Palliative Care Center Research Articles

The role and perception of the caregiver in a specialized pediatric palliative care center in medicine preparation and administration: a survey study

BackgroundIn pediatric palliative care, the main caregiver is primarily responsible for managing pharmaceutical therapies. Few data are available regarding the influence of this burden on quality of life in terms of time, concerns as well as a considerable risk of administration errors and adverse effects. This study aims to investigate how caregivers prepared and administrated medication, including errors and associated expectations, to identify improvement interventions.MethodsBetween October 2022 and March 2023, a descriptive single-center survey study was carried out in the tertiary care pediatric palliative center of the Padova University Hospital. Participants were the caregivers of the patients followed by our center up to 23 years old, receiving at least one drug daily and who cannot self-administer their therapy. The questionnaire consisted of 18 multiple-choice and semi-closed questions, grouped into 4 main topics: therapy preparation, therapy administration, administration errors and therapy assessment.ResultsA total of 100 caregivers responded to the survey. Mothers represented the main caregiver (91%). The prevalence of polypharmacy was 67% across the patients. 52% of caregivers handled prescriptions at least three times per day and for 32% it took to prepare them more than 5 min each time. Only 59% reported to have been trained for preparing and administrating drugs. 14% reported having made at least a drug administration error due to the tiredness or the complexity of therapeutic regimens in the preceding three months. Nearly one caregiver out of three felt their child was using too many drugs. 73% positively welcomed the possibility of having clinical pharmacist-led counseling.ConclusionsMany caregivers of pediatric palliative care patients frequently have trouble planning, preparing and delivering pharmacological therapy to their children. Attempting to simplify medication regimens, choosing formulations that are simpler to administer and measure, investing in improved caregiver training, talking about therapies with carers, and involving clinical pharmacists to clarify their doubts could be all potential strategies to improve this condition and reduce their burden.

A Retrospective Study of Tracheostomy Care and Decannulation of the Patients in a Palliative Care Center.

Background: World Health Organization defines palliative care as a multidisciplinary approach to enhancing patients physical, psychological, and emotional well-being. Our study investigated palliative care unit decannulation rates and factors affecting success. Methods: The data of patients hospitalized in the palliative care clinic between 2017 and 2019 were analyzed retrospectively. Demographic data, diagnoses, comorbidities, nutritional status, Norton and Braden Scale scores, day of hospitalization, and discharge direction of the patients were recorded. All patients were evaluated and treated by a multidisciplinary team. Results: One hundred two tracheostomy patients were monitored. Patients in the palliative care clinic had an average stay of 22.19 ± 13.67 days (median: 21, min: 4, max: 66). Forty-one patients were decannulated. Statistically significant age difference was observed between decannulated and non-cannulated groups, with the decannulated group having a significantly lower mean age (52.10 ± 20.54, median: 53) compared to the non-decannulated group (61.48 ± 18.07) (z = -2.516, P = .012). The mean Braden scale score of the decannulated group (14.29 ± 2.50) was significantly higher than that of the non-decannulated group (12.20 ± 2.82) (z = 3.823, P < .001), and the mean Norton scale score of the decannulated group (11.34 ± 2.50) was significantly higher than that of the non-decannulated group (9.46 ± 2.46) (z = 3.472, P = .001). Conclusion: Patients with tracheostomy can be easily followed and decannulated in palliative care clinics. It is important that a multidisciplinary team is involved in palliative care units. Age, immobility, Norton and Braden scales, and level of consciousness are factors affecting the success of decannulation.

Low-dose methadone added to another opioid for cancer pain: a multicentre prospective study

