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Background: Hospice and palliative medicine (HPM) is a board-certified subspecialty within emergency medicine (EM), but prior studies have shown that EM residents do not receive sufficient training in HPM. Experts in HPM-EM created a consensus list of competencies for HPM training in EM residency. We evaluated how the HPM competencies integrate within the American Board of Emergency Medicine Milestones, which include the Model of the Clinical Practice of Emergency Medicine (EM Model) and the knowledge, skills, and abilities (KSA) list.Methods: Three emergency physicians independently mapped the HPM-EM competencies onto the 2019 EM Model items and the 2021 KSAs. Discrepancies were resolved by a fourth independent reviewer, and the final mapping was reviewed by all team members.Results: The EM Model included 78% (18/23) of the HPM competencies as a direct match, and we identified recommended areas for incorporating the other five. The KSAs included 43% (10/23). Most HPM competencies included in the KSAs mapped onto at least one level B (minimal necessary for competency) KSA. Three HPM competencies were not clearly included in the EM Model or in the KSAs (treating end-of-life symptoms, caring for the imminently dying, and caring for patients under hospice care).Conclusion: The majority of HPM-EM competencies are included in the current EM Model and KSAs and correspond to knowledge needed to be competent in EM. Programs relying on the EM Milestones to plan their curriculums may miss training in symptom management and care for patients at the end of life or who are on hospice.

Background: The limited palliative care evidence base is poorly amenable to existing grading schemes utilized in guidelines. Many recommendations are based on expert consensus or clinical practice standards, which are often considered 'low-quality' evidence. Reinforcing provider hesitancy in translating recommendations to practice has implications for patient care. Aim: To rationalize the selection of an appropriate grading system for rating evidence to support recommendations made in palliative care clinical practice guidelines. Design: Review of the methodology sections of international palliative care guidelines published in English identified five grading systems comparison: Grading of Recommendations, Assessment, Development and Evaluations (GRADE); the Scottish Intercollegiate Guidelines Network (SIGN); Infectious Diseases Society of America-European Society for Medical Oncology (IDSA-ESMO); Confidence in the Evidence from Reviews of Qualitative research (CERQual) and the National Service Framework for Long Term Conditions (NSF-LTC). Results: There is heterogeneity among grading systems used in published palliative care or terminal symptom management guidelines. GRADE has been increasingly adopted for its methodological rigour and inter-guideline consistency with other medical associations. CERQual has the potential to support recommendations informed by qualitative evidence, but its role in clinical guidelines is less defined. The IDSA-ESMO system has an intuitive typology with the ability to categorize tiers of lower-quality evidence. Conclusions: It is challenging to apply commonly used grading systems to the palliative care evidence base, which often lacks robust randomized controlled trials (RCTs). Adoption of IDSA-ESMO offers a feasible and practical alternative for lower-resourced guideline developers and palliative clinicians without a prerequisite for methodological expertise. [ABSTRACT FROM AUTHOR]

Patients with advanced colorectal cancer nearing the end of life require a multidisciplinary approach to address the unique challenges they face. Using a case vignette, we outline the various stages of a patient's journey with advanced rectal cancer and the common obstacles to their care as they interface with the medical system. We highlight how Black persons might be vulnerable to differences in screening, treatment, procedural interventions, end-of-life care, and health care decision-making. The article also addresses how health inequities and barriers relating to concordant treatment goals can impact the relationship between patient and surgeon. This vignette illustrates the importance of ensuring a team approach to treatment and the value of early involvement of palliative medicine for patients with advanced colorectal cancer. [ABSTRACT FROM AUTHOR]

Simple Summary: Patients with advanced cancer often have high levels of emotional suffering, so it is necessary to identify their palliative needs and address them effectively. Although distress is highly prevalent among patients receiving palliative care, research in this area indicates that it remains significantly underdiagnosed and undertreated. The aim of our cross-sectional and correlational study was to analyze the psychometric properties of the Edmonton Symptom Assessment System (ESAS) and the Palliative Outcome Scale (POS) among inpatient cancer patients receiving palliative care in a Portuguese palliative care unit. We confirmed that self-reported anxiety and depression (reported through the ESAS scale) are correlated to emotional questions (reported through the POS), namely, anxiety related to disease, the meaning of life, and sharing feelings. This study showed us that the ESAS and POS complement each other as practical and easy-to-use tools for evaluating emotional distress in the context of palliative care. Introduction: Cancer patients in palliative care frequently experience psychological distress, encompassing cognitive, behavioral, and emotional dimensions. This distress can significantly affect their capacity to accept the inevitability of death. Commonly, such distress manifests as sadness, depression, anxiety, and fear, which may culminate in an existential crisis. Objectives: The purpose of this study was to analyze the psychometric properties of the Edmonton Symptom Assessment System (ESAS) and the Palliative Outcome Scale (POS) among hospitalized cancer patients receiving palliative care in a Portuguese palliative care unit. Methods: Data were collected from psychological screening instruments (ESAS and POS) used in oncology patients admitted to an oncology palliative service. The study period spanned from January 2021 to March 2021. Results: The study included a convenience sample of 60 patients diagnosed with advanced cancer who were sequentially admitted to a palliative care unit. The most frequently reported primary oncological diagnoses were gastrointestinal (41.7%) and head/neck (20%) tumors. The majority of the patients were male (n = 37; 61.7%), with a median age of 72 years (range: 43–94 years). Key findings from the analysis indicated the following associations: anxiety and self-reported symptoms (higher levels of patient anxiety related to illness or treatment were strongly correlated with increased self-reported anxiety (p < 0.01)); emotional sharing and perceived meaning of life (patients who shared their feelings less frequently with family and friends were significantly less likely to find meaning in life (p < 0.01) and were more likely to report a poorer self-perception (p < 0.05)); understanding the importance of life and self-perception (a diminished understanding of the importance of life was associated with worsened self-perception (p < 0.01)); anxiety and depressive symptoms (greater anxiety related to the disease or its treatment correlated with an increased severity of depressive symptoms (p < 0.01)). Discussion and conclusion: There are numerous validated instruments available for measuring emotional distress. Among these, the ESAS and POS complement each other as practical and easy-to-use tools for evaluating emotional distress in patients admitted to palliative care settings. Findings revealed that anxiety and concerns related to the disease and its treatment, as measured by the POS, served as predictors of the risk for self-reported anxiety and depression identified by the ESAS. Furthermore, the items within the POS that evaluate the emotional component demonstrated strong internal correlation, supporting their combined use for a comprehensive assessment of this dimension. [ABSTRACT FROM AUTHOR]

Aspiration pneumonia is a clinical entity with important ethical considerations. It is imperative for clinicians to understand these considerations to best provide counsel to patients and their families, allowing them to make fully informed decisions. Given that aspiration pneumonia is frequently associated with end of life, there are palliative medicine principles that may help in the treatment of this disease. [ABSTRACT FROM AUTHOR]

