Search Results (149)

Pruritus is a common and distressing symptom in palliative care, often resulting from complex underlying conditions such as cancer, chronic kidney disease, and liver failure. Conventional pharmacological treatments frequently offer limited relief and may produce undesirable side effects in this medically fragile population. Despite the high prevalence and impact of pruritus in palliative care, there is a lack of consolidated evidence on integrative non-pharmacological approaches. This narrative review explores the potential role of essential oils as a complementary approach to managing pruritus in palliative settings. A review of the literature was conducted to examine the mechanisms of action, safety considerations, and clinical outcomes associated with the use of essential oils, with a particular focus on their anti-inflammatory, neuromodulatory, and soothing properties. Evidence suggests that essential oils may provide symptom relief and enhance quality of life when integrated into multidisciplinary care; however, small sample sizes, heterogeneity, and methodological weaknesses often limit the findings of these studies. Furthermore, the long-term safety and antigenotoxic potential of essential oils remain underexplored. This narrative review concludes that while essential oils appear promising as adjunct therapies for pruritus, further rigorous research, particularly well-designed clinical trials and toxicological assessments, is needed to support their safe and effective use in palliative care. Full article

Background and Objectives: Acute respiratory failure (ARF) represents an increasingly relevant clinical challenge in older subjects due to population aging and the high prevalence of cardiopulmonary comorbidities. Non-invasive ventilation (NIV), developed as continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP), has become a first-line treatment in various forms of ARF, including acute cardiogenic pulmonary oedema (ACPE) and acute exacerbations of COPD (AECOPD), offering several clinical advantages. In this context, the limited evidence on the efficacy of NIV in older patients leaves considerable uncertainty as to whether it constitutes a valid therapeutic option or represents medical futility in these patients. Materials and Methods: This narrative review explores the use of NIV and its outcomes in four key clinical scenarios in the elderly: ARF due to ACPE, AECOPD, community-acquired pneumonia (CAP), and palliative/end-of-life care. Results: Strong evidence supports NIV use with improved outcomes in ACPE and AECOPD, even in older populations. Conversely, data on its use in pneumonia are inconclusive, with potential harm if applied inappropriately. In palliative care, NIV can help relieve symptoms, but if not used appropriately, it may extend suffering. Conclusions: Age alone does not appear to be a sufficient factor to determine whether or not to use NIV; it becomes relevant only when considered in conjunction with the purpose of its use and the patient’s clinical history and condition. Data remain limited and often conflicting, particularly when investigating the elderly population and patients with a “do not intubate” (DNI) order. There is a need for additional research on these patients, focusing on long-term outcomes and quality of life. Full article

Among adult advanced cancer patients already accessing palliative care, symptoms can contribute to unplanned acute care utilizations, which can disrupt care and worsen patient outcomes. We examined how a novel symptom complexity algorithm, using patients’ ratings of the nine Edmonton Symptom Assessment System—Revised (ESAS-r) symptoms to assign “low”, “medium”, or “high” complexity, predicts acute care utilizations. This retrospective observational cohort study used electronic medical record data from the Durham Regional Cancer Centre in Ontario, Canada, comprising adult advanced cancer patients who completed at least one ESAS-r report between 1 January 2022 and 31 December 2023. We applied chi-squared tests, Kruskal–Wallis H tests, and multivariable binary logistic regressions to evaluate factors associated with higher odds of acute care utilization within seven and fourteen days of patients’ first ESAS-r reports after their first palliative care interaction. Of 559 included patients, 125 (22.4%) exhibited low complexity, 180 (32.2%) exhibited medium complexity, and 254 (45.4%) exhibited high complexity on their first ESAS-r report. In total, 61 (10.9%) patients accessed acute care within seven days and 108 (19.3%) patients accessed acute care within fourteen days of their first ESAS-r report. Controlling for sociodemographic and clinical covariates, compared to low-complexity patients, high-complexity patients had higher odds of acute care utilization within seven days (aOR = 2.83, 95% CI: 1.18–6.77), but not within fourteen days (aOR = 1.78, 95% CI: 0.97–3.28). Accordingly, as a clinical decision-making tool, ESAS-r symptom complexity may help identify patients who would benefit from more intensive follow-up and potentially reduce unnecessary acute care utilizations. Full article

