Annals of palliative medicine最新文献

{"title":"Perinatal palliative care in low- and middle-income countries: a scoping review.","authors":"Sharla Rent, Daniela Titchiner, Erin Rholl, Allison Lyle, Ellen Diego, Krysten North, Sahar Rahiem, Avery Garmon, Raziya Gaffur, Aisa Shayo, Ana Lucia Diez Recinos, Monica Lemmon, Sharron L Docherty","doi":"10.21037/apm-24-87","DOIUrl":"10.21037/apm-24-87","url":null,"abstract":"<p><strong>Background: </strong>2.4 million neonatal deaths and 2.6 million stillbirths occur each year. Over 98% of perinatal loss occurs in low- and middle-income countries. Despite the global burden of perinatal loss, access to relevant perinatal palliative and psychosocial care is poor and understudied.</p><p><strong>Methods: </strong>In this review, we synthesize perinatal palliative care literature from low- and middle-income countries. We focus on the clinical practice of perinatal palliative care and educational models being used in resource-constrained settings. We used a systematic scoping review approach, following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) checklist. The PubMed, Scopus, Embase, Cochrane, CINAHL, and Global Health (embsco) databases were searched. There were no date or language restrictions placed during the search. Study selection was conducted using Covidence to facilitate a staged review process.</p><p><strong>Results: </strong>A total of 10,145 articles remained after removing duplicate studies. Following the three-staged review, 81 studies were included in our analysis. The largest portion of published perinatal palliative care literature focused on clinical care (n=44). Nine studies focused on provider training in perinatal palliative care and 28 studies addressed parent or family experience. Of the included studies, 84.9% had a first or last author from a low- or middle-income country and 91.8% included an author from the country of focus in the manuscript. The findings presented in this scoping review reveal that healthcare workers and families desire improved guidelines about perinatal palliative care that reflect the realities of local culture and resources. Additionally, providers need enhanced training in perinatal palliative care techniques and management approaches that can be applied in a range of clinical settings.</p><p><strong>Conclusions: </strong>Global perinatal palliative care strategies must encompass compassionate communication with families, psychosocial support after stillbirth or neonatal death, and emotional and mental health support for healthcare workers who provide perinatal palliative care.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"13 6","pages":"1420-1448"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142779436","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":"The most downloaded articles published in Annals of Palliative Medicine from 2023.","authors":"Charles B Simone","doi":"10.21037/apm-24-161","DOIUrl":"https://doi.org/10.21037/apm-24-161","url":null,"abstract":"","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"13 6","pages":"1312-1314"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142778726","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":"Psychological challenges for breast cancer survivors.","authors":"Hinpetch Daungsupawong, Viroj Wiwanitkit","doi":"10.21037/apm-24-126","DOIUrl":"https://doi.org/10.21037/apm-24-126","url":null,"abstract":"","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"13 6","pages":"1548-1549"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142778770","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":"Effectiveness of palliative hemostatic radiotherapy for hemoptysis: a prospective single-arm observation study.","authors":"Saif Aljabab, Ionut Busca, Yasir Alayed, Kristopher Dennis, Robert MacRae","doi":"10.21037/apm-24-45","DOIUrl":"10.21037/apm-24-45","url":null,"abstract":"<p><strong>Background: </strong>Palliative radiotherapy (RT) is commonly used for malignancy-associated hemoptysis. This study aims to determine RT control probability, durability, and influencing factors.</p><p><strong>Methods: </strong>This single-institution prospective observational study included patients ≥18 years old with any lung malignancy and active hemoptysis. Hemoptysis severity was captured and monitored via Common Terminology Criteria for Adverse Events (CTCAE) and an in-house developed Patient-Reported Outcome Measure (PROM) tool. Patients were interviewed at enrollment, 2 weeks, 3 months, and 6 months post-treatment. Descriptive statistics, the Kaplan-Meier (KM) method, the Wilcoxon signed-rank test, and Cox regression models were used.