The latest medical research on Hospice And Palliative Medicine

Achieving a 'good death' is one of the important goals of palliative care. Providing goal-concordant care and an environment tailored to the patient's preferences can contribute to a 'good death'. However, the concordance rate between the preferred and actual places of death among advanced cancer patients in Japan is less explored. This study aimed to identify the concordance between patients' preferred and actual places of death and the associated factors among patients with advanced cancer in Japan.

Patients with advanced cancer who underwent chemotherapy at Tohoku University Hospital between January 2015 and January 2016 were enrolled and followed up for 5 years. The enrolled patients were asked about their preference for their place of death. The response options were: "Own home," "General ward" and "Palliative care unit (PCU)." We compared the actual place of death with the patient's preference through a follow-up review of the medical records.

A total of 157 patients with advanced cancer were enrolled between January 2015 and January 2016. Of these patients, 22.9% (11/48) died at home according to their preference, 64.0% (16/25) in the general ward and 37.9% (11/29) in the PCU. Only thirty-seven (37.3%) patients died where they wanted, based on the comparison between patients' preferences and actual places of death.

The concordance rate between the preferred and actual places of death is not high in Japan. Improving concordance between patients' preferences and actual places of death has the potential to improve end-of-life care.

The Multidimensional Dyspnea Profile (MDP) comprehensively addresses dyspnea, incorporating both perceptual and affective components, and has proven effective in assessing breathlessness among patients with chronic lung conditions. Despite its validation in High-Income Countries, its applicability in Low/Middle-Income countries remains uncertain. Additionally, the MDP has not been translated into Hindi or validated in an Indian context. Our aim was to translate the MDP into Hindi and linguistically validate it for use in an Indian palliative care setting, with a high rate of illiteracy.

The comprehensibility and acceptability of the translated MDP in Hindi were assessed through in-depth interviews with seven Hindi-speaking patients with cancer. The study focused on tailoring the MDP in a socioeconomically disadvantaged population characterized by a high rate of illiteracy. The translation process involved forward and backward translations by independent certified translators, with input from in-country Indian palliative medicine physicians and healthcare personnel.

The Hindi version of the MDP was adapted for use in an Indian context and in a population with a high rate of illiteracy, aligning with international guidelines for Patient-Reported Outcomes demonstrating relevance in a specific cultural and healthcare context. The MDP increased healthcare staff 's understanding of underlying causes of dyspnea in a socioeconomically disadvantaged population enrolled into palliative care and with a high rate of illiteracy.

The study underscores the importance of linguistic validation and cultural adaptation in ensuring the applicability of Patient-Reported Outcomes measures in diverse healthcare settings. Because the MDP can be perceived as time-consuming, selected parts of the instrument may be used as needed.

The current global practice is to plan for the end-of-life period of persons already terminally ill with chronic diseases. However, affected persons should not have to wait till the stage of terminal illness to begin making plans for future healthcare preferences. This pilot study explored perceived barriers to and willingness of physicians to initiate discussions on advance care planning (ACP) with young adults living with cardiometabolic diseases.

The study was the pilot phase of descriptive cross-sectional research conducted among primary care physicians practising in Kuwait. Pilot data was collected with an electronic version of the modified DECIDE questionnaire (adapted from the "DECIsion-making about goals of care for hospitalized ElDErly patients" study) from February to April 2023. Data were analysed with Google Sheets.

Nine out of 22 participants exited the study early on grounds of non-familiarity with the concept of ACP. Thirteen responses were analysed and reported herein. The mean age of the participants was 44.2 (±7.9) years; eight were male and five were female; five were Hindu, 7 Muslim, and 2 Christian. Perceived barriers to initiating ACP discussions included lack of knowledge about ACP and its relationship to ACP and goals of care discussions (8), lack of knowledge about the legal status of ACP documents in Kuwait (11), religious disapproval (12), lack of knowledge about how to elicit values, beliefs, preferences related to end-of-life care (13) and fear that these conversations will diminish hope in patients with serious illness (12), among others. Twelve participants were willing to initiate discussions and exchange information with young adult patients. Twelve participants indicated that they were confident about initiating discussions and exchanging ACP information, had all not taken any extra training or certification in ACP, but, respectively, described their current level of skill in having ACP discussions and supporting patients in the finalisation of their advance care plans as limited (2), fair (3), average (4), very good (3) and expert (1).

Despite the low level of awareness and other factors perceived as barriers, the primary care physicians who participated in the study were confident and willing to initiate ACP discussions with young adults living with cardiometabolic diseases. With the generally reported lack of previous training in ACP, there might be a need for coordinated efforts in training or up-skilling on knowledge and practice of ACP among primary care physicians.