Current Status Of Palliative Care Research Articles

Perceptions of Pancreatic Surgeons and the Current Status of Palliative Care for Pancreatic Cancer in China: A Multi-Center Online Questionnaire Survey

Objective: To investigate the perceptions of pancreatic surgeons regarding palliative care for pancreatic cancer and the current status of palliative care for pancreatic cancer patients in China. Methods: An online questionnaire consisting of thirty-five questions in five domains, including basic information of the respondents, personal interest, training and experiences of palliative care, recognition of the importance of palliative care, palliative care in the hospital of the respondents, and advice to improve the service of palliative care for pancreatic cancer, was distributed to pancreatic surgeons by the WeChat APP. All the data were automatically recorded and can be downloaded. The respondents' perceptions of palliative care and the current status of palliative care were depicted, and the factors influencing the perceptions of the respondents and palliative care in hospitals were further analyzed. Results: Responses from 429 pancreatic surgeons were validated. 81.4% were from tertiary hospitals, and 18.6% were from secondary hospitals. 94.2% were from general hospitals, and 5.8% were from cancer hospitals. Most surgeons have worked for over five years (93%), 72% had senior titles, and 54.5% held administrative positions. 49% have not read papers on palliative care before. 73.4% of the hospitals did not have a palliative care team, 77.9% did not have specific ward or bed for palliative care, 76.2% of the surgeons thought palliative care needed more attention in their hospitals. 97.4% of the surgeons thought palliative care was important for pancreatic cancer patients, and 94.9% were willing to join the palliative team. 46.6% of the surgeons thought palliative care should be conducted once pancreatic cancer was diagnosed. Most surgeons thought palliative care was helpful and should be involved in the multidisciplinary team. Regarding the geographical differences, surgeons and hospitals in North China performed better than in other regions. Surgeons with experience in clinical trials of pancreatic cancer performed better. The top three advice from the surgeons to promote palliative care were more education and training, seminars, and public broadcasting. 69.9% of the surgeons have concerns about the legal issue of implementation of palliative care. Conclusion: In general, the majority of pancreatic surgeons in China lack training and experience in palliative care for pancreatic cancer, and the current status of palliative care in most hospitals needs to be further improved. Prevalence of the participants think that palliative care is very important for pancreatic cancer patients. Palliative care should be provided once pancreatic cancer is diagnosed, and palliative care should be involved in the multidisciplinary team. More seminars, education and training, and public broadcasting are practical ways to improve palliative care for pancreatic cancer patients.

The Current Status of Palliative Care, Hospice, and End-of-Life Health Care Utilization in Patients With Malignant Ureteral Obstruction.

Malignant ureteral obstruction is associated with a poor prognosis, with a median survival of 3 to 7 months. These patients are ideal candidates for concurrent palliative care services, consistent with American Society of Clinical Oncology guidelines. We aimed to characterize palliative care, hospice, and end-of-life health care utilization in patients with malignant ureteral obstruction. Patients ≥ 18 years old at our institution and diagnosed with malignant ureteral obstruction between May 2014 and August 2020 were retrospectively identified and pertinent data extracted. Palliative care, hospice, and end-of-life health care utilization was described, and factors associated with each were assessed with logistic regression models. Overall survival was assessed with Cox proportional hazard regression models. One hundred fifteen patients qualified for analysis; 39.1% (45/115) utilized palliative care and spent a median of 12.5 days (IQR 3-52 days) on nonhospice palliative care. On adjusted analysis Black ethnicity (aOR 3.44, 95% CI: 1.08-10.94) was associated with palliative care utilization. Of the patients, 53.9% (62/115) utilized hospice. The median time from hospice initiation to death was 12 days (IQR 5-23 days). On adjusted analysis, prior extirpative surgery (aOR 3.63, 95% CI 1.01-13.05) and palliative care utilization (aOR 4.38, 95% CI 1.70-11.31) were associated with hospice utilization. Median survival following diagnosis was 141 days (IQR 37.5-442.5). Of the patients, 43.0% (37/86) had high end-of-life health care utilization. On multivariable analysis, only hospice (aOR 0.03, 95% CI 0.01-0.14) was associated with less end-of-life health care utilization. Palliative care is underutilized in malignant ureteral obstruction. Hospice, but not palliative care utilization, was associated with decreased end-of-life health care utilization.

