Palliative Patients Research Articles

Palliative aspects in clinical acute and emergency medicine as well as intensive care medicine : Consensus paper of the DGIIN, DGK, DGP, DGHO, DGfN, DGNI, DGG, DGAI, DGINA and DGPalliativmedizin

The timely integration of palliative medicine is an important component in the treatment of various advanced diseases. While aGerman S‑3-guideline on palliative medicine exists for patients with incurable cancer, arecommendation for non-oncological patients and especially for palliative patients presenting in the emergency department or intensive care unit is missing to date. Based on the present consensus paper, the palliative care aspects of the respective medical disciplines are addressed. The timely integration of palliative care aims to improve quality of life and symptom control in clinical acute and emergency medicine as well as intensive care.

Perceptions of an educational intervention for family caregivers of palliative care patients.

Nursing interventions aimed at family caregivers of palliative cancer patients require not only an objective evaluation, but also subjective consideration of their contributions, and a qualitative evaluation that provides an in-depth understanding of these interventions. This study aimed to explore the perceptions that family caregivers of palliative cancer patients had of the nursing intervention, PalliActive Caregivers, in reducing the uncertainty associated with illness and improving the caregiver's quality of life. A qualitative approach with content analysis was used. Telephone interviews were conducted with 23 caregivers who participated in the intervention. Five themes emerged from the content analysis: consolidating physical care, adopting a positive attitude, strengthening the support available to the caregiver, strengthening spirituality and strengthening relationships. The themes showed a positive impact of the intervention on aspects such as the caregiver's ability to cope, spirituality and social support of caregivers. The results also indicated the possibility of conducting this type of study to identify other assessment variables for future interventions.

Advanced directives’ knowledge among Portuguese palliative patients and caregivers: do the sociodemographic factors influence it? A cross-sectional survey

BackgroundThe influence of demographic factors on the completion and knowledge of the Portuguese Advance Directives (PAD) and the Health Care Proxy’s (HCP) role is still not clear.ObjectivesTo identify sociodemographic features associated with knowledge and adherence to PAD and HCP in palliative care.DesignCross-Sectional analysis of the sociodemographic data, PAD and HCP role knowledge, and PAD Register from a group of Portuguese palliative patients and their caregivers enrolled on the DAVPAL trial to test the PAD efficacy in promoting better concordance between patients and caregivers.ParticipantsOne hundred twenty participants (60 palliative patients and 60 caregivers).MethodsAfter enrollment, the participants' sociodemographic data was acquired, their knowledge of PAD and the role of an HCP was questioned, and their prior register of the PAD was asked.Results60 patients and 60 caregivers were included (n=120), with differences among them regarding age (p<.001), gender (p=.003), education (p<.001), job (p<.001), marital status (p=.043), and access to the internet (p=.003), but not regarding religion (p=.21). Only 13.3% of the participants were aware of PAD, 15.0% were aware of the HCP role, and 5.0% had previously filled a PAD. Religious beliefs (Non-Catholic) were the only sociodemographic factor significantly related to these three topics.ConclusionsThere is low awareness of PAD and the HCP’s role in palliative care, and there is higher knowledge on these topics among non-Catholic individuals. End-of-life decisions seem to be influenced by similarities in religious beliefs between patients and HCP. Improving education is necessary, namely in palliative care.Trial registrationClinicalTrials.gov ID NCT05090072. Retrospectively registered on 22/10/2021.