ContextThe use of methadone for cancer pain management is gaining wider acceptance. However, switching to methadone treatment can still pose challenges. Consequently, there is ongoing development of its use in low doses in combination with other opioids, despite a lack of clinical evidence regarding its efficacy and safety.ObjectivesThis study aimed to evaluate the efficacy and tolerability of low-dose methadone in combination with another opioid in patients with moderate-to-severe cancer-related pain in a clinical setting.Patients and methodsThis was a prospective, open-label study conducted in 19 pain and/or palliative care centres treating patients with cancer-related pain. Pain intensity, patients' global impression of change, and adverse effects were assessed on day 7 and day 14. The main outcome measure was the proportion of responders.ResultsThe study included 92 patients. The daily dose of methadone was 3 [3–6] mg at baseline, 9 [4–10] mg on day 7 and 10 [6–15] mg on day 14. The NRS pain ratings significantly decreased from 7 [6–8] at baseline to 5 [3–6] on visit 2 (p < .0001) and 4 [3–6] on visit 3 (p < .0001). Similarly, the VRS pain ratings decreased from 3 [3–3] at baseline to 2 [2–3] on visit 2 (p = 0.026) and 2 [1–3] (p < 0.001) on visit 3. At Visits 1 and 2, half of the patients were considered Responders. Of those responders, 73.5% were High-Responders at Visit 1 and 58.7% were High-Responders at Visit 2. No adverse events related to the risk of QT prolongation, overdose, or drug interactions were reported.ConclusionFor patients experiencing moderate to severe cancer-related pain despite initial opioid treatment, our study found that low-dose methadone, when used in combination with another opioid, was both safe and effective. This supports the use of methadone as an adjunct to opioid-based treatment for cancer pain.

Caring for terminally Ill patients: the impact on oncologists

BackgroundJourneying with patients throughout their cancer trajectory and caring for them at the end of life can lead to emotional and moral distress in oncologists, negatively impacting their personal and professional identities. A better understanding of how transitions in care goals affect oncologists can shed light on the challenges faced and the support required. This study explored the impact of care transitions on oncologists’ professional identity formation (PIF).MethodsFrom September to December 2023, semi-structured interviews were conducted with oncologists in a palliative care center in Singapore. The Ring Theory of Personhood (RToP) was used as a framework to capture the effects of experiences with patients transitioning from curative to palliative care on the oncologists’ sense of self and identity. Data were analyzed using both inductive and deductive qualitative analysis.ResultsParticipants included six female and six male physicians, aged 30 to 53 years (mean 38 years), with an average of 9.75 years of experience as oncologists. The main domains identified were 1) challenges faced in transitioning patients to palliative care, 2) the impact of dealing with dying patients on oncologists, and 3) coping mechanisms.ConclusionOncologists experience self-doubt and moral distress as they manage transitions in care. The PIF of oncologists can be supported through reflection and introspection, peer support, and interventions to promote self-care — ultimately enabling them to make meaning of their experiences, renew family ties, and reaffirm their commitment to the profession.

24th Panhellenic Congress of Regional Anaesthesia, Pain Management and Palliative Care, September 19-22, 2024

PARIS.SY.A. in collaboration with ESRA HELLAS and the 1st Anesthesiology Clinic - Pain and Palliative Care Center EKPA awaits you at the 24th Panhellenic Congress of Regional Anesthesia, Pain Treatment and Palliative Care, September 19 – 22, 2024, in Lefkada, Greece.

Palliative care in terminally ill advanced chronic liver disease patients.

While mortality rates from advanced chronic liver disease (ACLD) are rapidly increasing, patients with an advanced disease stage have acomparable or even higher symptom burden than those with other life-limiting diseases. Although evidence is limited there is increasing recognition of the need to improve care for patients with ACLD; however, there are many limiting factors to providing good palliative care for these patients, including unpredictable disease progression, the misconception of palliative care and end of life care as being equivalent, alack of confidence in prescribing medication and alack of time and resources. Health professionals working with these patients need to develop the skills to ensure effective palliative care, while referral to specialized palliative care centers should be reserved for patients with complex needs. Basic palliative care, along with active disease management, is best delivered by the treating hepatologists. This includes discussions about disease progression and advance care planning, alongside the active management of disease complications. Liver disease is closely associated with significant social, psychological, and financial burdens for patients and their caregivers. Strategies to engage the discussion in multidisciplinary teams early in disease progression help to ensure addressing these issues proactively. This review summarizes the evidence on palliative care for patients with ACLD, provides examples of current best practice and offers suggestions on how disease-modifying and palliative care can coexist, to ensure that patients do not miss opportunities for quality of life improving interventions.

The effects of aromatherapy and music on pain, anxiety, and stress levels in palliative care patients.

