BMJ SUPPORTIVE & PALLIATIVE CARE 每季度出版一次，并持续在线发布，旨在通过提供高质量、临床相关的研究、评论、评论、信息和具有国际重要性的新闻来连接世界各地的许多学科和专业。我们持有包容性的支持观点和姑息治疗研究，我们能够征集专业知识来批评该主题内的所有方法，包括那些从事过渡研究、临床试验、流行病学、行为科学、伦理和卫生服务研究的方法。与临床实践和临床服务发展相关的文章将被考虑发表。在国际背景下，许多不同类别的临床医生和医疗保健工作者从事与姑息医学、专科或全科姑息治疗、支持性护理、心理社会肿瘤学和临终关怀。我们希望参与许多专业，而不仅仅是那些传统上与支持性和姑息治疗相关的专业。我们希望将读者范围扩大到医生、护士、其他医护人员和医学和外科专业的研究人员，包括但不限于心脏病学、胃肠病学、老年病学、神经病学、肿瘤学、儿科、初级保健、精神病学、心理学、肾脏医学、呼吸药物。

BMJ Supportive and Palliative Care is a quarterly journal that is continuously published online. The journal aims to connect readers from various disciplines and professions by providing high-quality, clinically relevant research, reviews, information, and internationally significant news. We advocate for inclusive perspectives in palliative care research and welcome critiques of diverse approaches within this field, including transitional research, clinical trials, epidemiology, behavioral science, ethics, and health services research. Articles related to clinical practice and service development will be considered for publication. A wide range of clinicians and healthcare professionals engage in palliative medicine, specialty or general palliative care, supportive care, psychosocial oncology, and end-of-life care in an international context. We aim to involve many professionals, not just those traditionally associated with supportive and palliative care. Our goal is to broaden our readership to include physicians, nurses, other healthcare providers, and researchers in medical and surgical specialties, including but not limited to cardiology, gastroenterology, geriatrics, neurology, oncology, pediatrics, primary care, psychiatry, psychology, nephrology, and respiratory medicine.

BMJ Supportive and Palliative Care 是一本每季度出版的期刊，同时持续在线发布。该期刊旨在通过提供高质量、临床相关的研究、评论、信息和具有国际重要性的新闻，连接来自不同学科和专业的读者。我们支持包容性的姑息治疗研究，欢迎各类专业人士对该领域的不同方法进行批评和探讨，包括过渡研究、临床试验、流行病学、行为科学、伦理学和卫生服务研究等。与临床实践和服务发展相关的文章将被考虑发表。许多不同类别的临床医生和医疗工作者在国际背景下从事姑息医学、专科或全科姑息治疗、支持性护理、心理社会肿瘤学和临终关怀等领域的工作。我们希望吸引更多专业人士的参与，而不仅限于传统的支持性和姑息治疗相关专业。我们的目标是扩大读者群体，包括医生、护士、其他医护人员以及医学和外科专业的研究人员，涵盖心脏病学、胃肠病学、老年病学、神经病学、肿瘤学、儿科、初级保健、精神病学、心理学、肾脏医学和呼吸药物等领域。

BMJ Supportive and Palliative Care

Background An audit of hospital notes of inpatients diagnosed with advanced pancreatic cancer on a tertiary heptobiliary unit found little evidence of end of life discussions and advance care planning. While patients were often told at diagnosis that their cancer was incurable, they were generally not told their prognosis. Few nurses had formal communication skills training and most had little confidence in having end of life discussions. Aims To examine outcomes of a two day interactive communications skills course on perceived self reflection of band 5 registered nurses. Methods At the start and end of the course the nurses were asked to reflect on themselves as a communicator using three self awareness describers: Informer, Ignorer, Inquirer and to consider what patients required of them. Participants were asked to identify the communication challenges they had encountered and skills which may help their practice. Results Over 80% of the 24 nurses identified themselves as Informers. S ome said that at times they were aware that they ignored patient statements because they did not what to say and one said ignoring is the “only way to survive”. Only two nurses identified themselves as inquirers, but they sometimes found this difficult and had both been “told about spending too long with patients”. The majority felt that their informer style matched patients' requirements. Two main areas of challenge and specific skills development were identified: dealing with patients with difficult questions and dealing with and angry patients and relatives. Following the course all participants said that they would be primarily an inquirer. The skills of listening, pausing, summarising and empathy were evaluated as the most useful enhanced skills. Confidence and knowledge increased in the specific challenges that were identified. Conclusion A two day interactive course may promote awareness, increase confidence and may enable change practice.

