Publications
2026
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Integrating Paramedics into End-of-Life Care Increases Cancer Patients' Time Spent at Home instead of the Emergency Room: A Retrospective Cohort Study
CONCLUSIONS: Including paramedics in the end-of-life care pathway is associated with decreased emergency department visits during the last month of life and increased time spent at home, including at the time of death. Therefore, this integration of paramedics seems to direct health care resources more beneficially while honoring most patients' preference to stay at home. -
Changes in opinions on intentional or unintentional hastening of death from graduation to 6 years as a physician-a follow-up cohort study
CONCLUSIONS: Acceptance of intentional or unintentional hastening of death presented in the survey did not significantly change after the first 6 years working as a physician, although a nonsignificant trend towards more accepting views was seen. Nevertheless, physicians' attitudes on this issue seemed to remain divided. Our results highlight the need for respectful discussion and education on ethics among medical profession to help physicians struggling with this demanding topic starting from... -
Physicians' Tendency to Choose Palliative Care for an Advanced Dementia Patient Increases Concomitantly With Clinical Experience
ObjectiveThe benefits of palliative care (PC) education are recognized, but the effects of physicians' attitudes, values and growing experience on end-of-life (EOL) decision-making remain unclear. This study aimed to evaluate whether graduating medical students' EOL decision-making regarding an advanced dementia patient with critical gastrointestinal (GI) bleeding has changed after 6 years' working experience.MethodsA questionnaire presenting a case scenario of a patient with advanced dementia... -
Finnish physicians' attitudes towards euthanasia and physician-assisted suicide: a nationwide cross-sectional study
CONCLUSIONS: Finnish physicians' attitudes and opinions towards assistance in dying are highly divided, emphasising the controversy of this challenging subject. -
Specialist Palliative Care Reduces the Need for Acute Health Care Services in Patients with Nonmalignant Pulmonary Diseases and Lung Cancer: A Nationwide Study
CONCLUSIONS: Contact with SPC services is more common in lung cancer than in nonmalignant pulmonary disease, although both groups have rather limited receipt of SPC. Early integration of SPC is recommended, as it has the potential to reduce burdensome acute health care use during the end-of-life in both patient groups. -
Management of Dyspnea With High-Flow Nasal Air or Fan-A Randomized Controlled Crossover Trial
CONCLUSION: The effect of airflow through HFNT or fan on dyspnea did not differ in nonhypoxemic patients with advanced cancer. Both therapies seemed to give slight relief on dyspnea without significant adverse events. Thus, the choice between HFNT with air or fan should be made according to the patient´s preferences.
2025
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Specialist Palliative Care Reduces the Need for Acute Health Care Services in Patients with Nonmalignant Pulmonary Diseases and Lung Cancer: A Nationwide Study
CONCLUSIONS: Contact with SPC services is more common in lung cancer than in nonmalignant pulmonary disease, although both groups have rather limited receipt of SPC. Early integration of SPC is recommended, as it has the potential to reduce burdensome acute health care use during the end-of-life in both patient groups. -
Palliative care competencies of nurses in primary care
CONCLUSION: This study provides an overview of nurses' PC competencies and highlighted some of the weaknesses they recognise. These shortcomings include evaluating and treating psychological and existential suffering, legal aspects of decision making and competencies related to ACP. -
Management of Dyspnea With High-Flow Nasal Air or Fan-A Randomized Controlled Crossover Trial
CONCLUSION: The effect of airflow through HFNT or fan on dyspnea did not differ in nonhypoxemic patients with advanced cancer. Both therapies seemed to give slight relief on dyspnea without significant adverse events. Thus, the choice between HFNT with air or fan should be made according to the patient´s preferences. -
Response-Letter to the Editor: Consensus Statements on End-Of-Life Care in ICU
No abstract -
"It is difficult to be absolutely sure one way or the other." - a mixed method study on Finnish physicians' views on euthanasia and physician-assisted suicide
CONCLUSION: Assisted dying is seen as a complex issue, and it was difficult to form an opinion on it. Physicians and the care team are faced with ethical dilemmas about topics related to AD, even though it is not legalized in Finland. Open and pluralistic discussion on AD, including ethical aspects, implications for society and end-of-life care practices is of utmost importance. -
Coping with the unthinkable: A qualitative metasynthesis of patients' experiences with incurable cancer
CONCLUSIONS: The study highlighted the coping experiences, expectations, and problems faced by patients with incurable cancer, aiming to make their needs more visible in public healthcare. The findings can help healthcare sectors design better services and support for these patients and their families. -
The use of specialist palliative care services differs in chronic obstructive pulmonary disease and interstitial lung disease: A national cohort study
CONCLUSIONS: ILD patients received more SPC than COPD patients, yet the numbers were low in both patient groups. Using acute hospital resources was common during the last months of life, but SPC reduced this. -
Consensus statements on end-of-life care in ICU - A Scandinavian multidisciplinary Delphi study
BACKGROUND: End-of-life care in the Intensive Care Unit (ICU) is complex, requiring a balance of ethical, cultural and medical considerations while ensuring comfort and dignity for critically ill patients and their families.
