{"title":"The Use of Artificial Intelligence in Hospice & Palliative Care Programs","authors":"Matthew Gonzales MD, Amy Baughman MD MPH FACP, Kathleen Strand PT MSPT CCM, Anant Vasudevan MD MBA, Kerry Son MSN FNP-BC","doi":"10.1016/j.jpainsymman.2025.02.086","DOIUrl":"10.1016/j.jpainsymman.2025.02.086","url":null,"abstract":"<div><h3>Abstract</h3><div>This pre-conference session will delve into the transformative potential of artificial intelligence (AI) in hospice and palliative care, offering attendees a comprehensive overview of how AI technologies can enhance patient care and operational efficiency. Participants will explore the latest AI applications, from predictive analytics that anticipate patient needs to chatbots that provide real-time support for caregivers and families. Through interactive discussions healthcare professionals will learn how AI can improve decision-making, personalize treatment plans, and streamline administrative tasks, ultimately improving patient outcomes and experiences. This session aims to equip attendees with the knowledge and tools necessary to integrate AI innovations into their practice, fostering a forward-thinking approach to compassionate end-of-life care.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 5","pages":"Page e461"},"PeriodicalIF":3.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143807059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kate Harris MD, Megan McMurray DO, Kristianna Kundrat DNP WHNP-BC, Cari Low MD FACP
{"title":"Addressing Sexual Dysfunction in Serious Illness","authors":"Kate Harris MD, Megan McMurray DO, Kristianna Kundrat DNP WHNP-BC, Cari Low MD FACP","doi":"10.1016/j.jpainsymman.2025.02.062","DOIUrl":"10.1016/j.jpainsymman.2025.02.062","url":null,"abstract":"<div><h3>Outcomes</h3><div>1. Participants will self-report the ability to integrate patient-centered language and communication skills to identify common sexual health concerns and sexual dysfunction in patients with serious illness.</div><div>2. Participants will self-report the ability to employ pharmacological and non-pharmacological treatments strategies for sexual dysfunction in patients with serious illness.</div></div><div><h3>Key Message</h3><div>Sexual dysfunction is common in serious illness and has a negative impact on sexuality, intimacy, and quality of life. (1, 2). This session will review common sexual health concerns in patients with serious illness and provide participants with practical assessment, communication, and management strategies for how to address these concerns.</div></div><div><h3>Abstract</h3><div>Sexual dysfunction and its negative effects on sexuality and intimacy are common in patients with serious illness and can result in decreased quality of life, depression, anxiety, and have a negative impact on relationships. (1-3). Intimacy includes both physical and emotional closeness and the World Health Organization defines sexuality as “a central aspect of being human throughout life” (2). Despite sexual dysfunction occurring in up to 90% of cancer patients and the National Coalition for Hospice and Palliative Care Clinical Practice Guidelines suggesting this be addressed in routine social assessments, palliative medicine providers infrequently discuss these issues with their patients (1). Barriers to these conversations include misperceptions around the importance of this topic, fear of causing offense, and lack of knowledge to guide treatment (2). Data shows that patients want their providers to broach this topic but are unlikely to seek specialized care for sexual dysfunction, despite its significant impact on quality of life (1, 2, 4-5). As a result, this important topic often goes unheard and unaddressed. The term sexual dysfunction includes decreased libido, erectile and ejaculatory dysfunction, and genitourinary symptoms of menopause (GSM). Sexual dysfunction can be caused by the disease process itself, secondary to treatment, or a result of psychological and relationship stresses. In this session, experts in gynecologic, urologic, oncologic, and palliative medicine will utilize a case-based presentation format to offer evidence- and consensus-based guidance on diagnosis and treatment of sexual dysfunction in serious illness. Presenters will review common sexual health concerns and patient-centered communication strategies to diagnosis sexual dysfunction and will discuss current ambulatory, pharmacological and non-pharmacologic treatment interventions. Participants will leave the session with practical assessment, communication, and management strategies for how to address these concerns.