BMJ Supportive & Palliative Care最新文献_第5页

Becoming a palliative care physician: how reflective learning shapes professional identity in postgraduate training - a qualitative study. 成为一名姑息治疗医生：反思性学习如何在研究生培训中塑造职业认同——一项定性研究。

IF 2.5 4区医学

BMJ Supportive & Palliative Care Pub Date : 2026-10-08 DOI: 10.1136/spcare-2026-006251

Kristoffer Marså, Dorte Høst, Louise Lausen, Bryan Cleal, Hanne Konradsen

引用次数: 0

Systemic anticancer therapy for refractory malignant bowel obstruction in advanced cancer patients: a retrospective cohort study. 晚期癌症患者难治性恶性肠梗阻的系统性抗癌治疗：一项回顾性队列研究。

IF 2.5 4区医学

BMJ Supportive & Palliative Care Pub Date : 2026-10-07 DOI: 10.1136/spcare-2026-006508

Emma Ferber, Marc-Antoine Benderra, Joseph Gligorov, Jean-Pierre Lotz, Mathieu Jamelot, Ahmed Khalil, Lauren Seknazi, Xavier Barthere, Elise Vandra, Djamel Ghebriou

{"title":"Systemic anticancer therapy for refractory malignant bowel obstruction in advanced cancer patients: a retrospective cohort study.","authors":"Emma Ferber, Marc-Antoine Benderra, Joseph Gligorov, Jean-Pierre Lotz, Mathieu Jamelot, Ahmed Khalil, Lauren Seknazi, Xavier Barthere, Elise Vandra, Djamel Ghebriou","doi":"10.1136/spcare-2026-006508","DOIUrl":"https://doi.org/10.1136/spcare-2026-006508","url":null,"abstract":"Objectives: Malignant bowel obstruction (MBO) is a common but severe complication of advanced cancer. The role of systemic anticancer therapy in patients with inoperable MBO remains poorly defined. This study aimed to assess the efficacy of systemic anticancer therapy in this setting.Methods: We conducted a retrospective, single-centre cohort study including patients hospitalised for MBO between January 2015 and February 2025 at Tenon University Hospital (Paris, France). Eligible patients had advanced cancer with inoperable MBO refractory to medical management and treated by systemic anticancer therapy. The primary endpoint was the rate of bowel resolution. Secondary endpoints included overall survival (OS), time to resolution, reobstruction rate and treatment-related toxicity. Subgroup analyses were performed according to line of therapy and tumour type.Results: 64 patients were included (median age 62 years; 84% female; 50% Eastern Cooperative Oncology Group Performance Status ≤2). Obstruction resolution occurred in 33% of patients. Median OS was 50 days (95% CI 39 to 83). Among responders, 38% experienced reobstruction (median time 33 days, IQR 24-48). Toxicity was substantial (70% adverse events in all grades; 58% grade ≥3). Patients with gynaecological tumours had improved OS compared with others (66 vs 39 days; HR 1.66; p=0.046). In this subgroup, first-line therapy was associated with higher resolution rates (OR 8.67; p=0.019).Conclusions: In inoperable MBO, anticancer therapy achieved obstruction resolution in one-third of patients but was associated with substantial toxicity and limited survival. Careful patient selection and early goals-of-care discussions are essential. Prospective studies incorporating quality-of-life outcomes are needed.","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126547","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

Response to 'Oral health in cancer palliative care: cross-sectional study'. 对“癌症姑息治疗中的口腔健康：横断面研究”的回应。

IF 2.5 4区医学

BMJ Supportive & Palliative Care Pub Date : 2026-10-01 DOI: 10.1136/spcare-2026-006688

Elizabeth Watts, Marie Hannon, Niamh Cleary

引用次数: 0

The algorithmic palliative medicine clinic prediction, prudence and clinical wisdom. 姑息医学的算法临床预测，审慎和临床智慧。

