BMJ Supportive & Palliative Care最新文献

{"title":"Shifting US location patterns in leukaemia mortality: retrospective analysis.","authors":"Ahmed Sami Raihane, Muhammad Ahmad Nadeem, Ahsan Raza Raja, Arlin A Bustillos, Abdul Rafeh Awan, Mohammed A Quazi, Jibran Ikram, Abdullah Khan, Asad Ullah, Marjan Khan, Abu Baker Sheikh, Amir Humza Sohail","doi":"10.1136/spcare-2025-005520","DOIUrl":"https://doi.org/10.1136/spcare-2025-005520","url":null,"abstract":"<p><strong>Objectives: </strong>Leukaemia is a haematological malignancy with high mortality, yet end-of-life care patterns remain underexplored. This study analysed trends in the place of death among leukaemia decedents and assessed demographic disparities in end-of-life care.</p><p><strong>Methods: </strong>A retrospective observational study was conducted using the Centres for Disease Control and Prevention's WONDER and National Center for Health Statistics mortality databases (2008-2020). Leukaemia deaths were identified from death certificates, and place of death was categorised as hospice, home, inpatient, nursing home or outpatient/emergency room. Temporal trends were analysed using the Mann-Kendall test, and logistic regression assessed associations between place of death and demographics.</p><p><strong>Results: </strong>Among 295 057 leukaemia-related deaths, inpatient deaths declined from 51% to 37% (τ=-0.872, p<0.001), while home deaths increased from 26% to 40% (τ=0.897, p<0.001). Hospice deaths nearly doubled from 5% to 9% (τ=0.692, p=0.001), and nursing home deaths declined from 11% to 8% (τ=-0.795, p<0.001). No significant trend was observed for outpatient/emergency room deaths. Younger adults (20-34 years) had the highest inpatient death rate (74%), decreasing with age, while home and hospice deaths increased among older adults. Racial disparities were evident, with non-Hispanic black, Hispanic and Asian patients more likely to die in hospitals and less likely to use hospice care than non-Hispanic whites.</p><p><strong>Conclusions: </strong>Leukaemia-related deaths have increasingly shifted from hospitals to home and hospice, reflecting broader palliative care trends. However, racial disparities persist, highlighting the need for targeted interventions to improve equitable access to hospice and home-based palliative care.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143954119","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":"Vagus nerve and cancer symptom science.","authors":"Aynur Aktas, Dori Beeler, Jake Waldman, Declan Walsh","doi":"10.1136/spcare-2025-005483","DOIUrl":"https://doi.org/10.1136/spcare-2025-005483","url":null,"abstract":"<p><p>Patients with cancer are often polysymptomatic due to significant disease and treatment-related morbidity. Vagus nerve stimulation (VNS), a type of neuromodulation, affects various physiological processes that are highly relevant to many cancer-related symptoms. It is an emerging therapy that uses the omnipotent nature of the nerve and is known to ameliorate conditions such as depression, epilepsy, gastrointestinal disorders and migraine. Given the evidence base for VNS and its proven utilisation outside of cancer, we suggest research and clinical application of this treatment modality in supportive oncology.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143965534","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":"Health literacy, end-of-life health literacy and assisted suicide: attitudes in older adults - a cross-sectional study.","authors":"Giulia Mac Dermott, Clément Meier, Solenne Blanc, Claudia Gamondi","doi":"10.1136/spcare-2025-005560","DOIUrl":"https://doi.org/10.1136/spcare-2025-005560","url":null,"abstract":"<p><strong>Objectives: </strong>As societal debates around assisted suicide persist, understanding the factors influencing individual attitudes is essential. Health literacy (HL) and end-of-life HL (EOL-HL) are critical for informed decision-making but remain underexplored in relation to attitudes towards assisted suicide. This study investigates the association between HL, EOL-HL and attitudes towards assisted suicide among older adults in Switzerland.</p><p><strong>Methods: </strong>Data were derived from 1461 participants aged 58+ from the Swiss component of the Survey of Health, Ageing, and Retirement in Europe, 2019/2020. Attitudes towards assisted suicide were assessed using three measures: support for its legality, consideration of personal use and membership in a right-to-die organisation. HL and EOL-HL were assessed using standardised scales. Probit regression models analysed the associations, controlling for sociodemographic and health characteristics.</p><p><strong>Results: </strong>The majority supported the legality of assisted suicide (82%) and could consider asking for it (64%), while 9% were members of a right-to-die association. Higher EOL-HL was significantly associated with greater support for assisted suicide (β=0.05, p<0.001), consideration of personal use (β=0.08, p<0.001) and membership in a right-to-die organisation (β=0.06, p<0.001). However, general HL was not statistically significantly associated with membership in such organisations.</p><p><strong>Conclusions: </strong>The findings underscore the distinct role of EOL-HL in shaping attitudes towards assisted suicide, particularly in decisions involving active engagement, such as joining right-to-die organisations. Enhancing EOL-HL among older adults could empower informed decision-making and promote meaningful engagement in end-of-life planning. These insights contribute to ongoing ethical and policy discussions surrounding assisted suicide in Switzerland and beyond.