BMJ Supportive & Palliative Care最新文献

{"title":"Dying, death and doctors-in-training: survey.","authors":"Conor Moloney, Daniel Nuzum, Mairead Lyons, Clara Steele, Clara Forrest, Emer Lynch, Eltayeb Elhassan, Hazel O'Sullivan, Mary Jane O'Leary, Seamus O'Reilly","doi":"10.1136/spcare-2025-005631","DOIUrl":"https://doi.org/10.1136/spcare-2025-005631","url":null,"abstract":"<p><strong>Objectives: </strong>Approximately 50% of deaths occur in acute hospitals, and doctors-in-training (DITs) regularly encounter death in many forms and settings. Despite this frequent exposure to death and dying, DITs often feel unprepared and unsupported, leading to significant distress. This study is the first performed to date in Ireland to assess the training and support provided to DITs at Cork University Hospital in managing death and dying and explore the impact of these experiences on their spiritual well-being.</p><p><strong>Methods: </strong>A 27-question electronic survey was completed by 130 DITs, gathering information on their training, confidence in managing end-of-life care (EoLC), perceptions of available support and spiritual impacts of death and dying.</p><p><strong>Results: </strong>67% of DITs felt inadequately trained in death and dying, with nearly half lacking confidence in discussing EoLC with patients or families. Additionally, 69% reported inadequate support or debriefing after patient deaths. Most respondents indicated that patient deaths had a personal impact; however, on average, respondents had a moderate sense of spiritual well-being.</p><p><strong>Conclusions: </strong>This study highlights the need for improved training and support for DITs in managing death and dying, which could enhance both their overall well-being and the quality of patient care. Further research will expand the survey to other hospitals nationwide.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145291074","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":"Psychedelic drugs in palliative care: research agenda.","authors":"Claire Stokes, Aaryan Khagram, Billie Metselaar, Taylan Gurgenci, Phillip Good","doi":"10.1136/spcare-2025-005661","DOIUrl":"https://doi.org/10.1136/spcare-2025-005661","url":null,"abstract":"<p><p>Patients with life-limiting illnesses often experience profound emotional and spiritual challenges that conventional palliative care treatments may not fully alleviate. Psychedelics, with their potential to facilitate deep psychological insight, offer a promising approach to enhancing end-of-life care. Despite growing interest and emerging psychiatric applications, their use in palliative settings remains poorly understood, with existing studies limited by small sample sizes and low methodological quality. This article outlines a research agenda that prioritises adequately powered randomised controlled trials with patient-centred outcome measures, with an aim to inform policy and practice change.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145291086","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":"Memantine efficacy in chemotherapy-induced peripheral neuropathy: double-blind placebo-controlled randomised clinical trial.","authors":"Niloofar Esmaili, Samineh Beheshtirouy, Zohreh Sanaat, Elnaz Shaseb, Parvin Sarbakhsh, Saba Ghaffary","doi":"10.1136/spcare-2024-005348","DOIUrl":"https://doi.org/10.1136/spcare-2024-005348","url":null,"abstract":"<p><strong>Background and aims: </strong>Chemotherapy-induced peripheral neuropathy (CIPN) is a detrimental side effect of chemotherapeutic agents. If left untreated, CIPN can persist for several years following the chemotherapy. CIPN management may enhance the quality of life of the affected patients. This study evaluated the efficacy of memantine, an antagonist of N-methyl-D-aspartate, in CIPN management.</p><p><strong>Methods: </strong>This double-blinded randomised clinical trial was performed on 176 individuals with CIPN. Patients were randomised to either the memantine or placebo groups (88 in each). The memantine group received a single daily dose of 5 mg for the initial 3 days. Subsequently, the dosage was increased to 20 mg per day, with 5 mg increments every 3 days. The placebo group received tablets of equal shape and size. All individuals received medications for 8 weeks. The McGill pain questionnaire and tuning fork test were used to evaluate the severity of neuropathic pain in patients, both at baseline and after the intervention ended.</p><p><strong>Results: </strong>Based on tuning fork test results, significant improvement in neuropathy was observed among patients who received memantine compared with those who received placebo (p<0.001 vs 0.665). McGill pain questionnaire score revealed a significant difference between memantine and placebo groups (p<0.001 for both groups). This difference was also significant after performing intention-to-treat analysis. Moreover, a higher proportion of patients in the memantine group achieved minimal clinically important difference.