BMC Palliative Care最新文献

{"title":"Practices and perspectives on dying at home in Norwegian home care services - a secondary analysis of qualitative data.","authors":"Kristin Valen, Ida Linn Johnsen Enerstvedt, Hilde Håland, Kristin Ådnøy Eriksen, Malin Knutsen Glette","doi":"10.1186/s12904-026-02121-0","DOIUrl":"https://doi.org/10.1186/s12904-026-02121-0","url":null,"abstract":"<p><strong>Background: </strong>There is increasing recognition that individuals of all ages with life-limiting conditions benefit from palliative care. Despite a preference for dying at home, most patients still spend their final days in hospital. The WHO encourages member states to integrate palliative care across all levels of their health system.</p><p><strong>Aim: </strong>This study aims to explore how home care services in a Norwegian municipality implement practices that enable patients to die at home, and how healthcare professionals experience these practices.</p><p><strong>Methods: </strong>A secondary analysis was conducted using qualitative data originally collected in May 2024 for the evaluation of a structured care model for days at home and home death. The dataset comprised four focus groups, one with members of the project team who had developed the model, one with home care unit managers, and two with healthcare workers involved in applying the structured care model in practice. The secondary analysis was conducted between May and August 2025, using Braun and Clarke's thematic analysis.</p><p><strong>Results: </strong>The analyses resulted in the following three themes, which describe how home care services implement practices enabling patients to die at home, as well as their experiences of this practice: T1) Advancing palliative care through focused projects: enhancing competence and addressing challenges; T2) Spending the final days at home: identifying patients with palliative care needs and providing compassionate and effective care, and, T3) Sharing responsibility versus reducing the workload. Fostering knowledge and support in home-based palliative care. Overall, the findings showed that a recently implemented care model improved focus, procedures and collaboration, but also revealed organizational weaknesses. Palliative home care was seen as a nuanced, nonlinear process shaped by patient and family wishes, and end-of-life meetings with patients and families were described as complex, requiring both skilled care and emotional support. Yet some nurses felt insecure and called for more colleagues with whom they could share their experiences, knowledge, and responsibilities.</p><p><strong>Conclusion: </strong>Supported by a newly implemented structured care model, the home care services worked systematically and purposefully to improve the quality of care for patients with palliative needs. However, the data revealed weaknesses in the system, such as a lack of clear reporting guidelines and unclear roles among collaborating healthcare services. Healthcare workers were engaged and described their work as complex and unpredictable, thus underlining the need for confidence, competence, and support from colleagues. Overall, the study demonstrates that palliative home care is enhanced by clearly articulated goals and a comprehensive understanding of the requirements needed to deliver high-quality care.</p>","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822515","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":"Prevalence and predictors of do-not-resuscitate orders among advanced cancer patients receiving palliative care at a tertiary cancer center in Jordan: a 10-year retrospective analysis.","authors":"Omar Shamieh, Waleed Alrjoub, Rahaf Tarawneh, Ghadeer Alarjeh, Rani Shnikat, Lina Alhasasneh, Esra'a Alzubaidi, Fadi Abu Farsakh, Mahmoud Abunasser, Mohammad Alnemer, Abdulrahman Shamieh, Asem Mansour, Hikmat Abdel-Razeq","doi":"10.1186/s12904-026-01995-4","DOIUrl":"https://doi.org/10.1186/s12904-026-01995-4","url":null,"abstract":"<p><strong>Background: </strong>In low- and middle-income countries (LMIC), Do-Not-Resuscitate (DNR) discussions are often delayed or omitted, adversely affecting the quality of end-of-life care. Despite the growing recognition of palliative care, limited evidence exists on the timing and determinants of DNR decisions in these settings.</p><p><strong>Objective: </strong>To assess the prevalence, temporal trends and predictors of DNR orders among advanced cancer patients receiving palliative care at a tertiary center in Jordan.</p><p><strong>Method: </strong>We conducted a retrospective review of all deceased advanced cancer patients who received palliative care at the King Hussein Cancer Center between 2013 and 2022. Demographic, clinical, and code status data at referral and at death were extracted from medical records. Descriptive statistics, chi-square tests, and t-tests were used to identify patterns and associations.</p><p><strong>Results: </strong>Among 5,264 patients were analyzed, 48.9% female, 79.9% married, and 94.6% Jordanian. The most common cancer types were gastrointestinal (26.5%), breast (16.6%), and genitourinary (14.9%). At referral, 26.4% had a DNR order, increasing to 81% at death. Cancer type was significantly associated with DNR status at death (p < .001), with breast and gastrointestinal cancers more likely to have DNR orders. The proportion of DNR orders at death demonstrated an overall upward trend across the study period.