Palliative Care Patients Research Articles

Perspectives on Self-Reported Sexual Dysfunction by Palliative Care Patients with Cancer.

Objectives: The aim of this study was to investigate from the perspective of palliative care (PC) patients with cancer, the frequency of sexual dysfunction (SD) and their views regarding the communication with their physicians. Design, Setting, and Participants: Adult PC patients with cancer seen at a Supportive Care Clinic in the United States were invited to participate in a survey about SD. Results: A total of 100 patients completed the survey. Only 29% would like to discuss SD with a clinician, even though 81% experienced it in the previous year, and 55% were dissatisfied with their sexual function. Only 20% reported that their clinician ever asked them about SD. Most (79%) considered appropriate to be inquired about SD, but only 32% thought it should always be asked. Conclusions: Our findings do not support the notion that PC specialists should always initiate a discussion about SD with their PC patients with cancer.

Impact of Symptom Distress on the Quality of Life of Oncology Palliative Care Patients: A Portuguese Cross-Sectional Study

Introduction: Uncontrolled symptoms are widely recognized as one of the main challenges in oncology palliative care patients. The central aim of palliative care is to improve the patient’s quality of life. In recent years, there has been a growing use of patient-reported outcome measures in palliative care, particularly to evaluate symptoms, quality of care, and well-being. Aim: To evaluate the sociodemographic and clinical profile, symptom distress, and perceived quality of life in oncology palliative care patients admitted to a specialized palliative care unit in Portugal. Methods: This study was cross-sectional, descriptive, and correlational, carried out in the inpatient setting of the palliative care unit at a tertiary oncology hospital (at admission). The evaluated protocol included a sociodemographic and clinical questionnaire, as well as two measurement instruments: the Edmonton Symptom Assessment Scale (ESAS) and the Palliative Care Outcome Scale (POS), both filled out by the patients. Data analysis was conducted using IBM SPSS® Statistics version 25.0, with a significance level set at 5% (p < 0.05). Results: The majority of participants in this sample were male (61.7%), with a mean age of around 72 years. More than half of the patients admitted (n = 34; 56.7%) were being monitored in outpatient care. Digestive and head and neck cancers were the most commonly found in the sample (41.7% and 20%, respectively). A significant correlation was found between high symptom intensity and poorer quality of life and care (p < 0.01). This association was particularly pronounced for symptoms such as pain, weakness, depression, anxiety, and anorexia. Conclusions: This study revealed a positive correlation between overall symptom severity and a perceived deterioration in quality of life, well-being, and quality of care. Future studies should consider utilizing alternative assessment tools for evaluating symptoms and quality of care. Additionally, including non-cancer palliative patients in similar studies may provide further valuable insights.

Exploring the Correlation Between Palliative Care Training in Brazil and Compassion Fatigue: A Cross-Sectional Study.

The literature lacks conclusive evidence regarding whether palliative care training confers a protective or predisposing influence on compassion fatigue. The present study hypothesizes that training in palliative care is associated with minor compassion fatigue levels among physicians and an improvement in their confidence in several procedures. To explore the physicians experiences with and without palliative care training who work as general practitioners in order to assess the prevalence of compassion fatigue in these groups. This is a quantitative and qualitative cross-sectional survey. For data analysis, Mann-Whitney and Pearson's chi-squared test tests were used considering P < 0.05 for significance. The majority respondents had no training in palliative care (77.8%), however, 58.3% declared that they cared for at least 1 palliative care patient every 2 shifts - an intermediate frequency in our analysis. Trauma levels among doctors were classified as medium (24 ± 6), burnout as low (19 ± 5) and compassion as medium (41 ± 5). Professionals without training in palliative care had higher rates of burnout (P = 0.002), but there was no association between training and rates of trauma or compassion. Doctors with training in palliative care in Brazil showed lower burnout rates when working as general practitioners in secondary hospitals. This could instigate the implementation of educational programs in palliative care at hospitals and the further development of the field so as to improve professionals' performance at patients' treatment. There was no difference between Trauma and Compassion scores.

