BMJ Supportive & Palliative Care最新文献

{"title":"Interprofessional palliative and end-of-life education: short-term and long-term outcomes - mixed-methods analysis.","authors":"Adir Shaulov, Adi Finkelstein, Inon Vashdi, Freda DeKeyser Ganz, Anna Kienski Woloski-Wruble, Estelle Rubinstein, Esther-Lee Marcus, Lior Lesser, Dorith Shaham","doi":"10.1136/spcare-2023-004290","DOIUrl":"10.1136/spcare-2023-004290","url":null,"abstract":"<p><p>ObjectiveInterprofessional care is integral to end-of-life (EOL) and palliative care (PC) and may be suited for EOL and PC education.We evaluate the impact of an interprofessional EOL care curriculum on participants, during the course, on completion and 4 years laterusing quantitative (questionnaires) and qualitative (open-ended questions and interviews) methods.The course included 14 fifth and sixth-year medical students, 9 social work students and 7 nursing students enrolled in master's degree programmes. Seventeen participants completed questionnaires 4 years later and eight participated in interviews.On postcourse questionnaires, participants attributed high value to interprofessional education (IPE) (4.77/5±0.50 on a Likert scale). Four years later, participants reported that IPE impacted their professional (3.65/5±1.11) and personal lives (3.94/5±1.09) and found PC IPE important (4.88/5±0.33).Conventional content analysis showed that the course enabled discussion of death and dying and provided an opportunity for a personal-emotional journey. It offered an approach to EOL care and an opportunity to experience interprofessional teamwork at the EOL resulting in behavioural change.Interprofessional EOL education resulted in meaningful and lasting self-reported personal and professional behavioural outcomes.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"e2966-e2971"},"PeriodicalIF":2.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9545724","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":"Novel multidisciplinary ambulatory palliative care clinic: staff opinion and job satisfaction.","authors":"Mary Ann Larkin, Michael Lucey","doi":"10.1136/spcare-2024-004845","DOIUrl":"10.1136/spcare-2024-004845","url":null,"abstract":"","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"e3056-e3058"},"PeriodicalIF":2.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140288194","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":"Prion diseases motor and neuropsychiatric symptom cluster pharmacotherapy: structured scoping review.","authors":"Roseanagh Hogg, John Centola, Eugene Ace McDermott, Francesca Mastaglio, Anna Grundy, Terri Awe, Matthew Carey, Mary Miller, Chloe Antoinette Chin, Rachel Quibell, Tomasz Bajorek, Suvankar Pal, Victoria Bradley","doi":"10.1136/spcare-2024-005027","DOIUrl":"10.1136/spcare-2024-005027","url":null,"abstract":"<p><strong>Background: </strong>Prion diseases are a group of rare, neurodegenerative conditions that are invariably fatal and cause a variety of symptoms, which can prove challenging to control. Through this paper, we aim to review the current evidence regarding pharmacological management of neuropsychiatric and motor symptoms of prion disease as well as draw on experts' and relatives' experience, to evaluate the current evidence and provide recommendations moving forwards.</p><p><strong>Methods: </strong>A scoping review of the literature for pharmacological management of symptoms was conducted using the systematic review tool, COVIDENCE, with searches conducted through four databases. 120 papers were selected for inclusion, and data extraction was carried out by two independent reviewers. Given the lack of high-quality data and small numbers, no further attempt at statistical analysis was made, and results are presented in a thematic synthesis.</p><p><strong>Results: </strong>Although a broad range of approaches and pharmacotherapies are trialled to manage these challenging symptoms, there are patterns emerging of some efficacy seen with the use of benzodiazepines, antipsychotic and anticonvulsant medications in both motor and neuropsychiatric symptoms in prion disease. These approaches and associated challenges were reflected in international expert opinion that was gathered via online survey.</p><p><strong>Conclusion: </strong>There continues to be a paucity of good-quality evidence and we suggest a need for longitudinal, population-based and standardised research to allow a robust evidence base, which in turn will guide excellent symptom control and end of life care for this group of complex patients.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"e2397-e2410"},"PeriodicalIF":2.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141765427","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":"Destitute and dying: interventions and models of palliative and end of life care for homeless adults - a systematic review.","authors":"Megan Rose Coverdale, Fliss Murtagh","doi":"10.1136/spcare-2024-004883","DOIUrl":"10.1136/spcare-2024-004883","url":null,"abstract":"<p><strong>Background: </strong>Homeless adults experience a significant symptom burden when living with a life-limiting illness and nearing the end of life. This increases the inequalities that homeless adults face while coping with a loss of rootedness in the world. There is a lack of palliative and end of life care provision specifically adapted to meet their needs, exacerbating their illness and worsening the quality of their remaining life.