Palliative Care Patients Research Articles

Impact of inpatient palliative care on end-of-life care among patients with early-onset colorectal cancer.

305 Background: Palliative care has proven benefits in elderly patients with advanced cancer; however, the objective benefits of palliative care in younger patients with cancer remain under-studied. We sought to examine the impact of inpatient palliative care consultation on end-of-life (EOL) care among hospitalized patients with early-onset colorectal cancer (EO-CRC). Methods: This study analyzed all admissions in the National Inpatient Sample (NIS) between 2016 and 2020 for patients younger than 50 years old with a diagnosis of CRC and death during the admission. Patients with CRC were identified utilizing ICD-10 codes C18.x, C19.x, and C20.x. Patient cohorts were made based on if they received inpatient palliative care consultation (ICD-10 code Z515). We assessed these encounters for patient demographics, Charlson comorbidity index (CCI), utilization of mechanical ventilation, vasopressors or blood transfusion, and presence of a Do Not Resuscitate (DNR) order. Results: Among 4,060 patients with EOCRC, 2,425 (59.7%) received inpatient palliative care consultation. There was no significant difference in age or length of stay between groups. The cohort of patients who received palliative care consultation had more female patients (44.3% vs 39.8%, p=0.004) and had higher comorbidity burden measured by the CCI (8.6 vs 8.3, p<.001). Patients receiving inpatient palliative care consultation at EOL were significantly more likely to have a DNR order (83.3% vs 44.6%, p<.001) in place and less likely to receive aggressive interventions, including mechanical ventilation (20.4% vs 43.4%, p<.001), blood transfusion (14.8% vs 22.6%, p<.001), vasopressor use (6.2% vs 8.6%, p=.004), and surgical intervention (3.0% vs 7.3%, p<.001). There was no difference in chemotherapy use between cohorts (2.8% vs 2.9%, p=0.8). Admissions including palliative care consultation were also associated with significantly lower average hospital charges ($99,387 vs $131,993, p<.001). Conclusions: Inpatient palliative care consultation at EOL among patients with EOCRC was associated with lesser use of aggressive interventions and higher rates of DNR code status. We also noted significantly lower costs of hospitalization among patients receiving inpatient palliative care consultation at EOL. These results underscore the importance of integration of inpatient palliative care consultation among patients with EOCRC at EOL. No PalliativeN=1635 PalliativeN=2425 p-value Age (in years) 41.9 ± 6.1 42.1 ± 6.5 .28 CCI 8.3 ± 2.6 8.6 ± 2.3 <.001 Total Charges 131993 ± 206404 99387 ± 151864 <.001 DNR 730 (44.6%) 2020 (83.3%) <.001 Blood transfusion 370 (22.6%) 360 (14.8%) <.001 Mechanical ventilation 710 (43.4%) 495 (20.4%) <.001 Vasopressor 140 (8.6%) 150 (6.2%) .004 Chemotherapy 45 (2.8%) 70 (2.9%) .800 Surgery 125 (7.3%) 75 (3.0%) <.001

Orally dissolving pilocarpine tablets for xerostomia in advanced cancer: A pilot N-of-1 feasibility study.

Xerostomia is a common and difficult symptom experienced by patients with cancer. Pilocarpine is a cholinergic agent that stimulates salivation. To assess the feasibility of conducting a N-of-1 trial to determine the efficacy of pilocarpine orally dissolving tablets in patients with xerostomia. Double-blind, crossover, placebo-controlled N-of-1 trials of 5 mg pilocarpine tablets vs placebo. Each trial consisted of three 6-day cycles containing pilocarpine (3 days) and placebo (3 days) in random order. Participants with advanced cancer and xerostomia (scoring >3 on an 11-point numerical rating scale) from any cause, were recruited from an inpatient and outpatient palliative care unit in Brisbane, Australia. Eighteen people were recruited in 17 months. Nine withdrew, seven before or during the first 4 days. Three withdrew due to unacceptable side effects. Two participants met the definition of response (⩾2 point reduction in mean scores active vs placebo cycles). When assessing individual cycles, 15 out of 27 cycles (56%) met the definition of response. More people reported at least one mild episode during pilocarpine than placebo of nausea (6 vs 3), vomiting (3 vs 0) and sweating (3 vs 2). About 48% of adverse event classifications were reported in placebo cycles only. Recruitment to an N-of-1 trial for xerostomia is feasible but attrition was high (50%). Early dropout may have been due to the trial length, complexity, appropriateness or number of questionnaires. Adverse events were generally mild. Two of 10 participants were considered to have benefited from pilocarpine warranting ongoing treatment.