Children are a uniquely vulnerable patient population with restricted abilities for self-advocacy and autonomy, risking infringement upon their dignity. Yet the concept of dignity in pediatrics remains underexplored relative to the adult literature and other outcome measures. To characterize how dignity is defined, evaluated, and/or measured in pediatrics. We conducted a systematic review following PRISMA guidelines across the following databases: MEDLINE, Embase, Cumulative Index of Nursing and Allied Health, PsycINFO, Global Health, Social Science Premium Collection, and Dissertation and Theses. We included publications from database inception through April 2023, in English, involving children aged 0–18 years, and prioritizing dignity as a central theme with a focus on defining, evaluating, or measuring dignity. Study descriptions and pertinent characteristics were extracted and synthesized using a predefined form. Forty-four articles met inclusion criteria; fewer than half comprised original research (20/44, 45%). Most studies (38/44, 86%) included description of the meaning of dignity, with emergence of salient themes around respect, communication, agency/autonomy, and privacy. Less than half (19/44, 43%) included a measurement or evaluation of dignity; approximately one-third described dignity therapy. More than one-third of publications focused on dignity at end of life (17/44, 39%) and included discussions of palliative medicine and hospice (15/44, 34%). Relatively few published studies describe dignity in pediatrics. Opportunities exist to broaden scholarship on this topic in partnership with patients, families, and clinicians, with the goal of assessing and strengthening dignity-centered care across the illness course and at the end of life. [ABSTRACT FROM AUTHOR]

Introduction Palliative care, with a focus on enhancing the quality of life for individuals facing life-limiting illnesses, relies on effective pain management as a fundamental component. Opioids, particularly methadone, play a crucial role in addressing moderate to severe pain in palliative care due to their unique pharmacological properties. Methadone, a long-acting opioid agonist and N-methyl-D-aspartate receptor antagonist, is valuable for treating both nociceptive and neuropathic pain. However, the transition to methadone from other opioids requires careful consideration. Objectives This study examines the use of methadone as an alternative to morphine or fentanyl for managing refractory cancer pain in a tertiary care hospital in India. Methods We conducted a retrospective analysis of anonymized medical records of cancer patients initiated on oral methadone for pain management at a tertiary cancer center's palliative medicine outpatient clinic from February 2020 to June 2021. Data included demographic characteristics, pain descriptions, concurrent analgesic use, reasons for transitioning to methadone, rotation methods, methadone dosages, clinical outcomes, adverse effects, and treatment discontinuations. Patients were routinely followed up, with pain scores, morphine equivalent daily doses, and methadone requirements recorded at each visit. Results Forty-four patients received methadone, either as a coanalgesic (41/44) or primary opioid (3/44). Refractory cancer pain, with a neuropathic component, was the predominant indication for methadone use. Following the methadone initiation, all patients experienced significant pain relief. Median daily methadone dose increased from 5 to 7.5 mg after 1 week. Adverse effects were minimal, with one patient experiencing QTc interval prolongation. Patient-specific factors often necessitated deviations from equianalgesic conversion tables in determining methadone dosages. Conclusion Methadone offers a viable option for refractory cancer pain when conventional treatments fall short. Physicians should prioritize personalized titration and thorough assessment during opioid rotation, rather than relying solely on conversion tables. Further research is needed to explore alternative approaches for opioid rotation and to expand our understanding of methadone's optimal use in cancer pain management. [ABSTRACT FROM AUTHOR]

The article discusses the Catholic and pro-life response to life-limiting anomalies, focusing on the debate surrounding abortion exceptions for infants with lethal anomalies. It highlights the shift towards perinatal hospice as an alternative to abortion for infants with lethal anomalies, emphasizing the need for informed consent and accurate medical information for parents facing challenging prenatal diagnoses. The text also addresses biases among medical providers, the importance of offering supportive medical care to infants with trisomy 13 and 18, and the ethical considerations surrounding perinatal hospice practices. [Extracted from the article]

Introduction: Uncontrolled symptoms are widely recognized as one of the main challenges in oncology palliative care patients. The central aim of palliative care is to improve the patient's quality of life. In recent years, there has been a growing use of patient-reported outcome measures in palliative care, particularly to evaluate symptoms, quality of care, and well-being. Aim: To evaluate the sociodemographic and clinical profile, symptom distress, and perceived quality of life in oncology palliative care patients admitted to a specialized palliative care unit in Portugal. Methods: This study was cross-sectional, descriptive, and correlational, carried out in the inpatient setting of the palliative care unit at a tertiary oncology hospital (at admission). The evaluated protocol included a sociodemographic and clinical questionnaire, as well as two measurement instruments: the Edmonton Symptom Assessment Scale (ESAS) and the Palliative Care Outcome Scale (POS), both filled out by the patients. Data analysis was conducted using IBM SPSS® Statistics version 25.0, with a significance level set at 5% (p < 0.05). Results: The majority of participants in this sample were male (61.7%), with a mean age of around 72 years. More than half of the patients admitted (n = 34; 56.7%) were being monitored in outpatient care. Digestive and head and neck cancers were the most commonly found in the sample (41.7% and 20%, respectively). A significant correlation was found between high symptom intensity and poorer quality of life and care (p < 0.01). This association was particularly pronounced for symptoms such as pain, weakness, depression, anxiety, and anorexia. Conclusions: This study revealed a positive correlation between overall symptom severity and a perceived deterioration in quality of life, well-being, and quality of care. Future studies should consider utilizing alternative assessment tools for evaluating symptoms and quality of care. Additionally, including non-cancer palliative patients in similar studies may provide further valuable insights. [ABSTRACT FROM AUTHOR]

Introduction: The provision of palliative care is central to primary health care delivery. In this setting, community pharmacies often act in a medication supply role, yet their broader involvement in supporting people in the last year of life is less well understood. Aim: This study aimed to review the literature on community pharmacies supporting adults with palliative care needs in their last year of life, emphasising challenges to optimising their role and improving equity and service accessibility. Methods: A five-stage scoping review using a comprehensive literature search was conducted using MEDLINE, EMBASE, CINAHL, Web of Science, Scopus, and grey literature up to 30 April 2024. Eligible articles were charted, descriptively analysed, and mapped to a bicultural and holistic health care model, Te Whare Tapa Whā Older Person's Palliative Care model. Results: Twenty-five studies from seven countries were reviewed, revealing that community pharmacies provide a range of services to support people with palliative care needs. The main role of community pharmacies resides in Tinana, the physical health domain of Te Whare Tapa Whā Older Person's Palliative Care model. Challenges experienced by pharmacy staff include communication with palliative care service providers and users, integrating their role into palliative care provision, addressing their educational needs, and managing palliative medication stock. Discussion: The role of community pharmacy in providing palliative care is not widely understood. If the challenges identified in these studies can be addressed, there is potential for community pharmacies to offer a more proactive palliative care approach to their communities. What is already known: Medication management for adults with palliative care needs in the last year of life is complex and challenging. However, there is a limited synthesis of the literature describing the breadth of palliative care services provided by community pharmacies. What this study adds: This review provides evidence that community pharmacies worldwide offer a range of services to support people with palliative care needs and face similar challenges concerning how the public perceives their role in delivering palliative care. A thorough understanding of the role of community pharmacies could enhance care quality, extending benefits to individuals not currently receiving palliative care support in the community. [ABSTRACT FROM AUTHOR]

