BMJ Supportive & Palliative Care最新文献

{"title":"Effectiveness of a virtual reality programme in improving understanding and practice of palliative care: a systematic review.","authors":"Ranaa Mubarak Almasoudi, Ali Alharbi, Clare Gardiner, Catriona R Mayland","doi":"10.1136/spcare-2026-006138","DOIUrl":"https://doi.org/10.1136/spcare-2026-006138","url":null,"abstract":"<p><strong>Background: </strong>Training in palliative care is essential to prepare healthcare professionals to provide compassionate care. Traditional methods often fail to equip students with necessary skills and knowledge. Virtual reality offers immersive, interactive learning environments which may offer a promising alternative.</p><p><strong>Aim: </strong>To conduct a systematic review to evaluate the effectiveness of virtual reality programmes in enhancing nursing and medical students' knowledge, skills and attitudes regarding palliative care.</p><p><strong>Design: </strong>A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The protocol was registered on PROSPERO (CRD42024538984).</p><p><strong>Data sources: </strong>A literature search was conducted in August 2025 using Cumulative Index to Nursing and Allied Health Literature, Medline, Scopus and Web of Science databases, covering publications from inception to August 2025 that identified studies on virtual reality interventions in palliative care education. A review of reference lists, citation searching and Google Scholar was also included.</p><p><strong>Results: </strong>Seven studies met inclusion criteria, reporting statistically significant improvements in knowledge, skills and attitudes following virtual reality training. The evidence highlights a clear pattern of improvement across various educational and clinical domains with participants reporting increased preparedness for real-world practice. Participants consistently reported high engagement and satisfaction.</p><p><strong>Conclusions: </strong>Virtual reality technology shows promise in improving palliative care education by enhancing knowledge, skills and attitudes among doctors and nurses, both qualified and students. Future research should employ robust experimental designs, larger sample sizes and long-term evaluations to confirm these findings.</p><p><strong>Prospero registration number: </strong>CRD42024538984.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833638","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":"Psoas muscle indices, visceral fat distribution, inflammatory markers and 90-day mortality in palliative medicine: retrospective cohort study.","authors":"Zeynep Irmak Kaya, Aral Karabağ, Sinem Gurcu, Ismail Beypinar","doi":"10.1136/spcare-2026-006215","DOIUrl":"https://doi.org/10.1136/spcare-2026-006215","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study is to evaluate the prognostic value of CT-based body composition parameters (skeletal muscle quantity and muscle quality), fat distribution, Global Leadership Initiative on Malnutrition (GLIM) malnutrition criteria and inflammatory/metabolic markers (C-reactive protein/albumin ratio (CAR) and triglyceride-glucose (TyG) index) on 90-day mortality.</p><p><strong>Methods: </strong>A total of 118 patients admitted to the palliative care unit between January 2020 and December 2021 were included in the study. The Psoas Area Index (PAI), Psoas Density Index (PDI) and visceral/subcutaneous fat area ratio were calculated from CT images at the L3 vertebra level. Malnutrition diagnosis was established according to GLIM criteria. Independent risk factors associated with 90-day mortality were evaluated using multivariate logistic regression analysis, and model performance was validated using the 1000-repetition bootstrap method.</p><p><strong>Results: </strong>Out of 118 patients, the 90-day mortality rate was 39.8% (n=47). In deceased patients, PAI (5.4±1.2 vs 6.9±1.4 cm²/m²) and PDI (33.8±7.5 vs 39.5±7.0 HU (Hounsfield unit)) values were significantly lower (p<0.001 for both). In multivariate logistic regression analysis, low PAI (OR 0.65), low PDI (OR 0.89), high CAR (OR 3.78), high TyG index (OR 2.11), GLIM-severe malnutrition (OR 2.94) and presence of dementia (OR 2.74) were identified as independent predictors of 90-day mortality. The model's discriminatory power was excellent (area under the curve: 0.91).</p><p><strong>Conclusions: </strong>CT-based skeletal muscle quantity and muscle quality measurements, when evaluated together with inflammatory and metabolic indices, offer a robust and objective approach to predicting short-term mortality risk in palliative care patients. These parameters may contribute to the early identification of high-risk patients and the planning of individualised care strategies.