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Introducción: El final de la vida (FV) implica un periodo en el cual una determinada enfermedad u otra situación conducen a un inexorable camino hacia la muerte. La situación clínica hace muy complejo el abordaje del FV, especialmente en aquellos estadios donde la vía parenteral constituye la única forma para proporcionar el soporte nutricional. Método: Se realizó una revisión bibliográfica narrativa basada en la búsqueda, en distintas bases de datos tales como Medline, Science Direct y Scopus, de todos los artículos publicados, hasta marzo de 2021, que muestran una serie de consideraciones nutricionales y tecnológicas de la nutrición parenteral (NP) suplementada y sus posibles beneficios en el FV. Resultados: Se hace necesario realizar una adecuada monitorización del FV con NP para determinar la importancia de adicionar suplementos nutricionales, por sus efectos beneficiosos, tales como glutamina, arginina, zinc, cromo, citrulina, selenio, zinc o coenzima Q para atenuar las alteraciones propias del FV y evitar nuevas complicaciones. También, deben considerarse una serie de criterios tecnológicos que garanticen la estabilidad de la NP y sus nutrientes. Conclusiones: La NP suplementada que se administra en el FV implica controlar una serie de factores que están implicados en su estabilidad. Se han observado acciones beneficiosas de NP suplementada con zinc, selenio, cromo y taurina., Introduction: The end of life (OL) implies a period in which a certain disease or other situation leads to an inexorable path towards death. The clinical situation makes the approach to VF very complex, especially in those stages where the parenteral route is the only way to provide nutritional support. Method: A narrative bibliographic review was carried out based on the search in different databases such as Medline, Science Direct and Scopus of all the articles published until March 2021 that show a series of nutritional and technological considerations of supplemented parenteral nutrition (PN) and your possible benefits at EOL. Results: It is necessary to carry out adequate monitoring of FV with PN to determine the importance of adding nutritional supplements, due to their beneficial effects, such as glutamine, arginine, zinc, chromium, citrulline, selenium, zinc or coenzyme Q to attenuate the alterations typical of FV and avoid new complications. Also, a series of technological criteria must be considered to guarantee the stability of the NP and its nutrients. Conclusions: The supplemented PN that is administered in the FV involves controlling a series of factors that are involved in its stability. Beneficial actions have been observed with NP supplemented with zinc, selenium, chromium and taurine.

Bu çalışmada hemşirelerin ölüm, ötanazi ve ölümcül hasta kavramları hakkındaki düşünce ve deneyimleri üzerinden ölüm ve ötanazi arasındaki ilişkiyi sosyolojik bir perspektif ile anlamak ve anlamlandırmak amaçlanmıştır. Nitel araştırma yöntemlerinden fenomenoloji yöntemi üzerine kurulan bu çalışmada, kartopu örnekleme yoluyla 20 hemşireye ulaşılmış, yarı yapılandırılmış görüşme formu kullanılarak derinlemesine görüşme gerçekleştirilmiş ve elde edilen veriler analiz edilmiştir. Çalışmada hemşirelerin ötanazi algısının çoğunlukla “istemli ötanazi” yönünde olduğu, ötanazinin uygulanması konusundaki düşüncelerinin çoğunlukla olumlu ancak yine de ötanazinin uygulama zeminine karşı tereddütlü oldukları belirlenmiştir. Çalışmada, hemşirelerin ölümü “son”, ölümcül hastayı “terminal dönem hastası ve kanser gibi ağır hastalar”, ötanazi ile ölmeyi ise “doğal ve yapay ölüm ayrımı” üzerinden tanımladığı görülmüştür. Araştırmadan elde edilen, hemşirelerin ölüm, ötanazi ve ölümcül hastaya ilişkin fikirleri ve deneyimleri üzerine veriler, çalışma kapsamında, Foucault’nun kuramsal çerçevesinden, biyopolitika, tıbbi bakış, tıbbileştirme kavramları temelinde tartışılmıştır. This study aimed to understand and make sense of the relationship between death and euthanasia from a sociological perspective. This relationship was assessed through the analysis of thoughts and experiences of nurses about the concepts of death, euthanasia and the terminally ill. The phenomenological methodological approach, as one of the qualitative research methods, was used in this research. Snowball sampling was used to reach 20 nurses, in-depth interviews were conducted using a semi-structured interview form, and the data were analyzed. In the study, it was seen that the nurses’ perception of euthanasia fell mostly within the category of “voluntary euthanasia”, and their thoughts on the implementation of euthanasia were mostly positive. However, the participants were hesitant about the practice of euthanasia. In the study, it was seen that nurses defined death as an “end”, terminally ill patients as “terminal-period patients and severe patients such as cancer”, and death by euthanasia through the “distinction between natural and artificial death”. The data gathered in this research regarding nurses’ thoughts and experiences about death, euthanasia and the terminally ill were analyzed within the theoretical framework of Foucault and the discussion was built on concepts of biopolitics, medical gaze, and medicalization.

The Last Gift is an observational HIV cure-related research study conducted with people with HIV at the end of life (EOL) at the University of California San Diego. Participants agree to voluntarily donate blood and other biospecimens while living and their bodies for a rapid research autopsy postmortem to better understand HIV reservoir dynamics throughout the entire body. The Last Gift study was initiated in 2017. Since then, 30 volunteers were enrolled who are either (1) terminally ill with a concomitant condition and have a prognosis of 6 months or less or (2) chronically ill with multiple comorbidities and nearing the EOL.Multiple ethical and logistical challenges have been revealed during this time; here, we share our lessons learnt and ethical analysis. Issues relevant to healthcare research include surrogate informed consent, personal and professional boundaries, challenges posed conducting research in a pandemic, and clinician burnout and emotional support. Issues more specific to EOL and postmortem research include dual roles of clinical care and research teams, communication between research personnel and clinical teams, legally required versus rapid research autopsy, identification of next of kin/loved ones and issues of inclusion. Issues specific to the Last Gift include logistics of body donation and rapid research autopsy, and disposition of the body as a study benefit.We recommend EOL research teams to have clear provisions around surrogate informed consent, rotate personnel to maintain boundaries, limit direct contact with staff associated with clinical care and have a clear plan for legally required versus research autopsies, among other recommendations.

Objectives: to assess the relationship between spiritual well-being, symptoms and performance of patients under palliative care. Methods: this is a descriptive correlational study, conducted with 135 patients seen in palliative care outpatient clinics. Karnofsky Performance Status Scale, Edmonton Symptom Assessment Scale, Spirituality Scale and Hospital Anxiety and Depression Scale were used. Data were submitted to descriptive statistical analysis and Spearman’s correlation. Results: among participants, 68.2% were cancer patients. The most prevalent symptoms were changes in well-being (65.2%), anxiety (63.7%), sadness (63%) and fatigue (63%). Sadness, dyspnea, sleepiness, anxiety and depression presented weak to moderate correlation with spiritual well-being. Symptom overload showed weak negative correlation with performance. Conclusions: symptom intensification was correlated with worsening in spiritual well-being perception. The reduction in performance was related to increased number of symptoms, especially depression and anxiety. RESUMEN Objetivos: evaluar la relación entre bienestar espiritual, síntomas y funcionalidad de pacientes en cuidados paliativos. Métodos: estudio descriptivo correlacional, realizado con 135 pacientes atendidos en consultas externas de cuidados paliativos. Se utilizaron la Escala Funcional de Karnofsky, la Escala de Evaluación de Síntomas de Edmonton, la Escala de Espiritualidad y la Escala de Ansiedad y Depresión Hospitalaria. Los datos fueron sometidos a análisis estadístico descriptivo y correlación de Spearman. Resultados: entre los participantes, 68,2% eran pacientes con cáncer. Los síntomas más prevalentes fueron cambios en el bienestar (65,2%), ansiedad (63,7%), tristeza (63%) y fatiga (63%). Tristeza, disnea, somnolencia, ansiedad y depresión mostraron una correlación débil a moderada con el bienestar espiritual. La carga de síntomas mostró una débil correlación negativa con la funcionalidad. Conclusiones: la intensificación de los síntomas se correlacionó con el empeoramiento de la percepción de bienestar espiritual. La reducción de la funcionalidad se relacionó con un aumento del número de síntomas, especialmente depresión y ansiedad. RESUMO Objetivos: avaliar a relação entre bem-estar espiritual, sintomas e funcionalidade de pacientes em cuidados paliativos. Métodos: estudo descritivo correlacional, realizado com 135 pacientes atendidos em ambulatórios de cuidados paliativos. A Escala Funcional de Karnofsky, a Escala de Avaliação de Sintomas de Edmonton, a Escala de Espiritualidade e a Escala Hospitalar de Ansiedade e Depressão foram utilizadas. Os dados foram submetidos à análise estatística descritiva e correlação de Spearman. Resultados: entre os participantes, 68,2% eram pacientes oncológicos. Os sintomas mais prevalentes foram alterações do bem-estar (65,2%), ansiedade (63,7%), tristeza (63%) e fadiga (63%). Tristeza, dispneia, sonolência, ansiedade e depressão apresentaram correlação fraca a moderada com bem-estar espiritual. A sobrecarga de sintomas mostrou correlação negativa fraca com funcionalidade. Conclusões: a intensificação dos sintomas esteve correlacionada à piora na percepção de bem-estar espiritual. A redução da funcionalidade esteve relacionada ao aumento da quantidade de sintomas, em especial depressão e ansiedade.