</p><p><strong>Conclusions: </strong>There was a substantial shift from CPR to DNR orders between referral and death primarily influenced by clinical rather than demographic factors. These findings underscore the importance of early advance care planning and targeted training in culturally sensitive end-of-life communication to promote patient-centered decision making.</p>","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822579","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":"Persistent nausea burden at peak antiemetic therapy in palliative care: an exploratory study.","authors":"Paulina Pietsch, Lea Summerer, Ruth Mair, Karolina Müller, Daniel Authier, Wolfgang Herr, Michael Rechenmacher, Annette Schnell","doi":"10.1186/s12904-026-02122-z","DOIUrl":"https://doi.org/10.1186/s12904-026-02122-z","url":null,"abstract":"<p><strong>Background: </strong>Nausea is a common and distressing symptom in palliative care, substantially impairing quality of life. Despite guideline-based antiemetic therapy, a considerable proportion of patients continue to experience substantial nausea burden. Evidence guiding personalised management strategies in this setting remains limited. This study aimed to identify routinely available laboratory markers and clinical factors associated with persistent nausea burden at peak antiemetic therapy.</p><p><strong>Methods: </strong>In this retrospective exploratory study, 788 admissions to a specialised palliative care unit (2019-2022) were screened, and 223 cases with documented nausea were included. Nausea burden and associated symptom burdens were assessed at the time of \"peak antiemetic therapy\", defined as the highest level of antiemetic treatment reached during admission beyond which therapy was not further escalated. Symptom burden was measured using the staff-completed Integrated Palliative Outcome Scale (IPOS). Baseline demographic, clinical, and laboratory variables were assessed at admission. Patients were stratified according to persistent nausea burden (IPOS ≥ 2 vs. < 2). Univariable analyses were performed to identify a core set of associated factors. Baseline variables meeting significance criteria were entered into complete-case binary logistic regression with bootstrap validation (1,000 samples; N = 143). Multiple testing was addressed using the Benjamini-Hochberg (BH) procedure.</p><p><strong>Results: </strong>Persistent nausea burden at peak antiemetic therapy was observed in 33% of patients with nausea. After BH adjustment, vomiting and poor appetite (both IPOS ≥ 2), cystatin C levels, broad-spectrum antiemetic therapy, in-house mortality, ileus, and peritoneal carcinomatosis were significantly associated with persistent nausea burden at peak antiemetic therapy in univariable analyses (BH-adjusted p < 0.05). Of these, the baseline variables ileus, peritoneal carcinomatosis, and cystatin C levels constituted the core set for multivariable analysis. In logistic regression, higher cystatin C levels were associated with lower odds of persistent nausea burden (OR = 0.235; 95% CI [0.08-0.47]; BH-adjusted p = 0.003), whereas peritoneal carcinomatosis was associated with higher odds (OR = 3.967; 95% CI [1.54-12.29]; BH-adjusted p = 0.005).</p><p><strong>Conclusions: </strong>Persistent nausea burden co-occurred with diverse clinical factors, underscoring its multifactorial nature in advanced disease. Nausea management in palliation remains a major challenge far beyond the application of antiemetics. Prospective studies are warranted.</p>","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":"25 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13134312/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822190","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":"Satisfaction with end-of-life care and self-rated health among bereaved family members; a descriptive cross-sectional study in an intensive care context.","authors":"Lena Palmryd, Tove Godskesen, Anette Alvariza, Åsa Rejnö","doi":"10.1186/s12904-026-02124-x","DOIUrl":"https://doi.org/10.1186/s12904-026-02124-x","url":null,"abstract":"<p><strong>Background: </strong>In intensive care units, critically ill patients often require life-sustaining interventions. When these no longer benefit the patient, care is often transferred to end-of-life care. Family members may find themselves in a stressful situation, since they often act as proxies in decision-making processes, and support the patient nearing the end of life, while also coping with their own grief. The aim of this study is to investigate bereaved family members' satisfaction with care, decision-making, the patients' last hours of life, and their own self-rated health in end-of-life care in an intensive care setting.</p><p><strong>Method: </strong>A descriptive cross-sectional design with the questionnaire Family Satisfaction with Care in the Intensive care unit (FS-ICU 24) and its subscales FS-ICU Care and FS-ICU Decision-making was used: Bereaved family members from seven intensive care units in an urban region in Sweden participated. Data were analysed using descriptive and inferential statistics.