BMJ Supportive & Palliative Care最新文献

{"title":"Opioid stewardship and reversible causes of hyperactive delirium.","authors":"Kathryn Bullen, Pippa Lovell, Tim Morgan","doi":"10.1136/spcare-2024-004996","DOIUrl":"10.1136/spcare-2024-004996","url":null,"abstract":"","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"58"},"PeriodicalIF":2.0,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141449732","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":"Spiritual assessment in palliative care: multicentre study.","authors":"Jheelam Biswas, Wai Wai Mroy, Nashid Islam, Nahid Afsar, Mastura Kashmeeri, Palash Chandra Banik","doi":"10.1136/spcare-2024-004997","DOIUrl":"10.1136/spcare-2024-004997","url":null,"abstract":"<p><strong>Objectives: </strong>This study aims to provide an in-depth exploration of everyday spiritual concerns of patients with advanced cancer seeking palliative care in Bangladesh, and assess their spiritual well-being (SWB).</p><p><strong>Methods: </strong>This study was conducted among 163 patients with advanced cancer from three tertiary care hospitals in Bangladesh. It was divided into two parts: a quantitative segment that assessed the SWB of the participants using the EORTC QLQ SWB32, and a qualitative segment that explored their spiritual history.</p><p><strong>Result: </strong>Spirituality was commonly interpreted and understood synonymously with religion by all participants, and their sense of life's meaning centred on their families and friends. The lack of support from religious organisations led to feelings of isolation and disconnection from spiritual communities. Highest scores in SWB were observed in Relationships with God and Someone/Something Greater Scales. The lowest score was observed for Existential fulfilment. Patients expressed a desire for their palliative care team to address their spiritual concerns, regardless of their training in this area.</p><p><strong>Conclusion: </strong>Spirituality is a deeply personal aspect of the human experience. Understanding and respecting these beliefs can empower palliative care professionals to deliver culturally sensitive care to their patients, irrespective of their level of training.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"130-133"},"PeriodicalIF":2.0,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142280259","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":"Osteonecrosis: photobiomodulation and photodynamic therapy - a systematic review.","authors":"Rodrigo Antico Benetti, Gabriela Biihrer Belei, Rafael Pecoraro-Andrade, Priscila Benitz Rios de Oliveira, Tânia Barbosa Dos Santos, Rodrigo Labat Marcos, Adriana Lino-Dos-Santos-Franco, Maria Fernanda Setúbal Destro Rodrigues, Linamara Rizzo Battistella, Rebeca Boltes Cecatto","doi":"10.1136/spcare-2024-004874","DOIUrl":"10.1136/spcare-2024-004874","url":null,"abstract":"<p><p>A wide range of adjuvant treatments have been studied to treat osteonecrosis. Photobiomodulation and photodynamic therapy are commonly used. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic review was conducted to evaluate photobiomodulation and photodynamic therapy for the treatment of osteonecrosis related to the use of medications or related to ionising radiation. After searching PubMed, EMBASE, LILACS and Livivo Database, 2 systematic reviews, 4 prospective comparative studies, 10 comparative studies and 23 retrospective case reports were selected. Photobiomodulation-positive outcomes were observed in pain management and healing linked to osteonecrosis of the jaw due to antiresorptive drugs. Limited studies exist on photodynamic therapy and osteoradionecrosis. No adverse effects were reported. Despite the low quality of evidence, findings suggest that photobiomodulation may serve as an adjuvant therapy for osteoporotic patients, particularly those ineligible for surgery. Similar benefits were noted for oncological patients, but controlled trials evaluating cancer-related outcomes are lacking, emphasising the need for further research.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"36-45"},"PeriodicalIF":2.0,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142458002","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":"The Surprise Question and clinician-predicted prognosis: systematic review and meta-analysis.","authors":"Ankit Gupta, Ruth Burgess, Michael Drozd, John Gierula, Klaus Witte, Sam Straw","doi":"10.1136/spcare-2024-004879","DOIUrl":"10.1136/spcare-2024-004879","url":null,"abstract":"<p><strong>Background: </strong>The Surprise Question, 'Would you be surprised if this person died within the next year?' is a simple tool that can be used by clinicians to identify people within the last year of life. This review aimed to determine the accuracy of this assessment, across different healthcare settings, specialties, follow-up periods and respondents.