Palliative Medicine最新文献

{"title":"The focus on life-prolonging anticancer treatment hampers shared decision-making in people with advanced cancer: A qualitative embedded multiple-case study.","authors":"Daisy Jm Ermers, Maartje J van Geel, Yvonne Engels, Demi Kellenaers, Anouk Sj Schuurmans, Floortje K Ploos van Amstel, Carla Ml van Herpen, Yvonne Schoon, Henk J Schers, Kris Cp Vissers, Evelien Jm Kuip, Marieke Perry","doi":"10.1177/02692163241281145","DOIUrl":"https://doi.org/10.1177/02692163241281145","url":null,"abstract":"<p><strong>Background: </strong>Implementing shared decision-making in oncology practice is often limited, particularly integrating the patient's context into decision-making. To improve this, we conducted a quality improvement project, <i>CONtext. CONtext</i> attempts to accomplish this by: (1) Integrating the patient's context into shared decision-making during consultation with the medical oncologist; (2) Actively involving the GP and case manager (a specialized oncology nurse), who often have knowledge about the patient's context, and; (3) Giving the person with advanced cancer a time-out period of up to 2 weeks to consider and discuss treatment options with others, including close family and friends.</p><p><strong>Aim: </strong>To explore how persons with advanced cancer and their involved professionals experienced shared decision-making after the introduction of <i>CONtext</i>.</p><p><strong>Design: </strong>A qualitative embedded multiple-case study using in-depth interviews analysed with inductive content analysis.</p><p><strong>Participants: </strong>A purposive sample of 14 cases, each case consisting of a patient with advanced cancer and ideally their medical oncologist, case manager, and GP.</p><p><strong>Results: </strong>Four themes were identified: shared decision-making is a dynamic and continuous process (1), in which the medical oncologist's treatment recommendation is central (2), fuelled by the patients' experience of not having a choice (3), and integrating the patient's context into shared decision-making was considered important but hampered (4), for example, by the association with the terminal phase.</p><p><strong>Conclusions: </strong>The prevailing tendency among medical oncologists and persons with advanced cancer to prioritize life-prolonging anticancer treatments restricts the potential for shared decision-making. This undermines integrating individual context into decision-making, a critical aspect of the palliative care continuum.</p>","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":" ","pages":"2692163241281145"},"PeriodicalIF":3.6,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142351667","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":"Identification of core indicators for the integration of a palliative care approach in hospitals: An international Delphi study.","authors":"Mary Nevin, Sheila Payne, Valerie Smith","doi":"10.1177/02692163241283540","DOIUrl":"https://doi.org/10.1177/02692163241283540","url":null,"abstract":"<p><strong>Background: </strong>Healthcare providers working in hospitals have significant exposure to patients with palliative care needs. For many patients, these needs often reflect non-specialist rather than specialist palliative care needs. Embedding a palliative care approach in acute hospital-based care however is challenging.</p><p><strong>Aim: </strong>To identify core indicators for the integration of a palliative care approach in hospitals.</p><p><strong>Design: </strong>A Delphi technique used three sequential online survey rounds. Preliminary indicators were identified in a concept analysis of a palliative care approach, and a systematic review of hospital-based healthcare providers' views of a palliative care approach.</p><p><strong>Participants: </strong>An international expert panel of three key stakeholder groups (clinicians, researchers, patients/family members) participated in each Delphi round.</p><p><strong>Results: </strong>The Delphi participants were recruited from 12 countries; 97 individuals responded to round 1, 78 to round 2 and 72 to round 3 (74% overall response rate). Consensus was achieved (defined a priori as >70%) on 32 core indicators of a hospital-based palliative care approach, with five structural indicators (relating to infrastructure and governance), 21 organisational indicators (relating to clinical care processes) and six staff indicators (relating to training and support for healthcare providers).</p><p><strong>Conclusions: </strong>This study offers multi-level guidance for clinical practice, policy and research related to integration of a palliative care approach in hospitals, based on evidence and international consensus from major stakeholder groups. These core indicators provide a means to assess, review and communicate the core elements of a palliative care approach in hospitals.