Patients can prepare for end of life and their forthcoming death to enhance the quality of dying.We aimed to longitudinally evaluate the never-before-examined associations of cancer patients' death-preparedness states by conjoint cognitive prognostic awareness and emotional preparedness for death with psychological distress, quality of life (QOL), and end-of-life care received.In this cohort study, we simultaneously evaluated associations of four previously identified death-preparedness states (no-death-preparedness, cognitive-death-preparedness-only, emotional-death-preparedness-only, and sufficient-death-preparedness states) with anxiety symptoms, depressive symptoms, and QOL over 383 cancer patients' last six months and end-of-life care received in the last month using multivariate hierarchical linear modeling and logistic regression modeling, respectively. Minimal clinically important differences (MCIDs) have been established for anxiety- (1.3-1.8) and depressive- (1.5-1.7) symptom subscales (0-21 Likert scales).Patients in the no-death-preparedness and cognitive-death-preparedness-only states reported increases in anxiety symptoms and depressive symptoms that exceed the MCIDs, and a decline in QOL from those in the sufficient-death-preparedness state. Patients in the emotional-death-preparedness-only state were more (OR [95% CI]=2.38 [1.14, 4.97]) and less (OR [95% CI]=0.38 [0.15, 0.94]) likely to receive chemotherapy/immunotherapy and hospice care, respectively, than those in the sufficient-death-preparedness state. Death-preparedness states were not associated with life-sustaining treatments received in the last month.Conjoint cognitive and emotional preparedness for death is associated with cancer patients' lower psychological distress, better QOL, reduced anti-cancer therapy, and increased hospice-care utilization. Facilitating accurate prognostic awareness and emotional preparedness for death is justified when consistent with patient circumstances and preferences.

BackgroundPalliative sedation is sometimes needed for refractory symptoms, and the Richmond Agitation-Sedation Scale (RASS) is one of the key measures. The primary aim of this study was to explore the association between the RASS score and degree of distress quantified by other measures: Support Team Assessment Schedule, item 2 (STAS), Discomfort Scale for Dementia of Alzheimer Type (Discomfort Scale), and Non-communicative Patient’s Pain Assessment Instrument (NOPPAIN), as well as a communication capacity measured by the Communication Capacity Scale, item 4 (CCS).MethodsThis was a prospective observational study on terminally ill cancer patients who received continuous infusion of midazolam to relieve refractory symptoms in a palliative care unit of a designated cancer hospital. Primarily responsible palliative care physicians rated RASS, Discomfort Scale, NOPPAIN, and CCS just before starting infusion, and 1 hour, 4 hours, 24 hours, and 48 hours after midazolam infusion, and ward nurses rated STAS at the same time. Since the ward nurses regularly evaluated STAS to titrate midazolam during palliative sedation as routine work, we regarded STAS rated by ward nurses as a standard of distress measure.ResultsA total of 249 assessments were performed for 55 patients. The RASS score was moderately to highly associated with symptom intensity measured by STAS, discomfort measured by the Discomfort Scale, and pain measured by NOPPAIN (r = 0.63 to 0.73). On the other hand, communication capacity measured by CCS is not parallel with the RASS score, and demonstrated a valley-shape. In 82 assessments with RASS of -1 to -3, 11 patients (13%) were regarded as having physical symptoms of STAS of 2 or more.Conclusions RASS can roughly estimate physical distress in patients receiving palliative sedation, but a measure to more precisely quantify the symptom experience is needed.

Context Patients in the terminal stages of cancer are frequently affected by infection, especially pneumonia; but the effects of antibiotics on respiratory symptoms and factors associated with improvement are still unclear. Objectives This study aimed to clarify the effects of antibiotics on respiratory symptoms of terminally ill cancer patients with pneumonia, and to explore factors associated with the improvement. Methods This was a prospective cohort study in which we consecutively recruited terminally ill cancer patients diagnosed with pneumonia and treated with antibiotics at one of 23 palliative care units across Japan. At the baseline and Day 3, primarily responsible palliative care specialists recorded patient backgrounds, the results of physical and laboratory examination, and patient symptoms using the Support Team Assessment Schedule. Improvement was defined as improvement of dyspnea, cough, and sputum production on Day 3. Results Among all 1896 patients admitted during the study periods, 137 patients (7.2%) were enrolled into this study. Improvement was achieved in 65 patients (47.4%; 95% confidence intervals, 39–56). Univariate analyses revealed that the Palliative Prognostic Index (PPI), respiratory rate (RR), and oxygen requirement were significantly associated with the improvement. A multiple logistic regression analysis identified that PPI score of ≤ 6 and RR of Conclusion Antibiotics may relieve respiratory symptoms from pneumonia in approximately half of the terminally ill cancer patients. PPI and respiratory rate are useful to identify the patients who received benefits of antibiotics.

Critical illness confers a significant risk of psychological distress, both during and after intensive care unit (ICU) admission. The Patient Dignity Inventory is a 25-item instrument initially designed to measure psychosocial, existential and symptom-related distress in terminally ill patients.This study was conducted to validate the inventory as a means of identifying distress in inpatient critical care settings.Single-center prospective cohort study of adult patients admitted to one of five ICUs within the University of Pennsylvania Health System for greater than 48 hours from January 2019 to February 2020. Patients completed the inventory in addition to the Patient Health Questionnaire-9 and the Generalized Anxiety Disorder-seven questionnaires.The tool's internal structure was assessed via principal components analysis. 155 participants consented, completed the surveys and were included for analysis. Scores on the inventory showed evidence of internal consistency when used in critical care settings (Cronbach's α=0.95). Moreover, principal components analysis elucidated four themes prevalent in critically-ill patients: Illness-related Concerns, Interactions with Others, Peace of Mind and Dependency. Construct validity was assessed through correlational analysis with depression and anxiety questionnaires. Scores on the inventory appear to be valid for assessing dignity-related psychological concerns in the critical care setting although there is overlap among components and with anxiety and depression scores.This study demonstrates that the inventory can be used to assess patient distress in critical care settings. Further research may elucidate the role of dignity-based interventions in treating and preventing post-intensive care psychological symptoms.

Artificial hydration (AH) is a challenging issue in terminally ill patients with cancer, because it influences patients' symptoms control, quality of life, and quality of dying (QOD). To date, it is not clear how much AH supply is proper for imminently dying patients. This study aimed to investigate the association between the amount of AH and QOD.This study is part of the East Asian Collaborative Cross-Cultural Study to Elucidate the Dying Process (EASED) conducted in Japan, Korea, and Taiwan from January 2017 to September 2018. Patients' demographics, symptoms, and managements on admission to palliative care units (PCUs) and before death were recorded. The AH amount was classified into different groups by 250-mL intervals to compare their difference. The Good Death Scale (GDS) was used to measure QOD, with patients classified into higher or lower QOD groups using GDS = 12 as the cutoff point. We used logistic regression analysis to assess the association between AH amount and QOD.In total, 1530 patients were included in the analysis. Country, religion, spiritual well-being, fatigue, delirium, dyspnea, AH, and antibiotics use before death were significantly associated with QOD. After conducting regression analysis, patients administered with 250 to 499 mL AH had significantly better QOD (odds ratio, 2.251; 95% confidence interval, 1.072-4.730; P = .032) than those without AH.AH use impacts the QOD of terminally ill patients with cancer admitted to PCUs. Communication with patients and their families on appropriate AH use has a positive effect on QOD.Our prospective cross-cultural multicenter study aims to investigate the relationship between artificial hydration (AH) amount and quality of dying among terminally ill patients with cancer. The findings reveal that country, religion, spiritual well-being, fatigue, delirium, dyspnea, AH, and antibiotics use before death were significantly associated with quality of death (QOD). After multivariable logistic regression, patients administered with AH amount 250 to 499 mL had significantly better QOD (odds ratio, 2.251; 95% confidence interval, 1.072-4.730; P = .032) than those without AH. Communication with patients and their families regarding AH is recommended as it may help them be better prepared for the end-of-life stage and achieve a good death.

