BMJ Supportive & Palliative Care最新文献

{"title":"12-week resistance training and body composition in women survivors of breast cancer: influence of tumour type and treatments.","authors":"Alba Esteban-Simón, David M Díez-Fernández, Paola Gonzalo-Encabo, Marina Olmedo-Pérez-Montaut, Manuel A Rodríguez-Pérez, Javier S Morales, Alberto Soriano-Maldonado","doi":"10.1136/spcare-2026-006317","DOIUrl":"https://doi.org/10.1136/spcare-2026-006317","url":null,"abstract":"<p><strong>Objective: </strong>To assess the effects of a 12-week resistance training intervention on body composition in female breast cancer survivors. The secondary exploratory aim was to evaluate whether tumour type and treatment received were associated with changes in body composition following the intervention.</p><p><strong>Methods: </strong>The <i>Ejercicio FÍsico para supervivientes de CÁNcer de mama</i> (EFICAN) trial recruited 60 volunteer women survivors of breast cancer who completed chemotherapy, radiotherapy and/or surgery and were randomly assigned to either a 12-week exercise-based intervention group (IG; two exercise sessions/week <i>plus</i> ≥10 000 steps/day) or a control group (CG; ≥10 000 steps/day). Baseline and postintervention assessments of body composition (ie, fat and muscle, fat percentage and visceral fat level) were conducted using a bioelectrical impedance device.</p><p><strong>Results: </strong>No significant between-group differences were observed in fat mass, muscle mass, fat percentage or visceral fat level. The exploratory analyses showed that participants who received chemotherapy experienced unfavourable changes in these outcomes (all p<0.05). However, the subgroup analyses revealed that while the participants in the CG who received chemotherapy (n=21) experienced an increase in fat mass (B=2.062 kg, p=0.045), body fat percentage (B=3.052%, p=0.004) and visceral fat mass (B=1.262 kg, p=0.017), the participants in the IG who received chemotherapy (n=24) did not present such negative changes in body composition.</p><p><strong>Conclusions: </strong>The EFICAN intervention that combined resistance training with home-based physical activity did not lead to significant changes in body composition in comparison to home-based physical activity alone. Although the tumour type and hormone therapy were not associated with changes in body composition, receiving chemotherapy was associated with a deterioration in body composition only in the CG.</p><p><strong>Trial registration number: </strong>ISRCTN14601208.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148599180","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":"Outpatient rapid drug desensitisation for chemotherapy and biologic agents: high success rates in a large single-centre cohort study.","authors":"Likitha Mamillapalli, Amelia Chan, John Timoney, Autumn Guyer, Qin Zhou, Alexia Iasonos, Roisin E O'Cearbhaill","doi":"10.1136/spcare-2026-006286","DOIUrl":"10.1136/spcare-2026-006286","url":null,"abstract":"<p><strong>Objectives: </strong>We evaluated rapid drug desensitisation (RDD) protocols at Memorial Sloan Kettering Cancer Center (MSK) to determine completion rates and characterise hypersensitivity reaction (HSR) phenotypes using clinical features and biomarker data. This study addresses an important gap by assessing an expanded range of antineoplastic agents, incorporating biomarkers such as tryptase and interleukin-6, and evaluating outcomes under updated outpatient oncology and allergy-co-managed desensitisation pathways.</p><p><strong>Methods: </strong>This retrospective, single-centre descriptive study included adult patients who underwent RDD to any chemotherapeutic or biologic agent between 1 October 2023 and 31 October 2024, following a documented HSR. RDD 'success' was defined as completion of at least one cycle without treatment discontinuation due to breakthrough HSR. This definition reflects MSK's current clinical decision-making approach.</p><p><strong>Results: </strong>A total of 142 patients met inclusion criteria. The median age was 62 years and 103 (73%) were female. Overall RDD success was 92.3%, (131 patients). Breakthrough HSRs occurred in 23% of patients and 19 patients (13.4%) subsequently discontinued the agent. Biomarker-based phenotyping was feasible in 26 patients; incomplete sampling due to workflow limitations precluded classification in the remaining cases.