2024
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Differences in the palliative care phase between patients with nonmalignant pulmonary disease and lung cancer: a retrospective study
CONCLUSIONS: Compared to lung cancer patients, patients with nonmalignant pulmonary disease had longer palliative care phases but fewer visits to the palliative care outpatient clinic and fewer referrals to the palliative care pathways. Palliative care arrangements seemed to have more influence on the end-of-life care of lung cancer patients. There is a need for long-term palliative care services with better abilities to meet the special needs of patients with nonmalignant pulmonary disease. -
Content validity of the questionnaire considering opinions of the Finnish physicians on euthanasia and assisted suicide
Despite numerous surveys conducted across the world considering assisted death, content validity evaluations of the survey questionnaires are seldom published. Likewise, there is no previous research about the content validity of the survey "Finnish physicians´ attitudes and opinions on euthanasia and physician-assisted suicide" conducted by the Finnish Medical Association. The aim of this study was to assess the content validity of the survey questionnaire. To study this, a purposive sample of... -
Integrated palliative care visits of patients with incurable cancer in Tampere University Hospital 2018-2021-a retrospective study
CONCLUSIONS: Based on the results of the study, the need for palliative care might be unmet, since so few patients are referred to integrated palliative care visits. Emphasis should be placed on identification of palliative care needs and advance care planning. The follow-up models of outpatient clinics should be examined and developed to better meet the needs of the patients. -
Health-related quality of life measured with K-BILD is associated with survival in patients with idiopathic pulmonary fibrosis
CONCLUSIONS: In IPF, a reduced HRQoL is associated with impaired survival. A K-BILD total score less than approximately 50 units is associated with a median survival of approximately two years. In addition to assessing the treatment needs of patients with IPF using K-BILD, a decreased score may be useful for facilitating advance care planning and transplantation assessment. -
Facing a request for assisted death - views of Finnish physicians, a mixed method study
CONCLUSIONS: Finnish physicians' actions regarding the requests for assisted death, and attitudes toward euthanasia and PAS vary substantially. Open discussion, education, and recommendations concerning a request for assisted death and ethics around it are also highly needed in countries where euthanasia and PAS are not legal. -
Palliative care patients in the emergency medical service: a retrospective cohort study from Finland
CONCLUSION: Patients in palliative care cause only a minimal load on the emergency medical services, but the paramedics do not necessarily recognize them as such. This leads to the risk of overtreatment and a high transportation rate to the emergency department, which is not an ethical choice. Recognition and treatment provided to palliative care patients by the paramedics could be improved with additional training and greater availability of patient records. -
Impact of Primary Tumor Location on Demographics, Resectability, Outcomes, and Quality of Life in Finnish Metastatic Colorectal Cancer Patients (Subgroup Analysis of the RAXO Study)
The primary tumor location (PTL) is associated with the phenotype, metastatic sites, mutations, and outcomes of metastatic colorectal cancer (mCRC) patients, but this has mostly been studied according to sidedness (right vs. left sided). We studied right colon vs. left colon vs. rectal PTL in a real-life study population (n = 1080). Health-related quality of life (HRQoL) was assessed multi-cross-sectionally with QLQ-C30, QLQ-CR29, EQ-5D, and 15D. A chi-square, Kaplan-Meier, and Cox regression...
