Current interventional options for palliative care for patients with advanced-stage cholangiocarcinoma

Primary biliary tract tumors are malignancies that originate in the liver,bile ducts,or gallbladder.These tumors often present with jaundice of unknown etiology,leading to delayed diagnosis and advanced disease.Currently,several palliative treatment options are available for primary biliary tract tumors.They include percutaneous transhepatic biliary drainage(PTBD),biliary stenting,and surgical interventions such as biliary diversion.Systemic therapy is also commonly used for the palliative treatment of primary biliary tract tumors.It involves the administration of chemotherapy drugs,such as gemcitabine and cisplatin,which have shown promising results in improving overall survival in patients with advanced biliary tract tumors.PTBD is another palliative treatment option for patients with unresectable or inoperable malignant biliary obstruction.Biliary stenting can also be used as a palliative treatment option to alleviate symptoms in patients with unresectable or inoperable malignant biliary obstruction.Surgical interventions,such as biliary diversion,have traditionally been used as palliative options for primary biliary tract tumors.However,biliary diversion only provides temporary relief and does not remove the tumor.Primary biliary tract tumors often present in advanced stages,making palliative treatment the primary option for improving the quality of life of patients.

Palliative care with adequate pain relief challenges the need for euthanasia legislation

Background:In today’s society the ongoing discussion about euthanasia triggers emotionally charged debates surrounding the delicate balance between valuing life and respecting an individual’s autonomy.With the persistence of this debate,there has been the emergence of the concept of the so-called alternative:palliative care.Positioned as a substitute for euthanasia,palliative care aims to alleviate suffering in terminally ill patients without engaging in the ethical dilemmas associated with euthanasia.Methods:This paper explores the facets of palliative care highlighting its core objectives such as providing adequate pain relief as a compassionate alternative to euthanasia.Results:By examining palliative care as a comprehensive approach to end of life support,this study challenges the perceived necessity of euthanasia and advocates,for compassionate and dignified end of life experiences.Conclusion:In conclusion,palliative care emerges as a viable and ethically sound alternative to euthanasia,emphasizing the importance of compassionate end-of-life care and pain management.

Gynecologic Oncologic Surgery for the Palliation of Life-Limiting Cancer Crises—The Importance of Education and Training in Palliative Care for the Gynecologic Oncologist

Introduction: Palliative care expertise is an important component of the comprehensive care of women with gynecologic cancers. Palliative care ranges from treatment of symptoms experienced by people with cancer such as constipation, nausea, anxiety, pain to careful and the skillful discussion of prognosis and goals of care. The purpose of this review is to summarize the basic issues in palliative care faced by healthcare providers caring for people with cancer and then focus on some examples of diagnostic and treatment dilemmas faced by gynecologic oncologists caring for women with recurrent cancers. Review Summary: Palliative and hospice care strategies are described. Palliative care refers to symptom management from diagnosis through active treatment, problems encountered by survivors, and concerns at the end of life. Hospice care pertains to care during the last six months of life and includes the alleviation of suffering of those dying from cancer and the support for family members. The symptoms at the end of life including pain, anorexia, and intestinal complications are reviewed. Palliative surgical procedures range from the drainage of pleural and abdominal fluid, including the management of intestinal obstruction via drains, diversionary procedures, or the creation of an ostomy. A comparison of outcomes between medical (when surgery was not feasible) and surgical management of bowel obstruction shows the average survival of 54 days compared to 193 days respectively. Conclusion: Gynecologic oncologists are uniquely positioned among other oncologists in managing intestinal obstruction, malignant ascites and pleural effusions, and oligometastatic recurrences where they must decide whether a medical or surgical approach will be effective in palliation and alleviation of suffering. The combination of traditional surgical gynecologic oncology training with palliative care is crucial to become the most effective clinician for each patient with advanced or recurrent gynecologic cancer.