</p><p><strong>Results: </strong>Bereaved family members (n = 141) reported overall satisfaction with end-of-life care, FS-ICU Total 77.6 (SD = 20.4); FS-ICU Care 79.5 (SD = 19.9), and FS-ICU Decision-making 74.8 (SD = 23.3). Dissatisfaction were reported by 12.3% (n = 17) of the family members with insufficient emotional support, 14.7% (n = 20) inconsistent information, and 17% (n = 24) limited control over patients' care. Family members who rated their health as worse compared to a year ago, reported lower satisfaction in FS-ICU Decision-making (p = 0.05).</p><p><strong>Conclusion: </strong>This study shows an overall high satisfaction with end-of-life care in ICUs with summary scores in the upper quarter as measured by the FS-ICU 24. This study also uncovers a lack of attention to the individual needs of family members. Dissatisfaction stemmed from the items concerning insufficient emotional support, inconsistent information, and limited control over patients' care. A markedly dissatisfied subgroup were also identified. These findings underscore the importance of paying attention to family members who express dissatisfaction with care and decision-making and items that received the lowest satisfaction scores. It is of paramount importance that when patients are cared for in ICU at the end of life, family members needs are identified and measures are taken to meet those needs, particularly for the most dissatisfied family members.</p>","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":"25 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13134228/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822335","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 associated with death anxiety in family caregivers of cancer patients: a systematic review.","authors":"HuiMin Su, Kuai In Tam, Yang Li","doi":"10.1186/s12904-026-02127-8","DOIUrl":"https://doi.org/10.1186/s12904-026-02127-8","url":null,"abstract":"<p><strong>Objectives: </strong>This systematic review synthesizes existing literature to identify the current status and key influencing factors related to death anxiety in family caregivers of cancer patients.</p><p><strong>Methods: </strong>A comprehensive search was conducted across seven databases-PubMed, Embase, PsycINFO, Scopus, Web of Science, MEDLINE, and CNKI on July 26th, 2025, with no time restrictions applied. The quality of all included studies was assessed using the Joanna Briggs Institute critical appraisal tools for cross-sectional studies.</p><p><strong>Results: </strong>Eighteen studies were included in the systematic review. Based on our analysis, death anxiety among family caregivers of cancer patients may be influenced by the following six categories of factors: (a) personal factors, (b) disease and caregiving-related factors, (c) psychosocial factors, (d) self-regulatory factors, (e) other factors, and (f) actor and partner effects. Several specific protective and risk factors related to death anxiety were also identified.</p><p><strong>Conclusion: </strong>This review categorizes influencing factors, including protective factors, risk factors, and several contested personal variables, associated with death anxiety. There is a need for longitudinal research to further elucidate the dynamic nature of death anxiety over time. Future studies should adopt a dyadic perspective encompassing both cancer patients and their family caregivers to provide comprehensive insights for healthcare professionals and facilitate the development of effective interventions targeting death anxiety.</p>","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822599","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":"Development and evaluation of an educational video for advance care planning among Chinese university students.","authors":"Qiqi Zhou, Shaoyu Mu, Fengling Xu, Junqing Zhang","doi":"10.1186/s12904-026-02123-y","DOIUrl":"https://doi.org/10.1186/s12904-026-02123-y","url":null,"abstract":"<p><strong>Purpose: </strong>To develop a culturally appropriate an educational video for advance care planning (ACP) in China based on the Delphi-constructed training content for college students with regards to ACP and to investigate the efficacy of its application among college students.</p><p><strong>Design: </strong>A two-round Delphi consultation survey was carried out to collect feedback from experts with regards to the construction of a training content indicator system for ACP and college students. In addition, we performed a quasi-experimental study to investigate the effect of these videos on college students.</p><p><strong>Methods: </strong>Training content was preliminarily determined by performing a literature review and assessing the needs of college students via a questionnaire survey. The Delphi technique was adopted to administer two questionnaires to 18 experts. Between June 2024 and July 2024, a total of 80 college students were recruited from two universities in Chongqing Municipality; these were grouped in the order of enrollment, with 40 students in each group. One group was trained online using the newly developed ACP educational video. The other group was trained offline through regular lectures. Before and after training, we used a questionnaire to compare the two student groups in terms of their readiness for ACP and knowledge score training efficacy.