Journal of Palliative Care最新文献

{"title":"Palliative Benefits of Zoledronic Acid on Pain, Functioning and Quality of Life in Metastatic Cancers: A Cohort Study.","authors":"Ranakishor Pelluri, Sreevally Kantamsetty, Pavan Sri Viswanadh Rudrapaka, Vamsi Venkata Srinivasa Reddy Satti, Lasya Sree Ponnapureddy, Bhima Sridevi, Usha Sree Puneem, Haneesha Polavarapu, Uday Venkat Mateti, Jayaraman Rajangam","doi":"10.1177/08258597251383377","DOIUrl":"https://doi.org/10.1177/08258597251383377","url":null,"abstract":"<p><p>ObjectiveThis cohort study evaluated the palliative benefits of zoledronic acid (ZA) in patients with metastatic cancers, focusing on clinical and functional improvements, with additional assessment of emotional well-being.MethodsAn observational cohort study was conducted at Omega Hospitals, Guntur, India, from August 2024 to March 2025. Adult patients with metastatic cancers who received at least four doses of intravenous ZA (4 mg) were included. Pain intensity was assessed using the Brief Pain Inventory-Short Form (BPI-SF), and quality of life (QoL) was measured using the EORTC QLQ-C30 questionnaire.ResultsA total of sixty-two patients (mean age 57.7 ± 9.65 years; 72.6% female) were enrolled. Treatment with ZA resulted in significant reductions in pain severity (median 5.0 to 0.0; <i>p</i> < 0.001) and pain interference (median 3.0 to 0.0; <i>p</i> < 0.001). Improvements were also observed in global health (58.08 to 68.57; <i>p</i> < 0.001), social functioning (57.35 to 64.40; <i>p</i> = 0.01), fatigue (54.81 to 48.88; <i>p</i> = 0.01), and emotional functioning (50.82 to 63.64; <i>p</i> < 0.001). Physical functioning increased slightly (65.44 to 66.50; <i>p</i> = 0.62) but did not reach statistical significance. However, joint pain and hot flashes worsened after treatment (<i>p</i> < 0.01).ConclusionZA provides meaningful clinical and functional benefits in metastatic cancer patients, particularly through pain reduction, global health improvement, and better social functioning, with additional gains in emotional well-being. The modest, non-significant change in physical functioning emphasizes the influence of advanced disease stage and comorbidities.</p>","PeriodicalId":51096,"journal":{"name":"Journal of Palliative Care","volume":" ","pages":"8258597251383377"},"PeriodicalIF":1.7,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment Satisfaction with Nonoperative Management of Suspected Hip Fractures in Nursing Home Patients with a Do-Not-Hospitalize Directive: A Prospective Case Series (NONU-HIP).","authors":"Sverre A I Loggers, Romke Van Balen, Jeroen Steens, Hanna C Willems, Pamela Riezebos, Anja Wagenaar-Huisman, Michael H J Verhofstad, Esther M M Van Lieshout, Pieter Joosse","doi":"10.1177/08258597251375240","DOIUrl":"https://doi.org/10.1177/08258597251375240","url":null,"abstract":"<p><p>ObjectivesSome nursing home residents opt to forgo hospital admission in case of a suspected hip fracture due to the poor prognosis. However, outcomes in these patients are unknown and hamper advance care planning and expectation management. This study assesses treatment satisfaction and quality of life in nursing home residents with a suspected hip fracture and a do-not-hospitalize directive.MethodsA prospective case series study was conducted in three nursing home organizations in The Netherlands. The primary outcome was the treatment satisfaction according to proxies and caregivers. Secondary outcomes were EuroQoL-5D-5L utility score, Qualidem scores, pain and opiate administration, adverse events, mortality, and quality of dying (Quality of Dying and Death Questionnaire).ResultsTwenty patients, with a median age of 87 years, were included. The treatment satisfaction as rated by proxies and caregivers was high (median numeric rating scale of 9 [P25-P75 8-10] and 9 [P25-P75 8-9], respectively). The life expectancy was short (median of 5 days [P25-P75 3-6]) with a 14-day mortality rate of 100%. The overall quality of the death was \"good to almost perfect\" in 77% of the patients (n = 10/13) and \"intermediate\" in 23% (n = 3/13). Symptom control was rated as \"good to almost perfect\" in 70% of patients. Four adverse events occurred in three patients (15%).ConclusionsThis study showed that nonoperative management of suspected proximal femoral fractures in nursing home patients that opted to forgo hospital admission, results in high treatment satisfaction, high quality of dying with good symptom control, and predictable short-term mortality rates.