BMJ Supportive & Palliative Care最新文献_第9页

Online palliative care curriculum: contextual adaptation for Nigerian healthcare workers. 在线姑息关怀课程：根据尼日利亚医护人员的具体情况进行调整。

IF 2 4区医学

BMJ Supportive & Palliative Care Pub Date : 2024-12-19 DOI: 10.1136/spcare-2024-004944

Ann Ogbenna, Matthew Caputo, Babatunde Akodu, Denise Drane, Debora Ohanete, Ashti Doobay-Persaud, Adeboye Ogunseitan, Lyra Johnson, Lifang Hou, Alani Akanmu, Joshua M Hauser

{"title":"Online palliative care curriculum: contextual adaptation for Nigerian healthcare workers.","authors":"Ann Ogbenna, Matthew Caputo, Babatunde Akodu, Denise Drane, Debora Ohanete, Ashti Doobay-Persaud, Adeboye Ogunseitan, Lyra Johnson, Lifang Hou, Alani Akanmu, Joshua M Hauser","doi":"10.1136/spcare-2024-004944","DOIUrl":"10.1136/spcare-2024-004944","url":null,"abstract":"Objectives: This study reports on a yearlong sequence of three periodic, virtual trainings in primary palliative care for healthcare professionals across Nigeria. Our overall objective was to determine the impact of the full course on participants' attitudes, knowledge, skills and plans to implement and deliver palliative care in their local contexts.Methods: The curriculum for this programme was codeveloped by a team of USA and Nigerian palliative care professionals and delivered via three 3-day virtual sessions. Daily surveys, knowledge tests and end-of-training surveys were administered to participants electronically. Demographics, knowledge scores, confidence levels and self-reported achievement were analysed using descriptive statistics.Results: Pretraining and post-training knowledge scores showed significant improvement with average gains of 10.3 percentage points in training 1 (p<0.001) to 11.7 percentage points in training 2 (p=0.01). More than three-quarters of participants improved their test scores. Most participants (89.4%-100%) agreed that they had achieved the daily learning objectives across all trainings. Nearly 100% of participants reported that they felt more empowered as healthcare workers, more confident in their decision-making and more comfortable communicating with patients and other healthcare workers about palliative care.Conclusions: Healthcare workers in Nigeria demonstrated increased knowledge and confidence in providing palliative care as a result of an adapted virtual training programme. Further research is needed to (1) demonstrate feasibility for online trainings in similar resource-limited settings and (2) evaluate impact on patient-centred outcomes.","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"e2937-e2943"},"PeriodicalIF":2.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141426358","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}

引用次数: 0

Supportive and palliative care needs in advanced non-malignant liver disease: systematic review. 晚期非恶性肝病患者的支持性和姑息治疗需求：系统性综述。

IF 2 4区医学

BMJ Supportive & Palliative Care Pub Date : 2024-12-19 DOI: 10.1136/spcare-2024-004785

Ellen Haire, Mala Mann, Andrew Yeoman, Clea Atkinson, Mark Wright, Simon Noble

{"title":"Supportive and palliative care needs in advanced non-malignant liver disease: systematic review.","authors":"Ellen Haire, Mala Mann, Andrew Yeoman, Clea Atkinson, Mark Wright, Simon Noble","doi":"10.1136/spcare-2024-004785","DOIUrl":"10.1136/spcare-2024-004785","url":null,"abstract":"Advanced cirrhosis confers a significant symptom burden and has a 50% 2-year mortality rate in those with decompensated disease. There is increasing demand for supportive and palliative care (SAPC) for these patients, yet no consensus on the best model of delivery. It is necessary to identify the needs of such patients and their carers, and evaluate whether they are being met.A literature search was conducted using key words pertaining to adult patients with liver cirrhosis and their SAPC needs. Study quality was assessed and findings grouped by theme. 51 full texts were selected for inclusion, 8 qualitative studies, 33 quantitative studies, 7 systematic reviews, 2 mixed methods studies and 1 Delphi methods. Key findings were grouped into three main themes: SAPC needs, access to SAPC and models of care.Patients with cirrhosis have significant psychological and physical symptom burden with many unmet needs. These data failed to identify the best service model of care. The impact of specialist palliative care (SPC) referral was limited by small numbers and late referrals. With the majority of studies conducted in the USA, it is unclear how well these findings translate to other healthcare systems. Comparison between hepatology led services and SPC was limited by inconsistent outcome measures and prevented pooling of data sets. These data also had limited evaluation of patient-reported outcome measures. We propose the development of a core outcome set to ensure consistent and meaningful evaluation of the SAPC needs of patients with advanced non-malignant liver cirrhosis.","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"e2341-e2348"},"PeriodicalIF":2.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140896412","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}

