BMJ Supportive & Palliative Care最新文献

{"title":"Electrical muscle stimulation: a multidisciplinary narrative review.","authors":"Mohamed J Saadh, Tamara Nazar Saeed, Karar H Alfarttoosi, Ashish Kakkad, Subbulakshmi Ganesan, Aman Shankhyan, S Sunitha, Aziz Kubaev, Waam Mohammed Taher, Mariem Alwan, Mahmood Jasem Jawad, Ali M Ali Al-Nuaimi","doi":"10.1136/spcare-2025-005732","DOIUrl":"10.1136/spcare-2025-005732","url":null,"abstract":"<p><p>Electrical muscle stimulation (EMS) is one of the most popular and efficient complementary techniques that mimics the action potential for adjacent muscles and maintains muscle health. Aside from muscular rehabilitation, a promising role for EMS has been reported in a wide range of clinical conditions, from cognitive disorders to metabolic diseases and pain management. However, the clinical response and effectiveness of this method remain variable. In this article, we reviewed the role of EMS in different health-related conditions in order to provide a comprehensive view of this matter.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"1054-1061"},"PeriodicalIF":2.5,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145480933","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":"Early oral feeding post gastrectomy in gastric cancer: quasi-experimental study.","authors":"Haiyan He, Yuanyuan Ma, Guo Liu, Shuying Liu, Qin Liu, Juan Yao, Chengcheng Huang, Jie Liu, Liang Zhou, Ting Wang, Teng Wang, Na Wang, Xiaolian Deng, Yaling Wang","doi":"10.1136/spcare-2024-005183","DOIUrl":"10.1136/spcare-2024-005183","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to investigate the safety and feasibility of early oral feeding in patients with gastric cancer after gastrectomy.</p><p><strong>Methods: </strong>A total of 135 patients with gastric cancer who would receive gastrectomy were enrolled in the study, with 61 in early oral feeding group and 74 in control group. Outcomes included nutrient intake, nutritional status, gastrointestinal functions and symptoms, pain, physical activity time, clinical outcomes and inflammation markers.</p><p><strong>Results: </strong>In comparison with control group, patients in early oral feeding group had significantly higher compliance rates of oral energy and protein intake, lower needs of parenteral nutrition and shorter postoperative oral feeding start time during hospitalisation. Moreover, the compliance rate of oral protein intake at 1 week after discharge was higher in patients with gastric cancer of early oral feeding group compared with control group. The gastrointestinal function was better in early oral feeding group, evidenced by shorter time to the first flatus and dwell time for gastric tube.</p><p><strong>Conclusion: </strong>This study demonstrated that early oral feeding is safe and can significantly improve oral energy and oral protein intake and gastrointestinal functions during hospitalisation in patients with gastric cancer who received gastrectomy, as well as the oral protein intake after discharge.</p><p><strong>Trial registration: </strong>Chinese Clinical Trial Registry: ChiCTR2300069202.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"1210-1220"},"PeriodicalIF":2.5,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143448121","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":"Eating-related distress in cancer cachexia: multicentre self-reported questionnaire study.","authors":"Tatsuma Sakaguchi, Koji Amano, Satomi Okamura, Saori Koshimoto, Akihiro Tokoro, Sayaka Arakawa, Takashi Takeuchi, Yoshinobu Matsuda, Eriko Satomi, Naoharu Mori","doi":"10.1136/spcare-2024-005325","DOIUrl":"10.1136/spcare-2024-005325","url":null,"abstract":"<p><strong>Objectives: </strong>The Asian Working Group for Cachexia (AWGC) updated the diagnostic criteria for cachexia, emphasising its multidimensional influence. We hypothesised that patients meeting the AWGC criteria would exhibit higher levels of eating-related distress (ERD) than those meeting the European Palliative Care Research Collaborative (EPCRC) criteria.</p><p><strong>Methods: </strong>A multicentre survey using a self-reported questionnaire was conducted between November 2023 and June 2024 among adult patients with advanced cancer. We evaluated ERD using the Questionnaire for Eating-Related Distress in Patients with Advanced Cancer (QERD-P). Cachexia was diagnosed using both AWGC and EPCRC criteria, examining their relationship with ERD using multiple linear regression models.</p><p><strong>Results: </strong>Among 192 patients analysed, the prevalence of cachexia was 74% according to AWGC and 64% according to EPCRC criteria. Anorexia scores were significantly associated with the presence of AWGC-defined cachexia but not EPCRC-defined cachexia (p<0.001, 0.177, respectively). Both AWGC-defined and EPCRC-defined cachexia showed significant associations with the total score of the QERD-P long version in simple linear regression models (p<0.001 and p=0.011, respectively); however, after adjusting for covariates, including age, sex, dietary intake, performance status, primary cancer site and treatment status, the total score of QERD-P long version was significantly higher only in AWGC-defined criteria group but not in EPCRC-defined cachexia group (p=0.020, 0.095, respectively).