</p><p><strong>Results: </strong>From April 2016 to November 2018, 41 patients were enrolled. One patient withdrew consent and was excluded. The median age was 68 years. Most patients were male (67%) with stage 4 (87.5%), lung primary (85%) disease, and Eastern Cooperative Oncology Group (ECOG) performance status ≥2 (55%). The most common fractionation scheme (72.5%) was 2,000 cGy in 5 fractions. Eight patients (20%) passed away before 2-week assessment. Median follow-up was 6.1 months (range, 0.9-6.2 months). The 6-month overall survival (OS) rate was 26% [95% confidence interval (CI): 13-41%]. The 6-month bleeding-related survival (BRS) was 95% (95% CI: 80-99%), and the 6-month freedom from hemoptysis rate was 37% (95% CI: 18-57%). No patient received re-irradiation for their hemoptysis. On univariate analysis, ECOG status (P=0.01) and prior radiation (P=0.006) were strongly associated with freedom from hemoptysis survival.</p><p><strong>Conclusions: </strong>Hemostatic RT remains an effective modality for controlling hemoptysis. The short interval high mortality rate post-RT challenges whether fractionated palliative RT should be used for this patient population. Conducting a large clinical trial with a hemoptysis PROM tool is necessary to identify hemostatic durability and influencing factors properly.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"13 6","pages":"1343-1352"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142779411","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":"\"You have to hold their hand\": experiences of providers integrating virtual care and communication methods while caring for ICU patients during the COVID-19 pandemic.","authors":"Sarah E Bradley, R Evey Aslanian, Cara Ferguson, C Ann Vitous, Adela Wu, Ashley Duby, M Andrew Millis, Pasithorn A Suwanabol","doi":"10.21037/apm-24-98","DOIUrl":"https://doi.org/10.21037/apm-24-98","url":null,"abstract":"<p><strong>Background: </strong>The rapid expansion of synchronous telephone and video virtual care options allowed the Veterans Health Administration (VHA) to adapt to the coronavirus disease 2019 (COVID-19) pandemic and provided a unique opportunity to assess the potential for integration and utility of virtual care in VHA systems. The objective of this study was to highlight the perspectives of VHA providers caring for intensive care unit (ICU) patients during the COVID-19 pandemic and their views on the use of virtual care and communication for palliative and end-of-life patients.</p><p><strong>Methods: </strong>Forty-eight semi-structured qualitative interviews were conducted with providers between April 2021 and March 2022 and were analyzed using steps informed by thematic content analysis. Participants were eligible if they delivered ICU care to surgical patients at VHA hospitals. Participants were recruited from 14 VHA facilities across the United States. Participants were asked questions about their experiences as providers working with ICU patients, including about the impacts of the COVID-19 pandemic and ways in which virtual care was adapted to deal with emerging challenges.</p><p><strong>Results: </strong>When asked about their experiences with ICU patient care during the COVID-19 pandemic, participant experiences showed: (I) disruption of staff roles and responsibilities, (II) reduced opportunities for communication and rapport building with family members, and (III) increased patient isolation. In each case, virtual options were adapted to overcome these emerging barriers, but limitations for the utility of those options for palliative and end-of-life care patients remain.</p><p><strong>Conclusions: </strong>Virtual options were an important adaptation for providers during the COVID-19 pandemic, but their use can be limited in palliative and end-of-life care settings. However, when visitation is limited, virtual options can support communication between providers, family members, and caregivers.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"13 6","pages":"1332-1342"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142779403","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":"The needs of patients with noncancer diseases and their families from hospital-based specialized palliative care teams in Japan.","authors":"Hideki Kojima, Naomi Doi, Sanae Takanashi, Kaori Kinoshita, Rieko Inokuchi, Hidekazu Kato, Hiroki Mase, Tomoyasu Kinoshita, Atsuko Ito, Yumiko Iizuka, Ayano Ishikawa, Tatsuya Morita, Mitsunori Nishikawa","doi":"10.21037/apm-24-42","DOIUrl":"10.21037/apm-24-42","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Hospital-based specialized palliative care teams (HSPC) are important for symptom management and ethics support, especially during complex decision-making, but the needs of patients with noncancer diseases and their families from the HSPC are unclear. This study aimed to (I) compare the prevalence of symptom between patients with and without cancer and explore changes in symptom intensity after HSPC consultation in patients with noncancer; (II) determine factors related to ethics support; and (III) compare the percentage of request contents from patients and their families when a certified nurse specialist in gerontological nursing (geriatric care nurse below) is present in the HSPC to that when a certified nurse specialist in palliative care (palliative care nurse below) is present in the HSPC.