</p>","PeriodicalId":51096,"journal":{"name":"Journal of Palliative Care","volume":" ","pages":"8258597251375240"},"PeriodicalIF":1.7,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145132655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sleep Quality of Children and Caregivers in Pediatric Palliative Care: A Single-Center Cross-Sectional Study.","authors":"Nilgün Harputluoğlu, Derşan Onur, Duygu Çubukçu, Tanju Çelik, Aycan Ünalp","doi":"10.1177/08258597251380349","DOIUrl":"https://doi.org/10.1177/08258597251380349","url":null,"abstract":"<p><p>ObjectivesHaving a child with a life-limiting or life-threatening illness affects the lives of family members. Sleep disorders are among the most common symptoms in pediatric palliative care, but strategies for symptom management associated with sleep disorders are poorly understood. In this study, we aimed to identify sleep disorders in children in pediatric palliative care, to identify sleep disorders in parents, and to examine associated factors.MethodsThe study was a cross-sectional, prospective study conducted between September 2020 and April 2021 in Izmir, Türkiye. The Child Sleep Habits Questionnaire and the Pittsburgh Sleep Quality Index were used to assess sleep disorders in children and parents.ResultsA total of 76 caregiver parent-child couples with life-threatening/limiting disease were included in the study. The mean age of the children was 7.79 ± 4.28 years and 61.8% (<i>n</i> = 47) were male. The child's The Child Sleep Habits Questionnaire total score and the parent's Pittsburgh Sleep Quality Index total score showed a weak positive correlation (<i>r</i>_s(76) = 0.309, <i>p</i> = 0.007). Among the subscales, \"Bedtime resistance\" score was statistically significantly higher only in girls (12.28 ± 2.34 vs 10.96 ± 1.89, <i>p</i> = 0.018), whereas \"Sleep duration\" score was statistically significantly lower in the male parent group (4.0 ± 1.15 vs 5.97 ± 1.63, <i>p</i> = 0.028).ConclusionsSleep disturbances in children in pediatric palliative care and their caregivers are important. Caregivers' sleep is affected by children's sleep duration, sleep anxiety, and nocturnal awakenings. Adjusting the treatment of patients on medication at night as well as during the day can improve both the child's and the mother's sleep.</p>","PeriodicalId":51096,"journal":{"name":"Journal of Palliative Care","volume":" ","pages":"8258597251380349"},"PeriodicalIF":1.7,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145132641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are Assisted Dying and Palliative Care Intersecting in Australian Clinical Practice? A Case Series.","authors":"Julia Corfield, Hannah Gooiker, Melanie Benson, Sandeep Bhagat","doi":"10.1177/08258597251380354","DOIUrl":"https://doi.org/10.1177/08258597251380354","url":null,"abstract":"<p><p>ObjectivesAssisted dying and palliative care represent distinct approaches to addressing the needs of patients with advanced, progressive, and life-limiting illness. Although 5 years have passed since the Voluntary Assisted Dying (VAD) Act was passed in Victoria (Australia), little is known about the VAD and palliative care interface in clinical practice. This retrospective case series examined patients who requested VAD and received inpatient specialist palliative care (SPC).MethodsRetrospective case series of patients admitted to a single-site public palliative care unit (PCU) between June 2019 and June 2024, who had enquired about or requested VAD at any point in time.Results6% of patients admitted to the PCU enquired about or requested VAD at any point in time; 2% raised VAD during their PCU admission, while the remaining patients were admitted with existing requests made in other healthcare settings. A small proportion of patients had VAD requests made by caregivers or had statements misinterpreted as VAD requests. Requests for VAD were made to palliative care professionals (50%) across multiple settings where palliative care is delivered. Most patients (44%) did not progress past an initial request for VAD, and 32% made requests in their final 2 weeks of life. Four patients administered the VAD substance and died while in the PCU. In the PCU, patients discussed VAD with their treating team (number of documented conversations ranging from 0 to 25 during admission).ConclusionsThis case series highlights a tangible intersection between SPC and VAD in that patients enquired about and requested VAD to palliative care teams, and in the PCU, they discussed and completed VAD. Implications for SPC will be discussed.