担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of the American Medical Directors Association  

Objectives: To elucidate factors related to the transitions of quality of life (QoL) and well-being in older adults living in residential facilities. Design: We undertook a systematic review and narrative synthesis. Setting and Participants: The participants were individuals aged ≥60 years living in various types of residential facilities. Methods: We conducted a search in PubMed and Embase (Ovid) using free-text words and Medical Subject Heading terms on December 1, 2024. We included longitudinal studies published after 2000 that quantitatively assessed QoL and/or well-being at ≥2 time points. Studies published before 2000, non–English-language papers, and interventional or qualitative studies were excluded. The title, abstract, and full-text assessments were performed by multiple independent reviewers based on eligibility criteria. The Study Quality Assessment Tool for observational cohort and cross-sectional studies was used to assess methodologic quality. Results: Of the 7705 papers initially identified, 18 studies involving 122,057 participants were included. These studies, predominantly multicenter studies and studies conducted in the United States, revealed that QoL and well-being tended to decline gradually after admission. Key factors associated with maintaining and enhancing QoL and well-being included facility-level factors (eg, age-friendly architectural environments, social support and activities) and individual aspects (eg, cognitive function, activities of daily living, urinary continence). The variation in outcome measures precluded a meta-analysis. Conclusions and Implications: We identified both facility- and individual-level factors associated with changes related to QoL and well-being in older adults living in residential facilities. The importance of modifiable facility-level factors should be reconsidered in ensuring quality care for older residents.

DOI： 10.1016/j.jamda.2025.105721

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：European Journal of Oncology Nursing  

Purpose: Artificial intelligence (AI) systems in palliative care have garnered attention and popularity in recent years. Understanding patient and family needs is crucial for developing and implementing AI systems in palliative care. Few studies in palliative care have focused on the demands of terminal patients with cancer and their families toward AI. This study aimed to explore the application of advanced AI in palliative care, focusing on high priority areas, while also analyzing bereaved relatives' perspectives on AI's role in supporting patients with cancer during end-of-life care. Methods: We conducted a web-based questionnaire survey among bereaved family members of deceased patients with cancer. We explored the needs and opinions of the bereaved families regarding using AI for end-of-life care. Results: We analyzed responses from 610 bereaved families. More than 80 % of mourning families wanted AI solutions that could offer the best approach to treat symptoms to health care providers, patients, or informal caregivers, with 79.7 % wishing for AI recommendations for discussions with health care providers. Furthermore, 74.4 % supported AI use in the medical field, while 79.7 % were concerned about accountability and 61.6 % about data leakage. Conclusion: The survey found that development of AI solutions focusing on symptom management and facilitating discussion is the highest priority. Furthermore, this study suggested developing principles and guidance to ensure ethical AI usage is essential.

DOI： 10.1016/j.ejon.2025.102875

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記述言語：英語   出版者・発行元：Journal of Pain and Symptom Management  

Context: Early palliative care is recommended within eight-week of diagnosing advanced cancer. Although guidelines suggest routine screening to identify cancer patients who could benefit from palliative care, implementing screening can be challenging due to understaffing and time constraints. Objectives: To develop and evaluate machine learning models for predicting specialist palliative care needs in advanced cancer patients undergoing chemotherapy, and to investigate if predictive models could substitute screening tools. Methods: We conducted a retrospective cohort study using supervised machine learning. The study included patients aged 18 or older, diagnosed with metastatic or stage IV cancer, who underwent chemotherapy and distress screening at a designated cancer hospital in Japan from April 1, 2018, to March 31, 2023. Specialist palliative care needs were assessed based on distress screening scores and expert evaluations. Data sources were hospital's cancer registry, health claims database, and nursing admission records. The predictive model was developed using XGBoost, a machine learning algorithm. Results: Out of the 1878 included patients, 561 were analyzed. Among them, 114 (20.3%) exhibited needs for specialist palliative care. After under-sampling to address data imbalance, the models achieved an Area Under the Curve (AUC) of 0.89 with 95.8% sensitivity and a specificity of 71.9%. After feature selection, the model retained five variables, including the patient-reported pain score, and showcased an 0.82 AUC. Conclusion: Our models could forecast specialist palliative care needs for advanced cancer patients on chemotherapy. Using five variables as predictors could replace screening tools and has the potential to contribute to earlier palliative care.