Palliative oral care in terminal cancer patients:Integrated review

BACKGROUND Palliative care(PC)aims to improve quality of life in patients and its families against life threatening diseases,through suffering’s prevention and relief.It is the duty of the dental surgeon to possess the knowledge needed to treat a patient with little life span,in order to establish an adequate treatment plan for each situation.AIM To synthesize the published evidence on oral conditions,impact,management and challenges in managing oral conditions among palliative patients.METHODS Articles were selected from PubMed and Scopus electronic platforms,using a research strategy with diverse descriptors related to“palliative care”,“cancer”and“oral health”.The article’s selection was done in two phases.The first one was performed by the main researcher through the reading of the abstracts.In the second phase two researchers selected eligible articles after reading in full those previous selected.Data was tabulated and analyzed,obtaining information about what is found in literature related to this subject and what is necessary to be approached in future researches about PC.RESULTS As results,the total of 15 articles were eligible,being one a qualitative analysis,13(92.8%)clinical trials and one observational study.Of the 15 articles,8(53.4%)involved questionnaires,while the rest involved:one systematic review about oral care in a hospital environment,2 oral exams and oral sample collection,one investigation of terminal patient’s(TP)oral assessment records,2 collection of oral samples and their respective analysis and one treatment of the observed oral complications.CONCLUSION It can be concluded that the oral manifestations in oncologic patients in terminal stage are,oral candidiasis,dry mouth,dysphagia,dysgeusia,oral mucositis and orofacial pain.Determining a protocol for the care of these and other complications of cancer–or cancer therapy–based on scientific evidence with the latest cutting-edge research results is of fundamental importance for the multidisciplinary team that works in the care of patients in PC.To prevent complications and its needed to initial the dentist as early as possible as a multidisciplinary member.It has been suggested palliative care protocol based on the up to date literature available for some frequent oral complications in TP with cancer.Other complications in terminal patients and their treatments still need to have further studying.

Medical School Students’ Knowledge of Pain and Palliative Care: An Observational Study

Background: Pain and palliative care are a reality in daily routines of medical treatment. However, the theoretical-practical curricula of traditional medical school course still unsatisfactorily contemplate pain management, as well as the palliative care approach. Objective: To assess the knowledge of medical students about pain and palliative care, as well as to identify their perception of teaching these topics during hospitalization. Methods: A cross-sectional observational study, with a descriptive and exploratory approach, data collection for which was carried out between August and November 2020. The target population was medical students, who responded to an online survey of a quantitative, anonymous and follow-up nature. The survey study variables concerned knowledge about pain management and palliative care. Results: An expressive majority of academics showed difficulty in understanding the pathophysiology of pain related to prescribing drugs for pain management purposes, and all of them believe that it is necessary to acquire more knowledge about pain treatment. In parallel, only 9.3% report having received sufficient information regarding palliative care during medical school. Conclusion: The results suggest a certain lack of knowledge and insecurity among medical school students with respect to pain management and care for patients receiving palliative care. The didactical approach to this theme is still deficient in the medical curriculum and requires immediate improvement and new proposals that address the training of these professionals in a more specific and effective way.

Towards an Effective Communication in the Care of Patients with Long Term Disease in Kenya via Cybernetic—A Systematic Review