</p>","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":" ","pages":"2692163241283540"},"PeriodicalIF":3.6,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142351666","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":"The ideal path to a good death: An international meta-synthesis of rural residents' perspectives.","authors":"Huan Wang, Meijing Cheng, Ziqing Zhang, Xiaoyu He, Lei Hu, Dan Yang, Ni Gong","doi":"10.1177/02692163241277928","DOIUrl":"https://doi.org/10.1177/02692163241277928","url":null,"abstract":"<p><strong>Background: </strong>Rural areas frequently encounter restricted access to healthcare and end-of-life services. Given current pressing realities, understanding their unique perspectives on what constitutes a good death is essential. Existing research has largely overlooked the voices of rural residents.</p><p><strong>Aim: </strong>To obtain a more comprehensive understanding of rural residents' expectations regarding a good death.</p><p><strong>Design: </strong>A meta-synthesis. By exploring the logic within relevant content, the stages of the life course serve as the framework for integration.</p><p><strong>Data sources: </strong>PubMed, Web of Science Core Collection, Embase, Cochrane Library, CINAHL (EBSCO), PsycINFO (EBSCO), China National Knowledge Infrastructure (CNKI), WanFang, and China Biology Medicine disc (CBM) were systematically searched from their inception to May 2023.</p><p><strong>Result: </strong>Of the 1100 articles retrieved, 8 studies were included. This paper outlines \"the path to a rural good death\": (1) When death is perceived as distant: acknowledge its inevitability while striving to achieve a successful and complete life journey. (2) As death approaches: maintain composure and have the capacity and support to face it. (3) When death truly arrives: depart in an envisioned scenario. (4) What's left behind: be properly arranged.</p><p><strong>Conclusion: </strong>The essential characteristics of a rural good death align with previous interpretations. However, distinct aspects emerge: communities play a significant role, characterized by reciprocal relationships; the role of medicine is less emphasized; and \"rurality\" deeply shapes residents' expectations of a good death. The pathway to a good death presented in this article is aspirational, requiring collaborative efforts to make it a tangible reality.</p>","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":" ","pages":"2692163241277928"},"PeriodicalIF":3.6,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142351668","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":"Exploring the contextual assumptions, interventions and outcomes of digital advance care planning systems: A theory of change approach to understand implementation and evaluation.","authors":"Andy Bradshaw, Matthew J Allsop, Jacqueline Birtwistle, Catherine J Evans, Samuel D Relton, Suzanne H Richards, Maureen Twiddy, Robbie Foy, Pablo Millares Martin, Sarah Yardley, Katherine E Sleeman","doi":"10.1177/02692163241280134","DOIUrl":"https://doi.org/10.1177/02692163241280134","url":null,"abstract":"<p><strong>Background: </strong>Digital advance care planning systems are used internationally to document and share patients' wishes and preferences to inform care delivery. However, their use is impeded by a limited understanding of factors influencing implementation and evaluation.</p><p><strong>Aim: </strong>To develop mid-range programme theory to account for technological, infrastructure and human factor influences on digital advance care planning systems.</p><p><strong>Design: </strong>Exploratory qualitative research design incorporating Theory of Change workshops that explored contextual assumptions affecting digital advance care planning in practice. A mid-range programme theory was developed through thematic framework analysis using the Non-adoption, Abandonment, Scale-up, Spread and Sustainability (NASSS) framework, generating a conceptual model depicting contextual assumptions, interventions and outcomes influencing implementation.</p><p><strong>Participants: </strong>A total of 38 participants (16 from London, 14 from West Yorkshire and 8 online) including patients, carers and health and care professionals (including those with commissioning responsibilities).</p><p><strong>Results: </strong>A conceptual model was generated depicting five distinct components relating to digital advance care planning system use: (sociocultural, technical and structural prerequisites; recognition of the clinical need for conversation; having conversations and documenting decisions; accessing, actioning and amending; and using data to support evaluation, use and implementation). There were differences and uncertainty relating to what digital advance care planning systems are, who they are for and how they should be evaluated.</p><p><strong>Conclusions: </strong>Digital advance care planning lacks shared beliefs and practices, despite these being essential for complex technology implementation. Our mid-range programme theory can guide their further development and application by considering technological, infrastructure and human factor influences to optimise their implementation.