Background and Aim: Hypercalcemia is one of the most common complications of advanced malignancy. Treatment of hypercalcemia among advanced cancer patients often gives rise to complex ethical issues. This study aims to explore treatment outcomes of hypercalcemia among advanced cancer patients so that palliative care physicians can design cost‐effective and efficient approaches to diagnosis and treatment for these patients. Methods: This observational study was conducted among 31 advanced (stages III and IV) cancer patients diagnosed with hypercalcemia of malignancy admitted to the Department of Palliative Medicine, Bangabandhu Sheikh Mujib Medical University, Bangladesh, from June to December 2023. The patients were observed on the day of admission and followed up on 3rd and 7th day for assessment of their response to the received treatment. Chi‐square test, Fisher's exact test, paired and unpaired t‐tests were done to assess the treatment response and changes in the clinical characteristics of the patients. Result: After 3 days of rehydration therapy, the mean serum calcium level decreased significantly from 12.43 ± 1.96 to 10.82 ± 2.07 after treatment, with a significant p‐value of < 0.001. For the management of remaining hypercalcemic patients, intravenous bisphosphonates are used in conjunction with normal saline. There was a substantial decrease in the mean value of serum calcium level from 12.66 ± 1.91 to 10.27 ± 0.75 after treatment with normal saline and bisphosphonate on the 7th day. The majority of patients (64.5%) showed improvement following treatment. A smaller percentage (16.1%) remained hypercalcemic even after getting all treatments. Unfortunately, 19.4% died, possibly due to the progressive nature of the disease along with hypercalcemia. Conclusion: Malignant hypercalcemia is a potentially fatal, undiagnosed, and undertreated complication of advanced malignancy. It is essential for palliative care physicians to identify hypercalcemia and develop comprehensive care plan to optimize the treatment outcomes. [ABSTRACT FROM AUTHOR]

Background: Emergency medicine (EM) resident training is guided by the American Board of Emergency Medicine Model of the Clinical Practice of Emergency Medicine (EM Model) and the EM Milestones as developed based on the knowledge, skills, and abilities (KSA) list. These are consensus documents developed by a collaborative working group of seven national EM organizations. External experts in geriatric EM also developed competency recommendations for EM residency education in geriatrics, but these are not being taught in many residency programs. Our objective was to evaluate how the geriatric EM competencies integrate/overlap with the EM Model and KSAs to help residency programs include them in their educational curricula.Methods: Trained emergency physicians independently mapped the geriatric resident competencies onto the 2019 EM Model items and the 2021 KSAs using Excel spreadsheets. Discrepancies were resolved by an independent reviewer with experience with the EM Model development and resident education, and the final mapping was reviewed by all team members.Results: The EM Model included 77% (20/26) of the geriatric competencies. The KSAs included most of the geriatric competencies (81%, 21/26). All but one of the geriatric competencies mapped onto either the EM Model or the KSAs. Within the KSAs, most of the geriatric competencies mapped onto necessary level skills (ranked B, C, D, or E) with only five (8%) also mapping onto advanced skills (ranked A).Conclusion: All but one of the geriatric EM competencies mapped to the current EM Model and KSAs. The geriatric competencies correspond to knowledge at all levels of training within the KSAs, from beginner to expert in EM. Educators in EM can use this mapping to integrate the geriatric competencies within their curriculums.

Abstract Introduction In Brazil, a country of continental dimensions, the lack of services in the different regions is a major barrier that prevents patients from accessing Pediatric Palliative Care (PPC). If accessing PPC is already challenging, end-of-life care for these patients may also be difficult. Therefore, this study is based on a recent mapping effort, aimed at reflecting on the end-of-life care for children in Palliative Care in Brazil. Method Descriptive, cross-sectional study, and online survey research, based on a larger study of Palliative Care Network. Results The final sample comprised 90 Pediatric Palliative Care services, which proved to be unevenly distributed across the country. Many services lack a minimum team, 40% face difficulties accessing opioids, and one-third do not provide bereavement care. Discussion There should be more services with better distribution across the country, and a minimum team should be required to provide adequate care for children and adolescents. Strategies to improve symptom control and grief support should be introduced. Conclusions It is concluded that continuing education and the inclusion of relevant topics in health courses are necessary. Additionally, health service managers must expand their focus to address these issues effectively.

Abstract Background The humanities can aid in the development of important skills for trainee physicians. Because of the nature of their work, palliative medicine residents are expected to apply humanities-based skills frequently in their clinical work and are also likely to use humanities-based skills to support their own self-care. Our project explored the role of the humanities in palliative medicine residency programs across Canada. Methods Each priority topic or objective of the current palliative medicine residency training standards in Canada was reviewed to determine whether they relate to the humanities. A cross-sectional survey was subsequently created using Qualtrics, with the target study population being current palliative medicine residents and palliative medicine staff physicians at academic centers in Canada. Results Multiple humanities objectives exist in Canadian palliative medicine training standards, primarily in the ethical, cultural, and spiritual domains. Eighty-seven people completed the cross-sectional survey, for a 17.4% response rate and 94.6% completion rate. The vast majority (90%) of survey participants felt that the humanities had an important role in medical training at the undergraduate and postgraduate levels, and more than 70% of participants felt that the humanities had an important role in palliative medicine residency training. In some areas, the humanities participants felt that their programs would most benefit from ethics, philosophy, and culture. Over 65% agreed or strongly agreed that their own palliative medicine program would benefit from more humanities content. Conclusion Canadian palliative medicine training standards require residents to demonstrate humanities-based skills. Most survey participants state that the humanities have an important role in medical training at the undergraduate and postgraduate levels, and that their own palliative medicine residency program would benefit from more humanities content. These results may guide future studies to better understand why and how more humanities content can be added to palliative medicine residency programs to optimize residents’ learning experiences and better prepare them for careers in palliative medicine.

Abstract Background Little is known about patient outcomes following treatment of malignant pleural effusions (MPE) in the real-world setting. Research question We aimed to compare post-procedure all-cause mortality between individuals who received indwelling pleural catheter (IPC) insertion versus chemical pleurodesis for managing MPEs. Study design and methods We performed a retrospective population-based study using provincial health administrative data (Ontario, Canada) of adults with a MPE who underwent IPC insertion or chemical pleurodesis between 2015 and 2019. Individuals were followed until death or March 31, 2021. Difference in post-procedure mortality was calculated using inverse probability of treatment weighting (IPTW)-adjusted Cox proportional hazard regression analysis to balance potential confounders at baseline. Results We identified 4,790 (77.3%) individuals who received an IPC and 1,407 (22.7%) who had chemical pleurodesis for MPE. IPC insertions are increasing and chemical pleurodesis procedures are decreasing. The majority of IPCs were inserted in outpatients (61%), by pulmonologists (64.2%) and at sites with higher annual IPC volume, while chemical pleurodesis procedures were generally done by thoracic surgeons (74%) and at sites with higher annual pleurodesis volumes. In unadjusted comparison median time from initial cancer diagnosis to intervention was significantly longer in the IPC group (244 days, interquartile range [IQR]:33–903) compared to pleurodesis group (81 days, IQR:10–737; p

Abstract Background Language and cultural discordance refer to when a physician and patient do not share the same language or culture. This can create barriers to providing high-quality care at the end-of-life (EoL). This study explores the intersections of language, culture, geography, and care model in EoL care from the perspectives of palliative care physicians. Methods In this exploratory-descriptive qualitative study, semi-structured interviews (1-h) were conducted virtually between July and November 2023. We interviewed 16 family physicians with experience providing linguistic and/or culturally discordant palliative/EoL care in various urban, suburban, and rural regions of Ontario, who practiced at community and hospital outpatient clinics, home-based care, or long-term care homes. We used reflexive thematic analysis to identify themes across the interviews guided by the intersectionality theoretical framework. Results We identified three themes 1) Visible barriers to care access due to the inability to communicate accurate information and insufficient time spent during appointments with patients; 2) Invisible barriers to care access, shaped by the Eurocentric approach to palliative care and physicians’ lack of awareness on cultural discordance; 3) Workplace supports that currently exist and interventions that physicians would like to see. Community physicians following fee-for-service models were less likely to have access to professional interpreter services. Physicians in long-term care emphasized resource limitations to providing culturally-appropriate care environments. Conclusion Cultural discordance required awareness of personal biases, while language discordance hindered basic communication. These findings will be useful in informing clinical practice guidelines and mobilizing policy-level change to improve palliative/EoL care for patients from linguistic and cultural minority groups.

