Palliative Care Plan Research Articles

Pain management in 2023

Pain is a frequent symptom for healthcare professionals in the community and in hospital. Appropriate management of pain begins with a precise and comprehensive assessment, whether acute or chronic. The available therapies are summarized below, so that they can be used as closely as possible to the pathophysiology of pain. Available drug analgesics are reinforced by non-drug interventions, which are increasingly present in the algology care offering. In 2023, the authorities have announced a new ten-year national plan for pain and palliative care. Proof that this public health issue, at the heart of caregivers' concerns, is also a priority for political leaders.

Decision on non-conveyance of patients suspected of COVID-19 in a novel arrangement with assessment visits by paramedics at home

BackgroundDuring the first weeks of the outbreak of the coronavirus disease 2019 (COVID-19), the North Denmark emergency medical services authorised paramedics to assess patients suspected of COVID-19 at home, and then decide if conveyance to a hospital was required. The aim of this study was to describe the cohort of patients who were assessed at home and their outcomes in terms of subsequent hospital visits and short-term mortality.MethodsThis was a historical cohort study in the North Denmark Region with consecutive inclusion of patients suspected of COVID-19 who were referred to a paramedic’s assessment visit by their general practitioner or an out-of-hours general practitioner. The study was conducted from 16 March to 20 May 2020. The outcomes were the proportion of non-conveyed patients who subsequently visited a hospital within 72 hours of the paramedic’s assessment visit and mortality at 3, 7 and 30 days. Mortality was estimated using a Poisson regression model with robust variance estimation.ResultsDuring the study period, 587 patients with a median age of 75 (IQR 59–84) years were referred to a paramedic’s assessment visit. Three of four patients (76.5%, 95% CI 72.8;79.9) were non-conveyed, and 13.1% (95% CI 10.2;16.6) of the non-conveyed patients were subsequently referred to a hospital within 72 hours of the paramedic’s assessment visit. Within 30 days from the paramedic’s assessment visit, mortality was 11.1% [95% CI 6.9;17.9] among patients directly conveyed to a hospital and 5.8% [95% CI 4.0;8.5] among non-conveyed patients. Medical record review revealed that deaths in the non-conveyed group had happened among patients with ‘do-not-resuscitate’ orders, palliative care plans, severe comorbidities, age ≥ 90 years or nursing home residents.ConclusionsThe majority (87%) of the non-conveyed patients did not visit a hospital for the following three days after a paramedic’s assessment visit. The study implies that this newly established prehospital arrangement served as a kind of gatekeeper for the region’s hospitals in regard to patients suspected of COVID-19. The study also demonstrates that implementation of non-conveyance protocols should be accompanied by careful and regular evaluation to ensure patient safety.

Spiritual well-being correlates with quality of life of both cancer and non-cancer patients in palliative care - further validation of EORTC QLQ-SWB32 in Finnish

BackgroundThe European Organisation for Research and Treatment of Cancer (EORTC) has developed the Spiritual Well-being Questionnaire (EORTC QLQ-SWB32), a measure of spiritual well-being validated with people receiving palliative care for cancer, although its usefulness is not restricted to that population. We aimed to translate and validate this tool in Finnish and to study the relationship between spiritual well-being (SWB) and quality of life (QOL).MethodsA Finnish translation was produced according to the guidelines of EORTC and included forward- and back-translations. Face, content, construct and convergence/divergence validity and reliability were studied in a prospective manner. QOL was assessed with EORTC QLQ-C30 and 15D questionnaires. Sixteen individuals participated in the pilot testing. 101 cancer patients drawn from oncology units, and 89 patients with other chronic diseases drawn from religious communities in different parts of the country participated in the validation stage. Retest was obtained from 16 individuals (8 cancer and 8 non-cancer patients). Inclusion criteria included patients with either a well-defined palliative care plan, or who would benefit from palliative care, as well as the capacity to understand and communicate in Finnish.ResultsThe translation appeared understandable and acceptable. Factorial analysis identified four scoring scales with high Cronbach alfa values: Relationship with Self (0.73), Relationship with Others (0.84), Relationship with Something Greater (0.82), Existential (0.81), and, additionally, a scale on Relationship with God (0.85). There was a significant correlation between SWB and QOL in all participants.ConclusionsThe Finnish translation of EORTC QLQ-SWB32 is a valid and reliable measure both for research and clinical practice. SWB is correlated with QOL in cancer and non-cancer patients undergoing palliative care or who are eligible for it.

