Journal of palliative medicine最新文献

{"title":"Billed Advance Care Planning Conversations by a Growing Palliative Care Team: Insights from a Five-Year Review.","authors":"Renato V Samala, Meena Bhaskaruni, Brittany T Peterre, Kimberlee Fong, Kathryn Richards, Anu Shrestha, David Harris, Xiaoying Chen, Laura K Shoemaker","doi":"10.1089/jpm.2024.0498","DOIUrl":"https://doi.org/10.1089/jpm.2024.0498","url":null,"abstract":"<p><p><b><i>Background:</i></b> In 2015, two Current Procedural Terminology codes were introduced for advance care planning (ACP), enabling a palliative care (PC) team to track its ACP conversations. <b><i>Objective:</i></b> To examine billed ACP conversations over five years. <b><i>Design:</i></b> Retrospective analysis. <b><i>Setting/Subjects</i></b>: PC patients in a large Midwest U.S. health care system. <b><i>Measurements:</i></b> Demographic information, service location, ACP codes. <b><i>Results:</i></b> From 2017 to 2021, total billed ACP conversations and PC clinicians increased from 381 to 5718 and 27 to 41, respectively. Of 10,307 unique patients from 17,091 billed conversations, the majority were female (52%), White (74%), and non-Hispanic (96%); 32% of in-state patients resided in areas of health care underutilization. Conversations occurred mostly (81%) in the hospital setting. A single 30-minute code was used in 81% of conversations. <b><i>Conclusion:</i></b> Integration of ACP billing into a growing PC team across five years saw a rise in billed ACP conversations and predominance of certain patient groups.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and Predictors of Perceived Stress at Work in Palliative Care Nursing: A Cross-Sectional Study from Poland.","authors":"Karol Czernecki, Grzegorz Nowicki, Michał Graczyk, Barbara Ślusarska","doi":"10.1089/jpm.2025.0003","DOIUrl":"https://doi.org/10.1089/jpm.2025.0003","url":null,"abstract":"<p><p><b><i>Background:</i></b> Palliative care (PC) nurses are exposed to the pain and suffering of patients and their families while also dealing with their own stress resulting from the nature of their work. <b><i>Objectives:</i></b> Among palliative care nurses in Poland, understanding the phenomenon of occupational-related stress and its predictors. <b><i>Design:</i></b> This is an observational study. <b><i>Setting/Subjects:</i></b> The study was conducted in Poland and the data was collected from palliative care nurses. The survey included 424 nurses, and their responses were utilized to assess the occupational stress level. <b><i>Measurements:</i></b> The occupational stress level was measured using questionnaires with standardized survey instruments. <b><i>Results:</i></b> The mean occupational stress level among palliative care nurses was 25.57 (±5.56). Nurses aged 50-59 who lived in rural areas and had 6-15 years of palliative care experience had higher levels of occupational stress (<i>p</i> < 0.05). The mean fatigue level was 20.78 (±5.41), while work engagement was 4.26 (±1.09). Palliative care nurses reported the greatest social support from significant others (20.87 ± 5.6). With regard to the professional quality of life, the highest mean score was obtained in the \"Compassion satisfaction\" subscale and was 40.59 (±6.67). <b><i>Conclusions:</i></b> Palliative care nurses experience moderate occupational stress. The number of years of professional experience, the amount of fatigue and burnout felt, as well as degree of secondary traumatic stress endured contribute to higher stress levels. The study has found significant gender differences, with men reporting significantly lower stress levels than women.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance of Three Conversational Artificial Intelligence Agents in Defining End-of-Life Care Terms.","authors":"Sonal Admane, Min Ji Kim, Akhila Reddy, Michael Tang, Yuchieh Kathryn Chang, Kao-Swi Karina Shih, Maxine De La Cruz, Sammuel Jumary Cepeda, Eduardo Bruera, David Hui","doi":"10.1089/jpm.2024.0526","DOIUrl":"https://doi.org/10.1089/jpm.2024.0526","url":null,"abstract":"<p><p><b><i>Background:</i></b> Conversational artificial intelligence agents, or chatbots, are a transformational technology understudied in end-of-life care. <b><i>Methods:</i></b> OpenAI's ChatGPT, Google's Bard, and Microsoft's Bing were asked to define \"terminally ill,\" \"end of life,\" \"transitions of care,\" \"actively dying,\" and provide three references. Outputs were scored by six physicians on a scale of 0-10 for accuracy, comprehensiveness, and credibility. Flesch-Kincaid Grade Level and Flesch Reading Ease (FRE) were used to calculate readability. <b><i>Results:</i></b> Mean (standard deviation) scores for accuracy were 9 (1.9) for ChatGPT, 7.5 (2.4) for Bard, and 8.3 (2.4) for Bing. Comprehensiveness scores averaged 8.5 (1.7) for ChatGPT, 7.3 (2.1) for Bard, and 6.5 (2.3) for Bing. Credibility was low with a mean score of 3 (1.8). The mean FRE score was 41.7, and the mean grade level was 14.1, indicating low readability. <b><i>Conclusion:</i></b> Chatbot outputs had important deficiencies that necessitated clinician oversight to prevent misinformation.