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833202","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":"Prehabilitation in older adults with cancer: scoping review of surgical outcomes.","authors":"Temesgen Birlie Asmare, Molla Amsalu Tadesse, Negesse Zurbachew Gobezie, Getachew Mekete Deress, Belete Muluadam Admassie, Biruk Demissie, Asnake Tadesse Abate, Begizew Yimenu Mekuriaw, Gezahagn Demsu Gedefaw, Habtie Bantider Wubet","doi":"10.1136/spcare-2026-006166","DOIUrl":"https://doi.org/10.1136/spcare-2026-006166","url":null,"abstract":"<p><strong>Background: </strong>Adults aged ≥65 years constitute a growing proportion of surgical oncology patients and often experience frailty, multimorbidity and reduced physiological reserve, increasing their risk of postoperative complications and functional decline. Multimodal prehabilitation has emerged as a strategy to improve surgical resilience; however, evidence specific to older cancer patients' remains fragmented. This study aimed to map the existing evidence on prehabilitation for older adult patients undergoing cancer surgery, characterise intervention components, summarise functional and surgical outcomes and identify research gaps.</p><p><strong>Methods: </strong>Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines and a protocol registered with the Open Science Framework, searches were conducted in PubMed, Science Direct, the Cochrane Library and Google Scholar up to November 2025. Eligible studies included older adults undergoing cancer-related surgery who received any form of prehabilitation. Two reviewers independently screened studies and extracted data. Due to heterogeneity, findings were synthesised narratively.</p><p><strong>Results: </strong>Thirteen studies were included, comprised of six randomised controlled trials (RCT), three cohort studies, two quasi-experimental studies, one feasibility study and one RCT protocol. Most interventions were multimodal and delivered over 1 to 6 weeks. Improvements in preoperative functional capacity-particularly 6 min walk distance, aerobic endurance, muscle strength and respiratory function-were consistently reported. High-intensity or supervised programmes were reduced severity of postoperative complications and shorter hospital stay, while low-intensity or minimally supervised interventions showed limited postoperative benefit. Nutritional optimisation improved preoperative nutritional status and supported functional gains. Feasibility and acceptable adherence were reported even among frail and very elderly patients. Evidence gaps included variable intervention dosage, inconsistent adherence reporting, heterogeneous outcome measures and limited long-term follow-up.</p><p><strong>Conclusion: </strong>Multimodal prehabilitation is feasible, safe and beneficial for older adults undergoing cancer surgery, improving preoperative function and, when sufficiently intensive, reducing postoperative morbidity and hospital stay. Further research should standardise outcomes, define optimal intervention parameters and evaluate long-term recovery using geriatric-focused models.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833194","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":"Target symptom-guided prescribing in home-based specialist palliative care: prospective quality improvement study.","authors":"Raffaele Giusti, Daniele Marinelli, Guglielmo Fumi, Paolo Toccaceli, Giulio Ravoni, Emilia Colpani, Denise Vacca, Claudia Fiorani, Giampiero Porzio, Maria Anna Siciliano","doi":"10.1136/spcare-2026-006159","DOIUrl":"https://doi.org/10.1136/spcare-2026-006159","url":null,"abstract":"<p><strong>Objectives: </strong>This study aims to assess whether single-agent pharmacotherapy directed at the patient-prioritised, highest-scoring PERSONS symptom (target symptom) produces concurrent improvements in both the target symptom and overall symptom burden in advanced-cancer patients.</p><p><strong>Methods: </strong>Consecutive adults receiving palliative care specialist between April 2023 and February 2024 were enrolled if ≥1 PERSONS item scored ≥ 7/10. At baseline (T₀), clinicians identified the target symptom and initiated one guideline-concordant drug for its control. Follow-up (T₁) occurred after 14 days (median). Outcomes were change in target-symptom severity and change in total PERSONS score. Paired t-tests compared T₀ and T₁; Pearson's r examined correlations.</p><p><strong>Results: </strong>81 patients (median age 71years; 55.6% female; 81.5% metastatic disease) completed both assessments. Target-symptom severity fell from 7.63 ± 1.02 to 3.78 ± 1.35 (mean reduction 3.85 points; 95% CI 3.45 to 4.25; p<0.0001). The total PERSONS score decreased from 21.94 ± 4.56 to 13.46 ± 5.12 (mean reduction 8.48 points; 95% CI 7.54 to 9.42; p<0.0001). Target-symptom severity correlated moderately with non-target PERSONS score at T₀ (<i>r</i> = 0.55) and strongly at T₁ (<i>r</i> = 0.65; both p<0.0001). Pain was the predominant target symptom (45.7 %).