BMJ Supportive & Palliative Care最新文献

{"title":"Testimony and judicial decisions that disregard medical evidence regarding delirium can lead to significant suffering for defendants.","authors":"Hideki Onishi, Mayumi Ishida","doi":"10.1136/spcare-2026-006360","DOIUrl":"https://doi.org/10.1136/spcare-2026-006360","url":null,"abstract":"","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148418649","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":"Bereavement in paediatric oncology: programme evaluation.","authors":"Marta Giorgia Podda, Olga Nigro, Francesco Barretta, Elisabetta Schiavello, Paolo Grampa, Roberto Luksch, Monica Terenziani, Andrea Ferrari, Michela Casanova, Filippo Spreafico, Cristina Meazza, Veronica Biassoni, Stefano Chiaravalli, Luca Bergamaschi, Valeria Colombo, Nadia Puma, Giovanna Gattuso, Giovanna Sironi, Carlo Alfredo Clerici, Martina Lombardi, Giuseppe Forzini, Maura Massimino","doi":"10.1136/spcare-2026-006115","DOIUrl":"https://doi.org/10.1136/spcare-2026-006115","url":null,"abstract":"<p><strong>Objectives: </strong>The death of a child from cancer is a devastating event with long-term psychological and social consequences for parents. While bereavement support is increasingly recognised as a standard of care in paediatric oncology, structured programmes remain limited and heterogeneous.</p><p><strong>Methods: </strong>We conducted a cross-sectional survey of bereaved parents of paediatric oncology patients treated at our institution. A structured questionnaire, developed by a multidisciplinary team, explored experiences with bereavement initiatives and preferences for supportive activities.</p><p><strong>Results: </strong>Of 156 questionnaires distributed, 74 were returned (47% response rate). Mothers completed 51% of the surveys, fathers 35% and both parents jointly 14%. Although 70% of parents reported no perceived need for formal bereavement support, 56% found volunteer activities and 62% ongoing contact with healthcare staff to be helpful. Preferred support options included counselling with a psychologist (38%), commemorative ceremonies (34%), peer groups (30%) and self-help groups (26%). Parents bereaved for more than 3 years expressed greater interest in peer meetings and contact with clinicians. No significant gender differences were observed.</p><p><strong>Conclusions: </strong>Parental bereavement needs are frequently underestimated and may extend beyond traditional counselling. A proactive and diversified model-integrating psychological care, peer mentorship and structured contact with healthcare teams-should be systematically offered to improve adaptation and reduce isolation among bereaved parents.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148418654","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 the neonatal intensive care unit: qualitative study of parent experiences.","authors":"Caroline M Wells, Mary Cossich, Rebecca May, Caroline Phelan","doi":"10.1136/spcare-2026-006363","DOIUrl":"https://doi.org/10.1136/spcare-2026-006363","url":null,"abstract":"<p><strong>Objectives: </strong>To explore parents' experiences of palliative care in the neonatal intensive care unit (NICU) to inform and improve the delivery of family-centred palliative care.</p><p><strong>Methods: </strong>This exploratory prospective qualitative study employed a pragmatic approach. Parents of an infant who had died in the NICU at the Women's and Children's Hospital, Adelaide, and were bereaved for 6-12 months participated in semi-structured interviews. Interviews via videoconferencing or telephone call were audio-recorded and transcribed. Inductive thematic analysis was conducted to generate themes.</p><p><strong>Results: </strong>Six parents (four mothers and two fathers) participated in five interviews. Four themes characterised parents' experiences: continual balance of hope and fragility, assuming responsibility for decision-making, forming deep connection and being together but also separate. Parents maintained hope when faced with uncertainty and infant fragility. Involvement in decision-making was important regardless of the scope of options. Opportunities for deep infant connection and sharing the infant with family were highly valued.</p><p><strong>Conclusions: </strong>Novel findings include parents holding unwavering hope and placing higher importance on both decision-making and forming deep infant connection over providing infant care. These findings can be implemented in neonatal care through clinician communication, hospital procedures and appropriate physical spaces within the NICU. Further similar research is needed to explore a greater range of parent experiences.