</p><p><strong>Aim: </strong>To identify interventions and models of care used to address the palliative and end of life care needs of homeless adults, and to determine their effectiveness.</p><p><strong>Methods: </strong>Standard systematic reviewing methods were followed, searching from 1 January 2000 the databases: Ovid MEDLINE, EMBASE, SCOPUS, Web of Science, CINAHL and PsycInfo. Results were reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and described using a narrative synthesis. Study quality was assessed using Hawker's Quality Assessment Tool.</p><p><strong>Results: </strong>Nine studies primarily focused on: education and palliative training for support staff; advance care planning; a social model for hospice care; and the creation of new roles to provide extra support to homeless adults through health navigators, homeless champions or palliative outreach teams. The voices of those experiencing homelessness were rarely included.</p><p><strong>Conclusion: </strong>We identified key components of care to optimise the support for homeless adults needing palliative and end of life care: advocacy; multidisciplinary working; professional education; and care in the community. Future research must include the perspectives of those who are homeless.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"e2411-e2422"},"PeriodicalIF":2.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11672054/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141995305","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":"Psychosocial screening instruments to assist support consultants in patients with cancer.","authors":"Helen Pieternel Antonie Driessen, Carin C D van der Rijt, Jan J V Busschbach, Erna J Elfrink, Leonieke W Kranenburg","doi":"10.1136/spcare-2023-004733","DOIUrl":"10.1136/spcare-2023-004733","url":null,"abstract":"<p><strong>Objectives: </strong>Around 30% of patients with cancer suffer from psychosocial problems requiring formal care; however, these problems are often not identified. Support consultants may play a role in identifying these problems. This study investigates the feasibility of using validated screening instruments to assist support consultants in identifying psychosocial problems.</p><p><strong>Methods: </strong>Prospective observational study focusing on patients visiting support consultants at hospital-affiliated centres for information and support. The feasibility of using screening instruments was assessed based on the percentage of patients willing to participate. For these patients, possible psychosocial problems were objectified, and referral to formal care was assessed.</p><p><strong>Results: </strong>Out of 227 eligible patients at IntermeZZo, 48 participated (21.1%). At PATIO, over 141 consultations took place and 27 patients participated. Main reason for non-participation was that patients did not feel such a need. The majority showed elevated scores, indicating possible psychosocial problems and around half were referred. Respecting the individual needs of patients and offering them with what benefits them is crucial, including screening instruments does not match their needs nor did support consultants feel it was appropriate in certain cases.</p><p><strong>Conclusion: </strong>Given the low percentage of questionnaires administered, it does not seem feasible to systematically administer them to patients visiting support consultants.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"e2488-e2491"},"PeriodicalIF":2.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11671957/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139401831","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":"Impact of bedside ultrasound on care in specialist palliative care units: a qualitative study.","authors":"Steven Moore, Bethany Stoneham, Vanessa Taylor, Paul Perkins","doi":"10.1136/spcare-2023-004619","DOIUrl":"10.1136/spcare-2023-004619","url":null,"abstract":"<p><strong>Objectives: </strong>To explore the experiences of palliative care doctors regarding the clinical impact of ultrasound in specialist palliative care units (SPCUs).</p><p><strong>Methods: </strong>The study adopted a qualitative research design using semistructured interviews and a reflexivity journal. Six participants were recruited through purposive and snowball sampling. Findings were analysed using framework analysis.</p><p><strong>Results: </strong>Analysis used four predetermined themes: (1) practicalities, (2) clinical indications, (3) impact on patient care and service provision and (4) governance and training. Analysis identified a relationship between procedural confidence and use of ultrasound.</p><p><strong>Conclusions: </strong>Our study provides information for understanding the current use and limitations of ultrasound in SPCUs. Ultrasound leads to safer practice, especially when performing invasive procedures such as paracentesis. Development of standards around the use of, and training of staff undertaking ultrasound in specialist palliative care, are recommended.