BMC Palliative Care最新文献

{"title":"LiverCare - a palliative care intervention for patients with liver cirrhosis: study protocol for a multi-center, pragmatic, non-randomised clinical trial.","authors":"Malene Barfod O'Connell, Birgitte Gade Jacobsen, Ane Søgaard Teisner, Palle Bager, Marie Louise Hamberg, Janni Mendahl, Kristoffer Marsaa, Mai-Britt Guldin, Nina Kimer, Mette Munk Lauridsen, Lea Ladegaard","doi":"10.1186/s12904-026-02182-1","DOIUrl":"10.1186/s12904-026-02182-1","url":null,"abstract":"<p><strong>Background: </strong>In the transition from compensated to decompensated cirrhosis, median survival decreases from 12 to two years, and patients face some of the highest rates of unplanned hospital admissions. Despite existing recommendations, palliative care is not routinely offered to this population. The aim of this study is to evaluate the effectiveness and implementation of an interdisciplinary palliative care intervention for patients with cirrhosis and their informal caregivers.</p><p><strong>Methods: </strong>The LiverCare study is a multi-center, mixed-method, pragmatic, non-randomised clinical study with a hybrid type 1 effectiveness-implementation design. The study is conducted in hepatology departments across four hospitals in three of Denmark's five regions. It is guided by the British Medical Research Council and Reach, Effectiveness, Adaption, Implementation, Monitor frameworks and includes both a feasibility study and a mixed-method process evaluation. The LiverCare intervention is grounded in a palliative approach, emphasising open, exploratory palliative care conversations. The intervention is integrated into routine outpatient care and the palliative care conversations are delivered by hepatologists and liver nurses who attended a specially designed course within palliative care. Eligible participants are adults with decompensated liver cirrhosis of any etiology who meet at least one general and one disease-specific palliative care indicator, assessed using the Supportive and Palliative Care Indicators Tool. Informal caregivers are invited to participate in the intervention. Palliative care conversations are initiated following a formal invitation and continue after four to ten weeks and then every six months up to 36 months or until study withdrawal or death. The primary outcome is healthcare utilization, defined as the number and length of hospital admissions, compared to a historic cohort. Secondary outcomes include outpatient contacts, symptom burden, quality of life, and caregiver burden. The study also includes cost-effectiveness and cost-utility analysis.</p><p><strong>Discussion: </strong>Insights gained from the study will inform future implementation strategies and contribute to the advancement of palliative care practices in hepatology. The results will further support education, training, and competence development for healthcare professionals caring for patients with advanced liver disease.</p><p><strong>Trial registration: </strong>The study is registered on clinicaltrials.gov (NCT05431946), approved by The Danish Data Protection Agency and reported to the Committee on Health Research Ethics (20222000-31).</p>","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504752/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148266783","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":"FuturePall: Forecasting the specialized inpatient palliative care in Germany based on demographic trends and utilization rates.","authors":"Marcel A Kamp, Joachim Bergmann, Christiane von Saß, Larissa Fink, Jil Adelstein, Felix Muehlensiepen, Birgitt van Oorschot","doi":"10.1186/s12904-026-02130-z","DOIUrl":"10.1186/s12904-026-02130-z","url":null,"abstract":"<p><strong>Introduction: </strong>Demographic aging poses a significant challenge for specialized inpatient palliative care (SIPC). In the German healthcare system, SIPC is defined as hospital-based multi-professional care delivered through dedicated palliative units, consultation services, or complex care on general wards. To inform future resource allocation, this study predicts the demand for SIPC in Germany up to 2035, specifically examining the impact of shifting population structures on hospital-based palliative service utilization.</p><p><strong>Methods: </strong>We analyzed baseline utilization data from the 2021 Trinovis Database, which aggregates mandatory structural and performance reports from German hospitals submitted to the Federal Joint Committee (G-BA). Specialized inpatient palliative care (SIPC) was defined using specific Operation and Procedure (OPS) codes. By applying these age-, gender-, and region-specific utilization rates to population projections provided by the German Federal Statistical Office, we forecasted the annual demand for SIPC from the 2021 baseline through the target year of 2035.</p><p><strong>Results: </strong>Germany's adult population is expected to decline slightly by 2035, but the proportion of individuals aged 65 years and older will increase. SIPC cases are projected to rise from 108,645 in 2021 to 119,923 by 2035, reflecting a growth rate of 0.7% annually. The proportion of SIPC cases involving patients aged 65 years and older will increase. Regional disparities will persist, with varying growth rates in different federal states.</p><p><strong>Conclusion: </strong>The \"FuturePall\" study forecasts a rising demand for SIPC in Germany due to demographic shifts, particularly among older adults. Policymakers must plan for these changes by allocating resources, enhancing infrastructure, and adapting healthcare strategies to meet the evolving needs of an aging population. Future research should explore the impact of non-demographic factors on SIPC demand.