BMJ Supportive & Palliative Care最新文献

{"title":"Psychosocial interventions and health-related quality of life in adults with incurable cancer: systematic review.","authors":"Heli Mikkonen, Minna Hökkä, Tiina Saarto, Jan-Henry Stenberg, Kristiina Junttila","doi":"10.1136/spcare-2024-005043","DOIUrl":"10.1136/spcare-2024-005043","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to assess the effects of psychosocial interventions in improving health-related quality of life (HRQoL) in adult patients with incurable cancer.</p><p><strong>Methods: </strong>A systematic search was performed in the MEDLINE, PsycINFO, CINAHL, Scopus and Medic databases to identify randomised controlled trials, quasi-experimental studies and cohort studies from 2004 to March 2024 aiming to influence HRQoL or psychosocial well-being.</p><p><strong>Results: </strong>The systematic search yielded 635 articles. After the removal of duplicates, screening of titles and abstracts, assessment of eligibility and screening of the reference list of included studies, 17 studies were included in the review, and a narrative synthesis was conducted. The delivery of psychosocial interventions varied considerably. They were most often structured, individual, performed in person or remotely, and applied multiple combined methods. Professionals delivering the intervention most often had a background in psychology, nursing or social work. The most frequent outcomes were quality of life, depression and anxiety, measured using multiple different tools. Of the studies, 35% reported significant sustainable improvements. The results favoured individual intervention and the multiple-method approach.</p><p><strong>Conclusions: </strong>The interventions presented as psychosocial interventions have their own characteristics and nature, but evidence of their efficacy is limited. There is an apparent need for research and discussion regarding the definitions, differences and relationships between psychosocial, psychological, social and spiritual interventions in cancer care.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"572-585"},"PeriodicalIF":1.8,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12421117/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085917","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":"20 years of palliative medicine practice in South Australia: from a burns unit to hospice.","authors":"Mary Alice Brooksbank","doi":"10.1136/spcare-2025-005492","DOIUrl":"10.1136/spcare-2025-005492","url":null,"abstract":"<p><p>This is a shortened version of the personal reflections of the early developments of palliative care in Adelaide, South Australia delivered as the Rosalie Shaw Oration at the Australia and New Zealand Society of Palliative Medicine conference, Adelaide 6 September 2024: 30 years of palliative medicine: constructing, challenging and transforming.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"628-630"},"PeriodicalIF":1.8,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802529","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":"Deprescribing antidepressant medications at end-of-life.","authors":"Karie Dennehy, Sarah Marshall","doi":"10.1136/spcare-2024-005226","DOIUrl":"10.1136/spcare-2024-005226","url":null,"abstract":"","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"631-632"},"PeriodicalIF":1.8,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142749871","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 in cirrhosis of the liver.","authors":"Feras Al-Moussally, Natalia Tejada, Saud Khan, Amar Mandalia, Sabiha Kazi","doi":"10.1136/spcare-2024-005247","DOIUrl":"10.1136/spcare-2024-005247","url":null,"abstract":"<p><strong>Background: </strong>Liver cirrhosis (LC) is a progressive disease characterised by chronic liver inflammation, leading to diminished liver function and complex symptomatology. As LC advances to decompensated cirrhosis and end-stage liver disease (ESLD), patients experience severe symptoms such as pain, ascites and encephalopathy, significantly impairing their quality of life. Despite the high symptom burden and a substantial mortality rate, palliative care remains grossly underused.</p><p><strong>Objective: </strong>This review aims to explore the current state of palliative care utilization in ESLD patients, identify barriers to palliative care access, and discuss strategies for enhancing symptom management and improving patient quality of life.</p><p><strong>Design: </strong>A comprehensive literature review was performed of palliative care in liver cirrhosis, symptom prevalence, management strategies, and barriers to palliative care consultation.</p><p><strong>Methods and data sources: </strong>Our review synthesized information from 49 referenced sources, covering symptom management, healthcare utilization, and palliative care approaches with regards to liver cirrhosis.</p><p><strong>Findings: </strong>We find significant underutilization of palliative care services, with consultation rates as low as 0.97% for patients with decompensated cirrhosis. Key barriers include liver transplant eligibility, racial disparities, and lack of insurance coverage.