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"e2996-e3001"},"PeriodicalIF":2.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138046132","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":"Assistive technology in palliative medicine: equipment needs.","authors":"Renae Kelly, Bridget Manning, Kieran Broome","doi":"10.1136/spcare-2022-003723","DOIUrl":"10.1136/spcare-2022-003723","url":null,"abstract":"<p><strong>Objectives: </strong>Most people prefer to die at home. Timely and appropriate provision of assistive technology can support people to remain at home in the palliative phase. A state-wide palliative care equipment programme (PCEP) was established in Queensland, Australia, to support coordinated assistive technology provision. The objective of this study was to identify population-wide palliative care equipment needs and their relationship to primary diagnostic categories.</p><p><strong>Method: </strong>A retrospective, cross-sectional analysis of equipment provided over a 19-month period was conducted. This included types of equipment provided and characteristics of the participants such as rurality, age and diagnostic category.</p><p><strong>Results: </strong>There were 13 764 approved equipment requests, with a median time between equipment application and death being around 35 days. There were significant differences in the types of equipment typically required across diagnostic categories.</p><p><strong>Conclusion: </strong>The findings from the study can provide a benchmark for the development of population-wide PCEPs. For practitioners who are new to palliative care, typical trajectories of equipment needs by diagnostic group can help guide equipment planning.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"e2700-e2707"},"PeriodicalIF":2.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10490530","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":"Meaning in life and quality of life: palliative care patients versus the general population.","authors":"Mathieu Bernard, André Berchtold, Florian Strasser, Claudia Gamondi, Gian Domenico Borasio","doi":"10.1136/bmjspcare-2020-002211","DOIUrl":"10.1136/bmjspcare-2020-002211","url":null,"abstract":"<p><strong>Background and objectives: </strong>Meaning in life (MIL) represent a key topic in palliative care. The aims of this study were to explore (1) the differences in perceived MIL and in the meaning-relevant life areas between a representative sample of the Swiss population and palliative care patients, and (2) to what extent MIL can be considered as a significant predictor of quality of life (QOL).</p><p><strong>Methods: </strong>A cross-sectional study was conducted separately for the patients (face-to-face interviews) and the general population (telephone survey). MIL was measured with the Schedule for Meaning in Life Evaluation (SMILE) and QOL with a single-item visual analogue scale (0-10). Sociodemographic variables were controlled for in the analyses.</p><p><strong>Results: </strong>206 patients and 1015 participants from the Swiss population completed the protocol. Results indicated high MIL scores in both populations even if the difference was significant (patients 81.9 vs general population 87, p<0.001). Patients were more likely to cite 'family' (OR=1.78), 'social relations' (OR=1.9), 'spirituality and religion' (OR=3.93), 'social commitment' (OR=1.94) and 'growth' (OR=2.07), and less likely to cite 'finances' (OR=0.15) and 'health' (OR=0.21) as MIL-relevant areas. The SMILE scores and MIL areas explained 21.8% of the QOL variance for the patients and 15.1% for the representative sample.</p><p><strong>Conclusions: </strong>Our data emphasise the importance of MIL as a contributor to QOL in both populations. It highlights the importance of the life areas contributing to MIL, especially social interactions for both populations, and spirituality and areas related to growth in palliative care patients.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"e2537-e2545"},"PeriodicalIF":2.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11671900/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38131404","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":"How to communicate with families living in complete isolation.","authors":"Giovanni Mistraletti, Giuseppe Gristina, Sara Mascarin, Emanuele Iacobone, Ilaria Giubbilo, Silvia Bonfanti, Federico Fiocca, Giorgio Fullin, Ennio Fuselli, Maria Grazia Bocci, Davide Mazzon, Gian Domenico Giusti, Alessandro Galazzi, Alessandra Negro, Fabio De Iaco, Enrico Gandolfo, Giulia Lamiani, Silvia Del Negro, Laura Monti, Fabrizia Salvago, Silvia Di Leo, Maria Nefeli Gribaudi, Mariassunta Piccinni, Luigi Riccioni, Alberto Giannini, Sergio Livigni, Carla Maglione, Marco Vergano, Franco Marinangeli, Luisa Lovato, Andrea Mezzetti, Elio Drigo, Elena Vegni, Sally Calva, Anna Aprile, Gianfranco Losi, Lucia Fontanella, Giulio Calegari, Cristina Ansaloni, Francesco Rocco Pugliese, Salvatore Manca, Luciano Orsi, Fabrizio Moggia, Silvia Scelsi, Antonio Corcione, Flavia Petrini","doi":"10.1136/bmjspcare-2020-002633","DOIUrl":"10.1136/bmjspcare-2020-002633","url":null,"abstract":"<p><strong>Importance: </strong>During the SARS-CoV-2 pandemic, a complete physical isolation has been worldwide introduced. The impossibility of visiting their loved ones during the hospital stay causes additional distress for families: in addition to the worries about clinical recovery, they may feel exclusion and powerlessness, anxiety, depression, mistrust in the care team and post-traumatic stress disorder. The impossibility of conducting the daily meetings with families poses a challenge for healthcare professionals.