Abstract Background Competence in palliative medicine is required in clinical practice. Based on a literature review, we developed a two-week elective course in palliative medicine for 5th and 6th year medical students. We wanted to study learning outcomes from the course, especially related to knowledge, confidence, and reflections on the doctor’s role in palliative care. Methods A multiple-choice questionnaire (MCQ) assessed knowledge in palliative care pre and post course. The Thanatophobia Scale (TS) and the Self-efficacy in Palliative Care Scale (SEPC) measured confidence in communication with patients close to death and in providing palliative care, respectively. Reflection notes were analysed using Systematic Text Condensation, a cross-case thematic analysis. Lave & Wenger’s theory about situated learning was used to support interpretations. Results From 2018 to 2022 we ran four courses for a total of 48 students. Test results improved over the course in all four groups. On average, MCQ scores increased by 22% (range 13–33), TS scores were reduced by 28% (24–32), and SEPC scores increased by 50% (42–64), reflecting increased confidence in dealing with seriously ill and dying patients and their relatives. The participants prepared reflection notes describing their main impressions and take-home messages from the course, focusing specifically on the role of the doctor. They described the doctor’s role linked to an overarching task of creating a sense of security for patients and relatives. Through the course, and especially through talking to patients and relatives and being part of the interprofessional team, the participants learned how this sense of security was built by gaining competence in the following domains: 1) Patient-centred communication about the disease, expected trajectory, and needs, establishing common ground and support; 2) Being the medical expert in symptom relief and decision-making, providing guidance and reassurance in difficult situations; 3) Professionalism rooted in a holistic and relational approach; and 4) Being a good team player, aware of their function and limitations. Conclusions A two-week student-selected course in palliative medicine improved knowledge and skills and increased confidence in providing palliative care. The comprehensive understanding of the doctor’s role obtained in this course may also be relevant to other clinical specialties. Trial registration Not applicable (no clinical trial).

INTRODUCTION: Prognostic scores are crucial to avoid unnecessary measures in palliative care, although their use in noncancer patients undergoing home care in low-income countries lacks evidence. OBJECTIVE: To compare the accuracy of the survival prediction instruments Palliative Performance Scale (PPS), Karnofsky Performance Status (KPS), Palliative Prognostic Index (PPI), and Palliative Prognostic Score (PaP) in the older population treated by a Home Care Service (HCS) program in Curitiba, southern Brazil. METHODS: This is a prospective, observational, diagnostic accuracy study evaluating older adults undergoing HCS-provided palliative care. PPS, The PPS, KPS, PaP, and PPI scores were administered, and after 90 days the patients were evaluated for the outcomes death and hospital admission. RESULTS: The final sample consisted of 53 patients aged ≥ 60 years; 28.3% (n = 15) of those had age ≥ 85 years. In the binary analysis, PaP had the best accuracy (79.2%). In the ordinal analysis, PPI had the best accuracy (58.5%), but all prognostic scales evaluated the sample similarly, with no significant differences. In both analyses, the patients aged ≥ 85 years had similar results compared to the total sample. Although the HCS program is a distinct setting, the study results were similar to those of studies conducted in hospices and hospitals. CONCLUSION: The prognostic scores showed better accuracy when predicting only the outcome death but are less accurate when admission is included. There was no superior scale neither any difference in accuracy regarding age range.

Background: Palliative care provides holistic support, addressing physical, psychological, social, emotional, and spiritual dimensions of suffering, known as “total pain”, to improve patients’ quality of life. Patients often rely on healthcare professionals, particularly nurses, for support. This study aimed to develop and validate questionnaires assessing nurses’ perceptions of psychological, social, and spiritual issues in palliative care and their effectiveness in managing them. Methods: Two self-rated questionnaires were created: the Psychological, Social, and Spiritual Problems of Palliative Patients’ Questionnaire and the Effectiveness in Coping with the Psychological, Social, and Spiritual Challenges of Palliative Care Patients. The study surveyed 237 nurses caring for palliative patients in Split Dalmatian County, Croatia. Results: The questionnaires demonstrated high reliability with Cronbach’s α values of 0.98 and 0.99. Factor analysis revealed four factors for the first questionnaire and three for the second. Nurses primarily perceived patients as experiencing fear and emotional/spiritual suffering, with the greatest difficulty coping with the fear of the disease outcomes. Nurses acknowledged the need for improvement in addressing patient challenges, highlighting gaps in the Croatian system. Conclusions: Ongoing efforts are crucial to prioritize palliative care globally, with nursing professionals playing a vital role in symptom management.

Abstract Background The number of advanced heart failure patients with left ventricular assist devices (LVAD) is increasing. Despite guideline-recommendations, little is known about specialist palliative care involvement in LVAD-patients, especially in Europe. This study aims to investigate timing and setting of specialist palliative care in LVAD-patients. Methods We conducted a retrospective multicenter study in 2022. Specialist palliative care services in German LVAD-centers were identified and invited to participate. Forty adult LVAD-patients (mean age 65 years (SD 7.9), 90% male) from seven centers that received a specialist palliative care consultation during hospitalization were included. Results In 37 (67.3%) of the 55 LVAD-centers, specialist palliative care was available. The median duration between LVAD-implantation and first specialist palliative care contact was 17 months (IQR 6.3–50.3 months). Median duration between consultation and death was seven days (IQR 3–28 days). 65% of consults took place in an intensive/intermediate care unit with half of the patients having a Do-Not-Resuscitate order. Care planning significantly increased during involvement (advance directives before: n = 15, after: n = 19, p