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When Prognosis Is Extremely Short: Approach to Depression Care in the Last Days to Weeks of Life.","authors":"Wei Lee, Brian Draper, Meera R Agar, David C Currow","doi":"10.1089/jpm.2024.0420","DOIUrl":"https://doi.org/10.1089/jpm.2024.0420","url":null,"abstract":"<p><p>Clinically significant depressive symptoms are prevalent in advanced life-limiting illnesses. The assessment and management of such illness can be challenging for clinicians when prognoses are extremely short (days to weeks). Currently, evidence to guide practice is lacking, and there exists no guideline that specifically addresses depression care in this patient population. An approach, illustrated by the mnemonic \"SCREENIN,\" is proposed in this commentary to optimize the care of individuals with depression when prognoses are extremely short. Even when prognosis is short, depression should still be routinely screened and promptly assessed, with proactive care delivered. There is an urgent need for clinician training, service linkage, research, and cultural change in this area through better collaboration between palliative care and psychiatry.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nurses Perspectives on Low-Dose Methadone for Pain in Nursing Homes: Semi-structured Interviews.","authors":"Jennifer Holler O'Brien, Caroline Baldwin, Jenica Burns, Amber Kleckner, Takeshi Uemura","doi":"10.1089/jpm.2024.0551","DOIUrl":"https://doi.org/10.1089/jpm.2024.0551","url":null,"abstract":"<p><p><b><i>Background:</i></b> Chronic pain is prevalent in nursing homes, yet safe and effective long-acting opioid options are limited. Studies suggest that low-dose methadone (LDM) may be an ideal alternative. However, its use in nursing homes remains rare and perspectives from nursing staff on its practical benefits and challenges are underreported. <b><i>Objectives:</i></b> To explore nurses' perspectives on LDM for pain in nursing home residents and assess potential benefits and barriers to its adoption. <b><i>Design:</i></b> A qualitative study employing semi-structured interviews and a modified phenomenological approach. <b><i>Setting/Subjects:</i></b> Nurses who administered LDM (<10 mg/day) as the primary opioid for pain in the past three years in Hawaii and British Columbia nursing homes. <b><i>Measurements:</i></b> Semi-structured interviews were conducted via Zoom™ using a standardized interview guide. Interviews were recorded, transcribed verbatim, and analyzed using a qualitative description approach. Data collection continued until thematic saturation was reached. <b><i>Results:</i></b> Of the 11 nurse participants, most reported that LDM was effective in managing pain without major side effects, even in cases where other opioids had failed, and observed improvements in resident behavior. Four key themes emerged: initial hesitancy and the role of education, effectiveness in pain control, preferable side effect profile, and pros and cons of administration. Participants noted that LDM's long-acting nature and liquid formulation were particularly beneficial in nursing home settings. Additionally, the use of LDM appeared to alleviate their workload by improving resident cooperation and reducing the need for frequent medication administration. <b><i>Conclusions:</i></b> LDM is effective and well-tolerated for pain management in nursing home residents, with minimal side effects and added benefits for resident behavior and nurse satisfaction. These findings support the need for further studies to assess LDM's utility in nursing home settings.