ABSTRACT Re-living trauma near death is a recognised phenomenon that is associated with increased pain and suffering. It presents with additional physical and psychological symptoms that can be ameliorated with improved clinical knowledge and appropriate management. Dying cancer patients living in developed countries have increasingly benefited from access to quality, effective palliative care, but this is not the case for other populations, where inequity and inequality of access to palliative care exist. Access to palliative care is dependent on where people live, there diagnosis, age, and circumstances of deprivation. Circumstances of deprivation may include people dying from dementia, in poverty, experiencing homelessness, and/or long-term substance use. As these experiences are more frequently observed in trauma survivors, people with a trauma history may experience dying with poor access to palliative care, increased suffering and unmet needs. This paper aims to explore and discuss the importance of identifying re-living trauma near death and offers an evidence-based approach for clinicians to do so using ‘trauma cues’. Trauma cues are presentations of symptoms that may occur in trauma survivors in the last weeks of their life, regardless of whether a history of trauma has been disclosed/documented. Trauma cues may be utilised to improve clinicians’ ability to identify re-living trauma near death for people dying, with or without cognitive impairment. The clinical practice of a Palliative Care Nurse Practitioner will be presented using composite case material to highlight trauma cues analysed against existing literature on re-living trauma near death.

Antibiotic prescribing remains common in terminally ill patients despite limited evidence of benefit. This study investigates the prevalence, clinical outcomes, and cost implications of antibiotic use in end-of-life patients receiving inpatient palliative care. A retrospective cross-sectional study was conducted, reviewing the medical records of 155 end-of-life patients who received palliative care consultations and died between January 1, 2021, and December 31, 2021. Of the 155 patients, 69.68% were diagnosed with cancer, and 94.84% had documented advance care planning. Antibiotics were prescribed in 83.23% of cases, with 71.61% continuing use during the last seven days of life. Respiratory (41.94%) and urinary tract infections (20.65%) were the most frequently identified infection sites, and Klebsiella pneumoniae (16.77%) was the most commonly identified pathogen. Fever was the most common symptom (69.03%) and showed the highest response rate to antibiotics (69.23%), whereas dyspnoea demonstrated limited improvement (13.92%). Gastrointestinal disturbances were the most reported adverse drug reactions (4.52%). The median total cost of antibiotic prescriptions and related care was 16,132.63 THB (IQR: 7,427.15–74,740.39 THB), equivalent to 1,203.93 international dollars (IQR: 554.26–5,577.64). These findings highlight the frequent use of antibiotics in terminally ill patients, often extending to the final days of life, with considerable economic impact. Given the limited symptomatic benefit and high costs, these results emphasise the need to re-evaluate antibiotic prescribing practices in end-of-life care to align with patient-centred goals and cost-effective strategies.

General practitioners (GPs) play a central role in the delivery of palliative care. Many GPs desire to improve their palliative care skills. Education resources, such as electronic resources (e-resources), that are easily accessible and validated for local use, are one recommended clinical learning tool. This observational, cross-sectional questionnaire study (1 July to 30 September 2022) aimed to investigate the frequency of use and perceived usefulness of palliative care e-resources by Australian rural GPs. Forty-seven GPs and GP registrars in southern NSW, Australia were invited to participate, with 44 questionnaires distributed; 35 were returned (response rate 80%). Thirty-three (94%) of respondents preferred electronic vs print-based resources and 27 (77%) used e-resources daily in their general clinical practice. Therapeutic Guidelines – Palliative Care was the most well-known and frequently used palliative care e-resource (86%, n = 30; 66%, n = 23) followed by Opioid Calculator (74%, n = 26; 66%, n = 23) and HealthPathways (71%, n = 25; 31%, n = 11). The remaining palliative care e-resources were largely unknown and underutilised. Barriers to use included GPs finding them difficult to use (49%, n = 17) or access (40%, n = 14), being unaware of available e-resources (40%, n = 14) and there being too many e-resources (29%, n = 10). This study suggests that rural GPs are unaware of and do not use most palliative care e-resources, and instead use palliative care sections/volumes within familiar general medical e-resources. Rather than continuing to develop a wide range of e-resources for GPs, efforts may be better placed by improving access and efficiency for time-poor GPs, such as centralising e-resources to one website.