</div></div><div><h3>References</h3><div>1. Walker LM, Sears CS, Booker R, et al. Development, implementation, and evaluatio","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 5","pages":"Page e448"},"PeriodicalIF":3.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143807219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Easing Opioids Compassionately: De-escalating High Dose Opioids in Cancer Survivorship","authors":"Kimberly Frier DNP APRN-CNP ACHPN FPCN, Justin Kullgren PharmD FAAHPM","doi":"10.1016/j.jpainsymman.2025.02.037","DOIUrl":"10.1016/j.jpainsymman.2025.02.037","url":null,"abstract":"<div><h3>Outcomes</h3><div>1. The learner should achieve a contrast and comparison of different opioid de-escalation strategies for patients that have completed cancer treatment.</div><div>2. The learner should achieve a review of communication strategies for a compassionate approach to negotiating and approaching de-escalation of opioids.</div></div><div><h3>Key Message</h3><div>Patients are living longer with cancer and there is an increasing number of cancer survivors. This requires palliative care clinicians to be keenly aware of long-term opioid side effects along with when and how to taper opioids. This session will review opioid tapering strategies.</div></div><div><h3>Abstract</h3><div>With the population of cancer survivorship increasing, more studies are evaluating long term effects and management of various symptoms, including cancer and related pain (Kline, et. al., 2018). Healthcare providers are assessing pain more comprehensively, accounting for chronic pain, cancer pain, cancer treatment pain and other co-morbidity pain. There is more recognition of the long-term side effects of opioids and limitations of their use. In 2016 the CDC and ASCO (Dowell, et. al., & Pace, et. al.,) released guidelines for managing opioids in chronic and cancer pain. Although the guidelines allowed for higher doses with terminal cancer or end-of-life situations, a ripple effect of the chronic pain guidelines were felt by many cancer survivors. Many of these patients are managed by outpatient Palliative Care/Clinics. The value of an interdisciplinary team in managing symptoms of cancer survivorship pain allows for individual de-escalating plans that address the holistic needs of cancer survivors. The purpose is to review two cases of cancer survivors managed on high dose opioids and the evidence-based process of slowly de-escalating opioids through a comprehensive, interdisciplinary team approach. One case will review de-escalation of opioids prior to cancer recurrence. One case will review de-escalation of high dose opioids in the face of disfiguring cancer treatment with no evidence of ongoing cancer.</div></div><div><h3>Objectives</h3><div>1. Participants will compare and contrast different opioid de-escalation strategies for patients that have completed cancer treatment. 2. Participants will review communication strategies for a compassionate approach to negotiating and approaching de-escalation of opioids.</div></div><div><h3>References</h3><div>Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016. JAMA. 2016;315(15):1624–1645. doi:10.1001/jama.2016.1464 Kline, R. M., Aurora, N. K., Bradley, C. J., Brauer, E.R., Graves, D. L., …Ganz, P. A. (2018). Long term survivorship care after cancer treatment: Summary of a 2017 national cancer policy forum workshop. Journal of the National Cancer Institute. 110(12): djy 176. doi: 10.1093/jnci/djy176 Pace, J.A., Portenoy, R., Lacchetti, C., Campbell, T., C","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 5","pages":"Pages e429-e430"},"PeriodicalIF":3.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143807318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Serious Illness Scorecard: Rating the States Across Key Capabilities","authors":"Allison Silvers MBA, Stacie Sinclair MPP, Rachael Heitner MPH MA, Allison Silvers MBA","doi":"10.1016/j.jpainsymman.2025.02.040","DOIUrl":"10.1016/j.jpainsymman.2025.02.040","url":null,"abstract":"<div><h3>Outcomes</h3><div>1. Participants will compare and contrast state-based infrastructure that supports access to high-quality palliative care.</div><div>2. Participants will devise a strategy to improve care for the population with serious illness in their own institution and/or state.</div></div><div><h3>Key Message</h3><div>The Serious Illness Scorecard uses an expansive methodology to rate U.S. states in care for families facing serious illness. Out of a possible five stars, nine states scored 4.0 or higher, while six scored 1.5 or below. Palliative care champions can leverage this resource to address disparities in access.