</p><p><strong>Conclusions: </strong>Focusing on a single, evidence-based drug on the patient-defined dominant symptom halved target-symptom intensity and reduced global symptom burden by 39% within 2 weeks. These findings support a pragmatic 'less-is-more' paradigm that may minimise polypharmacy while delivering broad symptomatic benefit in advanced cancer.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833226","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":"Implementing a digital advance care plan in practice: a qualitative study of healthcare professionals' perspectives.","authors":"Natasha Wiggins, Benjamin Daley","doi":"10.1136/spcare-2026-006196","DOIUrl":"https://doi.org/10.1136/spcare-2026-006196","url":null,"abstract":"<p><strong>Objectives: </strong>This study examines healthcare professionals' (HCPs') experiences of implementing digital advance care plans (DACPs) to support information-sharing and decision-making in end-of-life care (EoLC) across an Integrated Care Board in Southwest England. It provides evidence of HCPs' perspectives towards the potential of DACPs to enhance the coordination of patient care.</p><p><strong>Methods: </strong>A descriptive qualitative study was conducted. Purposive sampling recruited HCPs from diverse clinical settings. Four focus groups and one semi-structured interview were conducted between November 2024 and November 2025. Data were analysed inductively using thematic analysis. Reflexive practice was embedded throughout, acknowledging the research team's clinical and qualitative experience and potential influence on interpretation.</p><p><strong>Results: </strong>15 HCPs participated. Three overarching themes were identified: (1) Variations in DACP use-some clinicians acting as creators and others as viewers, shaping perceptions of value and workload. (2) Perceived benefits-improved information-sharing, enhanced decision-making in crises and support for nuanced and patient-centred planning. (3) Challenges-fragmented clinical systems, inconsistent updating, variable understanding of DACP purpose and tensions between detailed content and the need for rapid, actionable information. Participants highlighted that DACPs could guide multidisciplinary team (MDT) discussions and contingency planning but were limited by system integration issues and inconsistent use across settings.</p><p><strong>Conclusions: </strong>DACPs have considerable potential to enhance EoLC by improving communication, supporting personalised decision-making and supporting crisis response. Realising these benefits requires improved system interoperability, clearer role expectations and consistent updating across settings. Strengthening digital infrastructure and embedding DACPs into routine MDT processes may help them function as dynamic, evolving records supporting high-quality EoLC.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833640","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":"Application of a regional, multiorganisational education programme to implement a digital advance care plan.","authors":"Eve Barnes, Michelle Ainsworth, Natasha Wiggins","doi":"10.1136/spcare-2026-006194","DOIUrl":"https://doi.org/10.1136/spcare-2026-006194","url":null,"abstract":"<p><strong>Introduction: </strong>Advance care planning (ACP) is key to effective end-of-life care. If digitalisation of ACP is to be achieved, targeted education addressing the challenges of system-level change with diversity across roles, environments and patient groups is required. Currently, little is known about how to design and deliver this education.</p><p><strong>Methods: </strong>This report describes a multiorganisation education programme focused on increasing engagement with digital advance care plans (DACP). Education sessions were delivered by clinicians and evaluated by postsession participant feedback questionnaire. The number of DACP views and creations was analysed to evaluate impact.Purposive sampling methods were used throughout stakeholder engagement, with delivery of 48 organisation-specific education sessions and feedback from 90 healthcare professionals. Supplementary materials were provided, including videos, posters and a monthly newsletter.</p><p><strong>Results: </strong>Most respondents reported being very likely or somewhat likely to use the DACP in clinical practice (94%) following the education. The number of DACPs viewed and created increased across all organisations with the largest increase in primary care.