</p>","PeriodicalId":51096,"journal":{"name":"Journal of Palliative Care","volume":" ","pages":"8258597251380354"},"PeriodicalIF":1.7,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Atrial Ablation Procedure and Palliative Care for High-Risk Mortality Group With Atrial Fibrillation in U.S. Hospitals: 2016-2021 National Inpatient Sample Analysis.","authors":"Fye Angelyn Pinera, Pearl Angela Pinera, Pearl Kim, Leora Frimer, Pengfeng Jin, Gregory-Thoams Castaneda Stanger, Iuilia Ianitoaia-Chaudhry, Ronald Tan, Faizan Sheraz, Sebin Park, Hayden Leung, Ji Won Yoo, Jay J Shen","doi":"10.1177/08258597251372721","DOIUrl":"https://doi.org/10.1177/08258597251372721","url":null,"abstract":"<p><p>ObjectivesRecently, atrial fibrillation (AF) has contributed to an increase in cardiovascular deaths in the U.S. Palliative care (PC) and atrial ablation (AA) procedure can elevate quality of life of high-risk AF patients, who are associated with multiple comorbidities. We explore the combined PC and AA management among high-risk mortality groups with AF.MethodsThis pooled cross-sectional retrospective data used the National Inpatient Sample (2016-2021) and included national estimates of 2,965,334 hospital discharges in the high-risk mortality group with AF. Multivariable regression was performed to determine the factors associated with AA procedure and PC centered on CHA2DS2-VASc score, systolic heart failure, and in-hospital mortality. Race/ethnicity, health insurance, and hospital location were controlled in multivariable analyses.ResultsPalliative care utilization was on an uptrend from 9.02% in 2016 to 12.29% in 2021. Factors that were negatively associated with PC utilization were increasing CHA2-DS2-VASc score (OR = 0.878), systolic heart failure (OR = 0.976), AA procedure (OR = 0.287), racial minorities, and rural residents. Atrial ablation was positively associated with systolic heart failure (OR = 2.920) and was negatively associated with increasing CHA2-DS2-VASc score (OR = 0.951) and PC utilization (OR = 0.283). Racial minorities and rural residents were less likely to receive AA procedure.ConclusionsPalliative care utilization was associated with lower probability of AA procedures by approximately 75%, and vice versa. Atrial ablation procedures and PC utilization were discrete choice patterns indicating healthcare providers' tendency to favor the status quo and current practices rather than initiating change. Health disparities in PC utilization and AA procedures were identified in racial minorities and rural residents. Call to action is warranted to increase PC awareness and harmonious approach of PC and AA procedure for those with high-risk mortality AF patients in the U.S. hospitals.</p>","PeriodicalId":51096,"journal":{"name":"Journal of Palliative Care","volume":" ","pages":"8258597251372721"},"PeriodicalIF":1.7,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145031070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality of Palliative Care in Nursing Homes and Community Care in Deceased with Chronic Obstructive Pulmonary Disease (COPD), Dementia, Amyotrophic Lateral Sclerosis (ALS), and Cancer: A Retrospective Analysis of Claims Data (2016-2019).","authors":"Dr Med Ekaterina Slotina, Dr Rer Nat Bianka Ditscheid, Dr Phil Franziska Meissner, Ariane Wiese, Jonas Hezel, Dr Med Ursula Marschall Dipl Oec, Apl Prof Dr Med Ulrich Wedding, Pd Dr Rer Pol/Habil Med Antje Freytag","doi":"10.1177/08258597251353315","DOIUrl":"https://doi.org/10.1177/08258597251353315","url":null,"abstract":"<p><p>ObjectivePalliative care is more commonly provided to patients with cancer than to those with non-oncological conditions. Little is known about the prevalence of inappropriate care and whether differences exist depending on the underlying disease. This study investigates the care during the last month of life in patients with cancer and non-oncological conditions, such as amyotrophic lateral sclerosis (ALS), chronic obstructive pulmonary disease (COPD), and dementia, considering the care setting (nursing home vs. community care).MethodsWe conducted a population-based, retrospective analysis of deceased in 2016-2019 with COPD (<i>n</i> = 4,036), dementia (<i>n</i> = 40,853), or ALS (<i>n</i> = 608). Logistic regression analyses compared the care quality with that of the deceased with cancer (n = 58,315). Interaction analyses examined setting effects. Outcome measures included validated quality indicators: hospital and intensive care unit (ICU) stays, emergency service utilization, and place of death.ResultsDeceased with COPD, dementia, and ALS more frequently utilized emergency services compared to those with cancer (40.4%, 28.4%, 