Journal of palliative medicine最新文献

{"title":"A Case of Mistaken Identity: The Importance of Interdisciplinary Communication in the Discharge Process.","authors":"Mackenzie Goertz, Jordan Bauman, Danielle Jarvis, Diane Lahmann, Natalie McAndrew","doi":"10.1089/jpm.2025.0042","DOIUrl":"https://doi.org/10.1089/jpm.2025.0042","url":null,"abstract":"<p><p>Effective communication is a critical component of quality health care. In the setting of hospital admissions, communication among patients and the health care team is necessary for all stages of treatment, including discharge planning. Communication includes delivering relevant health information, discussing available options for continued care, and eliciting the patient's choices. The following case discussion describes a lapse in provider-patient communication that resulted in ruptured rapport and delayed discharge. Specifically, we reflect on a case in which a patient was erroneously identified as a registered sex offender, including the communication errors that stalled clarification of this misinformation, hindered eligibility for placement at appropriate care facilities, and ultimately delayed a timely hospital discharge. Discussion includes consideration for (a) the role of context and diffusion of responsibility, (b) stigma and unconscious bias, and (c) lack of standard operating procedure for information regarding criminal justice involvement. We conclude with recommendations for improving practice.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772014","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":"Prognosis of Cervical Fractures in Older Adults #504.","authors":"Courtney J Wagner, Mariel M Rickert, Christopher J Standaert, Robert M Arnold","doi":"10.1089/jpm.2025.0138","DOIUrl":"https://doi.org/10.1089/jpm.2025.0138","url":null,"abstract":"","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772362","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":"Palliative Care Involvement and End-of-Life Care Intensity Among Adolescents and Young Adults with Nonmalignant Illnesses: A Population-Based Cohort Study in Ontario, Canada.","authors":"Mohamed Abdelaal, Henrique Parsons, Ahmed Al-Awamer, Pamela Mosher, Julie Lapenskie, Stephen G Fung, Samantha Yoo, Peter Tanuseputro, James Downar","doi":"10.1089/jpm.2024.0524","DOIUrl":"https://doi.org/10.1089/jpm.2024.0524","url":null,"abstract":"<p><p><b><i>Background:</i></b> Adolescents and young adults (AYAs) with life-limiting illnesses face unique challenges and often receive late or no palliative care (PC). This study examines the correlation between PC involvement and the intensity of end-of-life care among AYAs with nonmalignant life-limiting illnesses. <b><i>Design:</i></b> A retrospective cohort study analyzing population-based health care data from 2010 to 2018. <b><i>Setting/Subjects:</i></b> The study population included AYAs aged 15-39 who died in Ontario, Canada, from nonmalignant life-limiting illnesses during the study period (<i>n</i> = 2313). <b><i>Measurements:</i></b> PC involvement was defined as at least one encounter with a PC provider. End-of-life (EOL) care intensity was measured using rates of emergency department visits, hospitalizations, intensive care unit admissions, and mechanical ventilation in the last 30 days of life. <b><i>Results:</i></b> Of the 2313 AYAs studied, 37.5% had at least one PC encounter during their lifetime. Specialist PC delivered ≥90 days before death was associated with lower intensity of EOL care, including fewer intensive care unit deaths (17% vs. 34% versus 31%, <i>p</i> < 0.0001) and emergency department visits (17% vs. 27% versus 21%, <i>p</i> = 0.0091) when compared to generalist PC and no PC, respectively. <b><i>Conclusions:</i></b> AYAs with nonmalignant illnesses received high EOL care intensity and had a high percentage of death in acute care settings. Specialist PC involvement was associated with improved EOL care outcomes compared with generalist and no PC.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772107","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 to the Editor:</i> Implementing the Surprise Question in the Emergency Department: Reducing Time to Palliative Care Consultation and Hospital Length of Stay with Significant Cost Savings.","authors":"Nancy Kim, Nora Segar, Karen Jubanyik, Jennifer Kapo, Deborah Rhodes","doi":"10.1089/jpm.2024.0466","DOIUrl":"https://doi.org/10.1089/jpm.2024.0466","url":null,"abstract":"","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772011","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 a Pediatrician Cares for Adults.","authors":"Brittany Rouchou","doi":"10.1089/jpm.2024.0518","DOIUrl":"https://doi.org/10.1089/jpm.2024.0518","url":null,"abstract":"","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772293","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":"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}