引用次数: 0

Role of palliative care intervention in patients with vulvar cancer: a retrospective study. 姑息治疗干预在外阴癌患者中的作用：一项回顾性研究。

IF 2 4区医学

BMJ Supportive & Palliative Care Pub Date : 2024-12-19 DOI: 10.1136/spcare-2023-004734

Silvia Rosa Allende, Rosa Salcedo-Hernandez, Georgina Dominguez Ocadio, Adriana Peña-Nieves, David Isla-Ortiz, Emma L Verástegui, Paula Cabrera-Galeana

{"title":"Role of palliative care intervention in patients with vulvar cancer: a retrospective study.","authors":"Silvia Rosa Allende, Rosa Salcedo-Hernandez, Georgina Dominguez Ocadio, Adriana Peña-Nieves, David Isla-Ortiz, Emma L Verástegui, Paula Cabrera-Galeana","doi":"10.1136/spcare-2023-004734","DOIUrl":"10.1136/spcare-2023-004734","url":null,"abstract":"Objective: To describe the experience of a Mexican cancer centre in vulvar cancer and the opportunity to incorporate palliative care (PC) during treatment.Patients and methods: A retrospective study of clinical and sociodemographic characteristics of women with vulvar cancer referred to the PC service (PCS) between 2010 and 2021 is reported. Frequencies were estimated, as well as medians and IQRs, accordingly. Referral time and overall survival were estimated using the Kaplan-Meier method.Results: 125 women with vulvar cancer were seen between 2010 and 2021, but only 42% were seen at PCS, mostly polysymptomatic, after several visits to the emergency room. 89% of the patients seen at PCS died at home.Conclusions: Vulvar cancer is a rare type of cancer, while squamous cell carcinoma is the most frequent type. At the time of referral, almost half of the patients had severe pain, bleeding, malodor, infection and urinary incontinence. Most of these patients lived in poverty, were poorly educated and had multiple surgeries. PC may play an important role in the care of patients with advanced vulvar cancer, relieving the physical and psychological symptoms, avoiding unnecessary hospitalisation and favouring death at home without pain and other symptoms.","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"e2492-e2494"},"PeriodicalIF":2.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139058170","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}

引用次数: 0

End-of-life care costs and place of death across health and social care sectors. 卫生和社会保健部门的临终关怀费用和死亡地点。

IF 2 4区医学

BMJ Supportive & Palliative Care Pub Date : 2024-12-19 DOI: 10.1136/spcare-2023-004356

Jiunn Wang, Jenny Shand, Manuel Gomes

{"title":"End-of-life care costs and place of death across health and social care sectors.","authors":"Jiunn Wang, Jenny Shand, Manuel Gomes","doi":"10.1136/spcare-2023-004356","DOIUrl":"10.1136/spcare-2023-004356","url":null,"abstract":"Objectives: This study explores the relationship between end-of-life care costs and place of death across different health and social care sectors.Methods: We used a linked local government and health data of East London residents (n=4661) aged 50 or over, deceased between 2016 and 2020. Individuals who died in hospital were matched to those who died elsewhere according to a wide range of demographic, socioeconomic and health factors. We reported mean healthcare costs and 95% CIs by care sectors over the 12-month period before death. Subgroup analyses were conducted to investigate if the role of place of death differs according to long-term conditions and age.Results: We found that mean difference in total cost between hospital and non-hospital decedents was £4565 (95% CI £3132 to £6046). Hospital decedents were associated with higher hospital cost (£5196, £4499 to £5905), higher mental healthcare cost (£283, £78 to £892) and lower social care cost (-£838, -£1,209 to -£472), compared with individuals who died elsewhere. Subgroup analysis shows that the association between place of death and healthcare costs differs by age and long-term conditions, including cancer, mental health and cardiovascular diseases.Conclusion: This study suggests that trajectories of end-of-life healthcare costs vary by place of death in a differential way across health and social care sectors. High hospital burden for cancer patients may be alleviated by strengthening healthcare provision in less cost-intensive settings, such as community and social care.","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"e2737-e2745"},"PeriodicalIF":2.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10170759","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}

引用次数: 0

What is a good death? A critical discourse policy analysis. 什么是美好的死亡？批判性话语政策分析。

IF 2 4区医学

BMJ Supportive & Palliative Care Pub Date : 2024-12-19 DOI: 10.1136/bmjspcare-2019-002173