</p>","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":" ","pages":"2692163241280134"},"PeriodicalIF":3.6,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142292977","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":"Practice review: Pharmacological management of severe chronic breathlessness in adults with advanced life-limiting diseases.","authors":"Steffen T Simon,Irene J Higginson,Claudia Bausewein,Caroline J Jolley,Sabrina Bajwah,Matthew Maddocks,Carolin Wilharm,Adejoke O Oluyase,Anne Pralong,","doi":"10.1177/02692163241270945","DOIUrl":"https://doi.org/10.1177/02692163241270945","url":null,"abstract":"BACKGROUNDSevere and refractory chronic breathlessness is a common and burdensome symptom in patients with advanced life-limiting disease. Its clinical management is challenging because of the lack of effective interventions.AIMTo provide practice recommendations on the safe use of pharmacological therapies for severe chronic breathlessness.DESIGNScoping review of (inter)national guidelines and systematic reviews. We additionally searched for primary studies where no systematic review could be identified. Consensus on the recommendations was reached by 75% approval within an international expert panel.DATA SOURCESSearches in MEDLINE, Cochrane Library and Guideline International Network until March 2023. Inclusion of publications on the use of antidepressants, benzodiazepines, opioids or corticosteroids for chronic breathlessness in adults with cancer, chronic obstructive pulmonary disease, interstitial lung disease or chronic heart failure.RESULTSOverall, the evidence from eight guidelines, 14 systematic reviews and 3 randomised controlled trials (RCTs) on antidepressants is limited. There is low quality evidence favouring opioids in patients with chronic obstructive pulmonary disease, cancer and interstitial lung disease. For chronic heart failure, evidence is inconclusive. Benzodiazepines should only be considered for anxiety associated with severe breathlessness. Antidepressants and corticosteroids should not be used.CONCLUSIONManagement of breathlessness remains challenging with only few pharmacological options with limited and partially conflicting evidence. Therefore, pharmacological treatment should be reserved for patients with advanced disease under monitoring of side effects, after optimisation of the underlying condition and use of evidence-based non-pharmacological interventions as first-line treatment.","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":"4 1","pages":"2692163241270945"},"PeriodicalIF":4.4,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142207806","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":"Patient and family perspectives on rural palliative care models: A systematic review and meta-synthesis","authors":"Claire Marshall, Claudia Virdun, Jane L. Phillips","doi":"10.1177/02692163241269796","DOIUrl":"https://doi.org/10.1177/02692163241269796","url":null,"abstract":"Background:Almost half the world’s population lives in rural areas. How best to provide palliative care to rural populations is unclear. Privileging rural patient and family voices about their experiences of receiving care delivered via rural palliative care models is necessary.Aim:To identify the key palliative care elements that rural patients with palliative care needs and their families perceive to be critical to receiving the care and support they need to live well.Design and Data Sources:A systematic review and meta-synthesis registered with Prospero (CRD42020154273). Three databases were searched in June 2024. Raw qualitative data were extracted and analysed using Thomas and Harden’s three-stage thematic synthesis methodology. Findings reported according to the PRISMA statement.Results:Of the 10,834 identified papers, 11 met the inclusion criteria. Meta-synthesis of extracted, raw quotes (n = 209) revealed three major themes: (1) Honouring the patient’s existing relationship with their General Practitioner (GP); (2) strategically timed access to specialist services, clinicians and equipment is critical; and (3) a need to feel safe, prepared and supported.Conclusion:The strategic inclusion of specialists alongside primary care providers is integral to optimising rural palliative care models. General Practioners are central to these models, through being embedded in their communities and as the conduit to specialist palliative care services. Rural palliative care patients and families value responsive care, trajectory signposting, effective communication, 24/7 support and recognise the value of virtual health. Globally, positive public policy and funding is critical to ensuring access to GP-led, specialist-supported, rural palliative care models.","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":"17 1","pages":"2692163241269796"},"PeriodicalIF":4.4,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142207808","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":"Communication processes in an advance care planning initiative: A socio-ecological perspective for service evaluation","authors":"Marie C Haverfield, Jessica