Alison Pilsworth

Kerry Blankley

Christina Faull

BMJ Supportive & Palliative Care

INFLUENCING NURSES' COMMUNICATION STYLE THROUGH A TWO DAY INTERACTIVE COMMUNICATION SKILLS COURSE

通过两天的互动沟通技巧课程影响护士的沟通风格

Heart failure (HF) is a prevalent condition associated with poor quality-of-life and high symptom burden. As patients reach ceilings of survival-extending interventions, their priorities may be more readily addressed through the support of palliative care services; however, the best model of care remains unestablished.We aimed to create and evaluate a cospeciality cross-boundary service model for patients with HF that better provides for their palliative care needs in the latter stages of life, while delivering a more cost-effective patient journey.In 2016, the Heart Failure Supportive Care Service (HFSCS) was established to provide patient-centred holistic support to patients with advanced HF. Patient experience questionnaires were developed and distributed in mid-2018 and end-of-2020. Indexed hospital admission data (in-patient bed days pre-referral/post-referral) were used allowing statistical comparisons by paired t-tests.From 2016-2020, 236 patients were referred to the HFSCS. Overall, 75/118 questionnaires were returned. Patients felt that the HFSCS delivered compassionate care (84%) that improved symptoms and quality of life (80% and 65%). Introduction of the HFSCS resulted in a reduction in HF-related admissions: actual days 18.3 to 4 days (p<0.001), indexed days 0.05 to 0.032 days (p=0.03). Cost mapping revealed an estimated average saving of at least £10 218.36 per referral and a total estimated cost saving of approximately £2.4 million over 5 years.This service demonstrates that a cospeciality cross-boundary method of care delivery successfully provides the benefits of palliative care to patients with HF in a value-based manner, while meeting the priorities of care that matter to patients most.

Clea Atkinson

Sian Hughes

Len Richards

Victor MF Sim

Julie Phillips

Imogen J John

Zaheer Yousef

Palliation of heart failure: value-based supportive care

心力衰竭的姑息治疗：基于价值的支持性护理

Adèle Jarry

Aurélie Lepeintre

Diane Constant-David

Clementine Paul

Chloe Chauvin

Julien Nizard

Adrien Evin

BMJ Support Palliat Care

Support programme for bereaved relative: a retrospective observational study

丧亲者支持计划：一项回顾性观察研究

Background End-of-life care among surgical patients is largely understudied and far fewer studies examine such care from the family perspective. To identify potential opportunities for improvement, we explored responses of family members of veterans who died following surgery using the Veterans Affairs (VAs) Bereaved Family Survey (BFS). Methods We examined data from the BFS open-text responses to explore insights into surgical patient’s end-of-life care. Data were analysed iteratively using qualitative content analysis and clustered into domains based on content. Results We evaluated 936 open-text responses to the BFS for all decedents who underwent any high-risk surgical procedure across 124 VA medical centres from 2010 to 2019. This report focused on the following domains: patient needs, family/caregiver needs, clinical teams/personnel characteristics and facility/organisational characteristics. Key themes within patient needs included concerns about pain management, preservation of patient dignity and spiritual support. Within the family/caregiver domain, key themes included enhanced communication needs, assistance with logistics and displays of gratitude for the patient’s military service. The clinical team’s domain included the key themes of professionalism concerns and understaffing. Finally, key themes identified within the facility/organisation domain were the need for more robust support services and discomfort with the physical space. Conclusions Narratives from the family perspective provide valuable insight into end-of-life care among surgical patients. Our data demonstrate the critical need for preserving patient dignity and improved communication, which emphasises family involvement and shared decision-making. In addition, hospital systems can optimise nurse-to-patient ratios and intentionally design physical spaces to help improve end-of-life care for surgical patients.

