BMJ Supportive & Palliative Care最新文献_第2页

Physical activity and supportive care intervention preferences: a cross-sectional study of barriers in advanced cancer.

IF 2 4区医学

BMJ Supportive & Palliative Care Pub Date : 2025-03-13 DOI: 10.1136/spcare-2025-005367

Megan Agnew, Lisa Cadmus-Bertram, Christian W Schmidt, Kristine Kwekkeboom, Amy Trentham-Dietz, Ronald Gangnon, Shaneda Warren Andersen

{"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":"Purpose: 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.Methods: 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.Results: 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.Conclusions: 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.","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}

引用次数: 0

Inflammatory marker cut-off points and prognosis in incurable cancer: validation study. 不治癌症的炎症标志物截断点和预后：验证研究。

IF 2 4区医学

BMJ Supportive & Palliative Care Pub Date : 2025-03-12 DOI: 10.1136/spcare-2024-005302

Gabriella da Costa Cunha, Emanuelly Varea Maria Wiegert, Larissa Calixto-Lima, Livia Costa De Oliveira

{"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":"Objectives: 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.Methods: 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.Results: 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).Conclusions: 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.","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}

引用次数: 0

Crisis pack prescribing in terminal haemorrhage: a national survey of specialist palliative medicine physicians.

IF 2 4区医学

BMJ Supportive & Palliative Care Pub Date : 2025-03-04 DOI: 10.1136/spcare-2025-005370

Grace Kennedy, Niall Manktelow, Ita Harnett, Camilla Murtagh

{"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":"Objectives: To establish practice among senior palliative medicine physicians regarding anticipatory prescribing to manage a terminal haemorrhage.To generate a guideline informed by data collected.Methods: An electronic questionnaire was sent to palliative medicine consultants and specialist registrars in Ireland.Results: 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.Conclusions: 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.","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}

引用次数: 0

End-of-life care in a major UK trauma centre.

IF 2 4区医学

BMJ Supportive & Palliative Care Pub Date : 2025-03-03 DOI: 10.1136/spcare-2025-005421

Sarah Edwards, Nicola Ubayasiri

引用次数: 0

Palliative care utilisation globally by cancer patients: systematic review and meta-analysis.

IF 2 4区医学

BMJ Supportive & Palliative Care Pub Date : 2025-03-03 DOI: 10.1136/spcare-2024-005000

Addisu Getie, Gizachew Yilak, Temesgen Ayenew, Baye Tsegaye Amlak

{"title":"Palliative care utilisation globally by cancer patients: systematic review and meta-analysis.","authors":"Addisu Getie, Gizachew Yilak, Temesgen Ayenew, Baye Tsegaye Amlak","doi":"10.1136/spcare-2024-005000","DOIUrl":"https://doi.org/10.1136/spcare-2024-005000","url":null,"abstract":"Introduction: The rising global prevalence of cancer reveals significant regional disparities in palliative care adoption. While some countries have incorporated palliative care into their systems, over half of the world lacks such services, and oncology-specific palliative care integration is sparse. This study evaluates the global prevalence of palliative care use among cancer patients.Methods: A comprehensive search across multiple databases was conducted to identify relevant studies. Data extraction and organisation were managed using Microsoft Excel, and analysis was performed with STATA/MP 17.0. A weighted inverse variance random-effects model was applied, and heterogeneity was assessed with Cochrane I² statistics. Subgroup analyses, sensitivity analyses and Egger's test were used to explore heterogeneity, publication bias and influential studies.Results: The global prevalence of palliative care among cancer patients was 34.43% (95% CI: 26.60 to 42.25). Africa had the highest utilisation rate at 55.72% (95% CI: 35.45 to 75.99), while the USA had the lowest at 30.34% (95% CI: 19.83 to 40.86). Studies with sample sizes under 1000 showed a higher utilisation rate of 47.51% (95% CI: 36.69 to 58.32). Approximately 55% (95% CI: 35.26 to 74.80) of patients had a positive attitude towards palliative care, and 57.54% (95% CI: 46.09 to 69.00) were satisfied with the services. Positive attitudes were significantly associated with higher palliative care utilisation.Conclusion: Only about one-third of cancer patients globally receive palliative care, with the highest utilisation in Africa. Nearly half of patients have a favourable attitude towards palliative care, and a similar proportion are satisfied with the services.","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":"143540172","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}

引用次数: 0

Divergence in DNACPR and resuscitation policies: institutional survey in England.