</p><p><strong>Conclusions: </strong>AWGC-defined cachexia showed a stronger association with ERD compared with EPCRC-defined cachexia, incorporating anorexia as a subjective symptom. AWGC criteria may better capture ERD-related aspects of cachexia, requiring further validation.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"1133-1140"},"PeriodicalIF":2.5,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148040842","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":"Clinical practice and pharmacology decisions of medical aid-in-dying providers in the United States.","authors":"David Nathaniel Hoffman, Gianna Rose Strand","doi":"10.1136/spcare-2025-005397","DOIUrl":"10.1136/spcare-2025-005397","url":null,"abstract":"<p><strong>Objectives: </strong>Comprehensive understanding of the technical aspects of medical aid-in-dying (MAiD) including candidate selection, clinician prescribing decisions, and complications in the USA has been absent from clinical literature. This is due to limited scholarship and highly fractured data reporting methods across states. This study seeks to characterise the current landscape of MAiD practice and management by American providers to assess whether and how national standards of care are emerging across jurisdictions.</p><p><strong>Methods: </strong>A digital survey tool recorded a series of quantitative and qualitative questions from 126 respondents practising in 10 jurisdictions and gathered 682 deidentified case reports of their patients who self-administered a MAiD prescription.</p><p><strong>Results: </strong>Respondents had cared for an average of 102 patients and 73% reported an increase in patient volume over time. Providers declined 9% of MAiD requests. More than half had changed pharmacological regimens, but lacked consistent clinical justification for these changes. The drug combination known as DDMAPh is the current predominant prescribed MAiD regimen. More than half use alternate MAiD regimens, change dosages, or add agents like macrolide antibiotics, indicating DDMAPh functions as a backbone rather than a standard order set. Unanticipated complications occurred in 7% of cases. The addition of sweeteners did not reduce burning or bitter taste.</p><p><strong>Conclusions: </strong>Although there are general trends among MAiD practice, primarily offered by two national organisations, US providers continue to pursue significant individual practice variation.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"1161-1169"},"PeriodicalIF":2.5,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13539847/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145833092","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":"Opioid analgesics prescribing in Latin America: systematic review and meta-analysis.","authors":"Ofelia Leiva, Mariana Dittborn, Pamela Turrillas, Emeka Chukwusa, Kennedy Nkhoma, Adejoke Obirenjeyi Oluyase, Oslando Padilla, Tania Pastrana","doi":"10.1136/spcare-2025-005720","DOIUrl":"10.1136/spcare-2025-005720","url":null,"abstract":"<p><strong>Background: </strong>Improving access to opioids in Latin America requires better understanding of prescription patterns in palliative care.</p><p><strong>Aim: </strong>To describe opioid prescribing patterns, including types and doses in morphine equivalent daily dose (MEDD), among patients receiving palliative care, including patients with cancer and non-cancer conditions in Latin America.</p><p><strong>Design: </strong>Systematic review and meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.</p><p><strong>Data sources: </strong>We searched MEDLINE, EMBASE, PubMed, LILACS and SciELO from inception to January 2025. Quantitative studies reporting opioid prescriptions in adult patients receiving palliative care were included. Two reviewers independently screened, extracted data and assessed methodological quality using the Effective Public Health Practice Project tool. A narrative synthesis and descriptive statistics were conducted. Meta-analysis of MEDD was performed post hoc using random-effects models.</p><p><strong>Results: </strong>Of 2855 records, 51 studies from seven countries met inclusion criteria. Most were observational (75%), with 8641 patients analysed. Cancer pain was the main indication (98%). Morphine (61%) and tramadol (15%) were the most frequently prescribed opioids. A meta-analysis of 48 studies (8433 patients) yielded a pooled mean MEDD of 98.06 mg (95% CI 77.07 to 119.05), with substantial heterogeneity (I²=100%). Most studies were rated as low to moderate quality.</p><p><strong>Conclusions: </strong>This review provides a regional synthesis of opioid prescribing patterns for palliative care in Latin America. Although morphine is the most used opioid, data show limited dosing variability and a scarcity of high-quality studies. Strengthening research capacity is essential to inform clinical guidelines and policy for equitable and adequate pain management in palliative care across the region.</p><p><strong>Prospero registration number: </strong>CRD42024497564.