Background: Heart rate (HR) monitoring is a medical standard to provide information about a patient's health status. In palliative care, relationship and social engagement are crucial therapeutic concepts. For fear of disrupting communication, social contact, and care, continuous HR monitoring is underutilised despite its potential to inform on symptom burden and therapeutic effects. This study investigates radar-based HR monitoring as an innovative and burden-free approach for palliative care patients, compares its accuracy with conventional ECG methods, and shows potential for therapeutic guidance. Methods: A single-centre, comparative clinical trial was conducted with palliative care patients at the ward of the Department of Palliative Medicine of the University Hospital of Erlangen. The HR measurements obtained with radar were compared with Holter ECG (study arm I, overnight) and Task Force® Monitor (TFM)-based ECG validation recordings (study arm II, one hour). In addition, long-term radar measurements without validation were analysed in comparison with clinical health records (study arm III). Results: Both validation methods showed correlation by scatter plot, modified Bland-Altman plot, and equivalence testing. N = 34 patients participated in study arm I. HR of 4,079 five-minute intervals was analysed. Radar measurements and ECG showed high agreement: difference of HRs was within 5 bpm in 3780 of 4079 (92.67%) and within ±13.4 bpm ( 1.96 times the SD of the mean) in 3979 (97.55%) intervals, respectively. In study arm II, n = 19 patients participated. 57,048 heart beats were analysed. The HR difference was within 5 bpm for 53,583 out of 57,048 beats (93.93%) and within 8.2 bpm (± 1.96 times the SD of the mean) in 55,439 beats (97.25%), respectively. Arm III showed HR changes extracted from radar data in correlation with symptoms and treatment. Conclusion: Radar-based HR monitoring shows a high agreement in comparison with ECG-based HR monitoring and thus offers an option for continuous and above all burden-free HR assessment, with the potential for use in symptom management in palliative care, among others. Further research and technological advancements are still necessary to fully realize this innovative approach in enhancing palliative care practices. [ABSTRACT FROM AUTHOR]

Introduction: In Brazil, a country of continental dimensions, the lack of services in the different regions is a major barrier that prevents patients from accessing Pediatric Palliative Care (PPC). If accessing PPC is already challenging, end-of-life care for these patients may also be difficult. Therefore, this study is based on a recent mapping effort, aimed at reflecting on the end-of-life care for children in Palliative Care in Brazil. Method: Descriptive, cross-sectional study, and online survey research, based on a larger study of Palliative Care Network. Results: The final sample comprised 90 Pediatric Palliative Care services, which proved to be unevenly distributed across the country. Many services lack a minimum team, 40% face difficulties accessing opioids, and one-third do not provide bereavement care. Discussion: There should be more services with better distribution across the country, and a minimum team should be required to provide adequate care for children and adolescents. Strategies to improve symptom control and grief support should be introduced. Conclusions: It is concluded that continuing education and the inclusion of relevant topics in health courses are necessary. Additionally, health service managers must expand their focus to address these issues effectively. [ABSTRACT FROM AUTHOR]

Background: The humanities can aid in the development of important skills for trainee physicians. Because of the nature of their work, palliative medicine residents are expected to apply humanities-based skills frequently in their clinical work and are also likely to use humanities-based skills to support their own self-care. Our project explored the role of the humanities in palliative medicine residency programs across Canada. Methods: Each priority topic or objective of the current palliative medicine residency training standards in Canada was reviewed to determine whether they relate to the humanities. A cross-sectional survey was subsequently created using Qualtrics, with the target study population being current palliative medicine residents and palliative medicine staff physicians at academic centers in Canada. Results: Multiple humanities objectives exist in Canadian palliative medicine training standards, primarily in the ethical, cultural, and spiritual domains. Eighty-seven people completed the cross-sectional survey, for a 17.4% response rate and 94.6% completion rate. The vast majority (90%) of survey participants felt that the humanities had an important role in medical training at the undergraduate and postgraduate levels, and more than 70% of participants felt that the humanities had an important role in palliative medicine residency training. In some areas, the humanities participants felt that their programs would most benefit from ethics, philosophy, and culture. Over 65% agreed or strongly agreed that their own palliative medicine program would benefit from more humanities content. Conclusion: Canadian palliative medicine training standards require residents to demonstrate humanities-based skills. Most survey participants state that the humanities have an important role in medical training at the undergraduate and postgraduate levels, and that their own palliative medicine residency program would benefit from more humanities content. These results may guide future studies to better understand why and how more humanities content can be added to palliative medicine residency programs to optimize residents' learning experiences and better prepare them for careers in palliative medicine. [ABSTRACT FROM AUTHOR]

Background: Little is known about patient outcomes following treatment of malignant pleural effusions (MPE) in the real-world setting. Research question: We aimed to compare post-procedure all-cause mortality between individuals who received indwelling pleural catheter (IPC) insertion versus chemical pleurodesis for managing MPEs. Study design and methods: We performed a retrospective population-based study using provincial health administrative data (Ontario, Canada) of adults with a MPE who underwent IPC insertion or chemical pleurodesis between 2015 and 2019. Individuals were followed until death or March 31, 2021. Difference in post-procedure mortality was calculated using inverse probability of treatment weighting (IPTW)-adjusted Cox proportional hazard regression analysis to balance potential confounders at baseline. Results: We identified 4,790 (77.3%) individuals who received an IPC and 1,407 (22.7%) who had chemical pleurodesis for MPE. IPC insertions are increasing and chemical pleurodesis procedures are decreasing. The majority of IPCs were inserted in outpatients (61%), by pulmonologists (64.2%) and at sites with higher annual IPC volume, while chemical pleurodesis procedures were generally done by thoracic surgeons (74%) and at sites with higher annual pleurodesis volumes. In unadjusted comparison median time from initial cancer diagnosis to intervention was significantly longer in the IPC group (244 days, interquartile range [IQR]:33–903) compared to pleurodesis group (81 days, IQR:10–737; p < 0.0001). Unadjusted median time from index procedure to death was significantly longer in the pleurodesis group (165[IQR:48–457] days vs. 81[IQR:29–256] days, p < 0.0001), however the difference between groups became insignificant after the IPTW was applied (HR 1.27, 95%CI 0.95–1.69). 35% of IPCs were removed prior to death or end of follow-up. Interpretation: After adjusting for differences in baseline characteristics there was no difference in post-procedure mortality between IPC and chemical pleurodesis groups. In the real world, there are significant differences in the characteristics of patients who receive these two procedures and notable regional practice variation between procedure use. Future research should evaluate these variations in care and their effect on patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Language and cultural discordance refer to when a physician and patient do not share the same language or culture. This can create barriers to providing high-quality care at the end-of-life (EoL). This study explores the intersections of language, culture, geography, and care model in EoL care from the perspectives of palliative care physicians. Methods: In this exploratory-descriptive qualitative study, semi-structured interviews (1-h) were conducted virtually between July and November 2023. We interviewed 16 family physicians with experience providing linguistic and/or culturally discordant palliative/EoL care in various urban, suburban, and rural regions of Ontario, who practiced at community and hospital outpatient clinics, home-based care, or long-term care homes. We used reflexive thematic analysis to identify themes across the interviews guided by the intersectionality theoretical framework. Results: We identified three themes 1) Visible barriers to care access due to the inability to communicate accurate information and insufficient time spent during appointments with patients; 2) Invisible barriers to care access, shaped by the Eurocentric approach to palliative care and physicians' lack of awareness on cultural discordance; 3) Workplace supports that currently exist and interventions that physicians would like to see. Community physicians following fee-for-service models were less likely to have access to professional interpreter services. Physicians in long-term care emphasized resource limitations to providing culturally-appropriate care environments. Conclusion: Cultural discordance required awareness of personal biases, while language discordance hindered basic communication. These findings will be useful in informing clinical practice guidelines and mobilizing policy-level change to improve palliative/EoL care for patients from linguistic and cultural minority groups. [ABSTRACT FROM AUTHOR]