Palliative Care in Portugal-From Intention to Reality, What Is Yet to Be Accomplished.

This article focuses on exploring the evolution of palliative care in Portugal. Ten years after the approval of its Basic Law, the aim was to investigate the quality of the path followed and the guidelines that could promote its development. Thus, this study sought to identify (a) the goals of the current members of parliament concerning palliative care, (b) the major priorities that should guide the development of palliative care in the coming decade, (c) the facilitating or hindering factors to accelerating the process, and (d) to propose consensually agreed measures for the integral development of palliative care within the health system. The qualitative data analysis was performed through the reading of the literature and interviews conducted via Zoom with several intentionally chosen participants. The data extracted from the previous studies were analyzed in a focus group. The NVivo® 10 was used for the data processing and categorization. Three key themes emerged concerning the current status of palliative care: the policymakers, the health professionals, and the society. This first line of structuring is explained by a second set of categories, namely, (a) the knowledge about palliative care; and (b) palliative care organization from the policymakers' perspective. In the health professionals' domain: (a) knowledge about palliative care, (b) clinical training, and (c) medical specialty. Finally, in society: (a) knowledge about palliative care. Advancing general education, increasing the qualitative training for different health professionals, reformulating the laws supporting them, promoting the flexibility of the implementation methodologies, and establishing a medical specialty are crucial to achieving the proposed goal. This study was not registered.

Challenges of Palliative Care in Advanced Cancer Patients in the Chinese Mainland: A Qualitative Study.

As cancer has become the second most common cause of death in the world today, how to allow advanced cancer patients to die with dignity has gotten gradually more and more taken paid attention. The study aims to explore the current status and challenges of palliative care for advanced cancer patients in the Chinese Mainland. This study used a semi-structured interview approach by interviewing 14 respondents. The respondents involved patients, family members and relevant practitioners in two regions in China in discovering and summarizing the current status of palliative care implementation for advanced cancer patients in the Chinese Mainland. The study found three challenges of palliative care in the Chinese Mainland: the development of theory and practice being out of sync, the dilemma of operation and promotion, and multiple challenges between different characters. The government should devote multi-dimensional developments and put advanced cancer patients in a central position to respond to patients' needs. The study suggests that the government should promote specialization, enlarge publicity, improve policy, and advocate death education and living wills to respond to the challenges.

Palliative care in China: a way out of the dilemma

It is still common for terminally ill patients to suffer from pain, and the development of palliative care faces many obstacles. The value of death to human society is ignored, and the intrinsic relationship between the meaning of life and the value of death has not been fully explored. This article discusses the current status of palliative care in China, how clinicians reflect and respond, the change of the whole society's concept of palliative care, and suggestions for action, and tries to provide a medical humanistic perspective for walking out of the dilemma of palliative care.

Current Status of Palliative and Terminal Care for Patients with Primary Malignant Brain Tumors in Japan.

