Journal of palliative medicine最新文献

{"title":"<i>Letter:</i> Where Do Patients with Advanced Cancer Die? Upstream System Failures Behind Emergency Department Deaths in Korea.","authors":"Si Won Lee","doi":"10.1177/10966218261474276","DOIUrl":"https://doi.org/10.1177/10966218261474276","url":null,"abstract":"","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"10966218261474276"},"PeriodicalIF":1.8,"publicationDate":"2026-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148592293","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":"Knowledge, Attitudes, and Practices Regarding Advance Care Planning Among Preoperative Patients in Malaysia.","authors":"Kwan Loong Lee, Kevin Wei Shan Ng, Siok Fuang Liong","doi":"10.1177/10966218261472951","DOIUrl":"10.1177/10966218261472951","url":null,"abstract":"<p><p><i>Background:</i> Advance care planning (ACP) enables patients to articulate their values and preferences for future medical care. Little is known about the attitudes and practices of preoperative patients from lower middle-income countries toward ACP. This study aimed to assess the knowledge, attitudes, and practices regarding ACP among preoperative patients in Malaysia and identify its associated factors.<i>Method:</i>A cross-sectional study was conducted from May to October 2024 at University Malaya hospital in Malaysia. In total, 135 patients attending the preoperative clinic were recruited through convenience sampling. Data were collected using a validated Advance Care Planning Questionnaire. Multiple logistic regression was performed to identify factors associated with ACP engagement.<i>Result:</i>Baseline awareness of ACP was low (17%), yet 87.4% of participants acknowledged its importance. More than two-thirds expressed willingness to engage in ACP discussions in future clinic visits, and 88.6% preferred family members as surrogate decision-makers. Patients with comorbidities like hypertension had higher odds to favor ACP (odds ratio [OR] = 5.287, 95% confidence level [CI]: 1.145-21.411, <i>p</i> = 0.033), while those under 65 years old (OR = 0.246, 95% CI: 0.065-0.933, <i>p</i> = 0.039) and male patients (OR = 0.326, 95% CI: 0.119-0.891, <i>p</i> = 0.029) were less incline to ACP. <i>Conclusion:</i>Preoperative patients are receptive to ACP, highlighting the preoperative clinic as a strategic setting for ACP.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"10966218261472951"},"PeriodicalIF":1.8,"publicationDate":"2026-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148592298","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":"Top Ten Tips Palliative Care Clinicians Should Know About Sickle Cell Disease.","authors":"Ashley Allen, Eberechi Nwogu-Onyemkpa, C Patrick Carroll, Sophie M Lanzkron, Adrienne D Mishkin, Jesse A Soodalter, Marsha J Treadwell, Samuel R Wilson, Dana L Guyer, Craig D Blinderman, Christopher A Jones, Rushil V Patel","doi":"10.1177/10966218261473333","DOIUrl":"https://doi.org/10.1177/10966218261473333","url":null,"abstract":"<p><p>Sickle cell disease (SCD) is a congenital, life-limiting illness that affects millions worldwide. It carries a high symptom burden and decreased quality of life. Although disease-modifying and even potentially curative therapies have recently emerged, significant tradeoffs and inequitable access remain. Opioids are the mainstay for acute pain but do not adequately address chronic pain syndromes that many people with SCD face. Additionally, individuals with SCD encounter emotional and psychosocial challenges, compounded by biases and structural racism within and outside the health care system. Despite improved life expectancy, prognostication is difficult as death can follow unpredictable and catastrophic complications; and older individuals develop other chronic illnesses associated with shortened survival, underscoring a role for advance care planning. Historically, palliative care (PC) involvement in SCD has been limited. This article, created by a multidisciplinary group of clinicians, offers an overview of SCD to better empower PC clinicians caring for individuals with SCD.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"10966218261473333"},"PeriodicalIF":1.8,"publicationDate":"2026-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148592266","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":"A Novel Tool for Assessing the Content and Quality of Goals of Care Documentation.","authors":"Kaitlyn Shrake, Tara Cook, Dio Kavalieratos, Christopher McLouth, Jane Schell, Robert Arnold","doi":"10.1177/10966218261472172","DOIUrl":"https://doi.org/10.1177/10966218261472172","url":null,"abstract":"<p><strong>Background: </strong>Addressing goals of care (GOC) serves a crucial role throughout the course of a patient's illness, but for it to be useful and enduring, documentation must provide enough detail to be actionable for the next clinician. Our aim is to describe GOC documentation content and quality across four clinical specialties (palliative care, hospitalists, internal medicine [IM] residents, and critical care) using structured assessment of high versus low quality documentation.</p><p><strong>Methods: </strong>Literature review suggests that five domains are most important for GOC notes: participants, prognosis, patient goals and values, treatment options, and advance directives. As part of an internal quality improvement initiative at our quaternary academic referral center in the Northeast United States, a novel note assessment tool was constructed and iteratively adjusted to achieve 80% interrater reliability. We then used this to review inpatient GOC notes from patients admitted under IM services with or without a palliative care consult (<i>n</i> = 100, 25 notes from each clinical specialty).