The Effects of Symptom Distress and Depression on Quality of Life in Patients With Terminal Cancer: The Mediating Role of Meaning in Life and Spiritual Well-being.

Terminal cancer patients experience worsening physical symptoms, psychological challenges, and spiritual difficulties. Improving the quality of life (QOL) and reconstructing the meaning of life (MIL) for these patients ensure a dignified end-of-life experience. Spiritual well-being is necessary to promote effective end-of-life coping strategies. This study aimed to construct and verify the suitability of a model that explains the impact of physical and psychological factors on the QOL of patients with terminal cancer using MIL and spiritual well-being as mediating factors. The participants were patients with terminal cancer 25 years or older hospitalized in 40 nationally designated hospices. A total of 172 patients were included in the final analysis. Data analysis was performed using structural equation modeling. In the effect analysis of the final model, the variables affecting QOL were depression (β = -.62, P < .001), symptom distress (β = -.33, P = .001), and spiritual well-being (β = .36, P = .002), and a significant indirect effect of MIL was found in the depression-MIL-spiritual well-being and depression-MIL-QOL paths. Spiritual interventions that help people find their MIL can serve as an important component of optimal hospice and palliative care for patients with terminal cancer. In clinical practice, interventions that increase the MIL and spiritual well-being of patients with terminal cancer are needed. Additionally, the practice will see other benefits including enhanced patient care, psychological support, effective treatment planning, family caregiver support, and further research advancement.

Protocol of a nation-wide post-bereavement survey on quality of hospice and palliative care: J-HOPE 5 study

BackgroundMaintaining quality of care and improving the quality of life (QOL) of patients and their families are important issues in palliative care. Therefore, there is a need to continuously evaluate the quality and outcomes of the care provided. In Japan, the Japan hospice and palliative evaluation (J-HOPE) study series has been conducted every three to four years since 2010, and we will conduct the fifth J-HOPE study (J-HOPE5). In the present paper, we describe the protocol of the J-HOPE5 study. The main objectives are: (1) to evaluate the processes, structures and outcomes of care at hospices or palliative care units; (2) to examine bereaved family members’ self-reported psychosocial condition, such as grief and depression as bereavement outcomes; (3) to provide data to ensure and improve the quality of care provided by participating institutions via feedback based on the results from each institution; and (4) to provide clinical and academic information regarding the implications of various issues in palliative care by conducting specific research.MethodsWe will conduct a cross-sectional, anonymous, self-reported questionnaire survey. In total, 153 institutions have agreed to participate in this study, meaning that approximately 12,240 bereaved family members (n = 80/institution) will be sent a questionnaire.DiscussionThis is one of the largest cross-sectional bereavement surveys to evaluate the quality of specialized palliative care for patients with cancer, both in Japan and worldwide. The large sample size of this study will enable wide analyses of specific targets and topics.

Unapproved and unproven cancer treatments in patients admitted to palliative care units.

To clarify the current use of unapproved and unproven cancer treatment (UUCT) among the bereaved families of patients with cancer who died in palliative care units, the financial burden and psychological experiences of the families, and the relationship between patients in palliative care who used UUCT and communication with their physicians'. This study was conducted as part of a cross-sectional, anonymous nationwide survey of the bereaved family members of cancer patients who died in palliative care unit in Japan. Questionnaires were sent to 1,039 bereaved family members, and responses were received from 661 (64%). Of these, 558 were included in the study after excluding the 103 who did not complete the questionnaire. A total of 7.3% (41 of 558) of patients received UUCT. Of these, 34% (14 of 41) of patients were informed that the treatment was in the research phase, and 49% (20 of 41) were informed that the efficacy of the treatment was unknown. Regarding expectations for UUCT, 61% (25/41) expected to be cured, and 80% (33/41) expected it to slow disease progression. In multivariate logistic regression analysis, use of complementary and alternative medicine (CAM) was associated with receiving UUCT (p = 0.024), and patients who could discuss CAM with their doctors tended to receive UUCT (p = 0.054). Patients in palliative care unit who expect to cure tended to receive UUCT. These results highlight the challenge of telling patients that UUCT is ineffective and informing them of their prognosis and severe medical conditions.

