IntroductionHeart failure (HF) causes high symptom burden and shortens life expectancy. Implementation of Palliative Care (PC) concurrently with cardiologic guidelines-directed medical therapy (GDMT) improves quality-of-life (QoL) more than disease-oriented management alone but is underused. To facilitate provision of PC for people living with HF, the Swiss Society of Cardiology (SSC) and the Swiss Society for Palliative Care (palliative.ch) have created joint working-group.MethodsDyads representing cardiology and PC from Swiss HF centres have been identified. Through online voting, workshops and Delphi process priority topics for incorporation of PC into standard care for people with HF have been identified.Results18 experts, from 8 Swiss HF-centres identified main topics relevant for implementation of PC in usual HF care: timely recognition of unaddressed health-related needs of affected people and their relatives (using validated assessment tools ID-PALL or NAT-PD:CH at least as the triggers evolve), identifying key palliative interventions for care of people living with HF, identifying strategies to facilitate cooperation between specialist PC and cardiology, defining research agenda to investigate efficacy of PC interventions, quality of care criteria, and outcomes of PC provision in Switzerland.DiscussionImprovement of QoL of people with HF and their relatives could be greater if PC would be integrated in usual care timely. Frequent needs assessment, using validated tools helps to recognize people having unaddressed needs, and helps to replace the outdated, based on risk of dying, involvement of PC. Dialogue between both disciplines is crucial to provide care prolonging life of best quality during the whole journey living with disease.

L'objectif de la liste Top 5 est de réduire les coûts et d'apporter une valeur ajoutée aux patientes et patients.

INTRODUCTION:Dyspnea is a common and distressing symptom in patients with advanced malignant and non-malignant diseases. It is a subjective experience that can only be described by the patients themselves and can be associated with a massive reduction in quality of life, including social isolation and wish to hasten death. Often there is an affective component such as anxiety or panic. Objective parameters do not necessarily correlate with the subjective experience. Health professionals often underestimate and inadequately treat the burden of dyspnea. The introduction of the concept of chronic breathlessness syndrome or acute-on-chronic-breathlessness aims to illustrate the nature of the condition and facilitate the identification and access to appropriate treatment. The management of dyspnea is complex, and for effective treatment, a combination of general, non-pharmacological, and pharmacological measures is usually advisable. Opioids should be offered to patients with incurable cancer and refractory dyspnea for symptom relief. They can be supplemented with benzodiazepines in cases of concomitant anxiety. The administration of oxygen is only indicated in cases of hypoxemia. Key measures include education, self-management skills acquisition and advance care planning for emergency situations.

INTRODUCTION:The topic of death and the dying is a crucial aspect of patient care, especially for individuals with terminal illnesses. However, discussions about death and dying are often avoided during patient interactions. In this article, our aim is to explore the reasons behind our fear of death and dying and to assess the importance of addressing these issues in shaping and cultivating relationships with our patients and in our personal lives. We argue that being open to impermanence is a valuable tool in our work with patients and their families and should be integrated into conversations with them. Furthermore, discussions about death and dying should play a central role in medical and nursing education as well as professional development.

This paper reviews and summarises the evidence of short-term psychosocial interventions (up to 12 sessions delivered within less than eight weeks) on anxiety, depression, and emotional distress in palliative patients in inpatient settings. We screened publications from the following five databases, Embase, PubMed, PsycINFO, Web of Science, and CINAHL, from their inception to 10 September 2021. The eligible studies included controls receiving standard palliative care, actively treated controls, and wait-list controls. Nine studies met the eligibility criteria and reported the effects of five psychosocial interventions in a total of N = 543 patients. We followed PRISMA-guidelines for outcome reporting and the Cochrane Risk of Bias Assessment Tool for assessing study quality. This paper used the network meta-analysis to compare multiple treatments by providing greater statistical power and the cross-validation of observed treatment effects, using the R package BUGSnet. Compared to control groups, the following psychosocial interventions in inpatient settings showed to be superior: life review interventions were the best ranked treatment for improving anxiety and distress, while the top ranked treatment for reducing depression was outlook intervention. The short-term psychosocial interventions investigated in this meta-analysis, especially life review intervention, are feasible and can potentially improve anxiety, depression, and distress in palliative inpatients and should therefore be offered in inpatient settings.

BackgroundRepeat hospitalizations, complications, and psychosocial burdens are common in patients with left ventricular assist devices (LVAD). Specialist palliative care (sPC) involvement supports patients during decision-making until end-of-life. In the United States, guidelines recommend early specialist palliative care (esPC) involvement prior to implantation. Yet, data about sPC and esPC involvement in Europe are scarce.Materials and MethodsThis is a retrospective descriptive study of deceased LVAD patients who had received sPC during their LVAD-related admissions to two university hospitals in Duesseldorf, Germany and Basel, Switzerland from 2010 to 2021. The main objectives were to assess: To which extent have LVAD patients received sPC, how early is sPC involved? What are the characteristics of those, how did sPC take place and what are key challenges in end-of-life care?ResultsIn total, 288 patients were implanted with a LVAD, including 31 who received sPC (11%). Twenty-two deceased LVAD patients (19 male) with sPC were included. Mean patient age at the time of implantation was 67 (range 49–79) years. Thirteen patients (59%) received LVAD as destination therapy, eight patients (36%) were implanted as bridge to transplantation (BTT), and one as an emergency LVAD after cardiogenic shock (5%). None of the eight BTT patients received a heart transplantation before dying. Most (n = 13) patients lived with their family and mean Eastern Cooperative Oncology Group (ECOG) performance status was three. Mean time between LVAD implantation and first sPC contact was 1.71 years, with a range of first sPC contact from 49 days prior to implantation to more than 6 years after. Two patients received esPC before implantation. In Duesseldorf, mean time between first sPC contact and in-hospital death was 10.2 (1–42) days. In Basel, patients died 16 (0.7–44) months after first sPC contact, only one died on the external sPC unit. Based on thorough examination of two case reports, we describe key challenges of sPC in LVAD patients including the necessity for sPC expertise, ethical and communicative issues as well as the available resources in this setting.ConclusionDespite unequivocal recommendations for sPC in LVAD patients, the integration of sPC for these patients is yet not well established.