</p><p><strong>Conclusion: </strong>The use of memantine mitigated the CIPN intensity. Thus, it appears that memantine is a promising option for the management of patients experiencing CIPN.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145243784","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":"Integrative gynaecological oncology in prehabilitation: scoping review of patient-centred care models.","authors":"Eran Ben-Arye, Jalid Sehouli, Georg Seifert, Noah Samuels, Sarah Blakeslee, Orit Gressel, Marlene Lee, Yakir Segev, Ofer Lavie","doi":"10.1136/spcare-2025-005571","DOIUrl":"10.1136/spcare-2025-005571","url":null,"abstract":"<p><strong>Objectives: </strong>Enhanced recovery after surgery is a concept increasingly addressed in prehabilitation research, addressing patients' unmet needs and quality of life (QOL)-related concerns, while overcoming barriers to implementing effective models of care. The present narrative overview examined the gynaecological oncology prehabilitation literature, within the context of integrative oncology (IO) whose goals include enriching prehabilitation care.</p><p><strong>Methods: </strong>A multidisciplinary and multinational team of 9 coauthors from Israel and Germany conducted a narrative review, searching PubMed/Medline databases for complementary medicine and IO-related keywords relevant to the gynaecological oncology-related prehabilitation setting.</p><p><strong>Results: </strong>A total of 55 papers addressing IO-related prehabilitation models in gynaecological oncology were identified. The research addressed issues related to QoL-related concerns, including anxiety and uncertainty among patients during prehabilitation. IO modalities addressing these symptoms included mind-body medicine; manual-movement therapies; acupuncture and guidance on the use of herbal medicine. Five stages along the prehabilitation timeline for implementing IO therapies were identified, beginning at the initial diagnosis of cancer, until surgery or the initiation of chemotherapy and other oncological drug treatments.</p><p><strong>Conclusions: </strong>The inclusion of IO programmes during prehabilitation for gynaecological cancer should be a routine part of patient care, from the initial diagnosis of cancer through surgery and anti-cancer drug treatments. The IO model of care can significantly enhance the patient-centred prehabilitation setting for those with gynaecological cancer, while exploring the patient's health belief model, expectations and unmet needs, especially for QoL-related concerns for which currently available supportive care has limited effectiveness.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124059","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":"Did the assisted dying debate kill evidence-based discussion?","authors":"Colin John Rees, Elizabeth Lamb, Mark Lee","doi":"10.1136/spcare-2025-005884","DOIUrl":"https://doi.org/10.1136/spcare-2025-005884","url":null,"abstract":"","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145243829","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":"UK Association of Supportive Care in Cancer (UKASCC) Enhanced Supportive Care (ESC) National Collaborative: Building a Community of Practice.","authors":"Shahlaa Walsh, Joanna Sheppard, Stephanie Lister-Flynn, Joanne Droney, Lynn Calman, Dipesh Gopal, Ollie Minton, Charlotte Chamberlain, Avril Chester, Sally Taylor, Kate Law, Daniel Monnery","doi":"10.1136/spcare-2025-005785","DOIUrl":"https://doi.org/10.1136/spcare-2025-005785","url":null,"abstract":"<p><strong>Background: </strong>Enhanced Supportive Care (ESC) delivers multi-professional and proactive support for people with treatable but not curable cancer by addressing physical, psychological and social needs throughout the disease trajectory from the point of diagnosis. Since the dissolution of the national NHS England Commissioning for Quality and Innovation funding, ESC services in the UK have lacked standardisation, financial backing and strategic oversight.</p><p><strong>Objectives: </strong>To create a national collaborative ESC framework by identifying evidence-based care models, mapping existing national services and informing future commissioning and research.</p><p><strong>Methods: </strong>The ESC Steering Group was established in 2022 under the UK Association for Supportive Care in Cancer (UKASCC) and developed two workstreams in collaboration with patient and public involvement: (1) an international scoping review to define components of effective ESC models and (2) a national survey to evaluate current ESC service provision, barriers, facilitators and measurable outcomes.