Background: A key issue in the development of population-based access to palliative care is identification of appropriate patients. Objective: To evaluate the NECPAL (NECesidades Paliativas) tool to identify unmet palliative care needs in the Czech Republic in regional hospitals of the Vysocina region. Methods: We used the End-of-Life care information system (ELFis) to evaluate prognostication to aid the identification of palliative care needs. The evaluation process was developed in cooperation with the regional government and central health care insurance agency as a step toward the development of a nation-wide palliative care program. Results: Our results demonstrate that the NECPAL tool successfully identified palliative care needs in specifically prepared clinical environment. An important part of this is a support of main stakeholders and an effective leadership. Conclusion: An unexpected finding was the role that leadership played in testing the tool, and very short time (10 months) needed for statistically visible changes in a regional system of care.

• Klíčová slova
• NECPAL, early indication for palliative care, hospice, leadership, multicausality, networking in palliative care, polymorbidity, specialized palliative care,
• MeSH
• chronická nemoc MeSH
• hospicová a paliativní ošetřovatelská péče * MeSH
• lidé MeSH
• paliativní péče metody   MeSH
• péče v hospici * MeSH
• průzkumy a dotazníky MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Background: Leadership competencies are essential for the future development of the field of palliative and hospice care. However, a consensus on the core competencies of good leadership is not yet available. Objective: To elicit consensus on core leadership competencies in palliative care. Design: Based on a literature review, a list of 119 specific leadership competencies was compiled. Subsequently, a Delphi technique used three online survey rounds and a final expert consultation (the board of the European Association for Palliative Care [EAPC]) to assess the importance of these competencies. Setting/Participants: International experts in leadership in palliative care were identified from an online search and EAPC networks. Results: From the 194 international multiprofessional experts invited to participate, 99/78/64 took part in the 3 rounds. One hundred fifteen items from eight domains of leadership (research, advocacy and media, communication, teamwork, project management, organizational learning and sustainability, leading change, and personal traits) reached consensus and were deemed as important. Conclusions: The eight domains provide evidence for teaching of leadership competencies in palliative care. We recommend that exploring, identifying, and integrating leadership competencies in palliative care are given more attention in educational curricula and in training interventions.

• Klíčová slova
• Delphi technique, consensus, education, leadership, palliative care,
• MeSH
• delfská metoda MeSH
• komunikace MeSH
• konsensus MeSH
• lidé MeSH
• paliativní péče * MeSH
• vůdcovství * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH

OBJECTIVES: The aim of this review was to analyze the effectiveness of teaching healthcare professionals in perinatal palliative care, methods of evaluating the teaching, and the teaching strategies used. DESIGN: An integrative review. METHODS: A systematic search was conducted for English language peer reviewed publications of any research design via SCOPUS, Medline/PubMed, EBSCOhost, Science Direct, ERIC, Web of Science, Wiley, Nursing Ovid, and ProQuest databases. Fourteen research papers published between 2002 and 2017 that met the selection criteria were included in the review. FINDINGS: All 14 studies considered perinatal bereavement education to be effective. Eight studies reported statistical improvements in knowledge, security/comfort in providing end-of-life care, or increased perceptions of the emotional care needs of bereaved families, after attending an educational program. Questionnaires or interviews were used to evaluate the educational programs. Innovative teaching strategies, in particular, were evaluated positively (e.g., simulation, discussion, and arts-based methods). CONCLUSION: Perinatal palliative care education is essential in pregradual education for midwives and neonatal nurses. Other research is vital for finding out the effectiveness of this education for pregraduate nursing students. Perinatal palliative care education programs need to be available in postgraduate education for professionals who encounter perinatal death and bereaved families in hospital and community care.

• Klíčová slova
• Education, Health care professionals, Integrative review, Perinatal palliative care, Training,
• MeSH
• lidé MeSH
• ošetřovatelství novorozenců výchova   MeSH
• paliativní péče metody   MeSH
• studenti ošetřovatelství psychologie   MeSH
• studium ošetřovatelství metody   normy   trendy   MeSH
• ztráta blízké osoby MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

According to surveys conducted over the last 10 years, more than 80 % of our population want to live with their loved ones at the end of life. With the ageing of the population and the success of medicine in the early stages of terminal illness, the trajectory and needs at the end of life are gradually changing. The need for health care support is increasing, and for most patients this means the need for 24/7 availability of health care, in this context in the home environment of the terminally ill patient. The question of how palliative care should be organised in an appropriate, meaningful and effective way, the role of specialised health care teams (mobile specialised palliative care), the role of general practitioners, and if, when and how the medical rescue service should/could/should effectively intervene in care, is becoming increasingly urgent. The article combines the experiences and views of an emergency physician and a doctor specialising in geriatrics and palliative medicine.