IF 2 4区医学

BMJ Supportive & Palliative Care Pub Date : 2025-03-03 DOI: 10.1136/spcare-2024-005263

Emily Fitton, Karen Chumbley, Caroline Barry, Aneta Bartova, Ben Troke, Wayne Martin

{"title":"Divergence in DNACPR and resuscitation policies: institutional survey in England.","authors":"Emily Fitton, Karen Chumbley, Caroline Barry, Aneta Bartova, Ben Troke, Wayne Martin","doi":"10.1136/spcare-2024-005263","DOIUrl":"https://doi.org/10.1136/spcare-2024-005263","url":null,"abstract":"Objectives: Our objective was to analyse the policies of hospitals and care homes in England as regards the use of do not attempt cardiopulmonary resuscitation (DNACPR) recommendations. We sought to identify (i) variations among policies at different institutions, and (ii) divergence of local policies from national guidance, particularly with reference to decisions either (a) to initiate cardiopulmonary resuscitation (CPR) despite the presence of a DNACPR recommendation, or (b) not to initiate CPR in the absence of a DNACPR recommendation.Methods: We conducted a survey of 14 DNACPR and/or resuscitation policies, drawn from care homes, NHS trusts and hospices.Results: Many of the policies we surveyed diverge significantly from national guidance. Some require that CPR be administered in all cases where no DNACPR recommendation has been made. Others fail to specify that CPR may be appropriate even in the presence of a DNACPR recommendation.Conclusions: Local DNACPR policies currently place both patients and healthcare professionals at significant risk.","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":"143540170","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}

引用次数: 0

End of life care in paediatric settings: UK national survey. 儿科临终关怀：英国全国调查。

IF 2 4区医学

BMJ Supportive & Palliative Care Pub Date : 2025-02-26 DOI: 10.1136/spcare-2023-004673

Andre Bedendo, Andrew Papworth, Bryony Beresford, Bob Phillips, Chakrapani Vasudevan, Gabriella Lake Walker, Helen Weatherly, Richard Feltbower, Sebastian Hinde, Catherine Elizabeth Hewitt, Fliss Murtagh, Jane Noyes, Julia Hackett, Richard Hain, Sam Oddie, Gayathri Subramanian, Andrew Haynes, Lorna Fraser

{"title":"End of life care in paediatric settings: UK national survey.","authors":"Andre Bedendo, Andrew Papworth, Bryony Beresford, Bob Phillips, Chakrapani Vasudevan, Gabriella Lake Walker, Helen Weatherly, Richard Feltbower, Sebastian Hinde, Catherine Elizabeth Hewitt, Fliss Murtagh, Jane Noyes, Julia Hackett, Richard Hain, Sam Oddie, Gayathri Subramanian, Andrew Haynes, Lorna Fraser","doi":"10.1136/spcare-2023-004673","DOIUrl":"10.1136/spcare-2023-004673","url":null,"abstract":"Objectives: To describe end of life care in settings where, in the UK, most children die; to explore commonalities and differences within and between settings; and to test whether there are distinct, alternative models of end of life care.Methods: An online survey of UK neonatal units (NNUs), paediatric intensive care units (PICUs) and children/young people's cancer principal treatment centres (PTCs) collected data on aspects of service organisation, delivery and practice relevant to end of life outcomes or experiences (referred to as the core elements of end of life care) across three domains: care of the child, care of the parent and bereavement care.Results: 91 units/centres returned a survey (37% response rate). There was variation within and between settings in terms of whether and how core elements of end of life care were provided. PTCs were more likely than NNUs and PICUs to have palliative care expertise strongly embedded in the multidisciplinary team (MDT), and to have the widest range of clinical and non-clinical professions represented in the MDT. However, bereavement care was more limited. Many settings were limited in the practical and psychosocial-spiritual care and support available to parents.Conclusions: Children at end of life, and families, experience differences in care that evidence indicates matter to them and impact outcomes. Some differences appear to be related to the type of setting. Subsequent stages of this research (the ENHANCE study) will investigate the relative contribution of these core elements of end of life care to child/parent outcomes and experiences.","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"221-230"},"PeriodicalIF":2.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11874335/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142749875","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}

引用次数: 0

Sedation from analgesics: patient preference survey. 镇痛药的镇静作用：患者偏好调查。

IF 2 4区医学

BMJ Supportive & Palliative Care Pub Date : 2025-02-26 DOI: 10.1136/spcare-2023-004759

