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New Sight of Palliative Medicine: Updates and Future Directions
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New Sight of Palliative Medicine: Updates and Future Directions

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Care Sciences & Services".

Deadline for manuscript submissions: closed (30 June 2023) | Viewed by 7071

Special Issue Editor

Dr. Linda Björkhem-Bergman

E-Mail Website
Guest Editor
Karolinska Institutet and Stockholms Sjukhem, Palliative Medicine, Stockholm, Sweden
Interests: palliative care; cancer; vitamin D; fatigue; antibiotics; clinical pharmacology; sex and gender
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The aim of palliative care is to relieve symptoms and improve quality of life in patients who are facing problems associated with life-threatening illness, regardless of diagnosis. This includes the correct assessment and treatment of symptoms such as pain, fatigue, nausea, anxiety, and breathlessness, but also meeting the psychosocial and spiritual needs of patients and their families. Palliative care uses a team approach including several different professions to support the patient in living as actively as possible until their death. In the recently proposed revision of the definition of palliative care, the need for evidence-based practice is emphasized.

This Special Issue aims to include up-to-date reviews and original articles on new treatment strategies for pain and other symptoms in palliative care patients, when to terminate or adjust treatments, how to improve symptom assessment, prognostication, and the identification of palliative care needs. In addition, articles on educational and research aspects of palliative medicine and care are also welcome in this Issue.

Dr. Linda Björkhem-Bergman
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • palliative care
  • end of life
  • cancer
  • pain
  • symptom management
  • clinical research

Published Papers (4 papers)

