Palliative Care

Early home-based specialised palliative care cuts emergency use in advanced GI cancer

In a randomized trial of 118 patients starting palliative chemotherapy, early home-based specialised palliative care (SPC) integrated with cancer treatment reduced emergency visits versus usual SPC referral. Medians were 1 vs 3 emergency visits, 1 vs 2 hospitalisations, and 1.5 vs 11.5 inpatient days (p < 0.001 for comparisons). There was no difference in time from last chemotherapy to death or place of death. Apply to patients with advanced gastrointestinal malignancies receiving palliative chemotherapy, acknowledging trial-specific context. 1

Clinician-directed nudges markedly increase goals-of-care documentation

This systematic review and meta-analysis of 51 studies found clinician-directed nudges increased GOCD documentation (pooled OR 3.30, 95% CI 2.40–4.53). Multicomponent interventions with a nudge component performed better than nudges alone (OR 4.03 vs 1.89). Effects on communication quality and readmissions were favorable in small numbers of studies, but heterogeneity was high (I2 = 96.7%). Nudges are scalable low-cost QI tools but expect variable effects across settings and interventions. 2

Most dry-mouth guidelines in palliative care lack AGREE-II quality

This review identified 72 dry-mouth guidelines from 42 countries but only 2 were recommended by AGREE II standards. Common recommendations across guidelines addressed assessment, oral care, saliva substitutes, stimulants, diet, and patient/family involvement. The evidence base is limited, and guideline methodological quality is heterogeneous. Clinicians should rely on shared practical measures while awaiting higher-quality, evidence-based guidance. 3