Risultati per: Le cure palliative, fascicolo dedicato con linee guida

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Introduction
Palliative care (PC) is a medical specialty focusing on providing relief from the symptoms and stress of serious illnesses such as cancer. Early outpatient specialty PC concurrent with cancer-directed treatment improves quality of life and symptom burden, decreases aggressive end-of-life care and is an evidence-based practice endorsed by national guidelines. However, nearly half of patients with advanced cancer do not receive specialty PC prior to dying. The objective of this study is to test the impact of an oncologist-directed default PC referral orders on rates of PC utilisation and patient quality of life.

Methods and analysis
This single-centre two-arm pragmatic randomised trial randomises four clinician-led pods, caring for approximately 250 patients who meet guideline-based criteria for PC referral, in a 1:1 fashion into a control or intervention arm. Intervention oncologists receive a nudge consisting of an electronic health record message indicating a patient has a default pended order for PC. Intervention oncologists are given an opportunity to opt out of referral to PC. Oncologists in pods randomised to the control arm will receive no intervention beyond usual practice. The primary outcome is completed PC visits within 12 weeks. Secondary outcomes are change in quality of life and absolute quality of life scores between the two arms.

Ethics and dissemination
This study has been approved by the Institutional Review Board at the University of Pennsylvania. Study results will be disseminated in peer-reviewed journals and scientific conferences using methods that describe the results in ways that key stakeholders can best understand and implement.

Trial registration number
NCT05365997.

Objectives
The aim of this study was to map existing emergency medical services (EMS) and palliative care literature by answering the question, what literature exists concerning EMS and palliative care? The sub-questions regarding this literature were, (1) what types of literature exist?, (2) what are the key findings? and (3) what knowledge gaps are present?

Design
A scoping review of literature was performed with an a priori search strategy.

Data sources
MEDLINE via Pubmed, Web of Science, CINAHL, Embase via Scopus, PsycINFO, the University of Cape Town Thesis Repository and Google Scholar were searched.

Eligibility criteria for selecting studies
Empirical, English studies involving human populations published between 1 January 2000 and 24 November 2022 concerning EMS and palliative care were included.

Data extraction and synthesis
Two independent reviewers screened titles, abstracts and full texts for inclusion. Extracted data underwent descriptive content analysis and were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews guidelines.

Results
In total, 10 725 articles were identified. Following title and abstract screening, 10 634 studies were excluded. A further 35 studies were excluded on full-text screening. The remaining 56 articles were included for review. Four predominant domains arose from included studies: (1) EMS’ palliative care role, (2) challenges faced by EMS in palliative situations, (3) EMS and palliative care integration benefits and (4) proposed recommendations for EMS and palliative care integration.

Conclusion
EMS have a role to play in out-of-hospital palliative care, however, many challenges must be overcome. EMS provider education, collaboration between EMS and palliative systems, creation of EMS palliative care guidelines/protocols, creation of specialised out-of-hospital palliative care teams and further research have been recommended as solutions. Future research should focus on the prioritisation, implementation and effectiveness of these solutions in various contexts.

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A vital place for poetry in the work of clinicians is in palliative care as patients, families, and end-of-life professionals confront the limits of what allopathic treatments offer. In a riff on an interview technique taught to palliative care clinicians to help elicit patients’ and loved ones’ concerns and priorities around final illness, the poem’s 4 “I wonder” stems invite us to join a dying patient and her husband in imagining what is to come and what it might mean: ghosts as longing; a faithful dog as comfort; a patterned blanket as warmth; and, in a kind of therapeutic synesthesia for the patient whom the speaker learns is a painter, “what color you get when you blend joy with sorrow.” The structure of the poem, in its insistent couplets, underscores the close connection between physicians and dying patient, while the regular breaks between stanzas suggest the power of silence and listening and the unbridgeable gap that separates them. With the closing “I wonder” (“if you will consider yourself/lucky to be haunted by the soft music/of brush strokes against canvas”), the poet signals a commitment to accompany the husband to and past his wife’s passing, fulfilling his duty as physician to ensure her dignity through the dying process. The concluding lines, “…when/the blanket is folded away, when the dog lingers/in the place where the bed used to be” evoke sadness surely, but also the patient’s humanity, the imprint she leaves behind, and the solace of fidelity and love that endures.

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