BMJ Supportive & Palliative Care最新文献

{"title":"Sedation from analgesics: patient preference survey.","authors":"Joseph Burdon, Samuel Fingas, Rachel Parry, Constantina Pitsillides, Paul Taylor","doi":"10.1136/spcare-2023-004759","DOIUrl":"10.1136/spcare-2023-004759","url":null,"abstract":"<p><strong>Background: </strong>The propensity for certain analgesics to cause sedation is well documented, yet physician-patient dialogue does not routinely include pre-emptive exploration of preferences regarding this side effect.</p><p><strong>Objectives: </strong>To investigate the extent to which palliative patients would accept sedation as a side effect of analgesia and to identify factors affecting decision-making.</p><p><strong>Methods: </strong>Patients (n=76) known to a specialist palliative care services were given hypothetical scenarios regarding pain and asked about the acceptability of varying levels of sedation occurring as an analgesic side effect. Demographic data, including diagnosis, performance status and experience of pain and sedation, were collated for evaluation of the influence of these factors on patient opinion.</p><p><strong>Results: </strong>Most patients (89.47%) would be quite or very likely to accept mild sedation. A significant minority (40.79%) would accept high levels of sedation. There is no significant association with the acceptability of sedation according to demographics. Almost half (40.79%) reported that their responses may change if the prognosis were extended, typically for less sedation with a longer prognosis.</p><p><strong>Conclusions: </strong>Increasing levels of sedation are less acceptable, although there is significant variation in views. Palliative care patients are likely to indicate preferences regarding their acceptability of sedation. Palliative physicians must explore preferences on an individualised basis.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"262-265"},"PeriodicalIF":2.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139930039","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 deaths in Switzerland for UK residents: diagnoses and their implications for palliative medicine and assisted dying legislation.","authors":"Colin Brewer, Marie-Claire Hopwood, Graham Winyard","doi":"10.1136/spcare-2023-004719","DOIUrl":"10.1136/spcare-2023-004719","url":null,"abstract":"<p><strong>Objective: </strong>UK campaigners for a law permitting assisted dying (AD) restricted to those with a maximum life expectancy of 6 months claim that this would largely remove the need for UK residents to seek AD in Switzerland. We wanted to discover whether this prediction was correct.</p><p><strong>Methods: </strong>We analysed the diagnoses of UK residents who had such deaths including, for the first time, data from all three of the main Swiss providers of AD to non-residents, comparing them with figures from Oregon, which has a 6-month restriction.</p><p><strong>Results: </strong>Only 22.7% of UK residents had cancer (Oregon 72.5%) while nearly half (49.6% and over half including dementias) had neurological conditions (Oregon 11.2%) and many with prognoses of much more than 6 months.</p><p><strong>Conclusion: </strong>Overall, less than half would meet a 6-month prognosis criterion. This has significant implications for patients, palliative care clinicians and legislators.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"259-261"},"PeriodicalIF":2.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139939632","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":"Implantable cardioverter defibrillator deactivation and end-of-life: British Heart Rhythm Society practical consensus guideline.","authors":"Honey Thomas, Jane Wallace, Paul Foley, Miriam J Johnson","doi":"10.1136/spcare-2024-005233","DOIUrl":"10.1136/spcare-2024-005233","url":null,"abstract":"<p><p>Implantable cardioverter defibrillators (ICDs) are implanted in increasing numbers of patients with the aim of treating ventricular arrhythmias in high-risk patients and reducing their risk of dying. Individuals are also living longer with these devices. As a result, a greater number of patients with an ICD will deteriorate either with worsening cardiac failure, another non-cardiac condition or general frailty and will have a limited prognosis. Frequently they will be cared for by non-cardiac teams who may be less familiar with ICDs. Therefore, to ensure the person receives high-quality end-of-life care, they should have the opportunity to consider and discuss the option to deactivate the shock function of their ICD. If the ICD shock therapy is not discontinued, there is an increased risk that as a person reaches the last days of life, the ICD may deliver painful shocks which are distressing. There is also a risk that the device may delay the person's natural death which the person would not have chosen if they had been given the opportunity to discuss discontinuation. The British Heart Rhythm Society has developed a practical document to support all healthcare professionals who are caring for patients who have an ICD. This includes descriptions of different device types, ethical and legal aspects, timing and nature of ICD discussions and practical advice regarding how the devices may be deactivated. It aims to promote awareness and timely discussion between professionals and patients and to encourage best practice.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"184-190"},"PeriodicalIF":2.