</p><p><strong>Conclusions: </strong>This clinician delivered and patient-focused approach to delivering multiorganisational education has led to increased system-wide engagement with DACPs. Further research is needed to understand challenges experienced by healthcare professionals to optimise education design and delivery.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833517","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":"Misalignment distress: when care is technically right but experientially wrong.","authors":"Richa Randhawa","doi":"10.1136/spcare-2026-006101","DOIUrl":"https://doi.org/10.1136/spcare-2026-006101","url":null,"abstract":"","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147762154","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":"Breaking bad news and the cost of caring on physicians: a systematic scoping review.","authors":"Cheng Yat Tan, Nicholas Wei Hong Thum, Trivikram Mohan, Aidan Kay Jan Cheng, Ranitha Govindasamy, Nur Amira Binte Abdul Hamid, Simon Yew Kuang Ong, Lalit Kumar Radha Krishna","doi":"10.1136/spcare-2025-005588","DOIUrl":"https://doi.org/10.1136/spcare-2025-005588","url":null,"abstract":"<p><strong>Background: </strong>Caring for dying patients and their distressed families can be traumatic. For physicians, these encounters shape the way they see, act and feel as professionals, influencing the inculcation and display of their professional expectations and values-otherwise known as professional identity formation (PIF). When inadequately supported, such changes in PIF can impact patient care, family support and teamwork. With recurrent, brief yet emotionally charged interactions with patients and families especially likely to predispose to moral distress, compassion fatigue and burnout, we propose a review into how breaking bad news (BBN) to patients and families impacts PIF and this personal cost of caring.</p><p><strong>Methods: </strong>Framed by the modified-Systematic Evidence-Based Approach, we conducted a systematic scoping review of studies on BBN published between 2000 and 2024 in PubMed, Embase, Scopus, CINAHL and PsycINFO. To chart changes in PIF, we employed the Ring Theory of Personhood (RToP). Thematic and RToP-guided content analyses were concurrently performed, supplemented by ChatGPT-5 to the triangulate human-led analysis.</p><p><strong>Results: </strong>15 786 titles and abstracts were identified, 346 full-text articles were reviewed and 31 were analysed. BBN demands physicians balance familial goals while preserving patient interests. This predisposes to the personal cost of caring and impacts PIF. These effects are aggravated by ineffective organisational support.</p><p><strong>Conclusion: </strong>BBN impacts PIF and triggers the personal cost of caring. Greater use of team-based approaches in BBN to families should be adopted in practice while training and longitudinal assessment in these approaches should be integrated within purpose-designed, holistic programmes.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":"16 3","pages":"509-518"},"PeriodicalIF":1.8,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147762247","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":"Under nutrition in cancer: single-centre prospective study.","authors":"Wala Ben Kridis, Afef Khanfir","doi":"10.1136/spcare-2023-004730","DOIUrl":"10.1136/spcare-2023-004730","url":null,"abstract":"","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"616-617"},"PeriodicalIF":1.8,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138884337","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":"Reimagining cancer care in the USA: advancing supportive oncology through the Cancer Moonshot Program.","authors":"Arunkumar Krishnan, Beth York, Declan Walsh","doi":"10.1136/spcare-2025-005547","DOIUrl":"10.1136/spcare-2025-005547","url":null,"abstract":"<p><p>The Cancer Moonshot Program aims to reduce cancer mortality by 50% within 25 years through innovation in early detection, precision medicine and novel therapies. However, achieving this goal requires an equal emphasis on supportive oncology, which addresses symptom management, psychosocial needs, and quality of life. Despite its proven benefits, supportive care remains underfunded and often delayed in cancer treatment. This editorial highlights ongoing initiatives within the Moonshot framework, such as the integration of early palliative care and the expansion of telehealth services. Challenges, including provider awareness and reimbursement barriers, must be addressed to ensure equitable, patient-centred cancer care.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"609-611"},"PeriodicalIF":1.8,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511502","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}