Palliative care and advance care planning (ACP) from the first diagnosis of glioblastoma are important. This questionnaire survey was conducted to understand the current status of palliative care for brain tumors in Japan. Representative characteristics of Japan in comparison with Western countries (P <0.01) are described below: (1) Gender ratio of male in physicians who treat brain tumors in Europe and the United States/Canada are about 70%, but 94% in Japan. (2) The specialty is predominantly neurosurgeon (93%) in Japan. The ratio of neurologists is predominantly 40% in Europe. In the United States/Canada, neurologist (27%) and neurosurgeon (29%) are main parts. (3) Years of medical experience over 15 in physicians is 73% in Japan. Proportions of those with over 15 years are 45% in Europe and 30% in the United States/Canada. (4) In practicing setting, the rate of academic medical centers is about 80% in Europe and the United States/Canada, and ~60% in Japan. Representative differences compared with past domestic data (2007) (P <0.01): (1) In glioblastoma, the rate of explaining about median survival time increases from 39% (2007) to 80% (2018). Explanation about medical conditions to the patient himself with his family increases from 20% (2007) to 39% (2018). (2) Place of death: The rate at hospital is decreasing from 96% (2007) to 79% (2018) and at home is increasing from 3% (2007) to 10% (2018) (3) The rate of ventilator in adult has decreased from 74% (2007) to 54% (2018), but nasal tube feeding has remained unchanged from 62% (2007) to 60% (2018). These results will be shared with physicians to make better care systems for patients with brain tumors.

Update on Palliative Care for Pediatric Neurology.

It has long been recognized that patients with neurological conditions, and particularly pediatric neurology patients, are well suited for palliative care because they frequently have a high symptom burden and variable prognoses. In 1996, the American Academy of neurology formally recognized a need for neurologists to "understand and apply the principles of palliative medicine." Subsequently, some reviews have proposed a simultaneous care model in which palliative care is integrated for all neurology patients from the time of diagnosis. This article will review the current status of palliative care in pediatric neurology and discuss barriers to its integration.

Specialist Palliative Care Service for Children With Life-Threatening Conditions: A Nationwide Survey of Availability and Utilization

ContextAccording to the International Observatory on End of Life Care, the level of pediatric palliative care in Japan is Level 2 (capacity building) and the current status of palliative care for children in Japan has not been clarified. ObjectivesThe objective of the study was to clarify the availability and utilization of specialist palliative care services among children with life-threatening conditions in Japan. MethodsA questionnaire was administered to assess the availability of specialist palliative care services among children with life-threatening conditions. All 427 certified regional cancer centers having hospital-based adult palliative care teams, 15 certified children's cancer centers having pediatric palliative care teams, and 368 medical institutions having a certified palliative care unit were surveyed. ResultsFifteen to twenty-one percent of adult palliative care teams and more than 90% of pediatric palliative care teams had experience providing palliative care to children with cancer. By contrast, only 2%–3% of adult palliative care teams and 15% of pediatric palliative care teams had experience providing care for the noncancer population. An estimated 12% of children with cancer in Japan used hospital-based palliative care teams in 2015. Eight children used a palliative care unit in 2015, and of those, seven (88%) had a solid tumor. An estimated 1.3% of children with cancer who died in Japan used a palliative care unit. ConclusionAn estimated 12% of children with cancer in Japan used hospital-based palliative care teams and an estimated 1.3% of children with cancer who died in Japan used a palliative care unit in 2015.

The Current Status of Palliative Care for Non-cancer Patients in Japan: Field Survey on the Representatives of the Japanese Society for Palliative Medicine

The Current Status of Palliative Care for Non-cancer Patients in Japan: Field Survey on the Representatives of the Japanese Society for Palliative Medicine

Cuidados paliativos en personas con discapacidad intelectual: estudio cualitativo desde la perspectiva de los profesionales del ámbito sociosanitario

In our current environment the final stage of life in individuals with intellectual disabilities is not currently well known. ObjectiveTo examine the current status of palliative care of people with intellectual disability based on the experiences of healthcare and social professionals. MethodQualitative study involving healthcare and social welfare professionals of the Health Area of Burgos (Spain), selected according to the link between their professional background and the objective of this study. Focus groups and semi-structured interviews, manual analysis of the data from these, and mixed coding processes were carried out. ResultsThe study involved 20 professionals from different backgrounds and disciplines spread over 2 focus groups (7 and 6 participants) and 7 semi-structured interviews. Particular aspects of palliative care in people with intellectual disabilities are described. Furthermore, it identified the needs of the patient, the family members and their environment, as well as the barriers and difficulties in their care. DiscussionThere is limited experience in palliative care for people with intellectual disabilities. The following 3 aspects stand out: the complexity of the assessment and communication, the difficulty in establishing the criteria for inclusion in palliative care programs, and in the decision making process. Specific training in palliative care and intellectual disabilities, improvement in communication skills, and promotion of integrated care are essential.

