Search Results (1,989)

Background/Objectives: Patients with incurable cancers enrolled in early phase clinical trials often face uncertainty about prognosis, yet advance care planning (ACP) is frequently delayed. The objective of this study was to assess the documentation of ACP discussions among patients enrolled in early phase oncology trials. Methods: We conducted a retrospective review of electronic medical records for all adults enrolled in early phase clinical trials at a single Australian institution (2012–2021). Data included time from metastatic diagnosis to first ACP discussion, clinical and sociodemographic factors, triggers for discussion, and clinician specialty. Results: Among 170 patients (58% male; median age 65 years), ACP documentation was identified in 109 (64%). ACP was most often initiated within the final year of life (73.8%), with a median interval of 23.5 months from metastatic diagnosis to first documentation. Common triggers were disease progression (39.6%) and hospital admission (37.8%). Discussions were typically led by the treating oncologist or trials specialist (43%) and palliative care physician (37.8%). The most frequently documented topic was the limitations of invasive care such as intubation (60%). Conclusions: ACP documentation was present in two-thirds of patients enrolled in early phase clinical trials, typically late in the disease trajectory. Integrating structured, earlier ACP discussions into oncology pathways would improve alignment of care with patient goals and enhance end-of-life care. Full article

Background/Objectives: Falls are a leading cause of hospitalization, injury, and healthcare spending among older adults. Surveillance data on local falls, especially for those associated with Alzheimer’s disease and related dementias (ADRD), are limited. We conducted a surveillance analysis to describe fall-related hospitalizations and their associations with ADRD in Los Angeles County (LAC). Methods: We analyzed countywide hospital discharge data for LAC residents aged 50+ from 2016–2022 (n = 3,520,927) to assess differences in fall-related hospitalizations by ADRD status and demographic characteristics. We used multivariable logistic regression to identify predictors of fall status and multinomial regression to examine associations between ADRD status and discharge disposition. Results: Of all hospitalizations, 6.8% were fall-related. Individuals hospitalized for falls had longer stays, higher charges, and were more frequently female, older, and White. Fall frequency peaks consistently occurred during winter months, with higher seasonal variation among those without ADRD. After adjustment, ADRD diagnosis was associated with increased odds of fall-related hospitalization (AOR = 1.14) and non-routine discharge, including transfer to a short-term hospital (AOR = 1.35), skilled nursing or other care facilities (AOR = 1.88), and home health care (AOR = 1.23). Conclusions: This study provides one of the most comprehensive local assessments of fall-related hospitalization among older adults in the United States. The findings highlight the increased risk and care complexity among patients with ADRD. As results are descriptive and reflect cross-sectional surveillance, temporality and causality cannot be inferred. Nevertheless, the findings underscore the need for better surveillance and integrated fall prevention, discharge planning, and post-hospital support strategies tailored to individuals with ADRD. Full article

Background: The intersection between oncology and intensive care has shifted from predominantly end-of-life care to a therapeutic bridge that can preserve anticancer trajectories in carefully selected patients. Yet, criteria separating benefit from futility remain fragmented. Objective: This paper seeks to map contemporary evidence (2015–2025) on outcomes after Intensive Care Unit (ICU) admission in adults with cancer and to identify clinical constellations in which ICU-level care still changes prognosis. Methods: PRISMA-ScR scoping review (PCC framework). PubMed search (2015–2025), dual screening, standardized extraction; narrative/thematic synthesis across six clusters (hematologic, solid tumors, sepsis/non-COVID-19 infection, COVID-19/viral pneumonia, novel/targeted-therapy toxicities, end-of-life/aggressive ICU) were used. No meta-analysis given heterogeneity. Results: Seventy-three studies (>170,000 ICU admissions) were included, mostly cohort designs across 27 countries. ICU mortality ranged 8–72% (weighted mean ≈ 41%); hospital ≈ 38%; 90-day ≈ 46%; 1-year ≈ 62%. About one third of ICU survivors resumed systemic therapy. Benefit concentrated in early admissions, single-organ failure, controlled/remission disease, postoperative/elective monitoring, and reversible treatment-related toxicities (e.g., ICI pneumonitis, CAR-T CRS/ICANS). Futility clustered around ≥3 organ supports, RRT > 7 days, refractory/progressive disease, and ECOG ≥ 3. Sepsis outcomes averaged 45–55% ICU mortality but improved with rapid recognition and source control; COVID-19 mortality was particularly high in hematologic malignancies early in the pandemic, with subsequent declines post-vaccination. Conclusions: In modern oncologic practice, ICU care changes prognosis when the acute physiological insult is reversible and cancer control remains plausible; conversely, high organ-support burden and refractory disease define practical futility thresholds. These signals support time-limited ICU trials, earlier ICU involvement for sepsis/irAEs, and embedded palliative care to align intensity with goals. Full article

