Journal of palliative medicine最新文献

{"title":"\"We Talk About Everything\": Experiences with Digital Health Communication in Palliative Care.","authors":"Sarah Nouri, Courtney R Lyles, Carly Zapata, Roman Martinez, Jasmine Gonzalez, Vincent Le, Yidi Wang, Mara Quinn, Carrie Huang, Claudia Perez-Vaughan, Steven Z Pantilat, Christine S Ritchie, Rebecca L Sudore","doi":"10.1177/10966218261449634","DOIUrl":"10.1177/10966218261449634","url":null,"abstract":"<p><strong>Background: </strong>Use of digital communication tools (e.g., telehealth, patient portals) is increasing in outpatient palliative care (OPC).</p><p><strong>Objective: </strong>Assess patient/caregiver experiences with digital communication tools.</p><p><strong>Design: </strong>Qualitative.</p><p><strong>Setting/subjects: </strong>Inclusion criteria were age ≥18 years, English/Spanish/Cantonese-speaking, and ≥1 telehealth OPC visit in the prior year. If patients could not converse by phone, we interviewed their caregivers.</p><p><strong>Measures: </strong>We developed an interview guide using the Capability-Opportunity-Motivation-Behavior framework. We analyzed semi-structured interviews using thematic analysis.</p><p><strong>Results: </strong>Among 32 participants, 10 were caregivers, 11 Spanish-speaking, 9 Cantonese-speaking. Theme 1: Video and in-person visits have important and distinct roles. Theme 2: Establishing a trusting rapport over video is possible. Theme 3: Engagement can be high with the patient portal despite poor usability.</p><p><strong>Conclusions: </strong>A flexible approach offering both video and in-person visits is ideal. Usability is a key factor in patient portal engagement. Our findings underscore the need to advocate for a permanent Medicare telehealth extension.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"1271-1277"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838937","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 Cross-Sectional Street Survey Examining a Preference for Truth-Telling in Serious Illness and End-of-Life in Maputo City Province.","authors":"Layne DeAnn Heller, Mary Lynn McPherson, Patricia Wright, Eve Namisango, Janet McCord, Carla Alexander, John Cagle","doi":"10.1177/10966218261451674","DOIUrl":"10.1177/10966218261451674","url":null,"abstract":"<p><strong>Background: </strong>Little is known about how Mozambicans feel about end-of-life preferences, especially their preferences for truth-telling in serious illness.</p><p><strong>Aim: </strong>To understand the end-of-life preferences and priorities of Mozambicans in Maputo City Province and their preferences for truth-telling in serious illness.</p><p><strong>Design: </strong>A face-to-face community-based street survey was performed with Mozambican nationals, aged ≥18, and fluent in Portuguese.</p><p><strong>Methods: </strong>Using convenience sampling, structured interviews investigated preferences in a hypothetical scenario of serious illness such as cancer. Descriptive analysis examined variations. General data were collected about illness understanding/steps in treatment, experiences/preferences with death, preferences in decision making, and end-of-life priorities.</p><p><strong>Setting/participants: </strong>The sample (<i>n</i> = 397) was stratified by province, age, and gender. Participants were from five districts of Maputo City Province.</p><p><strong>Results: </strong>The primary analysis was truth-telling. Binary logistic regression analyses were performed to explore the influence of age, gender, education, religion, and ethnicity on preferences for truth-telling. There was a statistically significant association with higher education and all variables examined: assessing the association between education/religion and the preference for truth-telling over all other responses (OR = 3.6, <i>p</i> = 0.002), as well as, education/religion and the preference of truth-telling to the individual, versus family (OR = 3.627, <i>p</i> = 0.020), and the association between education/ethnicity and the preference of telling-telling to the individual, not family (OR = 3.832, <i>p</i> = 0.015). Catholics were more likely to desire truth-telling to the individual versus family (OR = 2.975, <i>p</i> = 0.042).</p><p><strong>Conclusions: </strong>Those with higher education and Christian religion were more likely to desire doctors to tell the truth about diagnosis.