BMJ Supportive & Palliative Care最新文献

{"title":"Assisted ventilation withdrawal in motor neuron disease: updated results.","authors":"Lucy Bleazard, Jonathan Palmer, David Wenzel, Thomas Jeffery, Christina Faull","doi":"10.1136/spcare-2025-005389","DOIUrl":"https://doi.org/10.1136/spcare-2025-005389","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with ventilator-dependent motor neuron disease (MND) may request withdrawal of their assisted ventilation. Facilitating this process as a healthcare professional (HCP) can be emotionally and practically challenging. The Association for Palliative Medicine (APM) issued guidance to support HCPs and invited anonymised accounts of the withdrawal process to provide an update on the guidance.</p><p><strong>Methods: </strong>HCPs submitted anonymised accounts via email. Quantitative data was analysed descriptively in Excel. Free-text comments were analysed thematically using an inductive, iterative approach.</p><p><strong>Results: </strong>68 HCPs submitted 95 accounts of ventilation withdrawal between 2015 and 2024. Most patients received medications pre-withdrawal (94%), primarily a combination of an opioid and midazolam, mostly subcutaneously. Younger patients tended to need higher doses to achieve adequate symptom management prior to withdrawal. Practices of weaning the ventilator varied significantly between respondents. The median time to death following withdrawal of ventilation was 30 min, with three-quarters of patients dying within 2 hours.</p><p><strong>Conclusion: </strong>This is the largest data set to date regarding the withdrawal of assisted ventilation in MND. This updated analysis reaffirms that a personalised, titrated approach remains appropriate and effective. The revised APM Guidance 2025 incorporates new sections on recommendations for managing the ventilator.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699506","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":"Ambulatory palliative care and cancer symptom control: a systematic review and meta-analysis.","authors":"Rajvi Shah, Rachel Everitt, Dana Hince, David Kissane, Natasha Michael","doi":"10.1136/spcare-2024-005152","DOIUrl":"https://doi.org/10.1136/spcare-2024-005152","url":null,"abstract":"<p><strong>Background: </strong>Ambulatory palliative care clinics are associated with improved outcomes in cancer patients, including short-term quality of life. However, their impact on individual patient-reported symptoms is not well understood.</p><p><strong>Aim: </strong>We evaluated the impact of ambulatory palliative care on individual symptoms in adult cancer patients.</p><p><strong>Design: </strong>Following a standard protocol (PROSPERO: CRD42022321909), investigators independently identified randomised and non-randomised intervention studies that assessed patient-reported symptom scores using validated symptom assessment scales longitudinally. Data were synthesised using random-effects meta-analyses.</p><p><strong>Data sources: </strong>Database of PubMed, CINAHL, EMBASE, PsycINFO and Cochrane Central was searched from inception to September 2023 for eligible studies.</p><p><strong>Results: </strong>20 studies encompassing 4 prospective cohort studies, 1 randomised control trial and 15 retrospective studies were included. Most studies focused on cohorts with advanced cancers of mixed primary tumour type, were colocated within or linked to a tertiary cancer centre and assessed symptoms using the Edmonton Symptom Assessment Scale (ESAS). The meta-analyses confirmed evidence for improvement in pain (standardised mean difference (SMD) 0.31, 95% CI 0.18 to 0.44), anxiety (SMD 0.31, 95% CI 0.12 to 0.49), fatigue (SMD 0.31, 95% CI 0.10 to 0.51), insomnia (SMD 0.29, 95% CI 0.15 to 0.42), depression (SMD 0.25, 95% CI 0.09 to 0.40), drowsiness (SMD 0.23, 95% CI 0.11 to 0.34), well-being (SMD 0.28, 95% CI 0.12 to 0.45) and overall symptom burden (SMD 0.29, 95% CI 0.22 to 0.36). There was no evidence for improvement in nausea (SMD 0.19, 95% CI -0.02 to 0.40), dyspnoea (SMD 0.16, 95% CI 0.02 to 0.29) and appetite scores (SMD 0.14, 95% CI -0.00 to 0.29).</p><p><strong>Conclusions: </strong>Ambulatory palliative care had positive effects on multiple common symptoms. The strength of this evidence however is low, largely due to the considerable heterogeneity among included studies. Further research could determine thresholds on symptom assessment scales to guide urgency of referral, timing of follow-up and optimal multidisciplinary staff involvement.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691074","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":"Lower physical activity and functional capacity after breast cancer neoadjuvant chemotherapy.","authors":"Clarice Gomes Chagas Teodózio, Thamyres Vitória Francisco da Silva Correia Gomes, Louise Acalantis Pereira Pires Fernandes, Raphaela Nunes de Lucena, Jessica Malena Pedro da Silva, Suzana Sales de Aguiar, Luiz Claudio Santos Thuler, Anke Bergmann","doi":"10.1136/spcare-2024-005358","DOIUrl":"https://doi.org/10.1136/spcare-2024-005358","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to assess the levels of physical activity (PA) and functional capacity of breast cancer patients before and after neoadjuvant chemotherapy.