Some studies have developed a scoring system to determine the short-term survival of patients with respiratory malignancy.A total of 649 terminally ill patients with respiratory malignancy admitted to our palliative care unit were included in this study. They were randomly divided into the investigation (n = 390) and validation (n = 259) groups. Nineteen blood parameters were analyzed in the laboratory. Receiver-operating characteristic analysis was performed for each blood factor and the area under the curve was calculated to determine the predictive value for 14-day survival after the blood test. Multivariable logistic regression analysis was performed to identify the significant independent prognostic factors for 14-day mortality. To develop a scoring system, the laboratory prognostic score for respiratory malignancy (R-LPS) was calculated using the sum of the indices of the independent prognostic factors.Multivariable analysis showed that 8 out of 19 indices, namely, C-reactive protein ≥ 6.8 mg/dL, aspartate aminotransferase ≥ 43 U/L, blood urea nitrogen ≥ 22 mg/dL, white blood cell count ≥ 10.9 × 10The R-LPS developed from eight laboratory indices showed acceptable prognostic ability for terminally ill patients with respiratory malignancy.

Positive attitudes and a sense of competence toward end-of-life care are the key to adequately support terminally ill patients. This qualitative study aims to explore healthcare students’ attitudes toward caring for terminally ill patients. Eleven students from the University of Applied Health Sciences in Switzerland participated in focus groups. Attitudes were overall positive. Most participants felt that supporting dying patients was a way to achieve professional fulfillment. However, most students felt not competent in palliative care and lacking experience. They wanted to receive better training, more specifically in good practices and appropriate behaviors. Our study fills a knowledge gap regarding the opinions and pedagogical needs of healthcare students, and highlights the importance of experiencing end-of-life care during the educational process. We recommend early exposure to terminally ill patients and appropriate attitudes toward death and dying as part of the bachelor’s curriculum, accompanied by benevolent guidance from teachers and health professionals.

The aim of this article is to present and critically investigate a type of argumentagainst legalising assisted dying on request (ADR) for patients who areterminally ill and experiencing suffering. This type of argument has severalvariants. These—which we call ‘autonomy‐based arguments’ against legalisingADR—invoke different specifications of the premise that we ought not torespect requests for assistance in dying made by terminally ill and sufferingpatients because the basic conditions of autonomy cannot be met in scenarioswhere such requests are made. Specifically, it is argued either (1) that as a resultof pain, anxiety or desperation, terminally ill patients are not competentdecision makers or (2) that legalisation of ADR would lead to social pressure orin other ways change the patient's context of choice in ways that make suchrequests nonautonomous. We argue that these types of arguments areproblematic in light both of empirical studies and the fact that we usuallyjudge that it is morally right to respect the wishes and decisions of dying peopleeven if they suffer.

Einleitung Das Risiko einer Krebserkrankung steigt mit fortschreitendem Alter, aufgrund des Anstiegs der Lebenserwartung von Menschen in Österreich. Das Leben der krebserkrankten Patient*innen verändert sich besonders im letzten Lebensabschnitt. In der Terminalphase sind die körperlichen und geistigen Fähigkeiten durch die Erkrankung zunehmend eingeschränkt. In dieser Phase weisen Patient*innen, welche zu Hause betreut werden individuelle Bedürfnisse auf. Methodik: Zur Beantwortung der Fragestellung erfolgt eine systematische Literaturrecherche in den Datenbanken CINAHL, LIVIVO und Medline (via PubMed). Es wurden Studien herangezogen, die passend zu den Ein- und Ausschlusskriterien sind. Verwendet wurden qualitative und quantitative Studien im Zeitraum von 2017 bis 2023. Aus der Fragestellung wurden Suchkomponente festgelegt, aus denen in weiterer Folge Suchbegriffe definiert wurden. Ergebnisse: Die Bedürfnisse von Patient*innen mit einer unheilbaren Tumorerkrankung unterteilen sich in der Terminalphase in eine Vielfalt an Bedürfnissen, jedoch steht die Schmerzlinderung an erster Stelle. Ein schneller und schmerzloser Sterbeprozess und die Vorauswahl des Bestattungsortes sind für Betroffene wichtige spirituelle Bedürfnisse. Kompetente Gesundheits- und Krankenpfleger*innen, die rund um die Uhr für die Patient*innen zur Verfügung stehen, können dazu beitragen, dass der Sterbeprozess zu Hause in einer vertrauten Umgebung erleichtert wird. Schlussfolgerung: Zusammenfassend lässt sich sagen, dass krebserkrankte Personen in der Terminalphase im eigenen Umfeld zu Hause individuelle Bedürfnisse aufweisen. Durch professionelle Betreuung können die Wünsche und Bedürfnisse der Erkrankten unterstützt und erfüllt werden. Introduction: The risk of developing cancer increases with age, due to the increase in life expectancy of people in Austria. The life of patients with cancer changes especially in the last phase of life. In the terminal phase, physical and mental abilities are increasingly limited by the disease. In this phase, patients who are cared for at home have individual needs. Methodology: To answer the question, a systematic literature search is carried out in the databases CINAHL, LIVIVO and Medline (via PubMed). Studies were used that are suitable for the inclusion and exclusion criteria. Qualitative and quantitative studies were used in the period from 2017 to 2023. From the question, search components were defined, from which search terms were subsequently defined. Results: The needs of patients with incurable tumour disease are divided into a variety of needs in the terminal phase, but pain relief is the first priority. A quick and painless dying process and the pre-selection of the place of burial are important spiritual needs for those affected. Competent health care and nursing staff who are available for patients around the clock can help to facilitate the dying process at home in a familiar environment. Conclusion: In summary, it can be said that persons with cancer in the terminal phase have individual needs in their own environment at home. Professional care can support and fulfil the wishes and needs of the sick person.

Background and Objectives: In 2016, Medical Assistance in Dying (MAiD) became legal in Canada for those suffering a grievous and untreatable medical condition. Currently, it is not available to minors or to those with an untreatable mental illness, although it is likely the scope of MAiD will be widened to include persons with severe and untreatable mental illnesses. However, little is known about the factors predicting acceptance or rejection of MAiD for persons with either a grievous medical condition or an untreatable mental illness. Methods: A survey was administered to 438 undergraduate students to examine factors associated with their acceptance or rejection of MAiD. The survey included four different scenarios: a young or old person with an untreatable medical condition, and a young or old person with an untreatable mental illness. Demographic questions (age, sex, religion, etc), personality measures, and an attitude towards euthanasia scale were also administered, as well as questions assessing participants’ general understanding of MAiD and their life experiences with death and suicide. Results/Conclusion: Overall, most of the Canadian undergraduate participants accepted MAiD for both terminally ill and mentally ill patients; however, different variables, such as age, religion, and ethnicity, predicted the acceptance or rejection of MAiD for each scenario.

Introduction Pharmacy graduates should be equipped for one inevitable aspect of health care, mortality, yet only 10% of United States pharmacy curricula courses cover end-of-life (EoL) with limited evidence of effectiveness. This study's objective was to evaluate the impact of an EoL elective on student pharmacists' empathy and attitudes toward mortality and caring for terminally ill persons. Methods First- through third-year student pharmacists enrolled in an EoL elective. Students completed pre- and post-course surveys on self-perceptions of empathy and mortality. Surveys included the following: Kiersma-Chen Empathy Scale (KCES), which assesses empathy of pharmacy and nursing students; revised Collett-Lester Fear of Death and Dying Scale (CL-FODS), which measures fear related to death; and Frommelt Attitudes Toward Care of the Dying Scale Form B (FATCOD-B), which measures health care professionals' attitudes toward EoL care. Anonymous identifiers were used to link pre- and post-course surveys and were collected with an online survey software. Data were analyzed using two-sided paired t-tests. Results Twenty-seven student pharmacists completed the elective. The change in overall mean scores for KCES, CL-FODS, and FATCOD-B correlated with increased empathy, reduced fear of death, and increased positive attitudes toward caring for terminal patients (KCES pre-course = 86.15 vs. post-course = 90.37; CL-FODS pre-course = 93.70 vs. post-course = 75.15; FATCOD-B pre-course = 115.89 vs. post-course = 124.04). Conclusions After the EoL elective, student empathy and attitudes toward mortality and caring for terminally ill persons improved. Implementing EoL concepts in pharmacy curricula should be explored to better prepare graduates in patient care.

The COVID-19 pandemic poses challenges for palliative care. Terminal patients cannot wear masks and may demonstrate unspecific symptoms reminiscent of those caused by COVID-19. This report is about a terminally ill patient with lung cancer who displayed fever, cough, and fatigue. During hospital admission screening, the patient tested negative for SARS-CoV-2. When admitting his wife to stay with him, she also had to test for SARS-CoV-2 and displayed a positive test result. Until the positive results were reported, six staff members were infected with SARS-CoV-2, even though they were routinely wearing respirators. This resulted in the palliative care unit having to be closed. Hospitals need strict and adequate testing and re-testing strategies even for intra-hospital transfers. Workers must strictly adhere to recommended respirator practices. Ventilation of patient rooms is essential due to the possible enrichment of particle aerosols containing viruses, as negative pressure rooms are not recommended in all countries.

