Palliative Medicine最新文献

{"title":"Tensions in advance care planning with dementia: Time for a good-enough laid-back approach?","authors":"Jenny T van der Steen, Lieve Van den Block","doi":"10.1177/02692163251316135","DOIUrl":"10.1177/02692163251316135","url":null,"abstract":"","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":" ","pages":"328-331"},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441573","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":"Delirium prevention in hospices: Opportunities and limitations - A focused ethnography.","authors":"Imogen Featherstone, Miriam J Johnson, Trevor Sheldon, Rachael Kelley, Rebecca Hawkins, Alison Bravington, Sarah Callin, Rachael Dixon, George Obita, Najma Siddiqi","doi":"10.1177/02692163241310762","DOIUrl":"10.1177/02692163241310762","url":null,"abstract":"<p><strong>Background: </strong>Delirium is common and distressing for hospice in-patients. Hospital-based research shows delirium may be prevented by targeting its risk factors. Many preventative strategies address patients' fundamental care needs. However, there is little research regarding how interventions need to be tailored to the in-patient hospice setting.</p><p><strong>Aim: </strong>To explore the behaviours of hospice in-patient staff in relation to delirium prevention, and the influences that shape these behaviours.</p><p><strong>Design: </strong>Focused ethnography supported by behaviour change theory. Observation, semi-structured interviews and document review were conducted.</p><p><strong>Setting/participants: </strong>A total of 89 participants (multidisciplinary staff, volunteers, patients and relatives) at two UK in-patient hospice units.</p><p><strong>Results: </strong>Hospice clinicians engaged in many behaviours associated with prevention of delirium as part of person-centred fundamental care, without delirium prevention as an explicit aim. Carrying out essential care tasks was highly valued and supported by adequate staffing levels, multidisciplinary team engagement and role clarity. Patients' reduced physical capability limited some delirium prevention behaviours, as did clinicians' behavioural norms related to prioritising patient comfort. Delirium prevention was not embedded into routine assessment and care decision-making, despite its potential to reduce patient distress.</p><p><strong>Conclusions: </strong>The value placed on fundamental care in hospices supports delirium prevention behaviours but these require adaptation as patients become closer to death. There is a need to increase clinicians' understanding of the potential for delirium prevention to reduce patient distress during illness progression; to support inclusion of delirium prevention in making decisions about care; and to embed routine review of delirium risk factors in practice.</p>","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":" ","pages":"391-400"},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11877983/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143008012","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":"Coming to terms with dying: Advance care planning as a conduit between clinicians, patients, and conversations about death and dying - a qualitative interview study.","authors":"Rowena Jane Eason, Lisa Jane Brighton, Jonathan Koffman, Katherine Bristowe","doi":"10.1177/02692163251318907","DOIUrl":"10.1177/02692163251318907","url":null,"abstract":"<p><strong>Background: </strong>Advance care planning discussions exploring future care and support needs can be beneficial to people with advanced illness. While research has focussed on barriers, outcomes, and completion, little is known about how discussions influence thoughts, feelings, and behaviours.</p><p><strong>Aim: </strong>To explore experiences of advance care planning for people with incurable life-limiting illnesses, to understand the impact of discussions on individuals, and factors influencing psychological responses.</p><p><strong>Design: </strong>Semi-structured qualitative interviews were conducted. Data were analysed using framework analysis. Reflexive journalling and discussion of coding framework and themes supported rigour.</p><p><strong>Setting/participants: </strong>Twenty purposively sampled adults receiving hospice care, aged 30-93 with cancer (<i>n</i> = 15) and non-cancer (<i>n</i> = 5) diagnoses were interviewed.</p><p><strong>Results: </strong>Advance care planning elicits multiple complex thoughts, emotions, and behaviours, with responses ranging from the procedural to the profound. Discussions empowered and instilled confidence, promoted openness with relatives, encouraged people to make the most of their time remaining, and sometimes contributed to coming to terms with their mortality. Factors influencing experiences of discussions reflected the complexity and diversity in participants' lives, personalities, and life experiences, with discussions exposing the realities of living with terminal illness.</p><p><strong>Conclusion: </strong>Individuals' unique lives and experiences shape their responses to, and the impact of advance care planning on how they think, feel and behave. Advance care planning is not simply a means to document end-of-life care preferences, but can empower and instil confidence in patients, and may form part of the process of coming to terms with mortality, allowing clinicians to shift focus from process-related outcomes.