</p><p><strong>Methods: </strong>Searches were conducted of Medline, Embase, AMED, PubMed and the Cochrane Central Register of Controlled Trials, from inception until 01 January 2024. Studies were included if they reported original data on the ability of the Surprise Question to predict survival. For each study (including subgroups), sensitivity, specificity, positive and negative predictive values and accuracy were determined.</p><p><strong>Results: </strong>Our dataset comprised 56 distinct cohorts, including 68 829 patients. In a pooled analysis, the sensitivity of the Surprise Question was 0.69 ((0.64 to 0.74) I²=97.2%), specificity 0.69 ((0.63 to 0.74) I²=99.7%), positive predictive value 0.40 ((0.35 to 0.45) I²=99.4%), negative predictive value 0.89 ((0.87 to 0.91) I²=99.7%) and accuracy 0.71 ((0.68 to 0.75) I²=99.3%). The prompt performed best in populations with high event rates, shorter timeframes and when posed to more experienced respondents.</p><p><strong>Conclusions: </strong>The Surprise Question demonstrated modest accuracy with considerable heterogeneity across the population to which it was applied and to whom it was posed. Prospective studies should test whether the prompt can facilitate timely access to palliative care services, as originally envisioned.</p><p><strong>Prospero registration number: </strong>CRD32022298236.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"12-35"},"PeriodicalIF":2.0,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11874281/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141455338","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":"Symptom burden among men treated for castration-resistant prostate cancer: a longitudinal study.","authors":"Ulrika Rönningås, Per Fransson, Maja Holm, Lars Beckman, Agneta Wennman-Larsen","doi":"10.1136/spcare-2024-005054","DOIUrl":"10.1136/spcare-2024-005054","url":null,"abstract":"<p><strong>Objectives: </strong>Despite rapid expansion of treatments for metastatic castration-resistant prostate cancer (mCRPC) and the importance of symptom management for enhancing quality of life, few studies have focused on men's experiences of symptom burden over time when receiving one or more lines of treatment in a real-world situation in this phase. The aim was to investigate changes in the multidimensional symptom burden during the first year of life-prolonging treatment of mCRPC.</p><p><strong>Methods: </strong>Longitudinal data from the first year of life-prolonging treatment for 134 men with mCRPC were used. Symptoms were measured with the multidimensional Memorial Symptom Assessment Scale. Data are presented with descriptive statistics, and changes in symptom burden (physical, psychological and number of symptoms) were analysed using linear mixed modelling.</p><p><strong>Results: </strong>On average, the men had approximately 10 (0-31) symptoms at inclusion and 12 (0-33) at the last time point. Lack of energy and sweats were the two most reported symptoms at every time point. Sexual problems had the highest scores in all dimensions (frequency, severity, distress). Regarding pain, the distress score was higher than the scores for frequency and severity at t1-t4. Physical symptom burden and the number of symptoms changed significantly over time, towards a higher symptom burden. Psychological symptom burden did not change significantly over time.</p><p><strong>Conclusion: </strong>The different dimensions of physical symptoms in men treated for mCRPC need to be more acknowledged. Early integration of a palliative care approach could possibly help in enhancing symptom management and quality of life for these men.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"87-95"},"PeriodicalIF":2.0,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11874351/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141911692","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":"Anaemia, blood transfusions and survival in high-grade endometrial cancer: retrospective study.","authors":"Hannah H Foggin, Pascal Lambert, Lung Fung Tsang, Mark W Nachtigal, Nourah Ibrahim, Christine Robinson, Lesley F Roberts, Alon D Altman","doi":"10.1136/spcare-2024-005296","DOIUrl":"10.1136/spcare-2024-005296","url":null,"abstract":"<p><strong>Objective: </strong>To determine if anaemia and blood transfusions in the perioperative, chemotherapy and radiation treatment periods are associated with overall survival (OS) and recurrence-free survival (RFS) in high-grade endometrial cancer.</p><p><strong>Methods: </strong>This retrospective cohort study examined patients at a single centre treated for high-grade endometrial cancer (2010-2023). This included International Federation of Gynecology and Obstetrics (FIGO) grade 3 endometrioid, serous, carcinosarcoma, mixed, clear cell, mucinous, dedifferentiated and undifferentiated histology. Primary outcomes were OS and RFS. Predictor variables were nadir haemoglobin and transfusion status. Multivariable Cox regression models for OS and RFS analysed the associations of treatment period-specific anaemia, overall transfusion status and confounder variables.