DOI： 10.1016/j.jpainsymman.2024.01.009

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記述言語：日本語   出版者・発行元：(NPO)日本緩和医療学会  

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記述言語：英語   出版者・発行元：Annals of Palliative Medicine  

Background: Establishing appropriate quality assessment indicators for palliative care in intensive care units (ICUs) is vital. This systematic review summarizes the existing quality indicators (QIs) for palliative care in ICUs. It assesses the methodological quality of QI development to pave the way for more valid QIs. Methods: A literature search was conducted using MEDLINE, PsycINFO, CINAHL, Cochrane databases, and the Ichushi-web database for Japanese literature for all studies published until November 2021. The included QIs were drawn from the National Consensus Project for Quality Palliative Care (NCP) and the Donabedian model of quality. Methodological quality was assessed based on the appraisal of indicators through the research and evaluation tool. Results: Five studies were included, from which 109 indicators were extracted: 78% were process indicators, 5% were outcome indicators, and 17% were structure indicators. The most common indicators addressed the palliative care domain of “ethical and legal aspects of care” (n=38, 30%). Another distinctive feature of some indicators was a focus on supporting ICU staff. Regarding methodological quality, the “scientific evidence” varied (11–89%). Most of the data on QI measures and data sources were obtained from a review of electronic medical records (EMRs). Administrative data also provided a few measurable indicators. Conclusions: Out of all the QIs covered in this review, most were process indicators, and only a few were outcome indicators. Ethical and legal aspects of care and support for the ICU staff emerged as unique to palliative care. Although the existing QIs can be used for palliative care in ICUs, more specific indicators are urgently needed. Continuous quality assessment and improvement, as well as the addition of more palliative care practices in ICUs, would provide further evidence and help develop valid QIs.

DOI： 10.21037/apm-22-1005

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BMC Palliative Care  

Background: Older people with noncancer conditions are less likely to be referred to palliative care services due to the inherent uncertain disease trajectory and a lack of standardised referral criteria. For older adults with noncancer conditions where prognostic estimation is unpredictable, needs-based criteria are likely more suitable. Eligibility criteria for participation in clinical trials on palliative care could inform a needs-based criteria. This review aimed to identify and synthesise eligibility criteria for trials in palliative care to construct a needs-based set of triggers for timely referral to palliative care for older adults severely affected by noncancer conditions. Methods: A systematic narrative review of published trials of palliative care service level interventions for older adults with noncancer conditions. Electronic databases Medline, Embase, CINAHL, PsycINFO, CENTRAL, and ClinicalTrials.gov. were searched from inception to June 2022. We included all types of randomised controlled trials. We selected trials that reported eligibility criteria for palliative care involvement for older adults with noncancer conditions, where > 50% of the population was aged ≥ 65 years. The methodological quality of the included studies was assessed using a revised Cochrane risk-of-bias tool for randomized trials. Descriptive analysis and narrative synthesis provided descriptions of the patterns and appraised the applicability of included trial eligibility criteria to identify patients likely to benefit from receiving palliative care. Results: 27 randomised controlled trials met eligibility out of 9,584 papers. We identified six major domains of trial eligibility criteria in three categories, needs-based, time-based and medical history-based criteria. Needs-based criteria were composed of symptoms, functional status, and quality of life criteria. The major trial eligibility criteria were diagnostic criteria (n = 26, 96%), followed by medical history-based criteria (n = 15, 56%), and physical and psychological symptom criteria (n = 14, 52%). Conclusion: For older adults severely affected by noncancer conditions, decisions about providing palliative care should be based on the present needs related to symptoms, functional status, and quality of life. Further research is needed to examine how the needs-based triggers can be operationalized as referral criteria in clinical settings and develop international consensus on referral criteria for older adults with noncancer conditions.

DOI： 10.1186/s12904-023-01131-6

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その他リンク： https://link.springer.com/article/10.1186/s12904-023-01131-6/fulltext.html

担当区分：筆頭著者  

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