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143969317","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 sedation with propofol for refractory agitation.","authors":"Kelvin Lou, Brian Li, Shikha Minhas, Shalini Nayar","doi":"10.1136/spcare-2025-005524","DOIUrl":"https://doi.org/10.1136/spcare-2025-005524","url":null,"abstract":"<p><p>Palliative sedation is a useful intervention to manage refractory symptoms at the end of life. Currently, there is limited research on approaches to managing symptoms refractory to standard sedation protocols. Expanding awareness of therapeutic options is essential for improving management of refractory cases. Propofol, a short-acting anaesthetic, may be a valuable option when conventional sedatives at high doses fail to achieve adequate symptom relief. We present the case of a 40-year-old woman with high-grade metastatic ovarian cancer with refractory agitation that was successfully managed with propofol for palliative sedation.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143976126","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":"Breakthrough cancer pain management: mixed-methods study of health care professionals.","authors":"Gregory Brian Crawford, Ali Lakhani, L Palmer, Menka Sebalj, P Rolan","doi":"10.1136/spcare-2024-004951","DOIUrl":"10.1136/spcare-2024-004951","url":null,"abstract":"<p><strong>Objectives: </strong>Knowledge gaps in defining, diagnosing, educating health practitioners and treatment options hinder breakthrough cancer pain (BtCP) management. A systematic review revealed a lack of clarity on health professional derived definitions, management strategies and professional development for BtCP. The current study aimed to explore the perspectives of multidisciplinary health professionals by seeking to understand how they define, identify, treat and manage BtCP, barriers to management and professional development requirements.</p><p><strong>Methods: </strong>A mixed-methods approach involving a two-phase data collection process was employed. Health professionals initially completed an online survey capturing perspectives on BtCP, management strategies, barriers and education/professional development requirements. Survey participants expressing interest were then invited to complete a semistructured interview for an in-depth exploration of their perspectives. Descriptive statistics and frequencies summarised online survey data. Open-ended responses were themed, and categories created. Semistructured interview transcripts were inductively analysed for recurring or divergent themes.</p><p><strong>Results: </strong>Fifty-four participants completed the online survey and 11 of them participated in an interview. Findings confirmed the importance of patient communication and education in managing BtCP, emphasising the need for adequate resources and training. Interdisciplinary relationships were highlighted as important and contributing to effective BtCP management, supporting professional growth and confidence in prescribing pain management medication.</p><p><strong>Conclusions: </strong>The study filled research gaps by involving diverse health professionals to explore BtCP identification, treatment, barriers and professional development need. Future research should emphasise interdisciplinary collaboration, invest in targeted resources, training and culturally appropriate communication to address barriers in patient interaction.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"349-358"},"PeriodicalIF":2.0,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142805890","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":"Health literacy interventions for informal caregivers: systematic review.","authors":"Eva Yuen, Carlene Wilson, Joanne Adams, Tejashree Kangutkar, Patricia M Livingston, Victoria M White, Cherene Ockerby, Alison Hutchinson","doi":"10.1136/spcare-2023-004513","DOIUrl":"10.1136/spcare-2023-004513","url":null,"abstract":"<p><strong>Aim: </strong>The aim of the systematic review was to identify conceptual models and interventions designed to improve health literacy in caregivers of adults with a chronic disease/disability.</p><p><strong>Methods: </strong>MEDLINE, CINAHL, PsycINFO and Embase were searched for relevant literature. Articles were included if they focused on adults who provided informal care to someone aged 18+ with a chronic disease/disability. Quantitative studies were included if they reported an intervention designed to improve caregiver health literacy (CHL) and assessed outcomes using a validated measure of health literacy. Qualitative and mixed method studies were included if they described a conceptual model or framework of CHL or developed/assessed the feasibility of an intervention. Study quality was appraised using the Mixed Methods Assessment Tool.</p><p><strong>Results: </strong>Eleven studies were included. Five studies used pre-post design to assess outcomes of an intervention; four described intervention development and/or pilot testing; two described conceptual models. Two of five studies reported pre-post intervention improvements in CHL; one reported an improvement in one of nine health literacy domains; two reported no improvements following intervention. Interventions predominantly aimed to improve: caregiver understanding of the disease, treatment and potential outcomes, day-to-day care, self-care and health provider engagement. Few interventions targeted broader interpersonal and health service factors identified as influencing CHL.</p><p><strong>Discussion: </strong>Evidence on the development and assessment of comprehensive CHL interventions is scarce. Recommendations include the development of interventions that are guided by a CHL framework to ensure they address individual, interpersonal and health service/provider factors that influence CHL.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"300-318"},"PeriodicalIF":2.0,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139701810","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":"Low serum creatinine as a prognostic marker in advanced cancer.","authors":"Koji Amano, Vickie Baracos, Satomi Okamura, Tomomi Yamada, Isseki Maeda, Hiroyuki Otani, Hiroto Ishiki, Tomofumi Miura, Jun Hamano, Yutaka Hatano, Tatsuya Morita, Masanori Mori","doi":"10.1136/spcare-2023-004646","DOIUrl":"10.1136/spcare-2023-004646","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate whether low serum creatinine levels are associated with poor outcomes in patients with advanced cancer.