The importance of physical therapy and occupational therapy in palliative and hospice medicine (review)

Higher level of functional incapacity and invalidity is noted in palliative patients, as a result of disease progression, which is the reason for a significant decrease in the quality of life not only of these patients, but also of the family members who care for them. Physical therapy and occupational therapy are aimed at improving the patient's quality of life through rehabilitation measures to restore body function, ensure physical independence and activity, optimal physical condition and well-being, and patient adaptation in the environment. Aim: to review modern literary sources regarding the relevance of physical therapy and occupational therapy in palliative and hospice care. The search for literary sources was carried out in international scientometric databases: PubMed, Scopus, Web of Science, Google Scholar. The search depth is 13 years (from 2010 to 2022). The review indicates that physical therapy and occupational therapy in palliative and hospice medicine around the world are not used enough today. These two specialties of interdisciplinary treatment in palliative and hospice medicine play an important integral role, which is manifested in improving the quality of life of both patients and their family members who care for them through the use of a wide variety of methods. Hospice physical therapists not only help patients to support/keep functional abilities as long as possible, but also to reduce the burden on persons who care for terminally ill patients. Physical and occupational therapy have numerous benefits for patients with progressive life-threatening illnesses in palliative and hospice care. Physical therapy in palliative and hospice care can have a preventive, educational, and/or supportive function depending on the patient's situation. There is especially large deficiency in palliative physical therapy and occupational therapy among adolescents and young people, which requires wide implementation with high-quality training of relevant specialists. Physical therapy and occupational therapy play an important role in palliative and hospice care; all patients in palliative and hospice care, regardless of illness or severity, should have access to physical and occupational therapy based on individual needs.

Peculiarities of using the SF-36 questionnaire in palliative neurological patients

Assessment of the quality of life of patients is an important source of information about the severity of their disease, the dynamics of their condition, the effectiveness of medical interventions and medical and social support, and at the same time about the effectiveness of medical and social programs at the local and state levels. The standard SF-36 questionnaire contains questions about the physical activity of patients who do not correspond to the physical status (ability to move independently) of the vast majority of palliative patients. The SF-36 questionnaire was modified to determine the quality of life of neurological patients treated in the Kharkiv hospice in 2022. The analysis of literary sources in the Google Scholar, PubMed and ResearchGate databases showed the absence of already modified questionnaires for palliative patients with a neurological profile, but also confirmed the legitimacy of such a modification. Further research was conducted to determine the minimum number of patients who should be interviewed using a modified questionnaire with a sufficient level of representativeness according to the selected method of calculating the median of the binomial distribution. It was determined that the minimum necessary number of patients to be interviewed is 47 people, each of whom was in treatment for at least 330 days per year. The median of the defined group with a deviation was (45±1) people, which indicates the need to continue in 2023 the survey started in 2022. Expansion of the group of interviewed patients should be carried out taking into account the gender structure of the group (the ratio of men to women should be 1:3), age (at least 90% should be aged 60 and over) and the main palliative diagnosis (90% of the selected patients should be from lesions of the central nervous system, even among cancer patients and patients with HIV/AIDS). The need to continue the survey is indicated in the perspectives of further research. Keywords: quality of life, HRQOL, IQOLA, palliative and hospice care, modification of questionnaires.

Religious and Spiritual assistance of people in palliative care. Practical Assessment