Background: Competence in palliative medicine is required in clinical practice. Based on a literature review, we developed a two-week elective course in palliative medicine for 5th and 6th year medical students. We wanted to study learning outcomes from the course, especially related to knowledge, confidence, and reflections on the doctor's role in palliative care. Methods: A multiple-choice questionnaire (MCQ) assessed knowledge in palliative care pre and post course. The Thanatophobia Scale (TS) and the Self-efficacy in Palliative Care Scale (SEPC) measured confidence in communication with patients close to death and in providing palliative care, respectively. Reflection notes were analysed using Systematic Text Condensation, a cross-case thematic analysis. Lave & Wenger's theory about situated learning was used to support interpretations. Results: From 2018 to 2022 we ran four courses for a total of 48 students. Test results improved over the course in all four groups. On average, MCQ scores increased by 22% (range 13–33), TS scores were reduced by 28% (24–32), and SEPC scores increased by 50% (42–64), reflecting increased confidence in dealing with seriously ill and dying patients and their relatives. The participants prepared reflection notes describing their main impressions and take-home messages from the course, focusing specifically on the role of the doctor. They described the doctor's role linked to an overarching task of creating a sense of security for patients and relatives. Through the course, and especially through talking to patients and relatives and being part of the interprofessional team, the participants learned how this sense of security was built by gaining competence in the following domains: 1) Patient-centred communication about the disease, expected trajectory, and needs, establishing common ground and support; 2) Being the medical expert in symptom relief and decision-making, providing guidance and reassurance in difficult situations; 3) Professionalism rooted in a holistic and relational approach; and 4) Being a good team player, aware of their function and limitations. Conclusions: A two-week student-selected course in palliative medicine improved knowledge and skills and increased confidence in providing palliative care. The comprehensive understanding of the doctor's role obtained in this course may also be relevant to other clinical specialties. Trial registration: Not applicable (no clinical trial). [ABSTRACT FROM AUTHOR]

Context: The time-variable, competency-based mid-career fellowship in Hospice and Palliative Medicine (HPM) is a multicenter pilot program for physicians who want to train in HPM part-time. Objectives: This study describes the experience of the early cohort of mid-career fellows. Methods: Fellows at the seven sites were surveyed about their perceptions of the program and their confidence in subspecialty skills. Results: Surveys were sent to 13 fellows and completed by 8. All reported positive experiences with curricula, direct observation, feedback, and cross-site case reviews. Most responses were positive regarding individualized learning plans and case-stimulated reviews. Respondents reported high confidence in 9 of the 13 specialty-specific skills, including communication, caring for dying patients, and pain management. They reported less confidence with psychological and non-pain symptoms, spirituality, and prognostication. Fewer than half indicated that the process for graduation was clear. Conclusion: Physicians in the competency-based HPM fellowship report a positive experience and high confidence in subspecialty skills. [ABSTRACT FROM AUTHOR]

Palliative medicine represents the holistic multiprofessional treatment of severely and incurably ill people and their relatives, addressing their complex physical, psychological, social and spiritual needs. The central therapeutic goals are the quality of life and alleviation of suffering. In the course of many neurological diseases, high symptom burden, long and variable trajectories and unfavorable prognosis at times create a need for palliative care even at an early stage, which is currently still inadequately met. This can be countered by qualified neuropalliative care. In addition to intensifying interdisciplinary collaboration, this requires neurologists to have core competencies in palliative care. These include a team-oriented attitude, communication skills, expertise in symptom control and knowledge of biomedical ethics including palliative options at the end of life. [ABSTRACT FROM AUTHOR]

Purpose: Variable assessments of learner performances can occur when different assessors determine different elements to be differently important or salient. How assessors determine the importance of performance elements has historically been thought to occur idiosyncratically and thus be amenable to assessor training interventions. More recently, a main source of variation found among assessors was two underlying factors that were differently emphasised: medical expertise and interpersonal skills. This gave legitimacy to the theory that different interpretations of the same performance may represent multiple truths. A faculty development activity introducing assessors to entrustable professional activities in which they estimated a learner's level of readiness for entrustment provided an opportunity to qualitatively explore assessor variation in the context of an interaction and in a setting in which interpersonal skills are highly valued. Methods: Using a constructivist grounded theory approach, we explored variation in assessment processes among a group of palliative medicine assessors who completed a simulated direct observation and assessment of the same learner interaction. Results: Despite identifying similar learner strengths and areas for improvement, the estimated level of readiness for entrustment varied substantially among assessors. Those who estimated the learner as not yet ready for entrustment seemed to prioritise what information was exchanged and viewed missed information as performance gaps. Those who estimated the learner as ready for entrustment seemed to prioritise how information was exchanged and viewed the same missed information as personal style differences or appropriate clinical judgement. When presented with a summary, assessors expressed surprise and concern about the variation. Conclusion: A main source of variation among our assessors was the differential salience of performance elements that align with medical expertise and interpersonal skills. These data support the theory that when assessing an interaction, differential salience for these two factors may be an important and perhaps inevitable source of assessor variation. Addressing the tendency for raters to act in idiosyncratic ways, Li et al. argue that differential salience among assessors may be both legitimate and inevitable, shining new light on variation in rater‐based assessment. [ABSTRACT FROM AUTHOR]

The article discusses the establishment of the Kidney Disease Aging Research Collaborative (KDARC) to address barriers in geriatric nephrology research. Older adults with kidney disease face unique challenges, including higher prevalence of frailty, cognitive impairment, and depression. KDARC aims to overcome organizational, research priority, and data barriers by fostering interdisciplinary collaborations, identifying research priorities, and providing resources like a Data Cooperative and Geriatric Nephrology Toolbox. The goal is to stimulate high-impact research that will benefit the 22.4 million older adults living with kidney disease in the United States. [Extracted from the article]

Rationale, Aims and Objectives Method Results Conclusion With absence of a cure, the mainstay of management for patients with motor neurone disease (MND) is holistic supportive care and symptom control. Non‐invasive ventilation (NIV) can provide relief from distressing dyspnoea which often accompanies progressive respiratory muscle weakness. Some patients using NIV will become dependent on it, with a small proportion of these patients going on to request withdrawal. Despite being legal in the UK, elective withdrawal of NIV can be emotionally and ethically challenging for the staff involved. To guide the process of symptom‐controlled withdrawal, in 2015 the Association for Palliative Medicine (APM) released clinical guidance. The aim of this study is to explore the experiences of the multi‐disciplinary team (MDT) involved in elective withdrawal of NIV in an MND cohort following the publication of this guidance.A qualitative, semi‐structured interview study of eight NHS qualified staff members (three Doctors, four Nurses, one Allied Health Professional). Clinicians were asked questions relating to their experiences of the withdrawals. After full transcription, data was analysed thematically.Four main themes were identified, offering insight into how the withdrawals affected staff's well‐being and summarised via an ‘enablers and barriers’ model. The setting was important, as was the depth and longevity of the clinician's investment in the patient. Positive influences on staff's well‐being arose from the sense of fulfilling the patient's wishes, good teamwork, presence of an experienced clinician and awareness of the APM (2015) Guidance. Conversely, barriers to well‐being were expressed through the unpredictability of each scenario, moral and ethical uncertainties, external pressures on time, mismatched expectations, poor communication and the emotional intensity of the act.Elective withdrawal is highly emotive, simultaneously positively and negatively influencing staff well‐being. By addressing the potential mitigating factors, the overall impact on staff's mental health and well‐being maybe improved and thus, subsequently, patient care. [ABSTRACT FROM AUTHOR]