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We utilized a retrospective cohort study to analyze 761 patients (360 with noncancer and 401 with cancer) referred to our HSPC at the National Center for Geriatrics and Gerontology using 10-year data (since 2011) available in an electronic medical record database. (I) Symptom scores of the Support Team Assessment Schedule were compared between noncancer and cancer groups and between initial and 1-week assessments for noncancer patients. (II) Ethics support was compared between noncancer (including dementia) and cancer. The presence or absence of ethics support requests, which was set as the objective variable, was examined using logistic regression analysis. (III) The percentage of request contents selected from nine items defaulted on the electronic medical record when a geriatric care nurse was present in our HSPC were compared to those when a palliative care nurse was present in our HSPC.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Compared to those with cancer, patients with noncancer suffered more from dyspnea and sputum accumulation. More than 10% of patients with noncancer had suffered from pain, dyspnea, sputum accumulation, and anorexia that required treatment, with symptom scores showing improvement after 1 week of HSPC involvement, except for the sputum accumulation. Moreover, for anorexia, symptom scores improved, but &gt;10% of these patients continued to suffer. Patients with noncancer diseases, including dementia, received ethics support than those with cancer without dementia. More requests for ethics support were received when a geriatric care nurse was in the HSPC than when a palliative care nurse was in the HSPC. Logistic regression analysis revealed that requests for ethics support were more frequent from patients or families with impaired decision-making capacity or when the patient lacked an advocate.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The needs of patients with noncancer diseases and families from the HSPC in Japan included (I) symptom management for intractable conditions, such as sputum accumulation; (II) ethics support for patients with noncancer diseases, including dementia, with","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":" ","pages":"1385-1400"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141915969","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":"A narrative review of the challenges and impact of breast cancer treatment in older adults beyond cancer diagnosis.","authors":"Winnie W Y Sung, Kritika Sharma, Adrian Wai Chan, Muna Al Khaifi, Eva Oldenburger, Elizabeth Chuk","doi":"10.21037/apm-24-90","DOIUrl":"10.21037/apm-24-90","url":null,"abstract":"<p><strong>Background and objective: </strong>Breast cancer is the most prevalent cancer among women worldwide, with 45% of them over 65 years old. Older breast cancer patients tend to be underrepresented and understudied in major clinical trials. This narrative review provides a comprehensive overview of the current evidence regarding treatment decision-making, treatment toxicities, and proposed survivorship management recommendations for geriatric cancer patients.</p><p><strong>Methods: </strong>A literature search was conducted on PubMed and Google Scholar. The search strategy included a combination of keywords related to clinical management and treatment toxicities of older cancer breast cancer patients. English articles published between May 1990 to May 2024 were included.</p><p><strong>Key content and findings: </strong>Older breast cancer patients represent a heterogeneous group with specific needs and treatment considerations. Treatment decisions for geriatric cancer patients should be based on a comprehensive geriatric assessment (CGA), which considers the patient's functional status, comorbidities, and preferences, rather than relying solely on chronological age. Breast cancer surgery is generally well tolerated in older patients, with a low rate of systemic complications and 30-day post-surgery mortality. In selected elderly patients, axillary surgery may be omitted to minimize side effects. The choice of endocrine therapy should take into account the side effect profile, patient's comorbidities, concomitant medications, and preferences. While aromatase inhibitors provide better efficacy, musculoskeletal side effects and osteoporosis may be a concern for older patients. CDK4/6 inhibitors have a similar efficacy in elderly patients as younger patients, but the incidence of neutropenia and dose modifications or interruptions are more frequent. Reported radiotherapy side effects are similar across age groups, although the occurrence of radiation-induced pulmonary toxicities was found to be associated with old age. Chemotherapy is reserved for triple-negative and HER2-positive disease in elderly patients due to known side effects. such as neutropenia, cardiotoxicity, and cognitive impairment. Data on the efficacy and safety of immunotherapy use in older patients are limited.