Ma, Anne Walling, David B Bekelman, Cati Brown-Johnson, Natalie Lo, Karl A Lorenz, Karleen F Giannitrapani","doi":"10.1177/02692163241277394","DOIUrl":"https://doi.org/10.1177/02692163241277394","url":null,"abstract":"Background:Advance care planning initiatives are becoming more widespread, increasing expectations for providers to engage in goals of care conversations. However, less is known about how providers communicate advance care planning within and throughout a health care system.Aim:To explore perspectives of communication processes in the rollout of an advance care planning initiative.Design:Theoretically informed secondary analysis of 31 semi-structured interviews.Setting/Participants:Key partners in a Veterans Health Administration goals of care initiative.Results:Using the constant comparative approach followed by qualitative mapping of themes to the layers of the Socio-Ecological Model, four themes and corresponding Socio-Ecological layers were identified: Goals of Care Communication Training (Policy, Community, and Institutional) requires more resources across sites and better messaging to reduce provider misconceptions and promote an institutional culture invested in advance care planning; Interprofessional Communication (Interpersonal) suggests care team coordination is needed to facilitate continuity in goals of care messaging; Communication in Documentation (Institutional, Interpersonal, and Intrapersonal) highlights the need for capturing the context for goals of care preferences; and Patient/Family Communication (Interpersonal and Intrapersonal) encourages offering materials and informational resources early to facilitate rapport building and readiness to determine goals of care.Conclusions:Findings support the need for initiatives to incorporate an evaluation of how goals of care are discussed beyond the interpersonal exchange between patient and provider and signal opportunities for applying the Socio-Ecological Model to better understand goals of care communication processes, including opportunities to improve initiation and documentation of goals of care.","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":"17 1","pages":"2692163241277394"},"PeriodicalIF":4.4,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142207807","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":"Fostering nurse-patient relationships in palliative care: An integrative review with narrative synthesis","authors":"Suzanne Bishaw, Elisabeth Coyne, Georgia KB Halkett, Melissa J Bloomer","doi":"10.1177/02692163241277380","DOIUrl":"https://doi.org/10.1177/02692163241277380","url":null,"abstract":"Background:Nurse-patient relationships are an integral component of person-centred palliative care. Greater understanding of how nurse-patient relationships are fostered and perceived by patients and nurses can be used to inform nursing practice.Aim:To systematically identify and synthesise how nurse-patient relationships are fostered in specialist inpatient palliative care settings, and how nurse-patient relationships were perceived by patients and nurses.Design:Integrative review with narrative synthesis. The review protocol was registered with PROSPERO (CRD42022336148, updated April, 2023).Data Sources:Five electronic databases (PubMed, CINAHL Complete, Medline, Web of Science and PsycINFO) were searched for articles published from their inception to December 2023. Studies were included if they (i) examined nurse and/or patient perspectives and experiences of nurse-patient relationships in specialist inpatient palliative care, (ii) were published in English in a (iii) peer-reviewed journal. The Mixed Methods Appraisal Tool was used to evaluate study quality. Data were synthesised using narrative synthesis.Results:Thirty-four papers from 31 studies were included in this review. Studies were mostly qualitative and were of high methodological quality. Four themes were identified: (a) creating connections; (b) fostering meaningful patient engagement; (c) negotiating choices and (d) building trust.Conclusions:Nurses and patients are invested in the nurse-patient relationship, benefitting when it is positive, therapeutic and both parties are valued partners in the care. Key elements of fostering the nurse-patient relationship in palliative care were revealed, however, the dominance of the nurses’ perspectives signifies that the nature and impact of these relationships may not be well understood.","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":"14 1","pages":"2692163241277380"},"PeriodicalIF":4.4,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142207809","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":"Feasibility and effectiveness of a two-tiered intervention involving training and a new consultation model for patients with palliative care needs in primary care: A before-after study.","authors":"Carlos Seiça Cardoso, Filipe Prazeres, Bárbara Oliveiros, Cátia Nunes, Pedro Simões, Carolina Aires, Patrícia Rita, Joana Penetra, Paulo Lopes, Sara Alcobia, Sara Baptista, Carla Venâncio, Barbara Gomes","doi":"10.1177/02692163231219682","DOIUrl":"10.1177/02692163231219682","url":null,"abstract":"<p><strong>Background: </strong>Evidence suggests that involving General Practitioners in the care of patients with palliative care needs may improve patient outcomes.