"The primary purpose of this study is to understand if/how patients of hospice healthcare require ‘Spiritual’ or/and ‘Religious’ assistance and if its involvement in palliative care helps greatly. We have built a correlative of two scales and administrated them on the same sample, along with complete demographics questions to a group of people under palliative care and several people directly connected with patients, relatives- families. This methodological study is designed to assess the reliability and validity of two scales simultaneously for the same terminally ill patients (TIP): Paloutzian and Ellison’s (1982) Spiritual Well-being Scale. The scale was administered to 49 individuals, of which 45 are patients and 4 family members caring for a terminally ill relative. Background: Coping is a multifactorial and individual process related to responding to stressful situations, such as being a caregiver of a person with health conditions or terminal illness [such as in hospice]. Spiritual [S] / religious [R] coping is an essential internal resource used by individuals enduring stressful situations or, in this particular case, confronting imminent death. Instruments: The 14-item Brief RCOPE is widely used to assess religious coping. The other instrument we have used for S/R assessment is the Spiritual Well-Being (SWB) Scale, a general measure of the subjective quality of life. Neither one is available in the Romanian version Ciocan Tudor-Cosmin (2023) developed following Romanian culture. He worked with Professor Ray Paloutzian - author of the latter scale - to translate and validate the use of the translated scales. Objective: To investigate the S/RWB among palliative care patients in Romania and to identify the correlates of Spiritual and Religious Well-Being. Secondary: To translate, adapt and validate both the 14-item Brief RCOPE and SWBS in Romanian for caregivers of palliative patients facing death. Method: The methodological guideline provided by Ray Paloutzian and Craig W. Ellison was used to examine the psychometric properties of SWBS, while the manual provided by Kenneth Pargament on his website helped us accommodate the Brief RCOPE to Romanian culture and understanding. Results: The linguistic and conceptual equivalence of the scales was determined. The internal consistency was acceptable (Cronbach’s a = 0.891 for SWBS and a = 0.798 for RCOPE). The Principal Axis Factor (PAF) analysis with varimax rotation identified two factors comprising 13 items, and one item was excluded from the scale (14/RCOPE). The faith subscale (SWBS) showed similar distributions. Christians engaged in religious activities reported higher SWB in the meaning and peace subscale than patients without religious attendance. In the multivariate analysis, religious Frequency (P &lt; 0.001), and individual spiritual activities (P &lt; 0.003) were significantly related to a greater SWB. Conclusion: The Romanian versions of the SWBS and Brief RCOPE are reliable and valid measures for assessing both the spiritual and religious coping of patients in hospice, their families, and their caregivers. Although faith practices may be beneficial to improve spiritual well-being among Orthodox Christians (the majority in Romania), further research is needed to determine what individual spiritual activities can be supported by Orthodox Christians positively engaged – since they are very skeptical about practices other than religious ones, introduced by the traditional Church."

Monocytes in the Characterization of Pain in Palliative Patients with Severe Dementia-A Pilot Study.

In assessing and managing pain, when obtaining a self-report is impossible, therapeutic decision-making becomes more challenging. This study aimed to investigate whether monocytes and some membrane monocyte proteins, identified as a cluster of differentiation (CD), could be potential non-invasive peripheral biomarkers in identifying and characterizing pain in patients with severe dementia. We used 53 blood samples from non-oncological palliative patients, 44 patients with pain (38 of whom had dementia) and 0 without pain or dementia (controls). We evaluated the levels of monocytes and their subtypes, including classic, intermediate, and non-classic, and characterized the levels of specific phenotypic markers, namely CD11c, CD86, CD163, and CD206. We found that the relative concentrations of monocytes, particularly the percentage of classic monocytes, may be a helpful pain biomarker. Furthermore, the CD11c expression levels were significantly higher in patients with mixed pain, while CD163 and CD206 expression levels were significantly higher in patients with nociceptive pain. These findings suggest that the levels of monocytes, particularly the classic subtype, and their phenotype markers CD11c, CD163, and CD206 could serve as pain biomarkers in patients with severe dementia.

A survey of genetic and palliative care health professionals’ views of integrating genetics into palliative care

Genetic counselling and testing have utility for people with palliative care needs and their families. However, genetic and palliative care health professionals have described difficulties initiating palliative-genetic discussions. Between March and July 2022, we received n = 73 surveys (6% response rate) from genetic and palliative care health professionals in Australia and New Zealand that assessed and compared barriers and facilitators. The main perceived barrier to both groups was palliative care health professionals’ lack of genetic knowledge (44%). Most palliative care health professionals were ‘not at all confident’ performing several activities, including discussing DNA banking (52%) and knowing their legal responsibilities when sharing genetic information (58%). The most frequently selected facilitator for genetic health professionals was fostering close relationships with palliative care health professionals (52%), while palliative care health professionals indicated a genetic referral template (51%) would be of assistance. Almost all participants agreed genetic discussions do not undermine the central ethos of palliative care (87%). Fewer palliative care health professionals considered themselves well situated to have genetic discussions with a palliative patient’s family compared to genetic health professionals (p = 0.014). Our results suggest that genetic and palliative care health professionals support integrating genetics into palliative care, although refinement of the palliative care health professionals’ role in this process is required. We have identified intervention targets to overcome barriers related to knowledge and confidence, which ought to be integrated into future interventions designed to support health professionals deliver the benefits of genetic information to people with palliative care needs and their families.