</p>","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":"25 1","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13267715/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148254032","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":"Dying as a 'normal', 'ordinary' or 'natural' process in palliative care: a systematic scoping review and narrative synthesis.","authors":"Hyun Woo Yu, Pretty Manyimo, John I MacArtney","doi":"10.1186/s12904-026-02195-w","DOIUrl":"10.1186/s12904-026-02195-w","url":null,"abstract":"<p><strong>Background: </strong>The World Health Organization definition of palliative care describes dying as a 'normal' process and it, along with related ideas of 'ordinary' or 'natural' dying, is important in understanding what a 'good' death is. This scoping review aims to explore how dying has been described as 'normal', 'ordinary' or 'natural' in empirical palliative care literature to provide palliative care stakeholders with evidence-based insights into how this concept may enable quality dying experiences and a 'good' death.</p><p><strong>Methods: </strong>A scoping review was conducted by searching six online databases (Medline (via Ovid), Embase (via Ovid), PsycINFO (via Ovid), CINAHL (via EBSCO), Web of Science, and Scopus) for empirical English-language palliative care literature that explicitly described dying as 'normal', 'ordinary', 'natural', or their interchangeable terms 'standard, 'typical' or 'usual'. A narrative synthesis was used to present the clusters of features associated with their descriptions.</p><p><strong>Results: </strong>Twenty-one studies used 'normal', 'ordinary', 'natural' and 'typical' dying. They were often employed as a single statement despite some authors' concerns regarding the lack of conceptual clarity. Interchangeability between 'normal' and 'natural' dying was observed. Understandings of 'normal', 'natural' and 'typical' were found to be diverse, subjective, and contextually bounded. Although there was some evidence that 'normal', 'natural' and 'typical' dying can influence the quality of dying experiences in palliative care, there was no evidence for 'ordinary' dying due to a lack of explicit use in the included studies.</p><p><strong>Conclusions: </strong>Understandings of dying as 'normal', 'natural' or 'typical' are held by clinicians and patients to play an important role in shaping the quality of dying experiences and providing a 'good' death in palliative care. However, the use of each idea remains heterogeneous, with conflicting definitions across terms. The diffuse evidence base suggests that the potential benefits, harms or limitations of their use in palliative care are therefore unclear. For this reason, we recommend caution regarding their use in practice or policy.</p>","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13495523/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148260244","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":"Understanding pain in malignant mesothelioma: a prospective, longitudinal cohort study.","authors":"Catriona R Mayland, Michelle Collinson, Sam H Ahmedzai, Joseph Lucas, Jacqui Gath, Liz Darlison, Duneesha Defonseka, Barry Laird, Helena Stanley, Sarah Danson, Clare Gardiner, Anna C Bibby","doi":"10.1186/s12904-026-02187-w","DOIUrl":"10.1186/s12904-026-02187-w","url":null,"abstract":"<p><strong>Background: </strong>Pain associated with malignant mesothelioma can be complex. The natural course of pain over the disease trajectory is not well studied. The aim of this study was to explore the prevalence, severity, impact and clinical course of pain for people with mesothelioma over a 12-month period.</p><p><strong>Methods: </strong>A prospective observational study was conducted as a component of a larger national, multi-centre cohort study on mesothelioma - ASSESS-meso (A prospective obServational cohort Study collecting data on dEmographics, Symptoms and biomarkerS in people with mesothelioma) (ISRCTN: 61,861,764). Adults (> = 18 years) newly diagnosed with mesothelioma were recruited from out-patient clinics in 20 hospitals. Baseline demographic and clinical data were recorded. Frequency, severity and impact of pain, quality of life and mood were collected using Patient-Reported Outcome Measures (e.g., EORTC Quality of Life Questionnaire Core Questionnaire PALliative Cancer [QLQ-C15-PAL], Brief Pain Inventory [BPI]). Follow-up occurred 3-monthly for 12-months.</p><p><strong>Results: </strong>Among the 150 participants recruited, mean age was 72.4 years (SD 8.1), with 112 (74.7%) being men. Baseline assessments showed a greater proportion of participants were affected by dyspnoea compared with pain. Overall, twenty-one (14.0%) participants reported moderate or severe chest pain (defined as > = 40/100) although none were receiving strong opioids. Median pain duration was 14.1 weeks (IQR 10-24.1). At 9-12 months, quality of life was poorer in those reporting moderate or severe pain (mean overall QLQ-C15-PAL score 41.7 [SD = 20.4] vs. 71.6 [SD = 19.5]) and this pain interfered more with daily activities (mean BPI interference index, 29.1 [SD = 19.1] vs. 14.4 [SD = 14.5]). Sixty-six (44.0%) participants died during the 12-months follow-up period.