Impact of race on end-of-life care among patients with esophageal cancer.

337 Background: Esophageal cancer is an aggressive malignancy with rising incidence globally. Patients with advanced esophageal cancer suffer from a heavy burden of a wide array of symptoms including dysphagia and cachexia/anorexia, necessitating the need for focused symptom management and palliative care. Studies focused on other cancer types have shown that Black patients are more likely to receive aggressive care at end-of-life (EOL) and suffer from a decline in quality of life. We sought to investigate racial differences in EOL care among patients with advanced esophageal cancer in the US. Methods: The National Inpatient Sample (NIS) was queried to identify all hospitalizations with esophageal cancer utilizing ICD-10 codes C15x from 2016 to 2020. Hospitalizations of White and Black patients with documented inpatient mortality events were then extracted. Demographic and clinical data were analyzed using chi squared tests, independent sample t-tests, and binary logistic regression (adjusted for age, gender, and Charlson comorbidity index or CCI). Adjusted Odds ratios (aOR) are presented with 95% Confidence intervals (CI). Results: A total of 15,130 patients with esophageal cancer were included, of which 13,345 (88.2%) were White and 1785 (11.8%) were Black. Hospitalizations with White patients recorded higher age, more males, and higher comorbidities per CCI. Hospitalizations with Black patients had longer lengths of stay on average, higher total hospital charges, and significantly less likely to have a Do Not Resuscitate (DNR) code status (aOR 0.81, 0.74-0.9 95% CI). Rates of inpatient palliative care consultation at EOL were significantly lower among Black patients (aOR=0.53, 0.48-0.58 95% CI). Black patients were more likely to receive aggressive intervention at EOL demonstrated by rates of blood transfusion (aOR 1.9, 1.6-2.1 95% CI), mechanical ventilation (aOR 1.7, 1.5-1.8 95% CI), and vasopressor usage (aOR 1.4, 1.2-1.6 95% CI). Conclusions: We present a large retrospective analysis demonstrating significant racial disparities in EOL care amongst hospitalized patients with esophageal cancer. Black patients had longer lengths of stay, lower rates of palliative care consultation and DNR code status, and higher rates of aggressive interventions at EOL. These findings may have implications for improving health care decision making for EOL care amongst minority patients with esophageal cancer. WhiteN=13345 BlackN=1785 p-value Age (in years) 68.24±10.67 65.12±10.36 <.001 CCI 9.4±3.3 8.6±3.9 <.001 Mean length of stay (days) 7.5±11.3 10.4±22.8 <.001 Total Cost (In thousands of dollars) 108.6±231.0 141.9±388.5 <.001 Palliative Adjusted OR 60.9% 45.1% .53 (.48 - .58) <.001 DNR Adjusted OR 63.8% 58.0% .81 (.74 - .90) <.001 Blood transfusion Adjusted OR 13.0% 23.0% 1.9 (1.6-2.1) <.001 Mechanical ventilation Adjusted OR 31.4% 45.9% 1.7 (1.5-1.8) <.001 Vasopressor Adjusted OR 7.8% 10.6% 1.4 (1.2-1.6) <.001

Impact of inpatient palliative care consultation on end-of-life care among patients with esophageal cancer.

