INTRODUCTION

Chronic Kidney Disease (CKD) is a leading cause of morbidity and mortality in the Philippines. Most Filipino CKD patients prefer hemodialysis due to barriers such as cost and availability of Kidney Transplant. End-stage kidney disease (ESKD) patients face high symptom burden and unmet palliative care needs. Even with advancement in dialysis technology, the annual mortality rate of dialysis patients remains between 20% and 25%. While Advance Care Planning (ACP) can help align care with patient preferences by facilitating discussions about values and future decisions, its utilization in dialysis population remains low due to barriers in implementation. There is limited research specifically addressing the preferences and influencing factors of Advance Care Planning among CKD patients on hemodialysis in the Philippines.

This study aimed to determine the ACP preferences of CKD patients undergoing hemodialysis and to identify the clinicodemographic factors associated with these preferences.

An analytic cross-sectional study was conducted involving 96 chronic kidney disease (CKD) patients undergoing hemodialysis at Baguio General Hospital and Medical Center (BGHMC) from October to November 2024. Data were collected using validated questionnaires administered either through face-to-face interviews or self-administration, depending on patients’ preferences and capabilities. Descriptive and inferential statistical methods were employed for data analysis.

The study revealed limited awareness of ACP among participants (86.5%), underscoring the need for education. Family-centered decision-making was prominent, with most participants preferring family members as surrogate decision-makers and confidants. Quality of life was prioritized over life extension, and preferences for “Do Not Resuscitate” (DNR) orders were notable. Educational attainment and ethnicity significantly influenced preferences, with higher education linked to greater awareness; and Ethnicity shaping preferences for decision-makers, confidants, timing of discussions, and resuscitation choices. Additionally, duration of dialysis was linked to care setting preferences, while social support systems influenced the preferred place for discussions.

The findings highlight critical associations between clinicodemographic factors and ACP preferences among hemodialysis patients. Addressing these associations through targeted education and culturally sensitive approach can promote high-quality end-of-life care, aligned with diverse patient needs, values, and preferences.

Glioblastoma multiforme (GBM) is the most common malignant primary brain tumor with a poor prognosis and limited survival. Patients with GBM have a high demand for palliative care. In our present case, a 21-year-old female GBM patient received inpatient palliative care services including symptom management, mental and psychological support for the patient, psychosocial and clinical decision support for her family members, and pre- and post-death bereavement management for the family. Furthermore, we provided the family members with comprehensive psychological preparation for the patient's demise and assisted the patient's family throughout the mourning period.The aim of this study is to provide a reference and insights for the clinical implementation of palliative care for patients with malignant brain tumors.
Female ; Humans ; Young Adult ; Brain Neoplasms/therapy* ; Glioblastoma/therapy* ; Inpatients ; Palliative Care ; Terminal Care

Since end-stage renal disease leads to a variety of problems such as disability,reduced quality of life,and mental and psychological disorders,it has become a serious public health problem around the globe.Renal palliative care integrates palliative care philosophy in the care for patients with end-stage renal disease.As a planned,comprehensive,patient-centered care,renal palliative care focuses on the patient's symptoms and needs,aiming to reduce the suffering throughout the course of the disease,including but not limited to end-of-life care.This study reports the palliative care practice for a patient on maintenance dialysis in the Blood Purification Center of Peking Union Medical College Hospital and reviews the present situation of palliative care in end-stage renal disease.
Humans ; Palliative Care/psychology* ; Quality of Life ; Kidney Failure, Chronic/therapy* ; Terminal Care/psychology* ; Renal Dialysis/psychology*

Background: The Ospital ng Makati is a tertiary government hospital that is currently on its birthing phase of establishing the palliative foundation in the hospital in terms of the handling the terminally ill and dying patients by providing them quality of life while in the hospital and if still possible, to assist the family in the transition to home care. Objective: The objective was to determine the baseline knowledge, attitude and practices of the resident physicians who are undergoing training in the Ospital ng Makati. Methods: A cross-sectional study was conducted among the resident physicians of Ospital ng Makati to know the knowledge, attitude and practices with regards to the assessment of their end of life care understanding. A self-administered validated questionnaire was distributed among the participants from a previous study done by Pamplona that was utilized to facilitate the survey. Results: A total of 65 people took part in the study, with a median age of 20 to 39 years old. The majority of the participants were female (40%) and Roman Catholic 60 (92.3% ). The department of Pediatrics had a significant number of participants (24.6%). The University of the East Ramon Magsaysay Memorial Medical Center had a significant number of the participants 13 (20%). The majority 25. (38.5%) of the respondents are generally first years. The total of 65 respondents resulted to overall response rate of 56.5%. Conclusion The findings demonstrated that knowledge, attitudes, and practices related to palliative care were identified through this cross-sectional report. Interestingly, even though the majority of the participants had no prior exposure or rotation to palliative and hospice care and demonstrated a lack of understanding of the notion of palliative and hospice medicine, they had an appropriate understanding of palliative medicine in general.
Cross-Sectional Studies ; Terminal Care ; Knowledge

Community-based home hospice care provided by community service centers and family physician teams aims to alleviate the suffering of terminally ill patients and help them to receive end-of-life care and pass away at home.The Puhuangyu Community Health Service Center established the home hospice care model of PUMCH-Puhuangyu Coordination at the end of 2019.The model has been practiced and improved to date.This paper introduces this model of home hospice care.
Humans ; Hospice Care ; Tertiary Care Centers ; Hospices ; Home Care Services ; Terminal Care