</p><p><strong>Results: </strong>Only 69 out of 100 notes could be classified as GOC notes based on our tool and definitions. Except for palliative care specialists, high-quality documentation occurred infrequently in all specialties (palliative care 85.7%, critical care specialists 22.2%, hospitalists 20%, and IM residents 20%). Prognosis was both infrequently and poorly documented in all four groups, including palliative care. The remaining 31 notes were unrelated to GOC and commonly documented clinical updates, code status in isolation, or were left blank.</p><p><strong>Conclusion: </strong>Using a novel assessment tool, we found that, with the general exception of palliative care specialists, GOC documentation was inconsistent and of low quality. This highlights the need to improve the consistency and quality of GOC documentation. We also submit that the definitions and examples outlined in our novel note assessment tool can double as a guide to teach providers how to improve the quality of their GOC documentation.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"10966218261472172"},"PeriodicalIF":1.8,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148584581","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":"Fast Facts and Concepts #537: Post-Intensive Care Syndrome.","authors":"Noah Mathis, Bojana Milekic, Joshua Lasseigne, Amy Newman, Ankita Mehta","doi":"10.1177/10966218261472559","DOIUrl":"https://doi.org/10.1177/10966218261472559","url":null,"abstract":"","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"10966218261472559"},"PeriodicalIF":1.8,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148579099","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":"Top Ten Tips Palliative Care Clinicians Should Know About Neurosurgery and Neurosurgical Care.","authors":"Adela Wu, Miri Kim, Stephen P Miranda, Erin D'Agostino, Diana Wiseman, Kyle Zappi, Gregg Robbins-Welty, Joseph Stern","doi":"10.1177/10966218261471627","DOIUrl":"https://doi.org/10.1177/10966218261471627","url":null,"abstract":"<p><p>Neurosurgical conditions range broadly in etiology and acuity, including complications of advanced cancer, functional impairments caused by degenerative spinal disease and other chronic conditions, and sequelae of acute traumatic brain or spinal cord injuries, among others. This article presents a \"Top Ten Tips\" list, developed by an interdisciplinary group of neurosurgery, neurology, and palliative care (PC) specialists, to help PC clinicians care for patients with serious neurosurgical illness and support decision-making, symptom management, prognostic communication, and caregiver needs.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"10966218261471627"},"PeriodicalIF":1.8,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148579102","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":"Maternalism in Palliative Care: A Case for Relational Autonomy and Informed Non-Dissent.","authors":"Julia Wilkins, Heidi N Yeung, Julia Cain, Toluwalase A Ajayi, Christopher Onderdonk, Kyle P Edmonds","doi":"10.1177/10966218261472561","DOIUrl":"https://doi.org/10.1177/10966218261472561","url":null,"abstract":"<p><strong>Background: </strong>Clinicians often face situations in which patients or families desire aggressive care that medical teams believe offers no meaningful benefit. Traditional shared decision-making frameworks may inadequately address these tensions.</p><p><strong>Case: </strong>A 53-year-old woman with metastatic lung cancer desired full resuscitation despite progressive multisystem organ failure. She identified as a \"fighter\" but faced a clinical dilemma: adequate pain control required accepting respiratory compromise.</p><p><strong>Discussion: </strong>We apply the bioethical construct of maternalism, integrating relational autonomy and informed non-dissent to support clinician-guided decision making that preserves patient values while unburdening families from impossible choices.</p><p><strong>Conclusion: </strong>Maternalism offers palliative care clinicians a theoretically grounded approach for navigating value-laden decisions when patients cannot or choose not to bear the weight of deciding.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"10966218261472561"},"PeriodicalIF":1.8,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148579125","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":"An Exploration of Gratitude on Well-Being in Hospice and Palliative Care Familial Caregivers.","authors":"Kathryn Levy, Pei C Grant, Hannah Rachiele, Gina Schuster, Jonathan L Rossi, Sheila Conboy, Andrew Gasper, Christopher W Kerr","doi":"10.1177/10966218261472171","DOIUrl":"https://doi.org/10.1177/10966218261472171","url":null,"abstract":"<p><strong>Background: </strong>Familial caregivers (FCGs) play a critical role in health care by providing unpaid care to loved ones with serious illness. Although caregiving is often associated with emotional and physical burden, increasing attention has been directed toward potential sources of meaning and psychological growth, including gratitude.</p><p><strong>Objective: </strong>To investigate the role of gratitude on the well-being of hospice and palliative care FCGs.</p><p><strong>Design: </strong>Cross-sectional, quantitative survey study.</p><p><strong>Settings/subjects: </strong>FCGs were recruited from a single hospice and palliative care organization in New York State, United States. Participants completed in-person or online surveys at their residence.</p><p><strong>Measurements: </strong>Measures included demographics, perceived sources of gratitude, the Gratitude Questionnaire-6 (GQ-6), Positive Aspects of Caregiving Scale, Caregiver Strain Index-Expanded Positive Version, and Flourishing Scale.