</p><p><strong>Results: </strong>Two hundred twenty-seven cases were included; 64-86% of patients were anaemic during any treatment, with 0-10% having severe anaemia. Twenty-two patients (9.7%) had at least one blood transfusion. Transfusion in the perioperative and chemotherapy periods was associated with poorer survival, significant only for shorter RFS in the chemotherapy cohort (HR 3.22, p=0.04). There was no association between anaemia and survival.</p><p><strong>Conclusion: </strong>This study is among the first to assess anaemia in treated patients with high-grade endometrial cancer and the associations of anaemia and blood transfusion with survival outcomes. Further larger studies are needed to strengthen evidence and guide transfusion policies.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spiritual care in palliative medicine: interactive, virtual workshop for specialists.","authors":"David White, Deborah Barham, Judith McEniery, Martha Mherekumombe, Douglas Bridge","doi":"10.1136/spcare-2024-004889","DOIUrl":"10.1136/spcare-2024-004889","url":null,"abstract":"<p><strong>Background: </strong>Spiritual pain and distress are commonly unrecognised among patients receiving palliative care, yet engaging with a person's spirituality can allow healing to occur even amid suffering. Palliative care clinicians lack training in assessing and managing spiritual distress among patients.</p><p><strong>Objectives: </strong>Development of a virtually delivered spirituality workshop to improve clinicians' understanding of their own spirituality and confidence in addressing the spiritual dimension of patients' experience.</p><p><strong>Method: </strong>32 palliative care clinicians across Australia and New Zealand attended four 1.5-hour sessions across consecutive weeks, with additional pre-session and post-session written and audiovisual content. Participants completed a pre-post evaluation survey, rating their confidence in knowledge and skills relating to the provision of spiritual care.</p><p><strong>Results: </strong>All participants completed at least three of the four workshop sessions, and 19 responded to the pre-post evaluation survey. Confidence ratings across all skills significantly improved following the workshop. Most participants reported improved confidence in taking a spiritual history, assessing patients for spiritual issues and managing patients experiencing spiritual pain. All reported that they would recommend the workshop to a colleague, and most (11/19) felt virtual delivery of the workshop was appropriate for the content and activities.</p><p><strong>Conclusions: </strong>Spirituality training can be safely and effectively delivered through a virtual workshop for palliative care clinicians. The training was highly valued and deepened participants' understanding of their own spirituality. Further exploration of how virtual and face-to-face learning can be combined may identify a flexible and engaging experience for learners.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871408","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":"Core elements of serious illness conversations: an integrative systematic review.","authors":"Rebecca Baxter, Susanna Pusa, Sofia Andersson, Erik K Fromme, Joanna Paladino, Anna Sandgren","doi":"10.1136/spcare-2023-004163","DOIUrl":"10.1136/spcare-2023-004163","url":null,"abstract":"<p><strong>Background: </strong>Ariadne Labs' Serious Illness Care Program (SICP), inclusive of the Serious Illness Conversation Guide (SICG), has been adapted for use in a variety of settings and among diverse population groups. Explicating the core elements of serious illness conversations could support the inclusion or exclusion of certain components in future iterations of the programme and the guide.</p><p><strong>Aim: </strong>This integrative systematic review aimed to identify and describe core elements of serious illness conversations in relation to the SICP and/or SICG.</p><p><strong>Design: </strong>Literature published between 1 January 2014 and 20 March 2023 was searched in MEDLINE, PsycINFO, CINAHL and PubMed. All articles were evaluated using the Joanna Briggs Institute Critical Appraisal Guidelines. Data were analysed with thematic synthesis.</p><p><strong>Results: </strong>A total of 64 articles met the inclusion criteria. Three themes were revealed: (1) serious illness conversations serve different functions that are reflected in how they are conveyed; (2) serious illness conversations endeavour to discover what matters to patients and (3) serious illness conversations seek to align what patients want in their life and care.</p><p><strong>Conclusions: </strong>Core elements of serious illness conversations included explicating the intention, framing, expectations and directions for the conversation. This encompassed discussing current and possible trajectories with a view towards uncovering matters of importance to the patient as a person. Preferences and priorities could be used to inform future preparation and recommendations. Serious illness conversation elements could be adapted and altered depending on the intended purpose of the conversation.