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Objectives To investigate the impact of advance care planning (ACP) including decision aids for severely ill medical inpatients. Methods Single-centre randomised controlled trial at a Swiss university hospital. Patients were randomly assigned (1:1) to receive an extra consultation with the hospital social service or a consultation with in-house facilitators trained according to an internationally established ACP programme. Trial participants with the exception of the observers were fully blinded. 115 competent severely ill adults, their surrogates and their attending physicians were enrolled and followed for 6 months after discharge or 3 months after death. The patient’s wishes regarding resuscitation (primary outcome), last place of care and other end-of-life wishes were recorded. Knowledge and respect of the patient’s wishes by the surrogates and attending physician were monitored. Results Compared with controls, 6 months after the intervention, fewer patients wished to be resuscitated or were undecided (p=0.01), resuscitation wishes were documented more frequently (89% vs 64%, p=0.02) and surrogates and/or attending physicians had greater knowledge of the patient’s wishes (62% vs 30%, p=0.01). Groups were not different with regard to wishes being fulfilled, with the exception of last place of care being achieved more frequently in the intervention group (29% vs 11 %, p=0.05). Conclusion ACP including decision aids offered to severely ill medical inpatients leads to greater knowledge, documentation and respect of treatment and end-of-life wishes. Introducing ACP to these patients however may be too late for many patients. Early integration of ACP during the illness trajectory and a broader regional approach may be more appropriate., BMJ Support & Palliative Care, 12 (3), ISSN:2045-435X

ContextThe unmet needs of patients with advanced disease are indicative of the patient centredness of healthcare. By tracking unmet needs in clinical practice, palliative interventions are aligned with patient priorities, and clinicians receive support in intervention delivery decisions for patients with overlapping, complex needs.ObjectiveIdentify tools used in everyday clinical practice for the purpose of identifying and addressing unmet healthcare needs for patients with advanced disease.MethodsWe conducted PubMed and Cumulative Index of Nursing and Allied Health Literature searches to include studies published between 1 January 2008 and 21 April 2020. Three concepts were used in constructing a search statement: (1) patient need, (2) validated instrument and (3) clinical practice. 2313 citations were reviewed according to predefined eligibility, exclusion and inclusion criteria. Data were collected from 17 tools in order to understand how instruments assess unmet need, who is involved in tool completion, the psychometric validation conducted, the tool’s relationship to delivering defined palliative interventions, and the number of palliative care domains covered.ResultsThe majority of the 17 tools assessed unmet healthcare needs and had been validated. However, most did not link directly to clinical intervention, nor did they facilitate interaction between clinicians and patients to ensure a patient-reported view of unmet needs. Half of the tools reviewed covered ≤3 dimensions of palliative care. Of the 17 tools evaluated, 4 were compared in depth, but all were determined to be insufficient for the specific clinical applications sought in this research.ConclusionA new, validated tool is needed to track unmet healthcare needs and guide interventions for patients with advanced disease.

Objective To review the indications for and side effects of androgen deprivation therapy (ADT) in men affected by prostate cancer. Data Sources National guidelines, evidence-based summaries, peer-reviewed studies, and websites. Conclusion Indications for ADT include men with (1) intermediate- to high-risk localised prostate cancer undergoing radiation therapy, (2) biochemical recurrence after radical prostatectomy treated with salvage radiation therapy, or (3) metastatic prostate cancer. Several forms of ADT are available. To support self-management, body weight, diet, physical activity, alcohol consumption, and smoking should be discussed during clinical consultations. Important side effects of ADT may include flare-up phenomena of GnRH analogues, local reactions at injection sites, cardiovascular events, bone loss/fractures, drug-drug interactions, urinary tract dysfunction, hot flashes, cognitive impairment, seizure falls, and liver impairment. Implications for Nursing Practice Nurses have a role in personalized cancer care and should be familiar with indications, side effects, and interventions to optimize quality of life for men affected by prostate cancer receiving ADT.

Broadly neutralizing antibodies (bnAbs) are considered a key component of an effective HIV-1 vaccine, but despite intensive efforts, induction of bnAbs by vaccination has thus far not been possible. Potent bnAb activity is rare in natural infection and a deeper understanding of factors that promote or limit bnAb evolution is critical to guide bnAb vaccine development. This review reflects on recent key discoveries on correlates of bnAb development and discusses what further insights are needed to move forward.An increasing number of parameters have been implicated to influence bnAb development in natural infection. Most recent findings highlight a range of immune factors linked with bnAb evolution. Novel approaches have brought exciting progress in defining signatures of the viral envelope associated with bnAb activity.Focused efforts of recent years have unraveled a multiply layered process of HIV-1 bnAb development. As it is understood today, bnAb evolution can be triggered and influenced by a range of factors and several different pathways may exist how bnAb induction and maturation can occur. To capitalize on the gained knowledge, future research needs to validate factors to identify independent drivers of bnAb induction to advance vaccine design.