Background/Objectives: Despite its benefits for both nurses and patients, entrepreneurship among nurses remains uncommon. Specifically, impact entrepreneurship has rarely been applied in nursing. Impact entrepreneurship promotes solutions to health, social, and environmental challenges using business models committed to measurable social impact and return on investment. Beginning in 2020, an impact entrepreneurship course was introduced as a mandatory component of the master’s and nurse practitioner programs in geriatrics and palliative care at an Israeli college. This article examines the perceptions of the nurses who completed the course and explores how the course affected them and their professional practice. Methods: This mixed-methods study employed a convergent design and included self-administered questionnaires sent to all graduates of two cohorts, along with a qualitative thematic analysis of students’ reflective essays written during the course. Results: Students reported that the course empowered them to be innovators and contributed to their professional and personal development. They also explained that studying impact entrepreneurship could increase their earning potential and enable them to make a substantial difference for patients. Throughout the course, participants shifted their view of entrepreneurship and realized that, given nurses’ closeness with patients, they can and should be entrepreneurs. Before the course, students were reluctant to engage in entrepreneurship; afterward, students demonstrated marked interest in pursuing entrepreneurial pathways. Conclusions: Exposure to impact entrepreneurship can help nurses identify and implement creative and cost-effective solutions to workplace challenges. The professional characteristics of nurses position them as potential leaders of impact entrepreneurship in healthcare. Educational institutions worldwide should incorporate the subject of impact entrepreneurship into curricula and practice to realize that potential. Full article

Human Immunodeficiency Virus (HIV) infection is associated with a wide spectrum of urological manifestations, reflecting both the direct effects of viral infection and the indirect consequences of immunosuppression, opportunistic infections, malignancies and long-term combined antiretroviral therapy (cART). This narrative review provides a contemporary, multifaceted overview of the clinical and pathological presentations of urological conditions in people living with HIV (PLWHIV), based on articles published between 1989 and 2025. Conditions discussed include HIV-associated nephropathy (HIVAN), opportunistic genitourinary infections, malignancies such as Kaposi sarcoma and lymphoma, as well as non-infectious complications such as HIV-associated nephropathy and erectile dysfunction (ED). The review highlights the evolving epidemiology of these conditions in the cART era, with a noted decline in opportunistic infections but a rising burden of chronic kidney disease and malignancies, largely due to improved survival and ageing of the HIV-positive population. Pathological insights are explored and discussed, including mechanisms of HIV-associated renal injury, such as direct viral infection of renal epithelial cells and genetic predispositions linked to Apolipoprotein L1 (APOL1) variants. In addition, psychosocial factors, including anxiety, stress, stigma, and alcohol use, are discussed, as they may contribute to late presentation to clinical urology services. The review also considers the challenges faced in low and middle-income countries, the impact of HIV on urological services, and the important role of palliative care in advanced disease. Ultimately, this review underscores the need for early recognition, comprehensive diagnostic and surgical evaluation, and integrated social, psychological, and palliative management strategies tailored to the unique needs of PLWHIV. A deeper understanding of the interplay between HIV, cART, psychosocial determinants, and urological health is essential for improving patient outcomes and guiding future research in this evolving field. Full article