2023
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Finnish physicians' attitudes towards euthanasia and physician-assisted suicide: a nationwide cross-sectional study
CONCLUSIONS: Finnish physicians' attitudes and opinions towards assistance in dying are highly divided, emphasising the controversy of this challenging subject. -
Content validity of the questionnaire considering opinions of the Finnish physicians on euthanasia and assisted suicide
Despite numerous surveys conducted across the world considering assisted death, content validity evaluations of the survey questionnaires are seldom published. Likewise, there is no previous research about the content validity of the survey "Finnish physicians´ attitudes and opinions on euthanasia and physician-assisted suicide" conducted by the Finnish Medical Association. The aim of this study was to assess the content validity of the survey questionnaire. To study this, a purposive sample of... -
Impact of Primary Tumor Location on Demographics, Resectability, Outcomes, and Quality of Life in Finnish Metastatic Colorectal Cancer Patients (Subgroup Analysis of the RAXO Study)
The primary tumor location (PTL) is associated with the phenotype, metastatic sites, mutations, and outcomes of metastatic colorectal cancer (mCRC) patients, but this has mostly been studied according to sidedness (right vs. left sided). We studied right colon vs. left colon vs. rectal PTL in a real-life study population (n = 1080). Health-related quality of life (HRQoL) was assessed multi-cross-sectionally with QLQ-C30, QLQ-CR29, EQ-5D, and 15D. A chi-square, Kaplan-Meier, and Cox regression... -
The effect of palliative outpatient units on resource use for cancer patients in Finland
CONCLUSION: Cancer patients' contact with a PC unit was significantly associated with the reduced use of acute hospital services at the EOL, however; only one-third of the patients visited a PC unit. Thus, systematic PC unit referral practices for patients with advanced cancer are called for. -
End-of-life Decision-making Differs Between a Cancer and a Dementia Patient: Influences of the Physician's Background Factors
CONCLUSION: Finnish doctors and students were more likely to choose palliative care options for an advanced prostate cancer patient than for an advanced dementia patient. Decision-making was influenced by respondents' background factors and attitudes. Education on EOL care for different types of advanced and incurable diseases is highly needed. -
Dyspnea Associates With a Widely Impaired Quality of Life in Idiopathic Pulmonary Fibrosis Patients: A Longitudinal Study Using 15D
Background: Research on health-related quality of life (HRQoL) is crucial for developing comprehensive palliative care in idiopathic pulmonary fibrosis (IPF). Objectives: To study IPF patients' HRQoL compared with general population and its association with dyspnea in a longitudinal follow-up. Design: Assessment of IPF patients' HRQoL by a generic tool. Comparison of baseline data with the general population and a 30-month follow-up with 6 months intervals. Setting/Subjects: In total, 246 IPF... -
Palliation of Dyspnea With Mouthpiece Ventilation in Patients With Chronic Obstructive Pulmonary Disease: A Pilot Feasibility Study
Background: Mouthpiece ventilation (MPV) reduces hypoventilation, but its efficacy in relieving dyspnea in patients with acute chronic obstructive pulmonary disease exacerbation (AECOPD) is unclear. Objective: To assess the feasibility of MPV in relieving dyspnea among patients with AECOPD. Methods: In this prospective single-arm pilot study, the change in dyspnea on numeric rating scale (NRS) after using MPV and side effects of the treatment were studied in 18 patients with AECOPD. Results: The... -
Specialist Palliative Care Consultation for Patients with Nonmalignant Pulmonary Diseases: A Retrospective Study
CONCLUSIONS: Specialist palliative care consultation seems to enable better end-of-life care and supports shared decision making for patients with nonmalignant pulmonary diseases. Therefore, palliative care consultations should be utilized in nonmalignant pulmonary diseases preferably before the last days of life. -
'I am still valuable' - A qualitative study of incurable cancer patients coping in hospice care
CONCLUSIONS: The experiences of patients in hospice care of coping with incurable cancer were reminiscent of the common coping process descriptions. Surprisingly, even though participants voiced that they had accepted their situation, dying itself was something they did not find crucial to discuss. The crucial aspects - without being in denial - dealt more with focusing on positive thinking and facing life. -
Peripheral nerve blocks in advanced cancer pain: retrospective case series
CONCLUSIONS: Peripheral nerve blocks seem safe and may provide considerable analgesia and decrease the need for opioids in patients with advanced cancer.