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142892083","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":"Acute Mental Health Unit referrals to a Hospital Specialist and Supportive Palliative Care Liaison Team.","authors":"Despoina-Elvira Karakitsiou, Sarah Gilmour, Conn Haughey, Niall Corrigan","doi":"10.1136/spcare-2024-005359","DOIUrl":"https://doi.org/10.1136/spcare-2024-005359","url":null,"abstract":"","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514497","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":"Herb-antitumour drug interaction risks: retrospective integrative oncology study.","authors":"Noah Samuels, Shir Shapira, Eran Ben-Arye","doi":"10.1136/spcare-2024-005098","DOIUrl":"10.1136/spcare-2024-005098","url":null,"abstract":"<p><strong>Objectives: </strong>The use of herbal medicine is widespread among oncology patients, with potentially negative interactions with anticancer drugs. This study identified herbal products being used among a cohort of oncology patients, assessing the risk for an herb-drug interaction.</p><p><strong>Methods: </strong>Herbal medicine use was examined among 42 oncology patients, identifying potential herb-drug interactions using four online sites. The risk for an interaction was scored using the Working Group on Pharmacotherapy and Drug Information of the Royal Dutch Association for the Advancement of Pharmacy (KNMP).</p><p><strong>Results: </strong>Most patients (62%) reported herbal medicine use, with 70 products identified; 8 herbs and 13 herbal formulas with unidentified components; and 24 anticancer drugs. Herbal medicine use was more prevalent among female patients (p=0.038), with only nine potential herb-drug interactions identified on at least one site. A maximal KNMP Score of 1 (ie, incomplete published case report) was found with only one interaction.</p><p><strong>Conclusions: </strong>The risk for interactions between herbal products and anticancer drugs is difficult to predict, with online search engines providing limited and inconsistent information. Clinical implications of herb-antitumor drug interactions need to be better understood, enabling patients and their oncology healthcare providers to make informed decisions regarding their care.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"245-248"},"PeriodicalIF":2.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141975130","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":"Better end-of-life care in surgical patients: Veterans Affairs Bereaved Family Survey - a qualitative analysis.","authors":"Christina Shabet, C Ann Vitous, Emily Evans, Sydney Edwards, Sarah E Bradley, Ashley Duby, Pasithorn A Suwanabol","doi":"10.1136/spcare-2024-004873","DOIUrl":"10.1136/spcare-2024-004873","url":null,"abstract":"<p><strong>Background: </strong>End-of-life care among surgical patients is largely understudied and far fewer studies examine such care from the family perspective. To identify potential opportunities for improvement, we explored responses of family members of veterans who died following surgery using the Veterans Affairs (VAs) Bereaved Family Survey (BFS).</p><p><strong>Methods: </strong>We examined data from the BFS open-text responses to explore insights into surgical patient's end-of-life care. Data were analysed iteratively using qualitative content analysis and clustered into domains based on content.</p><p><strong>Results: </strong>We evaluated 936 open-text responses to the BFS for all decedents who underwent any high-risk surgical procedure across 124 VA medical centres from 2010 to 2019. This report focused on the following domains: patient needs, family/caregiver needs, clinical teams/personnel characteristics and facility/organisational characteristics. Key themes within patient needs included concerns about pain management, preservation of patient dignity and spiritual support. Within the family/caregiver domain, key themes included enhanced communication needs, assistance with logistics and displays of gratitude for the patient's military service. The clinical team's domain included the key themes of professionalism concerns and understaffing. Finally, key themes identified within the facility/organisation domain were the need for more robust support services and discomfort with the physical space.</p><p><strong>Conclusions: </strong>Narratives from the family perspective provide valuable insight into end-of-life care among surgical patients. Our data demonstrate the critical need for preserving patient dignity and improved communication, which emphasises family involvement and shared decision-making. In addition, hospital systems can optimise nurse-to-patient ratios and intentionally design physical spaces to help improve end-of-life care for surgical patients.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"270-280"},"PeriodicalIF":2.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11867864/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142692716","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":"Rethinking palliative care inside a cancer centre.","authors":"Silvia Tanzi, Francesca Sassi, Cinzia Cavalli, Cristina Autelitano, Sara Alquati, Simona Sacchi, Elisabetta Bertocchi, Loredana Buonaccorso","doi":"10.1136/spcare-2024-005105","DOIUrl":"10.1136/spcare-2024-005105","url":null,"abstract":"","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"180-181"},"PeriodicalIF":2.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11874283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142124822","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":"Physical activity, fatigue, kinesiophobia and quality of life: comparative study of prostate cancer survivors with healthy controls.","authors":"Emine Cihan, Ilknur Karalezli, Cansu Sahbaz Pirincci, Omer Faruk Cavdar, Yunus Emre Goger, Aydan Aytar, Giray Karalezli","doi":"10.1136/spcare-2024-005239","DOIUrl":"10.1136/spcare-2024-005239","url":null,"abstract":"<p><strong>Objectives: </strong>To determine the distribution of prostate cancer (PCa) patients between physical activity and kinesiophobia, fatigue and quality of life, and to what extent PCa persists compared to healthy males.