Pain and anxiety levels in palliative care patients negatively impact their quality of life, highlighting the need for research on non-pharmacological methods. This study aimed to evaluate the effects of music and aromatherapy interventions on pain, anxiety, and stress levels in these patients. The research was designed as a single-blind, four-group, randomized controlled trial. The sample consisted of 88 patients hospitalized in a palliative care center (receiving palliative care services with terminal or advanced diseases). Patients were randomly assigned to four groups (n = 22, music, aromatherapy, music and aromatherapy, and control group). Patients in the experimental groups received the intervention to which they were assigned for 20min each day for three consecutive days: music, aromatherapy, or music accompanied by aromatherapy. No intervention was applied to the control group. The patients' levels of pain, anxiety, and stress were assessed before and after the intervention using the Visual Analog Scale (VAS), the Facial Anxiety Scale (FAS), and the Distress Thermometer. No significant differences were found in the demographic characteristics of the groups (p > 0.05). The Wilcoxon Signed-Rank and Kruskal-Wallis tests indicated statistically significant differences in pre- and post-intervention scores for VAS, FAS, and Distress across all experimental groups on all follow-up days (p < 0.05). Implementing music, aromatherapy, and their combination effectively reduced pain, anxiety, and stress levels in palliative care patients, suggesting these non-pharmacological interventions can improve their quality of life. ClinicalTrails.gov (Registration number: NCT06024954) at 05-SEP-2024.

Challenges Faced by Nurses Working in Palliative Care Centers

Objective: This study was conducted to determine the difficulties experienced by nurses working in palliative care centers. Methods: Data were collected using the descriptive "Personal and Professional Introductory Information Form" prepared by the researcher and the "Palliative Care Difficulties Scale (PCDS)". In the evaluation of the data; numbers, percentages and means, Independent t-test, One Way ANOVA test, Mann Whitney U test, Kruskal-Wallis test, Spearman Correlation test, and simple linear regression analysis test were used. The significance level of statistical tests was accepted as p

Polypharmacy in Children with Medical Complexity: A Cross-Sectional Study in a Pediatric Palliative Care Center.

Children with medical complexity (CMC) often require multiple medications, leading to polypharmacy, which seems to be linked to adverse effects, administration errors, and increased caregiver burden. This study aimed to describe the prevalence of polypharmacy, medication burden, off-label drug use, and associated costs. Conducted at the Pediatric Palliative Care Center of Padua, Italy, from August to October 2021, this cross-sectional observational study included patients up to 23 years old with at least one prescribed drug. Data were collected from medical records and caregiver interviews. Drug costs were collected from the Italian Medicine Agency. Descriptive statistical analysis was performed. For comparisons among categorical variables, the Chi-square test was used, and for those among continuous variables, the ANOVA test was used. This study analyzed treatment regimens of 169 patients with a median age of 12.5 years (0.3-23). Polypharmacy was present in 52.7% of patients, and medication burden was observed in 44.4%, both varying significantly by primary diagnosis (p < 0.001). The median daily cost per patient was EUR 2.2 (IQR 0.9-7.1), with significant variation among subgroups. Only 34.6% of prescriptions were off-label. polypharmacy and medication burden are frequent among our CMC population, with some differences according to primary diagnosis.

Breast cancer symptom profile longitudinal changes: data mining study

ObjectivesIdentifying stable co-occurring symptoms in breast cancer (BC) patients during chemotherapy can improve symptom management and the treatment process. This study examines symptom cluster stability in Iranian BC patients receiving...

Psychological health in Palliative Care: Thematic analysis of a psychiatrist’s and an art therapist’s clinical reflexive journals

Background: Patients receiving palliative care often face psychological distress, which can be challenging for clinicians to manage. Therefore, reflexive and visual journaling can be used as powerful techniques for clinician selfreflection and personal development. These journals are a form of practice wisdom, providing insights into psychological health in palliative care. Aim: This study aims to describe how patients receiving palliative care experience psychological health, explore the meaning of a palliative care clinician’s work and contribute to the understanding of psychological health in palliative care through the reflexive and visual journals of clinicians. Design: Using Gibb’s reflective cycle as a framework for journaling, this study employs reflexive and visual journaling through the lenses of a psychiatrist and an art therapist. Journal data were analysed using a thematic analysis approach. Setting/participants: The two first authors journaled 107 clinical encounters and created 36 pieces of response art detailing encounters with patients and their families, and clinical conversations in two palliative care centres. Results: Patient attributes and the clinical environment were observed to influence psychological health in palliative care. The patient’s ability to navigate dying, maintain personhood, exert resilience and experience satisfying relationships contribute to psychological health. A clinical environment comprising clinicians with holistic competencies, systems promoting interdisciplinary collaborations and a values-based culture that promotes patient centricity strengthens the delivery of psychological care. Conclusions: Good psychological health in palliative care extends beyond psychopathology and is influenced by the cardinal elements of being human, value systems and systemic elements in the therapeutic environment.