29.0% vs. 24.4%, respectively, <i>p</i> < .05) and were less likely to die in a hospital (excluding palliative care units; 38.2%, 15.3%, 25.7% vs. 40.3%, respectively, <i>p</i> < .05). Differences were observed in ICU (13.6%, 3.4%, 6.1% vs. 4.3%, respectively, <i>p</i> < .05) and hospital admissions (42.7% for COPD vs. 31.5% for oncological patients, <i>p</i> < .001). The same pattern was observed across all conditions: deceased in community care had higher rates in all quality indicators than those in nursing homes.ConclusionsThe results suggest differences in care quality depending on the underlying disease. Nononcological patients in community care are less frequently and less adequately cared for than oncological patients.</p>","PeriodicalId":51096,"journal":{"name":"Journal of Palliative Care","volume":" ","pages":"8258597251353315"},"PeriodicalIF":1.7,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144977618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges, Benefits, and Future Directions of Pediatric Home-Based End-of-Life Care: A Qualitative Study.","authors":"Tiina Jaaniste, Mia Helyar, Marisa Eamens, Therese Smeal, Sandra Coombs, Martha Mherekumombe","doi":"10.1177/08258597251341039","DOIUrl":"https://doi.org/10.1177/08258597251341039","url":null,"abstract":"<p><p>ObjectivesPediatric end-of-life (EOL) care at home is often provided by community palliative care (CPC) nurses who are not specialist pediatric service providers. This study explores the challenges, benefits, and future directions of home-based EOL care as perceived by CPC nurses in New South Wales (NSW), Australia.MethodsEleven CPC nurses participated in a semi-structured interview to elicit information about their attitudes and experiences regarding their work in providing community-based EOL care to children. Reflexive thematic analysis was used to explore themes regarding the benefits, challenges and their thoughts on future directions regarding home-based EOL care.ResultsChallenges identified by CPC nurses included resource access, complexity of pediatric, models of care, and family psychological factors. Benefits included patient and family autonomy, home comforts and the nurses' sense of satisfaction. CPC nurses suggested the need for increased education, support and collaboration.ConclusionAreas of possible clinical and organizational improvements are discussed, including more pediatric training and experience for CPC nurses.</p>","PeriodicalId":51096,"journal":{"name":"Journal of Palliative Care","volume":" ","pages":"8258597251341039"},"PeriodicalIF":1.3,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Attitudes and Experiences of Community Palliative Care Nurses Regarding Pediatric Home-Based End-of-Life Care: A Statewide Survey.","authors":"Mia Helyar, Marisa Eamens, Sandra Coombs, Therese Smeal, Martha Mherekumombe, Tiina Jaaniste","doi":"10.1177/08258597241284286","DOIUrl":"10.1177/08258597241284286","url":null,"abstract":"<p><p><b>Objectives:</b> Pediatric end-of-life (EOL) care at home is often provided by community palliative care (CPC) nurses who do not specialize in pediatrics. This study aimed to better understand the challenges CPC nurses face when providing EOL care to children at home. <b>Methods:</b> A total of 52 CPC nurses across New South Wales (NSW), Australia, participated in an online survey about their training, attitudes, and experiences regarding the provision of home-based pediatric EOL care. Participants were asked to reflect back over a \"negative\" experience of caring for a child at EOL, where things did not go as well as hoped, and a \"positive\" EOL care experience, where nurses perceived that care of the child and family went well, and respond to questions about these experiences. <b>Results:</b> Confidence of CPC nurses when providing EOL care to pediatric patients was significantly lower than when caring for adults (<i>p</i>'s < .05). Most respondents expressed the desire for more training in pediatric EOL care. Cases identified as negative by CPC nurses did not significantly differ from positive cases in terms of the timing of the referral to CPC, clinical symptoms at EOL, or how well informed the nurses felt. Siblings were present at EOL in 74% of the negative experiences and 86% of the positive experiences, reportedly receiving significantly poorer support in the negative experiences (<i>p </i>= .002). <b>Conclusion:</b> This research contributes to an improved understanding of the challenges associated with home-based pediatric EOL care and highlights potential areas for improvement in CPC service delivery and training.