In this paper, to effectively treat chronic disorders and improve the standard of care, effective communication between patients and healthcare professionals was essential. The aim of the study was to review the literature on how good communication might improve treatment outcomes for Kenyan patients with chronic and terminal illnesses and to determine whether Cybernetic electronic communication can improve those outcomes even more. We uncovered the history of treatment outcomes for chronic and terminal diseases in this research study, both with and without communication at the core of the patient’s care plan. We discussed the importance of good communication in the treatment of patients with chronic and terminal illnesses and why it is a momentous endeavor comparable to medical diagnosis and treatment for the long-term health of patients. To locate pertinent material for the background literature study, we carried out a comprehensive literature search. Although the preliminary literature review was a continuation of the introduction research, it also highlighted the paucity of local Kenyan literature and suggested that improved communication might help patients with chronic and terminal illnesses have better treatment outcome. Methodology maintained the literature search, as a systematic literature review focused on core of the study, making separate sections of the same body necessary. This ensured that a methodological literature search section is as comprehensive as possible. We used an integrated PRISM model to limit a comprehensive literature search and a systematic literature review design as part of the overall process. Non-probability sampling and snowball approaches on literary papers over the previous 17 years were used in this arrangement. Since this was a multidisciplinary study, the four experts who also serve as authors were chosen from within their respective fields of expertise to design the study. They created search strategies, generated key words, looked up keywords in database engines, assessed the results of the literature using the PRISMA logical model, looked over successful literature, and triangulated their findings. The conclusions of the experts individually revealed a convergence of thoughts, beliefs, and practices across. The study concluded that even though there isn’t much research done in Kenya on the same subject;what is available illustrates how crucial good communication is for patients with chronic illnesses. The study’s findings also highlighted the positive effects of effective communication between patients and healthcare professionals on treatment plan adherence, patient satisfaction, and overall health outcomes. The results also noted that in order to improve patient care and outcome, Kenyan healthcare workers should underscore developing their communication skills. The study also found that the incorporation of cybernetics is crucial if a truly effective communication is required so as to enable centered care for patients with long-term diseases in Kenya. The goal of the Cybernetics is to activate genuinely effective communication in the care of Patients with long-term disease in Kenya. This study is organized to begin with an abstract, followed by keywords, an introduction, literature review, methodology, findings, discussion, and finally conclusions.

Palliative long-term abdominal drains vs large volume paracenteses for the management of refractory ascites in end-stage liver disease

BACKGROUND Long-term abdominal drains(LTAD)are a cost-effective palliative measure to manage malignant ascites in the community,but their use in patients with end-stage chronic liver disease and refractory ascites is not routine practice.The safety and cost-effectiveness of LTAD are currently being studied in this setting,with preliminary positive results.We hypothesised that palliative LTAD are as effective and safe as repeat palliative large volume paracentesis(LVP)in patients with cirrhosis and refractory ascites and may offer advantages in patients’quality of life.AIM To compare the effectiveness and safety of palliative LTAD and LVP in refractory ascites secondary to end-stage chronic liver disease.METHODS A retrospective,observational cohort study comparing the effectiveness and safety outcomes of palliative LTAD and regular palliative LVP as a treatment for refractory ascites in consecutive patients with end-stage chronic liver disease followed-up at our United Kingdom tertiary centre between 2018 and 2022 was conducted.Fisher’s exact tests and the Mann-Whitney U test were used to compare qualitative and quantitative variables,respectively.Kaplan-Meier survival estimates were generated to stratify time-related outcomes according to the type of drain.RESULTS Thirty patients had a total of 35 indwelling abdominal drains and nineteen patients underwent regular LVP.The baseline characteristics were similar between the groups.Prophylactic antibiotics were more frequently prescribed in patients with LTAD(P=0.012),while the incidence of peritonitis did not differ between the two groups(P=0.46).The incidence of acute kidney injury(P=0.014)and ascites/drain-related hospital admissions(P=0.004)were significantly higher in the LVP group.The overall survival was similar in the two groups(log-rank P=0.26),but the endpoint-free survival was significantly shorter in the LVP group(P=0.003,P<0.001,P=0.018 for first ascites/drain-related admission,acute kidney injury and drain-related complications,respectively).CONCLUSION The use of LTAD in the management of refractory ascites in palliated end-stage liver disease is effective,safe,and may reduce hospital admissions and utilisation of healthcare resources compared to LVP.

Use of Medicinal Cannabis for Palliative Care Patients: A Systematic Review

Background: Medical cannabis is a rapidly growing area of medicine. In this sense, due to the numerous benefits associated with its use, it has been increasingly proposed for patients in palliative care, in which the improvement of debilitating symptoms is directly associated with better quality of life. However, due to the complexity of treatments for these individuals, further studies are needed to determine the best possible prescription for them. Objective: Understand the endocannabinoid system and evaluate the feasibility of using medical cannabis in palliative care patients. Methods: Systematic literature review, addressing the following topics: “cancer, cannabis, and palliative care”. The search was carried out using the Virtual Health Library: Lilacs, SciELO, Medline, PubMed, and Cochrane, with articles between 2013 and 2022. Results and discussion: A total of 116 articles were found with the descriptors. After reading the abstracts, 22 showed greater association with the theme and were chosen for the preparation of this review. Conclusion: It is concluded that medical cannabis is an excellent treatment option for most of the symptoms present in patients in palliative care. In this way, the adoption of this drug by the public becomes logical. However, it is the physician’s role to seek to understand the particularities of these individuals and this new possibility of treatment, which, it seems, will significantly improve the end of life of these patients—this being the main role of the medical teams.