Establishing palliative care in tribal and rural Indian setting: A participatory action research approach.

e24085 Background: We established a palliative care center in the tribal area of Santhal Pargana, India, under a tertiary care facility, as a crucial step in addressing the palliative needs of oncology patients. This study assesses the center's inaugural year, focusing on referral patterns, morphine consumption, and pain management. Methods: Data from all patients visiting the palliative care outpatient department (OPD) in 2023 were prospectively collected and analyzed. The study focused on key palliative care indicators, including morphine consumption, patient referrals, and the mean Numeric Rating Scale (NRS) pain score after initial consultation. The PAR approach was utilized to tailor services to the community's needs. Results: The center observed an increase in patient referrals, from 8 new patients in January to 19 by December. The patient demographic primarily comprised individuals with head and neck cancer (43%), followed by breast cancer (28%) and gall bladder cancer (12%), alongside other types such as cervix, sarcomas, lung, and adult hematolymphoid malignancies. Bone metastasis was present in 46 (55.4%) patients at initial presentation. Morphine consumption demonstrated a notable rise, from 840 mg in May to 2860 mg in December, totaling 9800 mg for the year. The mean NRS pain score improved significantly from 6.5 in January to 4.3 post-initial consultation. The center maintained an overall median of 3 consultations per patient, and bereavement support was provided to 13 (15.7%) patients. Conclusions: The integration of the Participatory Action Research approach, specifically the CTC-5, was instrumental in the successful initiation and expansion of palliative care services within the center. The structured training, mentorship, and organizational restructuring, facilitated by the program, were crucial in establishing a modest palliative care infrastructure. This comprehensive approach not only enhanced care delivery but also ensured the sustainability and adaptability of palliative services, effectively addressing the gap in palliative care in rural, tribal settings.

Embodiment of Pharmacist Intervention in Palliative Care and Augmentation of a Curriculum for its Assessment

Background Palliative care is the care of patients who have progressive, life-threatening illnesses and who are facing death in the foreseeable future. Since there is a growing need for pharmacist’s intervention in palliative care and there is a gap in the education of palliative care for pharmacy students, this study aims to identify roles and services that have to be performed by palliative care pharmacists in medication-related areas and also to formulate an add-on course to train pharmacy graduates. Materials and Methods A prospective interventional study was done in the palliative care centre in Perinthalmanna, Kerala, India. Relevant data were pooled and analysed for drug-related problems. Necessary interventions were made. Results were interpreted and an add-on course for the training of pharmacy graduates was formulated. Results A total of 88 patients were included in the study. The most prevalent conditions in our palliative setting were kidney disease, liver disease, cancer and stroke. Notably, 38 and 10 cases were found to have drug interactions and drug duplications, respectively. Four patients required dosage adjustments. Fifty cases involved pharmacist intervention which improved the outcome by 80%. At the end of the study, a curriculum was formulated to implement a 3-month add-on course entitled ‘PALLIATIVE PHARMACY’ under the guidance of an Expert committee for training pharmacists and pharmacy students. Conclusion The study identified that there are various roles a pharmacist must undertake in a palliative setup. The involvement of pharmacists in patients’ treatment helps to prevent drug-related problems to a greater extent. The addition of an integrated course for the management of palliative care patients will help to improve the learning as well as practical skills of pharmacists. Incorporating basic and clinical sciences in the therapeutic course is an effective learning plan.

The pediatric palliative care of neurosurgical patients: condition and perspectives as exemplified by the Central Federal Okrug of Russia

Actually, there was active development of children palliative care service is expressed in increasing of the number of both corresponding departments in medical organizations and children seeking palliative care. The survey of parents of children with palliative status permitted to identify desired organizational forms of medical care of this contingent, their content and aspects of social care. Such problems as shortcomings in infrastructural and material support of departments, personnel deficiency, low level of inclusion of non-medical specialists in multidisciplinary team, need for additional training of physicians and nurses in specifics of palliative medical care and need for sufficient number of pediatric palliative care centers are identified.