Deliberative dialogue on euthanasia in girls, boys and adolescents. Prequel to the Cabildo Ciudadano (Citizen Council) carried out in Colombia.

To date, there is a lack of published information on the utilization of the Deliberative dialogue methodology and the right to a dignified death in minors under 18 years of age in Colombia and Latin America. To examine the issue of children and adolescents' entitlement to a dignified death, including the criteria for exclusion, and to formulate a comprehensive plan for pediatric palliative care. A public policy document will be created with the aim of supporting the implementation of Resolution 825/2018. Participatory Action Research utilizing a Deliberative dialogue methods that has been adapted based on feminist epistemological principles. The outcome of the exercise was the production of a document containing Public Policy recommendations regarding euthanasia in minors and its submission to the Ministry of Health and Social Protection of Colombia a few days prior to the release of the Resolution regulating the right to a dignified death for this population. Additionally, the conclusions of this event enabled the creation of a guide for the implementation of (Cabildos Ciudadanos) Citizen Council, in which girls, boys, and adolescents are included, trans-disciplinarity is encouraged, and feminist epistemological foundations are explored. The deliberative dialogue method may serve as a cost-efficient alternative to replace or complement participatory approaches utilized in the development of public health guidelines and policies.

Building an action plan to tackle palliative care inequality through multi-stakeholder platforms.

To achieve universal care and overcome existing barriers, the most effective strategy is to devise an action plan that incorporates palliative care into primary health care (PHC), as recommended by the World Health Organization's (WHO) Astana Declaration. In Colombia, a country with an upper-middle-income status, about 128,000 individuals experience severe health-related suffering (SHS) that necessitates palliative care. Although the country's healthcare system has made steady strides in the integration and development of palliative care, there is still no national plan in place for palliative care. Build up Colombia's palliative care plan through stakeholder consensus. Based on the participatory action research method and the multi-stakeholder platforms model, this study convened 142 stakeholders from different levels of the health system (patient representatives, journalists, health professionals, government entities, insurance companies, universities, and drug regulatory authorities). The national plan aims to achieve its objectives through a series of strategic actions. These include integrating and diversifying palliative care services, improving access to opioids, increasing palliative care education, promoting community-based palliative care programs, securing funding, and implementing a regulatory framework for palliative care by public policymakers. The national palliative care is an alliance that aims to reduce palliative care inequity in Colombia by 2026 by empowering stakeholders nationwide to collaborate around specific goals and objectives.

Perceived policy-related barriers to palliative care implementation: a qualitative descriptive study.

Ethiopia has a national palliative care guideline, and palliative care is explicitly recognised in the country's healthcare policy and health sector transformation plans. However, palliative care is not fully delivered in the regional public hospitals and primary health care units. This study explores perceived policy barriers to deliver palliative care services in rural and regional healthcare settings, which primary healthcare units largely serve. Face-to-face interviews were conducted in a rural region of Ethiopia. Forty-two participants were recruited from a variety of health settings including primary, secondary and tertiary levels across the region. Interviews were conducted with policymakers from the regional health bureau, pharmacists, medical doctors, health officers (clinical officers) and nurses, including chief nursing officers in leadership roles at all levels of healthcare institutions. Data analysed using thematic analysis. Participants described several barriers related to healthcare policy, including lack of government priority and focus on palliative care; lack of health professionals' awareness of the national palliative care plans and guidelines; and lack of palliative care integration into the existing healthcare system and the national budget. Participants remarked that palliative care services in the region were mainly limited to HIV patients, often managed with external support and, hence unsustainable. Policy priority and focus is a fundamental component for the provision of palliative care because lack of focus and support from the government have led to inadequate access to palliative care for all in need. Hence, as participants suggested, palliative care should be integrated into all healthcare levels, particularly into the primary health care units and the health extension programme, to facilitate health extension workers to support millions living in rural areas.