</p><p><strong>Conclusions: </strong>Participants reporting moderate or severe chest pain experienced poorer quality of life and none were receiving strong opioids. Given the limited prognosis, early identification of 'high risk' mesothelioma patients i.e. those who are most likely to have high symptom burden and poor prognosis, would help ensure timely input is given to implement pain management strategies. This includes Specialist Palliative Care guidance about opioid prescribing and interventional procedures. Future research should be directed towards the optimum ways to assess and improve breathlessness, without neglecting the smaller group of people who experience severe pain.</p>","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13491870/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148254107","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":"A study on the role of palliative care in the physical and psychological well-being of people with life-limiting illnesses in Kashmir, India.","authors":"Shaqul Qamar Wani, Muskan Matia, Akshithanand Kuzhikkat Jayaprakasan, Mushtaq Ahmed Sofi, Talib Khan, Mahrukh Parvaiz, Maryam Ayub, Uroosa Farooq, Tabinda Wani, Sajad Ahmed Najar, Smriti Rana, Parth Sharma","doi":"10.1186/s12904-026-02142-9","DOIUrl":"10.1186/s12904-026-02142-9","url":null,"abstract":"<p><strong>Background: </strong>Living with life-limiting illnesses (LLIs) is psychologically distressing, even more so in areas with a complicated terrain and which are conflict-prone, where insecurity, displacement, and limited healthcare access adds to the burden. In this study, we assessed the impact of palliative care on the psychological well-being of people with life-limiting illnesses in Jammu & Kashmir, a conflict-prone region in India.</p><p><strong>Methods: </strong>This retrospective study analyzed the records of patients with LLIs visiting a pain and palliative care clinic in Srinagar, Jammu & Kashmir, from November 2023 to March 2025. The impact of palliative care on their well-being was assessed twice using the Edmonton Symptom Assessment Scale (ESAS), one week apart, the socioeconomic and disease-related factors associated with a change in scores were also identified. Data were analyzed using Rv4.4.2.</p><p><strong>Results: </strong>Of the 881 patients included in the analysis, the mean age was 57.6 ± 15.2 years, with almost an equal number above and below 60 years. Males constituted 59.6% of the population. A majority (73.4%) were from Below Poverty Line (BPL) households. Sons were the primary caregivers in 52.5% of the cases, and most (73.2%) of the caregivers were males. The primary diagnosis in almost all (97.6%) was cancer. Statistically significant differences were noted: median pain scores reduced from 7 to 2 (p < 0.001) and total scores reduced from 29 to 20 (p < 0.001) between initial assessment and at follow-up after registration at the palliative care unit. There was no significant difference in median score across age groups, gender and BPL category.</p><p><strong>Conclusion: </strong>Our study population primarily consisted of patients with malignancies. There was a significant difference in pain score, well-being score, and total ESAS score on follow-up assessment after 1 week of receiving palliative care. No significant difference was seen based on age, gender, socioeconomic status, or diagnosis, highlighting the universal impact of palliative care in people with LLIs.</p>","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13483381/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148228818","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":"Adapting a palliative care intervention for people with advanced cancer across seven European countries: the Pal-Cycles intervention.","authors":"Rachel Hooley, Sheila Payne, Holger Brunsch, Severine Marie Surges, Daniela Mosoiu, Flavia Hurducas, Pablo Hernández-Marrero, Sandra Martins Pereira, Ágnes Csikós, Éva Pozsgai, Wojciech Leppert, Maria Forycka-Ast, Pippa van den Brand, Jeroen Hasselaar, Nancy Preston","doi":"10.1186/s12904-026-02105-0","DOIUrl":"10.1186/s12904-026-02105-0","url":null,"abstract":"<p><strong>Background: </strong>International adaptation of healthcare interventions requires sensitivity to local contexts, especially in palliative care, where healthcare systems and cultural expectations about end of life differ widely. Pal-Cycles is an intervention that aims to improve transitions in care for patients with advanced cancer. This intervention was adapted for implementation in a stepped wedge trial across seven European countries (Germany, Hungary, the Netherlands, Poland, Portugal, Romania and the UK). This paper aims to illustrate the process of adapting a palliative care intervention (Pal-Cycles) to meet the needs of those using healthcare settings across seven European countries.</p><p><strong>Methods: </strong>Adapted nominal group techniques (a structured group method that supports idea generation, discussion, and prioritisation) were used, involving both in-country and cross-country adaptation meetings focused on the five key components of the original intervention design, to ensure cultural sensitivity and best fit All countries established a group of clinicians and all except two countries (Portugal and Hungary) involved groups of patients and families. The adaptation process occurred in a series of 5 meetings, which were mostly held online to accommodate participants' schedules.</p><p><strong>Results: </strong>A total of 36 clinicians, 14 patients or family members, and 16 facilitators participated in the adaptation process over a four-month period. Structured guidance and iterative consultation meetings ensured that the final intervention was both standardised and adaptable to each country's healthcare setting. We produced a standardised intervention manual based on a theory of change model, ensuring consistency across countries while allowing for contextual flexibility.