Terminal ill cancer patients experience spiritual distress and need spiritual care. They are in need of palliative care in the long term to alleviate suffering. The aim of the study was to investigate spiritual needs of terminal ill cancer patients.This study is a cross-sectional study. The participants were Thai terminal ill cancer patients from seven hospitals in northern, northeast, central, and southern regions of Thailand. Three-hundred-and-twenty-two participants were purposively selected. The instrument used in this study was a spiritual needs scale, consisting of 41 items with 4-point rating scale. Statistical analysis was F-test for one-way analysis of variance.The majority of terminal ill cancer patients aged fifty-one years old. Most of them were females with end stage cancer status that did not respond to treatment. The overall spiritual needs of terminal ill cancer patients were at the moderate level (M = 18.21, SD = 2.56). The highest mean was found in the 'prepare for death' dimension, followed by the 'have meaning, values, and life purposes' and the 'have opportunity to pursue most important things in life' dimensions respectively and had different spiritual needs among status (F(3,318) = 3.66, p0.05), number of family members (F(8,313) = 5.07, p0.05), living with family (F(2,319) = 3.91, p0.05), and spiritual anchor (F(2,319) = 4.13, p0.05).The study results provide insight into spiritual needs of terminal ill cancer patients which assists in improving the provision of holistic care to let the patients be happy at end-of-life phase.

Background: Communicating bad news is of great interest in the geriatric field, but few works have considered the physician’s point of view in this regard. Objectives: The aim of this study was to explore possible differences related to physicians’ gender and work experience in how a terminal diagnosis is disclosed to older patients. Methods: Study participants were 420 Italian physicians (277 M, 143 F) working in clinical medicine (58.2%), surgery (33.3%), or other medical departments (8.5%). They completed an anonymous multiple-choice questionnaire that investigated various issues associated with communicating bad news to terminally ill older patients. Results: Men had more work experience than women (55.6% vs. 44.8% had worked for ≥23 years) and were more likely to work in surgery departments, while more women worked in clinical medicine. Most physicians declared that terminally ill older patients, if mentally competent, should always (14.4%) or generally (64.3%) be directly and openly informed of their condition. With no difference in gender, length of work experience, or specialty area, 36.9% of physicians thought that this was a human right and 18% that it would improve the patient’s quality of life. Where older patients were alone, male physicians were more likely than female (30.2% vs. 8.9%) to always communicate bad news directly to them. More than 70% of physicians, especially those with longer work experience, declared that they always or often took enough time to inform the patient. Female physicians and those working in clinical medicine were more likely to need psychological help when deciding to break bad news, but only a smaller proportion declared to have received it. Conclusions: Gender and work experience may influence how physicians communicate with patients and how often they seek psychological support.

Background Cancer patients may develop prognostic awareness (PA) heterogeneously, but predictors of PA‐transition patterns have never been studied. We aimed to identify transition patterns of PA and their associated factors during cancer patients’ last 6 months. Methods For this secondary‐analysis study, PA was assessed among 334 cancer patients when they were first diagnosed as terminally ill and monthly till they died. PA was categorized into four states: (a) unknown and not wanting to know; (b) unknown but wanting to know; (c) inaccurate awareness; and (d) accurate awareness. The first and last PA states estimated by hidden Markov modeling were examined to identify their change patterns. Factors associated with distinct PA‐transition patterns were determined by multinomial logistic regressions focused on modifiable time‐varying variables assessed in the wave before the last PA assessment to ensure a clear time sequence for associating with PA‐transition patterns. Results Four PA‐transition patterns were identified: maintaining accurate PA (56.3%), gaining accurate PA (20.4%), heterogeneous PA (7.8%), and still avoiding PA (15.6%). Reported physician‐prognostic disclosure increased the likelihood of belonging to the maintaining‐accurate‐PA group than to other groups. Greater symptom distress predisposed patients to be in the still‐avoiding‐PA than the heterogeneous PA group. Patients with higher functional dependence and more anxiety/depressive symptoms were more and less likely to be in the heterogeneous PA group and in the still‐avoiding‐PA group, respectively, than in the maintaining‐ and gaining‐accurate PA groups. Conclusions Cancer patients heterogeneously experienced PA‐transition patterns over their last 6 months. Physicians’ prognostic disclosure, and patients’ symptom distress, functional dependence, and anxiety/depressive symptoms, all modifiable by high‐quality end‐of‐life care, were associated with distinct PA‐transition patterns., Patients with cancer may not develop accurate prognostic awareness (PA) at the same rate or to the same degree and factors associated with PA‐transition patterns are unknown. Here, we identified PA‐transition patterns and their associated factors during the last six months of life for patients with advanced cancer and found that they developed PA in different ways. Four PA‐transition patterns were identified: maintaining accurate PA, gaining accurate PA, heterogeneous PA, and still avoiding PA. Prognostic disclosure by physicians, patient symptom distress, functional dependence, and anxiety/depression symptoms are major factors associated with PA‐transition patterns and can be acted on during high‐quality end‐of‐life care.

Background Frailty characteristics such as compromised response to stressors and accumulation of deficits in physiological systems may leave frailer older adults at higher risk of adverse outcomes from PIP, compared with their non-frail counterparts of the same age. This study aims to examine the relationship between measured frailty and potentially inappropriate prescribing in older adults presenting acutely to hospital. Methods A prospective observational study was conducted. Participants were acutely hospitalised older adults. Inclusion Criteria: Age ≥ 65 years old, acute admission 24 hrs. Exclusion Criteria: Results The mean (±standard deviation [SD]) age of study participants was 79.25[±7.14], 56.5% were female. The prevalence of frailty measured using the CFS and Frail-VIG were 61.5% and 50.5% respectively. Applying the CFS, the mean number of STOPP criteria in non-frail patients was 1.03 and 1.87 for frail patients (p = 0.001 CI 95%) and 1.14 and 2.10 (p = 0.001 CI 95%) using the Frail-Vig Index. Conclusion Frailty is associated with functional decline, falls, hospitalisation and death. Frail patients had a higher mean number of STOPP criteria. As medication side effects are themselves included as part of the frailty syndrome, in-hospital medication review and patient centred medication optimisation should be guided by patient’s frailty status to reduce adverse outcomes.

Background: A special survey carried out between April and September 2021 in Italy involving 600 respondents forms the basis of the present contribution. This survey focused on mapping and acquiring a deeper understanding of the possibilities of promoting a long-term vision for the development of future care for people in the pre-terminal and terminal stages of the disease and for the dying. Conclusion: Similar surveys may provide relevant and inspiring stimuli for additional and novel specific surveys, studies and analyses, as well as scientific and professional discourses regarding the importance of establishing inspiring long-term visions for the development of future care for the dying.

Background End-of-life simulation is proposed as an educational method that prepares undergraduate nursing students for palliative care nursing practice. Method An integrative literature review was undertaken to determine the effects of end-of-life simulation on nursing students’ competence, self-competence, and performance of palliative care and to identify evidence gaps. Results Findings from 11 studies reviewed suggest that end-of-life simulation effectively develops palliative care nursing competence and self-competence, but there is a lack of evidence regarding performance. Conclusion Further research is needed to evaluate simulation's impact on student performance in delivering end-of-life care to seriously ill patients.

Context Terminal dyspnea in dying cancer patients is frequent and distressing, and the impact extends to their families. Families are often involved in providing care for terminal dyspnea. Objectives This study aimed to describe various care strategies for terminal dyspnea in cancer patients hospitalized in palliative care units (PCUs), evaluate families’ satisfaction with care for terminal dyspnea, and explore determinants contributing to families’ satisfaction. Methods A nationwide, cross-sectional survey was conducted using a self-reported questionnaire among bereaved families of cancer patients who died in PCUs. The questionnaire consisted of questions on the perceptions of care offered to patients with terminal dyspnea and their families, satisfaction with care for terminal dyspnea, family-perceived intensity of terminal dyspnea, use of oxygen, and background data of patients and families. Results In total, 533 participants (response rate = 54%) returned the completed questionnaires, and 231 reported that their loved one had experienced terminal dyspnea. Dedicated and compassionate care was perceived by 60%–89% of the participants as the strategy provided for patients. Care for family members was perceived by 58%–69% of the participants. Perception of dedicated and compassionate care for patients and that of care for family members were significantly associated with high satisfaction (odds ratio, 95% confidence interval: 8.64, 3.85–19.36 and 15.37, 5.00–47.25, respectively). Conclusion Dedicated and compassionate care may be the essential part of the care for terminal dyspnea. Dedicated and compassionate care for patients and care for family members have a potential of improving the care satisfaction among family caregivers.