502 Background: Esophageal cancer is an aggressive malignancy with a high global prevalence. Patients often suffer from various debilitating symptoms like dysphagia and cachexia, particularly with more advanced stage disease. Most patients continue to receive aggressive interventions until terminal stages of disease without timely initiation of formal palliative care (PC). We sought to investigate the impact of formal inpatient palliative care consultation on end-of-life (EOL) care among patients with esophageal cancer. Methods: The National Inpatient Sample (NIS) was queried to identify all hospitalizations with esophageal cancer utilizing ICD-10 codes C15.x from 2016 to 2020. Hospitalizations with documented inpatient mortality events were extracted and stratified based on reception of PC consultation (ICD-10 code Z51.5). Demographic and clinical data were analyzed using chi-squared tests and independent sample t-tests. A threshold of p-value less than 0.05 was set to determine statistical significance. Results: A total of 17,745 patients with esophageal cancer were included, of which 10,370 (58.4%) received PC consultation. Patients that received PC consultation at EOL were more likely to have higher comorbidities per CCI. No significant difference between age and sex was observed between the two cohorts. Patients who received PC consultations at EOL had higher rates of Do Not Resuscitate (DNR) code status (78.1% vs 43.2%, p <0.001) and lower rates of aggressive interventions such as chemotherapy (0.9% vs 1.6%, p<.001), blood transfusions (12.3% vs 18%, p<.001), and mechanical ventilation (28.5% vs 41%, p<0.001). No significant difference was observed in the rates of vasopressor use between the two groups (p=0.83). Hospitalizations with PC consultations were associated with significantly lower total hospitalization cost ($97,879 vs $146,128, p<.001). Conclusions: Inpatient PC consultations among patients with esophageal cancer were associated with lower rates of aggressive interventions and higher rates of DNR code status in addition to significantly lower total hospitalization costs. These findings underscore the importance of inpatient PC consultation at the EOL in helping minimize aggressive interpretation and facilitate a greater focus on comfort and quality of life. No PalliativeN=7375 PalliativeN=10370 p-value Age (in years) 67.58 ± 10.9 67.58 ± 10.9 .98 CCI 9.1 ± 3.5 9.4 ± 3.3 <.001 Mean length of stay (days) 8.9 ± 14.9 7.5 ± 11.3 <.001 Total Charges 146128 ± 321830 97879 ± 195868 <.001 DNR 3170 (43.2%) 8100 (78.1%) <.001 Blood transfusion 1320 (18.0%) 1280 (12.3%) <.001 Mechanical ventilation 3015 (41.0%) 2960 (28.5%) <.001 Vasopressor 585 (8.0%) 835 (8.1%) 0.83 Chemotherapy 115 (1.6%) 95 (0.9%) <.001

Assessing Family Caregiver Readiness for Hospital Discharge of Patients With Serious or Life-Limiting Illness Using Electronic Health Record (EHR) and Self-Reported Data.

To assess how patient and caregiver factors influence caregiver readiness for hospital discharge in palliative care patients. This transitional care study uses cross-sectional data from a randomized controlled trial conducted from 2018 to 2023 testing an intervention for caregivers of hospitalized adult patients with a serious or life-limiting illness who received a palliative care consult prior to transitioning out of the hospital. Caregiver readiness was measured with the Family Readiness for Hospital Discharge Scale (n = 231). Caregiver demographic, intra- and interpersonal factors were self-reported. Patient demographic, comorbidity score, and risk score for complicated discharge planning were extracted from electronic health records. Stepwise regression models estimated variance explained (r2) in caregiver readiness for patient hospital discharge. Patient demographics and complexity were not statistically associated with caregiver readiness for discharge. Caregiver depressive symptoms, poor caregiver-patient relationship quality, and fewer hours spent caregiving prior to hospitalization explained 29% of the variance in caregiver readiness. Reliance on patient data may not be sufficient for explaining caregiver readiness for discharge. Assessing caregiver factors may be a better alternative for identifying caregivers at risk for low discharge readiness and those in need of additional support. ClinicalTrials.gov on November 13, 2017, (No. NCT03339271).

Addressing the concept of total pain in palliative care: A postcolonial South African hospice view.

Palliative care, which was formally established in the Global North, is now recognized globally as part of health care. As part of a larger study, we were interested in how decision-makers at a leading hospice in South Africa understood the changing local context and its influence on the delivery of services. We were interested in how the concept of "total pain," as outlined by Saunders, applies in a very unequal and under-resourced society in the shadow of a long, oppressive colonial, and apartheid past. We conducted face-to-face semi-structured interviews with 12 staff at St Luke's Combined Hospices in Cape Town, South Africa, and analyzed the data following Braun and Clarke's thematic analysis approach. Four major themes emerged from the data. First, St Luke's has faced the challenge of serving a larger and far more diverse population than it had under apartheid. Second, the organization has undergone a process of rethinking holism and holistic services offered to palliative care patients in this context. Third, diversity and cultural sensitivity are key to how services are offered, and finally, the concept of "total pain" in this context is linked to questions of power and empowerment. This study is small and situated within a particular context, and it is clear that more data are needed. Nevertheless, the study shows that considering the Global South and postcolonial context is important for thinking about total pain and a global system of palliative care which is sensitive to the majority world context.