Hospital-acquired malnutrition: point prevalence, risk identifiers and utility of a digital Dashboard to identify high-risk, long-stay patients in five Australian facilities.

There are limited hospital-acquired malnutrition (HAM) studies among the plethora of malnutrition literature, and a few studies utilise electronic medical records to assist with malnutrition care. This study therefore aimed to determine the point prevalence of HAM in long-stay adult patients across five facilities, whether any descriptors could assist in identifying these patients and whether a digital Dashboard accurately reflected 'real-time' patient nutritional status. HAM was defined as malnutrition first diagnosed >14 days after hospital admission. Eligible patients were consenting adult (≥18 years) inpatients with a length of stay (LOS) >14 days. Palliative, mental health and intensive care patients were excluded. Descriptive, clinical and nutritional data were collected, including nutritional status, and whether a patient had hospital-acquired malnutrition to determine point prevalence. Descriptive Fisher's exact and analysis of variance (ANOVA) tests were used. Eligible patients (n = 134) were aged 68 ± 16 years, 52% were female and 92% were acute admissions. HAM and malnutrition point prevalence were 4.5% (n = 6/134) and 19% (n = 26/134), respectively. Patients with HAM had 72 days greater LOS than those with malnutrition present on admission (p < 0.001). A high proportion of HAM patients were inpatients at a tertiary facility and longer-stay wards. The Dashboard correctly reflected recent ward dietitian assessments in 94% of patients at one facility (n = 29/31). HAM point prevalence was 4.5% among adult long-stay patients. Several descriptors may be suitable to screen for at-risk patients in future studies. Digital Dashboards have the potential to explore factors related to HAM.

Ethical Issues and the Role of Palliative Care for Patients with Aspiration Pneumonia.

Aspiration pneumonia is a clinical entity with important ethical considerations. It is imperative for clinicians to understand these considerations to best provide counsel to patients and their families, allowing them to make fully informed decisions. Given that aspiration pneumonia is frequently associated with end of life, there are palliative medicine principles that may help in the treatment of this disease.

Contactless radar-based heart rate estimation in palliative care – a feasibility study and possible use in symptom management

BackgroundHeart rate (HR) monitoring is a medical standard to provide information about a patient’s health status. In palliative care, relationship and social engagement are crucial therapeutic concepts. For fear of disrupting communication, social contact, and care, continuous HR monitoring is underutilised despite its potential to inform on symptom burden and therapeutic effects. This study investigates radar-based HR monitoring as an innovative and burden-free approach for palliative care patients, compares its accuracy with conventional ECG methods, and shows potential for therapeutic guidance.MethodsA single-centre, comparative clinical trial was conducted with palliative care patients at the ward of the Department of Palliative Medicine of the University Hospital of Erlangen. The HR measurements obtained with radar were compared with Holter ECG (study arm I, overnight) and Task Force® Monitor (TFM)-based ECG validation recordings (study arm II, one hour). In addition, long-term radar measurements without validation were analysed in comparison with clinical health records (study arm III).ResultsBoth validation methods showed correlation by scatter plot, modified Bland-Altman plot, and equivalence testing. N = 34 patients participated in study arm I. HR of 4,079 five-minute intervals was analysed. Radar measurements and ECG showed high agreement: difference of HRs was within \\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\:\\pm\\:$$\\end{document}5 bpm in 3780 of 4079 (92.67%) and within ±13.4 bpm (\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\:\\pm\\:$$\\end{document}1.96 times the SD of the mean) in 3979 (97.55%) intervals, respectively. In study arm II, n = 19 patients participated. 57,048 heart beats were analysed. The HR difference was within \\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\:\\pm\\:$$\\end{document}5 bpm for 53,583 out of 57,048 beats (93.93%) and within \\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\:\\pm\\:$$\\end{document}8.2 bpm ( ± 1.96 times the SD of the mean) in 55,439 beats (97.25%), respectively. Arm III showed HR changes extracted from radar data in correlation with symptoms and treatment.ConclusionRadar-based HR monitoring shows a high agreement in comparison with ECG-based HR monitoring and thus offers an option for continuous and above all burden-free HR assessment, with the potential for use in symptom management in palliative care, among others. Further research and technological advancements are still necessary to fully realize this innovative approach in enhancing palliative care practices.