</p><p><strong>Aim: </strong>To evaluate whether a two-tiered intervention involving training in palliative care and a new consultation model in primary care for patients with palliative care needs is feasible and could reduce patients' symptom burden.</p><p><strong>Design: </strong>Before-after study including an internal pilot.</p><p><strong>Setting/participants: </strong>Nine general practitioners working in a health region in Portugal and 53 patients with palliative care needs from their patient lists were recruited. General Practitioners received training in palliative care and used a new primary palliative care consultation model, with medical consultations every 3 weeks for 12 weeks. The primary outcome was physical symptom burden, self-reported using the Integrated Palliative care Outcome Scale (IPOS) patient version (min.0-max.1000). Secondary outcomes included emotional symptoms (min.0-max.400) and communication/practical issues (min.0-max.300).</p><p><strong>Results: </strong>Of the 35/53 patients completed the 12-week intervention (mean age 72.53 years, SD = 13.45; 54.7% female). All had advanced disease: one third had cancer (<i>n</i> = 13), one third had congestive heart failure (<i>n</i> = 12); others had chronic kidney disease and chronic obstructive pulmonary disease. After the 12 weeks of intervention, there was a reduction in physical symptom burden [mean difference from baseline of 71.42 (95%CI 37.01-105.85) with a medium-large effect size (0.71], and in emotional symptom burden [mean difference 42.86 (95%CI 16.14-69.58), with a medium effect size (0.55)]. No difference was found for communication/practical issues.</p><p><strong>Conclusions: </strong>Our intervention can be effective in reducing patients' physical and emotional symptoms.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov ID - NCT05244590. Registration: 14th February 2022.</p>","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":" ","pages":"842-852"},"PeriodicalIF":3.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11445974/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139472867","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":"Factors influencing deprescribing in primary care for those towards the end of life: A qualitative interview study with patients and healthcare practitioners.","authors":"Maike S van der Waal, Saskia Ccm Teunissen, Allegonda G Uyttewaal, Cathelijne Verboeket-Crul, Hanneke Smits-Pelser, Eric Ct Geijteman, Matthew P Grant","doi":"10.1177/02692163241261202","DOIUrl":"10.1177/02692163241261202","url":null,"abstract":"<p><strong>Background: </strong>For people with limited lifetime expectancy, the benefit of many medications may be outweighed by their potential harms. Despite the relevance of reducing unnecessary medication use, deprescribing is poorly enacted in primary care practice.</p><p><strong>Aim: </strong>This study aims to describe factors, as identified by primary care professionals and patients, that influence deprescribing in the last phase of life.</p><p><strong>Design: </strong>Semi-structured interviews were conducted and analysed using a thematic approach.</p><p><strong>Setting/participants: </strong>This study was performed in primary care settings, including general practices, hospices and community care teams in The Netherlands. Purposefully identified primary care professionals (general practitioners, pharmacists, nurses) and patients with limited lifetime expectancy due to advanced chronic illness or cancer and their caretakers were interviewed.</p><p><strong>Results: </strong>Three themes emerged detailing factors influencing deprescribing in the last phase of life in primary care: (1) non-maleficence, the wish to avoid additional psychological or physical distress; (2) reactive care, the lack of priority and awareness of eligible patients; and (3) discontinuity of care within primary care and between primary care and specialty care.</p><p><strong>Conclusions: </strong>Deprescribing is an incremental process, complicated by the unpredictability of life expectancy and attitudes of patients and health care professionals that associate continued medication use with clinical stability. Opportunities to facilitate the deprescribing process and its acceptance include the routinely systematic identification of patients with limited life expectancy and potentially inappropriate medications, and normalisation of deprescribing as component of regular primary care, occurring for all patients and continuing into end-of-life care.</p>","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":" ","pages":"884-892"},"PeriodicalIF":3.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11528977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141446738","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}