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148403613","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":"Subcutaneous antibiotics in palliative medicine: Retrospective chart review.","authors":"John Curtin, Keith Eldridge, Mary-Elodine D'silva, Paul Howard","doi":"10.1136/spcare-2025-005676","DOIUrl":"10.1136/spcare-2025-005676","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the use and safety of subcutaneous (SC) antibiotics for infection and symptom control in the palliative setting.</p><p><strong>Methods: </strong>We conducted a retrospective chart review of the use of SC antibiotics since it was introduced to our palliative care service 7 years ago. All records were examined to ascertain therapeutic aim and tolerability.</p><p><strong>Results: </strong>SC antibiotics were administered to 87 patients (79% had cancer) on 112 occasions (for infection, 105/112, or symptom control, 7/112) in the inpatient hospice or home. 85% wanted to avoid hospitalisation and requested active treatment in situ. Reasons for SC rather than intravenous administration included venous fragility and lack of an available cannulator. Piperacillin/tazobactam was the most common antibiotic given. Of the occasions when treating for infection, the respiratory tract was the most common site; half survived beyond 21 days. Of those used for symptoms, antibiotics appeared helpful in 3/7. Adverse events led to discontinuation in 7/112 (<i>Clostridium difficile</i>, generalised rash or SC site problems in 1, 1 and 5/112, respectively).</p><p><strong>Conclusions: </strong>SC antibiotics appear well tolerated in the palliative setting and could be a useful option in selected patients who want to avoid hospitalisation but receive active treatment in situ. Thus, we believe that further research is warranted.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"963-967"},"PeriodicalIF":2.5,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511503","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":"Turbulent illness trajectories in younger adults at the end of life.","authors":"Farzana Virani, Jane Brundish","doi":"10.1136/spcare-2025-006062","DOIUrl":"10.1136/spcare-2025-006062","url":null,"abstract":"","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"835-836"},"PeriodicalIF":2.5,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146149076","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":"Potentially inappropriate medications in outpatient palliative care: retrospective longitudinal study of exposure and costs.","authors":"Júlia Raso Ferreira De Oliveira, Bruno Aparecido Cazotti Ramalho, Bruno Vieira Felix Da Silva, Nátali Voltolini Marinho, Marília Silveira De Almeida Campos, Nereida Kilza Da Costa Lima, Leonardo Régis Leira Pereira, Maria Olivia Barboza Zanetti, Fabiana Rossi Varallo","doi":"10.1136/spcare-2026-006212","DOIUrl":"10.1136/spcare-2026-006212","url":null,"abstract":"<p><strong>Objective: </strong>To identify potentially inappropriate medications (PIMs) using deprescribing tools and to evaluate longitudinal changes in the number of PIMs and their associated costs between baseline (T₀) and follow-up (T_F) among patients receiving outpatient palliative care (PC).</p><p><strong>Methods: </strong>This retrospective longitudinal study reviewed electronic medical records of adult patients (≥18 years) who initiated follow-up in 2022 at an outpatient PC clinic of a Brazilian teaching hospital. Patients were monitored for up to 12 months. PIMs were identified using the STOPPFrail version 2 (v2) and OncPal criteria at baseline (T₀) and at the last outpatient consultation (T_F). Differences in the number of PIMs and their associated costs between T₀ and T_F were analysed using descriptive statistics and paired comparisons with the Wilcoxon signed-rank test.</p><p><strong>Results: </strong>Among 42 patients included in the longitudinal analysis, STOPPFrail v2 identified a small but statistically significant increase in PIM exposure over time (median 3 (IQR 3-4) at T₀ vs 4 (IQR 3-5) at T_F; p=0.041). Median PIM-related costs also increased, from US$0.06 (IQR 0.03-0.25) at T₀ to US$0.14 (IQR 0.04-0.26) at T_F; however, this difference was not statistically significant (p=0.165). In contrast, according to the OncPal criteria, PIM exposure remained stable (median 4 (IQR 3-5) at both T₀ and T_F; p=0.591). Likewise, PIM-related costs showed no significant change, increasing from US$0.05 (IQR 0.01-0.10) at T₀ to US$0.08 (IQR 0.04-0.14) at T_F (p=0.117).