Os cuidados paliativos são realizados por profissionais da saúde que buscam proporcionar melhor qualidade de vida ao paciente.Esses podem ser implementados, em situações de enfrentamento de um câncer terminal ou incurável. Objetivo: discorrer sobreo papel do odontólogo frente à prática dos cuidados paliativos e ao câncer de cabeça e pescoço. Método: foi realizada uma revisãode literatura, através de livros, disponíveis na biblioteca UNIFASIPE e artigos científicos, disponíveis em língua portuguesa e inglesa, obtidos em bancos de dados eletrônicos como PubMed, SciELO e Google Acadêmico entre os anos de 2000 e 2020. Resultado: A pesquisa demonstrou que o cirurgião-dentista pode auxiliar no diagnóstico precoce do câncer de cabeça e pescoço além de proporcionar maior conforto ao paciente acometido pela doença. Conclusão: o cirurgião-dentista desempenha um importante papel no cuidado com esses pacientes, visando à prevenção e diminuição de possíveis complicações bucais, proporcionando maior conforto ao paciente que encontra-se em estado terminal.

A protocol of a scoping review wich intends to map and to describe the evidence on high specificity clinical signs of impending death.

Aim: To investigate if acupuncture reduces nausea and vomiting in terminally ill patients. Design: A comparative effectiveness research design was used to generate evidence-based knowledge close to practice for the use of clinicians. The sample size was calculated to 136 patients randomised into an intervention and a control group, respectively. Nausea and vomiting were measured using the EORTC QLQ-c15-PAL (European Organisation for Research and Treatment of Cancer, Quality of Life Questionnaire, core 15, Palliation). Location: The trial was conducted among terminally ill patients admitted to three in-bed hospices in Demark. Participants: Terminally ill patients suffering from nausea and/or vomiting; 95% of patients had cancer. Intervention: The intervention group received acupuncture in addition to usual care for three days. We used the acupuncture spots: Pericardium-6, Stomach-36, Liver-3 and Yin Tang. The control group received usual care only. Results: In total, 136 patients were randomised, 24 patients withdrew resulting in a total sample of 112 patients: 52 patients in the intervention group and 60 patients in the control group. In the intervention group, 75% of the patients experienced a reduction of their nausea score after the intervention compared to 55% in the control group. The statistical difference was p = 0.028. In the intervention group, 52% of the patients did not experience nausea at all after the intervention compared to 30% in the control group. In the intervention group, 31% of the patients were still vomiting after the intervention compared to 34% in the control group; no statistically significant difference was found. Conclusion: Acupuncture reduced the experience of nausea among terminally ill patients but did not reduce vomiting. Thus, acupuncture is recommended to reduce nausea among terminally ill patients.

Background: Little is known about the quality of death of terminally ill patients in hospitals in Thailand. Aim: To examine the quality of death of terminally ill patients and investigate correlations between the quality of death and the organisational climate; nurses' palliative care knowledge; nurses' palliative care practice; and nurses' perceptions of barriers in providing palliative care. Methods: A cross-sectional survey design was used. Data collected among 281 nurses were analysed by descriptive statistics, Pearson correlation and Spearman's rank correlation. Results: The overall quality of death of terminally ill patients in the hospital was moderate. Organisational climate and nurses' palliative care practice positively correlate with terminally ill patients' quality of death. Nurses' difficulty in providing palliative care negatively correlates with terminally ill patients' quality of death. Conclusion: Promoting an organisational climate and enhancing nurses' palliative care practice may improve the quality of death of terminally ill patients in this hospital.

Objective: Although the medical potential of the hope for a cure has been fiercely debated within academia, few researchers have approached this topic from the perspective of terminally ill cancer patients themselves. As such, this article aims to help bridge the gap by exploring how terminally ill cancer patients in China construct the hope for a cure.Methods: Seventeen terminally ill cancer patients were recruited from the department of oncology at a tertiary hospital, where data were collected through individual interviews and participatory observation from April to December 2020 and analysed via thematic analysis.Results: The respondents experienced a dynamic swing between construction and denial of the hope for a cure. Furthermore, the patients negotiated between three forms of hope, including the hope for a cure, the hope for prolonged life expectancy and the hope of living in the moment. Meanwhile, family-oriented hope was centred on intergenerational relationships, which further shaped the construction of the hope for a cure.Conclusion: Medical staff needs to be sensitive to terminally ill cancer patients' dynamic swing, negotiation and motivation during the process of constructing the hope for a cure.

This scoping review explored the occupations of terminally ill Chinese adults and their caregivers. Seven databases were searched for peer-reviewed journal articles published in English or Chinese before June 2020. Of the 16 studies that met the selection criteria, only one directly used the term "occupations" while the other 15 studies contained descriptions of occupations. Eight themes were extracted and compared with existing literature. The top two reported themes were occupations surrounding life roles and tasks and those surrounding food and eating. More study is required about the occupational engagement of this client group.

Background:Awareness of the impending end of one’s life can pose profound existential challenges, thereby impairing well-being. Confronting one’s own end of life may be an approach to meet the psychological needs and consequently enhance overall well-being. Different approaches of confrontation have been evaluated positively using measures of psychosocial comfort. To date, there exists no systematic overview on the different ways of confrontation (e.g. psychosocial or individual coping approaches).Aim:To synthesize the existing knowledge on the effects of different approaches of confronting one’s own end of life on older individuals and those with a life-threatening disease.Design:A systematic review of quantitative, qualitative, and mixed-methods full research reports was conducted. The retrieved studies were screened and appraised for methodological quality by two independent reviewers based on MMAT and CASP. The findings were synthesized narratively using the meta-summary technique by Sandelowski and Barroso.Data sources:Medline, PsycINFO, and Web of Science were searched from inception to 12/2020.Results:N = 49 studies reported on different approaches of confronting one’s own end of life, including psychosocial interventions, meaning-enhancing approaches, educational programs, and learning from lived experiences. The results suggest a clear trend toward beneficial effects on psychosocial comfort (e.g. anxiety, sense of meaning, well-being).Conclusion:Low-threshold opportunities of confrontation have the potential to improve well-being and should be emphasized in practical implementation. The results can serve as a comprehensive basis for future research aiming to investigate the determinants of psychosocial comfort for people nearing the end of life.

ObjectivesAt the end of life oral fluid intake is often reduced. Consensus about the most appropriate management for terminally ill patients with limited oral fluid intake is lacking. The objective of this study is to investigate to what extent the amount of fluid intake, preceding and during the dying phase, is related to the occurrence of death rattle and terminal restlessness.MethodsA multicentre prospective observational study was performed. Data on the occurrence of death rattle and terminal restlessness, fluid intake and opioid use of patients expected to die within a few days or hours were collected.Results371 patients were included. Death rattle was reported at least once in 40% (n=149) of patients during the dying phase. Death rattle occurrence was not associated with the amount of fluid intake during the days before dying. Terminal restlessness was reported in 26% of patients (n=96). Terminal restlessness was not associated with a lower amount of fluid intake during the days before dying. Terminal restlessness during the last 24 hours of life was associated with a higher amount of fluid (ie, >250 mL/day) during 48–25 hours before death.ConclusionsCaution with fluid intake to prevent development of death rattle does not seem to be necessary. Our study suggests that a higher amount of fluid intake during 48–25 hours before death may be associated with the occurrence of terminal restlessness during the last 24 hours of life. These results suggest that actively providing dying patients with artificial fluid may not be beneficial.

Context Cardiopulmonary resuscitation is one of the most important end-of-life care decisions. However, the experience of bereaved families during code status discussions is not well documented. Objective The aims of this study were to describe the degree of emotional distress of bereaved families when discussing code status, identify their perceived areas for improvement and determine associated factors. Methods This study is part of a nationwide post-bereavement survey, the Japan Hospice and Palliative care Evaluation 3 (J-HOPE3) study. Questionnaires were sent to the relatives of cancer patients who had died in palliative care units in Japan in 2014. Results From an analysis of 338 questionnaires, 37% of families reported high emotional distress during code status discussions and 32% reported a need for improvement. Multiple logistic regression analyses revealed the following were associated with high-level distress: the family had hoped for the miraculous and spontaneous recovery of the patient (odds ratio [OR] 2.4, 95% confidence interval [CI] 1.31—4.43, P = 0.0049), the family felt they could not voice their opinion about Cardiopulmonary resuscitation (OR 2.07, CI 1.12—3.81, P = 0.02), or the physician failed to adapt the explanation to the family's preparation level (OR 0.36, CI 0.18—0.68, P = 0.0015). Factors identified for improvement were: holding discussions in a relaxing atmosphere conducive to questioning (OR 0.36, CI 0.16-0.80, P = 0.012), and ensuring the physician adapted the explanation to the family's preparation level (OR 0.47, CI 0.23-0.96, P = 0.037). Conclusion We recommend the development of educational programs for code status discussions to improve the experience of bereaved family members.