Traumatic brain injury and palliative care:a retrospective analysis of 49 patients receiving palliative care during 2013–2016 in Turkey

Traumatic brain injury（TBI）,which is seen more in young adults,affects both patients and their families.The need for palliative care in TBI and the limits of the care requirement are not clear.The aim of this study was to investigate the length of stay in the palliative care center（PCC）,Turkey,the status of patients at discharge,and the need for palliative care in patients with TBI.The medical records of 49 patients with TBI receiving palliative care in PCC during 2013–2016 were retrospectively collected,including age and gender of patients,the length of stay in PCC,the cause of TBI,diagnosis,Glasgow Coma Scale score,Glas gow Outcome Scale score,Karnofsky Performance Status score,mobilization status,nutrition route（oral,percutaneous endoscopic gastrostomy）,pressure ulcers,and discharge status.These patients were aged 45.4 ± 20.2 years.The median length of stay in the PCC was 34.0 days.These included TBI patients had a Glasg ow Coma Scale score ≤ 8,were not mobilized,received tracheostomy and percutaneous endoscopic gastrostomy nutrition,and had pressure ulcers.No difference was found between those who were discharged to their home or other places（rehabilitation centre,intensive care unit and death） in respect of mobilization,percutaneous endoscopic gastrostomy,tracheostomy and pressure ulcers.TBI patients who were followed up in PCC were determined to be relatively young patients（45.4 ± 20.2 years） with mobilization and nutrition problems and pressure ulcer formation.As TBI patients have complex health conditions that require palliative care from the time of admittance to intensive care unit,provision of palliative care services should be integrated with clinical applications.

Individualized Treatment and Palliative Care for A90-Year-Old Patient with Primary Gastric Diffuse Large-B Cell Lymphoma:4 Year Follow-up and Inspiration

A 90-year-old man was diagnosed with primary gastric diffuse large B-cell lymphoma(PGDLBL)by PET/CT examination,gastroscopy,biopsy and histopathological analysis at a regular physical check in April,2016.The patient received R-CO chemotherapy(rituximab,cyclophosphamide,and vincristine)and radiotherapy subsequently,with enteral nutritional treatment through 3-cavity nasogastric tube due to development of pyloric obstruction.To satisfy patient's strong desire of eating by himself,we performed surgery of exploratory laparotomy and Roux-en-Y gastric bypass(RGB)to relieve pylorus obstruction.Postoperatively,the patient resumed oral feeding,supplemented by nasogastric tube feeding at 1350-1550 Kcal daily.He is now 94 years old with fairly well nutrition and normal communication.The outcome of 4 year follow-up suggests that nutritional treatment and palliative medicine are important for improving prognosis and life-quality of very elderly patients with end-stage tumors apart from the effective chemotherapy,radiotherapy,and surgery.

A retrospective study on use of palliative care for patients with alcohol related end stage liver disease in United States