2022
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Health-related quality of life measured with K-BILD is associated with survival in patients with idiopathic pulmonary fibrosis
CONCLUSIONS: In IPF, a reduced HRQoL is associated with impaired survival. A K-BILD total score less than approximately 50 units is associated with a median survival of approximately two years. In addition to assessing the treatment needs of patients with IPF using K-BILD, a decreased score may be useful for facilitating advance care planning and transplantation assessment. -
Palliative care patients in the emergency medical service: a retrospective cohort study from Finland
CONCLUSION: Patients in palliative care cause only a minimal load on the emergency medical services, but the paramedics do not necessarily recognize them as such. This leads to the risk of overtreatment and a high transportation rate to the emergency department, which is not an ethical choice. Recognition and treatment provided to palliative care patients by the paramedics could be improved with additional training and greater availability of patient records. -
Impact of Primary Tumor Location on Demographics, Resectability, Outcomes, and Quality of Life in Finnish Metastatic Colorectal Cancer Patients (Subgroup Analysis of the RAXO Study)
The primary tumor location (PTL) is associated with the phenotype, metastatic sites, mutations, and outcomes of metastatic colorectal cancer (mCRC) patients, but this has mostly been studied according to sidedness (right vs. left sided). We studied right colon vs. left colon vs. rectal PTL in a real-life study population (n = 1080). Health-related quality of life (HRQoL) was assessed multi-cross-sectionally with QLQ-C30, QLQ-CR29, EQ-5D, and 15D. A chi-square, Kaplan-Meier, and Cox regression... -
Paramedics' experiences and educational needs when participating end-of-life care at home: A mixed method study
CONCLUSIONS: Paramedics considered end-of-life care at home meaningful but called for more competency in supporting and encountering the families and in symptom management. Our results can be utilized when developing end-of-life care protocols and education for the paramedics. Patients' and families' views on the paramedics' participation in end-of-life care should be evaluated in the future. -
Ambivalence toward euthanasia and physician-assisted suicide has decreased among physicians in Finland
CONCLUSIONS: This study shows that Finnish physicians' ambivalence toward euthanasia and PAS has decreased. The ongoing debate has probably forced physicians to form more solid opinions on these matters. Our study highlights that attitudes toward euthanasia and PAS are still divided within the medical profession. -
The effect of teaching methods in palliative care education for undergraduate nursing and medical students: a systematic review
Background: Palliative care should be seen as a human right and integrated into the healthcare system. Adequate palliative care education is seen as a facilitator to develop the integration of palliative care. Aims: To synthesise evidence of the effect of different teaching methods used in palliative care education to students' competences, knowledge, attitude or skills. Methods: Systematic review. A total of four databases (CINAHL, Eric, PubMed and Scopus) were searched, after which, 16... -
Endoscopic duodenal stenting is efficient, but has higher rate of reoperations than gastrojejunostomy in palliative treatment for gastric outlet obstruction
CONCLUSIONS: Patients undergoing endoscopic duodenal stenting are more able to initiate rapid oral intake and have shorter hospital stay. On the other hand, there are significantly more reoperations in stenting group. If the patient's life expectancy is short, we recommend stenting, but for patients whose life expectancy is longer, gastrojejunostomy could be a better procedure, for the reasons mentioned above. -
Finnish nursing students' perceptions of the development needs in palliative care education and factors influencing learning in undergraduate nursing studies - a qualitative study
CONCLUSIONS: This study provides detailed information about nursing student's perspectives of palliative care education and its development needs. Hence, the results are relevant to decision-makers who want to develop undergraduate nursing curricula. This study highlights that palliative care education should be developed by ensuring that all students have equal access to palliative care education provided by highly competent teachers. Possibilities for clinical placements or visits to... -
Nursing Students' Views of the Content of Palliative Care in Undergraduate Education and their Self-assessed Palliative Care Competence-A Nationwide Cross-sectional Study
Background: The importance of integrating palliative care (PC) education into undergraduate nursing studies has been recognized. Still, there is considerable variation in the PC education of nurses. Objective: To study the nursing students' views of the PC contents during the nursing education; students' self-assessed levels of PC competence; and whether prior education or work experience influence these views. Methods: A cross-sectional study. Data were collected using a questionnaire which was... -
Palliative-care nurses' and physicians' descriptions of the competencies needed in their working units
CONCLUSION: Interprofessional palliative-care education is recommended for the undergraduate and postgraduate education of nurses and physicians. -
Assessing Symptom Burden and Depression in Subjects With Chronic Respiratory Insufficiency
Objectives: Patients with chronic respiratory insufficiency suffer from advanced disease, but their overall symptom burden is poorly described. We evaluated the symptoms and screening of depression in subjects with chronic respiratory insufficiency by using the Edmonton symptom assessment system (ESAS). Methods: In this retrospective study, 226 subjects with chronic respiratory insufficiency answered the ESAS questionnaire measuring symptoms on a scale from 0 (no symptoms) to 10 (worst possible...