A clinical case of multidrug-resistant tuberculosis complicated by esophageal-pulmonary fistula in a palliative patient

We present our own observation of the multidrug-resistant tuberculosis course case, complicated by esophageal-pulmonary fistula, in a palliative patient who was treated in the Pulmonary Tuberculosis Department No. 2 of the Zaporizhzhia Regional Phthisio-pulmonology Clinical Treatment and Diagnostic Center. An esophago-pulmonary fistula in the patient with multidrug-resistant tuberculosis was detected in the area of the right upper lobectomy, wich was perfomed 8.5 years ago. The patient was on palliative treatment for almost 6 years before hospital admission when a tubercular esophago-pulmonary fistula was diagnosed. The patient was admitted to the hospital in serious condition, which significantly worsened over the course of a month. A decision was made to perform a computed tomography of the chest cavity (Сhest CT) as the patient's cough and chest pain were associated with liquid food intake. Esophageal-pulmonary fistula was detected on the Chest CT as a linear air defect of the esophageal wall up to 1.5 mm, which conjugates with the cavern in the upper lobe of the right lung. The small size of the esophageal-pulmonary fistula (1.5 mm) indicates the timeliness of its detection. In the presented case, the patient is on palliative treatment. Therefore, in order to prevent the progression of the esophageal-pulmonary fistula, feeding through a nasogastric tube and antibiotic therapy were prescribed. Thus, if a palliative patient with multidrug-resistant tuberculosis has a paroxysmal cough that occurs during or immediately after eating, the use of Chest CT is relevant for the timely diagnosis of eso­phagealpulmonary fistula. If such a fistula is diagnosed, it is necessary to use parenteral feeding and antibiotic therapy.

Diagnostic assessment of the comfort of palliative patients: scoping review protocol

Introduction: The competence to evaluate is essential in any profession in the health area. The concept of comfort is intrinsically linked to palliative care, being a concern shared by any health professional. These, when analyzing, must know what they are looking for and what they should expect to find. Objectives: To map how health professionals assess people's comfort in palliative and end-of-life situations. Methods: will follow the methodology proposed by the Johanna Briggs Institute (JBI) for scoping reviews. Considered studies in Spanish, English and Portuguese, without temporal definition. Databases to search: MEDLINE Complete, Academic Search Complete, CINAHL Complete and Mediclatina (EBSCOhost), Scopus and Web of Science Core Collection. For unpublished studies, the RCAAP (open access repository in Portugal) will be used. Two independent reviewers will evaluate the articles and extract the data using a specific tool created. In case of discrepancies, a third reviewer will be requested. Results: It is expected to map the data used by health professionals in assessing the comfort of people in palliative care. Conclusions: This review will make it possible to identify instruments used to collect data and what is the professional competence of the group that has in its practice the assessment of comfort. This can form the basis for a systematic review and/or help identify gaps where it may be important to invest in the future. This protocol was registered on the OSF platform with the DOI: 10.17605/OSF.IO/UF52X.

Palliative aspects in clinical acute and emergency medicine as well as intensive care medicine : Consensus paper of the DGIIN, DGK, DGP, DGHO, DGfN, DGNI, DGG, DGAI, DGINA and DGPalliativmedizin

The integration of palliative medicine is an important component in the treatment of various advanced diseases. While aGerman S3guideline on palliative medicine exists for patients with incurable cancer, arecommendation for non-oncological patients and especially for palliative patients presenting in the emergency department or intensive care unit is missing to date. Based on the present consensus paper, the palliative care aspects of the respective medical disciplines are addressed. The timely integration of palliative care aims to improve quality of life and symptom control in clinical acute and emergency medicine as well as intensive care.