<br/> A NECESSIDADE DA LITERACIA EM SAÚDE SOBRE OS CUIDADOS PALIATIVOS <br/>

Palliative care should be available to all people with chronic and life-threatening illnesses, but despite all the efforts of the Portuguese Association of Palliative Care and the National Commission for Palliative Care, there are still Portuguese people with palliative needs who do not have access to these. One of the recommendations of the Strategic Plans for the Development of Palliative Care (PEDCP) is that the curricular unit of palliative care be integrated into all pre-graduate training courses in the area of health so that health professionals may be provided with basic training in palliative care. In addition to this recommendation, palliative care should be incorporated into all levels of care to which the population has access in Portugal, Primary Health Care (CSP), Hospital Health Care (CSH) and Integrated Long-term Care (CCI), the greater the involvement of all stakeholders through collective and social action, the more effective this may become. Thus, palliative care reduces the length of hospital stay, readmissions, therapeutic futility, the use of emergency services and intensive care, and, consequently, decreases health costs. Therefore, this article aims to outline a health literacy plan for palliative care for the Portuguese population residing in Portugal.

917. Infectious Diseases Consult Improves Management of Candidemia

Abstract Background Infectious Diseases consultations (IDC) have been associated with improved outcomes in multiple disease states with high morbidity/mortality like invasive candidiasis. This study evaluated management of candidemia at Carilion Clinic in patient with and without IDC. Methods A retrospective, observational cohort study was performed among hospitalized patients with candidemia who either received or did not receive an IDC between January 2014 and August 2020. Patients included had Candida species from at least one blood culture. Exclusions were death or transfer to a palliative care plan within 48 hours of culture, cultures from an outside facility, and patients that were pregnant or incarcerated. The primary outcome was a composite of all-cause mortality and recurrent candidemia within 90 days. Secondary outcomes included compliance with candidemia management bundle items such as echocardiography, ophthalmologic evaluation, receipt of susceptible antifungal, source control and repeated blood cultures. Results A total of 194 patients were included in the study. The population was 50.3% male sex and mean ± standard deviation age was 57.8 ± 17.2 years. In the study timeframe, 131 patients received an IDC while 62 did not receive an IDC. ICU level of care, vasopressor requirement and Candida Score ≥ 3 were all similar between the two groups. Candida albicans was the most common species in IDC and non-IDC groups (48.1% vs. 41.1%). Empiric therapy was more commonly an echinocandin in 138/194 (71.1%) and definitive therapy was fluconazole in 117/194 (60.3%). An improved primary composite outcome was observed in the IDC group (34.9% vs. 21.4%, p = 0.043). Patients receiving IDC had a higher rate of repeated cultures (100% vs. 92%) and ophthalmologic examination (54.2% vs. 20.6%). More patients in the IDC group were found to have infective endocarditis (10.7% vs. 1.6%, p = 0.04) as they were more likely to have echocardiographic imaging (86.2% vs. 57.1%, p< 0.0001). The median time to susceptible antifungal was 43 (27-61) hours without ICD and 35 (27-52) hours compared in those with IDC. Conclusion A more comprehensive workup by IDC was associated with more identification of endocarditis and less recurrence of candidemia within 90 days. Disclosures Nathan Everson, PharmD, BCIDP, Merck: Advisor/Consultant|Merck: Grant/Research Support Nathan Everson, PharmD, BCIDP, Merck: Advisor/Consultant|Merck: Grant/Research Support Nathan Everson, PharmD, BCIDP, Merck: Advisor/Consultant|Merck: Grant/Research Support Lauren McDaniel, PharmD, BCIDP, Merck: Grant/Research Support.