2021
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Changes in opinions on intentional or unintentional hastening of death from graduation to 6 years as a physician-a follow-up cohort study
CONCLUSIONS: Acceptance of intentional or unintentional hastening of death presented in the survey did not significantly change after the first 6 years working as a physician, although a nonsignificant trend towards more accepting views was seen. Nevertheless, physicians' attitudes on this issue seemed to remain divided. Our results highlight the need for respectful discussion and education on ethics among medical profession to help physicians struggling with this demanding topic starting from... -
Physicians' Tendency to Choose Palliative Care for an Advanced Dementia Patient Increases Concomitantly With Clinical Experience
ObjectiveThe benefits of palliative care (PC) education are recognized, but the effects of physicians' attitudes, values and growing experience on end-of-life (EOL) decision-making remain unclear. This study aimed to evaluate whether graduating medical students' EOL decision-making regarding an advanced dementia patient with critical gastrointestinal (GI) bleeding has changed after 6 years' working experience.MethodsA questionnaire presenting a case scenario of a patient with advanced dementia... -
Integrated palliative care visits of patients with incurable cancer in Tampere University Hospital 2018-2021-a retrospective study
CONCLUSIONS: Based on the results of the study, the need for palliative care might be unmet, since so few patients are referred to integrated palliative care visits. Emphasis should be placed on identification of palliative care needs and advance care planning. The follow-up models of outpatient clinics should be examined and developed to better meet the needs of the patients. -
Palliative care patients in the emergency medical service: a retrospective cohort study from Finland
CONCLUSION: Patients in palliative care cause only a minimal load on the emergency medical services, but the paramedics do not necessarily recognize them as such. This leads to the risk of overtreatment and a high transportation rate to the emergency department, which is not an ethical choice. Recognition and treatment provided to palliative care patients by the paramedics could be improved with additional training and greater availability of patient records. -
Impact of Primary Tumor Location on Demographics, Resectability, Outcomes, and Quality of Life in Finnish Metastatic Colorectal Cancer Patients (Subgroup Analysis of the RAXO Study)
The primary tumor location (PTL) is associated with the phenotype, metastatic sites, mutations, and outcomes of metastatic colorectal cancer (mCRC) patients, but this has mostly been studied according to sidedness (right vs. left sided). We studied right colon vs. left colon vs. rectal PTL in a real-life study population (n = 1080). Health-related quality of life (HRQoL) was assessed multi-cross-sectionally with QLQ-C30, QLQ-CR29, EQ-5D, and 15D. A chi-square, Kaplan-Meier, and Cox regression... -
Assessing Symptom Burden and Depression in Subjects With Chronic Respiratory Insufficiency
Objectives: Patients with chronic respiratory insufficiency suffer from advanced disease, but their overall symptom burden is poorly described. We evaluated the symptoms and screening of depression in subjects with chronic respiratory insufficiency by using the Edmonton symptom assessment system (ESAS). Methods: In this retrospective study, 226 subjects with chronic respiratory insufficiency answered the ESAS questionnaire measuring symptoms on a scale from 0 (no symptoms) to 10 (worst possible... -
Online follow-up with a mobile device improves incurable cancer patients' coping - A qualitative study
CONCLUSIONS: The present study extends the knowledge of patients using a mobile application as a part of their cancer care and assesses of the acceptance of using this application to provide supportive care. The patients reported that they were better able to cope with the disease when using the mobile application, although some described it as being too disease centred. Overall, this study indicates that the patients' sense of security and freedom increased when using the mobile application. -
Physicians' decreased tendency to choose palliative care for patients with advanced dementia between 1999 and 2015
CONCLUSIONS: Physicians chose a palliative care approach for a patient with advanced dementia and life-threatening bleeding less often in 2015 than in 1999. Specialty, attitudes and other background factors influenced significantly physician decision-making. Education on the identification and palliative care of the patients with late-stage dementia are needed to make these decisions more consistent. -
End of life in multiple sclerosis: Disability, causes and place of death among cases diagnosed from 1981 to 2010 in Pirkanmaa hospital district in Western Finland
CONCLUSION: The level of hospitalization was high at end of life in all age-groups. High MS related disability and immobility among decedents likely relates to infections as the most common cause of death. Along with our and earlier surveys in this field, we showed that places of death and level of disability before death share similarities in both younger and older age groups highlighting the need of palliative care and end of life care plans in all MS patients with triggers of poor survival.... -
Dyspnea on Exercise Is Associated with Overall Symptom Burden in Patients with Chronic Respiratory Insufficiency
Background: Patients with chronic respiratory insufficiency suffer from many symptoms together with dyspnea. Objective: We evaluated the association of dyspnea on exercise with other symptoms in patients with chronic respiratory insufficiency due to chronic obstructive pulmonary disease or interstitial lung disease. Design: This retrospective study included 101 patients in Tampere University Hospital, Finland. Dyspnea on exercise was assessed with modified Medical Research Council (mMRC) dyspnea... -
Impact of the Regional Palliative Care Pathway on Emergency Room Visits and Hospitalizations
CONCLUSION: Organizing a PC pathway for cancer patients together with primary and secondary care decreases revisits to ER and admissions to secondary hospitals. -
Palliative Nursing Competencies Required for Different Levels of Palliative Care Provision: A Qualitative Analysis of Health Care Professionals' Perspectives
Background: Nurses must possess adequate competencies to provide high-quality palliative care. Earlier statements have described certain competencies that are relevant for palliative care, yet only limited empirical research has focused on the perspective of health care professionals to clarify which competencies are required for different levels of palliative care provision. Objective: The aim was to describe the required palliative nursing competencies of registered nurses aligned to different... -
Preplanned participation of paramedics in end-of-life care at home: A retrospective cohort study
CONCLUSIONS: Integration of paramedics into end-of-life care at home is reasonable especially in rural areas without 24/7 palliative care services and outside of office hours. The majority of patients can be managed at home or with the help of an end-of-life care ward without an emergency visit.
