Journal of palliative medicine最新文献

{"title":"A Profound Paradox for Caregivers in Cancer Care.","authors":"Joan W Hanania, Cristina Pozo Kaderman","doi":"10.1177/10966218251366154","DOIUrl":"https://doi.org/10.1177/10966218251366154","url":null,"abstract":"","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144804277","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":"The Unmet Needs of Parents in Pediatric Palliative Care: A Qualitative Systematic Review.","authors":"Piyumi Senanayake, John Oldroyd","doi":"10.1177/10966218251363405","DOIUrl":"https://doi.org/10.1177/10966218251363405","url":null,"abstract":"<p><p><b><i>Background:</i></b> The goal of pediatric palliative care is to improve the quality of life of children with life-limiting or life-threatening disease and their families through a holistic care approach. Although the current evidence suggests that the existing palliative care services are not meeting the needs of these families, especially the parents, these studies are heterogeneous with inconsistent results. The aim of this study was to systematically synthesize and critically evaluate the available evidence on unmet needs of parents in pediatric palliative care. <b><i>Methods:</i></b> A qualitative systematic review was conducted, informed by the Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 statement. Five electronic databases: MEDLINE, Scopus, Web of Science, CINAHL, and PsychINFO were searched. Included studies were appraised using the Critical Appraisal Skills Programme (CASP) checklist and then analyzed using a framework analysis. <b><i>Results:</i></b> Thirteen studies were included. Five major themes emerged: (1) pediatric palliative care services delivery and care coordination, (2) emotional, psychological, and spiritual support, (3) end-of-life care and bereavement support, (4) practical and daily living support, and (5) communication and information. Parents reported unmet needs in multiple dimensions and wished for more support in caring for their children. <b><i>Conclusion:</i></b> Given that all of the unmet needs align with already established pediatric palliative care standards, this review highlights the need for revised health care policies and practices that will lead to better implementation of these standards in practice.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144789413","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":"Using Large Language Models to Analyze Symptom Discussions and Recommendations in Clinical Encounters .","authors":"Anny T H R Fenton, Natasha Charewycz, Zarwah Kanwal, Brigitte N Durieux, Katherine I Pollack, James A Tulsky, Alexi A Wright, Charlotta J Lindvall","doi":"10.1177/10966218251363802","DOIUrl":"https://doi.org/10.1177/10966218251363802","url":null,"abstract":"<p><p><b><i>Background:</i></b> Patient-provider interactions could inform care quality and communication but are rarely leveraged because collecting and analyzing them is both time-consuming and methodologically complex. The growing availability of large language models (LLMs) makes these analyses more feasible, though their accuracy remains uncertain. <b><i>Objectives:</i></b> Assess an LLM's ability to analyze patient-provider interactions. <b><i>Design:</i></b> Compare a human's and an LLM's codings of clinical encounter transcripts. <b><i>Setting/Subjects:</i></b> Two hundred and thirty-six potential symptom discussions from transcripts of clinical encounters with 92 patients living with cancer in the mid-Atlantic United States. Transcripts were analyzed by GPT4DFCI in our hospital's Health Insurance Portability and Accountability Act compliant infrastructure instance of GPT-4 (OpenAI). <b><i>Measurements:</i></b> Human and an LLM-coded transcripts to determine whether a patient's reported symptom(s) were discussed, who initiated the discussion, and any resulting recommendation. We calculated Cohen's κ to assess interrater agreement between the LLM and human and qualitatively classified disagreements about recommendations. <b><i>Results:</i></b> Interrater reliability indicated \"strong\" and \"moderate\" agreement levels across measures: Agreement was strongest for whether the symptom was discussed (<i>k =</i> 0.89), followed by who initiated the discussion (<i>k</i> = 0.82), and the recommendation provided (<i>k</i> = 0.78). The human and LLM disagreed on the presence and/or content of the recommendation in 16% of potential discussions, which we categorized into nine types of disagreements. <b><i>Conclusions:</i></b> Our results suggest that LLMs' abilities to analyze clinical encounters are equivalent to humans. Thus, using LLMs as a research tool may make it more feasible to analyze patient-provider interactions, which could have broader implications for assessing and improving care quality, care inequities, and provider communication.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144789414","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":"Does Non-Beneficial Nasogastric Tube Feeding Occur During End-of-Life Care? An Audit of Outcomes for Those with a Malnutrition Universal Screening Tool Score of 2.","authors":"Ross Andrew James Webster, Moitree Banerjee, Rachel King, Rosana Pacella, Antonina Pereira","doi":"10.1177/10966218251364719","DOIUrl":"https://doi.org/10.1177/10966218251364719","url":null,"abstract":"<p><p><b><i>Background:</i></b> The consideration of artificial nutrition and hydration (ANH) is recommended for individuals with reduced nutritional intake. However, placing long-term nonoral feeding tubes is not appropriate in those with advanced dementia or if the individual is likely to die imminently-\"within hours or days\" (GMC, 2010;58). In some instances, the provision of ANH in the weeks leading up to death may be considered a \"Non-Beneficial Treatment.