</p>","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":" ","pages":"425-436"},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449894","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":"Caring toward end of life through acute hospital and community partnerships: A scoping review.","authors":"Joanna McIlveen, Catherine MacPhail, Mim Fox, Kerrie Noonan","doi":"10.1177/02692163241310692","DOIUrl":"10.1177/02692163241310692","url":null,"abstract":"<p><strong>Background: </strong>Global health systems are currently socially and economically burdened. Public health palliative care is an approach to caring toward end of life that can create the innovative change needed to address this inequity. Guided by the Ottawa Charter for Health Promotion (1986), public health palliative care promotes collaboration among palliative care services, civic institutions, and communities to build capacity in all aspects of death, dying, caregiving, and bereavement. Despite growing evidence for the public health approach to palliative care, little is known about how acute hospitals and communities can work together to provide care toward end of life.</p><p><strong>Aim: </strong>To explore how acute hospitals and communities work together to provide care toward end of life.</p><p><strong>Design: </strong>Scoping review guided by Arskey and O'Malley framework.</p><p><strong>Data sources: </strong>Scopus, Pubmed, CINAHL, and Informit as well as gray literature were searched. Citations were independently assessed against inclusion and exclusion criteria.</p><p><strong>Results: </strong>Of the six included studies and reports, a priori themes of creating supportive environments; strengthening community action; reorienting health services; developing personal skills and building healthy public policy from the Charter were well represented. Additional themes of communication and language, culture and risk were also identified. Educational, arts health, community engagement initiatives were explored as well as clinical tools, psychosocial interventions, and the No One Dies Alone (NODA) program.</p><p><strong>Conclusions: </strong>This review offers policymakers, hospitals, and practitioners a framework for implementing hospital-community partnerships toward end-of-life. Despite challenges in acute settings, these initiatives can enhance end-of-life experiences for patients and families.</p>","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":" ","pages":"346-357"},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11877981/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426021","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":"Training programs in communication skills for healthcare professionals caring for children with life-limiting and life-threatening conditions and their families: A systematic review of healthcare professionals' behavioral impact and children's health outcomes.","authors":"Noyuri Yamaji, Daichi Suzuki, Kiriko Sasayama, Aya Nitamizu, Mami Yamamoto, Mari Ikeda, Erika Ota","doi":"10.1177/02692163251313651","DOIUrl":"10.1177/02692163251313651","url":null,"abstract":"<p><strong>Background: </strong>Effective communication has potential benefits for children, their families, and healthcare professionals. Although communication skills training programs are essential for healthcare professionals, their effects remain unclear.</p><p><strong>Aim: </strong>This review summarized existing communication skills training programs and evaluated their impact on healthcare professionals' behavior and the health outcomes of children with life-threatening conditions and their families.</p><p><strong>Design: </strong>This systematic review was performed in accordance with the Cochrane Handbook version 6.4.</p><p><strong>Data sources: </strong>On January 21, 2024, we searched the following databases: Cochrane Central Register of Controlled Trials, PubMed, MEDLINE, Embase, PsycINFO, and CINAHL. The included studies' risk of bias was assessed using a revised Cochrane risk-of-bias tool for randomized controlled trials 2. Owing to insufficient data and high heterogeneity, we could not perform a meta-analysis, so the findings were described narratively.</p><p><strong>Results: </strong>We identified nine studies, which included various diseases, training programs, and outcome measurement tools and timings. Among the nine studies, five of the six studies that assessed healthcare professionals' behaviors reported that the interventions had improved them (low certainty of evidence). Only two studies reported on the quality of life and anxiety experienced by children and their families, with no clear difference between intervention and control groups.</p><p><strong>Conclusions: </strong>Communication skills training for healthcare professionals may improve their behaviors toward children with life-threatening conditions and their families. Measurement tools and timings must be standardized. Future research should develop training programs and assess their impact on children and their families, incorporating the perspective of children.