</p>","PeriodicalId":51096,"journal":{"name":"Journal of Palliative Care","volume":" ","pages":"215-224"},"PeriodicalIF":1.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12142375/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Relationship Between Palliative Care Nurses' Frequency of Providing Spiritual Care and Their Job Satisfaction: A Cross-Sectional Study.","authors":"Hakime Aslan, Hanife Çelik, Feride Kaplan","doi":"10.1177/08258597241301988","DOIUrl":"10.1177/08258597241301988","url":null,"abstract":"<p><p>ObjectiveThis study was conducted to evaluate the relationship between the frequency of spiritual care and job satisfaction of palliative care nurses.MethodsThis study was a cross-sectional type. The study population consisted of nurses working in palliative care units of three hospitals in eastern Turkey. The study was conducted with 110 nurses who agreed to participate in the study. The researchers' \"Information Form\", \"Nurse Spiritual Care Therapeutics Scale\" and \"Nurse Job Satisfaction Scale\" were used to collect data. Data was collected by face-to-face interview method between August and September 2022.ResultsIt was determined that the nurses scored 45.2 ± 15.8 points from the Nurse Spiritual Care Therapeutics Scale and 4.1 ± 0.7 points from the nurse job satisfaction scale. There was a positive and moderately significant relationship between the frequency of spiritual care giving and job satisfaction of nurses. The frequency of giving spiritual care positively affected job satisfaction (β = .409) and predicted it by 19% (Adjusted R² = .195). It was determined that satisfaction with the unit (palliative care) mediated the relationship between the frequency of spiritual care and job satisfaction.Conclusion\"Palliative care nurses' frequency of providing spiritual care was moderate and their job satisfaction was high, with frequency of providing spiritual care having a positive effect on job satisfaction. This suggests that increasing opportunities for nurses to provide spiritual care may further enhance their job satisfaction, leading to improved overall well-being.</p>","PeriodicalId":51096,"journal":{"name":"Journal of Palliative Care","volume":" ","pages":"195-204"},"PeriodicalIF":1.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conceptual Confusion: A Barrier to Multi-Professional Involvement in Advance Care Planning in Nursing Homes - An Ethnographic Study.","authors":"Nicola Andrews, Michelle Myall","doi":"10.1177/08258597241305846","DOIUrl":"10.1177/08258597241305846","url":null,"abstract":"<p><p>ObjectivesHow health and social care professionals need to work together to deliver advance care planning (ACP) in nursing homes is not fully understood, with a reliance on professionals external to the nursing home to support ACP in the United Kingdom. The objectives of this study were to (a) examine the factors that influence multi-professional involvement in the ACP process within nursing homes and (b) explore how multi-professional working impacts the ACP process in nursing homes.MethodsUsing ethnography, data was collected through observation, interviews and document review from 36 participants including residents (<i>n</i> = 6), relatives (<i>n</i> = 4), nursing home staff (<i>n</i> = 19) and visiting professionals (<i>n</i> = 7). Data analysis combined thematic analysis, mapping of ACP trajectories for participant residents, and documentary analysis of nursing home policies.ResultsThere was conceptual confusion around ACP. How ACP was understood and what was prioritised for inclusion varied between residents and professionals, and between different professionals. That ACP was frequently integrated with routine care planning was not recognised in how professionals accounted for their ACP practice. Professionals prioritised biomedical concerns, despite this not reflecting resident priorities and policy suggesting a broader definition. This created difficulties in enacting ACP, with a holistic understanding of resident wishes not always captured.ConclusionsA shared understanding of ACP was not consistently evident from those tasked with its enactment. This, combined with professional construction of ACP in biomedical terms, limits multi-professional working and can prevent a person-centred process being achieved for nursing home residents.</p>","PeriodicalId":51096,"journal":{"name":"Journal of Palliative Care","volume":" ","pages":"225-232"},"PeriodicalIF":1.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12130609/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}