Perceptions of Australian Palliative Medicine Specialists Toward Acupuncture for Palliative Care.

Background: With increasing multidisciplinary care strategies, palliative medicine practitioner perceptions toward acupuncture integration are significant. Objective: To evaluate acupuncture availability and acceptability in Australian palliative care. Outcomes: (1) Domains of the survey included participant characteristics, (2) workplace availability, (3) personal attitudes, and (4) recommendation likelihood. Design: An online REDCap survey of Australian palliative medicine practitioners was administered. Results: Acupuncture was mostly not available/permitted at workplaces (45.2%) due to cost/funding (57.1%) and limited evidence (57.1%). When available by workplace (24.2%) or affiliated service (4.8%), doctors mostly administered acupuncture (66.7%). Respondents were not up to date with current research (71.4%). Referral likelihood increased with confidence in provider (80.0%), workplace availability (77.1%), and patient prior/current use (77.1%). Patient acupuncture discussions were rare (62.9%) with barriers of effectiveness uncertainty (71.4%) and limited knowledge of availability (57.1%). Conclusion: Despite available integrative services and acceptability by Australian palliative medicine practitioners, utilization is low. Further research into acupuncture effectiveness for palliative symptoms, feasibility, and patient acceptability is required.

The Effects of the Ward Environment and Language in Palliative Care: A Qualitative Exploratory Study of Victorian Nurses' Perspectives.

The current study aimed to explore regional nurses' perspectives of how bad news is delivered and the physical, natural, social, and symbolic environments where these conversations occur. In regional hospitals within Victoria, Australia, palliative and end-of-life patients are cared for in acute wards that are often busy, noisy, and do not have a palliative psychosocial focus. On the other hand, Palliative Care Units (PCUs) have more home-like dedicated spaces, yet nearly all these facilities are in metropolitan areas. Diagnostic/prognostic (bad news) conversations about life-limiting illnesses often occur at the bedside in both environments. Nurses providing palliative or end-of-life care in regional or metropolitan Victorian hospital inpatient wards were invited to interview and recruited through social media and snowballing. Six semi-structured, audio-recorded online interviews were conducted between March and May 2022, and themes were developed using reflexive thematic analysis. Semi-structured online interviews were conducted with six female, registered nurses, four of whom worked in regional Victorian hospitals and two in metropolitan PCUs as Nurse Unit Managers. Three central themes were developed: "conducting family meetings," "palliative care practice," and "the environment matters." A therapeutic environment for palliative patients and their families consists of home-like ambience and aesthetics and a psychosocial environment created by staff who can provide holistic palliative care. Holistic palliative care requires mentoring and mirroring of expert practice to increase the expertise and capacity of the palliative care workforce in acute general hospital wards.

Problems in preparation of legally binding documents for oncological and palliative patients and their solutions

Introduction. Oncological and palliative patients undergo treatment causing adverse events including mental and cognitive disorders leading to their inability to express their wishes in the legal sense. This affects the possibility of preparation of documents on disposal of property: wills, donation or sale and purchase agreements, letters of authorization.Aim. To consider problems arising when an oncological or palliative patient decides to dispose of their property and to suggest solutions to these problems.Materials and methods. An analysis of the current normative legal acts and legal precedents in the Russian Federation in the context of property disposal by severely ill patients was performed. Clinical guidelines on treatment of chronic pain in oncological and palliative patients, as well as Russian and international approaches to this therapy were considered.Results. Legal solutions for the considered problem appear to lack effectiveness. Use of tafalgin in treatment of severely ill patients can decrease risks and ease the process of preparation of documents on property disposal. This medication is indicated for chronic pain syndrome and unlike other pharmaceuticals is not an opioid analgesic and does not have severe side effects. Administration of tafalgin allows patients to retain mental clarity and avoid the risk of physical and psychological addiction.Conclusion. It is necessary to continue the search for new therapeutic approaches to chronic pain treatment taking into account needs and special aspects of oncological and palliative patients which would allow them to preserve full legal competency and dispose of their property without legal risks.