Identifying, exploring and integrating the spiritual dimension in proactive care planning: A mixed methods evaluation of a communication training intervention for multidisciplinary palliative care teams

Background: Patients receiving palliative care value attention given to their spiritual needs. However, these needs often remain unexplored as healthcare professionals lack the skills to identify and explore them and to integrate this information into care plans. Aim: To evaluate the effects of an interactive communication training intervention for palliative care teams in order to identify and explore the spiritual dimension and integrate it in patients’ care plans. Design: A mixed methods pre-post study, including self-assessment questionnaires, evaluation of videos with simulated consultations (applied competence) and medical record review (implementation). Setting/participants: Three palliative care teams including nurses (N = 21), physicians (N = 14) and spiritual caregivers (N = 3). Results: The questionnaires showed an improvement on ‘Patient and family-centred communication’ of the End-of-life professional caregiver survey (+0.37, p < 0.01; the 8-item S-EOLC (+0.54, p < 0.01) and regarding the Spiritual Care Competence Scale, on the three subscales used (+0.27, p < 0.01, +0.29, p < 0.01 and +0.32, p < 0.01). Video evaluations showed increased attention being paid to patient’s aims and needs. The medical record review showed an increase in anticipation on the non-somatic dimension (OR: 2.2, 95% CI: 1.2–4.3, p < 0.05) and, using the Mount Vernon Cancer Network assessment tool, addressing spiritual issues (OR: 10.9, 95% CI: 3.7–39.5, p < 0.001). Conclusions: Our training intervention resulted in increased palliative care professionals’ competence in identifying and exploring patients’ spiritual issues, and their integration in multidimensional proactive palliative care plans. The intervention directly addresses patients’ spiritual concerns and adds value to their palliative care plans.

Die palliative Geburt

Feticide is largely accepted as the first-choice therapeutic option in the case of a desired late termination of pregnancy. However, alternatives for women and couples who may find it difficult to cope with this invasive procedure that kills the fetus in the womb have been developed in the form of advanced perinatal palliative care planning. The possibility of a “palliative birth” also exists when parents are confronted with a life-limiting diagnosis before the child is able to survive extrauterinely. A palliative birth can be seen as an alternative to termination of pregnancy at any week of gestation, regardless of whether the intention is to terminate the pregnancy by inducing labor before the fetus is viable or by feticide when it is viable.

Prepared to Accompany the End of Life during Pandemics in Nursing Homes.

Background: The COVID-19 pandemic confronted nursing homes with a variety of challenges to ensure the provision of palliative care for residents. PallPan-Implement aimed to adapt the recommendations of the National Strategy for the Care of Seriously Ill, Dying Adults and their Families in Times of Pandemic (PALLPAN) in such a way that nursing facilities can use and implement them. Methods: Based on 33 PALLPAN recommendations, we developed a questionnaire, conducted a pilot implementation for selected nursing homes, and asked for qualitative feedback. Results: The developed questionnaire contains 22 main questions. A three-stage pilot implementation with an introductory event, processing phase, and evaluation event took place in seven facilities. The facilities evaluated the developed questionnaire as helpful. Feedback from the facilities identified three major categories: (a) requirements for facilities should be realistic to avoid frustration, (b) the creation of a pandemic plan for palliative care only is impractical, (c) measures for the psychosocial support of staff is particularly necessary, but was perceived as difficult to implement. Conclusions: The practical implementation of recommendations requires a concept and material tailored to facilities and areas. The strategy of PallPan Implement developed in this project appears to be target-oriented, well-received, and can be recommended for further implementation.

Gastrostomy, tracheostomy, opioid, and health care utilization among patients with recurrent/metastatic head and neck cancer receiving immunotherapy.