Erica Borgstrom

{"title":"What is a good death? A critical discourse policy analysis.","authors":"Erica Borgstrom","doi":"10.1136/bmjspcare-2019-002173","DOIUrl":"10.1136/bmjspcare-2019-002173","url":null,"abstract":"Objective: The concept of a good death is a motivating factor for end of life care policy; this article examines what English end-of-life care (EOLC) policy defines as a good death.Methods: Critical discourse analysis of policy documents and policy-promoting materials published between 2008 and 2016.Results: Policy explicitly defines a good death as having the following attributes: being treated as an individual, with dignity and respect; being without pain and other symptoms; being in familiar surroundings and being in the company of close family and/or friends. Critical discourse analysis of 54 documents found that rather than just being an outcome or event, descriptions of what makes a death good also include many processes. A more extended definition includes: the person receives holistic EOLC; the dying person is treated with dignity and respect; the death is not sudden and unexpected; people are prepared and have ideally done some advance care planning; people are aware that someone is dying and openly discuss this; on knowing the dying person's preferences, all involved are to work towards achieving these; the place of death is important; the person's family are involved and the needs of the bereaved are considered.Conclusion: This analysis indicates the complex nature of the current discourses around good death in EOLC policy, which often focuses on care rather than death. Policy should focus on outlining what quality end-of-life care looks like, rather than assume 'good death' is a suitable outcome statement.","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"e2546-e2553"},"PeriodicalIF":2.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38131403","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}

引用次数: 0

Cancer experience in metaphors: patients, carers, professionals, students - a scoping review. 隐喻中的癌症经历：患者、护理者、专业人士、学生--范围界定综述。

IF 2 4区医学

BMJ Supportive & Palliative Care Pub Date : 2024-12-19 DOI: 10.1136/spcare-2024-004927

Yufeng Liu, Elena Semino, Judith Rietjens, Sheila Payne

{"title":"Cancer experience in metaphors: patients, carers, professionals, students - a scoping review.","authors":"Yufeng Liu, Elena Semino, Judith Rietjens, Sheila Payne","doi":"10.1136/spcare-2024-004927","DOIUrl":"10.1136/spcare-2024-004927","url":null,"abstract":"The use of metaphors to talk about cancer experiences has attracted much research and debate, especially in the case of military metaphors. However, questions remain about what metaphors are used by different populations for different aspects of the cancer experience. This scoping review aims to answer them.We searched PubMed, PsycINFO, CINAHL, Scopus and Web of Science databases. Eligible sources include peer-reviewed scientific research published in English between 2013 and 2023, investigating patterns of metaphor use from adult populations (age ≥18) for cancer-related topics, such as cancer itself, the general experience of being ill, treatment, and people and relationships.Out of 1929 articles identified, 30 met the criteria, spanning over different populations. While most papers focused on cancer in general, some focused on specific cancer types, such as breast cancer. Both spontaneous and elicited data were collected in ten languages: mostly English (N=12), Swedish (N=3) and Arabic (N=3). The identified metaphors were subsumed under various broad categories, including particularly violence and journey. Other categories include education and non-human animate entity for the cancer itself, confinement and deprivation and cleanliness for the general experience of being ill with cancer, Poison and gardening for cancer treatment, and distance for patients' social relationships.It was found that metaphors help to identify how patients describe experiences of vulnerability and empowerment. To provide patient-centred care, clinicians and researchers should avoid blanket conclusions about helpful or unhelpful metaphors, but consider the ways in which different metaphors are used by different populations in different contexts.","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"e2366-e2376"},"PeriodicalIF":2.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11671970/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140920826","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}

引用次数: 0

Care training and family caregiver anxiety: prospective cohort study. 护理培训与家庭照顾者的焦虑：前瞻性队列研究。

IF 2 4区医学

BMJ Supportive & Palliative Care Pub Date : 2024-12-19 DOI: 10.1136/spcare-2024-004895

Uğur Uzun, Aykut Sarıtaş, Sevda Kökçe, Bilge Togay

引用次数: 0

Bereaved pupil support in schools: teacher training. 在学校为失去亲人的学生提供支持：教师培训。

IF 2 4区医学

BMJ Supportive & Palliative Care Pub Date : 2024-12-19 DOI: 10.1136/spcare-2024-004953

Jodie Crooks, Austin Orr, Christine Irvine, Charlotte Simpson-Greene, Briony Hudson, Joan McEwan