Background Accurately predicting impending death is essential for clinicians to clarify goals of care. We aimed to develop diagnostic models to predict death ≤3 days in cancer patients. Methods In this multicenter cohort study, we consecutively enrolled advanced cancer patients admitted to 23 inpatient hospices in 2017. Fifteen clinical signs related to impending death were documented daily from the day when the Palliative Performance Scale (PPS) declined to ≤20–14 days later. We conducted recursive partitioning analysis using the entire data set and performed cross‐validation to develop the model (prediction of 3‐day impending death‐decision tree [P3did‐DT]). Then, we summed the number of systems (nervous/cardiovascular/respiratory/musculoskeletal), where any sign was present to underpin P3did score (range = 0–4). Results Data following PPS ≤20 were obtained from 1396 of 1896 inpatients (74%). The mean age was 73 ± 12 years, and 399 (29%) had gastrointestinal tract cancer. The P3did‐DT was based on three variables and had four terminal leaves: urine output (u/o) ≤200 ml/day and decreased response to verbal stimuli, u/o ≤200 ml/day and no decreased response to verbal stimuli, u/o >200 ml/day and Richmond Agitation‐Sedation Scale (RASS) ≤−2, and u/o >200 ml/day and RASS ≥−1. The 3‐day mortality rates were 80.3%, 53.3%, 39.9%, and 20.6%, respectively (accuracy = 68.3%). In addition, 79.6%, 62.9%, 47.2%, 32.8%, and 17.4% of patients with P3did scores of 4, 3, 2, 1, and 0, respectively, died ≤3 days. Conclusion We successfully developed diagnostic models for death ≤3 days. These may further help clinicians predict impending death and help patients/families prepare for their final days., In this multicenter, prospective, observational study involving 1396 patients with advanced cancer, we successfully developed two diagnostic models for death within 3 days using physical signs. These may further help clinicians predict impending death and help patients/families prepare for the last days of life.

Pain is a complex, multidimensional phenomenon and integral component of illness but little is known about its religious construction and interpretation. This article discusses an important yet neglected component of terminal illness which is the religious construction of pain. Eleven hepatitis C Muslim patients admitted to the liver center were recruited for this study. In-depth interviews helped the identification of dominant themes. The study found that terminal patients construct pain in a religious context and interpret it into religious realms. For them, pain helps to realize their debility and helplessness. They think pain has a transformatory potential and can help them turn to be very strong and brave. The participants also reported having a belief that pain in this world could be compensated in the life hereafter and they will be rewarded with good deeds and bestowed with the Jannah (paradise). The terminal patients strongly influenced by religion and spirituality believed to be experiencing pain as a punishment of their misdeeds. Thus, pain was helping them to normalize their end-of-life experiences and ease the terminal stage of their illness.

In many developing parts of the world, evidence on advance care planning (ACP) is either lacking or fragmented. Lack of streamlined means for ACP is known to lead to inconveniences for the clinicians as well as the patients and their families. This case report focuses on a young male diagnosed with metastatic osteosarcoma, who explicitly verbalised his wishes to be managed conservatively without involving invasive life-sustaining measures. However, the patient faced cardiopulmonary resuscitation before his demise against his wishes, which also contradicted with the medical point of view. Sri Lankan doctors face moral, ethical and legal dilemmas as they deal with terminally ill patients at the verge of their death due to the deficiencies in the medical and legislative frameworks in the country.

Background: Interpersonal hurt or offenses are common human experiences. Bereavement may be impacted for caregivers of a terminally ill loved one when these experiences occur. Objective: To determi...

Working with terminally ill patients is regarded as a stressful or traumatic event and may lead to negative outcomes, including job burnout and secondary traumatic stress (STS). Psychological resilience might protect employees from the negative consequences of stress. The aim of this study was to determine the mediating role of job burnout in the relationship between psychological resilience and STS. The study included 72 nurses aged from 22 to 72 years old (M = 46.01, SD = 10.69), working with terminally ill patients. The recipients completed 3 questionnaires: the Secondary Traumatic Stress Scale, the Oldenburg Burnout Inventory, and the Resilience Measurement. The results reveal negative associations between resilience, job burnout, and secondary traumatic stress, and a positive correlation between secondary traumatic stress and job burnout. Mediation analysis showed that job burnout plays a mediating role in the relationship between psychological resilience and secondary traumatic stress. Our findings highlight the role played by job burnout in the manifestation of STS. Professional and nonprofessional interventions for individuals experiencing work-related traumatic stress would benefit from interventions that build personal resources. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

End-of-life decision making involves clinicians, patients, and relatives; yet, the law in Israel hardly recognises the role of relatives. This raises the question of the law’s impact in practice and, hence, whether it should be amended. This issue is examined on the basis of findings from a qualitative, interview-based study conducted in Israel among relatives of dying patients. The findings indicate that there are areas in which clinicians and relatives do not adhere to the law in the end-of-life decision-making process. For example, they do not always ascertain the patient's end-of-life preferences, which ignores a patient's right to autonomy and their right to make informed decisions. The apparent gaps between the actual conduct of clinicians and relatives on the one hand and the directives of the Israeli Dying Patient Act 2005 on the other, lead us to propose several changes to the Act.

espanolEl cancer es una enfermedad multisintomatica que afecta a gran parte de la poblacion a nivel mundial y en los ultimos anos ha ido en aumento. La experiencia de los familiares cuidadores proporciona informacion acerca del cuidado y atencion que recibe el enfermo terminal. Se propuso como marco interpretativo la fenomenologia hermeneutica de Heidegger. El objetivo de este articulo fue conocer, a partir del relato de los familiares, las necesidades medicas, psicologicas, sociales, espirituales de los pacientes con cancer terminal. Se realizaron 11 entrevistas a familiares en la Ciudad de Mexico. Se llevaron a cabo transcripciones y se utilizo el analisis tematico y el metodo de van Manen. Se encontro que los cuidados paliativos en la etapa final de la enfermedad no son proporcionados en todos los casos. Se da prioridad por cubrir las necesidades medicas que se centran en el control del dolor, dejando de lado las necesidades psicologicas, sociales y espirituales. Estas ultimas son solucionadas por la propia familia. Es necesaria atencion integral a los enfermos desde diversas disciplinas, siempre velando por la dignidad y bienestar al final de la vida. EnglishCancer is a multisymptomatic disease that affects a large part of the world's population and has been increasing in recent years. The experience of family caregivers provides information on the care and attention that the terminally ill person receives. Heidegger's hermeneutical phenomenology was proposed as an interpretive framework. The objective of this article was to know, from the reports of relatives, the medical, psychological, social and spiritual needs of patients with terminal cancer. 11 interviews were conducted. Transcripts were made and thematic analysis and the van Manen method were used. It was found that palliative care in the final stage of the disease is not provided in all cases. Priority is given to meeting medical needs that focus on pain control, leaving aside psychological, social and spiritual needs. The latter are resolved by the family itself. Comprehensive care for patients is necessary from various disciplines, always ensuring dignity and well-being at the end of life.

The Covid19 Pandemic can generate challenges and difficulties for decision-making, especially in patients with advanced, incurable diseases with limited life prognosis. For this reason, palliative care should be developed with ethical, scientific and human criteria with the basic tool of assertive communication that will reduce the suffering of patients, families and health personnel.The objective of this work is to determine knowledge and attitudes about the care of patients at the end of life in Pandemic Covid19 and palliative sedation.The descriptive study was used as methodology, cross-sectional study by anonymous survey of health professionals from various healthcare centers.160 professionals were surveyed,Ages between 25 and 71 years old, 68% women, 68.8% doctors, 12.5% nurses, 15.6% kinesiologist, Years of practice in the profession 43.2 % over 20 years, Knowledge: 90.6% triage criteria, 81.9% criteria for admission to ICU, 51.9% criteria for not admission to ICU, 79.4% basic management of dyspnea, 26.3 % management of refractory dyspnea, 60% criteria for termination of a disease, 55.6% palliative sedation, 26.5% drug for palliative sedation, attitudes; 38.1% would not administer palliative sedation to a terminally ill patient suffering from refractory dyspnea, 25% are not sure if palliative sedation is euthanasia, 3.7% affirm palliative sedation is euthanasia.Knowledge was identified 79.4% basic management of dyspnea, 26.3% management of refractory dyspnea, 55.6% palliative sedation, only 26.5% which drugs are used, Attitude; 38.1% part would not use palliative sedation and 25% are not sure it is euthanasia. La Pandemia Covid19 puede generar retos y dificultades para la toma de decisiones sobre todo en pacientes con enfermedades avanzadas, incurables con pronóstico de vida limitado. Por ello es que la atención paliativa debería ser elaborada con criterios éticos, científicos, humanos con la herramienta base de la comunicación asertiva que disminuirá el sufrimiento de pacientes, familiares y del personal de salud. El objetivo del presente trabajo es determinarconocimientos y actitudes sobre la atención de pacientes al final de la vida en Pandemia Covid19 y la sedación paliativa.Se utilizó como metodología el estudio descriptivo, corte trasversal mediante encuesta anónima a profesionales de la salud de diversos centros asistenciales. Se encuestó160 profesionales, Edades entre 25 y 71 años, 68% mujeres, 68,8% médico/as, 12,5% enfermero/as, 15,6% kinesiólogo/as, Años de ejercicio en la profesión 43,2% más de 20 años, Conocimientos: 90,6% criterios de triaje, 81,9% criterios de ingreso a UCI, 51,9%criterios para no admisión a UCI, 79,4% manejo básico de la disnea, 26,3% manejo de la disnea refractaria, 60% criterios de terminalidad de una enfermedad, 55,6% sedación paliativa, 26,5%fármaco para la sedación paliativa, actitudes; 38,1% no le administraría sedación paliativa a un paciente en etapa terminal que padece disnea refractaria, 25% no está seguro si la sedación paliativa es eutanasia, 3,7% afirma la sedación paliativa es eutanasia.Se identificó conocimientos 79,4%manejo básico de la disnea, 26,3%manejo de la disnea refractaria, 55,6% sedación paliativa, solo el 26,5% que fármacos se utilizan, Actitud; 38,1% parte no usaría la sedación paliativa y 25% no están seguros es eutanasia.