Background: Although progress has been made, substantial barriers exist in the development and implementation of pediatric palliative care (PPC) in mainland China, Hong Kong, and Taiwan. Possible explanations include the idea that cultural taboos erect barriers that short-circuit PPC discussions among stakeholders, and secondly, regional guidelines intended to support PPC fail to do so effectively. Here, we aimed to identify and document the scope of barriers to and facilitators of PPC practices in these regions and to explore to what extent and how regional PPC guidelines address these barriers/facilitators. Methods: We identified and compared two kinds of documents: (1) recent journal articles reporting on empirical studies of barriers to/facilitators of PPC practices in mainland China, Hong Kong, or Taiwan and (2) published PPC regional guidelines from the three regions. International and regional databases were searched to identify articles, along with PPC professional organizations in the three regions to identify PPC guidelines. Inductive content analysis was used for data analysis, synthesis, and document comparison. Results: Seventeen relevant articles on PPC barriers/facilitators and 16 documents with PPC guidelines were identified. Barriers/facilitators were reported on three organizational levels: micro, meso, and macro levels. Micro refers to children and parents, meso to medical institutions and healthcare providers (HCPs), and macro to policy/guidelines and networks. Most barriers were addressed by PPC guidelines, and most facilitators were acknowledged and endorsed in the guidelines. For instance, HCPs reported that insufficient PPC-related knowledge among stakeholders was a barrier, while PPC guidelines provided detailed information to address this shortfall. Unaddressed barriers in the guidelines were also uncovered, such as the cultural taboo of discussing death, suggesting that HCPs often struggled to have effective PPC conversations with parents and the child. Conclusions: Our finding that PPC guidelines addressed most barriers/facilitators while HCPs still struggled with implementing PPC indicates that mature PPC guidelines are necessary but not sufficient for PPC practices to improve in these three regions. The wide availability of PPC guidelines and PPC education/training for HCPs and families needs to improve. Full article

Background: Pharmacogenetics (PGx), which examines how genetic variations influence drug metabolism and response, offers promise in hospice care where patients commonly experience polypharmacy, complex symptoms, and limited life expectancy. This study assessed the utility of PGx results in guiding medication adjustments to improve symptom management at the end of life. Methods: A retrospective chart review was conducted on ten patients enrolled in a Precision Hospice Program who had PGx results for six key metabolic genes. A PGx-trained pharmacist reviewed Clinical Pharmacogenetics Implementation Consortium (CPIC) guideline-based recommendations, which were discussed during interdisciplinary hospice team meetings. Results: Patients had a mean age of 85.7 years and were prescribed an average of 17.9 medications. Among the 27 prescriptions reviewed, actionable gene–drug interactions were identified, primarily involving antidepressants and analgesics. Three patients underwent medication changes based on PGx guidance, including switching from citalopram to bupropion and adding morphine to tramadol therapy, which improved symptom control. Conclusion: While not yet routinely implemented in hospice settings, this pilot study suggests PGx-guided prescribing can support personalized medication decisions and enhance emotional and physical comfort in end-of-life care when test results are available. Full article