</p><p><strong>Conclusions: </strong>This paper provides guidance for future cross-cultural adaptation of palliative care interventions, illustrating the value of detailed methodological planning, structured guidance, and multi-stakeholder engagement in the adaptation process.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov NCT06259136, registered on 6 February 2024.</p>","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":"25 1","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13289543/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148303658","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":"Communication practices and experience of connection in telehealth serious illness conversations with rural cancer patients: a qualitative study.","authors":"Elise C Tarbi, Stasha Medeiros, Amelia Haque, Serena Verma, Abhishek Ambati, Robert Gramling, Maija Reblin","doi":"10.1186/s12904-026-02192-z","DOIUrl":"10.1186/s12904-026-02192-z","url":null,"abstract":"<p><strong>Background: </strong>Telehealth can overcome functional, cost, and geographic barriers to attending in-person visits for people living with cancer in rural areas. Yet this medium presents clinicians, patients, and families with a different sensory and relational environment within which to engage in serious illness conversations. Within this different context, there is a need to better understand how clinicians preserve or adapt their communication strategies to connect interpersonally with patients and ensure high-quality care.</p><p><strong>Aim: </strong>We explored the characteristics of telehealth communication that patients reported fostered human connection in serious illness conversations among rural-dwelling patients with cancer.</p><p><strong>Methods: </strong>Grounded in a Basic Science Framework for Serious Illness Communication Research, we conducted semi-structured interviews with adult rural-dwelling patients with cancer. Eligible participants were either currently receiving or had recently completed treatment for their cancer and received some part of their cancer care via teleconferencing. Using directed content analysis, we qualitatively described participants' experiences with telehealth encounters with their providers (i.e., oncology or palliative care clinicians). We followed the consolidated criteria for reporting qualitative research (COREQ) for rigorous data collection, analysis, and reporting.</p><p><strong>Results: </strong>We interviewed 20 participants (average duration = 29 min; range: 14-56 min). Mean age was 66 years and 60% were women. All participants identified as white and 85% identified as financially secure. Over half reported high digital health care literacy, including 65% (13/20) reporting ability to use electronic device software applications (e.g. Zoom) independently. We identified three major themes in interviews: (1) the accessibility, comfort, and convenience of telehealth contributes to patient experience of connection; (2) communication actions that enable connection in this setting are those that foster a sense of patients feeling seen as a person, and allow them to see their clinicians as humans as well; (3) patients' experience of connection is impacted by relational, situational, and technological factors.</p><p><strong>Conclusions: </strong>Accessibility, clinician communication actions, and contextual factors of telehealth affect the experience of human connection in their cancer care among people with cancer who live in rural areas. This study provides a foundation to drive future research uncovering the optimal telehealth communication strategies to promote connection during virtual serious illness conversations.</p>","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13479412/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148228791","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":"Bereaved informal caregivers' experiences with a Canadian home hospice program: a qualitative study.","authors":"Miao Li, Davina Banner, Aderonke Agboji, Christopher A Klinger, Donna Flood, Shannon Freeman","doi":"10.1186/s12904-026-02158-1","DOIUrl":"10.1186/s12904-026-02158-1","url":null,"abstract":"<p><strong>Background: </strong>Most individuals wish to die at home, yet in Canada this is not always possible. Informal caregivers play a vital role to support individuals who wish to receive home-based end-of-life care and die at their own homes. Community-based home hospice programs aim to support both individuals at the end of life and their informal caregivers, however, informal caregivers' experiences within such programs, particularly in northern communities, remain underexplored. This study aimed to describe the experiences of bereaved informal caregivers who received support from a community-based home hospice program.</p><p><strong>Methods: </strong>A qualitative approached was used. Semi-structured interviews were conducted with bereaved informal caregivers (N = 15) approximately three months following the death of their care recipient. All participants had been involved as informal caregivers as part of a home hospice program in a geographically isolated, medium sized northern city in Western Canada. Interviews explored their experiences of the program, including perceived benefits and challenges. Data was analyzed using thematic analysis following Braun & Clarke's approach.