</p><p><strong>Conclusions: </strong>PIM exposure remained high over time in outpatient PC, with minimal variation depending on the assessment tool used and no significant reduction in medication-related costs. These findings highlight the complexity of prescribing in this population and the need for new deprescribing strategies.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"983-987"},"PeriodicalIF":2.5,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147940131","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":"Lost in Spanish translation? Ambiguity in EORTC instrument response categories.","authors":"Silvia Rosa Allende-Pérez, Adriana Peña-Nieves","doi":"10.1136/spcare-2026-006311","DOIUrl":"10.1136/spcare-2026-006311","url":null,"abstract":"","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"837-838"},"PeriodicalIF":2.5,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147873248","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":"Prehabilitation in older adults with cancer: scoping review of surgical outcomes.","authors":"Temesgen Birlie Asmare, Molla Amsalu Tadesse, Negesse Zurbachew Gobezie, Getachew Mekete Deress, Belete Muluadam Admassie, Biruk Demissie, Asnake Tadesse Abate, Begizew Yimenu Mekuriaw, Gezahagn Demsu Gedefaw, Habtie Bantider Wubet","doi":"10.1136/spcare-2026-006166","DOIUrl":"10.1136/spcare-2026-006166","url":null,"abstract":"<p><strong>Background: </strong>Adults aged ≥65 years constitute a growing proportion of surgical oncology patients and often experience frailty, multimorbidity and reduced physiological reserve, increasing their risk of postoperative complications and functional decline. Multimodal prehabilitation has emerged as a strategy to improve surgical resilience; however, evidence specific to older cancer patients' remains fragmented. This study aimed to map the existing evidence on prehabilitation for older adult patients undergoing cancer surgery, characterise intervention components, summarise functional and surgical outcomes and identify research gaps.</p><p><strong>Methods: </strong>Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines and a protocol registered with the Open Science Framework, searches were conducted in PubMed, Science Direct, the Cochrane Library and Google Scholar up to November 2025. Eligible studies included older adults undergoing cancer-related surgery who received any form of prehabilitation. Two reviewers independently screened studies and extracted data. Due to heterogeneity, findings were synthesised narratively.</p><p><strong>Results: </strong>Thirteen studies were included, comprised of six randomised controlled trials (RCT), three cohort studies, two quasi-experimental studies, one feasibility study and one RCT protocol. Most interventions were multimodal and delivered over 1 to 6 weeks. Improvements in preoperative functional capacity-particularly 6 min walk distance, aerobic endurance, muscle strength and respiratory function-were consistently reported. High-intensity or supervised programmes were reduced severity of postoperative complications and shorter hospital stay, while low-intensity or minimally supervised interventions showed limited postoperative benefit. Nutritional optimisation improved preoperative nutritional status and supported functional gains. Feasibility and acceptable adherence were reported even among frail and very elderly patients. Evidence gaps included variable intervention dosage, inconsistent adherence reporting, heterogeneous outcome measures and limited long-term follow-up.</p><p><strong>Conclusion: </strong>Multimodal prehabilitation is feasible, safe and beneficial for older adults undergoing cancer surgery, improving preoperative function and, when sufficiently intensive, reducing postoperative morbidity and hospital stay. Further research should standardise outcomes, define optimal intervention parameters and evaluate long-term recovery using geriatric-focused models.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"765-777"},"PeriodicalIF":2.5,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13422099/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833194","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":"Goals of care discussions in hospitalised patients: systematic review of randomised trials.","authors":"Carina DiDiodato, Chris Martin, Doug Austgarden, Jesse McLean, Giulio DiDiodato","doi":"10.1136/spcare-2025-005827","DOIUrl":"10.1136/spcare-2025-005827","url":null,"abstract":"<p><strong>Importance: </strong>Structured communication tools and decision aids are recommended to facilitate goals of care discussions (GOCDs) in hospitalised patients, but their impact remains unclear.