</p><p><strong>Conclusions: </strong>MSK's outpatient RDD protocols demonstrate consistently high success rates across a broad spectrum of chemotherapy and biologic agents, exceeding earlier institutional experience. Increased interdisciplinary collaboration, expanding institutional expertise and refined protocol tailoring represent key advances. Future work should prioritise biomarker-driven approaches and standardised workflows to support consistent biomarker collection, thereby improving phenotype classification and enhancing mechanistic insight to guide individualised desensitisation strategies.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13600258/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148599199","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":"Acute palliative care unit discharge outcomes: intensive versus non-intensive care transfers.","authors":"Kayley M Ancy, Ahsan Azhar, Gustavo S Mastroleo, Bonnie Nelson, Alexandra Cooper, Monica Aceves, Jasmin Crane, Clark R Andersen, David Hui, Rony Dev, Eduardo Bruera","doi":"10.1136/spcare-2026-006339","DOIUrl":"https://doi.org/10.1136/spcare-2026-006339","url":null,"abstract":"<p><strong>Objectives: </strong>No studies examining clinical outcomes for patients transferred to an acute palliative care unit (APCU) from an intensive care unit (ICU) versus a non-ICU exist. The objectives were to determine the proportions and outcomes of patients being discharged alive from an APCU after being transferred from an ICU versus a non-ICU.</p><p><strong>Methods: </strong>All patients transferred to our APCU from an ICU from 1 September 2021 to 31 August 2023 and an equally sized random sample of patients transferred from a non-ICU during the same period were identified. Demographics, clinical characteristics and outcomes were compared between the two groups.</p><p><strong>Results: </strong>400 patients (214 ICU and 186 non-ICU) were included (mean age, 62 years (SD, 14.3); 51.3% women; 63.8% in a relationship; 67.8% white). Non-ICU patients were more likely to be discharged alive than were ICU patients (32.8% (95% CI 26.5 to 39.8%) vs 22.4% (95% CI 17.4 to 28.5%); p=0.02). Of the 109 patients discharged from our APCU, most went either to hospice care at home (54.1%, n=59) or to inpatient hospice care (40.4%, n=44), and there was no difference in discharge location between the ICU and the non-ICU groups (p=0.93). On multivariable analysis, APCU mortality was more likely in the group overall among patients who were receiving oxygen via a high-flow nasal cannula (HFNC) (OR, 2.47 (1.25 to 4.90); p=0.01).</p><p><strong>Conclusions: </strong>Despite the APCU mortality in this cohort being high, 22.4% of patients transferring from the ICU were successfully discharged to the community. HFNC use at the time of APCU transfer was independently associated with increased odds of APCU mortality.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148599145","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":"Disadvantaged ethnic minority communities and legalising assisted dying: coercion, trust and equity in end-of-life care.","authors":"Jamilla Akhter Hussain, Ikhlaq Jacob, Rubina Khalid, Natalie Balaz, Carol Peltier, Mercia Jensen, Bhajneek Grewal, Amrita Brara, Julia Hackett","doi":"10.1136/spcare-2026-006365","DOIUrl":"https://doi.org/10.1136/spcare-2026-006365","url":null,"abstract":"<p><strong>Objectives: </strong>To explore perspectives on assisted dying legislation among disadvantaged ethnic minority communities in a UK city with high ethnic diversity and socioeconomic deprivation to inform deliberation of the Terminally Ill Adults (End of Life) Bill in England and Wales.</p><p><strong>Methods: </strong>Three community consultations were facilitated using semistructured discussions. Groups consulted included: (1) 98 adults from ethnic minority communities living in disadvantaged areas; (2) 24 ethnic minority women with experience of domestic abuse and (3) 15 parents of young people aged ≥18 years who are autistic and/or have learning disabilities. Findings were analysed thematically.</p><p><strong>Results: </strong>Across all consultation groups, participants expressed both compassion for people experiencing severe suffering who want assisted dying, alongside concerns about how assisted dying might be experienced by marginalised groups. Four themes were developed: fear and mistrust of healthcare systems; risks of direct and indirect coercion, including structural and interpersonal forms; concerns about decision-making, capacity and family involvement; and unintended consequences for trust in palliative care services.