BMJ Supportive & Palliative Care最新文献

{"title":"Advance care planning in the Asia Pacific region: comparative implementation study.","authors":"Raymond Ng Han Lip, Masanori Mori, Cheng-Pei Lin, Craig Sinclair, Trudy Giam, Joyce Chee, Josephine M Clayton, Sang-Yeon Suh, Diah Martina, Sayaka Takenouchi, Sun Hyun Kim, Shao-Yi Cheng, Ping-Jen Chen, Sumytra Menon, Kwok-Keung Yuen, Helen Chan, Annie Kwok, Yoshiyuki Kizawa","doi":"10.1136/spcare-2026-006110","DOIUrl":"10.1136/spcare-2026-006110","url":null,"abstract":"<p><strong>Objectives: </strong>There is a lack of understanding of the landscape of advance care planning (ACP) in the Asia Pacific, and to our knowledge, no previous comparative study has been performed. This study sets out to map the current landscape of ACP implementation across member sectors within the Asia Pacific Hospice Palliative Care Network (APHN).</p><p><strong>Methods: </strong>This was a cross-sectional survey of purposively sampled experts and leaders, with at least 5 years of experience in ACP-related practice, from the member sectors of APHN.</p><p><strong>Results: </strong>There is a rich diversity of approaches to ACP implementation, including its conceptualisation, time of initiation and accessibility across various sectors in the Asia Pacific region. The implementation of ACP as a national or organisational programme is associated with increased perceptions of its uptake and accessibility, particularly within Taiwan, New Zealand and Singapore. In some Asian sectors such as in Hong Kong, India, Indonesia, South Korea, Malaysia, Sri Lanka, Thailand and Vietnam, a more family-led ACP process exists, even if the patient has capacity to make healthcare decisions. Most sectors reported top barriers to ACP as a lack of public awareness (9 out of 15 sectors) and lack of empowerment of healthcare professionals (13 out of 15 sectors) as well as social taboo (11 out of 15 sectors).</p><p><strong>Conclusions: </strong>National and organisational support for the ACP process, cultural competency in ACP and engagement efforts to raise awareness and address barriers to ACP are important considerations in ACP implementation in the Asia Pacific.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"879-888"},"PeriodicalIF":2.5,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148040916","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":"Efficacy and safety of acupuncture for breast cancer-related insomnia: a systematic review and meta-analysis.","authors":"Hao Zhang, Kuojun Ren, Shengying Wang","doi":"10.1136/spcare-2025-006052","DOIUrl":"10.1136/spcare-2025-006052","url":null,"abstract":"<p><p>Breast cancer-related insomnia (BCRI) is a common and burdensome sequela. Acupuncture is frequently used, but robust evidence is limited, and previous systematic reviews included few trials yielding imprecise estimates. This updated systematic review and meta-analysis evaluated the efficacy and safety of acupuncture for BCRI. We systematically searched eight databases for randomized controlled trials (RCTs) up to July 1, 2025. RCTs comparing acupuncture with any control for BCRI were eligible. Methodological quality was assessed using the Cochrane Risk of Bias tool (RoB 2.0) and the modified Jadad scale. Meta-analyses employed a random-effects model. Subgroup analyses explored heterogeneity sources, and the GRADE framework rated evidence certainty. Twenty-seven RCTs (n=2,025) were included. Acupuncture significantly reduced Pittsburgh Sleep Quality Index (PSQI) scores (MD= -2.74, 95% CI [-3.92, -1.55], P<0.00001) and increased the overall efficacy rate (RR=1.51, 95% CI [1.27, 1.81], P<0.00001) compared to control, but did not significantly improve Insomnia Severity Index (ISI) scores. Subgroup analyses identified control intervention type and treatment frequency as significant sources of heterogeneity. Adverse events were infrequent and typically mild. GRADE assessments rated the certainty of evidence as low or very low, primarily due to risk of bias and substantial heterogeneity. Current evidence suggests acupuncture may improve sleep in patients with BCRI, with effects moderated by comparator type and treatment frequency. However, conclusions are limited by methodological weaknesses and heterogeneity. Future rigorous RCTs using validated sham controls, standardized protocols, and objective outcomes are needed to confirm efficacy and guide practice. <b>PROSPERO Registration number</b> (ID: CRD42024559828).</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"796-809"},"PeriodicalIF":2.5,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147762123","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":"Distress among primary caregivers of patients with cancer: a cross-sectional study.","authors":"Ram Mohan Jha, Suman Supratik, Surendra Uranw, Rajesh Kumar, Soniya Dulal","doi":"10.1136/spcare-2025-005932","DOIUrl":"10.1136/spcare-2025-005932","url":null,"abstract":"<p><strong>Objectives: </strong>The primary objective of this study was to determine the prevalence, severity and associated factors of distress among primary caregivers of patients with cancer using the National Comprehensive Cancer Network (NCCN) distress thermometer (DT). The secondary objective was to examine the demographic characteristics and cancer types associated with clinically significant distress.