Joseph Burdon, Samuel Fingas, Rachel Parry, Constantina Pitsillides, Paul Taylor

{"title":"Sedation from analgesics: patient preference survey.","authors":"Joseph Burdon, Samuel Fingas, Rachel Parry, Constantina Pitsillides, Paul Taylor","doi":"10.1136/spcare-2023-004759","DOIUrl":"10.1136/spcare-2023-004759","url":null,"abstract":"Background: The propensity for certain analgesics to cause sedation is well documented, yet physician-patient dialogue does not routinely include pre-emptive exploration of preferences regarding this side effect.Objectives: To investigate the extent to which palliative patients would accept sedation as a side effect of analgesia and to identify factors affecting decision-making.Methods: Patients (n=76) known to a specialist palliative care services were given hypothetical scenarios regarding pain and asked about the acceptability of varying levels of sedation occurring as an analgesic side effect. Demographic data, including diagnosis, performance status and experience of pain and sedation, were collated for evaluation of the influence of these factors on patient opinion.Results: Most patients (89.47%) would be quite or very likely to accept mild sedation. A significant minority (40.79%) would accept high levels of sedation. There is no significant association with the acceptability of sedation according to demographics. Almost half (40.79%) reported that their responses may change if the prognosis were extended, typically for less sedation with a longer prognosis.Conclusions: Increasing levels of sedation are less acceptable, although there is significant variation in views. Palliative care patients are likely to indicate preferences regarding their acceptability of sedation. Palliative physicians must explore preferences on an individualised basis.","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"262-265"},"PeriodicalIF":2.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139930039","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}

引用次数: 0

Assisted deaths in Switzerland for UK residents: diagnoses and their implications for palliative medicine and assisted dying legislation. 瑞士的英国居民辅助死亡：诊断及其对姑息医学和辅助死亡立法的影响。

IF 2 4区医学

BMJ Supportive & Palliative Care Pub Date : 2025-02-26 DOI: 10.1136/spcare-2023-004719

Colin Brewer, Marie-Claire Hopwood, Graham Winyard

引用次数: 0

Cardiac dysfunction in solid tumours: scoping review. 实体肿瘤中的心功能障碍:一个被忽视的问题。一篇心脏肿瘤学的检查综述。

IF 2 4区医学

BMJ Supportive & Palliative Care Pub Date : 2025-02-26 DOI: 10.1136/spcare-2023-004440

Bernadette Brady, Alexandra Brown, Michelle Barrett, Vikram Maraj, Fiona Lawler, Ross Murphy, Declan Walsh

{"title":"Cardiac dysfunction in solid tumours: scoping review.","authors":"Bernadette Brady, Alexandra Brown, Michelle Barrett, Vikram Maraj, Fiona Lawler, Ross Murphy, Declan Walsh","doi":"10.1136/spcare-2023-004440","DOIUrl":"10.1136/spcare-2023-004440","url":null,"abstract":"Cardio-oncology is a dynamic field. Research has suggested that cancer itself can damage the heart, independent of cancer treatment-related cardiac dysfunction (CTRCD). The aim of this study was to establish the nature of cardiovascular abnormalities reported in cancer, excluding CTRCD. Scoping review search included cardiovascular abnormalities in adults with solid tumour malignancies, and excluded CTRCD and thrombotic events. Three databases (CINAHL, Embase, Medline) were searched, supplemented by a handsearch. All screening and data extraction was done by two researchers with consensus reached for any conflicts. Given the heterogeneous nature of the studies identified, data synthesis was narrative. The search identified 42 366 studies. Following deduplication and title/abstract screening, 195 studies were assessed for full-text eligibility. Forty-four studies are included in the final analysis. There are 19 prospective observational studies, 13 retrospective studies, 9 case reports and 3 cross-sectional studies. Types of abnormality identified include cardiomyopathy (16, including Takotsubo (9)), autonomic nervous system (ANS) dysfunction (10), biomarker disturbances (9), reduced myocardial strain (6) and others (3). Due to variable study design, the prevalence was not determined. Cardiovascular abnormalities were associated with morbidity (chest pain, dyspnoea, fatigue) and shortened prognosis. In conclusion: (1) There is evidence for cardiovascular dysfunction in patients with solid tumour malignancies, distinct from CTRCD. People with solid tumours have higher rates of cardiac disease, even when newly diagnosed and treatment naïve. (2) Abnormalities manifest mainly as cardiomyopathies, ANS dysfunction and raised biomarker levels and are associated with significant symptoms. (3) Treatment plans need to take account of these risks, and widen criteria for screening.","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"168-177"},"PeriodicalIF":2.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138481914","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}

引用次数: 0