Christina Shabet

C Ann Vitous

Emily Evans

Sydney Edwards

Sarah E Bradley

Ashley Duby

Pasithorn A Suwanabol

Better end-of-life care in surgical patients: Veterans Affairs Bereaved Family Survey – a qualitative analysis

外科患者更好的临终关怀：退伍军人事务部丧亲家庭调查——一项定性分析

Background Constipation is a common symptom for patients receiving palliative care. Whilst national clinical guidelines are available on the management of constipation for people with advanced cancer in specialist palliative care (SPC) settings questions exist around clinical practice and the extent to which the guidelines are implemented in practice. This study examine current clinical practice for management of constipation for patients with advanced cancer in SPC settings. Methods A multi-site retrospective case-note review was conducted consisting of 150 patient case-notes from three SPC units across the United Kingdom between August 2016 and May 2017. Descriptive statistics were used to compare clinical practices to national policy guidelines for constipation. Results A physical exam and bowel history was recorded for 109 patients (73%). Whilst the Bristol Stool Chart was used frequently across sites (96%) involvement of the multidisciplinary team varied. Almost a third of patient charts (27%) recorded no evidence of non-pharmacological management strategies. Pharmacological management was recorded frequently with sodium docusate or senna as the preferred laxatives across all sites however 33% of patient charts recorded no information on the titration of laxatives. There were no consistent management strategies recorded for opioid induced constipation or bowel obstruction Conclusion Assessment and management of constipation in SPC settings is highly variable. Variations in assessment; limited use of non-pharmacological and preventative strategies and absence of consistent strategies for opioid induced constipation or bowel obstruction are evident. Further education is needed to equip HCPs with the necessary knowledge and skills to assess and manage constipation. References . Friedrichsen M, Erichsen E. The lived experience of constipation in cancer patients in palliative hospital-based home care. Int J Palliat Nurs [Internet] 2004;10(7):321–5. Available from: http://search.ebscohost.com/login.aspx?direct=true&amp;profile=ehost&amp;scope=site&amp;authtype=crawler&amp;jrnl?=13576321&amp;A?N=13991056&amp;h=XKMF4r08srZuhDY0j7C95oLLyYKNHUcvoeEuhyXNnsIM2BI%2BEhmcY1pPP%2BN1pvrMzQ9Bn9b5j45X6WzyBRydEA%3D%3D&amp;crl=c [Accessed: 21 August 2017] . Gilbert EH, et al. Chart reviews in emergency medicine research: Where are the methods?Annals of Emergency Medicine1996;27(3):305–8. Available at: http://www.ncbi.nlm.nih.gov/pubmed/8599488 [Accessed: 17 May 2018] . National Clinical Effectiveness Committee. Management of constipation in adult patients receiving palliative care national clinical guideline No. 10 November 2015. . Tvistholm N, Munch L, Danielsen AK. Constipation is casting a shadow over everyday life? A systematic review on older people’s experience of living with constipation [Internet]. Journal of Clinical Nursing2017;26:902–14. Available from: http://doi.wiley.com/10.1111/jocn.13422 [Accessed: 21 August 2017] . Wickson-griffiths A, et al . Revisiting retrospective chart review: An evaluation of nursing home palliative and end-of-life care research. Palliative Medicine Care 2014;1(2):8. Available at: www.symbiosisonlinepublishing.com [Accessed: 23 November 2017]

S McIlfatrick

DHL Muldrew

E Carduff

M Clarke

J Coast

A Finucane

L Graham-Wisener

F Hasson

P Larkin

J MacArtney

N McCorry

P Slater

M Watson

E Wright

31 A multi-site retrospective case note review for clinical practices of constipation in specialist palliative care settings

31 多中心回顾性病历审查：专科姑息治疗中便秘的临床实践

Background Literature on caregiver burden is limited in India and Kerala. We examined the prevalence and factors associated with caregiver burden and its impact on their quality of life. Methods We conducted a cross-sectional study among 115 informal caregivers (mean age 70 years, 80% female) of palliative care patients in Kerala. Caregivers were interviewed using the Zarit Burden Interview-22 and the WHOQOL-BREF questionnaires. Factors associated with caregiver burden were analysed using binary logistic regression. Results The prevalence of moderate to severe burden was 32.1% (95% CI 23.7% to 41.5%), with 6.2% reporting severe burden (95% CI 2.4% to 12.1%). Caregivers of patients aged ≥73 years (adjusted OR (aOR)=7.19, 95% CI 1.87 to 27.71, p=0.004), children acting as caregivers (aOR=11.09, 95% CI 1.21 to 101.03, p=0.033) and those caring for patients with prolonged disease duration (aOR=3.62, 95% CI 1.04 to 12.67, p=0.044) reported significantly higher burden compared with their counterparts. Moderate to severe burden was associated with lower physical (p&lt;0.001), psychological (p&lt;0.001) and social relations (p=0.002) quality of life scores. Conclusion Targeted interventions for caregivers of older patients, children acting as caregivers and those taking care of patients with prolonged disease duration are likely to reduce burden and improve their quality of life.