Pediatric palliative care (PPC) is an evolving field that focuses on supporting children with life-limiting conditions, where the quality of care is vital. This study is a retrospective observational investigation that examines the experiences of caregivers to inform health and social service planning and enhance PPC quality. Methods: Data of pediatric patients aged 3 months to 18 years admitted to a PPC inpatient unit over two years were retrospectively reviewed. Sociodemographic characteristics of primary caregivers, including age, gender, number of siblings, education, income, occupation, and marital status, were recorded. Caregiver burden and burnout were assessed using the Zarit Burden Interview and the Maslach Burnout Inventory, respectively. Associations between caregiver characteristics and these measures were analyzed. Results: A total of 118 patients and caregivers were evaluated; 54.2% of patients were male. The most common diagnoses were neurological diseases (44.9%), followed by syndromic–genetic disorders (28.8%). About 34% of patients required more than three medical devices. Most caregivers were female (91.5%), mainly mothers and 53% had only primary education. No significant differences in care burden or burnout were found based on caregiver gender, marital status, or child’s diagnosis. However, the use of nasogastric tubes and multiple medical devices was associated with higher burnout. Lower income was significantly linked to higher care burden, while longer caregiving duration correlated with both increased burden and burnout. A moderate positive correlation was found between Zarit and Maslach scores. Conclusions: The complexity of PPC patients’ care increases caregiver burden and burnout. Expanding specialized PPC services is crucial to support caregivers and sustain home-based care. Full article

Background/Objectives: The prevalence of people with incurable and progressive diseases in primary health care is high. Family doctors and nurses must be active agents in the early identification of palliative needs and the implementation of palliative approaches in cases of low to intermediate complexity. While there is a need for early referral of more complex palliative care (PC) cases to specialized teams, primary health care (PHC) professionals lack the confidence or skill to describe their role. This study sought to explore and describe (a) the practices of PHC professionals regarding their PC provision; (b) the barriers regarding access and referral of patients to specialized PC services; and (c) the strategies used or recommended to mitigate difficulties in accessing and referring to specialized PC. Methods: A descriptive qualitative study was carried out, using five focus groups conducted with nursing and medical staff at three local health units in the central region of Portugal. Semi-structured interviews were conducted, and then recorded, transcribed, and analyzed through a thematic analysis approach. The reporting of this research follows the COREQ checklist. Results: In total, 34 PHC professionals participated in this study. The majority of participants were women (n = 26) and family doctors (n = 24). Their mean age was 43.8 ± 11.9 (range: 29 to 65 years). The findings were organized into three core themes: (1) the contours of palliative action developed by PHC teams; (2) barriers to access and safe transition between PHC and specialized PC; and (3) ways to mitigate difficulties in accessing and referring to specialized PC. Conclusions: Our findings highlight the fundamental role of PHC professionals in providing primary PC, and in identifying PC needs and referring patients to PC early on, while exposing the systemic and interpersonal challenges that hinder these processes. To overcome these challenges, it is essential to invest in the development of integrated care models that promote practical, low-bureaucratic referral processes and capture the human resources necessary for the adequate follow-up of users. Full article

Background: The PATHFINDER-CHD Registry is a prospective, multicenter, non-interventional registry across tertiary care centers in Germany. The aim is to analyze real-world data on adults with congenital heart defects (ACHD) or hereditary connective tissue disorders who have manifest heart failure (HF), a history of HF, or are at significant risk of developing HF. This analysis investigates the prevalence and clinical impact of overweight and obesity in this unique population. Methods: As of 1st February, 2025, a total of 1490 ACHD had been enrolled. The mean age was 39.4 ± 12.4 years, and 47.9% were female. Patients were categorized according to Perloff’s functional class and the Munich Heart Failure Classification for Congenital Heart Disease (MUC-HF-Class). Results: The most common congenital heart disease (CHD) in this cohort was Tetralogy of Fallot, transposition of the great arteries, and congenital aortic valve disease. Marfan syndrome was the most common hereditary connective tissue disease. Of the patients, 46.1% were classified as overweight (32.8%) or obese (13.3%), while 4.8% were underweight. The highest prevalence of overweight (47.1%) was observed among patients who had undergone palliative surgery, whereas untreated patients showed the highest proportion of normal weight (57.2%). Cyanotic patients were predominantly of normal weight. Patients with univentricular circulation exhibited significantly lower rates of overweight and obesity (35%; p = 0.001). Overweight and obesity were statistically significantly associated with arterial hypertension, diabetes mellitus, and sleep apnea (all p < 0.001). High BMI was linked to increased use of HF-specific medications, including SGLT2 inhibitors (p = 0.040), diuretics (p = 0.014), and angiotensin receptor blockers (p = 0.005). Conclusions: The data highlight the clinical relevance of overweight and obesity in ACHD with HF, emphasizing the need for individualized prevention and treatment strategies. The registry serves as a critical foundation for the optimization of long-term care in this population. Full article