Palliative care refers to the prevention and relief of physical and mental suffering through early recognition,active assessment,and management of pain and other painful symptoms to improve quality of life for both the patients with severe diseases and their families.A successful case of palliative care requires not only the establishment of correct concepts but also the team work and the improvement of the medical system.This paper introduced the end-of-life care experience for a patient with advanced lung cancer,showing the gains and deficiencies in the practice of palliative care.
Humans ; Palliative Care ; Quality of Life ; Terminal Care ; Lung Neoplasms/therapy* ; Pain ; Death

Aged, 80 and over ; Betacoronavirus ; Coronavirus Infections ; diagnosis ; therapy ; transmission ; Critical Care ; organization & administration ; Humans ; Male ; Palliative Care ; organization & administration ; Pandemics ; Pneumonia, Viral ; diagnosis ; therapy ; transmission ; Terminal Care ; organization & administration

Background: End of life (EOL) care is a holistic approach for patients and their families, that involves physical, emotional, spiritual, and social needs. There are approximately 80,000 Malaysians requiring EOL care annually but only 2,000 patients have access to the service. Despite an increasing demand for EOL care in Malaysia, many healthcare professionals are still unfamiliar and inadequately trained in dealing with the EOL issue. The purpose of study is to evaluate the Diploma in Nursing students’ level of knowledge and attitude towards EOL care. Method: A cross-sectional descriptive study on 127 nursing students from a private nursing college in Penang, through simple random sampling was conducted. The Palliative Care Quiz for Nursing was used to determine the knowledge of EOL care, while Frommelt Attitude Towards Care of Dying Patients-Form B, was used to measure attitude towards EOL care. Result: Overall, the participants had poor knowledge towards EOL care with mean overall score of 8.18 ± 2.14. The mean overall score for attitude towards EOL care was 117.76 ± 11.12, implying a positive attitude towards EOL care. There was a significant difference in the level of knowledge (t = 5.250, p < 0.001) and attitude (t = 6.184, p < 0.001) according to the years of study. Conclusion The student nurses had poor level of knowledge on EOL but positive attitude towards EOL care. Adding an additional module on EOL alone is inadequate; instead emphasis on its relevancy and understanding on how it can be used to improve patient care is of far more importance.
Terminal Care ; Knowledge ; Attitude ; Students, Nursing

PURPOSE: This study was done to examine good death awareness, attitudes toward advance directives (ADs), and preference for care near the end-of-life (PCEOL) of hospitalized elders in long-term care hospitals. Relevant characteristics were investigated as well as correlation of the variables. METHODS: This descriptive research study involved 161 hospitalized elderly patients in long-term care hospitals. A self-report questionnaire was used to measure Good Death Scale, ADs Survey, PCEOL Scale, and general characteristics. Collected data were analyzed using descriptive statistics, t-test, ANOVA, and Pearson correlation with SPSS/WIN 23.0. RESULTS: In terms of good death awareness, a significant difference was observed; in according to age (F=3.35, p=.037), payer of treatment costs (F=3.98, p=.021), mobility (F=3.97, p=.021), heard discussion about ADs (t=−3.89, p<.001), and willing to complete ADs (t=2.12, p=.036). As far as attitudes toward ADs, the participants presented significant difference depending on religion (t=2.38, p=.018), average monthly income (F=3.91, p=.022), duration of hospital admission (F=5.33, p=.006), person to discuss ADs (t=−2.76, p=.006). On PCEOL, there was a significant difference, depending on religion (t=−3.59, p<.001) and perceived health status (F=3.93, p=.022). Finally, as for how the variables were related to each other, good death awareness and attitudes toward ADs had a weak positive correlation with PCEOL. CONCLUSION: To help seniors staying in nursing homes face a good death and enjoy autonomy, there should be educational and support systems that reflect each individual's sociodemographic characteristics so that the seniors can choose what kind of care they want to receive near the end-of-life.
Advance Care Planning ; Advance Directives ; Aged ; Health Care Costs ; Humans ; Long-Term Care ; Nursing Homes ; Terminal Care

PURPOSE: The purpose of this study was to investigate the frequency, patterns, and factors of reversals in decisions about life-sustaining treatment (LST) among older patients with terminal-stage chronic cardiopulmonary disease. METHODS: This was a retrospective correlational descriptive study based on medical chart review. De-identified patient electronic medical record data were collected from 124 deceased older patients with terminal-stage cardiopulmonary disease who had made reversals of LST decisions in an academic tertiary hospital in 2015. Data were extracted about the reversed LST decisions, LST treatments applied before death, and patients' demographic and clinical factors. Multivariate logistic regression analysis was used to identify the factors associated with the reversal to higher intensity of LST treatment. RESULTS: The use of inotropic agents was the most frequently reversed LST treatment, followed by cardiopulmonary resuscitation, intubation, ventilator therapy, and hemodialysis. Inconsistency between the last LST decisions and actual treatments occurred most often in hemodialysis. One-third of the reversals in LST decisions were made toward higher intensity of LST treatment. Patients who had lung diseases (vs. heart diseases); were single, divorced, or bereaved (vs. married); and had an acquaintance as a primary decision maker (vs. the patients themselves) were significantly more likely to reverse the LST decisions to higher intensity of LST treatment. CONCLUSION: This study demonstrated the complex and turmoil situation of the LST decision-making process among older patients with terminal-stage cardiopulmonary disease and suggests the importance of support for patients and families in their LST decision-making process.
Cardiopulmonary Resuscitation ; Decision Making ; Divorce ; Electronic Health Records ; Heart ; Humans ; Intubation ; Life Support Care ; Logistic Models ; Lung Diseases ; Renal Dialysis ; Retrospective Studies ; Terminal Care ; Tertiary Care Centers ; Ventilators, Mechanical