Becoming Housed During Palliative Care Enrollment: Identifying Drivers, Deterrents, and Directions for Future Care

Homelessness is associated with accelerated disease progression, and housing placements are less likely when experiencing serious illness. Little research to date has focused on how to successfully secure housing placement during serious illness and end of life. This study aimed to address this gap by examining factors influencing housing placement among seriously ill palliative care patients experiencing homelessness. By conducting reflexive thematic analysis of medical record data of palliative care patients who became housed during enrollment (n = 16), three themes were identified: (1) trends in placement timing showing most accessed housing within seven months of palliative care involvement due to the relationship between homelessness, disease progression, and goals of care; (2) social support networks that were involved in attaining housing to varying degrees; and (3) changes in internal motivation, such as identity affirmation, relational tasks, and accepting limitation, driven by illness and dying processes. Findings underscore the need for integrated medical and social support, expanded housing options for the seriously ill, and adaptable psychosocial–spiritual care within the housing care continuum.

Standardizing Initial Inpatient Palliative Care Consultations for Patients Receiving Left Ventricular Assist Devices at a Large Urban Hospital.

Left ventricular assist devices can improve survival rates and quality of life for individuals with advanced heart failure. However, complications and repeated hospitalizations are common. Palliative care involvement is required before and after left ventricular assist device placement. However, limited guidance on the objectives and structure of palliative care consultation in the left ventricular assist device context has led to variation in how these consultations are conducted and confusion around the consultations' objectives and structure. We piloted and modified an evidence-based, semistructured script to guide pre-left ventricular assist device palliative care consultations. Palliative care clinicians were trained on use of the script. Presurvey and postsurvey were used to examine changes in clinician confidence and assess script acceptability. Script use did not result in changes to clinicians' confidence. Clinicians felt the script provided valuable structure and guidance but suggested improvements to script structure and flow, emphasizing the need for a standardized workflow and closer collaboration between palliative care and heart failure teams.

Changes in perceived distress among patients receiving inpatient palliative care.

Understanding the impact of palliative care on patient outcomes is crucial for enhancing end-of-life care. This study aimed to examine changes in perceived distress among patients receiving inpatient palliative care. In this retrospective cohort study, data were collected from a palliative care unit in central Taiwan between January and December 2021. Patients were categorized into "survived to discharge" and "non-survivor" groups based on discharge status. The Symptom Assessment Scale (SAS) was used to measure subjective distress daily during hospitalization. SAS scores on the admission day were compared to days 3 and 7, with changes analyzed using the chi-square test. A total of 191 patients were included in the study. Significant differences in symptom intensity changes were observed for sleep disturbance, appetite problems, bowel issues, breathing difficulties, fatigue, and pain during the first week of hospitalization. In the "non-survivor" group, improvements in pain were noted over time; however, distress related to appetite, bowel function, and fatigue worsened. Conversely, the "survived to discharge" group showed continuous improvement in sleep disturbance and breathing distress throughout the hospitalization period. This study offers insights into how inpatient palliative care differentially influences perceived distress based on patients' end-of-life stage. Enhancements in palliative care approaches are needed to more comprehensively support patients, particularly those nearing the end of life.

Aggressive end-of-life care in patients with gastrointestinal cancers - a nationwide study from Denmark.

Knowledge of determinants of aggressive end-of-life care is crucial to organizing effective palliative care for patients with gastrointestinal (GI) cancer. This study aims to investigate the determinants of aggressive end-of-life care in patients with GI cancer. A national register-based cohort study using data from the Danish Register on Causes of Death, the Danish National Patient Register, and the Danish Palliative Database was the method of study employed. All Danish patients who died from GI cancers from 2010 to 2020 comprised the study setting. There were 43,969 patients with GI cancers in the cohort, of whom 62% were hospitalized in the last 30 days of life, 41% of patients died in the hospital, 10% had surgery, 39% were subjected to a radiological examination during the last 30 days of life and 3% had antineoplastic treatment during the last 14 days of life. Among all types of GI cancers, pancreatic cancer was significantly associated with all outcomes of aggressive end-of-life care except surgery. Patients in specialized palliative care (SPC) had lower odds of receiving aggressive end-of-life care and dying in the hospital. We found that patients with comorbidity and those who were divorced had higher odds of being hospitalized at the end of life and dying in the hospital. Aggressive end-of-life care is associated with disease factors and socio-demographics. The potential to reduce aggressive end-of-life care is considerable in patients with GI cancer, as demonstrated by the impact of SPC. However, we need to address the needs of patients with GI cancer who do not receive SPC.

