Review Article Complexity of patient care needs in palliative care: a scoping review Giovanni Cerullo, Antonio Videira-Silva, Margarida Carrancha, Francisca Rego, Rui Nunes

The artery of Percheron (AOP) is an abnormal variant of the arterial supply of the thalamus. Stroke caused by AOP occlusion is seldom reported. AOP leads to bilateral thalamic and rostral midbrain infarct presenting with unspecific manifestations. There are few descriptions of case series of stroke caused by AOP. We sought to review the clinicoradiological characteristics of AOP infarction from Algarve, Southern Portugal. Eight consecutive cases were retrospectively identified by searching the electronic clinical charts, as well as the stroke Unit database (2015–2020). Sociodemographic (age and gender) and clinicoradiological characteristics (etiological classification, admission severity, manifestations, and short- and long-term prognoses) were retrieved. The corresponding frequency of AOP infarction was 0.17% (95% confidence interval: 0.05–0.28). The mean age was 67.1 (range: 60–80) years. The range of stroke severity evaluated assessed by the National Institute of Health Stroke Scale ranged from 5 to 23 (median = 7.5). None of the patients receive acute ischemic stroke reperfusion treatment. AOP patterns were isolated bilateral paramedian thalamic (n = 2), bilateral paramedian and anterior thalamic (n = 2), and bilateral paramedian thalamic with rostral midbrain (n = 4). Two patients (20%) died on the short term (30 days). At hospital discharge, six patients had functional disability of ≤2 on the modified Rankin scale. In the follow-up at 6 months, half (n = 3) of the survivors had persistent hypersomnia and two had vascular dementia. Stroke from AOP presents with variable clinical and radiological presentations and patients do not receive alteplase. The short-term survivor and the long-term functional independency can be compromised after AOS infarct.

With Europe’s ageing population and rising demand for palliative care, it is crucial to examine the use of palliative care among older adults during their last years of life and understand the factors influencing their access and end-of-life circumstances. This study employed a cohort of SHARE participants aged 65 years or older who had passed away between Wave 6 (2015) and Wave 7 (2017). Information on death circumstances, palliative care utilization, and associated variables were analysed. The study revealed that nearly 13.0% of individuals across these countries died under palliative care, with Slovenia having the lowest rate (0.3%) and France the highest (30.4%). Palliative care utilization in the last 30 days before death was observed in over 24.0% of participants, with the Czech Republic having the lowest rate (5.0%) and Greece the highest (48.8%). A higher risk of using or dying in palliative care was significantly associated with cognitive impairment (low verbal fluency), physical inactivity, and good to excellent self-perceived health. This work highlights the urgent need for enhanced global access to palliative care and advocates for the cross-country comparison of effective practices within Europe, tailored to the unique healthcare needs of older adults.

Considering the multidimensionality of chronic pain, it is crucial to develop comprehensive strategies for its effective management. However, establishing well-defined, evidence-based guidelines for such approaches remains challenging. To overcome this, we present the finding from a 4-month intervention to enhance the management of non-cancer chronic pain in older adults with pre-frailty and frailty. The intervention’s core elements comprised a multidisciplinary individualized plan, a case manager, and patient education. This pilot study involved 22 participants (≥65 years). It assessed changes in pain frequency and intensity (pain scale), frailty (Fried frailty phenotype criteria), and medication adherence (Brief Adherence Rating Scale) before and after the 4-month intervention. The results were encouraging: pain frequency and intensity and frailty score tended to decrease, and medication adherence showed significant improvement. This preliminary small-scale pilot study provides a foundation for further research and for exploring the potential scalability of this multidisciplinary patient-centred intervention.

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Objective: This study aimed to: (1) develop a consensus definition of clinical complexity in adult patients with palliative care (PC) needs, adapted to the Portuguese health system context; (2) identify core determinants; (3) compare agreement between expert and non-expert professionals in a context where no standardised definition of clinical complexity in palliative care (PC) currently exists. Methods: A two-round Delphi study included 79 professionals in round 1, with 57 completing round 2, comprising experts (R1/R2: 52/43) and non-experts (27/14). Consensus was defined as ≥70% of responses in the top two categories of a 5-point Likert scale. Qualitative data were analysed by independent thematic analysis with two coders (κ=0.97). Results: All core elements of the revised definition achieved consensus (R2): profound suffering (97%), clinical unpredictability (95%), caregiver network (91%), complexity arising from a single dominant factor (84%) and practical examples (81%). The proposed short definition achieved overall agreement of 75%, with higher consensus for clinical relevance (91%) and comprehensiveness (86%) than for clarity (77%). Four thematic clusters were identified: experiential and subjective dimensions, systemic and access-related determinants, relational and social determinants and operationalisation requirements. Conclusions: This study proposes the first consensus definition of clinical complexity in PC in the Portuguese context—multidimensional, dynamic and centred on profound suffering, clinical unpredictability and the interactions between clinical, relational and systemic determinants, also providing a framework for instrument development, clinical referral improvement and international harmonisation of complexity assessment in PC.