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"1005-1018"},"PeriodicalIF":2.5,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145530680","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":"Assisted dying: participation barriers and facilitators - qualitative interview study of doctors' perceptions.","authors":"Laura Ley Greaves, Lindy Willmott, Rachel Feeney, Ben P White","doi":"10.1136/spcare-2024-004985","DOIUrl":"10.1136/spcare-2024-004985","url":null,"abstract":"<p><strong>Objectives: </strong>As more countries legalise assisted dying, it is of increasing significance for policy-makers and the medical profession. Doctors are needed for patients to access this choice; however, there is currently limited participation. Few studies identify what factors, if any, facilitate participation in assisted dying and how the inter-relationship of multiple factors may also influence participation. This study investigates factors influencing potential participation of doctors who have no in-principle objection to assisted dying in Queensland, Australia.</p><p><strong>Methods: </strong>A qualitative interview study with 31 doctors who have no in-principle objection to assisted dying. Interviews were conducted between March 2022 and January 2023 during the implementation period, when the assisted dying law had passed but was not yet in effect.</p><p><strong>Results: </strong>Participants identified four categories of barriers to participation: personal burdens; professional ramifications; external constraints and the difference from the traditional role of a doctor. Facilitators to participation were: continuation of care; philosophical support for assisted dying; providing a good death and scope of provision. The interplay between barriers and facilitators influenced the degree of expected participation, if any. Three key decision points determining participation were also identified: providing for all patients or only their own patients; participation as the co-ordinating or consulting practitioner and whether to participate in practitioner administration.</p><p><strong>Conclusions: </strong>Participation in assisted dying may be shaped by whether or not an individual doctor's philosophical support for this choice is outweighed by barriers to participation. Removing barriers could positively affect the future sustainability of an assisted dying workforce.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"1241-1249"},"PeriodicalIF":2.5,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799313","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":"Chemotherapy-associated neutropenia with same-day versus next-day pegfilgrastim in outpatient chemotherapy: solid tumour cohort study.","authors":"Mauricio Luján, Camila Lema, Diego Morán, Beatriz E Preciado, Katerin Puerta A, Mauricio Lema, Mateo Pineda Álvarez","doi":"10.1136/spcare-2025-005804","DOIUrl":"10.1136/spcare-2025-005804","url":null,"abstract":"<p><strong>Objectives: </strong>To compare the incidence of febrile neutropenia (FN) and chemotherapy delays (CD) due to neutropenia in chemotherapy cycles in which pegfilgrastim (PGF) was administered on the same day (D0) vs the following day (D+1), as treatment for solid tumours.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using the number of chemotherapy cycles with PGF administration as the unit of analysis. PGF administration on D0 was compared with administration on D+1. The incidence of FN and CD was calculated for the entire cohort and for subgroups. Relative risk (RR) between groups was assessed, a p value <0.05 considered statistically significant.</p><p><strong>Results: </strong>A total of 1091 cycles with PGF administration on D0 were compared with 1089 cycles on D+1. The incidence of FN was 1.6% in D0 and 0.5% in D+1 (RR=3.4; p=0.02), and CD was 2.2% and 2.6% in D0 and D+1, respectively (RR=0.9; p=0.67). The incidence of FN on breast cancer (BC) patients was 2.4% in D0 and 0.3% in D+1 (RR=7.0; p<0.01). No significant differences were identified in the incidence of FN among other tumours (OT) (RR=1.0; p=0.68).</p><p><strong>Conclusion: </strong>Higher rates of FN were observed in the overall cohort when PGF was administered on D0, largely influenced by the subgroup of BC patients. Among OT, the day of PGF administration did not impact the outcome. These findings support the administration of PGF on D+1 of chemotherapy in BC patients when FN prevention is the objective. For patients with OT, administration of PGF on D0 is considered appropriate.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"1141-1150"},"PeriodicalIF":2.5,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145450828","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":"Pharmacotherapy in palliative medicine-a decade of evidence: bibliometric review.","authors":"Júlia Raso, Fabiana Rossi Varallo","doi":"10.1136/spcare-2025-005709","DOIUrl":"10.1136/spcare-2025-005709","url":null,"abstract":"<p><strong>Background: </strong>Pharmacotherapy has a strategic role in palliative care (PC). Medications are prescribed in this context for various reasons, leading to polypharmacy, associated with several negative outcomes. Despite its clinical relevance, the scientific literature about pharmacological interventions in PC remains scarce and fragmented. This review aimed to explore and map the pharmacological interventions in PC.