Journal of palliative medicine最新文献

{"title":"Time is Money? A Retrospective Economic Study Comparing Early Versus Late Specialist Palliative Care in Dying Hospital Patients.","authors":"Monika Hagemann, Matthias Schwenkglenks, Odile Stalder, Steffen Eychmüller, Maud Maessen","doi":"10.1177/10966218261462665","DOIUrl":"10.1177/10966218261462665","url":null,"abstract":"<p><strong>Background: </strong>Early integration of specialist palliative care (sPC) improves patient-centered outcomes, but its impact on hospital costs during terminal admissions remains insufficiently studied.</p><p><strong>Aim: </strong>To compare total and daily hospital costs associated with early versus late initiation of sPC during the terminal hospital admission of patients who died in hospital.</p><p><strong>Design: </strong>Retrospective cohort study using routinely collected administrative and clinical hospital data. Costs were analyzed using generalized linear models adjusted with inverse probability of treatment weighting. Bias-corrected mean ratios with 95% confidence interval (CI) calculated from 2,000 bootstrapped samples were presented.</p><p><strong>Setting/participants: </strong>The study was conducted at a single Swiss tertiary care hospital and included adults aged ≥18 years who died during their terminal hospitalization between 2016 and 2022 and received sPC. Early sPC was defined as initiation within three days of admission. Patients with refusal of data use, external causes of death, perioperative death in otherwise healthy individuals, or incomplete cost data were excluded.</p><p><strong>Results: </strong>The cohort comprised 790 patients (397 early sPC; 393 late sPC). Adjusted total hospital costs were substantially lower among patients receiving early sPC (CHF, 22,999; 95% CI: 21,149-25,072) compared with late sPC (CHF, 60,691; 95% CI: 55,186-67,165). Patients receiving early sPC also had lower daily costs. The largest cost differences occurred in pharmacy, laboratory, material, and room categories, whereas staff costs were similar between groups.</p><p><strong>Conclusions: </strong>Early initiation of sPC during terminal hospitalizations is associated with markedly lower hospital costs without increased staff expenditures. Additional studies are needed to establish whether this association is causal. Nonetheless, these findings suggest that providing patients with the benefits of sPC earlier during terminal hospitalization may be possible without increasing overall hospital costs and may have important implications for health care resource utilization.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"1517-1525"},"PeriodicalIF":1.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148317680","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":"Clinical and Radiological Trajectories at the End of Life in Patients with Bone and Soft Tissue Sarcoma: A Retrospective Case Series.","authors":"Kumiko Yotsuya, Yoji Shido, Yukihiro Matsuyama","doi":"10.1177/10966218261460512","DOIUrl":"10.1177/10966218261460512","url":null,"abstract":"<p><strong>Objectives: </strong>To provide detailed characteristics of advanced malignant bone and soft tissue tumors at the end of life.</p><p><strong>Design: </strong>A retrospective case series analysis.</p><p><strong>Subject: </strong>We included 24 patients who presented to our department between 2014 and 2024, were diagnosed with malignant bone or soft tissue tumors, and died from tumor-related causes.</p><p><strong>Results: </strong>The mean age was 57.8 ± 15.6 years at death. Acute-onset events requiring emergency admission within three months before death occurred in 91.7%. The reasons for emergency admission included dyspnea due to malignant pleural effusion, sepsis, paraplegia, gastrointestinal bleeding, bone marrow dysfunction, difficulty moving due to pain, acute renal failure, and pulmonary thromboembolism.</p><p><strong>Conclusions: </strong>Patients with advanced sarcoma experience an exceptionally high rate of acute-onset events and emergency admissions in their final months. Emergency hospitalization provides an opportunity to consider transitioning to palliative care.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"1572-1577"},"PeriodicalIF":1.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148226097","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":"Impact of a Structured Pathway on Nausea and Vomiting Treatment in Palliative Care: A Before-After Study.","authors":"Jennifer Marie Berner-Sharma, Aaditya Berner-Sharma, Till Arnold, Claudia Bausewein, Constanze Rémi","doi":"10.1177/10966218261462313","DOIUrl":"10.1177/10966218261462313","url":null,"abstract":"<p><strong>Background: </strong>Nausea and vomiting are distressing symptoms in palliative care. Due to a heterogeneous population and limited evidence, clinical management remains challenging. Guidelines often recommend an etiology-based treatment approach, but supporting evidence is scarce, particularly for noncancer patients.