</p><p><strong>Conclusion: </strong>Despite evidence suggesting that palliative care improves patient outcomes and quality of life, its implementation in patients with ESLD remains insufficient. Increasing awareness and integration of palliative care into routine management for these patients are crucial. The concept of primary palliative care is proposed as a means to bridge the gap until specialised services are available, allowing all clinicians contribute to alleviating patient suffering and improving overall care.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"600-605"},"PeriodicalIF":1.8,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142852765","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":"Caring for a Patient with Inoperable Hip Fracture.","authors":"Arouba Imtiaz, Amelia Collins, Fiona Rawlinson, Antony Johansen","doi":"10.1136/spcare-2025-005440","DOIUrl":"10.1136/spcare-2025-005440","url":null,"abstract":"<p><p>Hip fractures pose significant challenges, particularly in managing severe incident pain in people who are not fit for surgery. We present the case of an older man with multiple comorbidities who was managed non-operatively. Standard opioids caused sedation with limited pain relief. Patient-controlled analgesia (PCA) with intravenous fentanyl provided effective, short-acting relief, allowing the patient to remain alert and engage in care. This case highlights PCA as a practical option for managing incident pain in selected palliative patients.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"618-619"},"PeriodicalIF":1.8,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144198229","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":"Parents' experiences of paediatric end-of-life care in the UK: a multisite qualitative study.","authors":"George Peat, Emma Victoria McLorie, Laura Barrett, Helen Weatherly, Sebastian Hinde, Gabriella Lake Walker, Jane Noyes, Sam Oddie, Chakrapani Vasudevan, Richard Feltbower, Bob Phillips, Catherine Elizabeth Hewitt, Richard Hain, Gayathri Subramanian, Andrew Haynes, Lorna Fraser, Fliss Murtagh, Julia Hackett","doi":"10.1136/spcare-2025-005427","DOIUrl":"10.1136/spcare-2025-005427","url":null,"abstract":"<p><strong>Objectives: </strong>Despite the marked improvement in child mortality over the last two decades, more than 7 million infants, children and young people still die worldwide every year. In the UK, four National Health Service settings care for more than 60% of the children who die each year: neonatal and paediatric intensive care units and children and teenager cancer principal treatment centres. There is limited evidence on how end-of-life care is experienced by parents and how this differs across settings. We aimed to explore parents' experiences of receiving end-of-life care for their child in these settings.</p><p><strong>Methods: </strong>A multisite qualitative study involving in-depth interviews with bereaved parents, analysed using reflexive thematic analysis. Recruitment via 14 National Health Service sites, three children's hospices and two third sector organisations across the UK.</p><p><strong>Results: </strong>55 parents participated (37 mothers, 18 fathers), representing 44 children and young people (median age 7 years, range 0-23 years). 42 interviews were conducted. Experiences of care were highly variable. Parents' perceptions of high quality end-of-life care were highlighted within three themes: (1) building the foundations for high quality end-of-life care; (2) working together towards best decisions and care and (3) continuing care after death and into bereavement.</p><p><strong>Conclusions: </strong>Bereaved parents' experiences of care at the end of life are too inconsistent. Feeling heard is crucial; without it, there is no foundation on which adequate end-of-life care can be built. Care must be tailored to the circumstances of each family and should continue after a child's death and into bereavement.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"681-692"},"PeriodicalIF":1.8,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12421113/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144697563","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":"Future care planning.","authors":"Mala Mann, Caitlin Cahill, Stephanie Sivell, Robyn Hackett, Elin Harding, Mark Taubert","doi":"10.1136/spcare-2025-005616","DOIUrl":"10.1136/spcare-2025-005616","url":null,"abstract":"<p><p>Future care planning (FCP) is increasingly discussed within supportive and palliative care policy contexts in the UK and internationally. This article incorporates a scoping review of the literature to provide a summary overview. FCP is discussed as a policy element improving end-of-life care by encompassing advance care planning and furthermore including individuals with diminished decision-making capacity through a best-interests approach. The evidence base further indicates that FCP is being increasingly applied in palliative care settings worldwide and has been adopted as part of several national strategies, including in Wales and in Scotland. A clear and consistent definition of FCP will help support health and social care professionals working in frailty and palliative care. Our review identified definitions of FCP in the existing literature and described what a future care plan is, including what end-of-life care should look like and incorporate.