</p><p><strong>Methods: </strong>A cross-sectional study was conducted at the oncology unit of B.P. Koirala Institute of Health Sciences, Dharan, Nepal, surveying 173 primary caregivers of patients with cancer between 22 September 2023 and 20 June 2024. An interview-based questionnaire, including the NCCN DT, assessed the prevalence and severity of distress. Distress levels were categorised as mild (DT 0-3), moderate (DT 4-6) and severe (DT 7-10); a score of ≥4 denoted clinically significant distress which encompasses moderate and severe distress. Secondary outcomes included domain-specific distress, sociodemographic and clinical factors.</p><p><strong>Results: </strong>Distress was reported by all caregivers, with 91.9% experiencing clinically significant (DT≥4) and 49.7% severe distress (DT≥7); median DT score was 6 (SD=1.755). Clinically significant distress was more common in caregivers aged ≥30 years, married individuals (p=0.03) and those with lower education levels (p=0.01). Caregivers of patients with gastrointestinal/hepatobiliary (p=0.029) and breast cancers reported higher distress. Statistically insignificant (p=0.208) higher distress was observed among caregivers of patients undergoing multimodal/palliative treatment. Domain-specific analysis revealed distress across physical, emotional, practical, social and spiritual domains.</p><p><strong>Conclusion: </strong>Distress among caregivers of patients with cancer in Nepal is significantly high. Routine screening and interventions reduce adverse outcomes and improve both caregiver well-being and patient care.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"902-909"},"PeriodicalIF":2.5,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13422032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145676473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychological distress and quality of life during chemotherapy for non-small cell lung cancer: prospective observational study.","authors":"Sarvadarshi Saraswata Mahapatra, Nishkarsh Gupta, Seema Mishra, Sachidanand Jee Bharti, Rakesh Garg, Prabhat Singh Malik, Anant Mohan, Rajeev Kumar Malhotra, Sushma Bhatnagar, Vinod Kumar","doi":"10.1136/spcare-2025-005463","DOIUrl":"10.1136/spcare-2025-005463","url":null,"abstract":"<p><strong>Objective: </strong>To assess psychological distress and quality of life (QoL) among patients with non-small cell lung cancer (NSCLC) receiving chemotherapy and examine the relationship between distress and QoL across treatment cycles.</p><p><strong>Methods: </strong>This prospective observational study enrolled 105 patients with NSCLC undergoing chemotherapy. Psychological distress was assessed using the Depression Anxiety Stress Scale-21 questionnaire, and QoL was evaluated using the WHO Quality of Life-BREF questionnaire at baseline (before chemotherapy) and after three and six cycles of chemotherapy. Linear mixed models with first-order autoregressive covariance were used to account for within-patient correlation.</p><p><strong>Results: </strong>Psychological distress worsened over time, with anxiety and stress increasing significantly. QoL declined across all domains, with physical health scores decreasing from 57.99 to 46.71 and psychological health from 54.48 to 43.00. Regression analysis demonstrated an inverse relationship between distress and QoL, with distress explaining 41.74% of QoL variance at baseline and 44.01% at the final assessment. Patients in severe and extremely severe distress categories had a two times higher risk of experiencing a ≥10-point drop in QoL than those with mild or no distress.</p><p><strong>Conclusion: </strong>This prospective observational study confirms that patients with NSCLC receiving chemotherapy experience significant psychological distress and impaired QoL. Early identification and intervention are critical for improving patient outcomes, treatment adherence and quality of care. These findings highlight the need for integrated palliative care in NSCLC management.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"927-935"},"PeriodicalIF":2.5,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145676549","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":"Body composition and physical function in postoperative pancreatic cancer: pancreatoduodenectomy versus distal pancreatectomy.","authors":"Hideaki Kurokawa, Yoshiteru Akezaki, Ritsuko Tominaga, Masato Kikuuchi, Ami Okazaki, Rie Sasaki, Koji Kawamichi, Shinsuke Sugihara","doi":"10.1136/spcare-2025-006029","DOIUrl":"10.1136/spcare-2025-006029","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study was to investigate the postoperative course of pancreatoduodenectomy (PD) and distal pancreatectomy (DP) by examining body composition, physical function, physical activity and total intake to 1 month postoperatively, and to compare the two groups.</p><p><strong>Study design: </strong>This study is a retrospective observational study investigating.