Patient expectations and understanding of treatment intent in Belize.

e24188 Background: Discordance between patient understanding and physician recorded treatment intent is well documented in high income countries. A large fraction of patients report their palliative intent therapy is curative. We sought to find the discordance rate between patient and physician reported intent in Belize, a low- and middle-income country (LMIC) with a single public oncology clinic, founded in 2018, staffed by a single bilingual medical oncologist who is undertaking additional training in palliative care. In 2022, we surveyed established patients on chemotherapy to assess their understanding of treatment purpose. Methods: Approval was obtained at the Karl Heusner Memorial Hospital and the University of Rochester IRB prior to the study. Between February and March 2022, patients who consented were given a 21-question survey. Here we report on one portion of this survey. Patients with both patient and physician reported data were compared with a McNamar's exact test; a pre-specified exact logistic regression was run to examine potential predictors of patient/provider discordance (age, race, number of days from first chemotherapy to survey administration, patient's primary language). A p-value of 0.05 was used for significance. Results: 29 surveyed patients had both physician- and patient-reported treatment intent; surveys were administered a median of 42 days after first chemotherapy (IQR 26 – 116). 61% (18 of 29) of the sample was on palliative intent treatment. Median age was 51 (IQR 43 – 62) and cancer types were as follows: 45% breast, 24% GI, 24% gynecological, 3.4% head/neck, 3.4% lymphoma. 97% agreed their doctor spoke medical language they understand and 90% agreed they had enough information about their treatment. 31% mis-classified their treatment intent (p = 0.004). All 9 patients who mis-classified stated their palliative intent treatment was curative; this was 50% (9 of 18) of the palliative intent patients. We found no relationship between patient/provider discordance and age, race, number of days from first chemotherapy to survey administration, or patient’s primary language. Conclusions: We surveyed cancer patients in Belize and found that half of the patients on palliative intent therapy thought their treatment was curative. Despite this gap in understanding, 97% reported they understood the medical language being spoken and 90% of the patients agreed that they had good knowledge of their treatment. The amount of discordance described here is similar to reports in high income countries. Most palliative care, and palliative care research, is performed in high income settings. Implementation research with the aim of reducing physician/patient discordance in high-income countries should consider design elements that allow for adaptation to LMICs.

Palliative care as a component of high-value and cost-saving care during hospitalization for metastatic cancer.