</p><p><strong>Results: </strong>The recovery rate of information from the two rounds was 100% and 94% respectively; the expert authority coefficients were 0.87 and 0.88 respectively, and the Kendall harmony coefficient was 0.201 and 0.220 respectively. The training content relating to ACP included four first-level indicators, nine second-level indicators and 27 third-level indices. The ACP education video featured six major themes and was developed based on the Delphi. Before training, the total ACP readiness scores for the video group and the control group were 86.15 ± 7.41 and 86.23 ± 10.70, respectively. After training, the total ACP readiness scores for the video group and the control group were 96.69 ± 10.34 and 91.82 ± 8.61, respectively. The total ACP readiness score for the video group was significantly higher than that of the control group (p < 0.05). The difference in the percentage of correctness for each entry of ACP knowledge between the two groups before and after training was statistically significant (p < 0.05). The scores for each entry in the video group were significantly higher than those of the control group after training (p < 0.05) for four entries: the content of ACP, the nature of living wills, the timing of activation of living wills, and the choice of decision-making agent.</p><p><strong>Conclusion: </strong>The ACP educational videos developed in this study are culturally appropriate to China, comprehensive and scientifically based, and may provide key reference guidelines for the training of college students.</p>","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786497","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":"Spiritual intelligence and family caregivers' self-efficacy in end-of-life: a cross-sectional study.","authors":"Cristina Teixeira Pinto, Ângela Coelho, Luísa Castro, Rui Nunes, Sara Pinto","doi":"10.1186/s12904-026-02119-8","DOIUrl":"https://doi.org/10.1186/s12904-026-02119-8","url":null,"abstract":"<p><strong>Background: </strong>Burden influences caregiving experiences for family caregivers and patients. While family caregivers are crucial in end-of-life, their burden remains under-researched, particularly regarding the role of spiritual intelligence in shaping this experience.</p><p><strong>Objectives: </strong>To explore the level and type of burden of family caregivers of palliative adult cancer patients and its relationship to variables related to: caregiver; patient; and caregiving process; exploring associated factors of burden.</p><p><strong>Methods: </strong>A quantitative, cross-sectional study including adult, unpaid, primary family caregivers providing support in at least one daily life activity to adult cancer patients. Caregiver burden was assessed using the Zarit Caregiver Burden Scale and spiritual intelligence through Spiritual Intelligence Self-Assessment Inventory. Linear regression analysis was used to examine significant relationships. The study followed the STROBE guidelines for reporting observational research and ethical procedures were ensured.</p><p><strong>Results: </strong>The mean burden level was intense, predominantly on burden subdimension \"Expectations Towards Caregiving\". Significant correlations were found between burden and caregiver age, social support, financial status, caregiver having chronic diseases or being on pain medication and resilience. The multivariable model identified key associated factors: caregiver's older age, having no social support, having other dependents, and lower resilience, explaining approximately 40% of the burden. Spiritual Intelligence subdimension of \"Personal Meaning Production\" was associated with lower burden on \"Self-efficacy Perception\" subdimension.</p><p><strong>Conclusions: </strong>Family caregivers face specific struggles. Policies should provide structured support and financial resources. Interventions to prevent burden should include resilience and spiritual intelligence training, aiming to improve caregivers' self-efficacy.</p>","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786647","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":"Deprescribing decisions in palliative care: a qualitative meta-synthesis of multi-stakeholder experiences and influencing factors.","authors":"Li Chen, Qiaoyan Wu, Yu Zhang, Yunjian Qu, Gang Lei, Zhangyi Wang","doi":"10.1186/s12904-026-02111-2","DOIUrl":"https://doi.org/10.1186/s12904-026-02111-2","url":null,"abstract":"","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786511","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 dilemma of perioperative shared decision-making in an octogenarian with advanced cancer: fracture after stent placement and delayed palliative care.","authors":"Wenwen Jiang, Nini Wang, Xixin Fan, Yuhui Zhao, Zhanzhi Zhao, Ying Zhang","doi":"10.1186/s12904-026-02108-x","DOIUrl":"https://doi.org/10.1186/s12904-026-02108-x","url":null,"abstract":"","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786619","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":"Assessing the feasibility of use and content validity of ICECAP-CPM with bereaved family members of young people who died from serious illness: a UK think-aloud study.","authors":"Isabella Floredin, Paul Mark Mitchell, Samantha Husbands, Susan Neilson, Joanna Coast","doi":"10.1186/s12904-026-02118-9","DOIUrl":"https://doi.org/10.1186/s12904-026-02118-9","url":null,"abstract":"","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786468","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}