IF 2.5 4区医学

BMJ Supportive & Palliative Care Pub Date : 2026-09-30 DOI: 10.1136/spcare-2026-006572

Abel Garcia Abejas

{"title":"The algorithmic palliative medicine clinic prediction, prudence and clinical wisdom.","authors":"Abel Garcia Abejas","doi":"10.1136/spcare-2026-006572","DOIUrl":"https://doi.org/10.1136/spcare-2026-006572","url":null,"abstract":"Background: AI is rapidly transforming palliative care, enabling earlier identification of patients with unmet needs, improving prognostic estimation, recognising symptom trajectories and supporting clinical decision-making. Much of the contemporary debate has focused on predictive accuracy, explainability, transparency and algorithmic bias. These questions are essential, yet they do not reach the deeper philosophical challenge that algorithmic medicine introduces.Aim: This essay examines whether increasingly powerful predictive systems risk obscuring the nature of clinical judgement itself, arguing that prediction and prudence are distinct but complementary forms of rationality.Approach: Drawing on Aristotle's concept of phronesis, Pellegrino's philosophy of medicine and Ricoeur's hermeneutics of practical wisdom, the essay examines how AI expands medicine's predictive capacity without replacing the practical reasoning through which clinicians determine what ought to be done for a particular patient. Predictive knowledge remains ethically incomplete until interpreted within the concrete circumstances of an individual's life, relationships and values.Main argument: Building on these philosophical foundations, the essay proposes an Architecture of Prudence for AI-enabled palliative care. Predictive systems should initiate deliberation rather than replace clinical judgement, preserve interpretative space, support the cultivation of practical wisdom and remain accountable to the relational-temporal dignity articulated in the DiRePal model.Conclusion: The future of palliative care will not be determined solely by the increasing accuracy of algorithms. It will depend on whether healthcare systems remain capable of preserving clinical wisdom as the form of judgement through which predictive knowledge becomes ethically responsible care. AI may change how medicine knows; only practical wisdom can determine how medicine ought to act.","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104266","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

Higher education palliative care programmes in Latin America: where do we stand? 拉丁美洲高等教育姑息治疗规划：进展如何？

IF 2.5 4区医学

BMJ Supportive & Palliative Care Pub Date : 2026-09-30 DOI: 10.1136/spcare-2026-006349

José Miguel Gutierrez Mendoza, Miguel Fortin Magaña, Mario López-Saca

{"title":"Higher education palliative care programmes in Latin America: where do we stand?","authors":"José Miguel Gutierrez Mendoza, Miguel Fortin Magaña, Mario López-Saca","doi":"10.1136/spcare-2026-006349","DOIUrl":"10.1136/spcare-2026-006349","url":null,"abstract":"Background: Palliative medicine education is a crucial factor in addressing gaps in the provision of palliative care. In Latin America, the availability of specialised training in palliative medicine is limited. Postgraduate study opportunities are heterogeneous and varied.Aim: The objective of this study is to describe postgraduate education in palliative care in Latin America, focusing on characteristics such as duration, educational format, credits and prerequisites.Methods: We searched online for postgraduate palliative medicine programmes, compared them with the second Latin American Atlas of Palliative Care, qualitatively described and compared existing programmes and verified findings with regional palliative care professionals and educators.Results: About 30% of Latin American countries offer a palliative medicine specialty, and 52% provide higher education programmes (eg, master's or diploma), meaning roughly 63% offer some postgraduate training. However, programme duration and requirements remain highly variable.Conclusions: In recent years, Latin America has seen substantial growth across most measurable indicators of palliative care development. Significant gaps remain in education and access to advanced palliative care training at the local level. The findings of this study aim to support the selection of appropriate training programmes and to guide health policymakers in reducing regional inequalities.","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149036512","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

Comparison of ketamine versus lignocaine intravenous infusion in refractory cancer pain: a prospective randomised double-blind controlled study. 氯胺酮与利多卡因静脉输注治疗难治性癌性疼痛的比较：一项前瞻性随机双盲对照研究。