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"e2268-e2279"},"PeriodicalIF":2.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11671901/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9692933","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":"Advanced breast, cervical and prostate cancer- Patient needs: systematic review.","authors":"Yusley Katerine Pabón-Salazar, César José Vela-Prieto, Gladys Amanda Mera-Urbano, Herney Andrés García-Perdomo, Jhon Edwin Polanco-Pasaje","doi":"10.1136/spcare-2023-004186","DOIUrl":"10.1136/spcare-2023-004186","url":null,"abstract":"<p><strong>Background: </strong>There are high rates registered globally of breast cancer, cervical and prostate. People going through have needs that cause an impact in their life's quality, especially in the final stages of the illness.</p><p><strong>Goal: </strong>To characterise the most evaluated and afflicted physical, emotional, roll, cognitive, social and spiritual needs of patients in the final stages of breast, cervical and prostate cancer.</p><p><strong>Interventions/methods: </strong>A thorough systematic search of databases such as Medline (Ovid) and Embase, from databases' creation throughout 31 December 2021. Quantitative studies were included to evaluate, from the adoption of tools, the dimensions or needs of people going under three types of cancer on final stages.</p><p><strong>Results: </strong>Twelve studies were included. More common symptoms such as nausea/vomiting and pain were the most evaluated with 83%. Fifty-eight per cent of papers studied the emotional function of people with breast and prostate cancer. Other 42% included roll, cognitive and social appreciations. Sexual, cognitive and physical, in that line, were the most affected. The most common questionnaires used to measure oncological patients on final stages were those from European Organisation for Research and Treatment of Cancer on its C-30, BR-23, C-15 PAL and CR-25 versions.</p><p><strong>Conclusions: </strong>On breast and prostate cancer, the most affected aspect was the sexual dysfunction, while for cervical cancer, the physical function was the most altered one. Spiritual dimension was not included in any of the evaluated literature.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"e2280-e2292"},"PeriodicalIF":2.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9920292","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":"Identification of factors associated with aggressive end-of-life antitumour treatment: retrospective study of 1282 patients with cancer.","authors":"Philippe Debourdeau, Mohamed Belkacémi, Guillaume Economos, Eric Assénat, Werner Hilgers, Julie Coussirou, Sfaya Kouidri Uzan, Léa Vasquez, Antoine Debourdeau, Jean Pierre Daures, Sebastien Salas","doi":"10.1136/bmjspcare-2020-002635","DOIUrl":"10.1136/bmjspcare-2020-002635","url":null,"abstract":"<p><strong>Objective: </strong>Antitumour treatment in the last 2 weeks of death (ATT-W2) and a new regimen of ATT within 30 days of death (NATT-M1) are considered as aggressive end-of-life (EOL) care. We aimed to assess factors associated with inappropriate use of antitumour treatment (ATT) at EOL.</p><p><strong>Methods: </strong>Data of patients with cancer who died in 2013, 2015, 2017 and 2019 in a single for-profit cancer centre were retrospectively analysed. ATT was divided into chemotherapy (CT), oral targeted therapy (OTT), hormonotherapy and immunotherapy (IMT).</p><p><strong>Results: </strong>A total of 1282 patients were included. NATT-M1 was given to 197 (15.37%) patients, and 167 (13.03%) had an ATT-W2. Patients with a performance status of <2 and treated with CT had more both ATT- W2 (OR=2.45, 95% CI 1.65 to 3.65, and OR=10.29, 95% CI 4.70 to 22.6, respectively) and NATT-M1 (OR=2.01, 95% CI 1.40 to 2.90, and OR=8.41, 95% CI 4.46 to 15.86). Predictive factors of a higher rate of ATT-W2 were treatment with OTT (OR=19.08, 95% CI 7.12 to 51.07), follow-up by a medical oncologist (OR=1.49, 95% CI 1.03 to 2.17), miscellaneous cancer (OR=3.50, 95% CI 1.13 to 10.85) and length of hospital stay before death of <13 days (OR=1.92, 95% CI 1.32 to 2.79). Urinary tract and male genital cancers received less ATT-W2 (OR=0.38, 95% CI 0.16 to 0.89, and OR=0.40, 95% CI 0.16 to 0.99) and patients treated by IMT or with age <69 years more NATT-M1 (OR=19.21, 95% CI 7.55 to 48.8, and OR=1.69, 95% CI 1.20 to 2.37). Patients followed up by the palliative care team (PCT) had fewer ATT-W2 and NATT-M1 (OR=0.49, 95% CI 0.35 to 0.71, and OR=0.42, 95% CI 0.30 to 0.58).</p><p><strong>Conclusions: </strong>Most recent ATT and access to a PCT follow-up are the two most important potentially modifiable factors associated with aggressive EOL in patients with cancer. Early integrated palliative oncology care could help to decrease futile ATT at EOL.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"e2580-e2587"},"PeriodicalIF":2.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38571680","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}