BACKGROUND Palliative care(PC)has been shown to be beneficial in end stage liver disease(ESLD),yet the hospitalization data for PC utilization is unknown.AIM To identify the trend of PC utilization for the special population of alcoholassociated ESLD patients,factors affecting its use and ascertain its impact on healthcare utilization.METHODS We analyzed around 78 million discharges from the 2007-2014 national inpatient sample and 2010-2014 national readmission database including adult patients admitted for decompensated alcohol-associated cirrhosis.We identified patients with PC consultation as a secondary diagnosis.Odds ratios(OR)and means were adjusted for confounders using multivariate regression analysis models.RESULTS Out of the total 1421849 hospitalizations for decompensated liver cirrhosis,62782(4.4%)hospitalizations had a PC consult,which increased from 0.8%(1258)of all alcohol-associated ESLD hospitalizations in 2007 to 6.6%in 2014(P<0.01).Patient and hospital characteristics associated with increased odds of PC utilization were advanced age,lower income,Medicaid coverage,teaching institution,urban location,length of stay>3 d,prolonged ventilation,and administration of total parenteral nutrition(all P<0.01).Palliative encounters in alcohol-associated ESLD and acute-onchronic liver failure(ACLF)score were associated with increased odds of discharge to a rehabilitation facility,but significantly lower odds of 30-d readmissions(aOR:0.35,95%CI:0.31-0.41),lower total hospitalization charges and lower mean hospitalization days(all P<0.01).CONCLUSION Inpatient PC is sparingly used for patients with decompensated alcohol related liver disease,however it has increased over the past decade.PC consultation is associated with lower 30-d readmission rates on multivariate analysis,and lower hospitalization cost and length of stay in patients with ACLF score≥2.

Effect of Integrated, Person-Centred Palliative Advanced Home and Heart Failure Care on NT-proBNP Levels: A Substudy of the PREFER Study

Objective: In 2012, we initiated a new person-centred model, integrated Palliative advanced home caRE and heart FailurE caRe (PREFER), to integrate specialised palliative home care with heart failure care. Natriuretic peptide-guided treatment is valuable for younger patients (age < 75 years), but its usefulness in palliative care is uncertain. We explored whether patients in PREFER reduced mean level of N-terminal pro B-type natriuretic peptide (NT-proBNP) more than the control group. Design: A pre-specified, exploratory substudy, analysed within the prospective, randomised PREFER study, which had an open, non-blinded design. Participants: Patients in palliative care with chronic heart failure, New York Heart Association class III-IV were randomly assigned to an intervention (n = 36;26 males, 10 females, mean age: 81.9 years) or control group (n = 36;25 males, 11 females, mean age:76.5 years). The intervention group received the PREFER intervention for 6 months. The control group received care as usual at a primary health care centre or heart failure clinic at the hospital. NT-proBNP was measured at the start and end of study. Results: Plasma levels of NT-proBNP differed significantly between groups at baseline. By the end of the study, no significant difference was found between the groups. The mean value for NT-proBNP decreased by 35% in the PREFER group but was not statistically significant (P = 0.074);NT-proBNP increased 4% in the control group. Conclusions: We found no statistically significant reductions of NT-proBNP levels neither between nor within the PREFER and the control group at the end of the study.

The Practice of Palliative Care amongst Nurses in Selected Hospitals in Eastern Nigeria

In recent times, palliative care nursing has caught the attention of nurse researchers in Africa as more individuals are being diagnosed with chronic diseases of the aged like cancer, cardiac and cerebrovascular conditions. This study examined the influence of knowledge and attitude on the practice of palliative care among practicing nurses in eastern part of Nigeria. A descriptive cross-sectional research design was used for the study. The population of the study is all registered, licensed and practicing nurses working in the named public and private hospitals where palliative care is supposedly well established. Proportionate sampling technique was used to select 289 respondents. Three commercial instruments that were modified were used for data collection. Level of significance was set at 5%. The study was conducted from October 2018 to June 2019. Results revealed that 52.7% of the respondents had satisfactory practice of palliative care, 73.7% of the respondents had adequate knowledge of palliative care (mean 2.64 (1.06) and 77.5% of the respondents had positive attitude towards palliative care (Mean 2.81 (1.14)). There was also a significant weak positive association between nurses’ educational level and their knowledge of palliative care with an effect size of 21.9% (P = 0.003). There was also a significant association between nurses’ years of experience and their attitude to palliative care with an effect size of 35.6% (P < 0.001). There was no significant association between type of hospital facility nurses work in and their practice of palliative care (P = 0.343). Recommendations were made on how to improve the practice of palliative care among professional nurses.