espanolEn este trabajo se parte del reconocimiento del importante papel que el farmaceutico comunitario desempena, en la atencion sanitaria, a personas que sufren de un proceso terminal y en sus familiares y/o cuidadores. No hay duda de que es fundamental el consejo, tratamiento y acompanamiento de los profesionales sanitarios en cualquier patologia que suponga un compromiso vital. El farmaceutico comunitario, como agente sanitario, debe estar implicado en esos procesos. Sin embargo, en muchas ocasiones es olvidado por un sistema sanitario que desaprovecha, de este modo, a uno de sus profesionales mas cualificados. Estamos convencidos de que el paciente en fase terminal y sus familiares y/o cuidadores se verian muy favorecidos por una implicacion mayor de los farmaceuticos en sus procesos. Por esta razon, en este articulo se reflexiona sobre los beneficios que reporta la inclusion del farmaceutico comunitario en el equipo asistencial que atiende a las personas en fase terminal. EnglishThis work starts from the recognition of the important role that the community pharmacist plays, in health care, to people who suffer from a terminal process and to their family members and / or caregivers. There is no doubt that the advice, treatment and accompaniment of health professionals is essential in any pathology that involves a vital commitment. The community pharmacist, as a health agent, must be involved in these processes. However, on many occasions it is forgotten by a health system that wastes, in this way, one of its most qualified professionals. We are convinced that the terminally ill patient and their family members and / or caregivers would be greatly favored by a greater involvement of pharmacists in their processes. For this reason, this article reflects on the benefits of including the community pharmacist in the healthcare team that cares for people in the terminal phase.

Purpose The purpose of this study was to investigate whether routine insertion of peripherally inserted central catheter (PICC) at admission to a hospice-palliative care (HPC) unit is acceptable in terms of safety and efficacy and whether it results in superior patient satisfaction compared to usual intravenous (IV) access.Materials and Methods Terminally ill cancer patients were randomly assigned to two arms: routine PICC access and usual IV access arm. The primary endpoint was IV maintenance success rate, defined as the rate of functional IV maintenance until the intended time (discharge, transfer, or death).Results A total of 66 terminally ill cancer patients were enrolled and randomized to study arms. Among them, 57 patients (routine PICC, 29; usual IV, 28) were analyzed. In the routine PICC arm, mean time to PICC was 0.84 days (range, 0 to 3 days), 27 patients maintained PICC with function until the intended time. In the usual IV arm, 11 patients maintained peripheral IV access until the intended time, and 15 patients underwent PICC insertion. The IV maintenance success rate in the routine PICC arm (27/29, 93.1%) was similar to that in the usual IV arm (26/28, 92.8%, p=0.958). Patient satisfaction at day 5 was better in the routine PICC arm (97%, ‘a little comfort’ or ‘much comfort’) compared with the usual IV arm (21%) (p

Purpose The aims of the present study were to investigate the symptom clusters in terminally ill patients with cancer using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative Care (EORTC QLQ-C15-PAL), and to examine whether these symptom clusters influenced prognosis. Methods We analyzed data from 130 cancer patients hospitalized in the palliative care unit from June 2018 to December 2019 in an observational study. Principal component analysis was used to detect symptom clusters using the scored date of 14 items in the QLQ-C15-PAL, except for overall QOL, at the time of hospitalization. The influence of the existence of these symptom clusters and Palliative Performance Scale (PPS) on survival was analyzed by Cox proportional hazards regression analysis, and survival curves were compared between the groups with or without existing corresponding symptom clusters using the log-rank test. Results The following symptom clusters were identified: cluster 1 (pain, insomnia, emotional functioning), cluster 2 (dyspnea, appetite loss, fatigue, and nausea), and cluster 3 (physical functioning). Cronbach’s alpha values for the symptom clusters ranged from 0.72 to 0.82. An increased risk of death was significantly associated with the existence of cluster 2 and poor PPS (log-rank test, p = 0.016 and p Conclusion In terminally ill patients with cancer, three symptom clusters were detected based on QLQ-C15-PAL scores. Poor PPS and the presence of symptom cluster that includes dyspnea, appetite loss, fatigue, and nausea indicated poor prognosis.

Background: Predictive factors for the development of dyspnea have not been reported among terminally ill cancer patients. Objective: This current study aimed to identify the predictive factors attributed to the development of dyspnea within 7 days after admission among patients with cancer. Methods: This was a secondary analysis of a multicenter prospective observational study on the dying process among patients admitted in inpatient hospices/palliative care units. Patients were divided into 2 groups: those who developed dyspnea (development group) and those who did not (non-development group). To determine independent predictive factors, univariate and multivariate analyses using the logistic regression model were performed. Results: From January 2017 to December 2017, 1159 patients were included in this analysis. Univariate analysis showed that male participants, those with primary lung cancer, ascites, and Karnofsky Performance Status score (KPS) of ≤40, smokers, and benzodiazepine users were significantly higher in the development group. Multivariate analysis revealed that primary lung cancer (odds ratio [OR]: 2.80, 95% confidence interval [95% CI]: 1.47-5.31; p = 0.002), KPS score (≤40) (OR: 1.84, 95% CI: 1.02-3.31; p = 0.044), and presence of ascites (OR: 2.34, 95% CI: 1.36-4.02; p = 0.002) were independent predictive factors for the development of dyspnea. Conclusions: Lung cancer, poor performance status, and ascites may be predictive factors for the development of dyspnea among terminally ill cancer patients. However, further studies should be performed to validate these findings.

Background: The palliative prognostic index (PPI) predicts the life expectancy of patients with terminally ill cancer in hospice settings. This study aimed to evaluate PPI as a prognostic tool for predicting the life expectancy of patients with hematological malignancies admitted to the acute ward. Methods: A total of 308 patients with hematological malignancies admitted to the hematological ward at a medical center between January 2016 and December 2017 were consecutively enrolled. PPI was scored within 24 h of admission. All patients were categorized into 3 groups by PPI for comparing survival and in-hospital mortality rates. Results: The median survival times were 38.4, 3.6, and 1.1 months for patients with good, intermediate, and poor prognostic group, respectively. The hazard ratio was 2.31 (95% CI 1.59-3.35, p < 0.001) when comparing the intermediate and good prognosis groups, and 3.90 (95% CI 2.52-6.03, p < 0.001) when comparing the poor and good prognosis groups. Forty-five (14.6%) patients died at discharge; in-hospital mortality rates among the good, intermediate, and poor prognostic groups were 9.0%, 23.4%, and 46.4%, respectively. The adjusted odds ratio for in-hospital mortality was 1.96 (95% CI, 0.80-4.82, p = 0.14) and 5.25 (95% CI, 2.01-13.7, p < 0.001) for patients in the intermediate and poor prognostic groups compared to those in the good prognostic group. Conclusion: PPI is an accurate prognostic tool for predicting survival times and in-hospital mortality rates in patients with hematological malignancies in an acute ward setting. PPI could assist clinicians in discussing end-of-life issues and in referring patients with hematological malignancies to palliative care.

Many terminally ill older adults depend on family members to make medical decisions in China. Many family members find it difficult to make do-not-resuscitate (DNR) decisions in emergency departments (ED). Currently, factors that affect DNR decision making by family members for older adults needing emergency care have not been well studied. This qualitative inquiry explores factors influencing DNR decision-making among family members of terminally ill older adults in ED. Semi-structured in-depth interviews were conducted for a 12-family member of terminally ill older adults at ED in China. Results of the conventional content analysis showed that family members made DNR decisions based on a wide of reasons: (a) subjective perception of family members, (b) conditions of the terminally ill older adults, (c) external environmental factors, and (d) internal family factors. The findings of this study expand our knowledge and understanding of factors influencing DNR decision-making by family members of terminally ill older adults in ED.