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"1262-1270"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148031847","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":"Scholarly Skills Series: How to Succeed in Writing Case Reports.","authors":"Ashima Lal, Emily Pinto Taylor, Dio Kavalieratos, Gregg A Robbins-Welty","doi":"10.1177/10966218261465073","DOIUrl":"10.1177/10966218261465073","url":null,"abstract":"<p><p>Case reports serve an important entry point for scholarship in palliative care (PC), yet many clinicians lack a practical roadmap for moving from an interesting encounter to a publishable article. In this inaugural article for the <i>Journal of Palliative Medicine</i> \"Scholarly Skills Series,\" we provide a concise, replicable framework for writing case reports with a PC lens. We focus on the PC adaptation of the CAse Report (CARE) guidelines while providing a structured three-phase framework. Organized into a \"Before, During, After\" structure, we outline key steps and common pitfalls, including selecting a publishable case, establishing authorship roles, obtaining informed consent, conducting a literature search, and framing the report using the CARE guidelines. We offer pragmatic guidance on article construction, journal targeting, submission logistics, and navigating revision, rejection, and resubmission. A summary table of \"Do's and Don'ts\" highlights actionable practices to streamline the process and improve the likelihood of publication. This guide is designed for those seeking a standardized approach that supports academic development, team-based and trainee scholarship, and dissemination of clinically meaningful lessons in serious illness care to positively impact patient care outcomes.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"1195-1200"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148405087","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 Intentionally Interprofessional Collaboration.","authors":"Michelle M Milic, DorAnne Donesky, Naomi Tzril Saks, Rebecca Cammy, Constance Dahlin, Susan DeSanto-Madeya, Tracy Fasolino, Seiko Izumi, Amanda Kirkpatrick, Joshua R Lakin, Vickie Leff, Kashelle Lockman, Jennifer Walter, William E Rosa, Cara L Wallace","doi":"10.1177/10966218251374425","DOIUrl":"10.1177/10966218251374425","url":null,"abstract":"<p><p>Although high-quality and holistic specialty palliative care is delivered by an interprofessional team, little guidance is available to optimize approaches to and sustainment of such teamwork. This article supports individuals to practice at the top of their education, clinical training, and scope of practice while maximizing the functionality of the palliative care team as a whole. We intentionally use the term <i>interprofessional</i> rather than <i>interdisciplinary</i> to clarify that we are focused on collaboration of team members who represent multiple professions or occupations that require specialized training and meet ethical standards (e.g., nursing, chaplaincy, social work, medicine, and pharmacy) rather than interactions among specific fields of study (e.g., cardiology, nephrology, and oncology). Synthesized from current data and best practices elicited from an interprofessional author team of palliative specialists, these ten tips aim to bolster collaboration, integration, and communication among palliative care team members, community providers, and referral sources. Topics are relevant for all teams across practice settings to promote and advance integrated teamwork, patient care, leadership, and research.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"1303-1311"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033577","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 Surrogates Disagree #532.","authors":"Calvin Gross, Elizabeth Gorman, Robert Arnold","doi":"10.1177/10966218261441687","DOIUrl":"10.1177/10966218261441687","url":null,"abstract":"","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"1331-1332"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147654391","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":"Implementation of Structured Oncologist Communication Skills Training within the Improving Goal Concordant Care Initiative: Lessons Learned and Future Progress.","authors":"Sahana Rajasekhara, Heather N Bitar, Elizabeth T Loggers, Kavitha Norton, Christine Sam, Amy A Case, James A Tulsky, Marcin Chwistek, Andrew S Epstein, Steven R Grossman, Judith E Nelson, Nico Nortjé, Joseph Papio, Peter Phung, Jack Kolosky, Kristen McNiff Landrum","doi":"10.1177/10966218261449540","DOIUrl":"10.1177/10966218261449540","url":null,"abstract":"<p><strong>Purpose: </strong>Effective communication about goals of care is critical in oncology but limited by insufficient training and system barriers. As part of a multicomponent intervention, the Improving Goal Concordant Care (IGCC) initiative aimed to implement structured communication skills training (CST) for oncology clinicians. This study reports on the implementation and evaluation of CST across 10 dedicated cancer centers.