The article delves into the experiences of older surgical patients and their care partners amidst the COVID-19 pandemic, shedding light on issues like scheduling delays, virtual care transitions, and policy adjustments. Older adults, often with complex medical needs and limited tech proficiency, leaned on care partners for assistance. The study pinpointed four main themes affecting surgical encounters: the urgency of procedures, the significance of face-to-face consultations, the necessity of care partner participation, and inconsistent communication from surgical teams. Recommendations include recognizing the significance of surgery for patient-care partner pairs, facilitating in-person meetings, advocating for care partner involvement, and establishing dependable communication channels. [Extracted from the article]

The document is a supplement to the Oncology Research & Treatment journal, providing information about the annual conference of the German, Austrian, and Swiss Societies for Hematology and Medical Oncology. It includes details about the conference location, dates, organizers, and key speakers. The journal aims to offer a platform for interdisciplinary cancer research and treatment, covering various aspects of medical oncology, surgery, diagnostics, and rehabilitation. It is targeted towards clinicians and practitioners in the field of hematology and oncology, providing peer-reviewed articles and clinical news to keep them informed. [Extracted from the article]

Context: Propofol is a general anesthetic used in multiple clinical scenarios. Despite growing evidence supporting its use in palliative care, propofol is rarely used in palliative sedation. Reluctance toward the adoption of propofol as a sedative agent is often associated with fear of adverse events such as respiratory arrest. Objectives: We aimed to describe efficacy and safety of palliative sedation in refractory sedation with propofol using a protocol based on low, incremental dosing. Methods: A retrospective observational study featuring inpatients receiving sedative treatment with propofol in our palliative care unit in Madrid (Spain) between March 1, 2018 and February 28, 2023, following a newly developed protocol. Results: During the study period, 22 patients underwent sedation with propofol. Propofol was used successfully to control different refractory symptoms, mainly psychoexistential suffering and delirium. All patients had undergone previous failed attempts at sedation with other medications (midazolam or lemovepromazine) and presented risk factors for complicated sedation. All patients achieved satisfactory (profound) levels of sedation measured with the Ramsay Sedation Scale, but total doses varied greatly between patients. Most patients (17, 77%) received combined therapy with propofol and other sedative medications to harness synergies. The median time between start of sedation with propofol and death was 26.0 hours. No cases of apnea or death during induction were recorded. Conclusion: A protocol for palliative sedation with propofol based on low, incremental dosing, with the option of administering an initial induction bolus, shows excellent results regarding adequate levels of sedation, without observing apnea or respiratory depression. Our results promote the use of propofol to achieve palliative sedation in patients with refractory symptoms and risk factors for complicated sedation at the end of life. [ABSTRACT FROM AUTHOR]

Dyspnea is one of the most common and distressing symptoms in patients with cancer and noncancer advanced diseases. The Japanese Society for Palliative Medicine revised previous guidelines for the management of respiratory symptoms in patients with cancer and newly developed clinical guidelines for managing dyspnea in patients with advanced disease, based on the result of systematic reviews for each clinical question and consensus among experts. We describe the recommendations of the guidelines as well as provide insights into the reasoning behind the recommendations and their development process. There has been a paucity of evidence regarding the interventions for dyspnea in patients with advanced disease. Thus, more clinical research that includes not only randomized controlled trials but also real-world observational studies is warranted. [ABSTRACT FROM AUTHOR]

Introduction: At the end of life, the prevalence of delirium and pain is high. Current therapy is not satisfactory. Dexmedetomidine could be useful in the control of delirium and pain but is not approved outside of intensive care setting. Our objectives are to evaluate existing evidence in the literature that assessed the efficacy of dexmedetomidine in pain and delirium control and its safety in palliative care patients outside intensive care units. This systematic review was prospectively registered with PROSPERO and included a risk of bias assessment. Methods: PubMed and SCOPUS were examined for literature published until 2023. Experimental, cohort, cross-sectional, case–control studies, and case series/reports were included if they evaluate the use of dexmedetomidine in delirium and/or pain management in hospitalized palliative care adult patients. Studies were excluded if they were carried out in intensive care units. Results: Of the initial 529 records, 14 were included. Although only two studies were randomized trials, most were small and only one had low risk of bias. In most case reports and in the two retrospective cohort studies, dexmedetomidine appears to be a better option for these symptoms, although differences were not significant in the randomized trials. Discussion: Dexmedetomidine seems to be a promising option for refractory pain and delirium and may contribute to a reduction in opioid administration to control pain. This is the first systematic review of dexmedetomidine in palliative care. Quality evidence is limited, but clinical properties of dexmedetomidine justify the conduction of controlled trials in palliative care. [ABSTRACT FROM AUTHOR]

The care of a patient with neurologic disease at end-of-life requires expertise in addressing advance care planning, hospice, symptom management, and caregiver support. Neurologists caring for patients with advanced neurologic disease often identify changes in disease trajectory, functional status, or goals of care that prompt discussions of advance care planning and hospice. Patients nearing end-of-life may develop symptoms such as dyspnea, secretions, delirium, pain, and seizures. Neurologists may be the primary clinicians managing these symptoms, particularly in the hospitalized patient, though they may also lend their expertise to non-neurologists about expected disease trajectories and symptoms in advanced neurologic disease. This article aims to help neurologists guide patients and caregivers through the end-of-life process by focusing on general knowledge that can be applied across diseases as well as specific considerations in severe stroke and traumatic brain injury, amyotrophic lateral sclerosis, Parkinson's disease, and dementia. [ABSTRACT FROM AUTHOR]

As neuropalliative care is better recognized and more widely utilized, there is as great a need for clinicians trained in the field as there is for disease-specific symptom management, advance care planning, and end-of-life care. In this manuscript, we describe potential career trajectories in neuropalliative care. For clinicians, this includes educational and training opportunities within primary neuropalliative care (integrating palliative care principles into usual neurology practice), specialty neuropalliative care (completing a hospice and palliative medicine fellowship), and hospice. We also describe considerations for establishing new clinical neuropalliative practices and highlight neuropalliative education and research as key areas for advancing the field. [ABSTRACT FROM AUTHOR]

Purpose. The Erector Spinae Plane Block (ESPB) is a widely used regional anesthesia technique in breast, thoracic, and spine surgery. However, its effectiveness and pain-relief capabilities in total hip arthroplasty have not been definitively established. This meta-analysis seeks to establish the analgesic effectiveness of ESPB in total hip arthroplasty. Methods. As per PRISMA guidelines, we carried out a meta-analysis of prospective randomized clinical trials that compared the effects of ESPB in the control group and different peripheral nerve blocks in total hip arthroplasty. The study was registered in the International Register of Systematic Reviews (PROSPERO) and can be accessed online (www.crd.york.uk/prospero, CRD42024498350). Results. Six studies involving 299 participants were critically evaluated and included for analysis. The results showed that ultrasound-guided ESPB led to a decrease in postoperative opioid consumption 24 hours after surgery compared to a placebo (mean difference -4.29, 95% CI -5.33 to -3.25; p < 0.00001). However, there were no significant differences in postoperative pain scores at Department of Palliative Medicine, Poznan University of Medical Sciences, Poznań, Poland 3-6 hours and 24 hours between the two groups. Conclusion. ESPB improved the effectiveness of pain relief in total hip arthroplasty, particularly without nerve block analgesia. More high-quality, well-defined RCTs are urgently required to assess the pros and cons of ESPB for total hip arthroplasty. [ABSTRACT FROM AUTHOR]