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Research

13 pages, 353 KiB  
Article
Dying during the COVID-19 Pandemic in Sweden: Relatives’ Experiences of End-of-Life Care (the CO-LIVE Study)
by Christel Hedman, Carl Johan Fürst, Birgit H. Rasmussen, Agnes van der Heide and Maria E. C. Schelin
Int. J. Environ. Res. Public Health 2022, 19(23), 16146; https://doi.org/10.3390/ijerph192316146 - 02 Dec 2022
Cited by 2 | Viewed by 1248
Abstract
Background: The COVID-19 pandemic has seen many deaths, but the majority were for causes other than COVID-19. However, end-of-life care in all settings has been affected by measures limiting the spread of the virus, for patients with and without COVID-19. The Swedish coronavirus [...] Read more.
Background: The COVID-19 pandemic has seen many deaths, but the majority were for causes other than COVID-19. However, end-of-life care in all settings has been affected by measures limiting the spread of the virus, for patients with and without COVID-19. The Swedish coronavirus strategy was different compared to many other countries, which might have affected end-of-life care. The aim was to describe the experiences of end-of-life care for bereaved relatives in Sweden during the “first wave” and to compare the experiences for deaths due to COVID-19 with the experiences for deaths for other reasons. Methods: A random sample of addresses for 2400 people who died during March–September 2020 was retrieved from the Swedish Person Address Registry. Relatives were contacted with a questionnaire regarding their experience of end-of-life care, with a focus on communication, participation, and trust. Results: In total, 587 relatives (25% response rate) answered the questionnaire (14% COVID-19-deaths, 65% non-COVID-19-deaths, 21% uncertain). In the COVID-19 group 28% of the relatives were allowed visits without restrictions compared to 60% in the non-COVID-19 group (p < 0.01). Only 28% of the relatives in the COVID-19 group reported that the person received “enough care from physicians”, significantly fewer than the non-COVID group (65%, p < 0.01). Conclusion: Relatives’ experience of end-of-life care for persons with COVID-19 was significantly worse than relatives of persons without COVID-19, but relatives for persons without COVID-19 were also negatively affected. Full article
(This article belongs to the Special Issue New Sight of Palliative Medicine: Updates and Future Directions)
17 pages, 869 KiB  
Article
Exploring Health Care Professionals’ Perceptions Regarding Shared Clinical Decision-Making in Both Acute and Palliative Cancer Care
by Helena Ullgren, Lena Sharp, Per Fransson and Karin Bergkvist
Int. J. Environ. Res. Public Health 2022, 19(23), 16134; https://doi.org/10.3390/ijerph192316134 - 02 Dec 2022
Viewed by 1962
Abstract
Developments in cancer care have resulted in improved survival and quality of life. Integration of acute and palliative cancer care is desirable, but not always achieved. Fragmented care is associated with sub-optimal communication and collaboration, resulting in unnecessary care transitions. The aim of [...] Read more.
Developments in cancer care have resulted in improved survival and quality of life. Integration of acute and palliative cancer care is desirable, but not always achieved. Fragmented care is associated with sub-optimal communication and collaboration, resulting in unnecessary care transitions. The aim of this study was to explore how health care professionals, from both acute and palliative care, perceive clinical decision-making when caring for patients undergoing active cancer treatment in parallel with specialized palliative care at home. Methods: Qualitative explorative design, using online focus-group interviews, based on patient-cases, among health care professionals (physicians and nurses) and Framework Analysis. Results: Six online focus-group interviews were performed. Few signs of systematic integration were found, risking fragmented care, and putting the patients in a vulnerable situation. Different aspects of uncertainty related to mandates and goals-of-care impacted clinical decision-making. Organizational factors appeared to hinder mutual clinical decision-making as well as the uncertainty related to responsibilities. These uncertainties seemed to be a barrier to timely end-of-life conversations and clinical decisions on optimal care, for example, the appropriateness of transfer to acute care. Conclusions: Lack of integration between acute and palliative care have negative consequences for patients (fragmented care), health care professionals (ethical stress), and the health care system (inadequate use of resources). Full article
(This article belongs to the Special Issue New Sight of Palliative Medicine: Updates and Future Directions)
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8 pages, 326 KiB  
Article
The Landscape of Outpatient Palliative Care in Germany: Results from a Retrospective Analysis of 14,792 Patients
by Sven H. Loosen, Sarah Krieg, Johannes Eschrich, Mark Luedde, Andreas Krieg, Manuela Schallenburger, Jacqueline Schwartz, Martin Neukirchen, Tom Luedde, Karel Kostev and Christoph Roderburg
Int. J. Environ. Res. Public Health 2022, 19(22), 14885; https://doi.org/10.3390/ijerph192214885 - 12 Nov 2022
Cited by 2 | Viewed by 1460
Abstract
Background: Palliative care comprises multiprofessional, integrated, person-centered healthcare services for patients and their families facing problems related to progressive or advanced diseases and limited life expectancy. Although non-oncology patients’ needs are similar to those of tumor patients, they are often underestimated. The purpose [...] Read more.
Background: Palliative care comprises multiprofessional, integrated, person-centered healthcare services for patients and their families facing problems related to progressive or advanced diseases and limited life expectancy. Although non-oncology patients’ needs are similar to those of tumor patients, they are often underestimated. The purpose of our study was to investigate the actual utilization of palliative care services in Germany, especially in the outpatient setting. Methods: Using the IQVIA Disease Analyzer database, a total of 14,792 outpatients from 805 primary care practices in Germany with documented palliative care and related diagnosis between 2018 and 2021 were analyzed. Proportions of different diagnoses among patients receiving outpatient palliative care were stratified by gender and different age groups. Results: The most common underlying diagnosis for outpatient palliative care was cancer (55%), followed by heart failure (16%) and dementia (8%), with age- and sex-specific differences found in the proportion of diagnoses for utilization. While the relative proportions of cancers decreased with age (87% in the 18- to 50-year-old age group versus 37% in the 80-plus age group), the proportion of palliative care related to heart failure increased in the older population (2% in the 18- to 50-year-old age group versus 25% in the 80-plus age group). Conclusions: This study provides an overview of the situation of outpatient palliative care in Germany and shows age- and gender-specific trends regarding the underlying medical diagnoses. Based on these data, palliative care should be adapted to current demographic developments. Full article
(This article belongs to the Special Issue New Sight of Palliative Medicine: Updates and Future Directions)
8 pages, 300 KiB  
Communication
The Challenge: Equal Availability to Palliative Care According to Individual Need Regardless of Age, Diagnosis, Geographical Location, and Care Level
by Bertil Axelsson
Int. J. Environ. Res. Public Health 2022, 19(7), 4229; https://doi.org/10.3390/ijerph19074229 - 01 Apr 2022
Cited by 6 | Viewed by 1785
Abstract
The European Council, the World Health Organization, the International Association of Hospice and Palliative Care, and various other national guidelines emphasize equal provision of palliative care. To fulfill this vision, all involved need to be aware of the existing situation even in western [...] Read more.
The European Council, the World Health Organization, the International Association of Hospice and Palliative Care, and various other national guidelines emphasize equal provision of palliative care. To fulfill this vision, all involved need to be aware of the existing situation even in western European countries. Data from the European Atlas of Palliative Care and the Swedish Registry of Palliative Care are used to illustrate the present inequalities. The data illustrate the unequal provision of palliative care relating to level of care, place of residence, diagnoses, and age. The challenge of providing equal palliative care remains, even in Western European countries, in spite of all positive developments. Different approaches that may contribute to successful implementation of equal palliative care are discussed. The challenge is still there and will require some effort to resolve. Full article
(This article belongs to the Special Issue New Sight of Palliative Medicine: Updates and Future Directions)
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