A longitudinal, multimodal palliative care curriculum for obstetrics and gynecology residents.

To incorporate a longitudinal palliative care curriculum into obstetrics and gynecology (Ob-Gyn) residency that could become standardized to ensure competencies in providing end of life (EOL) care. This was a prospective cohort study conducted among 23 Ob-Gyn residents at a tertiary training hospital from 2021 to 2022. A curriculum intervention was provided via lecture and simulation. An inpatient palliative care rotation was also created for the intern class. Scores for knowledge and confidence were compared pre- and post-curriculum. Performance on patient simulations was compared for interns who had the inpatient palliative rotation versus those that had not in a crossover fashion. Number of palliative care consults was also compared before and during the curriculum. A pooled, weighted rank-based test was used for analysis of the data with a p-value < 0.05 considered significant. One hundred percent of the 23 eligible participants participated in this study. A statistically significant increase in scores on all quizzes (p-values 0.047, <0.001, and <0.001) and confidence surveys (composite score p-value < 0.001) was seen after curriculum completion. No statistically significant difference was able to be identified in standardized patient simulation performance. Palliative care consultation increased by 55%. EOL care is a critical component of any physician's practice including obstetrician gynecologists. However, prior studies demonstrate a lack of standardized training. Our study demonstrates that a multimodal palliative care curriculum is an effective method to train Ob-Gyn residents and improve palliative care involvement in patient care.

Development of specialist palliative care in Dutch hospitals between 2014 and 2020: a repeated survey

BackgroundSpecialist palliative care teams (SPCTs) have significant benefits for patients with advanced disease or frailty, including improved quality of life, greater satisfaction with care, and less potentially inappropriate care at the end of life. Experienced SPCTs are recognised to have higher referral rates compared to novice teams. The aim of this study was to assess the development of hospital-wide integration of specialist palliative care (PC) and of SPCTs in Dutch hospitals between 2014 and 2020.MethodsThree cross-sectional surveys of SPCTs in Dutch hospitals were conducted in 2015, 2018 and 2021. Key members of the hospital SPCTs completed questionnaires about the preceding year that included items on hospital and PC program characteristics, hospital-wide integration of specialist PC, and SPCT characteristics (92 hospitals in 2015, 79 in 2018 and 74 in 2021). The analysis included hospitals with an operational SPCT, as determined by providing inpatient PC consultation services. Univariate analyses compared hospitals and SPCTs by year. Significance was determined by p-values < 0.05.ResultsIn 2014, 65% of participating hospitals provided inpatient PC consultations (n = 48). This increased to 92% in 2017 (n = 58) and 98% in 2020 (n = 48). Over the years, participating hospitals showed an increasing level of hospital-wide integration of specialist PC, such as an increased number of dedicated PC outpatient clinics (56% in 2020, compared with 47% in 2017 and 27% in 2014). The annual number of inpatient referrals to SPCTs has increased significantly over the years. The SPCTs have developed significantly in various aspects, including collaboration between primary and hospital care, the availability of services to patients at home and non-clinical activities.ConclusionOver the years, Dutch hospitals have shown growth in hospital-wide integration of specialist PC. Specialist palliative care teams have made significant progress in increasing inpatient consultations, and in improving collaboration between primary and hospital care.

Adapting to the emotional complexity of palliative care communication: Palliative care clinicians' experiences.

