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Our new article digest examines the boundaries, meanings, and timing of palliative care. If needs are not identified in time, advance care planning may occur too early for teens and too late for older adults. A 'good death' proves to be a deeply cultural concept, while patients with heart failure and transplant rejection continue to be overlooked by palliative teams. These studies urge us to rethink standards and adopt more sensitive, timely approaches based on patients’ preferences. Read the full selection.
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Gaining knowledge and experience is even more valuable through connections with colleagues at events, internships, and site visits. This is a reminder that applications for PACED professional mobility grant programme for palliative care specialists close on April 7! Find out more and apply via the link.
Is Advance Care Planning Too Much for Teens?
How does Advance Care Planning (ACP) affect adolescents with cancer? The FACE-TC study involved three-hour sessions with teens and their families to discuss treatment goals and end-of-life preferences. A year later, researchers found unexpected results: teens who participated in the conversations reported higher levels of anxiety, depression, and pain symptoms compared to those who didn’t participate. The study raises an important question: Could early end-of-life planning cause psychological harm to adolescents? The research team plans to continue their analysis to determine whether the potential benefits of ACP outweigh these effects, a topic that remains debated among pediatric palliative care teams.
Palliative Care in Nursing Homes: Too Little or Too Late
A study of nursing homes in the US and Europe revealed that, in most cases, residents either do not receive the palliative care they need or receive it only in the final weeks of life when it is too late for tangible benefit. Early identification of needs is key to quality care; yet, there are still no universal tools, guidelines, or policies for assessing palliative needs in older adults. The most frequently reported concerns were pain, depression, and social isolation. Staff tend to focus much more on physical symptoms than on psychological, spiritual, or social aspects of care. Gaps in staff knowledge, a lack of culturally adapted tools, and insufficient infrastructure all contribute to limited access to timely end-of-life care. The authors stress the need to develop context-sensitive approaches to help identify needs and initiate support before it is too late.
One’s Good Death Is Another’s Death Itself
Most research on the concept of a 'good death' originates from the Global North — and, as it turns out, is far from universal. In Western contexts, a good death is typically associated with pain control, autonomy, emotional support, and avoiding unnecessary life-prolonging measures. Studies from the Global South reveal very different perspectives. In Bangladesh, it involves the presence of loved ones; in India, preserving the secrecy of a terminal diagnosis; in Sri Lanka, not knowing about death; in Taiwan, maintaining relationships with the deceased; and in African contexts, collective care and metaphors to describe family suffering. This article challenges the universality of Western assumptions and advocates for rethinking global frameworks around dying and palliative care. The author calls for a departure from one-size-fits-all models and a closer examination of the cultural meanings that shape the experience of dying across different parts of the world.
Palliative Care and Heart Failure
Patients with advanced heart failure often face significant physical, psychological, and social needs, and their prognosis remains poor. Researchers predict that, over the next 20 years, the burden of heart failure will rise substantially across the Western world. Studies and international guidelines increasingly emphasise the importance of early integration of palliative care into treatment plans for these patients. The review indicates that a multidisciplinary approach offers the greatest benefits, including timely discussions about prognosis and care goals, caregiver support, symptom management, and shared decision-making. Initiating palliative care early helps improve the quality of life and reduce suffering for people living with heart failure.
Palliative Care and Kidney Transplant Recipients
Despite advancements in transplantation, many patients experiencing kidney graft failure endure significant physical, psychological, and financial burdens. The return to dialysis, anxiety over graft loss, and complications arising from immunosuppressive therapy severely affect quality of life. Nevertheless, palliative care is seldom provided to this population. These patients are often excluded from end-of-life care planning and often receive aggressive treatments, even when such interventions become burdensome. The authors contend that it is time to incorporate palliative care principles into the management of transplant recipients — to better align treatment with patient preferences, alleviate suffering, and enhance quality of life. Instruction in fundamental palliative care should become a vital component of nephrology and transplant education.