</p><p><strong>Methods: </strong>Total of 118 males participated in the study. These participants were allocated into two groups: PCa group (n:59) and control group (n:59). The International Physical Activity Questionnaire Short Form was used to assess physical activity levels, Functional Assessment of Chronic Illness Therapy-Fatigue Questionnaire (FACIT-F) was used for measuring fatigue, kinesiophobia was evaluated with the Kinesiophobia Causes Scale, and Functional Assessment of Cancer Treatment-Prostate Version questionnaire (FACT-P) was used to assess quality of life.</p><p><strong>Results: </strong>PCa had significantly lower scores in moderate activity (p=0.005) and total physical activity (p=0.010) compared with the control. Scores for kinesiophobia in both biological (p=0.045) and psychological subparameters (p=0.001), as well as the total kinesiophobia score (p=0.003), were higher in PCa. The FACIT-F (p<0.001) and total FACT-P (p<0.001) score were significantly lower in PCa than the control.</p><p><strong>Conclusion: </strong>Kinesiophobia in PCa is significantly influenced by both biological and psychological factors. Kinesiophobia negatively affects patients' functional status and overall quality of life. Their well-being is shaped not only by their physical and emotional conditions but also by the quality of their family relationships. This multifaceted impact highlights the complex interaction between physical activity, functional abilities, emotional health and social dynamics in PCa. In addition to routine treatments for PCa patients, the development and implementation of a comprehensive rehabilitation programme may lead to significant improvements in their quality of life.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"213-220"},"PeriodicalIF":2.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142909109","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":"Preoperative frailty in oesophageal cancer: postoperative outcomes and overall survival - meta-analysis and systematic review.","authors":"Bingyan Zhao, Min Wu, Leilei Bao, Si-Ai Zhang, Chunmei Zhang","doi":"10.1136/spcare-2024-005073","DOIUrl":"10.1136/spcare-2024-005073","url":null,"abstract":"<p><strong>Purpose: </strong>To assess the prevalence of preoperative frailty in patients with oesophageal cancer and its impact on postoperative outcomes and overall survival.</p><p><strong>Methods: </strong>A comprehensive computer-based search of the CNKI, Wanfang, VIP, CBM, PubMed, Embase, Cochrane Library, Web of Science and CINAHL databases was conducted for articles related to preoperative frailty in patients with oesophageal cancer. The search was carried out from the time of the construction of the database to 20 April 2024. Data related to the prevalence of preoperative frailty in patients with oesophageal cancer and their postoperative outcomes and overall survival were extracted.</p><p><strong>Results: </strong>A total of 13 studies were included, including 12 cohort studies and 1 cross-sectional study involving 53 485 patients. Meta-analysis showed that the prevalence of preoperative frailty in patients with oesophageal cancer was 29.6% (95% CI 24.5% to 34.8%). Preoperative frailty increased the risk of postoperative mortality (HR 1.80, 95% CI 1.51 to 2.14, p<0.001), complications (HR 1.32, 95% CI 1.16 to 1.49, p<0.001) and 30-day readmission (HR 1.24, 95% CI 1.18 to 1.31, p<0.001), in patients with oesophageal cancer, but had no significant effect on overall survival (HR 1.28, 95% CI 0.97 to 1.68, p=0.08).</p><p><strong>Conclusions: </strong>The prevalence of preoperative frailty is high in patients with oesophageal cancer, and preoperative frailty is strongly associated with increased adverse outcomes after surgery. Healthcare providers should identify preoperative frailty in patients with oesophageal cancer at an early stage and develop targeted intervention strategies to reduce the incidence of postoperative adverse outcomes.</p><p><strong>Prospero registration number: </strong>CRD42024541051.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"149-157"},"PeriodicalIF":2.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142944666","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 in advanced systemic rheumatic diseases: an integrated approach.","authors":"Adam Amlani, Kirsten Wentlandt, Alexandra P Saltman","doi":"10.1136/spcare-2024-005048","DOIUrl":"10.1136/spcare-2024-005048","url":null,"abstract":"<p><p>Despite rapid advances in the field of rheumatology, many patients with rheumatoid arthritis suffer from chronic and debilitating systemic disease, with a high symptom burden and limited life expectancy. In this paper, we demonstrate an approach to managing a patient with rheumatoid arthritis with life-limiting illness for the palliative care physician. In particular, we focus on the systemic nature of rheumatoid arthritis and nuances around medication management towards the end of life. It is our hope that this paper can serve as a guide for the palliative care clinician to decrease end-of-life morbidity from rheumatic disease and rheumatic medications.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"191-194"},"PeriodicalIF":2.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142749880","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}