</p><p><strong>Objectives: </strong>Evaluating the impact of a structured, etiology-based treatment pathway on nausea and vomiting burden and treatment quality in palliative care patients.</p><p><strong>Setting/subjects: </strong>Single-center, before-after study in adult patients on a German tertiary palliative care unit, comparing symptom burden and treatment quality before (Phase 1, 15 months) and after (Phase 2, 12 months) implementation of the pathway.</p><p><strong>Measurements: </strong>Outcome measures were change in symptom burden score on day 3 (Integrated Palliative Care Outcome Scale ([IPOS]), treatment quality (quality indicator [QI]; burden reduction on IPOS), and duration of symptoms (days). Significance level was set at α < 0.01.</p><p><strong>Results: </strong>In Phase 1, 172/330 patients (52.1%) experienced 230 episodes of nausea/vomiting, versus 139/280 patients (49.6%) with 178 episodes in Phase 2. On day 3, symptom burden scores for nausea decreased to a greater extent in Phase 2 (<i>p</i> = 0.007); vomiting showed a nonsignificant reduction (<i>p</i> = 0.021). The QI (nausea) was met in 124/178 (69.7%) versus 129/156 (82.7%) (<i>p</i> = 0.0056), and the QI (vomiting) was met in 66/93 (71.0%) versus 81/95 (85.3%) (<i>p</i> = 0.0176) episodes. Symptom duration decreased from 3 (0-25) to 2 (0-23) days (<i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>The systematic etiology-based pathway significantly improved cause identification and treatment quality. While benefits were more pronounced in cancer patients, this structured approach provides a robust framework for enhancing antiemetic management in the palliative care setting. Further studies should investigate antiemetic treatment in noncancer patients.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"1508-1516"},"PeriodicalIF":1.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148339036","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":"Where Hospice Fails Us: A Qualitative Study of Facilitators and Barriers in Transitions to Hospice According to Palliative Care Clinicians.","authors":"Morgan M Nakatani, Julia G Cohn, Kris W Herring, Thomas W LeBlanc","doi":"10.1177/10966218261469458","DOIUrl":"10.1177/10966218261469458","url":null,"abstract":"<p><strong>Background: </strong>Transitions to hospice are challenging for patients, caregivers, and health care teams, yet few studies have examined gaps in care from the perspectives of referring palliative care (PC) clinicians.</p><p><strong>Objectives: </strong>To identify facilitators and barriers in hospice transitions described by PC clinicians.</p><p><strong>Design: </strong>Qualitative study using semi-structured interviews focused on hospice transitions.</p><p><strong>Setting/subjects: </strong>Ten referring PC clinicians (physicians, advanced practice providers, and a social worker) at a large academic health center.</p><p><strong>Measurements: </strong>Interviews were transcribed and analyzed using thematic content analysis.</p><p><strong>Results: </strong>Clinicians emphasized the value of hospice and the Medicare benefit, while identifying barriers to hospice transitions. Challenges included inadequate caregiving support, limited reimbursement, uncertainty around eligibility and prognostication, and differences between for-profit and non-profit hospice agencies. These barriers contributed to inequitable access to hospice and gaps in care.</p><p><strong>Conclusions: </strong>PC clinicians identify substantial barriers to hospice transitions, underscoring the need to improve access to comprehensive end-of-life care.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"1591-1597"},"PeriodicalIF":1.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148455807","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> Involuntary Starvation for a Good Death: A Position Statement from the Taiwan Academy of Hospice Palliative Medicine.","authors":"Chih-Yuan Shih, Wan-Ting Hsieh, Jen-Kuei Peng, Yuen-Liang Lai, Ching-Yu Chen, Shih-Tzu Tsai, Shao-Yi Cheng","doi":"10.1177/10966218261456822","DOIUrl":"10.1177/10966218261456822","url":null,"abstract":"","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"1501-1502"},"PeriodicalIF":1.