</p><p><strong>Conclusions: </strong>Consultations provide insights into how assisted dying legislation may affect groups experiencing end-of-life inequalities. Findings suggest that without attention to equity, trust and safeguards, assisted dying policy risks widening disparities and undermining engagement with palliative care.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148547809","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":"How can speech and language therapists help decision-making on clinically assisted hydration for adults at the end of life?","authors":"Laura Mizzi","doi":"10.1136/spcare-2026-006169","DOIUrl":"https://doi.org/10.1136/spcare-2026-006169","url":null,"abstract":"<p><p>While reducing oral intake is a natural occurrence when a person is dying, there may be situations where the healthcare team need to decide whether to withhold, initiate, continue or withdraw clinically assisted hydration (CAH), in discussion with the dying person and significant others. Speech and language therapists (SLTs) are increasingly part of the healthcare team, managing a person's dysphagia and communication when they are nearing the end of their life. An SLT can assist with differentiating between clinical symptoms, help determine whether oral fluid intake is as comfortable as possible, enhance oral hygiene, ensure a person can make informed choices around their hydration, and support the person and those close to them to understand the healthcare team's decision-making. The SLT's specialist knowledge and skills can enhance the multidisciplinary team's care quality. This article aims to provide an overview of the clinical and ethical considerations of CAH in adults, relevant to the field of SLT, alongside the SLT role. Given there is no clinical consensus on the benefits and risks of CAH in the last week of life, healthcare teams need to take a person-centred approach when considering the options around CAH. Oral fluid intake, where possible, should be encouraged. Respect for a person's autonomy, alongside effective communication, ensures that a competent individual can decide whether to accept CAH if offered.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148535176","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":"Advance care planning in neurological disease to improve end-of-life care and reduce healthcare utilisation: cohort study.","authors":"Ivana Zamarbide Capdepón, Eduardo Garcia Romo, Bernadette Pfang, Catalina Paredes-Coronel, Andrés Enrique Suárez-Plaza, Lucía Esteban Fernández, Soraya De la Fuente Batista, Francisco Javier Pardo Moreno, Alvaro Gandara","doi":"10.1136/spcare-2026-006278","DOIUrl":"https://doi.org/10.1136/spcare-2026-006278","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the first year of a neurologist-led Advance Care Planning (ACP) consultation implemented within a tertiary hospital neurology department, and to assess its impact on end-of-life (EOL) care, alignment with patient preferences, and healthcare utilisation among patients with advanced neurological disease.</p><p><strong>Methods: </strong>A retrospective observational study of all patients referred to a specialised ACP consultation between May 2023 and June 2024 at the Fundación Jiménez Díaz University Hospital (Madrid, Spain). Referral was guided by a NECPAL (NECesidades PALiativas) - based tool. ACP discussions followed the LagunAdvance framework and generated individualised care plans documented using structured communication and therapeutic appropriateness fields. Fisher's exact test was used to compare differences before and after referral, and Bayesian methods were used where appropriate.</p><p><strong>Results: </strong>Eighty-six patients (median 83 years) were included. Severe cognitive impairment (68%) and moderate-severe dependency (88%) were common. Communication limitations affected 38%. ACP planning was completed for all patients. Engagement with palliative care teams occurred in 24%, and 47% used Web Dialogue. Healthcare utilisation decreased significantly following ACP: emergency department visits fell from 48% to 22% (p<0.001), and hospital admissions from 32% to 16% (p=0.020). Thirty-two patients (37%) died during follow-up; 66% died in their preferred location. Diagnostic interventions in the last week of life were infrequent (15%).</p><p><strong>Conclusions: </strong>A neurologist-led ACP consultation is feasible and improves key EOL outcomes for patients with advanced neurological disease, including reduced acute care use and greater alignment with patient preferences. This model may support broader integration of palliative principles within neurology services.