</p><p><strong>Methods: </strong>A bibliometric review was conducted using combined data from Scopus and Web of Science. Inclusion criteria covered original articles and reviews, published between 2014 and 2024, that had terms related to PC present in the title and terms related to the use of medications present in the title, abstract or keywords. RStudio and VOSviewer were used to analyse data, focusing on publication trends, authorship, keywords and thematic evolution.</p><p><strong>Results: </strong>A total of 2245 publications were included, mainly original articles (80%), although only 10% were clinical trials. Highest annual production was found in 2024, concentrating mainly in high-income countries. The term \"symptom management\" appears as a central term in keyword analysis; it also appears, along with \"deprescribing\" and \"polypharmacy\", in trending topics evolution, growing in 2019. Data indicate that pharmacotherapy is not yet a consolidated theme itself, being addressed mainly in more general references.</p><p><strong>Conclusion: </strong>Fragmentation hinders the advancement of key issues such as the identification and management of potentially inappropriate medications, therapeutic rationalisation at the end of life and the pharmacoeconomic impact of these prescriptions and interventions. The field of palliative pharmacotherapy should be considered as a possibility for future literature development.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"1081-1091"},"PeriodicalIF":2.5,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145676553","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":"Illusion of choice? Implicit coercion and assisted dying in clinical practice.","authors":"Ruslan Zinchenko, Sheila Hollins","doi":"10.1136/spcare-2026-006164","DOIUrl":"10.1136/spcare-2026-006164","url":null,"abstract":"<p><p>In this article, we argue that the narrow focus on explicit coercion in assisted dying obscures more pervasive forms of implicit coercion operating at interpersonal and institutional levels. Drawing on complex adaptive systems theory, we conceptualise healthcare systems as environments in which coercive dynamics emerge non-linearly and cannot be adequately mitigated through linear procedural safeguards.We look at the potential for implicit coercion within the unique context of terminal illness and consider how end-of-life emotional distress and attachment style shape individuals' responses to vulnerability, dependency and care, influencing how choices are expressed. We also examine the erosion of personal identity in terminal illness, arguing that beyond decision-making capacity and voluntariness, the authenticity of decision-making should be an important consideration in requests for assisted dying.We then turn to structural and institutional coercion, focusing on the influence of social roles, norms and professional authority. We examine how structural constraints and choice architecture affect freedom of choice. The Mental Health Act in England and Wales is used as a case study to illustrate how institutional coercion can emerge in practice despite the presence of statutory safeguards.Finally, we argue that assisted dying legal frameworks fail to adequately address implicit coercion and offer mitigation strategies to reduce the risk of it arising in complex healthcare systems.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"1102-1108"},"PeriodicalIF":2.5,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147389394","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":"Describing and monitoring quality in value-based palliative and end-of-life care at a population level in Wales: achievements and future direction.","authors":"Katherine E Woolley, Sarah Puntoni, Kathleen Withers, Sally Cox, Idris Baker, Anthony Byrne","doi":"10.1136/spcare-2026-006142","DOIUrl":"10.1136/spcare-2026-006142","url":null,"abstract":"<p><p>Improving and monitoring quality of palliative and end-of-life care is well documented within current and historic literature. However, there is a paucity of evidence around national data-informed approaches to ensure healthcare services are delivering high-quality, equitable care that meets the needs of the population within the last year of life. Wales has a legal 'Duty of Quality' obligation and has taken on the challenge to measure and monitor quality within the healthcare system at a population level within the last year of life, creating a dashboard using nationally held routine data. This manuscript aims to document the progress made in Wales to describe and monitor quality in care for people within the last year of life at a population level against the six domains of quality and discusses requirements and challenges of the approach and its future direction.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"1109-1114"},"PeriodicalIF":2.5,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13539824/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147580456","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}