6640 Background: Randomized controlled trials have demonstrated that palliative care can improve both quality of life and survival for outpatients with advanced cancer, but there is limited population-based data on the value of inpatient palliative care. We assessed palliative care as a component of high-value care among a nationally representative sample of inpatients with metastatic cancer. We further identified care, patient, and hospital characteristics significantly associated with high costs. Methods: This study analyzed hospitalizations of patients ≥18 years with a primary diagnosis of metastatic cancer from the National Inpatient Sample (covering 97% of the U.S. population) from 2010-2019. We utilized multivariable mixed-effects logistic regression to assess medical services (receipt of palliative care, invasive medical ventilation [IMV], systemic therapy), patient demographics, and hospital characteristics that were associated with higher charges billed to insurance and hospital costs. We utilized generalized linear mixed-effects models to determine cost savings associated with provision of palliative care. Results: Among 397,691 hospitalizations from 2010 to 2019, the median charge per admission increased by 24.9%, from $44,904 in 2010 to $56,098 in 2019, while the median hospital cost remained stable at $14,300. Receipt of inpatient palliative care was associated with significantly lower charges (Odds Ratio [OR], 0.62; 95% CI, 0.61-0.64; P &lt; .001) and costs (OR, 0.59; 95%CI, 0.58-0.61; P &lt; .001). Factors associated with high charges were receipt of invasive medical ventilation (P &lt; .001) or systemic therapy (P &lt; .001), Hispanic patients (P &lt; .001), and young age (18-49 years, P &lt; .001). For-profit hospitals were more likely to bill higher charges (OR, 5.05; 95%CI, 4.78-5.33, P &lt; .001) but less likely to incur high hospital costs (OR, 0.51; 95%CI, 0.48-0.54, P &lt; .001) than public hospitals. In adjusted generalized linear mixed effects regression, palliative care provision was associated with a $1,293 (-13.4%, P &lt; .001) reduction in costs per hospitalization compared to no palliative care, independent of receipt of invasive care and age. Significant interactions were observed between receipt of palliative care and patient age group (-9.6% for 18-49 years; -14.7% for ≥70 years), receipt of IMV (-6.4% for IMV receipt; -14.0% for no IMV), hospital ownership (-19.6% for for-profit; -10.5% for public), and year of hospitalization (-15.4% for 2010; -8.9% for 2019). Conclusions: Inpatient palliative care is associated with reduced hospital costs for patients with metastatic cancer, irrespective of age and receipt of aggressive interventions. Assuming inpatient palliative care receipt increases by 50%, we estimate $4,045,000 in annual national savings. Integration of inpatient palliative care may de-escalate costs incurred through low-value inpatient interventions.

Availability of palliative specialty care for adults in community oncology: Results from the 2022 NCORP landscape assessment.

e24125 Background: Palliative care promotes timely symptom management, and care planning and improves quality of life in oncology patients. About 60% of community oncology practices sampled in 2015 had outpatient palliative care. This study updates estimates of palliative care resources in community oncology. Methods: Questions from the 2022 Landscape Assessment of National Cancer Institute Community Oncology Research Program (NCORP) (funding provided by 2UG1CA189824) assessed the availability of specialist palliative care providers and ancillary care services, including utilization of advanced practice providers (APPs). Descriptive statistics describe availability of providers and services. Multivariable logistic regression was used to identify practice characteristics associated with palliative care specialist availability in 2022. Differences in rates of palliative care specialists, outpatient palliative care, APPs and patient portal use between 2015 and 2022 assessment results were assessed using Chi-Square tests, assuming independent time snapshots of general population characteristics. Results: Most community oncology practices sampled in 2015 had palliative care specialists (76%) and 62% of practices reported having outpatient palliative care. Of the 259 non-pediatric exclusive NCORP practice groups included in the 2022 analyses (Table 1), significantly more had palliative care specialists (86%; p = 0.003) and offered palliative care in the outpatient setting (76%; p = 0.001). Most practices utilized APPs (92%) and had a patient portal (95%), while only 41% had a survivorship clinic. Multivariable analyses demonstrated practices with more adult oncology providers (OR = 1.03, p = 0.039) and those with a designated survivorship clinic (OR = 3.16, p = 0.001), were significantly more likely to have specialty palliative care in the outpatient setting. Conclusions: More practices reported availability of palliative care specialists and outpatient services in community oncology practices in 2022 compared to 2015, with more oncology providers being associated with increased odds of having outpatient specialty palliative care in 2022. Smaller community oncology practices with fewer providers may need support to expand their capacity to provide palliative care. [Table: see text]

Impact of Environment and Milieu Therapy in Palliative Care.

The collaborative approach offered by palliative care benefits both patients and their caregivers. They provide a system of support that enables patients to lead as active a life as possible. This integrative review aimed to find out whether milieu and environment therapy has a significant impact on palliative care patients. Analyses and summaries of seventeen (17) papers were completed. There were three themes identified: environmental factors for quality of life, milieu therapy in forms of arts and music, and milieu therapy is safe, structured, and psychotherapeutic. This review demonstrates that milieu and environment therapy may also help to reduce physical symptoms, such as pain, and enhance quality of life. The study suggests that even if there are many interventions for palliative patients, more research is needed to generate a more thorough evaluation of the efficacy of various environmental control components and milieu therapies for palliative care patients.