• Klíčová slova
• palliative care, medical rescue service, mobile specialized palliative care, cardiac arrest, cardiopulmonary resuscitation,
• MeSH
• lidé MeSH
• paliativní péče * MeSH
• péče o pacienty v kritickém stavu organizace a řízení   MeSH
• péče o umírající MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Palliative care is a multidisciplinary approach that improves the quality of life of patients and their families facing the problem associated with a life-threatening illness, through the prevention and relief of suffering. To help people relieve suffering effectively, the deep understanding of the nature of suffering and its dynamic is a crucial condition for it. The research of the mindfulness-based approaches in oncology and palliative care has repeatedly revealed that mindfulness meditation training is an efficient and feasible tool in helping people with the relief and modulation of suffering associated with cancer. In mindfulness training, we help people to develop an awareness that arises through paying attention, on purpose, in the present moment, non-judgmentally with the aim to convey them a deep inside to the fundamental principles of the mind functioning. This kind of inside brings them freedom in reaction to how they can respond to symptoms. The development of the skill to be in the present moment, with acceptance and non-judgmental manner to whatever arises in our experience represents the fundamental pillar in the background of well-being and mental health. From this point of view, the mindfulness-based programs and interventions should be an integral part of complex oncology and palliative care.

• Klíčová slova
• mindfulness, palliative care, quality of life,
• MeSH
• lidé MeSH
• nádory psychologie   MeSH
• paliativní péče psychologie   MeSH
• psychoterapie metody   MeSH
• všímavost * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Advance care planning (ACP) is increasingly recognised in the global agenda for dementia care. The European Association for Palliative Care (EAPC) Taskforce on ACP in Dementia aimed to provide recommendations for policy initiatives and future research. We conducted a four-round Delphi study with a 33-country panel of 107 experts between September, 2021, and June, 2022, that was approved by the EAPC Board. Consensus was achieved on 11 recommendations concerning the regulation of advance directives, equity of access, and dementia-inclusive approaches and conversations to express patients' values. Identified research gaps included the need for an evidence-based dementia-specific practice model that optimises engagement and communication with people with fluctuating and impaired capacity and their families to support decision making, while also empowering people to adjust their decisions if their goals or preferences change over time. Policy gaps included insufficient health services frameworks for dementia-inclusive practice. The results highlight the need for more evidence and policy development that support inclusive ACP practice models.

• MeSH
• delfská metoda * MeSH
• demence * terapie   MeSH
• konsensus * MeSH
• lidé MeSH
• pacientova přání ohledně budoucí terapie MeSH
• paliativní péče * MeSH
• předběžné plánování péče * organizace a řízení   MeSH
• zdravotní politika MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Evropa MeSH

Singultus (hiccup) is caused by periodic involuntary spastic contractions of the respiratory muscles followed by a sharp inspiration and early glottis closure. This results in typical "hic" sound. Brief episodes of hiccups are quite common experience in general population, and they do not indicate serious disease nor require medical treatment. If chronic, they pose a significant problem with plethora of negative consequences on patient condition, particularly in palliative care. Treatment options involve many approaches - both nonmedication and medication options. However, there are no large controlled trials resulting in unambiguous recommendations. Current pharmacologic treatment strategies are therefore only based on small studies and case reports and they report more or less successful outcomes using medications with different mechanisms of action.

• Klíčová slova
• cancer patient, palliative care, pharmacotherapy, singultus,
• MeSH
• lidé MeSH
• paliativní péče * MeSH
• škytavka * farmakoterapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

The European Society of Intensive Care Medicine (ESICM) has developed evidence-based recommendations and expert opinions about end-of-life (EoL) and palliative care for critically ill adults to optimize patient-centered care, improving outcomes of relatives, and supporting intensive care unit (ICU) staff in delivering compassionate and effective EoL and palliative care. An international multi-disciplinary panel of clinical experts, a methodologist, and representatives of patients and families examined key domains, including variability across countries, decision-making, palliative-care integration, communication, family-centered care, and conflict management. Eight evidence-based recommendations (6 of low level of evidence and 2 of high level of evidence) and 19 expert opinions were presented. EoL legislation and the importance of respecting the autonomy and preferences of patients were given close attention. Differences in EoL care depending on country income and healthcare provision were considered. Structured EoL decision-making strategies are recommended to improve outcomes of patients and relatives, as well as staff satisfaction and mental health. Early integration of palliative care and the use of standardized tools for symptom assessment are suggested for patients at high risk of dying. Communication training for ICU staff and printed communication aids for families are advocated to improve outcomes and satisfaction. Methods for enhancing family-centeredness of care include structured family conferences and culturally sensitive interventions. Conflict-management protocols and strategies to prevent burnout among healthcare professionals are also considered. The work done to develop these guidelines highlights many areas requiring further research.