Background/Objectives: Early integration of palliative care (PC) improves outcomes for patients with life-limiting diseases (LLDs). This study evaluated the effectiveness of the Palliative Care and Rapid Emergency Screening (P-CaRES) tool—originally developed for emergency settings—in identifying unmet PC needs among patients admitted to internal medicine wards. Methods: In this retrospective study, the P-CaRES tool was applied to medical records of patients with LLDs. Demographic and clinical data were extracted from charts. Logistic regression identified predictors of PC receipt; survival was analyzed using Kaplan–Meier estimates and log-rank tests. Results: Among 2509 patients screened, 631 (23.9%) had at least one LLD. Of these, 451 (71.5%) were identified as having PC needs. However, only 132 (20.9%) received PC services—126 with documented need and 6 without. Advanced cancer (OR = 6.46, p < 0.001), a positive response to the surprise question (OR = 4.88, p = 0.008), and frequent hospitalizations (OR = 2.24, p < 0.001) predicted PC receipt. Median survival declined with increasing disease burden (10 vs. 372 days for patients with ≥3 vs. 1 LLD), unmet PC needs (85 vs. 1383 days), and a “yes” response to the surprise question (79 vs. 1598 days) (all p < 0.001). Conclusions: The P-CaRES tool effectively identified PC needs in patients with LLDs, including those with cancer. Clinical indicators such as frequent hospital admissions, a positive response to the surprise question, and multimorbidity predicted both the need for PC and shorter survival. Nonetheless, substantial gaps existed between identified needs and PC delivery—especially for non-cancer patients. Structured screening and timely referrals may bridge this gap and improve care for seriously ill individuals. Full article

Background: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease that leads to severe functional decline and death, imposing significant physical, emotional, and ethical burdens on patients and healthcare providers. With no curative treatment, ALS care depends on the early and sustained integration of palliative care to address complex and evolving needs. Nurses play a pivotal role in this process, yet their lived experiences remain underexplored. This study aimed to synthesize qualitative evidence on nurses’ experiences in ALS care, with a focus on emotional, ethical, and palliative dimensions. Methods: A meta-synthesis of qualitative studies was conducted using Sandelowski and Barroso’s four-step method. A systematic search across five databases identified eight studies exploring nurses’ experiences with ALS care. Thematic synthesis was applied to extract overarching patterns. Results: Three core themes emerged: (1) Relational Dimension: From challenges to empathy and Trust and mistrust—emphasizing communication barriers and the value of relational trust; (2) Care Dimension: Competence, Palliative care needs, and Rewarding complexity—highlighting the emotional demands of care, the need for timely palliative integration, and the professional meaning derived from ALS care; (3) Ethical Dimension: Medical interventionism and Patient-centered values—exploring dilemmas around life-sustaining treatments, patient autonomy, and end-of-life decisions. Conclusion: Nurses in ALS care face complex emotional and ethical challenges that call for strong institutional support and palliative training. Enhancing palliative care integration from diagnosis, alongside targeted education and psychological support, is crucial to improving care quality and sustaining the well-being of both patients and nurses. Full article

Objective: This study aimed to explore the unmet palliative care needs among young and middle-aged (YMA) Chinese patients with advanced cancer. Methods: We used the principle of maximum difference. A total of 16 YMA patients with advanced cancer from cancer hospital were recruited. Semi-structured, in-depth, and face-to-face interviews were conducted from 28 August 2023 to 23 October 2023. The recorded audio of each interview was typed into Word software with each personal code. The interview transcripts were coded using the method of inductive content analysis. Results: Four themes and 14 sub-themes were identified in participants’ descriptions of care needs: (1) symptom management needs: need for pain relief, need for anti-emetics, and need for aid in managing fatigue; (2) psychological support needs: help reducing fear of pain, help achieving a better death, and help with parents’ negative reactions; (3) social support needs: taking care of children, emotional support from family members, consultation and emotional support from other cancer patients, and company and guidance of healthcare personnel; (4) information needs: better understanding of disease trajectory and future care needs, better access to palliative care information, and more participation in medical decision-making. Conclusions: According to the results of this study, the unmet palliative care needs of YMA patients with advanced cancer are diverse, but they have not been fully recognized and met. Therefore, medical staff should develop effective management strategies and explore patients’ needs in an all-around way. Future studies will further develop the scale of unmet needs for palliative care to accurately identify needs and improve patients’ quality of life. Full article

