A recent Palliative Care digest,
as sent to subscribers

Study Type: Scoping review

Key Question: How is decisional regret measured and what clinical/psychosocial factors are associated with it across adult oncology populations?

Key Findings:

• 104 studies (from 858 screened) used a defined DR instrument, most commonly the Decisional Regret Scale, typically assessed within 24 months post-treatment.
• Overall DR levels were generally low to moderate across cancer types and treatment contexts.
• Higher DR was consistently linked to treatment-related morbidity, psychological distress, inadequate information provision, limited involvement in decision-making, and mismatch between expected and actual outcomes.

Clinical Relevance: For UK palliative and oncology teams, this reinforces that robust shared decision-making, clear communication, and expectation-setting—core tenets of NHS person-centred care frameworks—may reduce long-term decisional regret and improve patient-reported outcomes.

Limitations: As a scoping review, findings are descriptive/synthesised without formal quality appraisal or pooled effect estimates, limiting causal inference.

Study Type: Systematic review and network meta-analysis (13 RCTs)

Key Question: Which advance care planning (ACP) decision aids are most effective for increasing ACP documentation and advance directive (AD) completion rates?

Key Findings:

• Paper-based, video, electronic, and combined tools all outperformed usual care for ACP documentation, with paper-based tools ranking highest (SUCRA).
• For AD signing rates, personnel-supported interventions, motivational interviewing, and video tools outperformed usual care, with personnel-supported interventions ranking highest.
• Effectiveness varied by ACP stage: paper tools suited early engagement, personnel support suited formal AD completion.

Clinical Relevance: Suggests a stepped approach for UK ACP services—using low-cost paper prompts to initiate discussions, then dedicated facilitator/personnel support (e.g., specialist nurses) to progress patients to formal AD completion, potentially improving uptake within resource-constrained NHS palliative care pathways.

Limitations: Small number of heterogeneous trials with varying populations, settings, and outcome definitions limits certainty of indirect comparisons and generalisability.

Study Type: Cross-sectional comparative study

Key Question: Do self-reported symptoms differ between breast cancer survivors with and without lymphoedema, and how well do these symptoms correlate with objective lymphoedema measures?

Key Findings:

• Swelling (86.8% vs 44.2%), heaviness (89.7% vs 46.2%), tightness (79.4% vs 53.8%) and pain (79.4% vs 57.7%) were all significantly more frequent in the BCRL group (p≤0.010).
• Symptom severity/distress showed only weak-to-moderate correlations with arm volume difference (r=0.34–0.52), L-Dex (r=0.33–0.46), and tissue dielectric constant ratios (r=0.26–0.37), all p<0.01.

Clinical Relevance: In UK lymphoedema services, patient-reported symptoms remain clinically informative but should not replace objective bioimpedance/volumetric assessment when staging or monitoring BCRL.

Limitations: Cross-sectional design with modest correlation strength limits causal inference and predictive utility of symptom scores for objective lymphoedema severity.

Study Type: Descriptive/mapping study (qualitative comparative survey)

Key Question: What is the current landscape of postgraduate palliative care education across Latin America, and how consistent are programme structures?

Key Findings:

• Only 30% of Latin American countries offer a formal palliative medicine specialty programme.
• 52% provide higher education options (master's/diploma level), giving ~63% offering some form of postgraduate training overall.
• Programme duration, credit requirements and entry prerequisites vary substantially with no regional standardisation.

Clinical Relevance: UK palliative care clinicians involved in international education partnerships, workforce development, or global health links should note the marked disparity in specialist training pathways across Latin America, relevant when supporting capacity-building initiatives or evaluating overseas qualifications.

Limitations: Findings rely on online searches and expert verification rather than systematic curriculum audit, limiting comparability and completeness of data across countries.

Study Type: RCT (prospective, randomised, double-blind, controlled)

Key Question: In refractory cancer pain, how do IV ketamine and IV lignocaine infusions compare for analgesic efficacy, opioid-sparing effect and safety?

Key Findings:

• Effective pain relief (≥50% reduction): 84.8% ketamine vs 72.7% lignocaine (p=0.228) – no significant difference.
• Both drugs significantly reduced OME dose from baseline (p<0.01), with no between-group difference (p=0.738).
• Adverse effects significantly more frequent with ketamine (30.3% vs 9.1%, p=0.03); acute pain crises numerically higher with ketamine (42.9% vs 29.2%, p=0.307, not significant).

Clinical Relevance: For UK palliative care teams managing refractory cancer pain unresponsive to high-dose opioids, lignocaine infusion may offer similar analgesic benefit to ketamine with a better tolerability profile, supporting its use where infrastructure allows monitored IV infusions.

Limitations: Small sample size (n=66) from a single centre limits statistical power and generalisability.

Study Type: Qualitative study embedded within a randomised controlled feasibility trial

Key Question: How do bereaved parents of children who died from cancer experience a virtual, music-based storytelling bereavement intervention (Storytelling Through Music)?

Key Findings:

• Twelve parents interviewed one month post-intervention identified five themes: peer/music connection, coping through sharing, coexistence of grief and positive emotion, graded exposure via sequenced writing-storytelling-songwriting, and the final song as an enduring legacy/coping resource.
• The structured sequence appeared to support gradual emotional processing rather than overwhelming distress.
• The completed song was described as a lasting, tangible keepsake sustaining ongoing coping.

Clinical Relevance: Offers UK palliative and bereavement services a potentially scalable, remotely-delivered group intervention for parents bereaved by childhood cancer, relevant given limited NHS bereavement support capacity and geographic access barriers.

Limitations: Small, single-arm qualitative sample from a feasibility trial limits generalisability and causal inference regarding therapeutic benefit.

Study Type: Prospective observational cohort study

Key Question: How frequent and impactful are medication-related problems (ADEs) in hospitalised patients with palliative care needs?

Key Findings:

• 73.9% cumulative incidence of in-hospital ADEs among 46 patients; 70 ADRs identified, 61.4% opioid-related; ADRs predominated at admission and among those who died, medication errors more common at discharge.
• Age (IRR 1.030, 95% CI 1.002–1.060), time since diagnosis (IRR 1.0004), and PPI score (IRR 1.099) independently predicted higher ADE counts.
• Higher potentially inappropriate medication (PIM) count correlated with worse quality of life (β=0.386, p=0.031).

Clinical Relevance: Highlights high burden of largely opioid-related adverse drug events in inpatient palliative care, supporting UK adoption of structured medication reconciliation and pharmacist-led review, particularly at transitions of care and for patients with advancing prognosis.

Limitations: Small single-centre sample (n=46) from a middle-income setting limits statistical power and generalisability to UK palliative care populations.

Study Type: Retrospective cohort study

Key Question: Does morphine use for end-of-life dyspnoea differ between ED and inpatient settings within the same patient cohort, and what predicts ED administration?

Key Findings:

• Only 15.2% of dying patients received morphine in the ED versus 68% of the same cohort once admitted (mean time to ED administration 5.8 hours).
• ED morphine administration was predicted by lung cancer (OR 3.41), DNR status (OR 3.17), and higher pulse rate (OR 1.02) rather than dyspnoea severity.
• ED morphine use showed no association with time to death (p=0.165), supporting safety; inpatient survival comparisons were subject to immortal time bias and not interpreted causally.

Clinical Relevance: Highlights a structural gap in symptom management at the ED–ward interface relevant to UK emergency and palliative care pathways, where timely opioid use for dyspnoea is often delayed despite guideline support and no evidence of hastened death.

Limitations: Single-centre, non-UK retrospective design with potential unmeasured confounding and bias in survival comparisons.