Effects of Integrating Palliative Care in Patients With Advanced Cancer: A Systematic Review and Meta-Analysis of Quality of Life and Psychological Outcomes.

Background: Patients with advanced cancer frequently have a wide range of mental and physical symptoms, making it difficult for them to communicate and make informed decisions. Necessitating the incorporation of palliative care in this population to meet their supportive care requirements. Objective: To investigate the effects of integrating Palliative care in advanced cancer patients. Methods: PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar databases were comprehensively and systematically searched for Randomized clinical trials (RCTs) published up to February 2024. According to the PICOS criteria, trials enrolling adult patients with advanced cancer subjected to PC were included. Moreover, a risk of bias assessment was performed using the Cochrane Risk of Bias tool, and statistical analyses were performed using the Review Manager software. Results: Only 13 RCTs with 3,294 advanced cancer patients were included in the final analysis. A pooled analysis of data from these trials revealed that patients subjected to PC had improved quality of life (QoL) scores than those receiving standard care (SMD: 0.18; 95% CI: 0.07 - 0.30; p = 0.002). However, no significant difference was observed in depression (SMD: -0.03; 95% CI: -0.16 - 0.10; p = 0.63), anxiety (SMD: - 0.04; 95% CI: -0.23 - 0.15; p = 0.69), and survival (OR: 0.81; 95% CI: 0.56 - 1.16; p = 0.25). Conclusion: Integrating PC in patients with advanced cancer results in improved QoL with limited effect on psychological distress symptoms.

American Society of Clinical Oncology guideline update on palliative care for patients with cancer: Addressing the reality gap.

Plain Language Summary We commend the American Society of Clinical Oncology for their sweeping recommendations and advocacy for integrated palliative care as part of oncologic care. The literature that exists is heterogeneous and at times difficult to interpret, and the panel has clearly described their systemic review process and subsequent rationale for their recommendations. Although we agree with the overall recommendations, there are significant practical limitations to their application that renders them aspirational. We worry that the guidelines may be impossible for most programs to fully achieve due to a variety of factors including specialty palliative care workforce shortages, limited health care system resource allocation to integrate palliative care widely in cancer care, and lack of financial support for the research necessary to better answer outstanding clinical and implementation questions. We outline briefly some practical ways in which these recommendations can be applied by existing cancer centers and health care systems. Ultimately, both financial and quality incentives will be necessary to push forward the expansion and integration of palliative care within our national health care system as a whole.

Increasing Access to Palliative Care in Cameroon: Progress, Gaps, and Recommendations.

Access to palliative care is an urgent global need. Countries with the greatest palliative care needs have limited access. In Cameroon, demand for palliative care is growing due to the rising incidence of life-limiting conditions. Identifying available palliative care services and programs could provide an understanding of access gaps and inform future roadmaps for palliative care development in the country. We aim to map available palliative care services, identify gaps and inform recommendations to promote early access to palliative care in Cameroon. We undertook a literature review of articles reporting any aspects of palliative care in Cameroon. We searched Embase, MEDLINE, Scopus, PsycINFO, CINAHL, PubMed and gray literature. Data were analyzed thematically using the World Health Organization model for the assessment of palliative care development. We identified 41 articles reporting 21 organizations with some form of palliative care services such as clinical services, education, advocacy and research. These were led mostly by individual health care providers or private and faith-based organizations. Major palliative care initiatives included training in the form of workshops, and adult and pediatric outpatient, in-patient and community-based palliative care. There were few reports of oral morphine production, community engagement, advocacy and palliative care research. Progress in palliative care development was reported in five regions of Cameroon over the last two decades. Findings suggest the need for an intersectoral approach including government, community, and health care stakeholders to achieve sustainable palliative care. This could potentially ensure equitable access to palliative care in Cameroon.