</div></div><div><h3>Abstract</h3><div>While palliative care has grown tremendously in recent years, parts of the U.S. still lag in access and other best practices. Previous “America's Care of Serious Illness: State-by-State Report Cards” have tracked growth using the number of hospital programs. (1) Our new “Serious Illness Scorecard” better reflects the expansion of the field by scoring states across five domains and ten metrics.</div></div><div><h3>Objective</h3><div>To provide a comprehensive assessment of state readiness to deliver high-quality care during serious illness.</div></div><div><h3>Methods</h3><div>We collected data on ten variables across 50 states and DC, measuring: hospital program availability; certified specialists per 100,000 population; state policy mandating palliative care payment (2); relevant medical or nursing board education requirements; pediatric and adult long-term care capabilities (3); and other features. These data were combined to produce a rating out of five stars.</div></div><div><h3>Results</h3><div>Two states (Oregon and Massachusetts) earned 4.5 stars, 23 states scored above three (3) stars, six states scored under 1.5 stars, and two (Arkansas and Wyoming) earned only 1 star. Hospitals (>50 beds) with palliative care range from 45.5% (Arkansas) to 100% in six states. Home-based programs are reported in 79% of US counties. With a national median of 5.1 palliative care certified specialists per 100,000 population, states range from 2.24 (Oklahoma) to 12.62 (Rhode Island). Thirteen states have some form of palliative care payment policy, and 21 states require all licensed physicians and/or nurses to complete training in relevant skills.</div></div><div><h3>Conclusion</h3><div>U.S. states vary widely in their support of palliative care and their capacity to meet the needs of people with serious illness but, overall, states are skewing to higher capacity.</div></div><div><h3>References</h3><div>1. America's Care of Serious Illness: A State-by-State Report Card on Access to Palliative Care in Our Nation's Hospitals. Center to Advance Palliative Care and the National Palliative Care Research Center. September 2019 2. Bowman BA, Twohig JS, Meier DE. Overcoming Barriers to Growth in Home-Based Palliative Care. J Palliat Med. 2019 Apr;22(4):408-412. 3. Cheng Z, Mutoniwase E, Cai X, Li","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 5","pages":"Pages e431-e432"},"PeriodicalIF":3.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143807474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jennifer Temel MD, Joseph Greer PhD, Laura Hanson MD MPH, Toby Campbell MD MS, Simone Rinaldi MSN ANP-BC ACHPN
{"title":"Increasing the Accessibility of Early Palliative Care for Patients With Cancer","authors":"Jennifer Temel MD, Joseph Greer PhD, Laura Hanson MD MPH, Toby Campbell MD MS, Simone Rinaldi MSN ANP-BC ACHPN","doi":"10.1016/j.jpainsymman.2025.02.025","DOIUrl":"10.1016/j.jpainsymman.2025.02.025","url":null,"abstract":"<div><h3>Outcomes</h3><div>1. To understand the evidence for early integrated palliative care and the limitations of implementing this efficacious model as the standard of care for all patients with advanced cancer.</div><div>2. To gain familiarity with the results of two clinical trials evaluating novel palliative care models.</div></div><div><h3>Abstract</h3><div>The objectives of this session are: 1. To understand the evidence for early integrated palliative care and the limitations of implementing this efficacious model as standard of care for all patients with advanced cancer. 2. To describe the comparative effectiveness of delivering early integrated palliative care via telehealth using video versus in-person visits among patients with advanced lung cancer and their caregivers based on findings from the REACH-PC multisite trial. 3. To describe the comparative effectiveness of a stepped palliative care model for improving quality of life and other outcomes in patients with advanced lung cancer based on findings from the STEP-PC multisite randomized trial.</div></div><div><h3>References</h3><div>Temel JS, Jackson VA, El-Jawahri A, Rinaldi SP, Petrillo LA, Kumar P, McGrath KA, LeBlanc TW, Kamal AH, Jones CA, Rabideau DJ, Horick N, Pintro K, Gallagher Medeiros ER, Post KE, Greer JA. Stepped Palliative Care for Patients With Advanced Lung Cancer: A Randomized Clinical Trial. JAMA. 2024 Aug 13;332(6):471-481. PMID: 38824442. Greer JA*, Temel JS*, El-Jawahri A, Rinaldi S, Kamdar M, Park ER, Horick NK, Pintro K, Rabideau DJ, Schwamm L, Feliciano J, Chua I, Leventakos K, Fischer SM, Campbell TC, Rabow MW, Zachariah F, Hanson LC, Martin SF, Silveira M, Shoemaker L, Bakitas M, Bauman J, Spoozak L, Grey C, Blackhall L, Curseen K, O'Mahony S, Smith MM, Rhodes R, Cullinan A, Jackson V; REACH PC Investigators. Telehealth vs In-Person Early Palliative Care for Patients With Advanced Lung Cancer: A Multisite Randomized Clinical Trial. JAMA. 2024 Sep 11;332(14):1153-1164. PMID: 39259563. *co-first authors</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 5","pages":"Page e421"},"PeriodicalIF":3.