</p><p><strong>Patients and methods: </strong>IGCC was a collaborative improvement project led by the Alliance of Dedicated Cancer Centers between 2020 and 2023. Centers selected or developed CST programs meeting IGCC criteria and adapted local implementation and enabling strategies. The primary measure was the percentage of eligible oncology clinicians completing CST (target ≥65%). Post-training evaluation and training impact surveys assessed clinicians' experience and perceived benefit of CST.</p><p><strong>Results: </strong>Nine centers completed CST implementation, training 2271 of 2841 eligible clinicians (80%). CST completion rates at all but one site exceeded the target, as did rates for medical oncologists, hematological oncologists, and advanced practice providers. CST completion was higher when incentives or mandates were used. Post-training evaluations showed high satisfaction with aggregated top-box scores of 93% for training quality, 94% for recommending to colleagues, and 94% for likelihood to use skills. Training impact surveys administered 6-12 months after training suggested improved self-efficacy and reduced distress, with a strong correlation between self-efficacy improvement and distress reduction.</p><p><strong>Conclusions: </strong>IGCC demonstrated that CST can be effectively scaled across cancer centers and positively impact trained clinicians. Successful uptake was supported by leadership engagement, incentives, and mandates, while barriers included leadership transitions, time and resource constraints, and competing priorities. CST is a core component for advancing goal-concordant care.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"1214-1221"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839223","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 Patient-Oncologist Language Concordance on the Quality of End-of-Life Care.","authors":"Katherine Yoh, Lielle R Yellin, Joel Agarwal, Patricia Finnegan, Reena M Vattakalam, Alexandre Buckley De Meritens, Shayan Dioun, Thomas C Randall, Tarah Pua, Caryn M St Clair, Jason D Wright, June Y Hou","doi":"10.1177/10966218261449553","DOIUrl":"10.1177/10966218261449553","url":null,"abstract":"<p><strong>Objective: </strong>To compare end-of-life (EOL) care quality indicators for patients with gynecologic malignancies whose primary oncologist spoke their preferred language (language-concordant care) versus those who did not (language-discordant care).</p><p><strong>Methods: </strong>We conducted a retrospective chart review of patients with gynecologic malignancies who died between March 1, 2020, and May 30, 2024. The primary outcome was performance on National Quality Forum (NQF) quality indicators, a composite of six measures of aggressive EOL care. We used multivariable logistic regression to examine associations between language-discordant care and aggressive EOL care, adjusting for age, insurance status, and cancer stage at diagnosis.</p><p><strong>Results: </strong>Briefly, 83 patients met inclusion criteria; 60 (72.3%) received care from a language-concordant oncologist and 23 (27.7%) from a language-discordant oncologist. Discordant patients were more likely to identify as Hispanic or Asian and to have Medicaid insurance. Aggressive EOL care, defined as an NQF score ≥1, occurred in 87.0% of discordant patients compared with 60.0% of concordant patients (<i>p</i> = 0.0174). After adjusting for age, insurance, and cancer stage, language-discordant care was associated with more than six-fold higher odds of aggressive EOL care (adjusted odds ratios: 6.05, 95% confidence intervals: 1.38-26.53).</p><p><strong>Conclusion: </strong>Language discordance between patients and oncologists was associated with greater likelihood of aggressive EOL care in gynecologic oncology. Addressing language barriers is essential to improving equity and aligning care with patients' goals at the end of life.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"1222-1227"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147973210","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":"Evaluating the Performance of Large Language Models on Palliative Care Test Questions: A Mixed Methods Study.","authors":"Isaac S Chua, Yen-Ting Lo, David Liu, Marc D Succi, Mark Zhang, Jonathan Yeh, Lara M Skarf, Kathleen Doyle, Daniel A Gundersen, Emanuele Mazzola, David W Bates","doi":"10.1177/10966218261456817","DOIUrl":"10.1177/10966218261456817","url":null,"abstract":"<p><strong>Background: </strong>Little is known about large language model (LLM) performance on palliative care (PC)-related knowledge-based tasks. We evaluated two LLMs in answering PC-related test questions and explaining their answer choice rationale.