Association of Palliative Care With Readmission and Resource Utilization in Patients With Ovarian Cancer: A National Perspective.

Palliative care (PC) utilization in cancer care has been shown to alleviate symptoms, increase goals of care discussions, and reduce invasive end of life measures. This study examined the association of inpatient PC consultation with readmission and hospitalization costs among patients with ovarian cancer. All records for women (≥18years) hospitalized with a diagnosis of ovarian cancer were tabulated from the 2010-2020 Nationwide Readmissions Database. Multivariable logistic, Poisson, and linear regressions were used to evaluate the association of PC consultation during index hospitalization with length of stay, rates of 30-day non-elective readmission, time to readmission, as well as overall number of readmissions and hospitalization costs. Of an estimated 285,487 patients included, 25,957 (9.0%) received a PC consultation, with an increase from 5.1 to 11.7% (P < 0.001) across the period. Factors associated with use of PC included: increasing age (AOR 1.03/yr, 95% CI 1.03-1.03, P < 0.001) and Elixhauser comorbidity index (AOR 1.19/point, 95% CI 1.17-1.21). PC was associated with lower risk adjusted rates of 30 day (11.63%, 95% CI 11.0-12.3 vs 20.25%, 95% CI 20.0-20.6) non-elective readmission (P < 0.001). The adjusted incident rate ratio of readmission after PC consultation was 0.41 [0.38-0.43], P < 0.001. Patients receiving PC additionally had less cost associated with their index hospital stay; -$2,407 [-$2,669.86- -$2,144.43], P < 0.001). Inpatient PC consults appear to be associated with reduced medical readmissions for patients with ovarian cancer, as well as decreased hospital resource use, however disparities exist. Continued increase in access and early PC referral should be considered.

Early Palliative Care Following Aborted Cancer Surgery: Results of a Prospective Feasibility Trial

Background: Although resection is generally necessary for curative-intent treatment of most solid organ cancers, surgery is occasionally aborted due to intraoperative findings. Following aborted cancer surgery, patients have unique care needs that specialized palliative care (PC) providers may be best equipped to manage. We hypothesized that early ambulatory PC referral following aborted cancer surgery would be feasible and acceptable. Methods: This single-institution prospective clinical trial enrolled adult patients with gastrointestinal or hepatopancreatobiliary cancer with no prior PC exposure who had curative-intent oncologic surgery that was unexpectedly aborted. The primary endpoint was the completion of an ambulatory PC consultation within 30 days of enrollment. Secondary outcomes included changes in standardized measures of quality-of-life (QOL) and anxiety/depression during the 3-month follow-up. Results: Among 25 enrolled participants, the mean age was 65.3 ± 9.9 years, 68% were male, and 88% were White. The most common types of cancers were pancreatic (44%), hepatobiliary (20%), and colorectal (12%); reasons for aborting surgery were occult metastatic disease (52%) and local unresectability (36%). Only 13 of 25 (52%) met the primary endpoint of ambulatory PC within 30 days, less than the prespecified threshold of 70%. Overall, 16 (64%) patients completed ambulatory PC consultation a mean of 29.2 ± 15.8 days after enrollment. Of the 9 (36%) who did not, reasons included patient preference (n = 4), withdrawal from study (n = 1), lost to follow-up (n = 1), scheduling conflict (n = 1), and required inpatient PC before discharge (n = 2). Anxiety (4.94 ± 3.56 vs 3.35 ± 2.60, P = 0.06), depression (4.18 ± 4.02 vs 4.76 ± 3.44, P = 0.49), and QOL (82.44 ± 11.41 vs 82.03 ± 15.37, P = 0.92) scores did not significantly differ at 3-month follow-up compared to baseline. Conclusions: Barriers to early ambulatory palliative care consultation exist after aborted cancer surgery. Given the unique and complex care needs of this patient population, additional research is needed to optimize supportive care strategies.