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143807043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Motivational Interviewing: A Framework for Palliative Clinicians","authors":"Brianna Williamson MD, Danielle Chammas MD, Greg Merrill LCSW","doi":"10.1016/j.jpainsymman.2025.02.029","DOIUrl":"10.1016/j.jpainsymman.2025.02.029","url":null,"abstract":"<div><h3>Outcomes</h3><div>1. Define and illustrate the key tenets of Motivational Interviewing (MI) as they pertain to serious illness care.</div><div>2. Practice hands on application of MI skills to a sample palliative medicine case.</div></div><div><h3>Key Message</h3><div>Motivational interviewing (MI), one of the best studied modalities to evoke behavior change, is a crucial tool for palliative care clinicians. This session lays the groundwork for application of MI in the context of HPM. Using palliative, a case vignette and an interactive format, this engaging session explores the application of key tenets of MI to serious illness care.</div></div><div><h3>Abstract</h3><div>Motivational interviewing (MI) is an evidence-based intervention exploring patients' ambivalence to change, working together to resolve that ambivalence. In its forty-year history, hundreds of studies have demonstrated its efficacy across many domains (1). Despite these wide-reaching implications, little work has focused on how best to apply the key tenets of this approach to HPM practice (2). A crucial aspect of an MI approach is the focus on the therapeutic process as a tool for change, making it an ideal framework for HPM clinicians with communication expertise to help patients explore goals, values, and behaviors (3). This session will focus on the tenets of motivational interviewing through a palliative medicine framework. It was created with authors from different disciplines (all with expertise in both MI and palliative care) who have collectively taught MI to medical trainees, Master of Social Work programs, and to interdisciplinary palliative medicine departments. The session is geared toward all members of the IDT. Principles of DEI will be explored, as different elements of identity have a profound impact on how patients process their illness experience. Participants will engage with the content in interactive and applicable ways, working together to apply the underlying concepts to a palliative medicine case example. Using a case, we will reconceptualize the stages of change through an MI lens. We will then evaluate the four processes of motivational interviewing with a focus on communication techniques. Finally, participants will have the opportunity to practice these skills in real time through interactive exercises.</div></div><div><h3>Conclusion</h3><div>HPM clinicians consistently focus on behavior changes to increase quality-of-life and purpose-driven actions with our patients and their families. Learning the practical theory and application of motivational interviewing, considered the forefront therapeutic tool for behavior change, enhances our potential for clinical efficacy in HPM practice.</div></div><div><h3>References</h3><div>1, Rubak S, Sandbaek A, Lauritzen T, Christensen B. Motivational interviewing: a systematic review and meta-analysis. Br J Gen Pract. 2005 Apr;55(513):305-12. PMID: 15826439; PMCID: PMC1463134. 2. Pollak KI, Gao X, Arnold RM","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 5","pages":"Pages e423-e424"},"PeriodicalIF":3.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143807046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hope Wechkin MD FAAHPM HMDC, Chris Clement MSW LICSW APHSW-C, Cathy Scarcello RN BSN, Nathan Yemane MSW LICSW, Robert Macauley MD, Elizabeth Loggers MD PhD FAAHPM