2020
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"It is difficult to be absolutely sure one way or the other." - a mixed method study on Finnish physicians' views on euthanasia and physician-assisted suicide
CONCLUSION: Assisted dying is seen as a complex issue, and it was difficult to form an opinion on it. Physicians and the care team are faced with ethical dilemmas about topics related to AD, even though it is not legalized in Finland. Open and pluralistic discussion on AD, including ethical aspects, implications for society and end-of-life care practices is of utmost importance. -
Differences in the palliative care phase between patients with nonmalignant pulmonary disease and lung cancer: a retrospective study
CONCLUSIONS: Compared to lung cancer patients, patients with nonmalignant pulmonary disease had longer palliative care phases but fewer visits to the palliative care outpatient clinic and fewer referrals to the palliative care pathways. Palliative care arrangements seemed to have more influence on the end-of-life care of lung cancer patients. There is a need for long-term palliative care services with better abilities to meet the special needs of patients with nonmalignant pulmonary disease. -
Impact of Primary Tumor Location on Demographics, Resectability, Outcomes, and Quality of Life in Finnish Metastatic Colorectal Cancer Patients (Subgroup Analysis of the RAXO Study)
The primary tumor location (PTL) is associated with the phenotype, metastatic sites, mutations, and outcomes of metastatic colorectal cancer (mCRC) patients, but this has mostly been studied according to sidedness (right vs. left sided). We studied right colon vs. left colon vs. rectal PTL in a real-life study population (n = 1080). Health-related quality of life (HRQoL) was assessed multi-cross-sectionally with QLQ-C30, QLQ-CR29, EQ-5D, and 15D. A chi-square, Kaplan-Meier, and Cox regression... -
Specialist Palliative Care Consultation for Patients with Nonmalignant Pulmonary Diseases: A Retrospective Study
CONCLUSIONS: Specialist palliative care consultation seems to enable better end-of-life care and supports shared decision making for patients with nonmalignant pulmonary diseases. Therefore, palliative care consultations should be utilized in nonmalignant pulmonary diseases preferably before the last days of life. -
Ambivalence toward euthanasia and physician-assisted suicide has decreased among physicians in Finland
CONCLUSIONS: This study shows that Finnish physicians' ambivalence toward euthanasia and PAS has decreased. The ongoing debate has probably forced physicians to form more solid opinions on these matters. Our study highlights that attitudes toward euthanasia and PAS are still divided within the medical profession. -
Endoscopic duodenal stenting is efficient, but has higher rate of reoperations than gastrojejunostomy in palliative treatment for gastric outlet obstruction
CONCLUSIONS: Patients undergoing endoscopic duodenal stenting are more able to initiate rapid oral intake and have shorter hospital stay. On the other hand, there are significantly more reoperations in stenting group. If the patient's life expectancy is short, we recommend stenting, but for patients whose life expectancy is longer, gastrojejunostomy could be a better procedure, for the reasons mentioned above. -
Preplanned participation of paramedics in end-of-life care at home: A retrospective cohort study
CONCLUSIONS: Integration of paramedics into end-of-life care at home is reasonable especially in rural areas without 24/7 palliative care services and outside of office hours. The majority of patients can be managed at home or with the help of an end-of-life care ward without an emergency visit. -
Survival and end-of-life aspects among subjects on long-term noninvasive ventilation
CONCLUSIONS: Survival among subjects starting NIV in this real-life study varied greatly depending on the disease and degree of functional impairment. Subjects frequently died in the hospital after admission through the emergency department. A comprehensive treatment approach with timely advance care planning is therefore needed, especially for those needing help with activities of daily living and those with both NIV and LTOT. -
Factor analysis identifies three separate symptom clusters in idiopathic pulmonary fibrosis
CONCLUSION: We found three distinct symptom factors in IPF, of which respiratory and emotional factors showed the strongest association with decreasing HRQoL. Routine assessment of IPF patients' respiratory symptoms, mental health and pain are important as these may be linked with other symptoms and significantly impair the patient's HRQoL. -
Mouthpiece ventilation in the management of dyspnea: A single-arm pilot study
CONCLUSION: Mouthpiece ventilation is feasible and may relieve dyspnea in some patients with an advanced disease. Further studies are needed, and these might concentrate on stable patients in early palliative care. Before initiation, this study was registered at clinicaltrials.gov (study no. NCT03012737). -
The required competencies of physicians within palliative care from the perspectives of multi-professional expert groups: a qualitative study
CONCLUSIONS: The competencies described in this study emphasize decision-making, social interactions and networking. It is important to listen to the voices of the working-life representatives when planning curricula. Moreover, the views of the working-life representatives inform how the competencies gained during their education meet the challenges of the ordinary work. -
The impact of the duration of the palliative care period on cancer patients with regard to the use of hospital services and the place of death: a retrospective cohort study
CONCLUSIONS: The PC decision to initiate a palliative goal for the treatment had a distinct impact on the use of hospital services at the EOL. Contact with a PC unit further increased the likelihood of EOL care at primary care.