Rationale for integration of palliative care in the medical intensive care:A narrative literature review

Despite the remarkable technological advancement in the arena of critical care expertise,the mortality of critically ill patients remains high.When the organ functions de-teriorate,goals of care are not fulfilled and life-sustaining treatment becomes a burden on the patient and caregivers,then it is the responsibility of the physician to provide a dignified end to life,control the symptoms of the patient and provide psychological support to the family members.Palliative care is the best way forward for these patients.It is a multidimensional specialty which emphasizes patient and family-based care and aims to improve the quality of life of patients and their caregivers.Although intensive care and palliative care may seem to be at two opposite ends of the spectrum,it is necessary to amalgamate the postulates of palliative care in intensive care units to provide holistic care and best benefit patients admitted to intensive care units.This review aims to highlight the need for an alliance of palliative care with intensive care in the present era,the barriers to it,and models proposed for their integration and various ethical issues.

How to Integrate Palliative Care Into Primary Health Care

Integration of Palliative Care into Primary Health Care will have a substantial amount of positive impact on Health Care in Nakuru County,Kenya.Consequently,all aspects of Palliative Care should be given to more than 2/3 population that suffer from cancers and chronic illnesses which sometimes overflow to some acute conditions.While Palliative Care focuses on Holistic Care encompassing physical,psychological,social,and spiritual aspects to adults and children,Primary Health Care operates on the principles of equity,solidarity,universal access to services,multisectoral action,social justice,centralization,and community participation.Thus,there are similarities in Palliative Care and Primary Health Care putting into consideration that the latter is based on practical,scientifically sound and socially accepted methods and technology.It is affordable,universally accessible to individuals and families in the community.Universal Health Coverage ensures that all people and communities have access to promotive,preventive,curative,rehabilitative,and palliative health services they need,of sufficient quality to be effective while also ensuring that the use of these services does not expose the users to financial hardships.The 60%of the Nakuru County population are in need of Palliative Care services,but only about 20%access these services.They suffer from cancers,non-communicable diseases,dementia,and frailty.Geographical challenges,staff shortages,and lack of Palliative Care knowledge are the main barriers to provision of care.

Palliative care for Parkinson’s disease patients and their caregivers

Parkinson's disease is still incurable and the long-term care needs of patients represent a huge challenge for health systems.Palliative care as an alternative therapy can greatly alleviate the suffering and burden on patients and caregivers through effective medical symptom management,the provision of mental health support,and the development of health plans.This paper explores the current status and challenges regarding palliative care for patients with Parkinson's disease in recent years through a literature review approach.The findings can provide scientific evidence for researchers,clinical practitioners and policy makers in this field.We not only reviewed the systematic and effective therapy,but also concluded a new multidisciplinary cooperation model.TCM teams such as acupuncturists,TCM pharmacists and TCM physiotherapists should be key members of the new multidisciplinary team for the palliative care of Parkinson's disease.

Palliative care for end-stage liver disease and acute on chronic liver failure:A systematic review

BACKGROUND End stage liver disease(ESLD)represents a growing health concern characterized by elevated morbidity and mortality,particularly among individual ineligible for liver transplantation.The demand for palliative care(PC)is pronounced in patients grappling with ESLD and acute on chronic liver failure(ACLF).Unfortunately,the historical underutilization of PC in ESLD patients,despite their substantial needs and those of their family caregivers,underscores the imperative of seamlessly integrating PC principles into routine healthcare practices across the entire disease spectrum.AIM To comprehensively investigate the evidence surrounding the benefits of incorporating PC into the comprehensive care plan for individuals confronting ESLD and/or ACLF.METHODS A systematic search in the Medline(PubMed)database was performed using a predetermined search command,encompassing studies published in English without any restrictions on the publication date.Subsequently,the retrieved studies were manually examined.Simple descriptive analyses were employed to summarize the results.RESULTS The search strategies yielded 721 references.Following the final analysis,32 fulllength references met the inclusion criteria and were consequently incorporated into the study.Meticulous data extraction from these 32 studies was undertaken,leading to the execution of a comprehensive narrative systematic review.The review found that PC provides significant benefits,reducing symptom burden,depressive symptoms,readmission rates,and hospital stays.Yet,barriers like the appeal of transplants and misconceptions about PC hinder optimal utilization.Integrating PC early,upon the diagnosis of ESLD and ACLF,regardless of transplant eligibility and availability,improves the quality of life for these patients.CONCLUSION Despite the substantial suffering and poor prognosis associated with ESLD and ACLF,where liver transplantation stands as the only curative treatment,albeit largely inaccessible,PC services have been overtly provided too late in the course of the illness.A comprehensive understanding of PC's pivotal role in treating ESLD and ACLF is crucial for overcoming these barriers,involving healthcare providers,patients,and caregivers.