{"title":"“He Said He Wouldn't Want This”: Is Minimal Comfort Feeding Viable?","authors":"Hope Wechkin MD FAAHPM HMDC, Chris Clement MSW LICSW APHSW-C, Cathy Scarcello RN BSN, Nathan Yemane MSW LICSW, Robert Macauley MD, Elizabeth Loggers MD PhD FAAHPM","doi":"10.1016/j.jpainsymman.2025.02.092","DOIUrl":"10.1016/j.jpainsymman.2025.02.092","url":null,"abstract":"<div><h3>Outcomes</h3><div>1. Identify the practical and ethical challenges presented by both Comfort Feeding Only (CFO) and Stopping Eating and Drinking by Advance Directive (SED by AD) as options for people who want to ensure that they do not continue living with advance dementia.</div><div>2. Define the basic tenets of Minimal Comfort Feeding and describe the ethical considerations and operational challenges that may accompany its implementation.</div></div><div><h3>Key Message</h3><div>The provision of nutrition and hydration to those with advanced dementia is often ethically complex. This session will explore a new approach to providing food and liquids to people who have previously expressed a wish not to continue living with advanced dementia.</div></div><div><h3>Abstract</h3><div>In 2010, Comfort Feeding Only (CFO) was introduced as an alternative to feeding tubes, and since then has been shown to be appropriate for most patients with advanced dementia. However, CFO's emphasis on assiduous handfeeding (that may prolong life for years) fails to accommodate the preferences of those who do not want to continue living with this illness. Some have proposed advance directives instructing caregivers to completely halt the provision of nutrition and hydration once a person has reached an advanced stage of dementia. However, these directives may fail to address patients’ physical discomfort and caregivers’ ethical and clinical obligations.</div></div><div><h3>Objectives</h3><div>In this interactive session, a panel of clinicians, caregivers, patient surrogates, hospice leaders, and researchers will introduce Minimal Comfort Feeding (MCF) and its ethical basis, parameters, benefits and challenges. With MCF, it is proposed that caregivers provide nutrition and hydration only in response to signs of hunger and thirst, rather than offering food and liquids proactively as with CFO. Considerations regarding patient selection (particularly within vulnerable populations), surrogate responsibility, family/caregiver education and support, potential conflicts of interest, and regulatory concerns will be explored.</div></div><div><h3>Conclusion</h3><div>Audience feedback regarding MCF and its possible implementation will be gathered using an Audience Response System if supported/allowed by the Planning Committee. These responses, together with robust discussion off this potential innovation in goal-concordant care with a panel representing diverse and typically under-represented communities, will contribute to an emerging understanding of MCF and its acceptability in both private and institutional settings.</div></div><div><h3>References</h3><div>1. Palacek EJ, Teno JM, Casarett DJ, Hanson LC, Rhodes RL, Mitchell SL. Comfort feeding only: a proposal to bring clarity to decision-making regarding difficulty with eating for persons with advanced dementia. J Am Geriatr Soc. 2010 Mar;58(3):580-4. 2. Menzel PT, Chandler-Cramer MC. Advance directives, dementia, and ","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 5","pages":"Page e465"},"PeriodicalIF":3.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143807065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Discovering What Matters for Urban FQHC Patients: Can the Letter Project Help?","authors":"Rahee Nerurkar MD, Deborah Swiderski MD, Vyjeyanthi Periyakoil MD","doi":"10.1016/j.jpainsymman.2025.02.059","DOIUrl":"10.1016/j.jpainsymman.2025.02.059","url":null,"abstract":"<div><h3>Outcomes</h3><div>1. Participants will be able to identify the barriers that prevent minoritized patients from having high-quality values-centered conversations with their provider.</div><div>2. Participants will be equipped with the tools and resources to pilot a letter-based approach to discussing “What Matters” with their patients.</div></div><div><h3>Key Message</h3><div>Studies have shown that racial minority and non-English speaking patients experience reduced frequency and quality of values-centered conversations. Barriers commonly faced by providers include time, comfort, and competing priorities. We hypothesize that using a letter-writing exercise to discuss “What Matters” may reduce these barriers at an urban federally qualified health center (FQHC) serving a diverse patient population.</div></div><div><h3>Abstract</h3><div>Studies have shown that both patients and providers find values-centered conversations to be important and meaningful to the therapeutic relationship. (1) Unfortunately, racial minority and non-English speaking patients experience reduced frequency and quality of such conversations. (2) Barriers that providers encounter when attempting to have these conversations include time, comfort, and competing priorities in safety-net clinical settings. (3-5)</div></div><div><h3>Objectives</h3><div>Our objectives are to (a) implement a letter-based approach, adapted from the Stanford Letter Project (6), to discuss \"What Matters\" with patients in a high-volume, safety-net primary care setting and (b) investigate patient and provider experiences with this exercise to understand the feasibility of this approach to improving the frequency of values-centered conversations.