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"614-617"},"PeriodicalIF":1.8,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12421114/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144616220","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":"Cool facial airflow hastens exertion recovery in chronic breathlessness: randomised crossover trial of different fan airflow speeds.","authors":"Thomas Burrell, Andrew Simpson, Christina Ramsenthaler, Michael G Crooks, Miriam J Johnson, Flavia Swan","doi":"10.1136/spcare-2024-005103","DOIUrl":"10.1136/spcare-2024-005103","url":null,"abstract":"<p><strong>Objectives: </strong>Facial airflow from a hand-held fan (fan) hastens recovery from exertional breathlessness. We aimed to determine the effect of different airflow speeds on recovery from exertional breathlessness in patients with chronic breathlessness.</p><p><strong>Methods: </strong>A prospective, unblinded, randomised crossover trial. Participants with chronic breathlessness (modified Medical Research Council ≥ 3) completed five 1 min sit-to-stand (STS) tests to induce breathlessness. After each STS test, participants used a fan with one of four airflow speeds or control (no fan) during 10 min recovery. Numerical Rating Scale (NRS) breathlessness intensity, airflow pleasantness, heart rate, oxygen saturation and facial skin temperature were recorded.</p><p><strong>Results: </strong>10 participants were recruited (n=1 withdrew due to health concerns) and 9 (mean±SD age 66±14 years; 5 men; 8 chronic obstructive pulmonary disease, 1 long covid) completed the trial. Per-protocol analysis identified no difference in NRS breathlessness recovery across fan speeds (p>0.05). Sensitivity analysis (n=1 excluded due to low exertional NRS breathlessness post STS test) identified a significant interaction effect for fan speed over time (p=0.010). Fan speed 2.85 m/s reduced NRS breathlessness compared with control at minutes 4-8 during recovery (p<0.05), whereas fan speeds 1.98 m/s, 3.70 m/s and 4.91 m/s only differed from control after 7 min recovery (p<0.05). The perceived most pleasant and preferred airflow rate was 2.85 m/s. NRS pleasantness decreased with faster airflow speeds, suggesting a ceiling limit to net benefit.</p><p><strong>Conclusion: </strong>Our novel data suggest the optimal airflow speed to hasten recovery from exertional breathlessness in people with chronic breathlessness is 2.85 m/s. Net benefit reduces at higher flow rates.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"633-641"},"PeriodicalIF":1.8,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293302","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":"Anaemia, blood transfusions and survival in high-grade endometrial cancer: retrospective study.","authors":"Hannah H Foggin, Pascal Lambert, Lung Fung Tsang, Mark W Nachtigal, Nourah Ibrahim, Christine Robinson, Lesley F Roberts, Alon D Altman","doi":"10.1136/spcare-2024-005296","DOIUrl":"10.1136/spcare-2024-005296","url":null,"abstract":"<p><strong>Objective: </strong>To determine if anaemia and blood transfusions in the perioperative, chemotherapy and radiation treatment periods are associated with overall survival (OS) and recurrence-free survival (RFS) in high-grade endometrial cancer.</p><p><strong>Methods: </strong>This retrospective cohort study examined patients at a single centre treated for high-grade endometrial cancer (2010-2023). This included International Federation of Gynecology and Obstetrics (FIGO) grade 3 endometrioid, serous, carcinosarcoma, mixed, clear cell, mucinous, dedifferentiated and undifferentiated histology. Primary outcomes were OS and RFS. Predictor variables were nadir haemoglobin and transfusion status. Multivariable Cox regression models for OS and RFS analysed the associations of treatment period-specific anaemia, overall transfusion status and confounder variables.</p><p><strong>Results: </strong>Two hundred twenty-seven cases were included; 64-86% of patients were anaemic during any treatment, with 0-10% having severe anaemia. Twenty-two patients (9.7%) had at least one blood transfusion. Transfusion in the perioperative and chemotherapy periods was associated with poorer survival, significant only for shorter RFS in the chemotherapy cohort (HR 3.22, p=0.04). There was no association between anaemia and survival.</p><p><strong>Conclusion: </strong>This study is among the first to assess anaemia in treated patients with high-grade endometrial cancer and the associations of anaemia and blood transfusion with survival outcomes. Further larger studies are needed to strengthen evidence and guide transfusion policies.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"677-680"},"PeriodicalIF":1.8,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881236","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":"Letter to the editor: our friend in need service.","authors":"Lou Ikiua, Stephen Bass, Charlotte Ede, Emily Savage, Ollie Minton","doi":"10.1136/spcare-2025-005781","DOIUrl":"https://doi.org/10.1136/spcare-2025-005781","url":null,"abstract":"","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144942682","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}