PURPOSE: To give a first description of the perception of late effects among long-term survivors after Allogeneic Haematopoietic Stem Cell Transplantation (HSCT) and to validate the German Brief Illness Perception Questionnaire (BIPQ). METHODS: This is a secondary analysis of data from the cross-sectional, mixed-method PROVIVO study, which included 376 survivors from two Swiss HSCT-centres. First, we analysed the sample characteristics and the distribution for each BIPQ item. Secondly, we tested three validity types following the American Educational Research Association (AERA)Standards: content validity indices (CVIs) were assessed based on an expert survey (n = 9). A confirmatory factor analysis (CFA) explored the internal structure, and correlations tested the validity in relations to other variables including data from the Hospital Anxiety and Depression Scale (HADS), the number and burden of late effects and clinical variables. RESULTS: In total, 319 HSCT recipients returned completed BIPQs. For this sample, the most feared threat for post-transplant life was long lasting late effects (median = 8/10). The expert-survey revealed an overall acceptable CVI (0.82), three items-on personal control, treatment control and causal representation-yielded low CVIs (

ObjectiveExploration of healthcare utilisation patterns in the final life year to assess palliative care potential.MethodsRetrospective cluster analyses (k-means) of anonymised healthcare expenditure (HCE) trajectories, derived from health insurance claims of a representative sample of Swiss decedents who died between 2008 and 2010 (2 age classes: 4818 Results3 (As age increased, these potential target groups for palliative care gained in share among 90-year olds) among elderly.ConclusionsCost trajectory clustering is well suited for first-pass population screenings of groups that warrant closer inspection to improve end-of-life healthcare allocation. The Swiss data suggest that many decedents undergo intensive medical treatment until shortly before death. Investigations into the clinical circumstances and motives of patients and physicians may help to guide palliative care.

Background Siblings of pediatric cancer patients have a higher risk of developing emotional, behavioral, and social problems. However, little is known about specific experiences of this population in the first time after diagnosis. Objective The purpose of this qualitative study was to describe the experiences of siblings of pediatric cancer patients in different areas of life in the first half-year after the cancer diagnosis. Methods Semistructured interviews were conducted with 7 siblings of pediatric cancer patients (ages 11-18 years). Siblings were asked about their experiences in the hospital, in school, in their family, with peers, and with the ill child. Content analysis was used to derive important themes from the interviews. Results Twenty-three categories of siblings' experiences were identified from the data. Conclusions In all areas of life, siblings reported difficulties, such as absence of parents, dealing with the ill child's or other patients' suffering and appearance, or impaired school achievement. But the siblings also mentioned important resources such as peer relationship, helpful coping strategies, and increased family cohesion. Implications for practice The results of the present study lead to a list of important topics in different areas of life that might be helpful for healthcare professionals to have in mind when meeting with siblings of cancer patients. Integration of these findings should serve to improve sibling support and develop standardized sibling interventions.

Liver disease is a major cause of morbidity and mortality in HIV-infected persons. The long-term beneficial versus potentially harmful influence of antiretroviral therapy (ART) on the liver is debated. We review current data on factors contributing to liver disease in HIV-monoinfected as well as in HIV/viral hepatitis-coinfected patients, highlighting the role of ART, HIV itself, immunodeficiency, patient characteristics, and lifestyle risk factors.New ART-related clinical syndromes, including noncirrhotic portal hypertension and nonalcoholic fatty liver disease, have emerged, and observational data suggest long-term ART-associated liver injury. Recently, there is increasing evidence that HIV itself and immunosuppression are contributing to liver injury in both HIV-coinfected and HIV-monoinfected patients. In HIV-positive persons, ART attenuates progression of chronic viral hepatitis.Current expert guidelines recommend earlier treatment of HIV infection in persons coinfected with hepatitis B virus and possibly hepatitis C virus. It is unknown whether an earlier start of ART is beneficial for the liver in HIV-monoinfected patients. Future research should focus on long-term ART-related hepatotoxicity.