2019
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Specialist Palliative Care Reduces the Need for Acute Health Care Services in Patients with Nonmalignant Pulmonary Diseases and Lung Cancer: A Nationwide Study
CONCLUSIONS: Contact with SPC services is more common in lung cancer than in nonmalignant pulmonary disease, although both groups have rather limited receipt of SPC. Early integration of SPC is recommended, as it has the potential to reduce burdensome acute health care use during the end-of-life in both patient groups. -
The use of specialist palliative care services differs in chronic obstructive pulmonary disease and interstitial lung disease: A national cohort study
CONCLUSIONS: ILD patients received more SPC than COPD patients, yet the numbers were low in both patient groups. Using acute hospital resources was common during the last months of life, but SPC reduced this. -
Impact of Primary Tumor Location on Demographics, Resectability, Outcomes, and Quality of Life in Finnish Metastatic Colorectal Cancer Patients (Subgroup Analysis of the RAXO Study)
The primary tumor location (PTL) is associated with the phenotype, metastatic sites, mutations, and outcomes of metastatic colorectal cancer (mCRC) patients, but this has mostly been studied according to sidedness (right vs. left sided). We studied right colon vs. left colon vs. rectal PTL in a real-life study population (n = 1080). Health-related quality of life (HRQoL) was assessed multi-cross-sectionally with QLQ-C30, QLQ-CR29, EQ-5D, and 15D. A chi-square, Kaplan-Meier, and Cox regression... -
Assessing the utilization of the decision to implement a palliative goal for the treatment of cancer patients during the last year of life at Helsinki University Hospital: a historic cohort study
Background: To avoid aggressive treatments at the end-of-life and to provide palliative care (PC), physicians need to terminate futile anti-cancer treatments and define the palliative goal of the treatment in time. This single center study assesses the practices used to make the decision that leads to treatment with a palliative goal, i.e., the PC decision and its effect on anti-cancer treatments at the end of life.Material and methods: Patients with a cancer diagnosis treated in tertiary... -
Has there been a change in the end-of-life decision-making over the past 16 years?
CONCLUSIONS: Our findings may reflect the transition to a stronger emphasis on patient-centred care and a stronger tendency to avoid futile therapies that have only short-term goals. The results highlight that education in all aspects of EOL care should be incorporated into the post-graduate training of medical specialties that take care of dying patients. -
Does Decision-making in End-of-life Care Differ Between Graduating Medical Students and Experienced Physicians?
CONCLUSION: Medical students were more unwilling to withhold and withdraw therapies in EOL-care than were the GPs, but the students considered euthanasia less reprehensible. Medical education should include aspects of decision-making in EOL-care. -
Predictors of Impaired Survival in Subjects With Long-Term Oxygen Therapy
CONCLUSIONS: The survival of the subjects who started LTOT varied greatly. The subjects with interstitial lung disease and those who required assistance with activities of daily living were at risk of dying in ∼1 y, which suggested that advance care planning should be directed especially to these patients. -
Cancer Patients' Symptom Burden and Health-related Quality of Life (HRQoL) at Tertiary Cancer Center from 2006 to 2013: A Cross-sectional Study
CONCLUSION: There is a need for early integrated palliative care to improve HRQoL during cancer treatments. -
Attitudes of Nurses and the General Public Towards Euthanasia on Individuals with Dementia and Cognitive Impairment
OBJECTIVES: Despite the increasing prevalence of dementia, little is known about individuals' attitudes towards euthanasia on patients with dementia or cognitive impairment.