IF 2.5 4区医学

BMJ Supportive & Palliative Care Pub Date : 2026-09-25 DOI: 10.1136/spcare-2026-006327

Sai Sowmya Pulluri, Praveen Kumar Kodisharapu, Praneeth Suvvari, Basanth Kumar Rayani, Pallavi Ghosh, Kaduhole Shubha Pai, Dean George

{"title":"Comparison of ketamine versus lignocaine intravenous infusion in refractory cancer pain: a prospective randomised double-blind controlled study.","authors":"Sai Sowmya Pulluri, Praveen Kumar Kodisharapu, Praneeth Suvvari, Basanth Kumar Rayani, Pallavi Ghosh, Kaduhole Shubha Pai, Dean George","doi":"10.1136/spcare-2026-006327","DOIUrl":"https://doi.org/10.1136/spcare-2026-006327","url":null,"abstract":"Objective: To compare the analgesic efficacy, adverse effect profile, incidence of acute pain crises and opioid-sparing effects of intravenous ketamine versus lignocaine infusions in patients with refractory cancer pain.Methods: A prospective, randomised, double-blind, controlled trial was conducted at Basavatarakam Indo American Cancer Hospital and Research Institute (October 2023-January 2025). 66 adults with refractory cancer pain, defined as pain inadequately controlled despite an oral morphine equivalent (OME) dose exceeding 200 mg/day, were randomised equally to receive either intravenous ketamine (0.3 mg/kg/hour) or intravenous lignocaine (2 mg/kg/hour), each administered as two 6-hour infusions separated by 12 hours. The primary outcome was effective pain relief, defined as a ≥50% reduction in pain severity. Secondary outcomes included adverse effects, acute pain crises during 6-week follow-up and postinfusion changes in OME dose.Results: Effective pain relief was achieved in 84.8% of the ketamine group and 72.7% of the lignocaine group (p=0.228). Both groups demonstrated significant reductions in OME dose from baseline (p<0.01 for both), with no significant between-group difference (p=0.738). Adverse effects were significantly more frequent with ketamine than lignocaine (30.3% vs 9.1%; p=0.03). Acute pain crises during follow-up were numerically more common in the ketamine group (42.9% vs 29.2%), though this difference was not statistically significant (p=0.307).Conclusions: Ketamine and lignocaine demonstrated comparable analgesic efficacy and opioid-sparing effects in refractory cancer pain. Lignocaine, however, offers a more favourable safety profile with significantly fewer adverse effects, supporting its consideration as a preferred option in this clinical setting.","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149058386","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

Effectiveness of advance care planning decision aids for adults: a network meta-analysis of randomised controlled trials. 成人预先护理计划决策辅助的有效性：随机对照试验的网络荟萃分析。

IF 2.5 4区医学

BMJ Supportive & Palliative Care Pub Date : 2026-09-23 DOI: 10.1136/spcare-2026-006500

Zhuolin Yang, Jingying Sun, Pingping Huang, Qing Yang

{"title":"Effectiveness of advance care planning decision aids for adults: a network meta-analysis of randomised controlled trials.","authors":"Zhuolin Yang, Jingying Sun, Pingping Huang, Qing Yang","doi":"10.1136/spcare-2026-006500","DOIUrl":"https://doi.org/10.1136/spcare-2026-006500","url":null,"abstract":"Aims: To compare and rank the effectiveness of various advance care planning (ACP) decision aids in increasing the completion rates of ACP.Background: ACP protects patient autonomy, eases caregiver burden and improves interdisciplinary communication. However, its implementation remains challenging. This study compares the effectiveness of various ACP support tools to promote clinical ACP implementation.Designs: A systematic review and network meta-analysis.Methods: We searched PubMed, Embase, the Cochrane Library, CNKI, Wanfang and VIP databases up to December 2025. Statistical analysis was performed using RevMan V.5.4 and Stata V.18.0.Results: A total of 13 randomised controlled trials were ultimately included, covering eight types of support tools. The results of the network meta-analysis showed that, in terms of improving the rate of documentation of advance healthcare plans within the healthcare system, interventions using paper-based tools, video tools, electronic tools and various combined tools were more effective than usual care; paper-based tools ranked first in terms of the percentage of area under the cumulative ranking curve; in terms of increasing the signing rate of advance directives (AD) documents, personnel-supported interventions, motivational interviewing interventions and video tools were more effective than usual care; the intervention with the highest percentage of the cumulative ranked area under the curve was the personnel-supported intervention.Conclusions: During the initial stages of ACP, paper tools are effective; during the signing of the AD document, personnel support interventions are more effective. In clinical practice, different tools should be selected based on the specific stage of the process to promote ACP.","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149029690","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