Communication is essential to medical care and is key in improving patient outcomes. We aimed to understand clinicians' emotions when communicating with patients in palliative care (PC) and the evolution of their communication skills. Between October and November 2021, 231 Swiss PC clinicians participated in an online cross-sectional survey (65% nurses, 35% physicians). Three questions invited participants to reflect on the development of their communication skills and on their emotions when communicating with patients in PC. Answers to these questions were analyzed thematically. Constantly adapting to complex emotions in communication was the overarching theme. Three main themes further allowed for an understanding of different communication challenges: emotions as a dynamic compass, not always under control, and evolving comfort and competence through personal and professional growth. In evolving comfort and competence, 6 strategies helped clinicians overcome fears and improve their confidence in communication: learning by doing and formal training, integrating life experiences and gaining insight from private life, taking time, collaborating and connecting with peers, acknowledging individuality, and connecting with one's own and patients' emotions. Participants described powerful emotional experiences when communicating with patients in PC, underscoring the emotional labor involved in PC communication. Our study highlights the need to re-conceptualize emotions as a valuable resource rather than a hindrance in clinical practice. The interplay between personal and professional identities in shaping communication skills, emphasizes the importance of emotional competence as a core professional skill. As clinicians often develop these skills individually, our findings suggest a need for earlier integration of emotional competence training in medical education, along with ongoing support through collaboration, and improved allocation of time resources, to enhance clinician well-being and patient care.

Dignity therapy led by a chaplain for palliative care patients in Brazil: an empirical study

ABSTRACT Dignity Therapy (DT) has emerged as an effective tool for dealing with psychosocial and existential anguish and rescuing the dignity of palliative care patients. Thus, this study aimed to analyse the application effects of Dignity Therapy, led by a chaplain, with these patients. This is a qualitative study, categorised as a narrative intervention. Ten patients took part in the study. All reported positive effects of DT include feeling recognised, self-continuity, strengthening of hope and constructing meaning and purpose, connection with inner space, and manifesting spiritual virtues. The results suggest that DT fulfils its purpose, proving to be a valuable tool for chaplains to use in palliative care to promote patients’ dignity at the end of life. Professional chaplains trained in DT can significantly contribute to quality spiritual care for palliative care patients.

Characterizing Difficulties and Management of Sleep Disturbances in a Tertiary Palliative Care Unit-A Retrospective Review.

Objective: Difficulty sleeping is common in palliative care, however often unrecognized by palliative care physicians. This retrospective review aims to gain a better understanding of the causes and treatment of sleeping disturbances in a tertiary palliative care unit. Methods: This study included 200 palliative care inpatients admitted between January 1, 2015, and August 31, 2020. Patients with sleep disturbances were placed into 3 subgroups: insomnia, delirium, and those with an unclear diagnosis. These categories were analyzed by bivariate analysis (ANOVA, Kruskal-Wallis) to determine statistical significance. Results: A total of 156 (78%) patients had symptoms suggestive of sleep disturbance and 163 (81.5%) patients were prescribed a sedative for sleep disturbance. Most patients were prescribed lorazepam (52 [26%]), followed by haloperidol (47 [23.5%]), and zopiclone (33 [16.5%]). Benzodiazepine and zopiclone prescribing decreased over time, while antipsychotic prescribing remained stable. When analyzed according to the most likely cause of the sleep disturbance, patients with insomnia had a higher Palliative Performance Score (P < .035) and were more likely to have a previous medical history of insomnia (P < .0003) than those with delirium. Both insomnia and delirium were quickly diagnosed but patients with unclear sleep disturbances took longer to recognize and treat. Conclusion: These results suggest that sleep disturbances are common at the end of life and can be challenging to categorize. Using specific criteria may be helpful in differentiating insomnia versus delirium and ultimately lead to more consistent approaches to management.

The Effect of Life Activity Levels of Palliative Care Patients on the Caregivers' Perception of Caregivers Burden.

Objective(s): Studies show the effects of dependent patients' caregivers on the caregiving burden. Knowing the effects of maintenance of movement, especially in life activities, on the factors affecting the caregiving burden is important for the quality of care, ensuring that the caregiver's capacity is preserved. Methods: This descriptive and cross-sectional study research was carried out to determine the effect of life activity levels of palliative care patients on the care burden of caregivers. The number of individuals to be sampled was calculated according to the sample formula with a known population. The sample of the consisted of 108 patients and their caregivers in a district state hospital between June and December 2022. Data were collected using the Barthel Index of Patient Activities of Daily Living (ADL) and Caregiver Burden Scale. Descriptive statistical methods, quantitative data analyses, and correlation analyses were used in the analysis of the data. Results: The average age for patient was 78.13 ± 10.25 and for caregivers was 54.64 ± 13.22 years. Barthel ADL Index score of the patients was 35.05, and 38% of the patients were completely dependent. Caregiver Burden Scale scores was 50.80, and 76.8% of the caregivers had moderate caregiver burden. Patients with increasing age, with diabetes mellitus and dementia diagnosis, not using glasses, or having urinary catheters and gastrostomy tubes had lower activity levels. The caregiver burden of caregivers was higher in those who spent 3 to 4 h for daily patient care, who had sleep problems, who thought that their health deteriorated compared to those who did not. It was determined that as the patients' ability to perform their daily activities decreased, the caregiver burden increased (r = -0.417; P < .01). Conclusions: It might be recommended that nurses can implement the nursing interventions completely and severely dependent patients' caregivers psychological and social support.