</p><p><strong>Methods: </strong>The investigation comprises a prospective cohort study including women 18 years or older who underwent neoadjuvant chemotherapy for breast cancer at a single oncology centre between 4 April 2016 and 31 October 2018. Patients were evaluated in terms of self-reported PA levels and physical capacity using the following physical tests: handgrip strength, sitting and standing up in 30 s and stationary walking for 2 min. Variables were compared before and after neoadjuvant chemotherapy using the Wilcoxon test.</p><p><strong>Results: </strong>A total of 440 women were analysed, 88.2% of whom presented at an advanced clinical stage. The mean age of the patients was 51.0 years (±11.0), 68.0% were non-white and 53.9% were not working at the time of diagnosis. Decreased PA levels and handgrip strength (p<0.002) were observed following chemotherapy, although no changes in aerobic capacity and lower limb resistance (LLR) were noted (p=0.595 and p=0.163, respectively).</p><p><strong>Conclusion: </strong>Women with breast cancer exhibit decreased PA levels and handgrip strength following neoadjuvant chemotherapy, although no alterations in aerobic capacity and LLR were observed at the end of treatment.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691075","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":"'Blood transfusions in palliative medicine and symptom control in solid tumours'.","authors":"Geena Kelly, Claire Kruger, Ita Harnett, Camilla Murtagh","doi":"10.1136/spcare-2025-005406","DOIUrl":"https://doi.org/10.1136/spcare-2025-005406","url":null,"abstract":"<p><strong>Introduction: </strong>Fatigue and breathlessness are among the most distressing symptoms for palliative care patients and may be related to underlying anaemia. Red cell concentrate (RCC) transfusion is a common intervention, yet its efficacy in improving these symptoms in palliative populations remains unclear.</p><p><strong>Methods: </strong>This retrospective chart review examined the impact of RCC transfusion on fatigue, breathlessness and functional status in 33 patients admitted to a hospice inpatient unit over 30 months. Symptom and functional scores were assessed pre-transfusion, and at 14 and 30 days post-transfusion, using the Palliative Care Outcomes Collaboration Symptom Assessment Scale, Australian Karnofsky Performance Status (AKPS) and Resource Utilisation Groups-Activities of Daily Living (RUG-ADL) tools.</p><p><strong>Results: </strong>Results showed that fatigue scores improved in 58% of patients, with sustained improvement at 30 days in 36%. A statistically significant reduction in fatigue was observed at 14 days post-transfusion (p=0.02). However, the impact on breathlessness was limited, with only 18% of patients reporting improvement, and no significant changes in mean breathlessness scores over time. Functional status, measured by AKPS and RUG-ADL, declined in 36% and 27% of patients, respectively, likely reflecting the progressive nature of terminal illness.</p><p><strong>Conclusions: </strong>While RCC transfusion demonstrated potential for alleviating fatigue, particularly in the short term, its effects on breathlessness and functional status were limited. The high mortality rate (30% at 30 days) and small sample size highlight the challenges of research in this population. These findings support the role of RCC transfusion in managing fatigue in palliative care, though further prospective studies are warranted.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143668632","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 care is related to less aggressive end-of-life treatment in haematology-oncology: a retrospective cohort study.","authors":"Davide Facchinelli, Corinna Greco, Manuela Rigno, Daniela Menon, Pietro Manno, Leonardo Potenza, Claudio Cartoni, Marcello Riva, Laura Dalla Verde, Anna Varalta, Alberto Tosetto","doi":"10.1136/spcare-2024-005089","DOIUrl":"https://doi.org/10.1136/spcare-2024-005089","url":null,"abstract":"<p><strong>Objectives: </strong>Patients with haematological malignancies (HM) experience high-intensity medical care near the end of life (EOL), have low rates of hospice and palliative care (PC) use and are more likely to die in the hospital. We compared the quality indicators for EOL care in patients followed by a haematologist with or without PC.</p><p><strong>Methods: </strong>This observational, retrospective study evaluated a cohort of 196 consecutive patients with HM. We used a mean composite score for the aggressiveness of EOL. The quality indicators evaluated were chemotherapy, place of death, transfusions and hospital use in the last month of life.</p><p><strong>Results: </strong>Eighty patients were offered PC and 116 were not. The composite score for aggressive EOL care was significantly higher for patients not followed by PC (2.2 vs 0.5; p<0.0001). None of the PC group patients was intubated or admitted to intensive care; 91.2% of the patients followed by PC died at home or in hospice, while 81.9% of the other patients died in the hospital.</p><p><strong>Conclusion: </strong>Many patients who died of HM received intensive treatment near EOL. Our data support the value of integrating PC into the HM routine practice and can be the basis for new studies.