296 Background: Immune checkpoint inhibitors (ICI) are approved for recurrent and/or metastatic squamous head and neck cancers (R/M HNSCC). Landmark trials have shown stable or improved patient (pt) reported quality of life outcomes. It is unclear how these translate into gastrostomy (G) and tracheostomy (T) dependence, opioid use, or ER/unplanned hospitalizations (UH) in an unselected population. We sought to explore these in our large single institution cohort. Methods: We reviewed R/M HNSCC pts receiving ICI at a tertiary referral NCI designated cancer center. Outcomes were assessed between the first dose of ICI and 100 days after the last dose of ICI. Overall survival (OS) was estimated via Kaplan-Meier estimation. Differences between groups were assessed via log-rank testing procedure and adjusted for age, tumor characteristics, and smoking status. Results: Between 1/2012 and 12/2019, we treated 152 pts with ICI, mostly male (n = 142, 82%), partnered/married (n = 103, 68%), with median age 64 years (range 23 – 90). The most common primary sites were oropharynx (n = 55, 36%) and oral cavity (n = 33, 22%). 50 (35%) had ≥2 lines of prior systemic therapy and 29 (19%) had an ECOG ≥2. The most common pt races were white (n = 114, 75%), Asian (n = 14, 9%), and Hispanic, any race (n = 6, 4%). 83 (55%) and 23 (15%) had history of smoking and heavy alcohol use respectively. Median duration of ICI therapy was 95 days (range 1-1720). Prior to ICI, 49 (32%) had G, 17 (11%) had T, and 15 (10%) had both. While on ICI, 6 (4%) had G placed, and 1 (1%) had a G removed; 1 (1%) had T placed, and 2 (1%) had T removed. 69 (45%) had ER visits and 57 (38%) had UH; 11 (7%) were directly related to ICI adverse effects. Prior to ICI, 104 (68%) were on opiates; requirements increased in 58 (41%) pts and decreased in 17 (12%) pts. Pre-existing G prior to ICI had worse OS on log-rank testing, but significance was lost when adjusted for variables. Pre-existing T prior to ICI (p = 0.001, HR 3.08, 95% Cl [1.56,6.08]), and pts with increasing opiate requirements on ICI (p value = 0.0007, HR 2.13, 95% Cl [1.38,3.28]) had worse OS. Conclusions: In our cohort, ICI did not change G or T usage. Pre-existing T and increasing opiate use were also associated with worse survival. Our data supports augmentation of palliative care and advanced care planning in the R/M HNSCC population.

Inclusion of essential components of the World Health Organization palliative care development model in national palliative care plans: A documentary analysis in 31 countries

ContextThe World Health Organization has proposed a new model for the development of palliative care. Whether the current national palliative care plans of Member States are aligned or need to be reformed to meet the new model is unknown. MethodsWe conducted a documentary analysis of national palliative care plans based on an analytic framework structured with the elements recommended by the World Health Organization: (a) building a plan, (b) plan components, and (c) plan implementation. We conducted a categorical analysis of national plans by subgroups according to income and development level of palliative care. FindingsWe identified 112 countries with a palliative care plan, of which 31 were included in the analysis. Of these 31 plans, only 8 had the six components proposed by the World Health Organization, 29 reported an implementation strategy, 23 were aligned with the country's national public health plan, and 15 allocated financial resources for plan implementation. All the national plans assessed included the component provision of palliative care in integrated health services; 93%, education and training; 83%, research; 80%, empowered people and communities; 54%, health policies related to palliative care, and 48% use of essential medicines. ConclusionsNational palliative care plans include the two new development components, but few are fully aligned with the 2021 World Health Organization's model.

Experience of the temporary discharge from the inpatient palliative care unit: A nationwide post-bereavement survey for end-of-life cancer patients

ObjectiveInpatient palliative care units (PCUs) have two roles: place of death and symptom control. In case of symptom control, most patients whose distressing symptoms could be relieved would be temporarily discharged back home. However, the experience of the patient and their family during temporary discharge is unclear. MethodsThis study is a part of the Japan HOspice and Palliative Care Evaluation Study 3, a nationwide cross-sectional post-bereavement survey. We sent questionnaires to bereaved relatives of cancer patients who died in PCUs in 2018. ResultsAmong 968 questionnaires sent, 571 questionnaires were analyzed (59%). Sixteen percent of patients experienced temporary discharge from PCUs. Seventy-two percent of bereaved family members reported that patients said “I am happy to be discharged home.” Overall, 22%–37% of participants reported improvement in the patient's condition after discharge. The caregiver's recognition of better patient's quality of life at home and the doctor's assurance of re-hospitalization, if necessary, were significantly associated with positive experience. ConclusionsBereaved family members recognized temporal discharge as positive experiences for patients and families. Appropriate home palliative care and discharge planning would contribute to positive experience after discharge.