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Behavioral-Emotional Functioning of Children of Parents with Early Compared to Advanced Cancer.","authors":"Frances Marcus Lewis, Pamela Ganschow, Deborah Manst, Heather Derry-Vick, Kenneth P Tercyak, Kristin A Griffith, Monica Oxford, Jami Fukui, V K Gadi, Farya Phillips","doi":"10.1089/jpm.2024.0326","DOIUrl":"https://doi.org/10.1089/jpm.2024.0326","url":null,"abstract":"<p><p><b><i>Background:</i></b> Parental cancer represents a substantial psychological threat to children, but little is known about the relative impact of advanced compared to early-stage cancer on children's behavioral-emotional functioning. <b><i>Objectives:</i></b> To compare the behavioral-emotional functioning in children of parents with early compared to advanced cancer. <b><i>Design:</i></b> Single occasion, two-group design with historical comparison group. <b><i>Setting/Participants:</i></b> Participants were recruited through cancer centers, oncologists, service organizations, and self-referrals in the United States. Eligible parents had advanced or early-stage cancer, a child 5-17 years old, and spoke and read English. The Child Behavior Checklist was administered to parents to assess their children's Internalizing and Externalizing Problems. Data were obtained from 236 diagnosed parents, 176 with early and 57 with advanced cancer. <b><i>Results:</i></b> Internalizing and Externalizing Problems and Anxious/Depressed Mood were significantly greater for children of parents with advanced compared to early-stage cancer, even after controlling for covariates. Differences in children's functioning were not affected by parents' anxiety, depressed mood, treatment, or measures of social determinants of health. <b><i>Conclusions:</i></b> This is the first study to systematically compare the effects of parents' stage of cancer on children's behavioral-emotional functioning while controlling for potential confounders. Results demonstrate significantly elevated levels of behavioral-emotional problems in children affected by advanced compared to early-stage cancer that were explained by parents' stage of cancer, not other sources. Future studies need to identify mutable protective and risk factors to reduce the threat of parental cancer.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving Transdermal Fentanyl Prescribing Practices Using Electronic Medical Record.","authors":"Vandana Nagpal, Emily Vlass","doi":"10.1089/jpm.2024.0480","DOIUrl":"https://doi.org/10.1089/jpm.2024.0480","url":null,"abstract":"<p><p><b><i>Background:</i></b> Transdermal (TD) fentanyl has a unique place in pain management that is not universally understood, thereby raising concerns for patient safety. This project aimed to improve TD fentanyl prescribing practices through an ordering algorithm in the electronic medical record (EMR). <b><i>Measures:</i></b> The main outcome measure was the percentage of erroneous TD fentanyl orders after EMR order implementation. <b><i>Intervention:</i></b> After a retrospective chart review to assess TD fentanyl orders, a root cause analysis led to the development and introduction of an enhanced ordering algorithm in EMR in January 2023, accompanied by pharmacy education. <b><i>Outcomes:</i></b> After the intervention, a review of TD fentanyl orders over five months showed a reduction in inappropriate ordering from 42.5% to 15.2%. <b><i>Conclusions:</i></b> Standardized EMR order sets, combined with provider education, hold promise for enhancing the quality and safety of chronic pain management with TD fentanyl.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cultural Adaptation and Pilot Testing of a Basic Palliative Care Curriculum for Practicing Physicians and Nurses in Mainland China.","authors":"Xiaoyan Dai, Xiaohong Ning, Jessica Lin, Jun Jing, Bethany-Rose Daubman, Hsien Seow, Eric L Krakauer, Zhimeng Jia","doi":"10.1089/jpm.2024.0462","DOIUrl":"https://doi.org/10.1089/jpm.2024.0462","url":null,"abstract":"<p><p><b><i>Background:</i></b> To meet the growing palliative care (PC) needs of China's aging population, we culturally adapted and pilot tested an evidence-based basic PC training program for practicing clinicians. <b><i>Design:</i></b> Barrera's framework guided a multistage, surface, and deep structural adaptation of an existing course. We pilot tested the final curricula with 51 participants in September 2022. Participant demographics and postcourse satisfaction survey were descriptively analyzed. <b><i>Results:</i></b> A total of 20 nurses and 29 physicians completed the course and instruments. Majority of participants were between 31 and 50 years old (<i>n</i> = 39, 79.6%), female (<i>n</i> = 41, 83.7%), internal medicine trained (<i>n</i> = 30, 61.2%), and worked in tertiary hospitals (<i>n</i> = 47, 95.9). Most participants considered the course quality to be \"high\" or \"very high\" (<i>n</i> = 47, 95.9%). <b><i>Conclusions:</i></b> Practicing physicians and nurses in mainland China consider this culturally adapted basic PC training to be feasible and acceptable. Future studies should evaluate the effectiveness of PC training and develop strategies to overcome implementation challenges.