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656176","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":"Long-term opioid prescribing and healthcare encounters in metastatic cancer: observational population study.","authors":"Hannah Harsanyi, Lin Yang, Jenny Lau, Winson Y Cheung, Yuan Xu, Colleen Cuthbert","doi":"10.1136/spcare-2024-005185","DOIUrl":"https://doi.org/10.1136/spcare-2024-005185","url":null,"abstract":"<p><strong>Background: </strong>Although opioids are effective for cancer pain management, long-term use may result in adverse effects which are understudied among patients with metastatic disease.</p><p><strong>Objectives: </strong>To describe long-term opioid prescribing among patients with metastatic cancer and investigate how long-term prescribing practices are associated with the incidence of opioid-related hospitalisations and emergency department visits.</p><p><strong>Methods: </strong>This retrospective cohort study included all opioid-naïve patients diagnosed with solid metastatic cancer in Alberta, Canada from 2004 to 2017 who had ≥1 year of follow-up. Patients were identified and followed using linked administrative health data. Long-term prescribing was defined as receiving a ≥90-day supply of opioids with a <30-day gap in supply within a 180-day period. The incidence rate of opioid-related healthcare encounters was compared based on characteristics of long-term prescribing (timing, dosage, duration and concurrent medications).</p><p><strong>Results: </strong>The study included 10 927 patients, 2521 (23%) of whom received long-term opioid prescribing. These practices became more common near the end of life, with 53% of cases initiated during patients' last year of life. Opioid-related healthcare encounters were experienced by 85 (3.4%) recipients of long-term prescribing. Higher dosage (p<0.001) and concurrent prescribing of anxiolytics (p=0.001), benzodiazepines (p=0.001), antidepressants (p=0.027) and neuroleptics (p<0.001) were associated with a higher incidence of opioid-related healthcare encounters.</p><p><strong>Conclusions: </strong>Long-term opioid prescribing is common, and patients receiving long-term prescriptions with high dosage or concurrent psychoactive medications may benefit from interventions aimed at reducing opioid-related adverse effects. Further research is needed to determine strategies to minimise opioid-related harms for these patients while providing appropriate pain and symptom management.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143622968","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":"Physical activity and supportive care intervention preferences: a cross-sectional study of barriers in advanced cancer.","authors":"Megan Agnew, Lisa Cadmus-Bertram, Christian W Schmidt, Kristine Kwekkeboom, Amy Trentham-Dietz, Ronald Gangnon, Shaneda Warren Andersen","doi":"10.1136/spcare-2025-005367","DOIUrl":"https://doi.org/10.1136/spcare-2025-005367","url":null,"abstract":"<p><strong>Purpose: </strong>Physical activity may greatly benefit adults living with advanced cancer; however, barriers to physical activity and preferences for supportive care interventions are not well understood. This study investigates barriers to physical activity and differences in intervention preferences by demographic and clinical characteristics among adults with advanced cancer.</p><p><strong>Methods: </strong>Data came from a cross-sectional study of 247 adults with advanced cancer who visited the University of Wisconsin Carbone Cancer Centre from January 2021 to January 2023. The Godin-Shepard Leisure Score Index (insufficiently active, moderately active and active) was used to assess physical activity. Physical activity barriers were reported as mean scores (1-5: 'not at all' to 'a great deal'). Differences in intervention preferences were assessed using X² tests.</p><p><strong>Results: </strong>Adults living with advanced cancer were insufficiently active (53%), moderately active (21%) or active (26%). Respondents identified several barriers to physical activity spanning tiredness (x̄=3.2), winter weather concerns (x̄=3.2) and lack of motivation (x̄=2.7). Respondents were most interested in a supportive care intervention designed to increase energy (88%) and improve physical health (86%) with physical therapy (73%), walking (72%) and resistance exercises (72%). Differences in preferences emerged by demographic characteristics and to a lesser extent by clinical characteristics.</p><p><strong>Conclusions: </strong>Adults with advanced cancer reported several barriers to physical activity. Future interventions should emphasise increasing energy and physical health and include strategies to manage tiredness and winter weather concerns.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143622971","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":"Inflammatory marker cut-off points and prognosis in incurable cancer: validation study.","authors":"Gabriella da Costa Cunha, Emanuelly Varea Maria Wiegert, Larissa Calixto-Lima, Livia Costa De Oliveira","doi":"10.1136/spcare-2024-005302","DOIUrl":"https://doi.org/10.1136/spcare-2024-005302","url":null,"abstract":"<p><strong>Objectives: </strong>The study aimed to determine and validate cut-off points for selected inflammatory markers to predict 30-day, 60-day and 90-day survival in patients with incurable cancer exclusively receiving palliative care.