</p><p><strong>Methods: </strong>This is a secondary analysis of a prospective cohort study. Patients were divided into three groups according to their baseline serum creatinine levels. We performed time-to-event analyses using the Kaplan-Meier method and log-rank tests, and by conducting univariate and multivariate Cox regression analyses.</p><p><strong>Results: </strong>809 males were divided: male-low group (n=192), male-normal group (n=403) and male-high group (n=214). 808 females were divided: female-low group (n=239), female-normal group (n=389) and female-high group (n=180). Significant differences were observed in survival rates between the high and normal groups in the males and females (both log-rank p<0.001). Significantly higher risks of mortality were observed in the Cox proportional hazard model for the high group than for the normal group in both sexes (adjusted HR 1.292, 95% CI 1.082 to 1.542; adjusted HR 1.316, 95% CI 1.094 to 1.583, respectively). High serum creatinine was associated with shorter survival than normal creatinine, while low serum creatinine was not.</p><p><strong>Conclusions: </strong>Low serum creatinine levels did not have prognostic abilities in this population.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"391-395"},"PeriodicalIF":2.0,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71420559","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":"Cancer centre information and support services and patient needs: participatory action research study.","authors":"Helen P A Driessen, Jan J V Busschbach, Erna J Elfrink, Carin C D van der Rijt, Gabriël M R M Paardekooper, Corine J den Hollander, Leonieke W Kranenburg","doi":"10.1136/spcare-2023-004464","DOIUrl":"10.1136/spcare-2023-004464","url":null,"abstract":"<p><strong>Objectives: </strong>Clear information and supportive care are necessary for oncology patients and their relatives to manage the disease (trajectory). Centres for information and support aim to address their needs by offering informal and non-medical formal services. This study evaluated whether the centres' services offered meet the needs of its visitors, and whether there is interest for these among oncology patients treated at affiliated hospitals.</p><p><strong>Methods: </strong>In this participatory action research, interviews were conducted among visitors of two centres (Patient Information Center Oncology (PATIO) and IntermeZZo) and among patients treated at the affiliated hospitals. Visitors were interviewed to share their experiences regarding the centres' services offered. Patients from the hospitals were interviewed about their interest in such support. Data were collected during three different periods and adjustments were made to the centres' services between measurements.</p><p><strong>Results: </strong>111 (PATIO) and 123 visitors (IntermeZZo) were interviewed, and 189 and 149 patients at the respective hospitals. Reasons to visit PATIO/IntermeZZo were to relax (93.1%), seek professional advice (54.6%) and meet peers (36.3%). Visitors indicated that the visits met their needs (99.1%), citing the accessible support and the expertise in oncology. 20% of patients interviewed at the hospitals expressed interest in visiting PATIO/IntermeZZo. The majority of patients (89.6%) considered these centres an integral part of their treatment process. These findings were stable over time.</p><p><strong>Conclusions: </strong>Patients and their relatives highly value the services of hospital-affiliated centres for information and support. Future research should address how such centres best be integrated in the Dutch healthcare system.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"367-378"},"PeriodicalIF":2.0,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12128760/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140109194","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":"Purple urine bag syndrome: case series.","authors":"Jewell Joseph, Jenifer Jeba Sundararaj, Susan Shekinah, Shakila Murali, Anitha Gladys, Ramu Kandaswamy","doi":"10.1136/spcare-2024-005336","DOIUrl":"10.1136/spcare-2024-005336","url":null,"abstract":"<p><p>Purple urine bag syndrome is an uncommon condition that occurs in patients with long-standing indwelling urinary catheters, due to urinary tract infection (UTI) by bacteria producing sulfatase or phosphatase enzymes. This results in the formation of the pigments indigo (blue) and indirubin (red), together providing a purple appearance to urine. Management includes a change of catheter and appropriate antibiotics. Although prognosis is usually favourable, rare incidences of complications like Fournier's gangrene have been reported.We report three patients who developed purple urine bag syndrome: a man in his late 50s, a woman in her early 30s and a woman in her early 70s, who were on home-based care with regular home visits by the specialist palliative care team. None of them had any other signs or symptoms suggestive of UTIs. Their urinary catheters and collection bags were changed and proper catheter care was reinforced. All three patients were given antibiotics based on urine culture and sensitivity results. Following the same, urine colour reverted to normal in all patients and none of them had any recurrence.We would like to underline the importance of identifying purple urine bag syndrome as an indicator of underlying UTI, especially in palliative care settings, where patients may not manifest the classical signs and symptoms of UTI. We also would like to highlight the importance of patient and caregiver education on proper catheter care for prevention.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"335-337"},"PeriodicalIF":2.0,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143373614","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 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":"10.1136/spcare-2024-005000","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"291-299"},"PeriodicalIF":2.0,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12128768/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}