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.

BACKGROUND AND OBJECTIVE: The development of modern palliative care in China began in the 1980s and is currently in an accelerating phase. However, inconsistencies in terminology and concepts have hindered policy-making, clinical practice, and academic research. The Terminology of Clinical Medicine (2023 edition) has determined huan-he-yi-liao () and an-ning-liao-hu () as the formal terms of "palliative care" and "hospice care", respectively. To align with these terms, this study aims to establish expert consensus definitions tailored to the Chinese context. METHODS: We systematically retrieved and collected domestic and international literature and policy documents related to the definition of palliative care, then deconstructed and analyzed the relevant conceptual elements of these definitions. Core expert panel built the initial recommended definition upon the conceptual elements and consensus definition of palliative care by the International Association for Hospice and Palliative Care (IAHPC) through two rounds of online discussions. After nomination and selection, 61 professionals in the field of palliative care in China were invited to participate in the consensus expert group. Two rounds of Delphi consultation were conducted among the consensus experts, who were asked to score their agreement using Likert scale to the items in the initial recommended definition and the definition statements of palliative care and hospice care. Agreement rate of over 80% was considered as reaching consensus for each items. The core expert panel revised the items and the statements of recommended definitions based on the results from Delphi surveys. The final recommended definitions were formulated after feedback from patient and public involvement (PPI) group members. RESULTS: The response rates for the first and second round of Delphi surveys were 83.6% and 100.0%, respectively. The agreement rates of the items and statements of the recommended definitions exceeded 90%. Accordingly, the definitions based on Chinese expert consensus are recommended. Palliative care is an active holistic approach aimed at patients of all ages suffering from life-threatening illness and their families and caregivers. It seeks to improve their quality of life by preventing, assessing, and relieving physical, psychological, social, and spiritual suffering. Hospice care is an integral part of palliative care, focusing on holistic care for patients at the end of life and their families and caregivers. Its goal is to help patients to maintain dignity and achieve a good death by alleviating physical, psychological, social, and spiritual distress without intentionally hastening or postponing death, meanwhile improve the quality of life for families and caregivers. CONCLUSIONS: This study has established the Chinese expert consensus definitions of palliative care and hospice care in China, as well as the relationship between the two. The definitions highlight the holistic nature of palliative care, providing a foundation for discipline development, clinical practice, and public communication.
Palliative Care ; Humans ; China ; Hospice Care ; Consensus ; Delphi Technique ; Terminology as Topic

A living will is a record of the patient's willingness to choose the medical care plan at the critical or dying stage when the patient is conscious.Due to the influences of traditional ethical ideas,policies,laws,medical service supply and other factors,the social implementation of living wills face great obstacles.Therefore,we should strengthen the education of citizens' view of life and death,improve the specific operation procedures of living wills,and establish a national security system for palliative care,so as to better promote the development of hospice care in China.
Humans ; China ; Palliative Care ; Hospice Care

BACKGROUND

Identifying the patient-specific, disease-related, and hospitalization profiles of admitted patients referred to the Palliative & Hospice Care Program (PHCP)—including the pattern of services rendered to them over a period of three years is valuable groundwork statistics for a nascent institution looking into improving their service delivery.

After total population sampling of 304 distinct referral cases from July 2021 to June 2024, a retrospective chart review on electronic medical records uploaded to the Health Information Management Systems was done. With approval from the institutional ethics board, and guided by a data collection form, data were gathered and prepared upon completion before subjecting to descriptive statistics.

Majority of patients referred to the PHCP were elderly (50.56%), with a higher prevalence of females (60.2%). Most were of Roman Catholic faith (94.7%). Most referrals were cancer cases (74.24%) with dyspnea (26.9%) as the usual complaint upon admission. More than half of the referrals were from Internal Medicine (58.1%). Half of the patients expired during their hospital stay (52.3%). Average time from admission to referral was 8.49 days on the overall mean length of stay of 13.46 days. Psychosocial Support (97.37%), Transition to Home Care (42.11%), and Motivational Counseling (32.24%) were the most frequently rendered PHCP service to the referred cases during the three-year study period.

The demand for psychosocial support and transition-to-home services spells the need for capacity building of community-led initiatives and home-based interventions. Reapplication of the study method to other institutions in future studies is recommended to help gain broader perspective on palliative care service delivery. Overall, the increasing trend in in-patient referrals underscores the growing recognition of the importance of palliative care in improving patient outcomes and quality experience at the of life.

In palliative and hospice practice, health care professionals frequently faced ethical challenges related to end-of-life care. The complexities of patient care in the hospice and palliative care setting mandated a shift from healthcare professionals operating in “silo” to embracing an interprofessional team-based approach. However, ethical dilemmas and ethical conflicts within the interprofessional team and between the professional and patient family may arise, due to different perspectives about the patient's best interest. This paper utilized the Walker and Avant's (2011) concept analysis process in which the concept of interprofessional ethical reflective practice was developed. Adopting the analysis methodology from Walker and Avant (2011), this paper defined the concept and related concepts, attributes, antecedents, consequences, model case, borderline case and opposite case to describe the concept of interprofessional ethical reflective practice. The concept proposed a cyclical approach for interprofessional ethical reflective practice which includes three phases, pre-ethical situation reflection, intra-ethical situation reflection and post-ethical situation reflection. This concept allowed for the significance of interprofessional ethical reflective practice to become apparent, guiding healthcare professionals to navigate through ethical dilemmas with awareness, sensitivity, collaboration, and an attitude of commitment to upholding the ethical care principles in palliative and hospice care.

BACKGROUND

Th Philippines has faced challenges in quality end-of-life care and ranks poorly on the 2015 Quality of Death Index. This study explores the perceptions of a good death among patients, caregivers, and bereaved family members within the Palliative and Hospice Care Program of Ospital ng Makati.

The research aimed to offer insights into the factors that influence end-of-life care preferences in the Philippine context.

The study involved 38 participants – patients, caregivers, and bereaved family members. It adapted and modified the Good Death Inventory, a validated scale with 47 questions covering 18 domains related to end-of-life care.

Results show significant differences in perceptions of a good death among patients, caregivers, and bereaved family members. Maintaining hope and pleasure, having control over the future, and a good relationship with medical staff were identified as top priorities while dying in a favorite place was of lower importance. Caregivers and bereaved members valued patient autonomy, with higher importance placed on being respected as an individual and feeling that one’s life is worth living. Additionally, spiritual comfort was more significant for caregivers and bereaved family members. The study highlights the importance of understanding distinct preferences in the context of end-of-life care. The findings also call for longer data collection periods, larger sample sizes, and potential qualitative research methods.

By addressing these nuances, healthcare providers can better improve end-of-life care, ensuring that patients and their families experience a more positive and meaningful transition at this crucial stage of life.

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

To let the general public,regardless of gender,age,career and education background,understand the core concept of hospice and palliative care,practice in their lives,and then spread to and serve as many people as possible,the hospice and palliative care team of Peking Union Medical College Hospital established the professional hospice and palliative care training platform for volunteers in 2021.This article reviews the training design,content,methods,and results of the platform.It is concluded that the platform has theory-based training design,logical and complete training content,suitable training method for volunteers,and satisfactory training results.The establishment of this hospice and palliative care training platform for volunteers has excellent feasibility.Efforts should be made to further explore the performance and long-term development strategy of the training platform.
Humans ; Hospices ; Palliative Care ; Hospice Care ; Volunteers/education*