EVALUATION OF THE NUTRITIONAL STATUS AND RESULTS OF PATIENTS FOLLOWED IN THE PALLIATIVE CARE CENTER

OBJECTIVE: The aim of this study is to examine the nutritional status and results of the patients followed in the palliative care center. MATERIAL AND METHODS: 250 consecutive patients who were hospitalized in the palliative care center were included in this study. The patients were grouped according to their nutritional status during hospitalization and discharge. RESULTS: The mean age of the patients subjected to this study is 73±19.22 years. Out of these patients, 125 are female. The average daily calorie requirement of the patients was calculated as 1463.71±21.55 kcal/day, while the maximum tolerated calorie intake was determined to be 1030.54 ±320.54 kcal/day in our patient (P =0.039). No significant change was detected between the calculated calories and the calories consumed by diabetic individuals (P = 0.083). When the nutritional patterns were examined, it was determined that 51.60 % of the patients were orally fed at the time of admission to the palliative care center, the rate of patients fed with a Percutan gastrostomy (PEG)/Percutan jejunostomy (PEJ)/nasogastric tube was 32.05%, and 13.21% of the patients fed total parenteral nutrition (TPN). 67.06% of the patients were discharged with oral feeding, 30.53% with PEG/PEJ/nasogastric tube and 4 (2.39%) with long-term TPN feeding methods. When the patients were divided into percentages according to their calorie consumption, we found that the hospitalization day was significantly shorter in the group consuming 0-25 percentile calories (P = 0.021) but had a significantly higher rate of mortality (%71.42) (P=0.018). In the group with 50-75 percentile calorie intake, mortality was observed significantly at the lowest rate during hospitalization, with 14 (13.59%) patients. (P=0.003). Infections (28.57%) were significantly higher in the 0-25 group (P = 0.051). CONCLUSIONS: At palliative care centers, besides end-of-life management, all needs of patients should be identified. Instead of making strict calorie calculations, it is necessary to develop new nutritional goals compatible with all patients.

RELIGIOUS AND CULTURAL RITUALS THAT CAREGIVERS OF MUSLIM PALLIATIVE CARE PATIENTS REFRAIN FROM PERFORMING DURING THE GRIEVING PROCESS

Aim: This study was conducted to determine the religious and cultural rituals that caregivers of palliative care patients refrain from performing during the grieving process. Method: This study was conducted between May-July 2021. The population of the study consisted of caregivers of patients hospitalised in the palliative care centre of a hospital. The sample size was 286 people. Results: When we asked the caregivers about the activities they avoid doing after the death of their relatives; 59.1% stated that they avoid wearing make-up, 61.2% avoid wearing colourful/ornate clothes, 74.8% avoid laughing, 73.4% avoid going to wedding/parties, 71.3% avoid singing, 78.7% avoid dancing/playing. When we asked the caregivers why they did not do these activities; 71% stated that they felt uneasy, 69.6% stated that it was a sin, and 75% stated that they avoided disrespecting the deceased. Conclusions and Suggestions: According to the results of the study, it was determined that caregivers of palliative care patients have religious and cultural rituals that should be avoided during the grieving process regarding daily life, food, colours and clothes and personal care. There are religious and cultural rituals that societies avoid applying as well as the rituals they apply. In order for public health nurses to support the family during the mourning period, they need to know the rituals that families and societies avoid applying as well as the rituals they apply in order to make the grieving process healthier.

Perception of Good Death and Level of Perceived Stress in Relatives of Palliative Care Patients.

This study aimed to examine the perception of a good death and the level of perceived stress in relatives of palliative care patients. Relatives of 110 patients hospitalized in a palliative care center constituted the research sample. A personal information form, the "Good Death Scale," and the "Perceived Stress Scale" were used for data collection. The patients' relatives defined good death as being with family members and living this process without suffering. The mean total Good Death Scale score of the relatives of palliative care patients was 54.86 ± 7.78, and their mean total Perceived Stress Scale score was 31.11 ± 10.10. These findings showed that patients' relatives had high perceptions of good death and that their stress levels were above average. To expand the scope of nursing care, it is important to know how patients' relatives are affected by this process. It is recommended that more studies be conducted on this subject.