Stakeholder perspectives towards implementing the national framework on palliative care in Canada

ContextIn 2018 Health Canada developed a national framework and subsequent action plan for palliative care. Collaboration and implementation by stakeholder organizations however continues to take place without coordination. Little is known about their attitudes toward national policy development and motivation to work together. MethodsWe employ a well-known stakeholder analysis framework to identify and understand the attitudes of key stakeholders. Organizations that have contributed to national palliative policy development over the past 25 years were identified and prioritized. In this paper, we survey key stakeholders to understand their attitudes towards collaboration and implementation of the 2018 Framework. A novel method to identify homogeneous stakeholder cohorts was developed. FindingsFifty-four out of 75 key organizations (72%) completed the survey. Organizations genuinely support the Framework. However, three-quarters of organizations were not confident in their abilities to strongly influence national palliative care policies. Barriers to collaboration include differences in governance models and funding arrangements, a lack of resources and divergent priorities. Homogeneous stakeholder cohorts and in-depth analysis of stakeholder characteristics resulted in recommendations to support targeted engagement strategies. ConclusionsImplementation of national palliative care policies requires a large-scale coordinated approach involving all stakeholders. Recommendations are centered on the premise that targeted and tailored stakeholder engagement needs to be coordinated and is superior to a one-size fits all approach.

Ten-year trends of utilizing palliative care and palliative procedures in patients with gastric Cancer in the United States from 2009 to 2018 - a nationwide database study

ObjectivesLittle is known about the current status and the changing trends of hospitalization and palliative care consultation of patients with gastric cancer in the United States. The aim of this study was to evaluate the changing trend in the number of hospitalization, palliative care consultation, and palliative procedures in the US during a recent 10-year period using a nationwide database.MethodsThis was a retrospective study that analyzed the National Inpatient Sample (NIS) database of 2009–2018. Patients aged more than 18 years who were diagnosed with a gastric cancer using International Classification of Diseases (ICD)-9 and 10 codes were included. Palliative care consultation included palliative care (ICD-9, V66.7; ICD-10, Z51.5) and advanced care planning (ICD-9, V69.89; ICD-10, Z71.89). Palliative procedures included percutaneous or endoscopic bypass, gastrostomy or enterostomy, dilation, drainage, nutrition, and irrigation for palliative purpose.Results and discussionA total of 86,430 patients were selected and analyzed in this study. Using a compound annual growth rate (CAGR) approach, the annual number of hospitalizations of gastric cancer patients was found to be decreased during 2009–2018 (CAGR: -0.8%, P = 0.0084), while utilization rates of palliative care and palliative procedures increased (CAGR: 9.3 and 1.6%, respectively; P < 0.0001). Multivariable regression analysis revealed that palliative care consultation was associated with reduced total hospital charges (−$34,188, P < 0.0001).ConclusionUtilization of palliative care consultation to patients with gastric cancer may reduce use of medical resources and hospital costs.

144 DEVELOPING AN INTEGRATED POST DIAGNOSTIC PATHWAY FOR PERSONS LIVING WITH DEMENTIA—EXPERIENCES OF A REGIONAL SPECIALIST MEMORY SERVICE

Abstract Background The frequently heterogeneous nature of a dementia presentation confers the need for a personalised approach to post-diagnostic supports. It’s an essential right for persons living with dementia (PlwD) and their families/supporters to have access to a comprehensive diagnosis and a responsive holistic pathway of care thereafter. We report our development of an integrated specialist-clinic/community post-diagnostic pathway responsive to the evolving personal needs of PlwD and their care-supporters. Methods This pathway was developed in an iterative inclusive-design methodology with input from hospital/community clinical specialists, health and social care professionals, senior nursing, PlwD and their care supporters. The post-diagnostic process starts at diagnosis disclosure, followed for all six-weeks later with a designated post diagnostic clinic, where a single point of contact to address any concerns in between visits is established. Results Iterative review cycles have identified integral components of an effective pathway: Guidance to live well with their personal manifestation of dementia; Acknowledgment of biopsychosocial elements of care; Timely access to comprehensive geriatric assessment via ambulatory hub MDT and/or and Integrated care team for older persons offering home assessment &amp; intervention; Prevention of ‘harmful-events’ e.g. falls/delirium/hospitalisation; Timely access to therapies e.g. SLT/OT focussed on enhanced life at home/assistive technology; facilitation and planning of palliative care. Other aspects include signposting to community resources and forward planning e.g. Citizen’s Information Centres; Peer support and education through designated training; Promotion of brain health- Exercise Programmes; social/cognitive stimulation e.g. Men’s sheds, Walking groups &amp; Memory Resource Rooms; Opportunities for research involvement; Enhanced relationships with national organisations e.g. embedded ASI dementia advisor. Conclusion This approach has developed into a fully integrated holistic care-pathway where specialist-clinic, ambulatory-hospital, community older persons, and third sector services work together to provide the right care, at the right time, in the right place for PlwD and their families.