</div></div><div><h3>Methods</h3><div>10 provider/patient pairs from an urban FQHC serving primarily racial minority and non-English speaking patients will be enrolled in the study. Patients will be provided with a “What Matters” letter template, will fill it out at home, and send it back to their provider. We will interview patients about their experience writing the letter and discussing it with their provider. We will also interview providers about their experience with this exercise to understand if it reduces barriers that they face when attempting to have values-centered conversations. We will use a qualitative, thematic analysis methodology to evaluate our objectives.</div></div><div><h3>Results</h3><div>IRB approval for the study was received in September 2024. Currently, we are in the process of informing providers about the research protocol and will begin recruiting provider/patient pairs in October 2024.</div></div><div><h3>Conclusion</h3><div>We hypothesize that a letter-based approach to discussing “What Matters” can improve the frequency of values-centered conversations in the care of racial minority and non-English speaking patients. Additionally, we hypothesize that this approach can reduce barriers providers encounter when attempting to h","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 5","pages":"Pages e445-e446"},"PeriodicalIF":3.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143807132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ian Kwok MD, Kimberly Murdaugh MD MS, Daniel Shalev MD, Walter Boot PhD, Cary Reid MD PhD, Ronald Adelman MD
{"title":"New Frontiers in Artificial Intelligence: A Multimodal Communication Model","authors":"Ian Kwok MD, Kimberly Murdaugh MD MS, Daniel Shalev MD, Walter Boot PhD, Cary Reid MD PhD, Ronald Adelman MD","doi":"10.1016/j.jpainsymman.2025.02.070","DOIUrl":"10.1016/j.jpainsymman.2025.02.070","url":null,"abstract":"<div><h3>Outcomes</h3><div>1. Participants will be able to evaluate a new, patient-facing application of artificial intelligence to improve information-sharing in family meetings.</div><div>2. Participants will be able to apply a new model of multimodality to advance communication science in palliative care research.</div></div><div><h3>Key Message</h3><div>Verbal communication can be augmented by a multimodal approach. In the first use of artificial intelligence for patient-facing communication, we developed a prototype capable of generating real-time transcriptions of family meetings. Applying user-centered design, artificial intelligence can complement and advance communication science in palliative care settings.</div></div><div><h3>Abstract</h3><div>Patients and families face complex communication challenges in the setting of serious illness. These difficulties are compounded for individuals who are non-English-speaking, have low health literacy, have visual/auditory impairments, or possess unique learning styles. Improving accessibility for these patients and caregivers is paramount.</div></div><div><h3>Objectives</h3><div>We hypothesize that augmenting standard verbal communication modalities with a multimodal communication approach (integrating written, visual, and other modalities) can improve medical information-sharing.</div></div><div><h3>Methods</h3><div>In the first use of artificial intelligence for patient-facing communication, we developed a prototype capable of generating real-time transcribed reports of family meetings for patients, their caregivers, and other clinicians. The prototype uses an iPhone for audio recording, followed by the use of machine learning, natural language processing, and speaker diarization modules to create a written transcript, which accurately integrates medical terminology, translates between multiple languages, and distinguishes between a large number of different speakers. This transcript can then be physically shared and digitally uploaded to the electronic medical record. To inform the development of this invention, we implemented a user-centered design process based on patient, caregiver, and clinician interviews (in process). We also conducted an interdisciplinary literature review exploring the use of multimodality for communication spanning medical, educational, and social science research.