</p><p><strong>Results: </strong>The UKASCC ESC National Collaborative involves over 40 professionals from 27 organisations and found considerable variation in ESC service delivery, therefore supporting the need for a standardised, evidence-informed model. The scoping review and survey distribution are in progress.</p><p><strong>Summary: </strong>The UKASCC ESC National Collaborative demonstrates the power of collaborative working in supportive oncology. Despite challenges, this network guides national ESC development and aims to support a future research portfolio and commissioning strategy.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231420","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":"Palliative and end-of-life care research funding: an analysis of current UK health research spending.","authors":"Bethan Sheridan, Fliss Murtagh","doi":"10.1136/spcare-2025-005584","DOIUrl":"https://doi.org/10.1136/spcare-2025-005584","url":null,"abstract":"<p><strong>Objectives: </strong>Despite increasing demand for palliative and end-of-life care, the funding for research in this area has historically been low. Previous UK analyses in 2016 found that less than 0.3% of the funding for cancer research was directed towards palliative care research; current expenditure on palliative and end-of-life care research is unknown. We therefore sought to determine current UK expenditure on palliative and end-of-life care research.</p><p><strong>Methods: </strong>Secondary analysis of publicly available research funding data-UK Health Research Analysis 2022, from the UK Clinical Research Classification System Health Research Classification System. This dataset details UK health research funding from all public sectors (including the governments of the four nations of the UK), charities, societies and professional bodies for the year 2022.</p><p><strong>Results: </strong>Out of 18 023 research funding awards in total in 2022, we identified 136 relating to palliative and end-of-life care research. The total funding for palliative and end-of-life care research was £10.9 million, representing just 0.26% of the total £4.2 billion awarded.</p><p><strong>Conclusions: </strong>Palliative and end-of-life care research continues to be one of the lowest-funded areas of healthcare research in the UK. More investment into palliative and end-of-life care research is urgently needed to advance evidence to meet the rising demand for palliative care.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231458","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":"Red blood cell transfusions in advanced cancer near the end-of-life: narrative review.","authors":"Daniele Marelli, Michela Romelli, Cristina Cornali, Daniela Martinelli, Andrea Sbrana, Cosimo Chelazzi","doi":"10.1136/spcare-2025-005579","DOIUrl":"https://doi.org/10.1136/spcare-2025-005579","url":null,"abstract":"<p><strong>Background: </strong>Red blood cell (RBC) transfusions are commonly used to manage anemia-related symptoms, such as fatigue and dyspnea in patients with advanced cancer. Their use in palliative care (PC) remains controversial due to the lack of clear guidelines, potential risks, and ethical considerations.</p><p><strong>Objective: </strong>This narrative review aims to evaluate the role of RBC transfusions in patients with advanced cancer and those at the end of life.</p><p><strong>Methods and data sources: </strong>A comprehensive review of relevant existing literature was performed in various databases, using combinations of relevant keywords. Only studies published in English were considered.</p><p><strong>Findings: </strong>Anemia affects up to 77% of men and 68% of women with advanced cancer in palliative care. RBC transfusions may offer temporary symptomatic relief, but evidence supporting their routine use in palliative cancer patients is inconclusive. Studies report subjective response rates ranging from 31% to 70%. Benefits on fatigue and dyspnea often last <2 weeks and 23-35% of patients die within two weeks after the transfusion, raising concerns about futility. Variability in transfusion practices across different palliative care settings highlights the influence of clinician attitudes, resource availability, and institutional policies.</p><p><strong>Conclusion: </strong>RBC transfusions in advanced cancer and end-of-life care should be considered on a case-by-case basis, prioritizing patient-centered decision-making and ethical considerations. Though the benefit is often short, they may improve the quality of life for highly selected patients. Risks such as adverse reactions and resource allocation concerns must be considered. Further research is needed to establish evidence-based guidelines and standardized assessment tools to evaluate transfusion efficacy in this population.