</p><p><strong>Conclusions: </strong>Physicians should make additional efforts to evaluate age-specific treatment efficacy and treatment-induced toxicities. Further efforts to enhance the representation of older patients in breast cancer trials are warranted.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":" ","pages":"1521-1529"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142613462","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":"Electronic Patient Reported Outcome Measures after palliative radiotherapy: evaluation of implementation.","authors":"Eva Oldenburger, Sofie Isebaert, Annemarie Coolbrandt, Chantal Van Audenhove, Karin Haustermans","doi":"10.21037/apm-24-74","DOIUrl":"https://doi.org/10.21037/apm-24-74","url":null,"abstract":"<p><strong>Background: </strong>Radiotherapy is a frequently utilized palliative treatment for cancer patients. Electronic Patient-Reported Outcome Measures (ePROMs) offer a method for patients to communicate their symptoms and concerns to healthcare providers (HCPs) remotely. While ePROMs have demonstrated significant benefits for oncology patient care, their integration into routine clinical practice of palliative radiotherapy (PRT) poses challenges. The current study aimed to evaluate the implementation of an ePROM-intervention after PRT.</p><p><strong>Methods: </strong>We conducted a two-phase study to evaluate the implementation of a self-developed ePROM intervention, known as the ePRomT diary, for symptom monitoring post-PRT. This diary offered automated self-management advice for mild symptoms and also guided patients to contact an HCP for severe symptoms. We assessed various implementation aspects using the RE-AIM framework and collected data through surveys, interviews, electronic health records, and field notes. Quantitative data analysis employed descriptive statistics, while qualitative data underwent thematic analysis using NVivo. Recruitment periods for both phases spanned 10 weeks.</p><p><strong>Results: </strong>In Phase I, 37 out of 87 eligible patients (43%) participated, a number that rose to 40 out of 49 eligible patients (82%) in Phase II. Among participating patients, 93% in Phase I and 98% in Phase II reported the ePRomT diary as a valuable addition to their care. Additionally, 75% and 84% expressed willingness to reuse it, while 70% and 80% would recommend it to others in Phases I and II, respectively. In Phase I, 17 out of 39 patients (44%) completed at least one ePROM assessment, increasing to 26 out of 40 patients (65%) in Phase II. While patients found the self-management advice generally correct and relevant, they noted its somewhat generic nature. Moreover, while the advice to contact an HCP was deemed appropriate, adherence to it varied. HCPs expressed satisfaction with the intervention, deeming it valuable in patient care, and believed that integrating it into routine clinical practice would enhance patient acceptability with minimal workflow disruptions.</p><p><strong>Conclusions: </strong>Despite certain limitations, including participant bias, our study offers valuable insights into the implementation and potential implications of an ePROM intervention for symptom follow-up post-PRT, framed within the RE-AIM framework. ePROM interventions like the ePRomT diary show promise and are well-received by both patients and HCPs. However, optimizing such interventions to better align with patient needs and seamlessly integrating them into clinical workflows within the context of PRT warrants further investigation.