{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T10:02:35Z","timestamp":1774605755136,"version":"3.50.1"},"reference-count":36,"publisher":"Mark Allen Group","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Int J Palliat Nurs"],"published-print":{"date-parts":[[2026,3,2]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Despite its limited therapeutic value, high costs and the fact that it can compromise a patient's quality of life, aggressive care continues to be provided at the end of life. It has been associated with a significant symptom burden for patients, a greater use of healthcare resources, delay in accessing palliative care programmes and personal\/family and healthcare costs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim:<\/jats:title>\n                    <jats:p>To investigate sociodemographic, clinical and community healthcare service factors associated with aggressive end-of-life care across malignant and non-malignant conditions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method:<\/jats:title>\n                    <jats:p>A 1-year retrospective analysis was conducted in a tertiary care centre in Saudi Arabia. All deaths of adult patients that occurred between 1 January, 2023 and 1 January, 2024, were included. Data were retrieved from medical charts, including sociodemographics, medical history, invasive medical interventions and use of healthcare services in the last 3 months of life.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The study included 590 adults (mean age 59.6 years; 52.2% male), with 62% diagnosed with malignancy. The majority (71%) had one or more chronic comorbidities. In their last 90 days, 48.6% were admitted to the intensive care unit. Advance directives were present for only half of the patients included in this study. Non-malignant patients received significantly more aggressive end-of-life care, including intubation and cardiopulmonary resuscitation. Palliative care referrals were low overall (48.1%), but higher in cases of malignancy (70.5%). Patients with involvement in a palliative care team showed a lower symptom burden and less aggressive treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>These findings suggest unequal access to end-of-life advocates for earlier palliative care referral, which could reduce aggressive treatments, especially for younger patients with non-malignant diseases. Non-cancer referral rates were low, highlighting a need for further collaboration and integration with palliative care services.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.12968\/ijpn.2025.0078","type":"journal-article","created":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T16:35:38Z","timestamp":1774024538000},"page":"112-122","source":"Crossref","is-referenced-by-count":0,"title":["Goals of care and advance directives: A 1-year retrospective analysis of a tertiary centre in Saudi Arabia"],"prefix":"10.12968","volume":"32","author":[{"given":"Steven","family":"Callaghan","sequence":"first","affiliation":[{"name":"Advanced clinical nurse specialist, Cancer Centre of Excellence, King Faisal Specialist Hospital and Research Centre, Saudi Arabi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kim","family":"Sadler","sequence":"additional","affiliation":[{"name":"Advanced clinical nurse specialist, Cancer Centre of Excellence, King Faisal Specialist Hospital and Research Centre, Saudi Arabi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gassan","family":"Abudari","sequence":"additional","affiliation":[{"name":"Clinical nurse specialist, Cancer Centre of Excellence, King Faisal Specialist Hospital and Research Centre, Saudi Arabi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kholoud","family":"Alhassan","sequence":"additional","affiliation":[{"name":"Nurse practitioner, Cancer Centre of Excellence, King Faisal Specialist Hospital and Research Centre, Saudi Arabi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muneerah","family":"Almutairi","sequence":"additional","affiliation":[{"name":"Head nurse, Cancer Centre of Excellence, King Faisal Specialist Hospital and Research Centre, Saudi Arabi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruth","family":"Evangelista","sequence":"additional","affiliation":[{"name":"Registered nurse, Cancer Centre of Excellence, King Faisal Specialist Hospital and Research Centre, Saudi Arabi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mahmoud","family":"Sroor","sequence":"additional","affiliation":[{"name":"Assistant consultant, Faculty of Medicine Department, Cairo University, Egypt; Cancer Centre of Excellence, King Faisal Specialist Hospital and Research Centre, Saudi Arabi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Goncalo","family":"Placido","sequence":"additional","affiliation":[{"name":"Nursing quality specialist, Nursing Affairs Department, King Faisal Specialist Hospital and Research Centre, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lemon","family":"Bacalso","sequence":"additional","affiliation":[{"name":"Nursing quality improvement coordinator, Nursing Affairs Department, King Faisal Specialist Hospital and Research Centre, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammed","family":"AlGhamdi","sequence":"additional","affiliation":[{"name":"Fellow, Academic and Training Affairs Department, King Faisal Specialist Hospital and Research Centre, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bashayer","family":"Albayjan","sequence":"additional","affiliation":[{"name":"Fellow, Academic and Training Affairs Department, King Faisal Specialist Hospital and Research Centre, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lubna","family":"Shaltoot","sequence":"additional","affiliation":[{"name":"General practitioner, Internal Medicine Department, King Faisal Specialist Hospital and Research Centre, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Reema","family":"Alomari","sequence":"additional","affiliation":[{"name":"Registered nurse, Paediatrics and Women's Nursing Department, King Faisal Specialist Hospital and Research Centre, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammed","family":"Azuny","sequence":"additional","affiliation":[{"name":"Fellow, Academic and Training Affairs Department, King Faisal Specialist Hospital and Research Centre, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amjad","family":"Alsubaie","sequence":"additional","affiliation":[{"name":"Registered nurse, Paediatrics and Women's Nursing Department, King Faisal Specialist Hospital and Research Centre, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"5130","reference":[{"key":"e_1_3_2_1_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.auec.2025.01.004"},{"key":"e_1_3_2_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/2110-5820-1-5"},{"key":"e_1_3_2_3_1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.87960"},{"key":"e_1_3_2_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12904-023-01285\u20133"},{"key":"e_1_3_2_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12904-025-01667-9"},{"key":"e_1_3_2_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00277-020-04386-8"},{"key":"e_1_3_2_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.esmoop.2024.104099"},{"key":"e_1_3_2_8_1","doi-asserted-by":"publisher","unstructured":"Dasch B Zahn PK. 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