</p><p><strong>Objective: </strong>This paper aims to delineate and share consensus statements in order to enable healthcare team to provide by telephone or video calls an optimal level of communication with patient's relatives under circumstances of complete isolation.</p><p><strong>Evidence review: </strong>PubMed, Cochrane Database of Systematic Reviews, Database of Abstracts and Reviews of Effectiveness and the AHCPR Clinical Guidelines and Evidence Reports were explored from 1999 to 2019. Exclusion criteria were: poor or absent relevance regarding the aim of the consensus statements, studies prior to 1999, non-English language. Since the present pandemic context is completely new, unexpected and unexplored, there are not randomised controlled trials regarding clinical communication in a setting of complete isolation. Thus, a multiprofessional taskforce of physicians, nurses, psychologists and legal experts, together with some family members and former intensive care unit patients was established by four Italian national scientific societies. Using an e-Delphi methodology, general and specific questions were posed, relevant topics were argumented, until arriving to delineate position statements and practical checklist, which were set and evaluated through an evidence-based consensus procedure.</p><p><strong>Findings: </strong>Ten statements and two practical checklists for phone or video calls were drafted and evaluated; they are related to who, when, why and how family members must be given clinical information under circumstances of complete isolation.</p><p><strong>Conclusions and relevance: </strong>The statements and the checklists offer a structured methodology in order to ensure a good-quality communication between healthcare team and family members even in isolation, confirming that time dedicated to communication has to be intended as a time of care.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"e2954-e2965"},"PeriodicalIF":2.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38492220","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":"Peer support-based online education, burden of care and quality of life among family caregivers of patients with leukaemia: non-randomised clinical trial.","authors":"Mehrnaz Keramatikerman, Shokoh Varaei, Mohammad Vaezi, Leila Sayadi","doi":"10.1136/spcare-2023-004610","DOIUrl":"10.1136/spcare-2023-004610","url":null,"abstract":"<p><strong>Objective: </strong>The responsibility of caring for patients with leukaemia places a heavy burden on family caregivers (FCs) and negatively impacts their quality of life (QoL). This study aimed to investigate the effects of peer support (PS)-based online education programme on the burden of care (BoC) and QoL of FCs of patients with leukaemia.</p><p><strong>Methods: </strong>This before-after study involved a total of 80 eligible FCs of patients with leukaemia (40 individuals per group). The participants received the necessary information from a researcher and peers through online sessions and WhatsApp group. To collect data, the Zarit Burden Interview and the Caregiver Quality of Life Index-Cancer (CQOLC) had been been completed once before the intervention and once 1 month after the intervention.</p><p><strong>Results: </strong>There was no significant difference between the two groups regarding baseline variables except the mean BoC that was significantly higher in the intervention group (IG) (p<0.001). However, after controlling for the effects of confounding variables, the mean BoC score of participants in IG was significantly lower than that of the control group (p<0.001). Additionally, there was no significant difference between the two groups in terms of CQOLC before (p=0.178) and after (p=0.538) the intervention.</p><p><strong>Conclusion: </strong>The PS-based online education programme had a positive impact on reducing the care burden of FCs of patients with leukaemia. This programme can effectively reduce costs, particularly during emergencies and crises such as pandemics, as it eliminates the need for FCs and peers to physically visit hospitals.</p><p><strong>Registration: </strong>The study was registered at the Iranian Registry of Clinical Trials on 18 July 2021 (IRCT registration number: IRCT20210507051209N1).</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"e2827-e2835"},"PeriodicalIF":2.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11671940/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139563070","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}