2018
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Differences in the palliative care phase between patients with nonmalignant pulmonary disease and lung cancer: a retrospective study
CONCLUSIONS: Compared to lung cancer patients, patients with nonmalignant pulmonary disease had longer palliative care phases but fewer visits to the palliative care outpatient clinic and fewer referrals to the palliative care pathways. Palliative care arrangements seemed to have more influence on the end-of-life care of lung cancer patients. There is a need for long-term palliative care services with better abilities to meet the special needs of patients with nonmalignant pulmonary disease. -
Integrated palliative care visits of patients with incurable cancer in Tampere University Hospital 2018-2021-a retrospective study
CONCLUSIONS: Based on the results of the study, the need for palliative care might be unmet, since so few patients are referred to integrated palliative care visits. Emphasis should be placed on identification of palliative care needs and advance care planning. The follow-up models of outpatient clinics should be examined and developed to better meet the needs of the patients. -
Impact of Primary Tumor Location on Demographics, Resectability, Outcomes, and Quality of Life in Finnish Metastatic Colorectal Cancer Patients (Subgroup Analysis of the RAXO Study)
The primary tumor location (PTL) is associated with the phenotype, metastatic sites, mutations, and outcomes of metastatic colorectal cancer (mCRC) patients, but this has mostly been studied according to sidedness (right vs. left sided). We studied right colon vs. left colon vs. rectal PTL in a real-life study population (n = 1080). Health-related quality of life (HRQoL) was assessed multi-cross-sectionally with QLQ-C30, QLQ-CR29, EQ-5D, and 15D. A chi-square, Kaplan-Meier, and Cox regression... -
Specialist Palliative Care Consultation for Patients with Nonmalignant Pulmonary Diseases: A Retrospective Study
CONCLUSIONS: Specialist palliative care consultation seems to enable better end-of-life care and supports shared decision making for patients with nonmalignant pulmonary diseases. Therefore, palliative care consultations should be utilized in nonmalignant pulmonary diseases preferably before the last days of life. -
Peripheral nerve blocks in advanced cancer pain: retrospective case series
CONCLUSIONS: Peripheral nerve blocks seem safe and may provide considerable analgesia and decrease the need for opioids in patients with advanced cancer. -
The required competencies of physicians within palliative care from the perspectives of multi-professional expert groups: a qualitative study
CONCLUSIONS: The competencies described in this study emphasize decision-making, social interactions and networking. It is important to listen to the voices of the working-life representatives when planning curricula. Moreover, the views of the working-life representatives inform how the competencies gained during their education meet the challenges of the ordinary work. -
Marked deterioration in the quality of life of patients with idiopathic pulmonary fibrosis during the last two years of life
CONCLUSIONS: To our knowledge this is the first study demonstrating, that IPF patients experience remarkably low HRQOL already two years before death, especially regarding physical role. In addition, they suffer from severe breathlessness and fatigue. Furthermore, physical, social and emotional wellbeing deteriorate, and symptom burden increases near death. Regular symptom and HRQOL measurements are essential to assess palliative care needs in patients with IPF. -
Simulated Encounters With Vaccine-Hesitant Parents: Arts-Based Video Scenario and a Writing Exercise
Vaccine hesitancy is an increasing and urgent global public health challenge. Medical students' encounters with vaccine-hesitant parents, however, remain incidental and unexplored. During pre-clinical training, the vaccine-hesitant parents are typically represented through impersonal text-based cases, lists of their concerns, and sometimes a virtual patient. However, in reality, vaccine-hesitant parents have many health beliefs and arguments that are accompanied with intense emotions, and... -
The Coping and Support Needs of Incurable Cancer Patients
The purposes of this study were to describe the coping processes and support needs of patients with incurable cancer. The study was conducted as a qualitative study. The research data were gathered by conducting thematic interviews with outpatients with incurable cancer (n = 16) and analyzed by means of inductive content analysis. The results of the study indicate that the lives of patients were temporarily interrupted by the incurable illness. A sympathetic family was perceived as strength, and... -
Does special education in palliative medicine make a difference in end-of-life decision-making?
CONCLUSION: Physicians with special education in palliative medicine make less aggressive decisions in end-of-life care. The impact of specialty on decision-making varies among treatment options. Education in end-of-life care decision-making should be mandatory for young physicians and those in specialty training. -
Changes in attitudes towards hastened death among Finnish physicians over the past sixteen years
CONCLUSION: Finnish physicians accepted the risk of hastening death more often in 2015 than in 1999. The physicians' specialty and many other background factors influenced this acceptance. They also regarded euthanasia as less reprehensible now than they did 16 years ago. -
Therapeutic Procedures for Malignant Ascites in a Palliative Care Outpatient Clinic
CONCLUSIONS: Free drainage of MA seems feasible in an outpatient clinic. Early insertion of TC should be considered to avoid repeated paracenteses. However, in patients with pancreatic cancer, paracentesis might be an accepted alternative due to their short life expectancy. -
The indirect costs of palliative care in end-stage cancer: A real-life longitudinal register- and questionnaire-based study
CONCLUSION: The 45% share of indirect costs is substantial in end-of-life care. The healthcare costs increase towards death, which is especially true of patients living alone. This highlights the significant role of caregivers. More attention should be paid to home care and caregiver support to reduce inpatient care needs and control the costs of end-of-life care.