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Objective The objective of this research is to investigate the efficacy of integrated palliative care in enhancing advanced cancer patients' quality of life, alleviating pain, and improving psychological well-being through the development of a multidimensional hospice care model. Methods This study involved 150 advanced cancer patients who received palliative care at our institution from January 2020 to December 2023. Participants were randomly assigned into two groups: the control group ( n  = 75) received standard care, while the treatment group ( n  = 75) received integrated palliative care, which included pain management strategies, psychological support, and family involvement. The quality of life of both groups was assessed pre- and post-intervention using the EORTC QLQ-C30 scale, which evaluates physical, emotional, and social functioning among other indicators. Mental health was assessed through the GAD-7 (Generalized Anxiety Disorder Scale) and PHQ-9 (Patient Health Questionnaire-9) to measure anxiety and depression levels. Furthermore, family members' satisfaction and support regarding the patient care process were evaluated using a tailored family satisfaction questionnaire. Results There was no statistically significant difference in age, gender, and tumor type among the treatment group ( P  > 0.05). Prior to the intervention, there were no statistically significant differences between the two groups in EORTC QLQ-C30 scores, GAD-7 and PHQ-9 assessments, or family satisfaction ( P  > 0.05). Post-intervention, the treatment group exhibited significantly higher quality of life scores compared to the control group, alongside significantly lower anxiety and depression scores, and notably higher family satisfaction, all of which were statistically significant ( P  < 0.05). Conclusion Integrated palliative care demonstrated substantial benefits in enhancing advanced cancer patients' quality of life, alleviating pain, and improving overall psychological health. The findings advocate for the integration of hospice care as a vital component of standard clinical practice and recommend its broader implementation across various departments to provide more compassionate care for patients and their families.

Background Although the benefits of early palliative care have been established in advanced cancers, there remains a lack of access to and poor uptake of these services. Barriers include healthcare provider attitudes, lack of standardized referral approach, misaligned policy limited resources, and lack of palliative care expertise. Purpose In consideration of these barriers, a description of the development and implementation of an early palliative care initiative at CancerCare Manitoba in Canada is presented. Explanations of innovative planning, processes, teams, and interventions are offered to facilitate insight for those intending to offer early palliative care. Discussion Barriers and facilitators to integrating a nurse-led early palliative care initiative are discussed. Considerations to mitigate common barriers encountered and leveraging existing resources are offered. Conclusions This information may be beneficial to those working to facilitate access to palliative care in oncology for patients with advanced cancers. This model has been successful at our institution with pre and post implementation data presented in an upcoming publication.

Introduction Heart failure (HF) patients experience significant palliative care needs (PCN), which can be assessed using the Integrated Palliative Care Outcome Scale (IPOS). This study evaluates PCN in hospitalized HF patients and their association with patient characteristics and mortality. Population and methods A prospective observational study was conducted on 160 hospitalized HF patients in Vietnam. PCN were assessed using IPOS (17 questions, scored 0–4, none to severe). PCN was defined as ≥ 2 items scoring 4 or ≥ 3 items scoring ≥ 3. All-cause mortality was tracked post-discharge.  Results PCN were identified in 59.4% of patients, with shortness of breath (57.5%), weakness (51.9%), and pain (45.6%) being the most common symptoms at moderate severity. PCN correlated with longer HF duration, lower eGFR, and specific medication use (intravenous drugs, RAAS inhibitors, MRAs). PCN independently predicted higher post-discharge mortality (adjusted HR: 2.63, 95% CI 1.06–6.53, p=0.037). Conclusion PCN are prevalent in hospitalized HF patients and independently associated with increased mortality, underscoring the need for routine PCN assessment and early palliative care integration.

Purpose Benefits of early palliative referral in oncology are well documented. Palliative care referral “triggers” may help identify patients for referral. Many triggers have been proposed, but are not commonly used. This study reviewed the timing of palliative care involvement for patients in a tertiary referral oncology hospital, and whether the use of a trigger tool prior to admission would have facilitated earlier referral. Methods This was a retrospective cohort study of cancer patients who died during an unplanned admission between November 2014 and October 2015. A literature review identified seven palliative care referral tools which were included in this analysis, and compared by identifying common themes. Each tool was applied to patients by reviewing electronic patient records. Timing of palliative referral and whether patients met any triggers within 6 months before their terminal admission were assessed. Results A total of 159 patients were identified. Forty-six percent were referred to palliative care prior to terminal admission. Application of 6 out of 7 trigger tools would have resulted in the majority of patients (up to 91 . 2%) referred to palliative care prior to admission. Most patients (52 . 2%) were referred only during their terminal admission. Patients known to palliative care before admission ( N = 73) were reviewed quicker than those who were not ( N = 86) (median (range) 1 day (0–23 days) versus 5 days (0–59 days), p < 0 . 00001). Conclusions In this patient cohort, a palliative referral trigger tool may have proactively identified most patients prior to their terminal admission. Prospective testing of trigger tools in oncology populations is warranted.