Maintaining independence and quality of life are significant issues for patients with a life-limiting illness and physiotherapists play an essential role in the palliative care multidisciplinary team in maintaining, restoring, and improving physical function and quality of life (QOL). This study aims to describe current physiotherapy interventions utilized in a palliative care service and compare it to the evidence base of physiotherapy interventions in palliative care. An audit was conducted of all inpatient and community palliative care patients referred for physiotherapy review and intervention, over a 4-week period. A literature search was conducted and the level of evidence for individual physiotherapy interventions was assessed. The audit identified 35 patients referred to the Physiotherapist for the assessment and management of mobility, falls risk management and prevention, lymphoedema management and assessment of functional decline. The most frequently performed physiotherapy assessments and interventions were for mobility and transfer (94.3%), falls prevention and management (74.3%), reconditioning and strengthening (57.1%), and exercise prescription (48.6%). Physiotherapy in the palliative care setting is becoming more accepted to help benefit the function and QOL of patients with advanced progressive diseases. This audit highlights the importance of these interventions in assisting patients to manage their symptoms and function at home.

Background Globally, palliative care services do not meet demand. The World Health Organisation reports that 14% of people who need palliative care currently receive it. Moreover, the increase in chronic disease prevalence will result in the need for services to continue to grow. In Ireland, to help manage this demand, it is recommended that all physiotherapists should be able to deliver basic palliative care to patients diagnosed with life-limiting illnesses. Objective To explore the competency and confidence levels of physiotherapists in the management of patients with life-limiting conditions. Methods An anonymous, cross-sectional online questionnaire was designed and administered to physiotherapists working across various settings in Ireland. Results There were 90 respondents (response rate = 4.2%). A significant majority (93%, n = 84) agreed that most patients with life-limiting conditions can participate in physiotherapy. Just over half (56%, n = 50) felt confident in their ability to prescribe exercise for this cohort. Less than one-third (29%, n = 26) felt that the role of physiotherapy in palliative care was understood by the multi-disciplinary team. The majority (76%, n = 68) did not agree that their undergraduate training prepared them for work in this area. The ability to access mentorship from specialist palliative care physiotherapists was deemed as a facilitator in providing patient care. Conclusion This study highlights the demand for greater palliative care education, the need for a better understanding among the wider multi-disciplinary team so that patients receive timely access to physiotherapy, and the importance of establishing strong links between specialist physiotherapists and their generalist counterparts.

The aim of this study was to identify barriers and mechanisms in the development of palliative care in the province of Aceh, North West Indonesia. Several factors, including an ageing population, have increased palliative care needs in the region; however, as with many low to middle income countries (LMICs), palliative care is not well established or integrated into mainstream health care services. Consequently, many people may experience serious health-related suffering (SHRS) at the end-of-life. Qualitative semi-structured interviews and focus groups were conducted with key stakeholders in Aceh, Indonesia and a semi-structured interview guide prompted an exploration of palliative care provision, including barriers and enablers. Interviews were digitally recorded, transcribed, and analysed using the principles of thematic analysis. Eight interviews and two focus groups were conducted with medics (n = 6), nurses (n = 7), hospital management (n = 1) and religious/cultural leaders (n = 2). The findings indicate that all participants recognise a need to reduce SHRS and a growing impetus to embed a culturally salient and sustainable model of palliative care within the Aceh healthcare system. The following four themes indicate key areas for further focus: (1) Local vision and leadership, (2) Prioritisation of palliative care policy and funding, (3) Access to palliative care in community and public services, and (4) supporting palliative care in the cultural context of Sharia law, family, and faith. Future expansion requires the identification of a culturally and socioeconomically salient package of palliative care which operates across rural community and acute care settings and is informed by further evaluation and evidence.

Objective To assess the effects of auriculotherapy for the management of CINV in cancer patients. Methods This is a systematic review of randomized controlled trials (RCTs). We searched MEDLINE via PubMed, AMED, Biblio Auriculo, Embase, CINAHL, CENTRAL, BVS, MTCI Américas, Web of Science, Scopus, PEDro, CNKI, CBMdisc, and CSJD-VIP databases up to September 2021 with no language restrictions. Results We included 25 studies with a total of 2,167 randomized participants. The results of the included studies suggest positive effects of auriculotherapy for the control of CINV, however 92% studies presented a high risk of bias overall. In the included studies, the most used auricular acupoints in the studies were the stomach (CO4) (n = 24, 96%), shenmen (TF4) (n = 23, 92%), sympathetic nerve (AH6a) (n = 15, 60%), spleen (CO13) (n = 14, 56%), liver (CO12) (n = 11, 44%), subcortex (AT4) (n = 10, 40%), and cardia (CO3) (n = 9, 36%). Conclusions It was not possible to assess the effectiveness of auriculotherapy for the management of CINV due to the great heterogeneity of the studies regarding the form of evaluating the outcome, the application of auriculotherapy, and the high risk of bias. It is suggested that robust clinical trials be conducted and reported according to the STRICTA guidelines.