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Background: Leadership competencies are essential for the future development of the field of palliative and hospice care. However, a consensus on the core competencies of good leadership is not yet available. Objective: To elicit consensus on core leadership competencies in palliative care. Design: Based on a literature review, a list of 119 specific leadership competencies was compiled. Subsequently, a Delphi technique used three online survey rounds and a final expert consultation (the board of the European Association for Palliative Care [EAPC]) to assess the importance of these competencies. Setting/Participants: International experts in leadership in palliative care were identified from an online search and EAPC networks. Results: From the 194 international multiprofessional experts invited to participate, 99/78/64 took part in the 3 rounds. One hundred fifteen items from eight domains of leadership (research, advocacy and media, communication, teamwork, project management, organizational learning and sustainability, leading change, and personal traits) reached consensus and were deemed as important. Conclusions: The eight domains provide evidence for teaching of leadership competencies in palliative care. We recommend that exploring, identifying, and integrating leadership competencies in palliative care are given more attention in educational curricula and in training interventions. [ABSTRACT FROM AUTHOR]

Background: The fear of taking away hope hinders clinicians' willingness to share serious news with patients with advanced disease. Unrealistic illness expectations, on the other hand, can complicate decision making and end-of-life care outcomes. Exploration of the association between hope and illness expectations can support clinicians in better communication with their patients. Aim: The aim of this study was to explore whether realistic illness expectations are associated with reduced hope in people with advanced cancer. Design: This is a cross-sectional secondary analysis of baseline data from a primary palliative care cluster-randomized trial CONNECT (data collected from July 2016 to October 2020). Hope was measured by Herth Hope Index. Illness expectations were measured by assessing patients' understanding of their treatment goals, life expectancy, and terminal illness acknowledgement. Multivariable regression was performed, adjusting for demographical and clinical confounders. Setting/participants: Adult patients with advanced solid cancers recruited across 17 oncology clinics. Results: Data from 672 patients were included in the study, with mean age of 69.3 years (±10.2), 53.6% were female. Proportion of patients indicating realistic expectations varied based on which question was asked from 10% to 46%. Median level of hope was 39 (IQR = 36–43). Multivariate non-inferiority regression did not find any significant differences in hope between patients with more and less realistic illness expectations. Conclusions: Our results suggest that hope can be sustained while holding both realistic and unrealistic illness expectations. Communication about serious news should focus on clarifying the expectations as well as supporting people's hopes. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to analyse longitudinal development of prognostic awareness in advanced cancer patients and their families. Methods: This was a longitudinal cohort study, involving 134 adult cancer patients, 91 primary family caregivers and 21 treating oncologists. Key eligibility criterion for patients was life expectancy less than 1 year (estimated by their oncologists using the 12‐month surprised question). Structured interviews, including tools to measure prognostic awareness, health information needs, and demographics were conducted face to face or via phone three times over 9 months. Forty‐four patients completed all three phases of data collection. Results: Only 16% of patients reported accurate prognostic awareness, 58% being partially aware. Prognostic awareness of both patients and family caregivers remained stable over the course of the study, with only small non‐significant changes. Gender, education, type of cancer, spirituality or health information needs were not associated with the level of prognostic awareness. Family caregivers reported more accurate prognostic awareness, which was not associated with patients' own prognostic awareness (agreement rate 59%, weighted kappa 0.348, CI = 0.185–0.510). Conclusions: Prognostic awareness appears to be a stable concept over the course of the illness. Clinicians must focus on the initial patients' understanding of the disease and be able to communicate the prognostic information effectively from the early stages of patients' trajectory. [ABSTRACT FROM AUTHOR]

Aim: To address the wishes of patients with cardiovascular disease in relation to their end-of-life stage - an issue that has long been regarded taboo. Design: Cross-sectional study. Methods: After an initial interview, 127 patients completed an anonymous questionnaire: 86 patients (67.7%) hospitalized in a cardiology department, and 41 patients (32.3%) on follow-up at an outpatient clinic. The mean age was 67 ± 13 years; 60.6% were male; 51.7% were NYHA class III. Seventeen patients (13.4%) had an implantable cardioverter-defibrillator. Results: The patients most concerned about their future were those aged 65-79 years (p = 0.044); patients who felt they were not receiving sufficient information (p = 0.008); hospitalized patients (p < 0.001); or those with a known diagnosis of less than one month, or over one year (p = 0.038). Seventy-one patients (57.7%) would prefer to die at home, although this would mean receiving less health care than in hospital. Only 19 patients (15.4%) expressed a preference for extension of life over quality of life. Twenty-nine patients (23.6%) would contemplate having their cardioverter-defibrillator deactivated. 90.2% subjects considered it important for physicians to be interested in the views of patients regarding these issues. Conclusion: Despite the contrast with practice in some countries, most patients with cardiovascular disease would appreciate physicians being interested in their attitudes to the issue of end of life. An adequate level of information would help reduce patient concerns about their futures. [ABSTRACT FROM AUTHOR]