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Community Health Workers and Technology Interventions' Impact on Palliative Support Globally: A Scoping Review of Randomized Controlled Trials.","authors":"Alekhya Gunturi, Margarita Pertierra, Irma Elizabeth Huayanay Espinoza, Maya Kavita Ramachandran, Mpho Ratshikana Moloko, Karl A Lorenz","doi":"10.1089/jpm.2024.0382","DOIUrl":"https://doi.org/10.1089/jpm.2024.0382","url":null,"abstract":"<p><p><b><i>Background:</i></b> Palliative care has the potential to relieve burdened global health systems but is in short supply in many low-resource settings. Community health workers (CHWs) and digital health tools/telephonic support have the potential to scale scarce palliative care resources and improve outcomes for seriously ill adults in home/community settings. <b><i>Aim:</i></b> To describe the utilization of CHWs and digital health/telephony in the palliative care of seriously ill adults in these settings. <b><i>Design:</i></b> We conducted a scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews guidelines. Search terms were developed with a health sciences librarian. <b><i>Data Sources:</i></b> The databases PubMed, EMBASE, LILACS, and CINAHL were searched for articles published from January 1, 2012, to December 30, 2023. <b><i>Results:</i></b> A total of 31 articles out of 7518 screened were included in the final analysis. Studies were mostly conducted in the United States. Most interventions were remote, with only four addressing rural or minority populations. Nineteen targeted advanced cancer, with others focusing on chronic obstructive pulmonary disease, heart failure, renal disease, and hospice care. CHWs and digital health/telephony were commonly used for physical and psychological care. Culturally tailored interventions with CHWs were few but effective. Patient quality of life, health care utilization, and caregiver outcomes were significantly impacted. <b><i>Conclusions:</i></b> CHWs and digital health/telephony can improve quality of life, health care use, and caregiver support. Most research focuses on physical and psychological aspects of care instead of cultural aspects of care. Future research is needed to explore culturally tailored interventions in minority populations and low- and middle-income countries, as well as investigate emerging remote technologies to allow for scaling palliative care into home/community settings.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Variability of the Analgesia Nociception Index During Painful Procedures in Noncommunicative Patients at the End of Life: A Prospective, Observational Pilot Study.","authors":"Chloé Prod'homme, Anne Wojtanowski, Mathilde Herbet, Emeline Cailliau, Licia Touzet, Claire Pasqualini, Philippe Sabot, François Puisieux, Magali Pierrat","doi":"10.1089/jpm.2024.0510","DOIUrl":"https://doi.org/10.1089/jpm.2024.0510","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Monitoring parasympathetic activity by the Analgesia Nociception Index (ANI) is reliable for assessing nociception during general anesthesia or in sedated critically ill patients. The aim of our study is to evaluate the variability of the ANI during painful procedures in noncommunicative patients at the end of life (EOL). <b><i>Methods:</i></b> This study was a blinded, prospective, observational study. Consecutive noncommunicative EOL patients were recruited from the palliative care unit. The minimum ANI score and the Critical Care Pain Observation Tool (CPOT) scale were collected before, during, and after a painful procedure. <b><i>Results:</i></b> Twenty patients were included; five were sedated. We found that ANI scores decreased significantly (<i>p</i> < 0.001) and CPOT scores increased (<i>p</i> = 0.006) during painful procedures. ANI changed more frequently than CPOT. There was no correlation between ANI and CPOT scores. <b><i>Conclusion:</i></b> In this preliminary study, we found that the ANI was effective in detecting discomfort during painful procedures at the EOL.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}