</p><p><strong>Objective: </strong>To determine the effectiveness of communication tools and decision aids on GOCDs between healthcare providers, patients and substitute decision makers.</p><p><strong>Data sources: </strong>PubMed, Web of Science, CINAHL and ClinicalTrials.gov were searched from January 2015 to July 2025, with backward citation tracking to identify additional trials.</p><p><strong>Study selection: </strong>Randomised trials of communication tools or decision aids for hospitalised adults or substitute decision makers were eligible, regardless of primary outcomes.</p><p><strong>Data extraction and synthesis: </strong>Trial characteristics, primary outcomes and methodological quality were extracted and assessed using the Core Grading of Recommendations, Assessment, Development and Evaluation framework. Random-effects meta-analyses were conducted when appropriate.</p><p><strong>Results: </strong>22 trials were included. Communication tools increased GOCD documentation (OR 1.46, 95% CI 1.04 to 2.05). Effects on resuscitation preferences were inconsistent (OR 1.84, 95% CI 0.95 to 3.60). Mixed effects were observed for concordant care, psychosocial outcomes and healthcare utilisation. Evidence certainty was moderate for most outcomes; several small pilot trials were rated low due to bias, imprecision or heterogeneity. Interventions were most effective when combining structured patient-facing or clinician-facing prompts such as videos, guides or electronic health record alerts.</p><p><strong>Conclusions and relevance: </strong>Communication tools and decision aids improve GOCD documentation in hospitalised patients but show uncertain effects on other patient-centred outcomes or healthcare utilisation. Interprofessional training and system-level support may enhance impact, and future large trials should evaluate the effectiveness of facilitated GOCDs on important patient and health system outcomes.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"757-764"},"PeriodicalIF":2.5,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13422081/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145862091","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":"Distress among primary caregivers of patients with cancer: a cross-sectional study.","authors":"Ram Mohan Jha, Suman Supratik, Surendra Uranw, Rajesh Kumar, Soniya Dulal","doi":"10.1136/spcare-2025-005932","DOIUrl":"10.1136/spcare-2025-005932","url":null,"abstract":"<p><strong>Objectives: </strong>The primary objective of this study was to determine the prevalence, severity and associated factors of distress among primary caregivers of patients with cancer using the National Comprehensive Cancer Network (NCCN) distress thermometer (DT). The secondary objective was to examine the demographic characteristics and cancer types associated with clinically significant distress.</p><p><strong>Methods: </strong>A cross-sectional study was conducted at the oncology unit of B.P. Koirala Institute of Health Sciences, Dharan, Nepal, surveying 173 primary caregivers of patients with cancer between 22 September 2023 and 20 June 2024. An interview-based questionnaire, including the NCCN DT, assessed the prevalence and severity of distress. Distress levels were categorised as mild (DT 0-3), moderate (DT 4-6) and severe (DT 7-10); a score of ≥4 denoted clinically significant distress which encompasses moderate and severe distress. Secondary outcomes included domain-specific distress, sociodemographic and clinical factors.</p><p><strong>Results: </strong>Distress was reported by all caregivers, with 91.9% experiencing clinically significant (DT≥4) and 49.7% severe distress (DT≥7); median DT score was 6 (SD=1.755). Clinically significant distress was more common in caregivers aged ≥30 years, married individuals (p=0.03) and those with lower education levels (p=0.01). Caregivers of patients with gastrointestinal/hepatobiliary (p=0.029) and breast cancers reported higher distress. Statistically insignificant (p=0.208) higher distress was observed among caregivers of patients undergoing multimodal/palliative treatment. Domain-specific analysis revealed distress across physical, emotional, practical, social and spiritual domains.</p><p><strong>Conclusion: </strong>Distress among caregivers of patients with cancer in Nepal is significantly high. Routine screening and interventions reduce adverse outcomes and improve both caregiver well-being and patient care.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"902-909"},"PeriodicalIF":2.5,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13422032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145676473","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}