Suhail K Shefeek

Teena Mary Joy

Jeby Jose Olickal

Malathu Abdulnazer Nezrin

Annie George

Kavumpurathu Raman Thankappan

Caregiver burden and quality of life in palliative care: cross-sectional study

姑息护理中的照护者负担和生活质量：横断面研究

Objectives To compare a novel method of methadone rotation used in a specialist palliative care inpatient unit (SPCU) in Cork, Ireland, with rapid titration methods using Perth and Brisbane Protocols as well as the Edmonton method of methadone rotation. Methods A retrospective chart review was performed in March–June 2022. All patients who completed rotation to methadone during 2018–2019 in the SPCU were included. 2018–2019 was selected to study a population not affected by the coronavirus pandemic. Oral morphine equivalent (OME) was calculated using the opioid conversion chart. From the OME, the expected daily methadone dose was calculated using the Perth, Brisbane and Edmonton methods. These figures were then compared directly with the actual methadone doses achieved using our dosing schedule. Results A comparison of the expected doses using the Perth and Brisbane rapid titration protocols and stable daily dose achieved revealed that the stable methadone dose was significantly lower than both rapid titration protocols (p=&lt;0.0001) and (p=0.0035, respectively). However, a comparison of the expected dose using the Edmonton method and the dose achieved did not determine any significant difference (p=0.7602). Conclusions This is the first evaluation of a novel Irish method of methadone rotation and demonstrates a lower overall daily methadone dose compared with established protocols.

Elaine Cunningham

Nicole DiBiagio

Florry O’ Connell

Maedhbh Flannery

Michael Cronin

Marie Murphy

Mary Jane O’Leary

Fiona Kiely

Aoife C Lowney

Comparison of a novel methadone rotation method with other commonly used methods

新型美沙酮转换方法与其他常用方法的比较

Objective During the period of caregiving, informal caregivers of incurably ill patients experience caregiving burden that is often overlooked since the focus is on the suffering of the care receiver. In Bangladesh, informal caregivers often cannot express their suffering as they are culturally obliged to take responsibility for sick family members. This cross-sectional study was conducted among 156 informal caregivers of patients with advanced cancer attending the Department of Palliative Medicine at Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. Methods The sample was chosen consecutively based on the inclusion and exclusion criteria. Face-to-face interviews were conducted using a well-designed questionnaire. A previously translated and validated Bangla version of the Zarit Burden Interview (ZBI) was used to assess the burden of the informal caregivers. Results The mean ZBI score of the informal caregivers was 28±11. The study found that caregiver burden was significantly associated with the relationship between the informal caregiver and the patient, as well as the caregiver’s awareness of the patient’s prognosis. Conclusion Currently, no facilities for informal caregivers are available in Bangladesh. As extended members of the patient’s care team, the burden experienced by the caregivers needs to be given more attention and should be taken into account in healthcare.

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BMJ Supportive and Palliative Care

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INFLUENCING NURSES' COMMUNICATION STYLE THROUGH A TWO DAY INTERACTIVE COMMUNICATION SKILLS COURSE

Palliation of heart failure: value-based supportive care

Support programme for bereaved relative: a retrospective observational study

Better end-of-life care in surgical patients: Veterans Affairs Bereaved Family Survey – a qualitative analysis

31 A multi-site retrospective case note review for clinical practices of constipation in specialist palliative care settings

Better end-of-life care in surgical patients: Veterans Affairs Bereaved Family Survey – a qualitative analysis

Support programme for bereaved relative: a retrospective observational study

Caregiver burden and quality of life in palliative care: cross-sectional study

Comparison of a novel methadone rotation method with other commonly used methods

Caregiver burden in advanced cancer in tertiary care palliative medicine