</p><p><strong>Methods: </strong>Forty-nine patients for whom preoperative and postoperative evaluation was possible were included. Measurements included operative time, intraoperative blood loss, body weight, body fat mass, skeletal muscle mass index (SMI), grip strength, lower limb muscle strength, walking speed, physical activity, oral intake, total intake, sarcopenia and complications. Body weight, body fat mass, SMI, grip strength, muscle strength of the lower limb, walking speed and sarcopenia were measured preoperatively and 1 month postoperatively.</p><p><strong>Results: </strong>Weight, SMI, body fat mass and grip strength were significantly lower in both groups at 1 month postoperatively compared with preoperatively (p<0.05). The per cent change in body weight, SMI, body fat mass and grip strength between preoperative and 1 month postoperatively for each group was all significantly lower for PD compared with DP (p<0.05). Postoperative activity and oral intake were significantly lower in the PD group compared with the DP group (p<0.05). The incidence of sarcopenia increased significantly in PD at 1 month postoperatively (p<0.05).</p><p><strong>Conclusions: </strong>The present study suggests that PD is associated with lower postoperative body composition, physical function and activity than DP. Rehabilitation intervention that takes into account postoperative physical function, physical activity and nutritional status is required, especially for the PD group.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"936-942"},"PeriodicalIF":2.5,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146008831","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":"Ethical dilemmas for palliative care nurses: systematic review.","authors":"Shuwan Geng, Lei Zhang, Quan Zhang, Yijin Wu","doi":"10.1136/spcare-2023-004742","DOIUrl":"10.1136/spcare-2023-004742","url":null,"abstract":"<p><strong>Background: </strong>Nurses play a unique and critical role in palliative care, and it is noteworthy that nurses often encounter ethical dilemmas in this field.</p><p><strong>Objective: </strong>This review aims to conduct a summarised synthesis of the latest research on the ethical considerations nurses faced in palliative care.</p><p><strong>Methods: </strong>We conducted a rigorous systematic review of relevant existing studies published in high-quality English peer-reviewed journals from January 2017 to July 2023. We identified a total of 4492 articles (1029 in Web of Science, 1570 in PubMed and 1893 in Science Direct). Out of these, only 13 studies met the inclusion criteria.</p><p><strong>Results: </strong>Following the thematic analysis, the ethical considerations reported in these 13 studies were grouped into three main themes and four subthemes: ethical issues in communication (ethical issues in communication with patients, ethical issues in communication with families), ethical issues in decision-making (autonomy, dignity) and moral distress in palliative care.</p><p><strong>Conclusion: </strong>This study elaborated on the ethical challenges faced by nurses in their communication with patients and families as well as decision-making and analysed the causes and effects of ethical distress, hoping to give a hand to ethical issues for nurses' work in palliative care.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"810-817"},"PeriodicalIF":2.5,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140304837","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":"Gold standards framework implementation in an acute hospital: end-of-life outcomes.","authors":"Louis Harpham-Lockyer, Joanne Bowen, Holly Sides","doi":"10.1136/spcare-2025-005768","DOIUrl":"10.1136/spcare-2025-005768","url":null,"abstract":"<p><strong>Objectives: </strong>Hospitals remain the most common place of death in the UK, with 30% of inpatients in their last year of life. National policies emphasise early identification and proactive planning to support patients to die in their preferred place. The Dudley Group National Health Service (NHS) Foundation Trust implemented the Gold Standards Framework (GSF) to identify patients nearing the end of life and guide proactive care. This study evaluated whether GSF coding influenced outcomes, specifically advance care planning (ACP) and place of death.</p><p><strong>Methods: </strong>A retrospective review was conducted of all adult inpatients at a 670-bed UK hospital on 01/09/2023 who died within 12 months. Patients were categorised as GSF-coded or non-coded. Outcomes assessed were evidence of ACP and place of death.</p><p><strong>Results: </strong>Of 216 patients who died, 104 (48%) were GSF-coded on 01/09/2023. Among those coded GSF Green or Amber (n=71), 54% had documented ACP compared with 13% of non-coded patients. 65% of GSF-coded patients died outside the hospital, compared with 45% of uncoded patients. This trend was consistent for both non-cancer (60% vs 40%) and cancer (76% vs 54%) diagnoses.</p><p><strong>Conclusion: </strong>GSF implementation and coding support earlier end-of-life identification, greater ACP engagement and fewer hospital deaths, promoting care aligned with patient preferences and potentially reducing hospital-based costs.