Decisional regret in oncology: a scoping review. 肿瘤学中的决策后悔：一项范围综述。

IF 2.5 4区医学

BMJ Supportive & Palliative Care Pub Date : 2026-09-22 DOI: 10.1136/spcare-2026-006384

Lauren Halladay, Ved Hatolkar, Hadia Malik, Lucy Zhao, Gabriel Boldt, Michael Lock, Charles B Simone, Lawson Eng, Jennifer Leigh, Camilla Zimmermann, Eduardo Bruera, Ronald Chow

{"title":"Decisional regret in oncology: a scoping review.","authors":"Lauren Halladay, Ved Hatolkar, Hadia Malik, Lucy Zhao, Gabriel Boldt, Michael Lock, Charles B Simone, Lawson Eng, Jennifer Leigh, Camilla Zimmermann, Eduardo Bruera, Ronald Chow","doi":"10.1136/spcare-2026-006384","DOIUrl":"https://doi.org/10.1136/spcare-2026-006384","url":null,"abstract":"Background: Decisional regret (DR) is an important patient-reported outcome, reflecting patients' retrospective evaluation of healthcare decisions. In oncologic settings, treatment choices typically involve trade-offs between survival, toxicity and/or quality of life, which may influence DR after decisions are made. This scoping review aimed to map the existing literature on DR among adult patients with cancer and to characterise how DR has been measured, reported and associated with clinical and psychosocial factors across oncology contexts.Methods: MEDLINE, EMBASE and Cochrane CENTRAL were searched from database inception to the search date. Studies involving adults with cancer that measured DR using a defined instrument were included. Data were extracted on study characteristics, cancer types, treatment context, measurement tools, timing of DR assessment and associated factors. Findings were synthesised descriptively and thematically.Results: Among 858 identified records, 104 studies were included in this review. The Decisional Regret Scale was the most frequently used instrument. Most studies assessed DR after treatment completion, commonly within 24 months following treatment decisions. DR levels were generally low to moderate. Higher DR was associated with treatment-related morbidity, psychological distress, inadequate information, limited involvement in decision-making and discordance between expectations and outcomes.Conclusion: DR in oncology is influenced by clinical outcomes and quality of the decision-making process. Greater emphasis on shared decision-making, communication and expectation management may help reduce DR and improve patient-centred cancer care.Keywords: Decisional regret, cancer, decision regret scale, treatment decision making, psychosocial factors.","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149023870","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

Minimal clinically important differences and the illusion of precision. 最小的临床重要差异和精确的错觉。

IF 2.5 4区医学

BMJ Supportive & Palliative Care Pub Date : 2026-09-17 DOI: 10.1136/spcare-2026-006203