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225048","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":"Circadian rest-activity rhythm disorders in advanced cancer: assessment, diagnosis and clinical correlates.","authors":"Craig Gouldthorpe, Andrew Neil Davies","doi":"10.1136/spcare-2025-005410","DOIUrl":"https://doi.org/10.1136/spcare-2025-005410","url":null,"abstract":"<p><strong>Introduction and aims: </strong>Circadian rest-activity rhythms describe patterns in rest and physical activity across and between 24-hour periods. Research highlights important associations between circadian disruption, including the rest-activity rhythm, and clinical outcomes in patients with cancer. This study aimed to assess the circadian rest-activity rhythms, and prevalence of circadian rest-activity rhythm disorders (CARDs), in patients with advanced cancer.</p><p><strong>Methods: </strong>An observational study of 72 outpatients with locally advanced or metastatic cancer took place over a 1-year period, considering objective (accelerometry) and subjective (patient diary) measures of circadian rest-activity rhythms, patient-reported outcomes (Memorial Symptom Assessment Scale-Short Form, European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire, brief Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale) and clinical markers.</p><p><strong>Results: </strong>CARDs affected up to 60% of patients with advanced cancer. Increased circadian disruption was seen in patients with more advanced disease, particularly with metastatic organ involvement (p=0.038), poorer performance status (p=0.018), higher inflammatory status (p=0.018), anaemia (p=0.007) and iron deficiency (p=0.002). The study also highlights that patients with advanced cancer and a CARD diagnosis have a higher symptom burden, particularly fatigue (p=0.003) and drowsiness (p=0.005), higher symptom-related distress (p<0.001), a poorer Global Health tatus (p=0.005) and poorer functioning subscales (p<0.014).</p><p><strong>Conclusion: </strong>This is the first study to assess circadian rest-activity rhythms in accordance with new assessment and diagnostic guidelines. Further research is now required to validate the diagnostic criteria, standardise technical approaches to assessment and consider risk factors for the development of a CARD and additional clinical outcomes of interest.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145224994","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":"Phenobarbital for palliative sedation therapy: narrative review.","authors":"Grace Freeman-Spratt, Brendan Tan, Hossein Kasiri","doi":"10.1136/spcare-2024-005316","DOIUrl":"https://doi.org/10.1136/spcare-2024-005316","url":null,"abstract":"<p><strong>Background: </strong>Palliative sedation therapy (PST) is used to treat refractory symptoms at the end of life. Phenobarbital is infrequently used as a third-line agent following unsuccessful symptom control with first-line and second-line agents. However, there is wide clinical and guideline variance in the use of phenobarbital, reflecting a gap in the literature.</p><p><strong>Objective: </strong>The aim of this study is to summarise the current evidence and guidelines surrounding practices of phenobarbital use in PST and discuss areas for future investigations, specifically regarding route of administration, time to death, dosing and concurrent use of first-line and second-line PST.</p><p><strong>Methods: </strong>Studies and guidelines on the use of phenobarbital in PST were retrieved from PubMed and Google and the reference list of identified papers through to August 2024.</p><p><strong>Key findings: </strong>Limited case studies and retrospective audits have been conducted into the use of phenobarbital in PST. These studies and existing guidelines reflect a degree of variance specifically regarding recommendations about route of administration, dosing and use of first-line and second-line PST. Efficacy is not well reported. However, phenobarbital use appears to be safe and does not appear to impact time to survival.</p><p><strong>Conclusion: </strong>Phenobarbital appears to have a safe and potentially efficacious role as a third-line agent in PST. Great variance exists with regards to optimal dosing and the concurrent use of first- and second-line PST agents. High-quality research and multicentre reviews are required to enhance the understanding of optimal phenobarbital use and encourage evidence-based practice in palliative medicine.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225058","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}