Genetic testing is rapidly becoming standard practice in the care of critically ill newborns within NICUs. Numerous studies have demonstrated the utility of genetic testing, including changes in clinical care, improved diagnostic certainty, and cost savings, related to a reduced length of hospital stay. Changes in clinical management reported in previous studies also included redirection to comfort or end-of-life care. However, it has been difficult to study the influence of genetic testing in the redirection of care decisions within the NICU because of the complexity of the medical decision-making process. Redirection of care decisions are deeply personal for each individual family and often must be made in the setting of clinical instability and diagnostic and prognostic uncertainty. A recent study exploring the impact of genetic testing in redirection of care decisions by surveying palliative care providers suggested genetic testing plays a minor role in decisions to redirect to end-of-life care or in the implementation of DNR/DNI orders. However, factors such inadequate treatment options were found to be important in redirection of care decisions, implying the need for further investigation to clarify the role of genetic testing. Future studies will need to focus on how genetic information affects healthcare provider recommendations regarding palliative care and how families use this information to make end-of-life care decisions. Full article

Background/Objectives: Caregivers play a central role in supporting patients in palliative care but often face significant challenges to their physical, emotional, social, and financial well-being. Family doctors are uniquely positioned to help alleviate this burden through early identification, targeted interventions, and coordinated care. This scoping review analyzed existing literature on caregiver burden in palliative care to explore the specific role of family doctors in identifying, preventing, and reducing this burden. Methods: A scoping review was carried out following the methodology set out by the Joanna Briggs Institute. The following databases were searched: PubMed, the Cochrane Library, Scopus, the National Institute for Health and Care Excellence, and the British Medical Journal. The search strategy was based on the use of the following keywords and Medical Subject Headings: “caregiver burden” AND “palliative care” AND (“family physician” OR “general practitioners” OR “primary care physicians”). The search was performed on 10 March 2024, with a time horizon between 2013 and 2023. Results: From 259 identified articles, 8 met the inclusion criteria. Key themes included factors influencing caregiver burden, strategies used by family doctors to mitigate it, and challenges in providing support. Family doctors play a crucial role in offering psychological support, educating caregivers on disease progression, and coordinating multidisciplinary care. Conclusions: The active involvement of family doctors significantly reduces caregiver burden by addressing emotional distress, improving communication, and ensuring care coordination. Key interventions include early distress screening, tailored education, and access to multidisciplinary networks. Strengthening their integration in palliative care teams is essential for optimizing patient and caregiver outcomes. Full article

Cancer is one of the leading causes of global morbidity and mortality and one of the most challenging global health conditions, impacting the lives of millions every year. The Eastern Mediterranean Region (EMR) is not on track to achieve the sustainable development goal (SDG) target 3.4 which aims to reduce premature mortality (i.e., before the age of 70 years) for non-communicable diseases (NCDs), including cancer, by a third by year 2030; instead, it is projected that the EMR will experience the least progress towards achieving this target. This review therefore highlights the importance of context-specific cancer management, with a focus on nutritional, lifestyle and supportive care, in the EMR. A comprehensive literature search was conducted using electronic databases, including PubMed, Scopus and Google Scholar, as well as the Academy of Nutrition and Dietetics and key oncology institutes. Nutritional and lifestyle management is a fundamental aspect of cancer care which should be context-specific, achievable and individualized to minimize symptoms and side effects, while maximizing benefits and better addressing the needs of the patients with cancer. A multidisciplinary approach that integrates medical, nutritional, psychological and palliative care is essential to address this growing issue effectively. Cancer care and management requires coordinated efforts from policymakers, healthcare providers and communities to implement evidence-based interventions and promote cancer awareness. Full article