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148143744","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":"Early Palliative Debriefing to Mitigate Grief and Burnout in Hematology/Oncology Fellows: A Pilot Study.","authors":"Cameron Oswalt, Richard F Riedel, Andrea Sitlinger, Anthony Galanos","doi":"10.1177/10966218261483467","DOIUrl":"10.1177/10966218261483467","url":null,"abstract":"<p><p>Background/Local Problem:Oncology providers are regularly exposed to grief, contributing to rising rates of burnout in practicing oncologists and trainees. Improved supportive interventions to combat grief are necessary. One solution is utilization of palliative care expertise to facilitate debriefing sessions, which provide protected time and space to discuss emotions related to oncology practice.</p><p><strong>Methods/interventions: </strong>This pilot study aimed to evaluate how debriefing sessions led by a palliative care physician helped fellows cope with burnout and grief. Fellows at a large academic hematology/oncology program attended four debriefing sessions and completed a survey after each session. Descriptive statistics were utilized to analyze survey responses.</p><p><strong>Results: </strong>A total of 43 surveys were completed. Thirty-six respondents (83.7%) endorsed experiencing professional grief in the past 6 months; 20 respondents (46.5%) endorsed experiencing personal grief. Thirty-eight respondents (88.4%) reported that debriefing sessions provided time and space to discuss grief, with 79.1% indicating benefit after the first session. All respondents reported the desire for debriefing sessions to continue.</p><p><strong>Conclusions: </strong>Debriefing is an inexpensive solution to the problem of increasing grief and burnout in oncology trainees. These findings suggest the importance of adopting similar palliative care-led practices throughout fellowship training programs and at other levels.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"1606-1609"},"PeriodicalIF":1.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148808681","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":"Assessing Clinical Reasoning in Hospice and Palliative Medicine Fellows.","authors":"Alex Choi, Laura J Morrison, Donna M Windish","doi":"10.1177/10966218261464237","DOIUrl":"10.1177/10966218261464237","url":null,"abstract":"<p><strong>Introduction: </strong>Clinical reasoning is essential for hospice and palliative medicine (HPM) fellows, yet structured assessment tools are lacking. The Assessment of Reasoning Tool (ART) has shown positive results for early learners but has not been applied to advanced learners.</p><p><strong>Methods: </strong>We conducted an 18-month mixed-methods study at a single academic center. Seven fellows and seven faculty participated. Faculty used the ART every day during clinical teaching rounds on a fellow's inpatient rotation. Pre- and post-intervention surveys assessed the ART via 4-point Likert scale and free-response questions.</p><p><strong>Results: </strong>Fellows reported increased feedback on clinical reasoning (2.33 vs. 3.25; <i>p</i> = 0.05) and reflection on cognitive bias (2.67 vs. 2.81; <i>p</i> = 0.02), and no difference in satisfaction with feedback, comfort with clinical reasoning terminology, and time spent on feedback. Faculty reported no difference across all areas. Both groups cited time constraints and a need for clearer guidance on effective use as barriers to using the ART. Qualitative themes highlighted the ART as a diagnostic versus management reasoning tool, limited application to non-symptom-based case scenarios, and persistent faculty discomfort despite training.</p><p><strong>Conclusion: </strong>This study suggests the ART is feasible for HPM fellowship training and may enhance certain aspects of clinical reasoning assessment for fellows, particularly during early fellowship. However, its broader utility is limited by the absence of faculty-perceived benefit, persistent faculty discomfort with implementation, and the tool's emphasis on diagnostic rather than management reasoning. Further research on effective faculty development and assessment tools tailored to management reasoning would help define the optimal role of the ART in HPM training.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"1578-1582"},"PeriodicalIF":1.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148317703","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> From Silent Grief to Supported Care: Recognizing Pediatric Postmortem Care as Professional Bereavement.","authors":"Nila Zaimatus Septiana, Dwi Sri Rahayu, Santy Andrianie, Khairul Bariyyah, Binti Isrofin","doi":"10.1177/10966218261456824","DOIUrl":"10.1177/10966218261456824","url":null,"abstract":"","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"1499-1500"},"PeriodicalIF":1.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148143684","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":"How Would Hospice Use Differ if Every Medicare Beneficiary Were in Medicare Advantage?","authors":"Claire K Ankuda, Karen McKendrick, Melissa Aldridge","doi":"10.1177/10966218261464669","DOIUrl":"10.1177/10966218261464669","url":null,"abstract":"<p><strong>Background: </strong>Hospice use is higher in the growing Medicare Advantage (MA) program compared to Traditional Medicare (TM). It is uncertain if this is due to different hospice referral patterns.