\" <b><i>Objective:</i></b> To determine the extent to which \"non-beneficial\" nasogastric tube (NGT) feeding occurs at the end of life. <b><i>Design:</i></b> An audit of outcomes for individuals with a Malnutrition Universal Screening Tool (MUST) score of 2 who may be considered for artificial nutrition. <b><i>Methods:</i></b> All admissions to an acute hospital trust who met the following criteria: ≥65 years old and MUST score (Malnutrition Universal Screening Tool) of ≥2 over a six-month period (September '21-February '22). 1765 individuals met the inclusion criteria. For analysis, individuals were grouped by the presence of an NGT flag and admission survival. <b><i>Results:</i></b> 84 (4.8%) had NGT procedure flags. Of these 84, 28 (33%) died during admission. A further 12 died within six months. In total 40 (47.6%) of 84 NGT-flagged individuals were deceased within six months. Chi-square analysis demonstrated a significant relationship between death during admission and NGT Flag (χ² = 36.888, df = 1, <i>p</i> = < 0.001). Individuals with NGT flags who passed away were significantly older than peers who survived the admission (<i>t</i> = 2.576, df = 82, <i>p</i> = 0.012). <b><i>Conclusions:</i></b> NGT insertions in this cohort have a high likelihood of being considered \"non-beneficial.\" Frailty associated with increasing age may be a factor.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144789411","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":"Across the Bridge She Did Not Choose.","authors":"Sarah Rossmassler","doi":"10.1177/10966218251366091","DOIUrl":"https://doi.org/10.1177/10966218251366091","url":null,"abstract":"","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144789410","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":"The Palliative Gaze: A Star Beside the Moon.","authors":"Juan Luis Torres-Tenor","doi":"10.1177/10966218251366073","DOIUrl":"https://doi.org/10.1177/10966218251366073","url":null,"abstract":"","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144789412","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":"<i>Letter:</i> Advance Care Planning Documentation Changes Among Neurologists in an Amyotrophic Lateral Sclerosis Clinic with Addition of Specialist Palliative Care.","authors":"Minh Nguyen, James P Orengo, Astrid Grouls","doi":"10.1177/10966218251365262","DOIUrl":"https://doi.org/10.1177/10966218251365262","url":null,"abstract":"","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144789409","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":"\"There Should Be a Nurse on Call\": Complex Care Needs of Low-Income Older Adults in Medicaid-Supported Assisted Living.","authors":"Komal Patel Murali, Rebecca K F Lassell, Abraham A Brody, Dena Schulman-Green, Daniel David","doi":"10.1089/jpm.2024.0445","DOIUrl":"10.1089/jpm.2024.0445","url":null,"abstract":"<p><p><b><i>Background:</i></b> In the United States, nearly 1 million older adults reside in assisted living facilities, which aim to provide support for safe, autonomous living. However, low-income residents, especially those in Medicaid-supported facilities, experience unmet medical and social complex care needs and limited serious illness communication due to limited resources. <b><i>Objective:</i></b> The objective of this study was to explore the complex care needs and serious illness communication challenges experienced by low-income older adults in Medicaid-supported assisted living. <b><i>Methods:</i></b> A qualitative secondary framework analysis was conducted on data from a parent qualitative study involving 17 residents aged 60 and older with serious illnesses at a Medicaid-supported facility in New York City. Residents completed the Edmonton Symptom Assessment Scale and participated in semistructured interviews. This study was guided by the National Consensus Project for Quality Palliative Care, focusing on the residents' experiences, complex care needs, and communication within palliative care domains. <b><i>Results:</i></b> Residents were predominantly Black and Hispanic, with nearly one-third having a history of homelessness or shelter use, and they experienced a high symptom burden. Four key themes emerged: (1) compromised quality of life; (2) high symptom burden and limited access to care, with residents reporting pain, fatigue, and emotional distress; (3) communication gaps while navigating health care, resulting in frustration and feelings of being unheard; and (4) fragmented care coordination, which exacerbated feelings of isolation and mistrust in the health care system. <b><i>Conclusion:</i></b> The findings reveal that Medicaid-supported assisted living residents encounter substantial challenges related to complex care needs and serious illness communication. There is an urgent need for community-based interventions to enhance care access, improve symptom management, and facilitate effective communication, ultimately supporting the residents' quality of life and health outcomes. Enhanced training for staff and policy changes are key to addressing these systemic barriers to care.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"1029-1037"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12417050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144003126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"On the Power of Diversion.","authors":"Jennifer E Geller","doi":"10.1089/jpm.2025.0090","DOIUrl":"10.1089/jpm.2025.0090","url":null,"abstract":"","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"1125-1126"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143998452","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":"<i>Letter:</i> Response to Feder et al., Use of Hospice and End-of-Life Care Quality Among Medical Centers with High Versus Lower Specialist Palliative Care Reach Among People with Heart Failure: An Observational Study.","authors":"Edward W Martin","doi":"10.1089/jpm.2025.0052","DOIUrl":"10.1089/jpm.2025.0052","url":null,"abstract":"","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"1001"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022200","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}