Determining timeframes to death for imminently dying patients: a retrospective cohort study

BackgroundClinicians are frequently asked ‘how long’ questions at end-of-life by patients and those important to them, yet predicting timeframes to death remains uncertain, even in the last weeks and days of life. Patients and families wish to know so they can ask questions, plan, make decisions, have time to visit and say their goodbyes, and have holistic care needs met. Consequently, this necessitates a more accurate assessment of empirical data to better inform prognostication and reduce uncertainty around time until death. The aims of this study were to determine the timeframes for palliative care patients (a) between becoming comatose and death, and (b) between being totally dependent and bedfast, and then comatose, or death, using Australia-modified Karnofsky Performance Status (AKPS) scores. The secondary aim was to determine if covariates predicted timeframes.MethodThis is a large retrospective cohort study of 2,438 patients, 18 years and over, cared for as hospice inpatients or by community palliative care services, died between January 2017 and December 2021, and who collectively had 49,842 AKPS data points. An Interval-Censored Cox Proportional Hazards regression model was used.ResultsOver 53% (n = 1,306) were comatose (AKPS 10) for longer than one day before death (mean = 2 days, median = 1, SD = 2.0). On average, patients were found to be totally dependent and bedfast (AKPS 20) for 24 days, before progressing to being comatose. A difference in life expectancy was observed at AKPS 20 among people with cancer (mean = 14.4, median = 2, SD = 38.8) and those who did not have cancer (mean = 53.3, median = 5, SD = 157.1).ConclusionResults provide clinicians with validated data to guide communication when answering ‘how long’ questions at end-of-life. Knowledge of projected time to death can prompt timely conversations while the patient can understand and engage in meaningful conversations. The importance of considering covariates such as location and diagnosis in determining timeframes has been highlighted. Shared decision-making and essential person-centered end-of-life care can be planned.

Palliative Care Consults in the Southeast: Lower Readmissions Despite Increased Length of Stay.

Background: Inpatient palliative care (PC) consultations are increasingly used to address operational challenges. We aimed to understand how PC consultations in a southeastern program, affected by pandemic-related care delays, impacted common clinical performance metrics. Methods: This is a retrospective analysis of a tertiary system's adult patients who received PC consultations from December 2021 to August 2022. A Medicare Severity Diagnosis Related Groups (MS-DRG) code was identified for each PC encounter, and a comparison cohort was created from non-PC encounters. Outcomes: There were 1906 patients who received a PC consultation and 7730 patients in the matched cohort. Patients receiving a PC consultation were older (mean age 68.55 years) compared with the matched cohort (mean age 62.75 years). Despite a significantly longer length of stay (LOS) (12.46 days vs. 6.99 days, p < 0.001), the PC group experienced a lower readmission rate (adjusted odds ratio 0.54, 95% confidence interval 0.44-0.65, p < 0.001). Conclusions: Our cohort study using MS-DRG matching indicates that despite increased LOS, PC consultations were associated with significantly lower readmission rates. This suggests their potential to improve resource utilization, especially in regions affected by pandemic-deferred care.

Associations Between Anticipatory Grief and Post-Bereavement Depression and Post-Loss Grief of Family Members of Dying Patients With Cancer in Palliative Care Units: A Cohort Study.