Background Early integration of palliative care for patients with advanced cancer is recommended by major organizations and guidelines, yet palliative care is often still perceived as end-of-life care or as incompatible with active oncological treatment. Such misconceptions may delay timely integration. Methods We conducted a cross-sectional mixed-methods survey among healthcare professionals in oncology services in Ostrobothnia, Finland. The survey included 15 Likert-scale statements (1–5) addressing perceived knowledge, values and role beliefs, and perceived capacity and support, plus one free-text question: “What is palliative care?”. Likert responses were summarized descriptively and compared across demographic groups using non-parametric tests. Free-text responses were coded using a predefined framework of 25 themes derived from the WHO definition of palliative care and Finnish national quality recommendations, generating a binary concept-coverage score (0–25). Responses were also classified for an end-of-life/non-concurrent conceptualization (“non-concurrent framing”). Group differences in concept-coverage scores were tested using Mann–Whitney U. Results Ninety-six professionals completed the survey (response rate 88.1%); 95 responded to the free-text item. While participants strongly endorsed statements about palliative care benefits and values, endorsement was lower for perceived competence and lowest for resources and support. Nearly one-third of participants expressed a non-concurrent/end-of-life framing of palliative care in their free-text definition. Concept-coverage scores were significantly lower among participants with non-concurrent framing compared with those without, particularly framework categories related to practical factors and system-level drivers. Conclusion The open-ended responses indicated variability in the conceptualization of palliative care, including descriptions consistent with an end-of-life or non-concurrent view. This pattern identifies a potential target for education and implementation aligned with national guidance and quality recommendations.

Purpose Integrated Palliative care Outcome Scale (IPOS) is a specific tool for assessing needs in palliative care, recording and monitoring physical symptoms, emotional concerns, and communication and practical issues. This study aimed to evaluate if the IPOS tool was able to assess the impact of at-home palliative care program on physical symptoms and psychosocial problems in advanced cancer patients. Methods This observational prospective longitudinal mixed-method study included advanced cancer patients assisted at home. IPOS questionnaire (patient version—7-day recall) was administered at the entry, after 2 and 4 weeks. A qualitative thematic analysis (TA) of the first open-ended question was performed. Change over time in IPOS scores was analyzed by Friedman’s test for repeated measures. Results Among the 60 patients included (29 men, 31 women; 68.2 ± 14.0 years), 47 completed the 4-week observation period. TA indicated that the 3 main themes running through the three surveys (at the entry, day 14, and day 28) relate patients’ concerns about symptoms and side effects of treatments , family members, the evolution of the disease , and the daily issues . Repeated measures test demonstrated that patients entering with medium–high IPOS total score ( n  = 27) showed a significant decrease in IPOS total score ( p  = 0.003), physical symptoms ( p  = 0.002), and communication and practice ( p  = 0.028) subscales after 2 and 4 weeks. Conclusion Patients entering in home care with higher burden of symptoms and psychosocial problems reported significant decrease in IPOS scores. In these patients, IPOS was responsive to change showing substantial clinical improvements after the activation of home assistance.

Background The Integrated Palliative care Outcome Scale (IPOS) is a key tool for assessing the quality of palliative care using patient-reported outcomes. This study aimed to culturally adapt and translate the IPOS to Korean and verify its psychometric properties for use in palliative care settings. Methods The IPOS was translated and culturally adapted, followed by validation in 119 terminally ill cancer patients and 28 healthcare providers across six Hospice and Palliative Care Units from September 2023 to January 2024. Reliability was assessed using internal consistency, test-retest reliability, and inter-rater reliability. Concurrent validity was assessed using Spearman’s correlation coefficients between the IPOS items and the corresponding EORTC QLQ-C15-PAL and the corresponding FACIT-Sp-12. Results The Korean IPOS demonstrated good internal consistency, with Cronbach’s alphas of 0.74 for patients and 0.81 for staff. The test-retest reliability showed moderate-to-good stability, with an intra-class correlation coefficient of 0.722 for the IPOS total score. Concurrent validity was supported by moderate correlations with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative Care (EORTC QLQ-C15-PAL) and Functional Assessment of Chronic Illness Therapy-Spiritual Well-being Scale (FACIT-Sp-12). Known-group validity was demonstrated by significant differences in the IPOS scores across Phase of Illness. Conclusion The Korean IPOS is reliable and valid for assessing palliative care outcomes. This validation supports its use in clinical practice and research and provides a robust framework for evaluating and improving palliative care delivery in Korea.