</p><p><strong>Results: </strong>Participants described both emotional and practical benefits of home hospice, as well as challenges related to timing of referral and aspects of service delivery. Five themes were identified that captured informal caregivers' experiences with the home hospice program: a preference for home-based end-of-life care, the ability to fulfill the wishes of the person they cared for, relief associated with receiving hospice support, the importance of compassionate relationships with hospice staff, and the perceived need for early awareness and referrals to home hospice services.</p><p><strong>Conclusions: </strong>Bereaved informal caregivers valued home hospice support for enabling home-based end-of-life care, honoring the wishes of the person they cared for, and reducing caregiver burden through compassionate and holistic support. Improving early awareness and timely referral to home hospice programs may further improve caregiver experiences and strengthen the delivery of home hospice services in Canadian northern communities.</p>","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13480195/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148220374","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":"Referral and utilization patterns for home-based palliative care services among older adults.","authors":"Joohyun Chung, Aaron Langlois, TylaAnn Burger, David L Chin","doi":"10.1186/s12904-026-02179-w","DOIUrl":"10.1186/s12904-026-02179-w","url":null,"abstract":"<p><strong>Background: </strong>Home-based palliative care (HPC) improves quality of life for individuals with serious illness but remains underutilized in the United States, with persistent disparities in access. HPC is also frequently misconceived as appropriate only at the end of life.</p><p><strong>Aim: </strong>This study examined disparities in access to HPC by comparing patients who received services with those who were referred but not enrolled.</p><p><strong>Methods: </strong>A secondary analysis was conducted using 567 clinical records from a healthcare facility in the eastern United States between 2022 and 2023. Descriptive statistics, chi-square tests, and Cox proportional hazards regression model were used to compare demographic and clinical characteristics between groups.</p><p><strong>Results: </strong>No significant differences were observed by gender or race between patients who received HPC and those who did not. Significant differences were found for age (t = 2.33, p = 0.02), insurance type (p < 0.001), and referral source (p = 0.02). Patients who received HPC were more likely to be older, female, insured through Medicare Part B, and referred from larger hospitals.</p><p><strong>Conclusion: </strong>These findings underscore ongoing structural disparities in access to home-based palliative care and highlight the need for targeted strategies to improve equitable access to HPC services.</p>","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13445677/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148220341","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":"Navigating existential conversations about life and death with families in paediatric palliative care: a qualitative interview study with healthcare professionals.","authors":"Elin Hjorth, Christina Melin-Johansson, Bodil Holmberg, Tove Godskesen, Carina Lundh Hagelin, Anneli Ozanne, Annica Lagerin, Camilla Udo","doi":"10.1186/s12904-026-02171-4","DOIUrl":"10.1186/s12904-026-02171-4","url":null,"abstract":"<p><strong>Background: </strong>When a child has a life-threatening illness, guidelines emphasise the importance of providing holistic support to the whole family. Conversations about existential issues are essential in this support, yet staff often lack formal training in communication, particularly when addressing such issues as life and death. This qualitative study explored how paediatric healthcare professionals in Sweden experience and approachconversations about existential issues with children and their families facing life-threatening illness.</p><p><strong>Methods: </strong>Eight professionals representing different disciplines and paediatric palliative care settings took part in individual interviews, analysed using an interpretative description approach.</p><p><strong>Results: </strong>The results show that healthcare professionals experienced the existential conversations with families as emotionally intense, ethically complex, yet meaningful. A balance between courage, presence, sensitivity, and professional boundaries was crucial, as well as the need for collegial support. The importance of honest communication and age-appropriate ways of talking about illness and death was emphasized. They stressed that communication should be empathetic and culturally sensitive, without ready-made solutions, and based on the unique needs of the family. They also described organizational factors that influenced their ability to engage in existential conversations with the families.</p><p><strong>Conclusions: </strong>Maintaining an open approach to existential conversations is essential to how these dialogues are carried out. Such an approach includes creating workplaces with an organizational culture that encourages existential conversations with patients and families. The importance of both personal and professional development is also emphasized, where collegial support and structures that promote professional growth, such as supervision and debriefing, strengthen the ability to address existential issues.</p>","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":"25 1","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13251064/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148212914","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}