{"title":"Bereaved pupil support in schools: teacher training.","authors":"Jodie Crooks, Austin Orr, Christine Irvine, Charlotte Simpson-Greene, Briony Hudson, Joan McEwan","doi":"10.1136/spcare-2024-004953","DOIUrl":"10.1136/spcare-2024-004953","url":null,"abstract":"Objectives: Approximately, 1600 pupils are bereaved by a parent or sibling each year in Northern Ireland, equating to at least one child in every school class. Despite this, many children who are bereaved do not receive support from their school or college. Unsupported childhood bereavement is a risk factor for a number of social, psychological and educational difficulties. We aimed to carry out a service evaluation to explore the impact of a bereavement training course delivered to teaching staff in Northern Ireland.Methods: A mixed methods, participant-oriented evaluation was carried out. Data were collected via a survey distributed at baseline (prior to training) and 4-month follow-up, and semistructured interviews. All participants were staff within the school community who had participated in the training. Quantitative survey data were analysed via statistical analysis, and open-text survey responses and interview data were analysed via thematic analysis.Results: Quantitative survey responses indicated statistically significant improvements in teachers' confidence and knowledge on supporting bereaved children after the training. Six key themes were developed from interview data: the impact of the training on teaching staff's confidence, knowledge, on the schools' policy and practice, the impact on pupils, and whole school training.Conclusions: Given the significant role that teachers have in a child's formative years, it is essential that teaching staff are adequately trained and equipped to recognise and support both prebereavement and grief in pupils. A whole school bereavement training programme can be effective, as part of a wider culture and practice which values bereavement support in school.","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"e2930-e2936"},"PeriodicalIF":2.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11671948/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141320508","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}

引用次数: 0

Trends in utilisation of palliative care services in COVID-19 patients and their impact on hospital resources in the USA: insights from the national inpatient sample. 美国 COVID-19 患者使用姑息关怀服务的趋势及其对医院资源的影响：从全国住院病人样本中获得的启示。

IF 2 4区医学

BMJ Supportive & Palliative Care Pub Date : 2024-12-19 DOI: 10.1136/spcare-2023-004621

Ishan Garg, Karthik Gangu, Kenneth Matthew Zabel, Hina Shuja, Amir Humza Sohail, Adeel Nasrullah, Sachal Sohail, Sara A Combs, Abu Baker Sheikh

{"title":"Trends in utilisation of palliative care services in COVID-19 patients and their impact on hospital resources in the USA: insights from the national inpatient sample.","authors":"Ishan Garg, Karthik Gangu, Kenneth Matthew Zabel, Hina Shuja, Amir Humza Sohail, Adeel Nasrullah, Sachal Sohail, Sara A Combs, Abu Baker Sheikh","doi":"10.1136/spcare-2023-004621","DOIUrl":"10.1136/spcare-2023-004621","url":null,"abstract":"Objectives: Poor prognosis and lack of effective therapeutic options have made palliative care an integral part of the management of severe COVID-19. However, clinical studies on the role of palliative care in severe COVID-19 patients are lacking. The objective of our study was to evaluate the utility of palliative care in intubated COVID-19 patients and its impact on in-hospital outcomes.Methods: Rate of palliative care consult, patient-level variables (age, sex, race, income, insurance type), hospital-level variables (region, type, size) and in-hospital outcome variables (mortality, cost, disposition, complications) were recorded.Results: We retrospectively analysed 263 855 intubated COVID-19 patients using National Inpatient Sample database from 1 January 2020 to 31 December 2020. 65 325 (24.8%) patients received palliative care consult. Factors associated with an increased rate of palliative care consults included: female gender (p<0.001), older age (p<0.001), Caucasian race (p<0.001), high household income (p<0.001), Medicare insurance (p<0.001), admission to large-teaching hospitals (p<0.001), patients with underlying comorbidities, development of in-hospital complications and the need for intensive care procedures. Patients receiving palliative consults had shorter hospital length of stay (LOS) (p<0.001) and no difference in hospitalisation cost (p=0.15).Conclusions: Palliative care utilisation rate in intubated COVID-19 patients was reflective of disease severity and disparities in healthcare access. Palliative care may help reduce hospital LOS. Our findings also highlight importance of improving access to palliative care services and its integration into the multidisciplinary management of severe COVID-19 patients.","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"e2818-e2826"},"PeriodicalIF":2.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138884336","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}

引用次数: 0

Unmet needs: system-focused investigations. 未满足的需求：以系统为重点的调查。

IF 2 4区医学

BMJ Supportive & Palliative Care Pub Date : 2024-12-19 DOI: 10.1136/spcare-2023-004529

Nick Woodier, Helen Jones, Amanda Gregory, Matthew Wain

引用次数: 0