Objectives To explore perspectives on assisted dying legislation among disadvantaged ethnic minority communities in a UK city with high ethnic diversity and socioeconomic deprivation to inform deliberation of the Terminally Ill Adults (End of Life) Bill in England and Wales.Methods Three community consultations were facilitated using semistructured discussions. Groups consulted included: (1) 98 adults from ethnic minority communities living in disadvantaged areas; (2) 24 ethnic minority women with experience of domestic abuse and (3) 15 parents of young people aged >= 18 years who are autistic and/or have learning disabilities. Findings were analysed thematically.Results Across all consultation groups, participants expressed both compassion for people experiencing severe suffering who want assisted dying, alongside concerns about how assisted dying might be experienced by marginalised groups. Four themes were developed: fear and mistrust of healthcare systems; risks of direct and indirect coercion, including structural and interpersonal forms; concerns about decision-making, capacity and family involvement; and unintended consequences for trust in palliative care services.Conclusions Consultations provide insights into how assisted dying legislation may affect groups experiencing end-of-life inequalities. Findings suggest that without attention to equity, trust and safeguards, assisted dying policy risks widening disparities and undermining engagement with palliative care.
Aims To compare and rank the effectiveness of various advance care planning (ACP) decision aids in increasing the completion rates of ACP.Background ACP protects patient autonomy, eases caregiver burden and improves interdisciplinary communication. However, its implementation remains challenging. This study compares the effectiveness of various ACP support tools to promote clinical ACP implementation.Designs A systematic review and network meta-analysis.Methods We searched PubMed, Embase, the Cochrane Library, CNKI, Wanfang and VIP databases up to December 2025. Statistical analysis was performed using RevMan V.5.4 and Stata V.18.0.Results A total of 13 randomised controlled trials were ultimately included, covering eight types of support tools. The results of the network meta-analysis showed that, in terms of improving the rate of documentation of advance healthcare plans within the healthcare system, interventions using paper-based tools, video tools, electronic tools and various combined tools were more effective than usual care; paper-based tools ranked first in terms of the percentage of area under the cumulative ranking curve; in terms of increasing the signing rate of advance directives (AD) documents, personnel-supported interventions, motivational interviewing interventions and video tools were more effective than usual care; the intervention with the highest percentage of the cumulative ranked area under the curve was the personnel-supported intervention.Conclusions During the initial stages of ACP, paper tools are effective; during the signing of the AD document, personnel support interventions are more effective. In clinical practice, different tools should be selected based on the specific stage of the process to promote ACP.
Objectives Breast cancer is a major health burden, and breast cancer-related lymphoedema (BCRL) is a potentially persistent complication that may cause swelling, heaviness, tightness, pain and functional and psychological limitations. This study compared the frequency of self-reported symptoms between patients with and without BCRL and examined associations between symptom severity and distress and objective lymphoedema measures. Methods A total of 120 women who completed primary cancer treatment were included (n=68 with BCRL; n=52 without BCRL). Symptom severity and distress were assessed using the Visual Analogue Scale. Arm volume, the Lymphoedema Index (L-Dex) derived from bioimpedance spectroscopy and local tissue water (LTW) assessed by tissue dielectric constant were measured. Group differences were analysed using the chi(2) test, and associations using Spearman's correlation. Statistical significance was set at p<0.05. Results Swelling (86.8% vs 44.2%, chi(2)=24.60, p<0.001), heaviness (89.7% vs 46.2%, chi(2)=27.00, p<0.001), tightness (79.4% vs 53.8%, chi(2)=8.90, p=0.003) and pain (79.4% vs 57.7%, chi(2)=6.61, p=0.010) were significantly more frequent in the BCRL than non-BCRL group. Weak-to-moderate significant correlations were observed between symptom severity and distress related to swelling, heaviness, and tightness and arm volume difference (r=0.34-0.52, p<0.001) and L-Dex scores (r=0.33-0.46, p<0.001), and arm and forearm LTW ratios (r=0.26-0.37, p=0.006 to <0.001). Conclusions Self-reported symptoms were more prevalent in patients with BCRL. Despite significant but weak-to-moderate associations with objective measures, these findings highlight that symptom reporting provides valuable complementary information and should be interpreted alongside objective assessments in the evaluation of BCRL.
