study.","authors":"Maria Labori, Marc Oliva, Claudia Cruz Sequeiros, Pierluigi Bavestrello, Jennifer Milla, Gala Serrano-Bermudez, Mariluz Naharro, Silvia Llorens-Torromé, Maria Plana, Arnau Lagarda Tous, Judith Peñafiel, Isabel Linares-Galiana, Jesús González-Barboteo","doi":"10.1177/02692163261464439","DOIUrl":"10.1177/02692163261464439","url":null,"abstract":"<p><strong>Background: </strong>Integrated palliative care may improve outcomes in patients with cancer, but few studies have specifically evaluated its benefits in head and neck cancer.</p><p><strong>Aim: </strong>To assess changes in symptom control, quality of life, and supportive care needs in patients with head and neck cancer consecutively treated at a palliative care outpatient clinic over 12 months.</p><p><strong>Design: </strong>Prospective cohort study. Symptoms were assessed at baseline and at 1.5, 3, 6, 9, and 12 months, and quality of life at baseline, 2, and 4 months. Symptom management was adjusted and referrals made as needed.</p><p><strong>Setting and participants: </strong>Palliative care outpatient clinic integrated into the head and neck cancer unit of a comprehensive cancer center. Patients with head and neck cancer referred to this clinic who attended their first consultation were eligible.</p><p><strong>Results: </strong>118 patients (69.5% males; mean [SD] age 62.9 [10.5] years) were included. Most (91%) had active disease (85% receiving anti-cancer treatment). From baseline to month 12, improvements were observed in: average pain intensity (mean [95% CI]), 2.53 [2.09; 2.96] to 1.5 [0.86; 2.14]; total symptom distress score, 27.96 [25.35; 30.57] to 20.34 [16.63; 24.05]; anxiety, 1.86 [1.48; 2.24] to 1.14 [0.57; 1.7]; depression, 3.46 [3; 3.93] to 2.79 [2.13; 3.45]. Quality of life improved from baseline to month 4. Referral rates to supportive care were: social work (50%), psycho-oncology (21%), psychiatry (12%).</p><p><strong>Conclusions: </strong>Patients managed at a dedicated palliative care outpatient clinic showed improvements in symptom control and quality of life over time, which may reflect the contribution of integrated palliative care in the ambulatory setting.</p>","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":" ","pages":"1394-1399"},"PeriodicalIF":6.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148437531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unveiling the 35-year evolution of palliative care in mainland China: An in-depth policy analysis.","authors":"Jiao Tang, Yuan Li, Jie Li, Wei Zhou, Jie Mi, Huanhuan Huang, Xinyu Yu, Li Liu, Yongyi Chen, Yan Jiang, Mingzhao Xiao, Liping Liu, Di Luo, Jinbo Fang, Qinghua Zhao","doi":"10.1177/02692163261464373","DOIUrl":"10.1177/02692163261464373","url":null,"abstract":"<p><strong>Background: </strong>Global aging and rising severe illnesses prevalence have increased demand for palliative care, widening service gaps. Policy support is vital for advancing high-value services.</p><p><strong>Aim: </strong>To unveil the 35-year evolution of palliative care policy in mainland China.</p><p><strong>Design: </strong>An in-depth analysis of the external and internal characteristics of palliative care policy documents. Developmental periods were delineated using core characteristics, key events, and annual releases. Network analysis mapped intersectoral collaboration in palliative care policy-making. Text mining techniques, including burst words and word frequency analysis, identified policy priorities and inclinations. Policy instruments were classified using Rothwell and Zegveld's framework to analyze the policy landscape and its evolution.</p><p><strong>Setting/participants: </strong>Palliative care policies, the research subject of this study, were retrieved from Chinese legal databases and government websites.</p><p><strong>Results: </strong>Policy evolution spanned five periods: germination (1991-2002), exploration (2003-2010), expansion (2011-2015), rapid development (2016-2019), and stable development (2020-2023). Intersectoral collaboration among policymakers evolved from single-department regulation to multi-sectoral governance, with the National Health Commission serving as the pivotal entity. Policy priorities and inclinations reflected the unification of policy terminology, the establishment of an institution-community-home continuum, and the active incorporation of local elements. Policy instruments transitioned from imbalance to greater balance over time, although several sub-instruments remained underutilized.</p><p><strong>Conclusions: </strong>Mainland China has established a comprehensive palliative care policy framework with distinctive features, with development particularly accelerating after 2016. Nonetheless, gaps persist in dedicated legislation or planning, financially sustainable funding strategies, integration into health professional education, and supportive digital infrastructure. Future efforts should prioritize the transition from framework-building to ensuring equitable access.</p>","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":" ","pages":"1375-1387"},"PeriodicalIF":6.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148726026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Propofol for palliative sedation: A systematic review of clinical outcomes, safety, and ethical implications.","authors":"Luís Almeida-Jardim, Paulo Reis-Pina","doi":"10.1177/02692163261465774","DOIUrl":"10.1177/02692163261465774","url":null,"abstract":"<p><strong>Background: </strong>Palliative sedation is used to relieve refractory suffering in terminally ill patients. Propofol, an intravenous anesthetic, may offer advantages due to its rapid onset and short half-life.</p><p><strong>Aim: </strong>To evaluate the role of propofol in palliative sedation, focusing on symptom control, sedation depth, survival time, safety, and ethical implications.</p><p><strong>Design: </strong>Systematic review registered in PROSPERO (CRD42025643575; February 6, 2025).</p><p><strong>Data sources: </strong>Scopus, MEDLINE, and Web of Science were searched for English-language studies (2005-2024) on propofol use in adult terminally ill patients. Studies comparing propofol with other sedatives or non-sedated controls were included; those involving anesthetic or intensive care settings were excluded. Risk of bias and certainty of evidence were assessed. Results were synthesized narratively.</p><p><strong>Results: </strong>Ten non-randomized studies were included (observational, cross-sectional, cohort, case series, and before-and-after designs), mostly of moderate quality, conducted in Europe (<i>n</i> = 7) involving 4072 patients (28,3% received palliative sedation), mainly with cancer. Symptom control was reported in 73%-100% of cases, target sedation depth was achieved in 52%-100%, although outcome definitions and measurement methods varied. Survival ranged from 19 h to 38 days. Propofol was used alone (<i>n</i> = 4) or with other sedatives (<i>n</i> = 6). Respiratory depression was the main safety concern. Ethical issues included absence of explicit consent and rare reports of life-shortening intent.</p><p><strong>Conclusions: </strong>Propofol may be considered as a rescue option in selected refractory cases managed by experienced teams; however, given the low to very low certainty of available evidence, findings should be interpreted cautiously and supported by institutional protocols and further prospective research.</p>","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":" ","pages":"1302-1321"},"PeriodicalIF":6.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13612869/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148631235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}