Children from marginalized groups are at risk for worse medical outcomes, yet little is known about their end of life experiences. We examine the characteristics of deceased children with a focus on race, ethnicity, and preferred language. We conducted a cross-sectional study of patients who died at Texas Children's Hospital from 2018 to 2019. Demographics, date of death, and final code status were extracted. Medical complexity prior to admission and mode of death were obtained from chart review. We included 433 patients. Over one-third were Hispanic (39.3%) with 42.3% preferring Spanish. The majority were White (61.4%) or Black (21.0%). Most patients had significant medical complexity (52.0%) or were infants in their birth admission (29.4%). Half (52.4%) received palliative care; patients with increased medical complexity were more likely to have palliative care involved (P <0.001). There were no differences in palliative care, code status, or mode of death by race. Hispanic patients were less likely to have a full code status (OR 0.42, 95% CI: 0.25–0.73). Spanish-speaking patients were more likely to have palliative care involvement (OR 2.05, 95% CI: 1.21–3.46) and less likely full code orders (OR 0.24, 95% CI: 0.1–0.63). Palliative care services are engaged with most children at end of life and is accessible to marginalized patient groups. Spanish-speaking patients have different code status orders and modes of death at end of life. Further studies are needed to elucidate explanatory factors for differences revealed and multicenter studies are needed to characterize more widespread experiences. [ABSTRACT FROM AUTHOR]

Outpatient palliative care (PC) has strong evidence demonstrating impact across serious illnesses, resulting in growing demand for skilled outpatient PC clinicians. However, there is limited literature examining the existing state and quality of outpatient PC education during postgraduate training. Characterize the current state of outpatient training in United States (US) Hospice and Palliative Medicine (HPM) physician fellowships and elicit perceptions regarding quality of outpatient PC education. A cross-sectional survey of US adult HPM fellowship program directors (PDs) or their designee conducted between March and July, 2023. Of 161 programs, 85 participated (53% response rate) with representation across all US regions. HPM fellows spend a median of 4.8 weeks in outpatient PC compared to 24 weeks inpatient PC and 10.5 weeks in hospice settings. Over half (51%) of fellows saw outpatients from primarily one disease type with limited exposure to patients with other serious illnesses. Across programs, fellows' clinic structure, interdisciplinary team composition, and didactic experiences varied. On a 5-point rating scale, PDs reported significantly lower quality outpatient versus inpatient training (mean rating: 3.58 vs. 4.62, P <0.001) and perceived fellows as less prepared for independent outpatient practice upon graduation (mean: 4.06 vs. 4.73, P <0.001). Our survey of US HPM fellowships identified multiple gaps between outpatient and inpatient PC education and training during fellowship and raises concern about the adequacy of outpatient PC training. To prepare the HPM workforce to meet the diverse needs of seriously ill populations and ensure adequate access, outpatient PC training requires reform. [ABSTRACT FROM AUTHOR]

Background: Collaboration between palliative care units (PCUs) and community palliative care (CPC) services is key to providing integrated care across inpatient and outpatient settings, in response to local and global challenges. Aim: To identify the effect of the COVID-19 pandemic and local CPC service changes on admissions, discharges, and patient access to a metropolitan Australian specialist PCU. Methods: A retrospective cohort study of PCU admissions was performed across three six-month periods, in 2017, 2019, and 2021. Patients' demographics and primary diagnoses were assessed for association with CPC service involvement prior to their first PCU admission. Admission characteristics including referral location, indication for admission, length of stay, palliative care phase and place of death were compared between the three time periods. Results: There were 707 admissions during the studied time periods, corresponding to 589 unique patients, of whom 89% had a principle diagnosis of malignancy. Non-cancer and haematology patients were less likely to be linked with a CPC service prior to their first admission. Most admissions (51%) were arranged directly to the PCU from the community. Compared to earlier time periods, during the COVID-19 pandemic, patients had shorter admissions, were more likely to be discharged in the deteriorating or terminal phases, and had four times the odds of dying at home. Conclusion: COVID-19 had significant impacts on the characteristics of PCU admissions, which has ongoing implications for CPC services. Continuous service delivery evaluation and adaptation are required to ensure equitable access to palliative care during periods of change. [ABSTRACT FROM AUTHOR]

Introduction: This study explored the Osona palliative care system, recognized internationally for its good results in managing the chronic patient. The literature notices a gap of models that evaluate integration in healthcare systems. This study assesses the degree of integration of the Osona palliative care system, as well it implements a model that evaluates integration. Methods: This research used a qualitative methodology, involving a case study design with three study phases. The first phase involved reviewing primary sources, followed by conducting interviews. The final phase entailed comparing the findings with a theoretical model to analyse and validate the results. Results: The study found the integrative elements that the Osona system includes such as: multidisciplinary teams, leadership and a palliative care system that is cost-efficient. It also found aspects to improve including collaboration, continuity of care, early patient identification and lack of funding. Discussion: Our findings suggest that the Osona system has made significant progress toward integration, even though it continues the path of ongoing development in integrated care. Conclusion: This research found that the Osona palliative care system includes many integrating aspects such as multidisciplinary teams, leadership and the system's cost-efficiency. Nevertheless, some aspects need changes such as continuity of care, collaboration, enhanced early patient identification and increase funding. Furthermore, this study provides an example of how to assess integration in a system. [ABSTRACT FROM AUTHOR]

Objectives: The aims of this study are to identify the challenges faced by non-palliative care professionals (NPCPs) in caring for end-of-life patients; determine how these challenges interact with and influence each other systemically; and advance the theories and practices for supporting NPCPs in the provision of quality end-of-life care beyond the boundaries of palliative medicine. Methods: A constructivist phenomenological research design with an Interpretive-Systemic Framework of inquiry was adopted. Thirty-five physicians, 35 nurses, and 35 Medical Social Workers who play critical roles in caring for end-of-life patients and belonging to the 9 major medical disciplines of Cardiology, Geriatric, Intensive Care Medicine, Internal Medicine, Nephrology, Neurology, Oncology, Respiratory Medicine, and Surgery were recruited through purposive snowball sampling from 3 major public hospitals. Results: Framework analysis revealed 5 themes and 17 subthemes that illuminate the individual, relational, cultural, institutional, and structural challenges that NPCPs faced in rendering end-of-life care. These challenges influence each other within the health-care ecosystem, serving to perpetuate or heighten care obstacles. Significance of results: This is the first known study exploring the systemic challenges of NPCPs spanning 9 major medical disciplines and encompassing 3 professional stakeholders responsible for the care for end-of-life patients, thus ensuring perspective inclusivity across the health-care system. Recommendations that consider the complexity of the interactions between these systemic challenges are presented in detail. [ABSTRACT FROM AUTHOR]