Nutritional Support in Terminal Patient

Malnutrition is a frequent problem in the situation of terminal illness. The indication of artificial nutritional support in these patients creates ethical conflicts that are difficult to resolve. Palliative care is a type of approach that seeks the humanization and wellbeing of patients with chronic conditions, regardless of the underlying disease. In this sense, seeking the joint participation of a multidisciplinary care team, the patient, and his or her family is the main goal. In patients in this situation, nutrition should be regarded as an approach that is able to provide benefits but that can also bear risks. Therefore, its indication should be subject to a careful and continuous evaluation. Indication for hydration and artificial nutrition (HAN) is based on respect for autonomy, beneficence, non-maleficence, and justice. Nutrition in palliative patients should be addressed in the same ways as other care processes, such as antibiotic therapy or mechanical ventilation. Therefore, HAN should be indicated to improve patient comfort and clinical outcomes, but when HAN results in suffering or discomfort, outweighing its benefits it should be contraindicated or discontinued. This paper suggests lines of action that can serve as clinical guidance, although decision-making must always be individualized, taking into account the balance between risks and benefits of this treatment modality. The patient's wishes must be given top priority.

Effect of Perioperative Palliative Care on Health-Related Quality of Life Among Patients Undergoing Surgery for Cancer

Involvement of palliative care specialists in the care of medical oncology patients has been repeatedly observed to improve patient-reported outcomes, but there is no analogous research in surgical oncology populations. To determine whether surgeon-palliative care team comanagement, compared with surgeon team alone management, improves patient-reported perioperative outcomes among patients pursuing curative-intent surgery for high morbidity and mortality upper gastrointestinal (GI) cancers. From October 20, 2018, to March 31, 2022, a patient-randomized clinical trial was conducted with patients and clinicians nonblinded but the analysis team blinded to allocation. The trial was conducted in 5 geographically diverse academic medical centers in the US. Individuals pursuing curative-intent surgery for an upper GI cancer who had received no previous specialist palliative care were eligible. Surgeons were encouraged to offer participation to all eligible patients. Surgeon-palliative care comanagement patients met with palliative care either in person or via telephone before surgery, 1 week after surgery, and 1, 2, and 3 months after surgery. For patients in the surgeon-alone group, surgeons were encouraged to follow National Comprehensive Cancer Network-recommended triggers for palliative care consultation. The primary outcome of the trial was patient-reported health-related quality of life at 3 months following the operation. Secondary outcomes were patient-reported mental and physical distress. Intention-to-treat analysis was performed. In total, 359 patients (175 [48.7%] men; mean [SD] age, 64.6 [10.7] years) were randomized to surgeon-alone (n = 177) or surgeon-palliative care comanagement (n = 182), with most patients (206 [57.4%]) undergoing pancreatic cancer surgery. No adverse events were associated with the intervention, and 11% of patients in the surgeon-alone and 90% in the surgeon-palliative care comanagement groups received palliative care consultation. There was no significant difference between study arms in outcomes at 3 months following the operation in patient-reported health-related quality of life (mean [SD], 138.54 [28.28] vs 136.90 [28.96]; P = .62), mental health (mean [SD], -0.07 [0.87] vs -0.07 [0.84]; P = .98), or overall number of deaths (6 [3.7%] vs 7 [4.1%]; P > .99). To date, this is the first multisite randomized clinical trial to evaluate perioperative palliative care and the earliest integration of palliative care into cancer care. Unlike in medical oncology practice, the data from this trial do not suggest palliative care-associated improvements in patient-reported outcomes among patients pursuing curative-intent surgeries for upper GI cancers. ClinicalTrials.gov Identifier: NCT03611309.