• Klíčová slova
• Communication, Conflict management, Cultural variations, Decision-making, End of life, Family-centered care, GRADE, Intensive care unit, Palliative care,
• MeSH
• jednotky intenzivní péče * organizace a řízení   normy   MeSH
• komunikace MeSH
• lidé MeSH
• paliativní péče * normy   metody   MeSH
• péče o pacienty v kritickém stavu metody   normy   MeSH
• péče o umírající * normy   metody   MeSH
• rozhodování MeSH
• společnosti lékařské MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• směrnice pro lékařskou praxi MeSH
• Geografické názvy
• Evropa MeSH

OBJECTIVES: Despite a number of studies on effectiveness of palliative care, there is a lack of complex updated review of the impact of in-hospital palliative care consult service. The objective is to update information on the impact of palliative care consult service in inpatient hospital setting. METHODS: This study was a systematic literature review, following the standard protocols (Preferred Reporting Items for Systematic Reviews and Meta-Analyses, Joanna Briggs Institute tools) to ensure the transparent and robust review procedure. The effect of palliative care consult service was classified as being associated with improvement, no difference, deterioration or mixed results in specific outcomes. PubMed, Scopus, Academic Search Ultimate and SocINDEX were systematically searched up to February 2020. Studies were included if they focused on the impact of palliative care consult service caring for adult palliative care patients and their families in inpatient hospital setting. RESULTS: After removing duplicates, 959 citations were screened of which 49 full-text articles were retained. A total of 28 different outcome variables were extracted. 18 of them showed positive effects within patient, family, staff and healthcare system domains. No difference was observed in patient survival and depression. Inconclusive results represented patient social support and staff satisfaction with care. CONCLUSIONS: Palliative care consult service has a number of positive effects for patients, families, staff and healthcare system. More research is needed on factors such as patient spiritual well-being, social support, performance, family understanding of patient diagnosis or staff stress.

• Klíčová slova
• clinical assessment, communication, hospital care, quality of life, service evaluation, symptoms and symptom management,
• MeSH
• dospělí MeSH
• hospicová a paliativní ošetřovatelská péče * MeSH
• konziliární vyšetření a konzultace MeSH
• lidé MeSH
• nemocnice MeSH
• pacienti hospitalizovaní MeSH
• paliativní péče * MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• systematický přehled MeSH

BACKGROUND: Effective cooperation between a pediatric palliative care team (PPCT), primary treating specialists, patients and families is crucial for high quality care of children with complex life-limiting conditions. Several barriers among patients, families and treating specialists have been identified in the context of initializing pediatric palliative care. The aim of the study was to assess the experience with initial pediatric palliative care consultations from perspectives of family caregivers and treating physicians with a special focus on two innovative approaches: attendance of the treating specialist and the opportunity for parents to give feedback on the written report from the consultation. METHODS: This was a qualitative study using semi-structured interviews with family caregivers of children with malignant and non-malignant disease and their treating specialists. Framework analysis was used to guide the data collection and data analysis. RESULTS: In total, 12 family caregivers and 17 treating specialists were interviewed. Four main thematic categories were identified: (1) expectations, (2) content and evaluation, (3) respect and support from the team and (4) consultation outcomes. Parents viewed the consultation as a unique opportunity to discuss difficult topics. They perceived the attendance of the treating specialist at the initial consultation as very important for facilitating communication. Treating specialists valued the possibility to learn more about psychosocial issues of the child and the family while attending the initial palliative care consultation. All participants perceived the written report from the consultation as useful for further medical decisions. Family members appreciated the chance to give feedback on the consultation report. CONCLUSIONS: Our study identified several clinically relevant issues that can help initialize pediatric palliative care and establish effective collaboration between families and PPCT and treating specialists. Supporting treating specialists in their ability to explain the role of palliative care is important in order to reduce the risk of misunderstanding or unrealistic expectations. Developing more specific expectations seems to be one of the ways to further increase the effectiveness of initial consultations. The results of the study can be especially helpful for the initial phase of implementing pediatric palliative care and initializing the process of setting up a collaborative relationship with palliative care teams in the hospital.

• Klíčová slova
• Communication, Initial consultation, Parental feedback, Pediatric palliative care,
• MeSH
• dítě MeSH
• komunikace MeSH
• kvalitativní výzkum MeSH
• lidé MeSH
• osoby pečující o pacienty * MeSH
• paliativní péče * metody   MeSH
• rodiče psychologie   MeSH
• rodina psychologie   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH