Advance care planning for patients with chronic obstructive pulmonary disease on home non-invasive ventilation: A qualitative study exploring barriers, facilitators and patients' and healthcare professionals' recommendations

Experiences of cancer patients in palliative care with advanced care planning: A systematic review and meta-synthesis of qualitative studies

PURPOSE

This systematic review and meta-synthesis aims to synthesize the perspectives and experiences of patients with advanced cancer of advanced care planning and advanced directives in a PC setting.

METHODS

Qualitative studies published between 1991 and 2024 were included. A comprehensive search was performed across six electronic databases: CINAHL, Cochrane, OVID, PubMed, Scopus, and ScienceDirect. The Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research was applied for quality assessment. Thematic synthesis was applied to analyze data from 20 selected studies, involving 534 participants.

RESULTS

Six key themes emerged: (1) Meaning of advanced care planning (ACP), (2) Initiating ACP, (3) Barriers and facilitators, (4) Communication in ACP, (5) Outcomes of ACP, and (6) Needs and wishes in ACP. Findings highlight ACP as a complex and dynamic process shaped by emotional, social, and institutional factors. While ACP promotes patient autonomy and reduces anxiety, reluctance, avoidance, and cultural barriers limit engagement. Effective clinician-patient communication, emotional readiness, and tailored interventions enhance ACP participation.

CONCLUSIONS

Understanding the perspectives of advanced cancer patients is essential for improving ACP implementation in PC settings. Healthcare professionals must foster trust, provide culturally sensitive communication, and adapt ACP approaches to patients' evolving needs. Future research should focus on addressing emotional and systemic barriers to increase ACP participation and improve end-of-life care quality.

A narrative review of proactive palliative care models for people with COPD

Chronic obstructive pulmonary disease (COPD) refers to a group of lung diseases that are distinct in underlying aetiology but share a common disease course of persistent and progressive airflow restriction. People living with COPD, as well as the people who care for them, frequently have severe and unmet physical and psychosocial needs, including breathlessness, fatigue, cough, anxiety and depression. Early proactive palliative care is well placed to address these needs, yet it is frequently under-utilised in this group. This narrative review aimed to identify core components of palliative care and examine how existing models of care are implemented to better understand which models can best serve the needs of people with COPD. Symptom palliation, advance care planning, and support for caregivers emerged as the common components underpinning both generalist and specialist models of palliative care. Models of proactive palliative care were diverse in terms of where and how care was delivered as well as which health professionals were involved. Five key models of palliative care were identified: (1) multi-disciplinary integrated services, (2) nurse-led care, (3) hospice and residential aged care, (4) home-based care, and (5) telemonitoring and telehealth. Each model describes a diverse set of interventions and many of these share common elements, including the normalisation of palliative principles within routine care and the provision of diverse delivery settings to accommodate individual preferences and needs. Successful palliative care models must be practical, accessible and innovative to respond to individuals' complex and evolving needs, foster multi-disciplinary collaboration and input and optimally utilise local healthcare resources.

Bridging knowledge gaps: a bibliometric analysis of non-invasive ventilation in palliative care studies

BACKGROUND

Despite being a useful strategy for providing respiratory support to patients with advanced or terminal illnesses, non-invasive ventilation (NIV) requires in-depth investigation in several key aspects.

OBJECTIVES

This bibliometric analysis seeks to comprehensively examine the existing research on the subject. Its goal is to uncover valuable insights that can inform the prediction trajectory of studies, guide the implementation of corrective measures, and contribute to the improvement of research networks.

METHODS

A comprehensive review of literature on NIV in the context of palliative care was conducted using the Web of Science core collection online database. The search utilized the key terms "non-invasive ventilation" and "palliative care" to identify the most relevant articles. All data were gathered on November 7, 2023. Relevant information from documents meeting the specified criteria was extracted, and Journal Citation Reports™ 2022 (Clarivate Analytics) served as the data source. The analysis employed literature analysis and knowledge visualization tools, specifically CiteScope (version 6.2.R4) and VOSviewer (version 1.6.20).

RESULTS

A dataset with bibliometric findings from 192 items was analyzed. We found a consistent upward of the scientific output trend over time. Guidelines on amyotrophic lateral sclerosis management received the highest number of citations. Most documents were published in top-ranked journals. Less than one-third of the documents pertain to clinical studies, especially retrospective analyses (25%). Key topics such as "decision making", and "communication" were less addressed.

CONCLUSIONS

Given the substantial clinical implications, further high-quality studies on this subject are recommended. Encouraging international collaborations is needed. Despite the growing volume of documents in the field, this bibliometric analysis indicates a decline in collaborative networks.