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"947-949"},"PeriodicalIF":2.5,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145353779","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":"Chitosan for arterial bleeding in advanced head and neck cancer.","authors":"Sarah P Bowers, Susan Bateman, Anna Sutherland","doi":"10.1136/spcare-2026-006268","DOIUrl":"10.1136/spcare-2026-006268","url":null,"abstract":"","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"858-860"},"PeriodicalIF":2.5,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147970381","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":"Traditional Chinese medicine: extension guidelines for international clinical research reporting standards.","authors":"Yilin Li, Zhiyi Zhou, Qianwen Zhu, Yufeng Yang, Conghua Ji","doi":"10.1136/spcare-2026-006329","DOIUrl":"10.1136/spcare-2026-006329","url":null,"abstract":"<p><p>With the continued advancement of evidence-based medicine, four major international clinical research reporting guidelines-standard protocol items: recommendations for interventional trials (SPIRIT), consolidated standards of reporting trials (CONSORT), preferred reporting items for systematic reviews and meta-analyses (PRISMA) and reporting items for practice guidelines in healthcare (RIGHT)-have formed a comprehensive framework covering the entire research process. However, the unique theoretical system and diagnostic and therapeutic modalities of traditional Chinese medicine (TCM) pose significant challenges for the direct application of these universal standards. In response, the field of TCM has developed a series of guidelines for extension based on international reporting frameworks. This article systematically reviews the core content of these TCM extension guidelines, identifies and summarises key adaptations for TCM characteristics by comparing them with the original international guidelines. Furthermore, from the perspective of evidence-based medicine, this study evaluates the applicability of these extension guidelines in terms of evidence validity, applicability and clinical importance. This review aims to provide a theoretical foundation and practical guidance for standardising TCM clinical research practices, thereby facilitating the generation of high-quality evidence and its translation into clinical practice.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"818-826"},"PeriodicalIF":2.5,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147873312","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":"Methylphenidate in improving cancer-related fatigue: efficacy and safety - systematic review and meta-analysis of randomised controlled trials with trial sequential analysis.","authors":"Yonghao Wen, Peng Gu, Jingxin Yan, Jiawu Li, Genshan Li, Zheng Zhang, Manjun Deng, Haining Fan","doi":"10.1136/spcare-2025-005741","DOIUrl":"10.1136/spcare-2025-005741","url":null,"abstract":"<p><strong>Background: </strong>Cancer-related fatigue (CRF) affects up to 70.7% of patients with cancer, significantly impairing quality of life and treatment adherence. Methylphenidate (MPH) and its dexmethylphenidate (D-MPH) are commonly used psychostimulants, but evidence regarding their efficacy remains inconsistent.</p><p><strong>Methods: </strong>Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, we systematically searched PubMed, Cochrane Library, Embase and Web of Science from inception to June 2025. Primary outcomes were CRF improvement and safety. Meta-analysis was performed using R software (V.4.2.1) with random-effects models. Trial sequential analysis (TSA), Bayesian methods for sparse adverse event data and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessment were applied.</p><p><strong>Results: </strong>Nine randomised controlled trials (RCTs) involving 668 patients were included. Pooled analysis showed a slight but significant reduction in fatigue for MPH versus placebo (standardised mean difference, SMD=0.23, 95% CI 0.06 to 0.40; I²=0%). Efficacy increased at 6-week follow-up (SMD=0.30, 95% CI 0.08 to 0.52; 3 RCTs). Subgroup analysis indicated that D-MPH significantly improved CRF (SMD=0.29, 95% CI 0.01 to 0.57; 3 RCTs), while racemic MPH did not (SMD=0.19, 95% CI -0.02 to 0.41; 4 RCTs). Safety analysis revealed no significant increase in overall adverse events versus placebo, though non-significant trends towards increased mood changes (OR=3.35) and dizziness (OR=2.66) were observed. TSA indicated insufficient information size to confirm definitive efficacy (cumulative Z-curve crossed traditional boundary but not O'Brien-Fleming boundary). GRADE evidence certainty was moderate for overall MPH and D-MPH efficacy, and low for racemic MPH.</p><p><strong>Conclusions: </strong>MPH demonstrates a modest improvement in CRF, with enhanced effects at 6 weeks. D-MPH shows superior therapeutic potential compared with racemic MPH. However, current evidence is insufficient to support widespread clinical application due to limitations in sample size and heterogeneity. Higher-quality RCTs are needed to confirm efficacy and safety profiles.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"778-786"},"PeriodicalIF":2.5,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147580510","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}