Palliative care development in the Asia-Pacific region: an international survey from the Asia Pacific Hospice Palliative Care Network (APHN)

BackgroundAlthough palliative care is an important public healthcare issue worldwide, the current situation in the Asia-Pacific region has not been systematically evaluated.ObjectivesThis survey aimed to clarify the current status of...

Status of palliative care in Latin America

Several studies have been published reporting the status of palliative care in different countries of Latin America, but no studies have been published on the status of the discipline across the whole region. This article provides a summary of the current situation as reported in the Atlas of Palliative Care recently completed by the Latin American Association for Palliative Care. The aim of this project was to collect information on the degree of palliative care development, help create a network, and influence the progress of palliative care across Latin America. The Atlas provides an overview of the status of palliative care in Latin America according to the World Health Organization public health strategy for palliative care: policies, drug availability, education, and implementation of services. The results indicate that there is significant variation among countries in the region and that strategies to support and develop palliative care require tailored approaches to meet the needs of each. The information in this review gives a broad notion of the current status of palliative care in Latin America. The Atlas is expected to help the progress of palliative care and serve as a driver of the field in Latin America and other regions.

Palliative care in Japan

Providing palliative care in Japan is one of the most important health issues. Understanding palliative care delivery systems of other countries is useful when developing and modifying palliative care systems worldwide. This review summarizes the current status of palliative care in Japan, focusing on the structure and process development. Palliative care units and hospital palliative care consultation teams are the two main specialized palliative care services in Japan. The number of palliative care units is 215 (involved in 8.4% of all cancer deaths), and there are approximately 500 hospital palliative care teams. Conversely, specialized home care services are one of the most undeveloped areas in Japan. However, the government has been trying to develop more efficient home care services through modifying laws, healthcare systems, and multiple educational and cooperative projects. The numbers of palliative care specialists are increasing across all disciplines: cancer pain nurses (1365), palliative care nurses (1100), palliative care physicians (646), and palliative care pharmacists (238). Postgraduate education for physicians is performed via the special nationwide efforts of the Palliative care Emphasis program on symptom management and Assessment for Continuous medical Education (PEACE) project - a 2-day program adopting a trainer-trainee strategy. Over 30,000 physicians have participated in the PEACE program. A total of 1298 and 544 physicians have completed a trainer course for palliative medicine and psycho-oncology, respectively. Multiple structure and process evaluation, bereaved family surveys in palliative care units, and patient and family evaluation in the regional palliative care program indicate many improvements. Palliative care in Japan has progressed rapidly, and the Cancer Control Act has played a very important role in developing palliative medicine. Challenges include developing a structure for palliative care in the community or regional palliative care programs, establishing a method to measure and improve the quality of palliative care at a national level, developing evidence-based medicine and policy making, and palliative care for the noncancerous population.

The Current Status of Palliative Care in Cyprus

The oncology and palliative care services in Cyprus were reviewed looking especially on changes that occurred recently. Although there are encouraging signs in the management of palliative care patients, there is still room for improvement. Especially efforts should be made to improve communication between hospitals and palliative care organizations. The Ministry of Health should also take the initiative to get all palliative care organizations to work together under an official body and integrate palliative care into mainstream health service provision and education.