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"13 6","pages":"1317-1331"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142779424","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":"Prospective surveillance and early intervention to prevent chronic breast cancer-related arm lymphedema-what are the barriers?","authors":"Shirley S W Tse, Cindy Wong, Kaori Tane, Yuichiro Kikawa, Bolette Skjødt Rafn, Adrian W Chan, Shing Fung Lee, Jennifer Y Y Kwan, Muna AlKhaifi, Robin Sheung, Cadia Kwong, Alex Tse, Katy Sham, Jack Ling, Yuet Ming Liu, Candy Leung, Fion Chan, Sally Tsang, June Wong, Wai Yung Choy, Yin Ping Choy, Jessica Lai, Tracy Shum, Edward Chow, Henry C Y Wong","doi":"10.21037/apm-24-93","DOIUrl":"https://doi.org/10.21037/apm-24-93","url":null,"abstract":"<p><p>Up to one in five early breast cancer patients develop chronic upper limb lymphedema after breast cancer treatments. This treatment complication is irreversible and can significantly impact the quality of life of breast cancer survivors. The model of prospective surveillance and early intervention has emerged as a potential strategy to prevent the development of this debilitating treatment-related complication. However, the widespread implementation of such programs worldwide is challenging. The aim of this review is to identify barriers of implementation, including selecting suitable patients to be enrolled, determining the optimal method for lymphedema screening, and choosing the most effective treatment to prevent progression when early or subclinical breast cancer-related arm lymphedema (BCRAL) is detected. Future research should develop accurate predictive models for the development of upper limb lymphedema using population based datasets with artificial intelligence and investigate the comparative efficacy of different screening methods and treatment options for early intervention for BCRAL. The medical community should also regularly review whether new treatments such as immunotherapy, targeted therapies and new surgical or radiation techniques could contribute to the development of arm lymphedema. By overcoming these barriers, we can improve the feasibility of implementing early prospective surveillance programs in clinical practice, ultimately improving the care and outcomes for breast cancer survivors at risk of treatment-related upper limb lymphedema.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"13 6","pages":"1513-1520"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142779453","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":"Childhood cancer in Bangladesh: a qualitative evaluation.","authors":"Taufique Joarder, Samiun Nazrin Bente Kamal Tune, Shahaduz Zaman","doi":"10.21037/apm-24-30","DOIUrl":"10.21037/apm-24-30","url":null,"abstract":"<p><strong>Background: </strong>Childhood cancer persists as a prominent public health concern in low- and middle-income countries (LMICs), with only a 20% survival rate. In Bangladesh, 67% of healthcare expenses are out of pocket. Since 2012, World Child Cancer-UK (WCC-UK) has collaborated with Bangabandhu Sheikh Mujib Medical University (BSMMU) to address this issue. This evaluation aimed to assess the project's purpose and impact, delivering insights to donors regarding their contributions, best practices, lessons learned, potential challenges encountered, and recommendations for future project development or refinement.</p><p><strong>Methods: </strong>This study employed a qualitative method to evaluate the WCC-UK project objectives from May to June 2017. It involved seven document reviews and nine key informant interviews (KIIs) with project leadership, collaborating partners at the Hub and Satellites, management staff, and Twinning Partners. Besides, two in-depth interviews (IDIs) were carried out with certain beneficiaries, particularly parents of children with cancer. Thematic data analysis was performed to emanate the findings.</p><p><strong>Results: </strong>Despite facing challenges such as an unclear management structure, ambiguous patient eligibility criteria, personnel issues, and communication gaps, the project made strides in several areas. BSMMU provided essential space and leadership, while Satellite Centers supported the project with continuing medical education (CME) and data entry. The project offered subsidies to poor patients and improved cancer awareness among healthcare providers and service seekers. Despite some parents receiving health and nutrition education during their hospital stays, developing a long-lasting system to educate them about long-term cancer care for their children was found to be formidable. The analysis also highlighted staffing shortages, a hierarchical gap between physicians and nurses, and a predominantly male leadership structure.</p><p><strong>Conclusions: </strong>While the project has made progress toward its goals, there are critical areas that require attention to fully realize its objectives. Specifically, it is recommended that the project clarify its management structure, establish clear patient eligibility criteria, address staffing and communication issues, and work towards a more inclusive leadership. These improvements are essential for the project's long-term success and sustainability.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":" ","pages":"1371-1384"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142016162","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}