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148468896","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 integration in oncology: narrative review.","authors":"Dimitrios Stylianakis, Vasiliki Bampiolaki, Konstantinos Grigoriou, Maria Vasilopoulou, Ioannis Stylianakis, Christos Tsagkaris, Serafina Martella, Denise Vacca, Nerina Denaro, Mariangela Cogoni, Fabiana Melis, Marios Spanakis, Emmanouil Symvoulakis, Giorgio Astara, Mario Scartozzi, Raffaele Giusti, Cinzia Solinas","doi":"10.1136/spcare-2026-006174","DOIUrl":"10.1136/spcare-2026-006174","url":null,"abstract":"<p><p>Palliative care integrated with standard oncology treatment improves symptoms, quality of life and communication, and may extend survival in select populations. However, its integration into routine oncology practice remains inconsistent, delayed and unequal. This review critically approaches international guidelines on integrating palliative care into oncology, outlines critical gaps in referral timing, triggers, team composition, haematologic malignancies and resource stratification, and translates recommendations into practical service-delivery models and implementation strategies. Meta-analyses, randomised controlled trials and guidelines collectively advocate for early, concurrent palliative care, delivered by interdisciplinary teams with primary palliative care skills within oncology. However, key gaps persist in referral triggers, service standards, resource-stratified pathways and performance metrics, particularly for haematologic malignancies, caregivers and underserved populations. Crucially, we detail how workforce shortages, inequitable opioid access and financing gaps create predictable disparities for paediatric, rural, low-income and minority populations, and propose practical, resource-stratified adaptations for each barrier. Real-world programmes show promise in multiple delivery models, but scaling these models is limited by workforce shortages, funding, opioid access and infrastructure. This work additionally synthesises evidence on the integration of palliative care in oncology care across different continents and countries. The focus now must shift from demonstrating palliative care's benefits to ensuring equitable, timely delivery through clear referral triggers, strengthened primary palliative care, sustainable funding and measurable quality indicators.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148435182","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":"Quality indicators for cancer pain management: natural language processing and machine learning from electronic clinical records.","authors":"Uta Kondo, Miku Ishida, Kento Masukawa, Ryusuke Inoue, Masaharu Nakayama, Mitsunori Miyashita","doi":"10.1136/spcare-2026-006282","DOIUrl":"https://doi.org/10.1136/spcare-2026-006282","url":null,"abstract":"<p><strong>Objectives: </strong>The continual evaluation of quality indicators (QIs) for cancer pain management is essential to maintaining and improving its quality. However, free-text notes in electronic medical records (EMRs) must be reviewed to accurately assess pain management QIs, and the heavy workload of this process can be limiting.Therefore, this study evaluated the performance of natural language processing and machine learning for assessing pain management QIs using EMR data.</p><p><strong>Methods: </strong>This single-centre cross-sectional study included adult patients with cancer who died at a Japanese university hospital between 1 January 2022 and 31 December 2024. Clinical notes concerning inpatients and outpatients were extracted from the EMR system. A model was developed to automatically identify documentation related to pain management from free-text notes. We then compared the model's QIs assessment with a manual review concerning the number of patients who underwent pain screening.</p><p><strong>Results: </strong>The study included 865 patients, and 2 119 377 clinical records were used to evaluate QIs. The model achieved 85%-96% accuracy, and the F1 score ranged from 0.38 to 0.58 for identifying pain-screening documentation. The pain screening rate for the centre's inpatients was 100%, according to the manual and model-based evaluations. For the outpatients, the rates were 35.0% and 35.9%, respectively, by the manual and model-based evaluations.