Objective: The aim of physiotherapy interventions for palliative care patients is to relieve pain, promote active movement and thereby improve quality of life and wellbeing. Physiotherapy is an important adjunct to medical and pharmacological treatments. The aim of this study is to identify the specific challenges, self-perceptions and therapeutic approaches of physiotherapists working in palliative care. Methods: An online survey of German physiotherapists was conducted using a 22-question questionnaire. The quantitative data were analysed descriptively (frequencies and percentages), and the qualitative responses were reviewed and grouped thematically. Results: A total of 450 valid responses were evaluated, of which 349 respondents worked in palliative care. The most common treatments for palliative care patients are respiratory therapy (85.8%), general physiotherapy measures (82.4%) and massages (72.9%). The analysis of the free-text responses identified five topics representing the work and challenges of physiotherapists in palliative care. A key issue identified is that the standard 20 min therapy session covered by health insurance is often insufficient to meet the individual needs and daily conditions of each patient. Physiotherapists with no previous experience of palliative care patients often require additional training and often feel inadequately prepared to work effectively with this patient population without appropriate further training. Many physiotherapists believe that they are involved in treatment too late. In addition, other healthcare professionals may not fully recognise the scope of their expertise. Conclusions: Physiotherapy in palliative care requires sensitivity, adaptability and sufficient time. Further training and early involvement are necessary to better address patients’ needs and harness the therapeutic potential of physiotherapists. Full article

Background: Stroke has high mortality. Challenges in providing end-of-life care include uncertainty among healthcare professionals about when to start care. While generic tools and guidelines exist, which outline components of quality end-of life care, they may not fully address stroke’s unpredictable trajectories, complicating care planning. Objective: To enhance understanding of end-of-life care post-stroke. Methods: We undertook an explanatory sequential mixed methods approach, including a cross-sectional survey and semi-structured interviews. All 286 United Kingdom (UK) National Health Service (NHS) hospitals providing inpatient stroke care were approached for participation in an on-line cross-sectional survey. The survey of healthcare professionals from UK stroke units was used to map current stroke end-of-life care and models of care. Fourteen staff who completed the survey and agreed to a future interview were purposively selected. The semi-structured interviews with healthcare professionals involved in delivering end-of-life care post-stroke were conducted and interpreted using the Theoretical Domains Framework. We aimed to enhance our understanding of the experiences, expectations, challenges and barriers in providing end-of-life care post-stroke, including effective clinical decision-making. Results: Across 108 responding survey sites, 317 responses were received. Results showed a lack of structured tools and approaches, an absence of stroke-specific guidance and variable delivery of end-of-life care post-stroke. Thirteen staff (nurses, occupational therapists, medical stroke consultants, and a speech and language therapist) agreed to be interviewed. The data provided a fuller understanding of the context within which end-of-life care post-stroke is delivered. The varied challenges faced include: uncertain prognosis, complex decision-making process, varying skill levels, staffing levels, the hospital environment, emotional strain on both families and staff, inequitable access to specialist palliative care, and difficulties associated with different models of care (stroke service structures and cultural context). Conclusions: Provision of end-of-life care post-stroke is complex, challenging, uncertain, and inconsistent. There is limited evidence or guidance to support healthcare professionals. There is a need for implementation support, which includes education, to better enable quality and more consistent end-of-life care post-stroke. Further research is required to assess interventions that can support end-of-life care post-stroke to aid clinicians in providing quality palliative care for stroke patients. Full article

Spinal cord injury (SCI) is a life-altering condition that leads to severe neurological deficits and significantly impacts patients’ quality of life. Despite advancements in medical care, current treatment options remain largely palliative, with limited ability to promote meaningful functional recovery. Induced pluripotent stem cells (iPSCs) have emerged as a promising avenue for regenerative medicine, offering patient-specific, cell-based therapeutic potential for SCI repair. This review provides a comprehensive overview of recent advancements in iPSC-based approaches for SCI, detailing the strategies used to generate neural cell types, including neural progenitor cells, oligodendrocytes, astrocytes, and microglia, and their roles in promoting neuroprotection and regeneration. Additionally, we examine key preclinical and clinical studies, highlighting functional recovery assessments and discussing both standardized and debated evaluation metrics. Furthermore, we address critical challenges related to safety, tumorigenicity, immune response, survival, integration, and overcoming the inhibitory microenvironment of the injured spinal cord. We also explore emerging approaches in biomaterial scaffolds, gene editing, and rehabilitation strategies that may enhance the clinical applicability of iPSC-based therapies. By addressing these challenges and refining translational strategies, iPSC-based interventions hold significant potential to revolutionize SCI treatment and improve outcomes for affected individuals. Full article