Current Status of Palliative Care in Turkey

Patients with cancer are still suffering a lot, especially those in developing countries. The concept of palliative care has improved and disseminated slowly in Turkey since the early 1990's. It is essential that improved palliative care program should be integrated into national health-care systems to control this suffering. In this review the history of the development of palliative care, opioid availability and some ethical issues in Turkey are reported.

The Current Status of Palliative Care in Turkey

There has been a growing awareness for the need to develop a palliative care service in Turkey. But a significant proportion of the Turkey population still does not have access to palliative care. The majority of cancer patients are treated in university hospitals that have support units with pain specialists and medical oncologists. Some significant barriers to the development of palliative care nursing were identified: 1) Lack of palliative care education and training programs 2) Lack of certification for Palliative Care Nursing 3) There is very limited research about palliative care nursing 4) lack of public awareness and 4) shortage of nursing staff 5) the limited availability of/knowledge about opioid analgesics. Nurses have a unique and primary responsibility for advocating for the right of patients to maintain their quality of life for as long as possible and to experience a dignified and peaceful death. Continued efforts are needed to overcome these barriers to successful implementation of palliative and end-of-life care for patients with cancer.

Current Status of Palliative Care in Israel

Pediatric cancer palliative care is characterized by diversity of care delivery models; effect of cancer on the family as the central focus of care and consideration of culture, spirituality, communication, and ethical standards. In Israel, children who are in palliative care are treated by the staff of the centers and about 70 to 80 % of the children are dying in the pediatric Hematology Oncology departments and units. Special efforts are also made in the pediatric departments in order to better treat adolescents in terminal phases. Palliative care education program in Israel was started several years ago together with adult palliative care specialists, the Israeli pediatric oncologists still witness many barriers for treatment amongst parents as well as in medical pediatric teams especially in pain management. During the last years, the Israeli pediatric palliative care teams improved the management of all symptoms in a dying child with special attention to existential, emotional and social demands of the child and the whole family. Education of the medical and nursing team is imperative, training in pharmacology and metabolism of antalgic drugs is also mandatory in order to better manage symptom control of the children at the end of life.

Modification and Implementation of NCCN Guidelines™on Palliative Care in the Middle East and North Africa Region

Palliative care is an important component of cancer treatment. Advancing palliative care in the developing countries is essential to improving patient care. The issues limiting its practice must be addressed, especially in light of the initiative to adapt the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) to the Middle East and North Africa (MENA) region. Palliative care is in its early stage of evolution in the MENA region, and its practice encounters many challenges and barriers. Adaptation of guidelines should take into consideration the situation and conditions in the targeted region to improve the standard of care to an internationally acceptable level. A group of experts in the MENA region reviewed the literature and collaborated to assess the current status of palliative care and recommend modifications to the NCCN Guidelines based on the unique needs of the region.

Current Status of Palliative Care--Clinical Implementation, Education, and Research

Palliative and end-of-life care is changing in the United States. This dynamic field is improving care for patients with serious and life-threatening cancer through creation of national guidelines for quality care, multidisciplinary educational offerings, research endeavors, and resources made available to clinicians. Barriers to implementing quality palliative care across cancer populations include a rapidly expanding population of older adults who will need cancer care and a decrease in the workforce available to give care. Methods of integrating current palliative care knowledge into care of patients include multidisciplinary national education and research endeavors, and clinician resources. Acceptance of palliative care as a recognized medical specialty provides a valuable resource for improvement of care. Although compilation of evidence for the importance of palliative care specialities is in its initial stages, national research grants have provided support to build the knowledge necessary for appropriate palliative care. Opportunities are available to clinicians for understanding and applying appropriate palliative and end-of-life care to patients with serious and life-threatening cancers.

The current status of palliative care among Japanese gynecologists in tertiary referral hospitals: A questionnaire survey of Kansai Clinical Oncology Group (KCOG)

The current status of palliative care among Japanese gynecologists in tertiary referral hospitals: A questionnaire survey of Kansai Clinical Oncology Group (KCOG)