</p><p><strong>Conclusions: </strong>Pain management QIs can be accurately assessed using natural language processing and machine learning applied to EMRs, with performance comparable to that of manual reviews. This approach may improve cancer pain management by providing clinician feedback and visualising achievement rates.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148454642","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":"As needed or pro re nata medication prescribing accuracy in haematology/oncology: quality improvement initiative.","authors":"Nessa Keane, Sinead Deane, Leona Reilly, Eileen Mannion, Dympna Waldron, Julien O'Riordan, Niamh Keane, Sharon Beatty","doi":"10.1136/spcare-2026-006249","DOIUrl":"https://doi.org/10.1136/spcare-2026-006249","url":null,"abstract":"<p><strong>Objectives: </strong>Inaccurate prescribing of as needed medications in haematology/oncology patients poses a significant risk to patient safety and symptom control. This quality improvement initiative aimed to reduce as needed prescribing errors from 30% to below 10% over 12 weeks at Galway University Hospital.</p><p><strong>Methods: </strong>A multidisciplinary 'Medication Safety Team' was formed, and a baseline audit using point prevalence surveys revealed a 30% as needed error rate, predominantly in dose and frequency domains. Semistructured interviews with non-consultant hospital doctors (NCHDs) identified barriers such as limited knowledge of resources, time pressure and inadequate education. Four Plan-Do-Study-Act cycles were implemented focusing on tools, education, resources and awareness.</p><p><strong>Results: </strong>As needed prescribing errors reduced from 30% to 8%. Stakeholder feedback indicated improved confidence and clarity in prescribing practices. Sustainability is addressed with the introduction of QR-code resources at the point of care and embedding of education at induction for NCHDs.</p><p><strong>Conclusions: </strong>This initiative demonstrates that structured, stakeholder-driven interventions can meaningfully improve prescribing accuracy. Systematic integration of education and resources supports long-term impact, offering a replicable model for enhancing medication safety in palliative and oncology care settings.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148454662","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":"Agitation and delirium in the last days of life: terminology and management-systematic review and narrative synthesis.","authors":"Rebecca A Hatton, Gilli Erez, Miriam J Johnson","doi":"10.1136/spcare-2025-005872","DOIUrl":"https://doi.org/10.1136/spcare-2025-005872","url":null,"abstract":"<p><strong>Background: </strong>Delirium and agitation are common and distressing in the last days of life. In specialist palliative care practice, descriptions such as 'terminal agitation' appear to be used more commonly than diagnostic terms. We aimed to explore the discourse surrounding these terms in this setting, their use and impact on management.</p><p><strong>Methods: </strong>In this systematic review, we searched electronic databases (Medline, Embase and PsycINFO) for papers focusing on delirium and agitation in the last days of life in palliative care settings. Three reviewers independently selected papers. The frequency of use of terms of interest was noted and surrounding text extracted. Text data were subjected to thematic synthesis.</p><p><strong>Results: </strong>29 studies were included and three themes identified in the context of the last days of life: (1) definitions and terminology (varied and inconsistent); (2) causes, diagnosis and recognition in the palliative care setting (eg, 'terminal' delirium viewed as irreversible); and (3) management and impact (terminology influences assessment and management, and the clinical and emotional impact on patients, family and staff).Review limitations include the restriction to English language papers and being unable to access some relevant full texts.</p><p><strong>Conclusion: </strong>We found that inconsistent terminology and ambiguous definitions surrounding agitation and delirium had an impact on care of people with delirium-related and non-delirium-related agitation in the last days of life. The synonymous use of agitation and delirium may compound under-recognition of hypoactive delirium, and the use of the prefix 'terminal' may preclude appropriate assessment of potentially reversible factors despite proximity of death.</p><p><strong>Prospero registration number: </strong>CRD42024582291.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148444238","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}