</p><p><strong>Methods: </strong>Prospective cohort study with patients referred to the palliative care unit of a national reference centre for cancer in Brazil. The sample (n=2098) was randomised into development (n=1049) and validation (n=1049) groups. C-reactive protein (CRP), CRP/albumin ratio (CAR), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), lymphocyte/monocyte ratio (LMR), prognostic nutritional index (PNI) and systemic immune-inflammation index (SII) were evaluated. Time-dependent receiver operating characteristic curves were used to define the optimal cut-off points. Kaplan-Meier curves, Cox proportional hazards models and concordance statistic (C-statistic) were used to evaluate their predictive ability.</p><p><strong>Results: </strong>The optimal cut-off points related to 30-day, 60-day and 90-day mortality were, respectively, as follows: CRP ≥6.0 mg/L, ≥4.8 mg/L and ≥4.7 mg/L; CAR ≥2.0, ≥1.7 and ≥1.5; NLR ≥6.5, ≥5.8 and ≥5.7; PLR ≥298.0, ≥286.7 and ≥281.2; LMR ≥1.9, ≥2.2 and ≥2.0; PNI ≥35.5, ≥46.8 and ≥30.5; and SII ≥2254.4, ≥1983.0 and ≥1844.1. The inflammatory markers that showed discriminatory accuracy (CRP, CAR, NLR, PLR and SII) were selected for validation. These markers demonstrated predictive ability, with good discriminatory power (C-statistic ≥0.75).</p><p><strong>Conclusions: </strong>Optimal cut-off points were validated for CRP, CAR, NLR, PLR and SII for use in the prognostic assessment of patients with incurable cancer exclusively receiving palliative care.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143622965","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":"Crisis pack prescribing in terminal haemorrhage: a national survey of specialist palliative medicine physicians.","authors":"Grace Kennedy, Niall Manktelow, Ita Harnett, Camilla Murtagh","doi":"10.1136/spcare-2025-005370","DOIUrl":"https://doi.org/10.1136/spcare-2025-005370","url":null,"abstract":"<p><strong>Objectives: </strong>To establish practice among senior palliative medicine physicians regarding anticipatory prescribing to manage a terminal haemorrhage.To generate a guideline informed by data collected.</p><p><strong>Methods: </strong>An electronic questionnaire was sent to palliative medicine consultants and specialist registrars in Ireland.</p><p><strong>Results: </strong>The response rate was 50%. All respondents (100%) prescribe crisis packs. The most prescribed medications were morphine and midazolam. Over 95% prescribe medication via the subcutaneous route. Regarding indications for prescribing, about two-thirds of respondents would prescribe for a patient with a head and neck malignancy. Almost two-thirds of respondents do not follow any policy or guideline. The main area of variation is in the dose prescribed for those already on a scheduled opioid and/or benzodiazepine.</p><p><strong>Conclusions: </strong>The proposed guideline is based on the expert opinion of questionnaire respondents. The recommended medications, route of prescription and broad indications for prescribing included in the guideline were based on a clear consensus. Most respondents vary the dose of crisis medication prescribed based on whether the patient is on a baseline anxiolytic/opioid. As the calculations used for dose variation were not consistent between respondents, the most reported calculation, 1/6 of 24-hour dose, is recommended in the guideline.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143555908","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":"End-of-life care in a major UK trauma centre.","authors":"Sarah Edwards, Nicola Ubayasiri","doi":"10.1136/spcare-2025-005421","DOIUrl":"https://doi.org/10.1136/spcare-2025-005421","url":null,"abstract":"<p><strong>Objectives: </strong>Death occurs within the emergency department (ED) sadly not infrequently. There is limited evidence exploring the demographics of these patients and the experience they have in the ED when they die or are approaching the end of life (EOL).</p><p><strong>Methods: </strong>A retrospective review of patients aged 18 years and over who died in our major trauma centre was conducted. Data collected included demographics, frailty scores, time of arrival, time of death, time of EOL decision, cause of death in the ED and who wrote do not attempt cardiopulmonary resuscitation (DNACPR) forms.</p><p><strong>Results: </strong>From January to December 2023, 326 patients died in the ED. 76% of patients were aged 65 years or over, with 69% having a clinical frailty score of 5 or more. The average time from arrival to death was 5 hours 56 min, with the average time from EOL decision to death being 1 hour and 53 min. 60% of all patients had a DNACPR, with 75% of those being written by ED clinicians.</p><p><strong>Conclusion: </strong>EOL is becoming ever more important in the ED. Further work is needed to see if our local experience matches other EDs.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540171","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}