The effect of hope intervention on the anxiety, hope and symptom levels of patients in palliative care: A pilot randomized controlled trial

Background: One of the main aims of palliative care is the management of symptoms that disturb the person. There are very limited studies to determine the increase of hope through hope intervention and its effect on symptom levels.Objective: This study has been carried out to determine the effect of hope intervention on anxiety, hope, and symptom levels of patients under palliative care.Method: This research is a randomized controlled intervention study. The sample of the study consisted of 42 patients who were treated as inpatients in a palliative care center in Turkey. A "hope intervention program" (three consecutive days, three sessions) was implemented on the intervention group. Measurement tools were applied three times before the intervention, on the 8th day and on the 15th day after the intervention. The research data were collected using a Personal Information Form, the Herth Hope Index, the Hospital Anxiety Depression Scale, and the Edmonton Symptom Assessment Scale. The data were analyzed in the SPSS 25.0 program using independent sample t-tests, ANOVA in repeated measurements, Bonferroni Post-Hoc tests, chi-square tests, Pearson correlation, and regression analysis.Results: There was a statistically significant difference in the Herth Hope Index scores of the intervention group on the 8th and 15th day after intervention (p<.05), and patients in the control group had a higher hope level. A statistically significant difference was found between the anxiety score measurements of the patients in the intervention group before intervention, on the 8th day and 15th day (p<.05), however, no statistically significant difference was found between the anxiety scores of the intervention and control groups. No statistically significant difference was found between symptoms of nausea, anxiety, insomnia, and shortness of breath between the intervention and control groups.Conclusion: Hope intervention increased the hope status of patients receiving palliative care and reduced the level of anxiety. In palliative care, it is recommended to use hope intervention programs that support and contribute to the maintenance of hope.

A spectacular galactic scale magnetohydrodynamic powered wind in ESO 320-G030

How galaxies regulate nuclear growth through gas accretion by supermassive black holes (SMBHs) is one of the most fundamental questions in galaxy evolution. One potential way to regulate nuclear growth is through a galactic wind that removes gas from the nucleus. It is unclear whether galactic winds are powered by jets, mechanical winds, radiation, or via magnetohydrodynamic (MHD) processes. Compact obscured nuclei represent a significant phase of galactic nuclear growth. These galaxies hide growing SMBHs or unusual starbursts in their very opaque, extremely compact (r &lt; 100 pc) centres. They are found in approximately 30% of the luminous and ultra-luminous infrared galaxy population. Here, we present high-resolution ALMA observations (∼30 mas, ∼5 pc) of ground-state and vibrationally excited HCN towards ESO 320-G030 (IRAS 11506-3851). ESO 320-G030 is an isolated luminous infrared galaxy known to host a compact obscured nucleus and a kiloparsec-scale molecular wind. Our analysis of these high-resolution observations excludes the possibility of a starburst-driven wind, a mechanically or energy driven active galactic nucleus wind, and exposes a molecular MDH wind. These results imply that the nuclear evolution of galaxies and the growth of SMBHs are similar to the growth of hot cores or protostars where gravitational collapse of the nuclear torus drives a MHD wind. These results mean galaxies are capable, in part, of regulating the evolution of their nuclei without feedback.

Quality of sleep and depression in family caregivers of patients receiving palliative care

Introduction: This study aimed to evaluate the depression symptoms and quality of sleep of palliative care patients’ family caregivers. Methods: A total of 120 patients were hospitalized at the palliative care center and primary caregivers were included. Depression symptoms of caregivers was assessed by the Beck Depression Inventory (BDI) and quality of sleep with Pittsburgh Sleep Quality Index (PSQI). Results: The mean age of 120 caregivers included in the study was 47.2±12.8 years. The mean BDI score was 10.4±7.2, and the mean PSQI score was 4.6±2.9. Significantly higher rates of depression symptoms were observed in singles than in married people (p=0.037). The healthy sleep rate of the patients whose caregiving period was 6-10 years was significantly lower (p=0.018). While 78.5% of those who received support from their families had a healthy sleep, this rate was 52.4% in those who did not receive support from their families (p=0.034). A significant difference was found between PSQI and BDI categories (p=0.004). People with moderate depressive symptoms were more likely to have poor sleep quality and long-term sleep disorders. Conclusions: Family caregivers of patients receiving palliative care are at risk for poor sleep quality and depression symptoms. We think that the evaluation of these people in terms of the presence of depression symptoms and poor sleep quality may provide early intervention to alleviate the symptoms.