Un apercu des mesures therapeutiques qui peuvent etre utilisees dans le secteur hospitalier pour les patients qui ne recevront pas de traitements vitaux tels que l'intubation et la reanimation.

Eine Übersicht über die therapeutischen Massnahmen, die im stationären Bereich bei Patienten zur Anwendung kommen können, die keine lebenserhaltenden Behandlungen wie Intubation und Reanimation erhalten werden.

Cet article présente une sélection de faits essentiels pour la pratique médicale quotidienne et il porte un regard orienté vers la pratique sur certains développements actuels et certaines controverses.

There is a widespread consensus about the importance of hope for human life (Dalferth 2016). However, opinions diverge greatly when it comes to defining the essence, the function and the value of hope (Woschitz 1979). The ancient Greek culture illustrates the different perspectives on hope (elpis) eloquently: according to the Greek myth of Pandora’s Box, hope is the only blessing mankind has left to bear the toil and suffering of life. Interestingly, the ancient narrative recalls the harshness of life, and less the extraordinary human capacity not only to endure suffering, but also to make sense of it (Most 2006). A similarly negative evaluation of hope is to be found in the Greek fabulist Aesop. The moral lessons of his fables is that it is unreasonable to give up a present good – how small it may be – for the sake of something we do not have yet, i.e., we hope to get (Aesop 2008). But Theognis of Megara and the Hippocratic writings give a more favourable account of hope by stressing the supporting effect of hope. According to the Greek physician, hoping that patients recover or feel better is the doctors’ raison d’être (Gallois 2005). The following essay is an attempt to understand what hope is in the context of palliative care: wishful thinking, i.e., a reactive attitude or coping strategy to face bad news, as it is often mentioned in the literature (Shirado et al. 2013; Olsman et al. 2014; Koopman et al. 2016) an active will for something to happen, an expression of faith or trust in a beneficent transcendence, a form of inborn optimism, a positive feeling (Hilpert 2017; Wienand et al. submitted)? Sometimes we associate hope with denial of reality, for example when a person says they continue hoping for their complete recovery despite their imminent death. In a palliative care context, a similar tension is noticed time and again: despite prognosis of death, some patients and their family do not give up their hope of complete cure. But this example illustrates only one particular – and in fact relatively rare – form of hope qua wishful thinking. Yet, there is a variety of hope as our study has documented. The analysis of hope in a palliative care context should therefore be undertaken with greater interpretative caution in order to understand the patient’s inner perspective (Dalferth 2016). In other words, a preconceived opinion on hope prevents from grasping what patients and family actually mean when they speak about hope (Bühler & Peng-Keller 2014). This stumbling block drew our attention while reading and analysing 300 palliative patients’medical records collected at three Swiss university hospitals between April and September 2016. Since qualitative research design helps to investigate medical staff’s written statements about patients in more depth than quantitative research (Green and Britten 1998), we used this approach to understand patients’ perspective. More precisely, we used content analysis for analysing the data (Vaismoradi et al. 2013). Details on the data extraction sheet and data collection are described elsewhere (Rakic et al. under revision). The quotes cited in this essay are verbatim texts written by the medical team into the patients’ medical records. The passages were copied and translated from French or German into English. We obtained the ethical approval from the local research ethics committee ([EKNZ]; Nr. EK 2015–197).

Background: Care for palliative care patients is often provided by unpaid caregivers (eg, family members) who take care of the patient’s daily needs (eg, bathing, dressing). Family members of palliative care patients are involved in numerous ways. These tasks and responsibilities can make them feel burdened and even overburdened. Aim: We specifically looked at patients’ medical records to determine what is being reported about burden and overburden and who seems to be mostly affected. Burden was understood as a weight or task that is difficult to accept or carry, whereas overburden indicates that this weight or task cannot be carried anymore. Methods: We looked at 300 medical records of palliative care patients written by health-care professionals. Written notes were analyzed using latent content analysis as it helps to analyze large amounts of textual data qualitatively and to understand the underlying concepts of what was said. Results: Most (73.5%) patients had a cancer diagnosis. Mean age was 67.6 years (range, 22-98 years). Burden and overburden were identified as main categories and further divided into the following subcategories: for patients and families. According to the written notes, patients often felt burdened by their disease, financial problems, situation at home, and families’ reactions to their disease. By and large, patients felt overburdened by their own disease. Families often felt burdened because of issues related to patients’ medical condition, providing home care, or financial and social aspects. Families mentioned home care and the decision-making process as being overburdening. Conclusion: Findings in the palliative care patients’ medical records are inasmuch important, as they point at the health-care staff’s awareness of possible weights and tasks that might be burdensome for patients and their families. Attention should be drawn to the documentation of medical records in order to identify recurrent difficulties and to help discuss these.