The aim of this case is to clarify the need to maintain the terminally ill oncological patients who have had a thrombotic event in the course of their underlying disease under antithrombotic therapy. This case addresses a 63-year-old man with stage IV gastric antrum adenocarcinoma, completely bed-ridden and anticoagulated with subcutaneous enoxaparin for more than a year, following deep venous thrombosis of the left lower limb. After reviewing the literature, it was found that, for end-of-life patients, anticoagulation seems to have little benefit as the main objective is not the extension of life itself, but rather the preservation of the best quality of life through practices that are well established in the relief of suffering.O presente caso pretende clarificar qual a verdadeira necessidade de manter sob terapêutica anti-trombótica os doentes oncológicos terminais que tiveram um evento trombótico no decorrer da evolução da sua doença de base. O caso em questão aborda um doente de 63 anos com uma neoplasia do antro gástrico em estadio IV, totalmente acamado, hipocoagulado com enoxaparina subcutânea há mais de um ano, no seguimento de uma trombose venosa profunda no membro inferior esquerdo. Após revisão da literatura, constatou-se que em doentes em fim de vida, a anticoagulação parece ter pouco benefício, visto que o principal objetivo não é o prolongamento da vida, mas sim a preservação da melhor qualidade de vida possível através de práticas cuja evidência no alívio do sofrimento está bem documentada.

Background: Loneliness is a prevalent societal issue and can impact on a person’s physical and mental health. It is unclear how loneliness impacts on end of life experiences or how such feelings can be alleviated. Aim: To explore the perceived prevalence, impact and possible solutions to loneliness among people who are terminally ill and their carers in Northern Ireland through the lens of health and social care professionals. Design: An explanatory multi-method study. Setting/participants: An online survey ( n = 68, response rate 30%) followed by three online focus groups with palliative and end of life care health and social care professionals ( n = 14). Data were analysed using descriptive statistics and thematic analysis. Results: Loneliness was perceived by professionals as highly prevalent for people with a terminal illness (92.6%) and their carers (86.8%). Loneliness was considered a taboo subject and impacts on symptoms including pain and breathlessness and overall wellbeing at end of life. Social support was viewed as central towards alleviating feelings of loneliness and promoting connectedness at end of life. Four themes were identified: (1) the stigma of loneliness, (2) COVID-19: The loneliness pandemic (3) impact of loneliness across physical and mental health domains and (4) the power of social networks. Conclusion: There is a need for greater investment for social support initiatives to tackle experiences of loneliness at end of life. These services must be co-produced with people impacted by terminal illness to ensure they meet the needs of this population.

The aim of this study was to highlight the role of the dentist in palliative care of adult cancer patients. This is an integrative review with search on PubMed, SciELO, Scopus, LILACS and Embase platforms. Primary articles published between 2010 and 2022 in English and Portuguese were included. Studies not directly related to the topic were excluded. Among 550 articles found, 11 were selected. Regarding the treatment of cancer patients, therapies such as surgery, radiotherapy and chemotherapy harm oral health, causing the appearance of oral manifestations during and after therapies, with the following problems being more frequent: xerostomia, mucositis or stomatitis, candidiasis, post-radiotherapy caries and osteoradionecrosis. In this sense, dental management is responsible for preventing and treating such complications, and pre-therapeutic evaluations and procedures are essential, as well as education in oral hygiene and periodic consultations with the dentist. The dentist's role is also to prevent opportunistic infections, which are frequent due to immunosuppression caused by radiotherapy or chemotherapy, reducing hospital stay and medication use. In addition, patients may have difficulty swallowing and breathing, as well as aesthetic and phonetic impairment, requiring rehabilitation with prosthetic devices. The dental role in palliative care in cancer patients is very important to promote a better quality of life, in view of the needs in oral care that arise during all stages of treatment. Insufficient training in undergraduate courses makes it difficult for dental surgeons to work in palliative care teams for cancer patients. El objetivo de este estudio fue resaltar el papel del dentista en los cuidados paliativos de pacientes adultos con cáncer. Esta es una revisión integradora con búsqueda en las plataformas PubMed, SciELO, Scopus, LILACS y Embase. Se incluyeron artículos primarios publicados entre 2010 y 2022 en inglés y portugués. Se excluyeron los estudios no relacionados directamente con el tema. Entre los 550 artículos encontrados se seleccionaron 11. En cuanto al tratamiento de pacientes oncológicos, terapias como la cirugía, la radioterapia y la quimioterapia perjudican la salud bucal, provocando la aparición de manifestaciones orales durante y después de las terapias, siendo más frecuentes los siguientes problemas: xerostomía, mucositis o estomatitis, candidiasis, caries post-radioterapia y osteorradionecrosis. En este sentido, el manejo odontológico se encarga de prevenir y tratar dichas complicaciones, siendo fundamentales las evaluaciones y procedimientos preterapéuticos, así como la educación en higiene bucal y las consultas periódicas con el odontólogo. El papel del odontólogo también es prevenir las infecciones oportunistas, que son frecuentes debido a la inmunosupresión provocada por la radioterapia o la quimioterapia, reduciendo la estancia hospitalaria y el uso de medicamentos. Además, los pacientes pueden tener dificultad para tragar y respirar, así como deterioro estético y fonético, que requieren rehabilitación con dispositivos protésicos. El papel de la odontología en los cuidados paliativos del paciente oncológico es muy importante para promover una mejor calidad de vida, en vista de las necesidades en el cuidado bucal que se presentan durante todas las etapas del tratamiento. La formación insuficiente en los cursos de pregrado dificulta que los cirujanos dentistas trabajen en equipos de cuidados paliativos para pacientes con cáncer. O objetivo deste estudo foi destacar o papel do cirurgião-dentista nos cuidados paliativos de pacientes adultos oncológicos. Trata-se de uma revisão integrativa com busca nas plataformas PubMed, SciELO, Scopus, LILACS e Embase. Foram incluídos artigos primários, publicados entre os anos de 2010 e 2022 nos idiomas inglês e português. Estudos sem relação direta com o tema foram excluídos. Dentre 550 artigos encontrados, foram selecionados 11. Em relação ao tratamento de pacientes oncológicos, as terapias como cirurgia, radioterapia e quimioterapia prejudicam a saúde oral, acarretando o aparecimento de manifestações orais durante e após as terapias, sendo mais frequentes os seguintes problemas: xerostomia, mucosite ou estomatite, candidíase, cárie pós-radioterapia e osteorradionecrose. Nesse sentido, o manejo odontológico é responsável por prevenir e tratar tais complicações, sendo imprescindíveis avaliações e procedimentos pré-terapêuticos, bem como educação em higiene oral e consultas periódicas com o dentista. O papel do dentista consiste também em prevenir infecções oportunistas, que são frequentes devido à imunossupressão causada por radioterapia ou quimioterapia, reduzindo o tempo de internação e o uso de medicamentos. Ademais, os pacientes podem apresentar dificuldade para deglutir e respirar, como também comprometimento estético e fonético, sendo necessária a reabilitação com dispositivos protéticos. A atuação odontológica nos cuidados paliativos em pacientes oncológicos é bastante importante para promover melhor qualidade de vida, tendo em vista as necessidades em cuidados orais que surgem durante todas as etapas do tratamento. O treinamento insuficiente nos cursos de graduação dificulta a preparação dos cirurgiões-dentistas na atuação em equipes de cuidados paliativos de pacientes com câncer.

To explore the trajectory of clinical symptoms and biomarkers in the last four weeks of life in terminally ill cancer patients.Observational study.Department of Oncology, Shijingshan hospital, Shijingshan Teaching Hospital of Capital Medical University, Beijing, China, between January 2017 and January 2020.This study evaluated 173 terminally ill cancer patients. Seventeen symptoms and fifteen biomarkers were identified. For sequential analysis, the authors divided the final four weeks of life into four time periods from the date of death. Ordinal multiple logistic regression analysis was used to explore the association between the changes in clinical parameters and the risk of death in a given period. Changes in clinical parameters across different time periods were evaluated using the Wilcoxon signed rank test.Abnormal consciousness; elevated ECOG (Eastern Cooperative Oncology Group) scores, neutrophil-to-lymphocyte ratio (NLR), blood urea nitrogen (BUN) to creatinine ratio, C-reactive protein (CRP)-to-albumin ratio; and decreased platelet (PLT) counts were independent factors (p0.05) for predicting closer death in the final month of life. All parameters above showed significant changes over time in the last month, although the starting time points for these changes varied.Abnormal consciousness, elevated ECOG scores, NLR, BUN-to-creatinine ratio, CRP-to-albumin ratio, and decreased PLT counts are potentially useful markers for approaching death in terminally ill cancer patients. These findings are valuable for understanding the biology of death in terminally ill cancer patients. And to some extent, they may help clinicians recognise that a patient will die in the near future.Cancer, Ordinal regression analysis, Death, Terminal illness, Biomarkers.