</p>","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":" ","pages":"358-372"},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365568","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":"'Regrets become a lasting source of pain': A qualitative study on family caregivers' experiences leading up to a relative's death.","authors":"Hui-Ju Liang, Qian Xiong, Peng-Chan Lin, Jui-Hung Tsai, Nancy Preston","doi":"10.1177/02692163251316677","DOIUrl":"10.1177/02692163251316677","url":null,"abstract":"<p><strong>Background: </strong>Death preparations can benefit families both before and during bereavement. While these preparations are culturally influenced, evidence from non-Western cultures, like Eastern Asia, is limited.</p><p><strong>Aim: </strong>To explore how family caregivers prepare for a relative's death in Taiwan.</p><p><strong>Design: </strong>A qualitative interview study analysed with reflexive thematic analysis.</p><p><strong>Setting/participants: </strong>Twenty-two primary family caregivers following a death involving specialist palliative care were interviewed.</p><p><strong>Results: </strong>An overarching theme was 'getting everything right to have no regrets between the dead and the living'. Within this, two themes focussed upon improving the dying relative's outcomes and the families' subsequent bereavement: (1) 'making the right end-of-life decisions is crucial but complex', exploring preparations to involve (or not) the dying relative in making choices to minimise regrets. Participants often felt they understood the dying relative's wishes so respected their preferences while maintaining family harmony through consensus-building and professional guidance. (2) 'becoming a competent caregiver is the priority', addressing preparations for fulfilling responsibilities, making sacrifices and developing caregiving competence to ensure the dying relative's comfort. This would help reduce feelings of regret about not having done enough.</p><p><strong>Conclusion: </strong>Preparing for end-of-life decisions and caregiving is important for participants to reduce regret, benefiting subsequent bereavement. Of particular importance is family involvement and consensus-building in end-of-life decisions, reflecting Taiwan's family-led culture. These findings can inform clinical practices in family-centric decision-making cultures where healthcare workers should be aware of the need to build consensus, sometimes without involving the dying person. Future research should include patients' and healthcare professionals' perspectives.</p>","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":" ","pages":"401-412"},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11877984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382979","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":"Changes and predictors of resilience among wife and husband caregivers of patients with advanced cancer: A longitudinal study.","authors":"Haiyan Sun, Chintana Wacharasin, Pornpat Hengudomsub, Ayano Nagai","doi":"10.1177/02692163251323118","DOIUrl":"https://doi.org/10.1177/02692163251323118","url":null,"abstract":"<p><strong>Background: </strong>Resilience as a dynamic process plays a significant role in caregivers' mental health. Little is known about gender differences in the resilience process and predictors of resilience in spousal caregivers.</p><p><strong>Aim: </strong>To investigate changes in resilience among wives and husbands of patients with advanced cancer over a 6-month posttreatment period, and identify different predictors of resilience between females and males.</p><p><strong>Design: </strong>This longitudinal, observational study was conducted from January to December 2022.</p><p><strong>Setting/participants: </strong>Spousal caregivers of patients with newly diagnosed advanced cancer were recruited from five regional tertiary hospitals in China. There were three assessment points at 1, 3, and 6 months post-initial treatment. The dependent variable was resilience, and five independent repeated variables were investigated.</p><p><strong>Results: </strong>Totally, 179 wife caregivers and 133 husband caregivers were included. Resilience in both wife caregivers and husband caregivers increased over time (Wald χ² = 29.83, <i>p</i> < 0.001) but husbands had higher levels of resilience than wives (Wald χ² = 35.59, <i>p</i> < 0.001). However, there was no interaction between time and gender (Wald χ² = 5.25, <i>p</i> > 0.05). Patient functional status, caregiver burden, social support, coping self-efficacy, and mutuality were predictors of resilience for wife caregivers. Meanwhile, patient functional status, caregiver burden and coping self-efficacy could predict resilience for husband caregivers.</p><p><strong>Conclusions: </strong>Healthcare providers may develop gender-specific interventions to promote resilience in spousal caregivers of patients with advanced cancer. This would improve mental health for caregivers in the process of palliative care.