A Prospective Longitudinal Study to Demonstrate the Utility of the Palliative Prognostic Index in Forecasting the Short-term Survival of Patients with Advanced Cancer in India.

In this study, our primary objectives were to validate the palliative prognostic index (PPI) tool in the context of palliative care for patients with advanced cancer. Specifically, we aimed to assess the accuracy of the PPI in predicting actual survival in these patients through prospective validation. To achieve our objectives, we enrolled a cohort of 227 advanced cancer patients receiving palliative care. The study population comprised 132 (58.1%) men and 95 (41.9%) women, with a median age of 52 years (Range: 20-81). Among them, 56 (24.7%) underwent chemotherapy, and 26 (11.5%) underwent palliative radiotherapy. We utilised the PPI score to categorise patients into three prognostic groups: (a) PPI score <4 indicating likely survival of more than 6 weeks; (b) PPI score 4-6 indicating likely survival shorter than 6 weeks; and (c) PPI score >6 indicating likely survival <3 weeks. Through our analysis, we found that the PPI demonstrated limited predictive capabilities, particularly for short-term survival (<3 weeks). The PPI's performance metrics included a positive predictive value of 45.24%, a negative predictive value of 100%, a sensitivity of 100.00% and a specificity of 88.94%. In conclusion, our study establishes the limited reliability of the PPI in predicting short-term survival (<3 weeks) among patients in palliative care with advanced cancer. These findings underscore the PPI's potential as a valuable tool for healthcare professionals, aiding in the development of treatment plans and facilitating discussions on end-of-life care options with patients and their families. In addition, the PPI may assist healthcare professionals in identifying individuals who could benefit from more aggressive interventions or those approaching the end of life, thereby guiding the provision of additional support and care.

The impact of an emercency form on the place of death of palliative care patients

Apilot study conducted by our research group in 2019 showed that adecision made in advance about the transfer of palliative care patients documented within the emergency information was associated with the actual place of death, thus realizing the patient's wishes regarding the place of death. There were also details on how the scope, duration, and frequency of home visits by mobile palliative care teams should be designed in order to fulfill patients' wishes regarding the place of death. Systematic reviews point to adiscrepancy between preferred and actual places of death and alack of prospective studies and data to support patients and their caregivers.The current observational study lasted one year, included all mobile palliative care teams for adults working in Styria and collected data from atotal of 1425 patients (52.6% men). The median age at the time of death was 78.1 years (IQR = 17.4). 76.9% of the sample were cancer patients. Other diseases included cardiovascular (6.3%), neurological (4.1%) and respiratory diseases (2.3%).The emergency information used in this study was an optimized version of the emergency information used in the 2019 pilot, based on input from all palliative care teams who participated in 2019.Atotal of 109 patients (7.6%) of the entire sample took part in the intervention (emergency information). Of these, 85individuals (78.9% of the intervention group) indicated apreference for on-side treatment, i.e., without transfer. Only 8patients (7.3%) indicated apreference for transfer and 16 (14.7%) did not indicate apreference. Of the 85patients who did not wish to be transferred, 75 (88.2%) died at home, i.e., in around 9out of 10cases the patient's wishes were complied with. In contrast, of the 8people who requested transfer, only 3 (37.5%) died at home, i.e., the majority (5or 62.5%) died in hospital or apalliative care unit, indicating that the patient's wishes were complied with in the majority of cases.The preference expressed in the emergency information for on-site treatment and against transfer was associated with amore than five times higher odds (p < 0.001) of actually dying at home. The preference expressed in the emergency information increased the probability of dying at home from 63% in the control group to 89% in the intervention group.There was also asignificant difference according to the number of medical contacts, i.e. patients who took part in the intervention and did not wish to be transferred had twice as many contacts with physicians (p = 0.031).The results of the logistic regression model also suggested an influence of age, disease and intensity of care by physicians on the odds of dying at home: Older people and the minority of palliative care patients who did not suffer from cancer had higher odds of dying at home than those with cancer. While there was no correlation between the duration of care and the total number of care contacts, the odds of dying at home increased with the number of medical contacts (+7% per contact).