</p><p><strong>Objectives: </strong>To compare hospice use patterns in MA versus TM across beneficiary characteristics.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting/subjects: </strong>United States decedents in the Medicare Current Beneficiary Survey (2010-2022).</p><p><strong>Measurements: </strong>We employed a counterfactual modeling approach: among those in MA, we estimated the association between hospice use and sociodemographic, health, and regional characteristics. We then applied these coefficients to the TM population to predict hospice use had they been enrolled in MA.</p><p><strong>Results: </strong>Among 5153 decedents, 35.3% were in MA at death. Compared to TM decedents, MA decedents were younger, more likely to be Hispanic, less likely to reside in a facility, and less likely to report serious illnesses (dementia, cancer, stroke, heart disease, and lung disease). We estimated that if ^TM decedents had been enrolled in MA, hospice use would have been 6.1% higher (95% confidence interval, CI, 3.4%-8.8%) versus observed hospice use in TM. This difference was pronounced among those with higher education and serious illnesses in TM: for example, 10.1% higher for those with dementia (95% CI 6.9%-13.3%) versus without dementia (2.5% higher, 95% CI 1.2% lower-6.1% higher).</p><p><strong>Conclusions: </strong>Relative to TM, hospice use is highest among MA beneficiaries with higher education and specific serious illnesses. Future work needs to assess the drivers of this difference (e.g., palliative care, networks).</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"1549-1554"},"PeriodicalIF":1.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148338996","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":"Understanding Clinicians' Perspectives on End-of-Life Dreams and Visions: An International Survey.","authors":"Muhammad Hamza Habib, Laura Fontanesi, Zainab Yusufali Motiwala, Arzu Çöltekin, Sidharth Misra, Alasdair MacLullich, Rasita Vinay, Caroline Hertler, David Blum, Katrin Singler, Catarina Simões, Vincenza Frisardi, Virginia Boccardi, Giuseppe Bellelli, Meltem Koca, Christopher W Kerr, Christopher A Jones, Simon Peng-Keller, Mathias Schlögl","doi":"10.1177/10966218261463311","DOIUrl":"10.1177/10966218261463311","url":null,"abstract":"<p><strong>Background: </strong>End-of-life dreams and visions (ELDVs) are vivid, often subjective experiences that occur during the dying process. Even though the patient and family experiences of ELDVs are well documented, there is limited knowledge regarding the perspectives, preparedness, and perceived needs of health care professionals. ELDVs also remain insufficiently addressed in clinical care.</p><p><strong>Objective: </strong>To describe how frequently clinicians encounter ELDVs, perceived preparedness/training, and approaches to clinician and family education and communication.</p><p><strong>Methods: </strong>We conducted a survey to explore health care professional's perspectives and experiences surrounding ELDVs. The <i>Checklist for Reporting Results of internet E-Surveys</i> was followed. Our survey included 30 items across 7 sections. Professionals that take care of patients with serious or terminal illness were eligible for the study. We utilized a structured multimodal dissemination to achieve maximum diversity in participants.</p><p><strong>Results: </strong>Briefly, 247 participants were eligible for analysis. Frequent encounters for ELDVs were reported by participants. Participants perceived positive effects on patients more frequently than negative effects (W = 446.0, <i>p</i> < 0.001, r = 0.64). Clinical challenges were rated differently across categories (χ² = 160.97, <i>p</i> < 0.001, Kendall's W = 0.13). The most commonly endorsed clinical challenges were lack of institutional protocols and lack of standardized diagnostic criteria, both rated significantly higher than all other challenges (Bonferroni-corrected Wilcoxon tests: All <i>p</i> < 0.001). Participants endorsed multidisciplinary involvement and formal policy implementation.</p><p><strong>Conclusion: </strong>ELDVs are common, but clinicians feel underprepared to respond to them. There is a need for structured training and institutional protocols. Future studies should include patients and their families and analyze how their experiences are shaped by physician responses.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"1526-1534"},"PeriodicalIF":1.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148317731","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}