</p><p><strong>Results: </strong>Among 196 FCGs, participants reported relatively high levels of gratitude (GQ-6 mean = 36.30, SD = 5.43), with family, social relationships, and personal health identified as the most common sources of gratitude. Higher gratitude (GQ-6) was significantly associated with greater self-perceived flourishing (<i>r =</i> 0.426, <i>p</i> < 0.01), greater recognition of positive aspects of caregiving (<i>r =</i> 0.221-0.348, <i>p</i> < 0.01), and lower caregiver strain (<i>r</i> = -0.131, <i>p</i> < 0.05). In addition, caregiver strain was negatively associated with flourishing (<i>r</i> = -0.250, <i>p</i> < 0.01) and positive aspects of caregiving (<i>r</i> = -0.273, <i>p</i> < 0.01).</p><p><strong>Conclusions: </strong>Higher levels of gratitude were associated with greater flourishing and recognition of positive caregiving experiences and were inversely associated with caregiver strain among FCGs of hospice and palliative care patients. Future longitudinal and intervention-based research is needed to determine whether gratitude-focused approaches can improve resilience, psychological well-being, and relational connection in end-of-life caregiving.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"10966218261472171"},"PeriodicalIF":1.8,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148562177","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":"Integrating Paramedics into End-of-Life Care Increases Cancer Patients' Time Spent at Home instead of the Emergency Room: A Retrospective Cohort Study.","authors":"Leena K Surakka, Tuomas Selander, Pekka Mäntyselkä, Juho T Lehto","doi":"10.1177/10966218261471232","DOIUrl":"https://doi.org/10.1177/10966218261471232","url":null,"abstract":"<p><strong>Background: </strong>To enable patients with advanced cancer to spend their final days at home, palliative care support must be available at home around the clock.</p><p><strong>Objectives: </strong>To evaluate how the integration of paramedics into end-of-life care for cancer patients affects the utilization of the emergency department, the time spent at home, and places of death.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting/subjects: </strong>Patients who died of cancer in 2016-2017 in North Karelia, Finland.</p><p><strong>Methods: </strong>Emergency department visits and time spent at home among patients with or without enrollment in the paramedics' end-of-life care protocol were evaluated.</p><p><strong>Results: </strong>Of the 767 patients who died of cancer, 160 (21%) were included in the end-of-life care protocol. An emergency department visit during the last month of life was needed in 34% of patients with and 48% without the protocol (<i>p</i> = 0.002). The mean number of emergency department visits for patients with and without the protocol was 0.47 and 0.75, respectively (RR 0.55 [95% Cl: 0.47-0.67], <i>p</i> < 0.001 in Poisson regression analysis). During the last 30 days of life, patients in the protocol spent more time at home (median of 21 vs. 11 days, <i>p</i> < 0.001) and died more often at home (26% vs. 4%, <i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"10966218261471232"},"PeriodicalIF":1.8,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148549487","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":"Systematic Review of Advance Care Planning Implementation in Nursing Homes.","authors":"Peiyuan Zhang, Joan Davitt, Nancy Kusmaul, Paul Sacco, Kathleen T Unroe, Hyunjin Noh, John G Cagle","doi":"10.1177/10966218261470490","DOIUrl":"https://doi.org/10.1177/10966218261470490","url":null,"abstract":"<p><strong>Background: </strong>Advance care planning (ACP) implementation in NHs is inconsistent and often hindered by systemic challenges. Prior reviews have largely focused on ACP outcomes or discrete implementation factors, with limited attention to the overall implementation process.</p><p><strong>Aim: </strong>To identify elements that can shape ACP implementation quality in NHs using Donabedian's model of quality of care.</p><p><strong>Design and data source: </strong>A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, which was registered at PROSPERO (CRD42024561386). Search terms covering ACP, implementation processes, and assessment were applied across four databases (CINAHL, PsycInfo, SocINDEX, and Medline [Ovid]) in June 2024. Nineteen studies met inclusion criteria, confirmed through independent review and consensus by two researchers.</p><p><strong>Results: </strong>A deductive thematic analysis, guided by Donabedian's model, identified 11 subthemes under two major themes: (1) NH structural support in ACP, including regulations incorporating ACP into admission, role clarity, and resource availability (e.g., dedicated time and training for ACP, particularly among people with impaired decision-making capacity), and (2) standardized implementation processes, emphasizing resident and family engagement, trust building, discussions of care options and residents' preferences, documentation of ACP in a standardized place, sharing ACP-related information among an interdisciplinary team, and reviewing ACP regularly.</p><p><strong>Conclusion: </strong>The findings highlighted the need for enhancing NH buy-in for ACP and standardized implementation processes, providing a framework for future NH ACP quality improvement initiatives.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"10966218261470490"},"PeriodicalIF":1.8,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148549407","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}