Objectives: Anticipatory grief is associated with post-bereavement grief; however, reports on the influence of pre-loss depression are limited. Therefore, we investigated the association between the anticipatory grief of family members and post-loss and post-depression grief adjusted for pre-loss depression. Methods: This cohort study included the family members of dying patients with cancer. Questionnaires were distributed to them during hospitalization in four inpatient palliative care units from 2016 to 2017. We also administered follow-up questionnaires after their bereavement in 2018. The pre-bereavement questionnaire consisted of three items from the Anticipatory Grief Scale for Families Caring for a Terminally Ill Person for assessing anticipated grief and the Patient Health Questionnaire 9 for assessing depression. The Brief Grief Questionnaire was used to assess post-loss grief. Results: We distributed 181 pre-bereavement questionnaires to the family members; 112 (62%) responded to the pre-bereavement survey, out of which 71 (63%) responded to the post-bereavement survey. Anticipatory grief was significantly associated with pre-loss (ρ = 0.37, ρ < 0.001) and post-loss (ρ = 0.24, P = 0.009) depression and marginally associated with post-loss grief (ρ = 0.15, P = 0.10). Pre-loss depression was also significantly associated with post-loss depression (ρ = 0.50, P < 0.001) and post-loss grief (ρ = 0.41, P < 0.001). However, anticipatory grief was not significantly associated with post-loss depression (P = 0.35) and post-loss grief (P = 0.65) after adjusting for pre-loss depression. Significance of Results: Bereaved families who experienced anticipatory grief had worse post-bereavement depression. However, this association was not statistically significant after adjusting for pre-bereavement depression. Post-bereavement depression may be in a continuum with pre-loss depression, and anticipatory grief does not independently affect post-loss reactions.

Creative pathways to comfort: the transformative role of art therapy in palliative and hospice care.

Art therapy offers a creative outlet for patients in palliative and hospice care to express emotions, manage distress and enhance wellbeing by addressing physical, emotional and spiritual challenges. This review evaluates the effectiveness, challenges and outcomes of art therapy in improving the quality of life for patients in palliative and hospice care. An integrative review. The review of 27 studies identified four key themes: (1) the effects of art therapy on the quality of life of patients, (2) intervention and patient outcomes, (3) improved wellbeing through self-expression, and (4) challenges in care delivery. Art therapy significantly reduced emotional distress, including anxiety, depression and psychological fatigue, while alleviating physical symptoms, like pain and exhaustion. It fostered emotional expression, personal growth and coping skills, helping patients manage their conditions more effectively. Participants also reported enhanced self-awareness, stronger interpersonal connection and a greater sense of control over their lives, leading to improved emotional and physical wellbeing. Art therapy provides significant benefits by alleviating emotional and physical distress and enhancing wellbeing. Integrating art therapy into palliative and hospice care supports holistic, patient-centered care, though further research is needed to address access barriers and ensure consistent delivery.

Behind the scenes of palliative care: Qualitative study with oncology family caregivers.

Long-term caregiving tasks can be exhausting for family caregivers, resulting in high psychological morbidity. The study aims to explore the experiences, challenges, and strengths of family caregivers providing care for cancer patients in palliative care, in-patient or at home. Nine caregivers were included, predominantly women aged 34 to 70, from various regions of Portugal. They participated in four focus groups between May 2021 and May 2022, held online due to COVID-19 restrictions. A qualitative research methodology was employed, using semi-structured interviews conducted through focus groups. Data were analyzed using thematic analysis to identify key themes in caregivers' experiences. The study revealed several challenges, categorized into three main themes, listed in order of frequency: (lack of) communication, pain and suffering, and caregiver burden. Death emerged as a meta-category. Despite these difficulties, caregivers identified sources of strength and support that helped them cope during this time. The findings underscore the profound impact of caregiving on family members and highlight the need for enriched support systems and interventions to reduce caregiver burden and suffering, boosting their resources. Despite its limitations, the study's diverse and rich content illustrate the value of group settings in fostering belonging and comfort among caregivers.

Pediatric palliative care in patients with cardiovascular disease: The basics of why, when, where, who and how

Pediatric palliative care in patients with cardiovascular disease: The basics of why, when, where, who and how

Palliative care for patients with chronic kidney disease and severe COVID-19 in Brazil: a retrospective study in a quaternary hospital

Palliative care for patients with chronic kidney disease and severe COVID-19 in Brazil: a retrospective study in a quaternary hospital

Palliative Care for Patients With SMI and Life-Threatening Medical Illness Inadequate

Palliative Care for Patients With SMI and Life-Threatening Medical Illness Inadequate