Background: Perceived stress occurs when environmental demands are appraised as exceeding an individual’s coping resources, triggering emotional dysregulation and physiological hyperactivation with adverse mental and physical outcomes. University students are particularly vulnerable to psychological distress due to academic pressure, social transitions, and lifestyle changes. Despite increasing attention to mental health in higher education, data on perceived stress among Italian university students remain limited. This study aimed to assess stress profiles using the Italian Perceived Stress Scale—Revised (IPSS-R) and to explore associations with sociodemographic and academic variables. Methods: A multicenter cross-sectional study was conducted among 2.103 undergraduate and master’s students enrolled in Italian universities. Participants completed the 15-item IPSS-R, which measures three dimensions: general stress, coping, and academic stress. Sociodemographic and academic data were collected via a structured questionnaire. Non-parametric tests and Principal Component Analysis were employed to identify group differences and multivariate patterns. Results: Two principal components were retained through the principal component analysis, overall perceived stress (40.9% of the variance) and coping-related responses (13.7% of the variance). The mean total IPSS-R score was 30.6 (SD = 7.08, p < 0.001), reflecting moderate-to-high levels of perceived stress. Academic demands emerged as the predominant stressors. Higher stress levels were reported by female students, younger individuals, first-year undergraduates, and those enrolled in health sciences and STEM programs. Conversely, older students, postgraduate students, and those studying in Southern Italy demonstrated stronger coping abilities and lower academic stress. Students attending private universities reported elevated academic pressure, potentially due to heightened family and financial expectations. Conclusions: Italian university students experience substantial perceived stress, primarily driven by academic workload, performance expectations, and institutional pressure. Early identification using instruments such as the IPSS-R may enable targeted interventions to promote mental health and academic achievement in student support services, during triage, in wellness checks, and in psychoeducation. Full article

Since the enactment of Belgium’s euthanasia law in 2002, clinical psychologists have played an increasingly significant role in the multidisciplinary approach to euthanasia, particularly regarding cases involving unbearable mental suffering (UMS euthanasia). This cross-sectional study examined the attitudes, roles, and competencies of clinical psychologists in Flanders concerning UMS euthanasia using an online questionnaire (n = 242). The survey explored attitudes towards UMS euthanasia, as well as self-perceived competencies and involvement. Results indicate that most psychologists hold a generally positive stance towards UMS euthanasia and believe in supporting patient requests under appropriate conditions. Their roles are seen as essential in decision-making, exploring alternatives, and providing aftercare for families, though opinions vary about their involvement during the actual procedure. Demographic factors such as age, gender, work setting, and prior involvement in euthanasia showed no significant influence on attitudes; however, greater knowledge and skills were reported among those in specialized settings, palliative care, or with prior euthanasia involvement. A pronounced lack of training and education in this area was reported, highlighting the need for targeted measures. The findings underscore the necessity of clarifying psychologists’ roles, expanding legal guidelines, and improving training to enhance care quality in the context of UMS euthanasia. Full article

Background: Pancreatic metastases from cervical cancer are exceptionally rare, with limited cases described in the literature. Their diagnosis and management remain challenging due to the absence of standardized protocols and the often poor prognosis. Case Presentation: We report the case of a 39-year-old woman with a history of treated stage IIIB cervical squamous cell carcinoma who presented with a solitary mass in the pancreatic tail. Diagnosis was established through cross-sectional imaging, PET-CT, and EUS-guided needle biopsy. The patient underwent systemic chemotherapy and SBRT followed by surgical resection. Histopathological analysis confirmed metastatic squamous cell carcinoma associated with HPV. Despite an initially favorable recovery, peritoneal metastases developed three months later. The patient died seven months after surgery under palliative care after disease progression on immunotherapy. Methods: A systematic review following PRISMA guidelines was conducted across PubMed, Cochrane, and Embase (2000–2025) to identify case reports and series describing pancreatic metastases from cervical cancer. A total of 14 published cases, together with the present case, were analyzed for demographic, clinical, diagnostic, therapeutic, and outcome data. Results: The mean age at diagnosis was 52.5 years (range 36–70). Squamous cell carcinoma was the predominant histology (73%). The pancreatic head was the most common metastatic site (53%). Diagnosis typically relied on abdominal CT, PET-CT, and EUS-guided biopsy. Surgical resection was performed in 28.6% of cases, while systemic therapy—most commonly cisplatin, paclitaxel, and bevacizumab—remained the mainstay for inoperable patients. Conclusions: Pancreatic metastases from cervical cancer usually occur in advanced disease stages and are associated with poor outcomes. Accurate diagnosis requires integration of imaging and histopathology, with PET-CT useful for detecting additional metastases. Surgery may be beneficial in selected patients with isolated lesions, but systemic therapy remains the primary treatment for most. Emerging immunotherapies show promise but are still in early development. Multidisciplinary management and further research are needed to optimize outcomes in this rare presentation. Full article