Improving palliative care with Maslow's hierarchy of needs

BackgroundAdvanced cardiac diseases causes a person to face issues concerning the meaning of life, death and an uncertain future. It can be challenging to improve the quality of life of those who are living with a terminal illness. For patients with a compromised cardiovascular health state, implementing a palliative care framework could play a key role in alleviating suffering and grief. This article aims to apply a modified version of Abraham Maslow's hierarchy of needs to provide effective palliative care to patients with cardiac conditions.MethodsA narrative review was conducted using PubMed, ScienceDirect and Google scholar search engines to extract relevant literature and evidence-based practices.ResultsMaslow's hierarchy of needs can also be adapted to palliative care of patients with terminal cardiac illnesses. Priority should be given to low hierarchical stages, leading to the highest physical symptoms management, personal and social security, acceptance and love during illness, restoration of self-esteem, and self-actualisation and transcendence.ConclusionsAdvanced cardiac diseases have long-term effects on a patient's life. The challenge is to provide holistic care to meet the physical, psychosocial, and spiritual needs of vulnerable patients through the use of appropriate palliative care plans. A modified version of Maslow's hierarchy of needs in palliative care for cardiovascular diseases could be effectively applied for the assessment of patients' requirements and the planning of interventions to achieve aims that initiate wellbeing and potentially cover the experience of transcendence.

Coping with deterioration over months – Glioma

Considering the short life expectancy of malignant glioma patients and their care needs throughout the disease trajectory, coping strategies should be considered a key component in the management of Brain Tumor patients. Patients' coping styles have an important influence in critical aspects of care such as communication of diagnosis and prognosis, discussion with patients and their caregivers about goal of treatments, early introduction of palliative care and advanced planning of patients' preferences concerning end of life treatment and issues. Understanding the coping style along the disease trajectory may help clinicians to personalize communication strategies, to promote adherence to treatment, to assess the time of transition to terminal care and to prepare in advance a shared end of life decision making process. Available data show that, despite the aggressiveness of the disease and the poor prognosis, at diagnosis and during the first line treatment, most of BT patients are able to display functional coping strategies such as combative spirit which favors active participation and adherence to treatment; also, cognitive avoidance coping style preserves the individual from excessive exposure to distress. According to recent studies in advanced cancer, coping style adopted may strongly influence patients' prognostic awareness and patients' availability to participate to prognosis discussions. This data are in line with previous literature on other cancer patients, demonstrating that coping style is not a persistent dimension of personality, but can change depending on the situation.

Coping with deterioration over years - multiple sclerosis

Multiple sclerosis presents with a wide range of physical, mental and psychiatric symptoms. It is also a major cause of disability globally. Studies have demonstrated that patients living with MS often experience physical, mental, social, and spiritual suffering which significantly impacts their health and quality of life. Palliative care can help provide patients with relief from suffering by reducing pain and discomfort, providing emotional support, improving functional ability and quality of life, as well as addressing end-of-life and legacy issues. It is often unclear to physicians, and patients what elements of palliative care should be provided and when. One reason for this is the uncertainty that surrounds the progression of the disease, the wide range of symptoms, and the prognosis of the patient. As a result, patients are often poorly prepared to cope with the impact of new symptoms, disabilities, or loss of function. While little can be done about the uncertainty of MS, the adoption of a care model where palliative care is introduced early and provided alongside neurological care can help patients cope with the suffering experienced with MS. Specific triggers to intensify palliative care can be arranged while EDSS milestones can be used to revise the palliative care plan. Early introduction of palliative care can also allow physicians to gain a better sense of the patient's priorities and care preferences, which is important for the development of a care plan that allows them to achieve their goals, reduce suffering, and improve quality of life over the years.