</p>","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":" ","pages":"2692163251323118"},"PeriodicalIF":3.6,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524064","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":"Validating the socio-spiritual items of the Utrecht Symptom Diary-4 Dimensional: Content and construct validity.","authors":"Tom Lormans, Everlien de Graaf, Frederieke van der Baan, Carlo Leget, Saskia Teunissen","doi":"10.1177/02692163251321692","DOIUrl":"https://doi.org/10.1177/02692163251321692","url":null,"abstract":"<p><strong>Background: </strong>The Utrecht Symptom Diary-4 Dimensional (USD-4D) is a multidimensional Patient-Reported Outcome Measure to monitor symptoms and needs and increase patients' self-efficacy. Assessing the content and construct validity of the USD-4D ensures it accurately measures the intended construct and is contextually relevant.</p><p><strong>Aims: </strong>This study aimed to assess the content and construct validity of the socio-spiritual items of the USD-4D in a population of Dutch patients in the palliative phase of their illness.</p><p><strong>Design: </strong>A multiple method study was performed consisting of a cross-sectional survey and an observational cohort study.</p><p><strong>Participants: </strong>The study population consisted of (a) healthcare providers working with patients in the palliative phase and (b) a cohort of patients with a life limiting illness in all settings supplemented by a cohort of hospice patients.</p><p><strong>Results: </strong>At least 80% of participants positively assessed the items comprehensibility and relevance. About half of the respondents indicated that certain items are missing from the USD-4D. A qualitative analysis of missing topics revealed either topics for monitoring over time or topics underlying the constructs included. For every item, at least 75% of hypotheses were confirmed. One hypothesis for the item \"I can let my loved ones go\" was rejected.</p><p><strong>Conclusions: </strong>This study confirmed the content and construct validity on the socio-spiritual items of the USD-4D. Hence, the USD-4D is a validated PROM suitable to be structurally used in clinical palliative care to signal, monitor and to go into dialogue about social and spiritual aspects of patients' values, wishes, and needs.</p>","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":" ","pages":"2692163251321692"},"PeriodicalIF":3.6,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524104","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":"Where to for core outcome sets for best care for the dying person?","authors":"Mary Miller","doi":"10.1177/02692163251322741","DOIUrl":"https://doi.org/10.1177/02692163251322741","url":null,"abstract":"","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":" ","pages":"2692163251322741"},"PeriodicalIF":3.6,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143493058","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":"Changes in perception of prognosis in the last year of life of patients with advanced cancer and its associated factors: Longitudinal results of the eQuiPe study.","authors":"M A J Versluis, L V van de Poll-Franse, M Zijlstra, H W M van Laarhoven, G Vreugdenhil, I Henselmans, L Brom, E J M Kuip, Y M van der Linden, N H J Raijmakers","doi":"10.1177/02692163241301220","DOIUrl":"10.1177/02692163241301220","url":null,"abstract":"<p><strong>Background: </strong>Many patients with advanced cancer are unaware of their limited prognosis, however little is known about the change in awareness during the last year of their lives.</p><p><strong>Aim: </strong>To investigate changes in the perception of prognosis in the last year of life of patients with advanced cancer and its associated factors.</p><p><strong>Design: </strong>Prospective, longitudinal, multicentre, observational study in patients with advanced cancer (eQuiPe). Patients completed 3-monthly follow-up questionnaires until death.</p><p><strong>Setting/participants: </strong>Adult patients diagnosed with advanced cancer were recruited by their treating physician or self-enrolled in one of the forty Dutch hospitals. Only deceased patients with available prognostic data were included for analysis (<i>n</i> = 801).</p><p><strong>Results: </strong>Perception of prognosis changes in the last year of life with an increase in the percentage of patients who are aware of their limited prognosis (from 15% to 40%). Especially in the last 6 months of life, most of the changes were towards a more realistic perception of prognosis. Patients who did not want to know their prognosis remained relatively stable in their wish not to know (range: 14%-18%). Time to death was associated with having a perception of prognosis of < 1 year, >1 year or not knowing the prognosis, but was not associated with not wanting to know the prognosis.</p><p><strong>Conclusion: </strong>Becoming aware of their limited prognosis may make patients with advanced cancer more receptive to start end-of-life discussions. Although some patients prefer not to know their prognosis, it remains important to respectfully explore their preferences and wishes for end-of-life care.</p>","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":" ","pages":"277-285"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771330","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}