Background/Objectives: Engaging patients, caregivers, and community groups in health research priority-setting ensures that research agendas reflect genuine needs and enhance patient-centered care. Regions with cultural and linguistic diversity, such as South Tyrol in northern Italy, face challenges in achieving fair representation. This study aimed to identify health services research priorities in South Tyrol, a culturally and linguistically diverse region in Italy, through a bilingual participatory survey involving general practitioners (GPs) and patient and social interest organizations (PSIOs). Methods: A cross-sectional online survey (August–September 2025) was conducted among invited PSIOs (n = 64) and regional GPs (n = 290). A bilingual, self-developed questionnaire assessed organizational characteristics, priority ratings for predefined topics, experiences with research participation, and preferred participation modes. The data were analyzed descriptively. Group comparisons were performed using the Mann–Whitney U and chi-square tests with effect size calculation. Associations were examined using Spearman’s correlation. Free-text responses were thematically content-coded. Results: Ninety-five responses were analyzed, including nine general practitioners (9.5%) and 86 participants (90.5%) from patient and social interest organizations, of whom 27 (28.4%) held leadership or board positions. Across all groups, the highest-rated research priorities included children and adolescent mental health, palliative and end-of-life care, and continuity of primary care. Willingness to participate in future research was expressed by 38% of the respondents, with an additional 52% indicating conditional interest. Online surveys were the most preferred mode of participation, followed by workshops and board meetings. Conclusions: Participatory bilingual approaches are feasible in South Tyrol and highlight priorities that are highly relevant for patient-centered health services. Future initiatives should strengthen the structures for research participation, enhance GP engagement, and link identified priorities to research funding and policy action. Full article

Discontinuing active oncological treatment and initiating palliative care is a critical moment in cancer care, requiring oncologists to address complex clinical, ethical, and emotional challenges. This narrative review aims to provide clinicians with practical guidance for conducting conversations about treatment discontinuation and transitioning patients to palliative or hospice care. Drawing from current clinical guidelines, empirical research, and expert perspectives, the article reviews evidence-based communication strategies and frameworks, including the SPIKES protocol, Ask–Tell–Ask, the WHO model, and the disclosure model. The article also explores the clinical, functional, psychosocial, and ethical criteria relevant to treatment withdrawal decisions, as well as the timing and structure of end-of-life discussions. A practical algorithm is proposed, synthesizing key principles into a step-by-step guide for use in daily oncology practice. The algorithm supports clinicians in balancing medical indications with patient values and preferences, fostering shared decision-making and maintaining therapeutic relationships even in the most difficult circumstances. The review concludes that structured yet flexible communication enhances patient understanding, reduces unnecessary interventions, and improves the quality of end-of-life care. By promoting patient-centered care and timely palliative integration, this article offers oncologists a clear and adaptable approach to one of the most sensitive aspects of cancer care. Full article

Background: Patients with hematologic malignancy (HM) experience high symptom burden (SB) and diminished quality of life (QOL). While early palliative care (EPC) benefits solid tumors, its impact in HM remains uncertain. Objectives: To systematically review the effects of EPC on patient-centered outcomes in individuals with HM. Methods: MEDLINE, Web of Science, Cochrane Library, and Scopus were searched for English-language articles published between 2020 and 2024. Eligible studies included adults with advanced HM receiving EPC compared with usual care, reporting outcomes on SB, QOL, place of death (POD), healthcare costs (HCCs), or healthcare utilization (HCU). All original study designs were considered. Critical appraisal was performed, and results were synthesized narratively. The review was registered in PROSPERO (CRD420251019687). Results: Twelve studies were included, most of high quality (n = 10) and mainly conducted in America and Europe. Collectively, they enrolled 42,053 participants, largely with advanced disease, poor performance status, or limited prognosis. EPC consistently improved SB, particularly pain, appetite, and functional well-being, although results for anxiety and depression were inconsistent. Findings for QOL were mixed. EPC was associated with higher likelihood of home or hospice death. One study demonstrated substantial cost savings with home-based EPC. Across several studies, EPC was linked to lower HCU, including fewer transfusions, reduced chemotherapy near the end-of-life, and fewer aggressive interventions, hospitalizations, and intensive care admissions. Conclusions: EPC improves SB, influences POD, and reduces HCCs and HCU in HM. Evidence for QOL and psychological outcomes remains inconclusive. Further high-quality research is required to consolidate these findings. Full article