</div></div><div><h3>Results</h3><div>Our results will be presented in a multimodal format, including audiovisual and written components. Using a professionally filmed video, we will perform a full demonstration of the prototype (depicting a simulated family meeting) to illustrate usage recommendations and to demystify its technological components. We will also elucidate our proposed model of multimodal communication, which offers insight into future opportunities and analyses.</div></div><div><h3>Conclusion</h3><div>The use of artificial intelligence to actualize multimodality in family meetings is opening ","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 5","pages":"Pages e454-e455"},"PeriodicalIF":3.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143807168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Carine Davila MD MPH, Edward Penate DMin BCC, Sarah Byrne-Martelli BCC-PCHAC, Mayra Sanchez MD FAAHPM, Miriam Garcia-Hocker MSN APRN AGNP-C AOCNP, Erica Gomez-Aranda ACSW, Marvin Omar Delgado Guay MD FAAHPM, Carine Davila MD MPH, Grace La Torre DO MS FACP
{"title":"Un Milagro de Dios: Navigating Latino Patients & Families’ Hopes/Prayers for Miracles","authors":"Carine Davila MD MPH, Edward Penate DMin BCC, Sarah Byrne-Martelli BCC-PCHAC, Mayra Sanchez MD FAAHPM, Miriam Garcia-Hocker MSN APRN AGNP-C AOCNP, Erica Gomez-Aranda ACSW, Marvin Omar Delgado Guay MD FAAHPM, Carine Davila MD MPH, Grace La Torre DO MS FACP","doi":"10.1016/j.jpainsymman.2025.02.067","DOIUrl":"10.1016/j.jpainsymman.2025.02.067","url":null,"abstract":"<div><h3>Outcomes</h3><div>1. Describe the importance of spirituality and miracle literacy in a Latino and spiritually diverse clinical context.</div><div>2. Review tools that assist palliative care clinicians and other clinicians explore and respond sensitively to Latino patient and/or family's expression of hoping for a miracle.</div></div><div><h3>Key Message</h3><div>Recognizing the spirituality and religious beliefs of Latino patients living with serious illness who express hope for a miracle along with developing tools to best address these beliefs, is an opportunity for the interdisciplinary team to connect with the needs of patients and families, decrease suffering and promote healing.</div></div><div><h3>Abstract</h3><div>The Latino population accounted for 52% of U.S. population growth over the last decade (1). Latino patients frequently cite religion and la Espiritualidad, which serves as a source of strength and coping and influences how others understand them and the world around them (2). It encompasses their values, morals, behaviors, feelings, interpretation of events, and views of illness and death, impacting complex medical decision-making (3-5). Differences in religious/spiritual beliefs around death and dying, have been reported by clinician to be a barrier when communicating with patients (6). When facing serious illness, patients and families may express hope for a miracle, or un Milagro. This expression may be perceived as being “in denial” about one's illness severity (7). Palliative care clinicians are often called to support patients and families who express hope for a miracle (5). They should be equipped with tools to provide culturally-spiritually sensitive care, including the ability to respond to these expressions of beliefs, assess the diverse spiritual needs of patients/families and lastly understand the nuances and diversity of the Spanish language.</div></div><div><h3>Objectives</h3><div>An interdisciplinary team (physician, nurse, chaplain, social worker) representing multiple institutions will discuss practical strategies for exploring what seriously ill Latino patients and families mean by a hope for a miracle, strategies on repairing missteps that negatively impact trust, and sample language for aligning with their spirituality & bridging perspectives for all involved (patients, families, and clinicians).</div></div><div><h3>Conclusion</h3><div>As the U.S. Latino population continues growing and aging, there is a need for palliative care clinicians to better equip themselves on how to effectively support this population who express hope for a miracle. Though we examine this through the lens of Latino patients, lessons learned can be applied to patients and families from other cultures expressing hope for a miracle.</div></div><div><h3>References</h3><div>1. Krogstad JM, Passel JS, Noe-Bustamante, L. Key facts about U.S. Latinos for National Hispanic Heritage Month. <span><span>https://www.pewresearch.org/","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 5","pages":"Page e452"},"PeriodicalIF":3.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143806989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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