Objective To construct a scientific and practical management model of the hospice and palliative care outpatient clinic and provide a reference for the operation and development of the outpatient clinic. Methods The basic framework of the whole process management model of hospice and palliative care outpatient clinic was determined preliminarily by literature analysis,qualitative interviews and experts group meetings.Two rounds of consultation were conducted among 18 experts in hospice and palliative care and medical-nursing combined outpatient service by the Delphi method. Results The questionnaire response rates of the two rounds of expert consultation were both 100% and the authority coefficients of the two rounds of expert consultation were 0.88 and 0.91,respectively.Finally,the whole process management model of hospice and palliative care outpatient clinic was constructed,which was composed of three first-level indicators including staff composition,work structure and effect evaluation,5 second-level indicators and 62 third-level indicators. Conclusion The constructed whole process management model is scientific,innovative and continuous,which can provide a reference for the operation and development of the hospice and palliative care outpatient clinic.

Objective To gain an in-depth understanding of the motivations,patterns,and related factors in family decision-making regarding the referral of terminal patients in tertiary hospitals. Methods Using purposive sampling,terminal patients and their family members from three tertiary hospitals in Beijing were selected as subjects.Semi-structured interviews were conducted,and the interview data were subjected to thematic analysis. Results Following the saturation principle,a total of 11 patients and 15 family members were included.The interview data were organized and analyzed,yielding six major themes:decision premises,decision patterns,family support,support from the referring hospital’s medical team,referral channel conditions,and involvement of volunteer teams and social support.Based on these findings,a flowchart illustrating the family decision-making process for the referral of terminal patients was constructed. Conclusions The study provides a comprehensive analysis of various factors influencing family decision-making in the referral of terminal patients in tertiary hospitals.The results underscore the significance of internal and external factors,emphasizing the integrated impact of decision patterns,family support,medical team support,referral channel conditions,and the involvement of volunteer teams and social support.The research offers profound insights into improving the referral process for terminal patients and enhancing the quality of family decision-making.It provides valuable recommendations for future improvements in medical services and decision support.

Objective To investigate clinicians’ practice and opinions on sedation therapy in end-stage patients at Peking Union Medical College Hospital. Methods From August,2022 to April,2023,an online questionnaire survey was conducted among clinicians involved in end-stage patient management. Results A total of 205 questionnaires were distributed,with an effective response rate of 56.1%.Among the clinicians,55.7% of them had experience of applying sedation therapy in end-stage patients;85.2% of clinicians believed that sedation could relieve the suffering of terminal patients from physical refractory symptoms;75.7% of clinicians considered that sedation therapy could be used to relieve agony from psycho-existential distress.Most clinicians had concerns about sedation therapy due to the lack of legal support(86.1%)and the lack of understanding of patients or families(59.1%).The majority (90.4%) of clinicians were willing to receive training on palliative sedation. Conclusions A majority of clinicians agree that sedation therapy could relieve the physical distress and psycho-existential distress in end-stage patients.However,most clinicians have concerns about the application of sedation therapy due to the lack of legal support.It is necessary to enhance the training on palliative sedation.

Terminally ill patients face multiple difficulties in home care.Home-based palliative care adhering to the concept of whole-person,whole-family,whole-team,and whole-course care is able to meet the needs of terminally ill patients and their families.In this paper,we reported the care history and home-based palliative care process of a patient with end-stage breast tumor and summarized the experience,aiming to provide reference for the future work of home-based palliative care.

Objective To analyze the changes of death status of the inpatients in Peking Union Medical College Hospital before and after the development of palliative care.Methods All the death cases of Peking Union Medical College Hospital in 2013 (384 cases) and 2019 (244 cases) were included in this study,and the general information of the patients and the details of diagnosis and treatment before death were collected.Results The departments of intensive care,emergency,and respiratory diseases and the international medical services had highest number of deaths in both 2013 and 2019,with the cumulative constituent ratios of 67.7% and 62.7%,respectively.The number of clinical departments that involved or implemented palliative care increased from 7 in 2013 to 14 in 2019.The number of patients who died in 2019 and exposed to palliative care increased (P<0.001) compared with that in 2013,and increasing patients received humanistic care (P<0.001).Compared with 2013,2019 witnessed reducing patients receiving vasoactive drugs (P=0.006),cardiopulmonary resuscitation (P=0.002),endotracheal intubation (P=0.002),invasive mechanical ventilation (P<0.001),and invasive operation (P<0.001) before death in 2019.Conclusion The concept and practice of palliative care have significantly reduced the proportion of terminal patients receiving traumatic treatment.

Integrative palliative care is the early intervention of palliative medicine for the patients with serious illness,jointly providing care with the patients’ primary care team.By literature review and real-life experience study,we conclude that the integrative palliative care can make effective use of existing healthcare resources and provide the original treatment team with palliative medical technical support,thereby improving the patients’ quality of life.The healthcare institutions need to choose an appropriate care model on the basis of evaluating its own strengths and weaknesses.The palliative care team needs to establish a long-term and sustainable relationship with each department in the hospital to provide patients with a safer and more effective medical experience.

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.

Objective To reveal the current situation of palliative care for patients who died in Peking Union Medical College Hospital,so as to guide the practice of palliative care for patients in terminal stage. Methods A retrospective study was conducted on patients who died in Peking Union Medical College Hospital from January 1,2019 to December 31,2019.The general clinical data of the patients,whether they received palliative care,and the treatment details including invasive rescue measures,symptom controlling,and psychological,social,and spiritual care status before dying were collected for descriptive analysis. Results A total of 244 inpatients died in 2019,including 135 males and 109 females,with an average age of (65.9±16.4) years (1 day to 105 years).Among the 244 patients,112 (45.9%) died of neoplastic diseases and 132 (54.1%) died of non-neoplastic diseases.Sixty-one (25.0%) patients received palliative care before death,and they were mainly distributed in internal medicine departments such as nephrology (100.0%),gastroenterology (80.0%),and geriatrics (72.7%).Twenty-nine patients received sound palliative care,with all symptoms under control and no invasive treatment before death,and twenty-six patients received psychological,social,and spiritual care.Compared with the patients who were not exposed to the concept of palliative care,the patients who received palliative care showed decreased probabilities of cardiopulmonary resuscitation (0 vs 20.2%;χ²=13.009,P<0.001),tracheal intubation (3.3% vs 48.6%;χ²=38.327,P<0.001),and invasive mechanical ventilation (4.9% vs 47.5%;χ²=33.895,P<0.001) and an increased probability of psychological,social,and spiritual care (54.1% vs 2.4%;χ²=91.486,P<0.001). Conclusion The concept of palliative care has a positive impact on the death of end-stage patients.Palliative care services can increase the probability of end-stage patients receiving psychological,social,and spiritual care and reduce the use of invasive treatment.