Background/Objectives: Identifying patients with palliative care needs can be challenging in clinical practice. This study reports on the tailoring and evaluation of a minimally invasive intervention (MINI) to support early planning of palliative care in acute hospitals. The MINI includes the Surprise Question (SQ) and the Supportive and Palliative Care Indicators Tool (SPICT^TM) for health and social care professionals, as well as a patient Question Prompt Sheet. Methods: A multi-method intervention study was conducted, including interviews and a pre–post survey of professionals on the development, implementation, and experiences with MINI. Interview data were analyzed inductively and survey data descriptively. Results: Data from 44 participants were included. MINI was generally considered acceptable and relevant, particularly the SQ, which prompted reflection among staff. Following the intervention, a significant improvement was observed in the presentation of regional specialist palliative care services for patients, as well as in the identification of psychosocial problems and their discussion with patients and relatives. While physicians reported increased confidence in initiating end-of-life conversations, other hospital staff showed mixed responses. Reported barriers for implementing MINI included limited time, the COVID-19 pandemic, staff strikes, emotional burden, and unclear responsibilities, indicating a low level of commitment. SPICT use was inconsistent, suggesting low integration into workflows. Interprofessional collaboration improved, particularly with external palliative care providers. Sustainability was hindered by a lack of institutional support, ongoing training, and formal routines. Conclusions: MINI may have the potential to shift the focus away from purely curative approaches. However, to guarantee success, future studies should ensure better alignment between intervention design, implementation and framework conditions. Full article

Background/objectives: High-quality pediatric critical care includes supporting children nearing the end-of-life (EOL) and their families. Cataloging existing interventions for children dying in the neonatal or pediatric intensive care unit (NICU, PICU) establishes critical areas for future research. In this scoping review, we evaluated characteristics of PICU EOL interventions. Methods: A librarian guided a search of OVID Medline, CINAHL, OVID PsycINFO, OVID Embase, Cochrane Central, and Web of Science, plus backwards and forwards reference searching. We included interprofessional interventions, defined as any systematic change (e.g., educational programs, symptom management, electronic medical record, etc.), for children dying from any cause. Studies were independently screened by two reviewers. Data were extracted by one team member and reviewed by a second. We extracted intervention elements, contextual factors, implementation barriers/facilitators, and generated frequencies from qualitative coding. Results: Of 11,643 screened articles, 44 met the inclusion criteria. Most were in neonatal ICUs (n = 28/44, 64%) and general PICUs (n = 10/44, 23%). Most interventions aimed to improve clinician knowledge (25/44, 57%), augment clinical structures and processes (n = 11/44, 25%), or enhance communication (n = 8/44, 18%). Common delivery methods included clinical practice changes (n = 25/44, 57%; e.g., protocols, order sets [n = 12]), and educational sessions (n = 20/44, 45%). Outcomes included clinician knowledge (n = 17/44, 39%), qualitative feedback (n = 18/44, 41%), feasibility/acceptability (n = 12/44, 27%), or treatment utilization (n = 11/44, 25%). Few examined families’ mental health (n = 3, 7%) or bereavement (n = 2, 5%). Few reported implementation facilitators or barriers. Conclusions: Most included studies targeted clinician outcomes through education. Designing, testing, and implementing interventions focused on family outcomes is a critical next step. Full article