Pain management in chronic pancreatitis

Pain in chronic pancreatitis(CP)is difficult to manage.Many patients suffer from inadequate pain relief,completely incapacitating them in their daily activities.Historically,despite their well-known adverse effects,opioids have been the pillar of treatment regimens in painful CP.The management is now gradually evolving with a better understanding of the underlying pathophysiology of CP-related pain.Clinicians should follow a holistic approach to the management of CPassociated pain,which must involve lifestyle changes that are coupled with analgesic medications and other pain-relieving interventions.Furthermore,there is no easy cure for vanquishing CP-associated pain.Each patient must be evaluated on a case-by-case basis by a multidisciplinary team to decide which treatment option is best suited for that individual.

Between Euthanasia and Dysthanasia: The Ethical Issue of Sedation in the Terminal Phase of Illness

Background: Deep sedation, euthanasia and therapeutic relentlessness lead us today to rethink the paradigm of life and the contingency of human existence. Between therapeutic relentlessness, the unreasonable care which uses heavy therapeutic means which are often disproportionate to the expected benefit, namely keeping alive a patient whose condition is considered medically hopeless;and euthanasia which would precipitate the process of death would be sedation in the terminal phase of the illness. Should doctors and families of comatose patients decide the “life” and “death” of their patients? For anti-euthanasia associations, doctors, relatives of terminally ill patients and the State itself, if they accept the principle of euthanasia, they are “murderers”, while for pro-euthanasists, the dignity of the human being would recommend that the days of patients in situations considered critical be shortened, to avoid unnecessary suffering and humiliation. Methods: A systematic review of the literature was carried out to identify relevant articles relating to euthanasia, dysthanasia and sedation in the terminal phase of illness. The search was conducted in French or English in three databases: PubMed, Google Scholar and Science Direct. Objectives: The objectives of this article are: 1) define the terminologies and concepts of palliative sedation, deep sedation, deep and continuous sedation until death, euthanasia and dysthanasia;2) present aspects of the meaning of life and the human person in African cultures;and 3) propose an ethical reflection on the value of life. Results: After precisely defining the concepts of euthanasia, dysthanasia and sedation, this research presented the African anthropological and ethical approach to the mysteries of life and death. Conclusion: With this in mind, the golden rule of medicine always remains as such “Primum non nocere”.

Literature Review on Support for Children and Families Experiencing Parental Bereavement

Purpose: This study aimed to understand the actual nursing support in a wide perspective by reviewing overseas literature on support for children who have experienced parental bereavement and their families. The goal was to identify future challenges in nursing support in clinical practice in Japan. Method: Literature searchable as of May 2023 was retrieved using PubMed, resulting in 11 relevant articles. Result: The results revealed the following: 1) For support provided to children, 13 codes were condensed into 5 subcategories and 4 categories. 2) For support provided to families, 36 codes were condensed into 11 subcategories and 4 categories. Conclusion: Open communication was found to be essential for supporting children and their families who have experienced parental bereavement. Moreover, involvement of multiple professions facilitated the provision of specialized support to address diverse needs of children and families, playing a crucial role in overcoming grief. Additionally, the effectiveness of support systems for bereaved families highlighted the need for nursing professionals in Japan to gain knowledge through learning opportunities and to establish a multi-disciplinary approach to support, thus indicating future challenges in nursing support.