Background Family carers manage a wide range of responsibilities in the lives and care of patients receiving palliative care. They fulfil multiple roles and perform activities within different settings. This has immediate consequences on family carers’ every-day lives. According to literature, family carers in palliative care are both part of the formal and informal care network, but also persons in need of support. This article aims to investigate 1) burdens and rewards associated with family caregiving and 2) what family carers find helpful in their contact with professionals from integrated palliative care initiatives (IPC-i) and other services. Methods Family carers looking after patients with cancer, chronic obstructive pulmonary disease or chronic heart failure were purposefully recruited at 22 IPC-i in Belgium, Germany, Hungary, the Netherlands and the United Kingdom in the course of the project “Patient-centred palliative care pathways in advanced cancer and chronic disease” (InSup-C). Semi-structured interviews ( n  = 156) and 87 quantitative questionnaires (CRA, POS, CANHELP Lite) were conducted with family carers. Interviews were analysed with transnationally agreed thematic codes (MAXQDA or NVivo). Statistical tests (SPSS) were carried out in accordance with the characteristic value of the items and distributions. Results On average, quantitative data showed moderate burden, but the qualitative findings indicated that this burden might be underrated. There is some evidence that IPC-i with well-developed professional care networks and communication systems relieved family carers’ burden by direct and indirect interventions; e.g. provision of night shift nurses or psychological support. Needs of family carers were similar in all participating countries. However, in all countries IPC-i mostly offered one-off events for family carers, lacking systematic or institutionalised support structures. Conclusions Data suggest that, most IPC-i did not pay enough attention to the needs of most family carers, and did not offer proactive care and access to supportive resources to them (e.g. training, respite care, access to resources). We recommend recognizing family carers as part of the ‘unit of care’ and partner in caregiving, to improve their knowledge about, and access to, and the support available.

Background Patient-centred measures to capture symptoms and concerns have rarely been reported in severe COVID. We adapted and tested the measurement properties of the proxy version of the Integrated Palliative care Outcome Scale–IPOS-COV for severe COVID using psychometric approach. Methods We consulted experts and followed consensus-based standards for the selection of health status measurement instruments and United States Food and Drug Administration guidance for adaptation and analysis. Exploratory Factor Analysis and clinical perspective informed subscales. We tested the internal consistency reliability, calculated item total correlations, examined re-test reliability in stable patients, and also evaluated inter-rater reproducibility. We examined convergent and divergent validity of IPOS-COV with the Australia-modified Karnofsky Performance Scale and evaluated known-groups validity. Ability to detect change was examined. Results In the adaptation phase, 6 new items were added, 7 items were removed from the original measure. The recall period was revised to be the last 12–24 h to capture fast deterioration in COVID. General format and response options of the original Integrated Palliative care Outcome Scale were preserved. Data from 572 patients with COVID from across England and Wales seen by palliative care services were included. Four subscales were supported by the 4-factor solution explaining 53.5% of total variance. Breathlessness-Agitation and Gastro-intestinal subscales demonstrated good reliability with high to moderate (a = 0.70 and a = 0.67) internal consistency, and item–total correlations (0.62–0.21). All except the Flu subscale discriminated well between patients with differing disease severity. Inter-rater reliability was fair with ICC of 0.40 (0.3–0.5, 95% CI, n  = 324). Correlations between the subscales and AKPS as predicted were weak (r = 0.13–0.26) but significant ( p  < 0.01). Breathlessness-Agitation and Drowsiness-Delirium subscales demonstrated good divergent validity. Patients with low oxygen saturation had higher mean Breathlessness-Agitation scores (M = 5.3) than those with normal levels (M = 3.4), t = 6.4 (186), p  < 0.001. Change in Drowsiness-Delirium subscale correctly classified patients who died. Conclusions IPOS-COV is the first patient-centred measure adapted for severe COVID to support timely management. Future studies could further evaluate its responsiveness and clinical utility with clinimetric approaches.

Background Older people account heavily for palliative care needs at the population level and are growing in number as the population ages. There is relatively little high-quality data on symptom burden and quality of life, since these data are not routinely collected, and this group are under-recruited in primary research. It is unclear which measurement tools are best suited to capture burdens and experience. Methods We recruited a cohort of 221 patients aged 75 + years with poor prognosis who had an unplanned admission via the emergency department in a large urban hospital in England between 2019 and 2020. Risk of dying was assessed using the CriSTAL tool. We collected primary data and combined these with routine health records. Baseline clinical data and patient reported quality of life outcomes were collected on admission and reassessed within the first 72 h of presentation using two established tools: EQ-5D-5 L, EQ-VAS and the Integrated Palliative Outcomes Scale (IPOS). Results Completion rate was 68% ( n  = 151) and 33.1% were known to have died during admission or within 6 months post-discharge. The vast majority (84.8%) reported severe difficulties with at least one dimension of EQ-5D-5 L at baseline and improvements in EQ-VAS observed at reassessment in 51.7%. The baseline IPOS revealed 78.2% of patients rating seven or more items as moderate, severe or overwhelming, but a significant reduction (-3.6, p  < 0.001) in overall physical symptom severity and prevalence was also apparent. No significant differences were noted in emotional symptoms or changes in communication/practical issues. IPOS total score at follow up was positively associated with age, having comorbidities (Charlson index score > = 1) and negatively associated with baseline IPOS and CriSTAL scores. Conclusion Older people with poor prognosis admitted to hospital have very high symptom burden compared to population norms, though some improvement following assessment was observed on all measures. These data provide valuable descriptive information on quality of life among a priority population in practice and policy and can be used in future research to identify suitable interventions and model their effects.