Taylan Gurgenci, Sharon Lee, Luc Farnan, Phillip Good

{"title":"Minimal clinically important differences and the illusion of precision.","authors":"Taylan Gurgenci, Sharon Lee, Luc Farnan, Phillip Good","doi":"10.1136/spcare-2026-006203","DOIUrl":"https://doi.org/10.1136/spcare-2026-006203","url":null,"abstract":"Objective: Minimal clinically important differences (MCIDs) are used in palliative care trials to guide sample size calculations and to judge whether changes in patient-reported outcomes represent meaningful benefit. Several methods are used to estimate MCIDs. For the Total Symptom Distress Score (TSDS), two common approaches are the within-patient mean change and receiver-operating characteristic (ROC)-based method.MCIDs derived using these approaches often differ across otherwise similar studies. We examined whether this variability reflects limited sample size or whether commonly used ROC-based methods contribute to persistent instability.Methods: Data for 186 participants were drawn from two published randomised controlled trials. MCIDs were estimated using (1) the within-patient mean change (anchored to minimal improvement) and (2) ROC analysis to maximise Youden's J. Stratified bootstrap resampling was performed at nominal sample sizes of 50, 100 and 150.Results: With increasing sample size, variability in ROC-derived MCIDs decreased only modestly and remained substantial even in large samples. Multiple thresholds showed near-equivalent discriminatory performance. At n=150, multiple near-optimal thresholds were observed in up to 85.4% of bootstrap samples. The differences in the threshold values were clinically relevant. In contrast, mean-change MCIDs converged towards more consistent values (approximately -6.5 TSDS points), with markedly lower clinically-relevant variability.Conclusion: When MCIDs are used as fixed thresholds for trial design or interpretation, mean-change approaches are more reproducible across plausible samples, whereas ROC-based MCIDs show greater variability that can meaningfully affect trial conclusions. Caution is therefore warranted when using single ROC-derived MCIDs in palliative care trials.","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148987874","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

Non-invasive ventilation (NIV) and high-flow nasal therapy (HFNT) in palliative care: a critical narrative review. 无创通气（NIV）和高流量鼻治疗（HFNT）在姑息治疗中的应用：一个关键的叙事回顾。

IF 2.5 4区医学

BMJ Supportive & Palliative Care Pub Date : 2026-09-16 DOI: 10.1136/spcare-2026-006580

Sebastiano Mercadante

{"title":"Non-invasive ventilation (NIV) and high-flow nasal therapy (HFNT) in palliative care: a critical narrative review.","authors":"Sebastiano Mercadante","doi":"10.1136/spcare-2026-006580","DOIUrl":"https://doi.org/10.1136/spcare-2026-006580","url":null,"abstract":"Background: Dyspnoea is a prevalent, debilitating symptom in advanced life-limiting illnesses. While opioids and non-pharmacological measures remain foundational, refractory breathlessness presents a major palliative challenge.Objectives: To critically appraise the evidence regarding patient selection, comparative tolerability, adverse effects and ethical considerations of non-invasive ventilation (NIV) and high-flow nasal therapy (HFNT) in palliative care.Methods: A comprehensive narrative review of literature from PubMed, Embase and Cochrane Library (from inception to June 2026) and major clinical guidelines was conducted.Results: NIV is best supported in hypercapnic respiratory failure (PaCO >45 mm Hg), showing benefits in chronic obstructive pulmonary disease exacerbations, pulmonary oedema and amyotrophic lateral sclerosis (ALS). In advanced cancer, NIV reduces dyspnoea primarily in hypercapnic patients but mask discomfort and communication barriers limit tolerability. Conversely, HFNT has emerged as a superiorly tolerated option in hypoxemic failure-particularly in end-stage interstitial lung disease (ILD) and advanced cancer-providing significant dyspnoea relief while preserving oral intake and verbal communication until the end of life. Time-limited trials (<1 hour for NIV; 2 hours for HFNT) help identify early responders. Ethical challenges include potential overtreatment and support withdrawal complexities.Conclusions: Respiratory support selection should be guided by respiratory physiology (hypercapnic vs hypoxemic), explicit goals of care and tolerability. NIV remains optimal for hypercapnic failure, whereas HFNT offers superior comfort and preserves communication in hypoxaemic patients. Robust randomised trials are needed.","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982269","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