</p><p><strong>Methods: </strong>LLMs were prompted to answer 25 randomly selected questions from the <i>Fast Facts Quiz</i> and provide their answer choice rationale. Three PC educators ranked and rated LLM-generated answer choice explanations versus the test's answer key explanations. Linear fixed-effect models evaluated reviewer ranking, and ordinal logistic regression evaluated reviewer ratings of quality, suitability, accuracy, relevance, and comprehensiveness.</p><p><strong>Results: </strong>Both LLMs answered 96% of selected questions correctly. Reviewers rated LLM-generated explanations more highly than <i>Fast Facts Quiz</i> explanations. Five themes emerged from reviewer comments: perceived inaccuracies, clarity of writing, educational value, linguistic style, and miscellaneous.</p><p><strong>Conclusions: </strong>LLMs demonstrated high answer choice accuracy and generated preferable answer explanations when compared to the <i>Fast Facts Quiz</i> answer key.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"1282-1286"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148150185","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":"Racially and Ethnically Marginalized Patients' Perspectives on Nurse-Led Serious Illness Conversations.","authors":"Masami Tabata-Kelly, Christina Sheu, Amy L Bulger, Mengyuan Ruan, Karen Bullock, Tamryn F Gray, Barbara J Healy, Lisa Wichmann, Rachelle E Bernacki","doi":"10.1177/10966218261451051","DOIUrl":"10.1177/10966218261451051","url":null,"abstract":"<p><strong>Background: </strong>Although racial and ethnic disparities in serious illness conversations have been documented, the experiences of racially and ethnically marginalized patients in nurse-led conversations remain underexplored.</p><p><strong>Aim: </strong>To explore racially and ethnically marginalized patients' experiences of nurse-led serious illness conversations and their engagement in discussions about goals and future care.</p><p><strong>Design: </strong>A mixed-methods convergent study using surveys and semi-structured interviews.</p><p><strong>Setting/participants: </strong>Racially and ethnically marginalized patients ≥18 years old from a single U.S. health care system.</p><p><strong>Measurements: </strong>The Advance Care Planning Engagement Survey, Serious Illness Conversation Patient Experience Survey, and semi-structured interviews.</p><p><strong>Results: </strong>Fifteen patients participated in the study. Participants felt confident engaging in advance care planning (mean: 4.35/5.00) but were less ready to act (mean: 3.40/5.00). Nearly half reported that nurse-led serious illness conversations increased hopefulness about their quality of life, closeness with the nurse, sense of control over medical decisions, and understanding of their future health. The mean \"heard and understood\" score was 3.00, indicating that nurse-led conversations moderately helped participants feel heard and understood. Integrated analysis showed that nurse-led serious illness conversations supported participants feel comfortable and confident engaging in discussions about their goals and future care. Nurse-led conversations also helped foster a better understanding of participants' future health. However, confidence did not translate into readiness in the context of multifaceted distress.</p><p><strong>Discussion: </strong>Nurse-led serious illness conversations facilitated greater confidence among racially and ethnically marginalized patients to discuss their goals and future care and fostered understanding of their future health; however, additional support is needed to address multifaceted distress affecting readiness.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"1240-1250"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148031666","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 Electronic Health Record-Assisted Patient Safety Intervention to Identify Missing Code Status Orders in Patients with Prior Do-not-Attempt-Resuscitation or Partial Code Status.","authors":"Emily Jacobson, Alex Harris, Shuo Tian, Sachita Shrestha, Melinda Seiler, Rafina Khateeb","doi":"10.1177/10966218261463864","DOIUrl":"10.1177/10966218261463864","url":null,"abstract":"<p><strong>Background: </strong>Hospitalized patients with serious illnesses often lack code status documentation, increasing the risk of goal-discordant care during hospitalization.</p><p><strong>Local problem: </strong>Patients with a prior preference for do-not-attempt-resuscitation (DNAR) sometimes lacked a code status order during subsequent encounters, creating a patient safety risk of undesired resuscitation in the event of cardiac arrest.</p><p><strong>Intervention: </strong>In May 2025, we developed an electronic health record (EHR) alert to prompt code status discussion for hospitalized medicine patients with prior DNAR or partial code.</p><p><strong>Methods: </strong>We compared the proportion of patients with active code status during admission and timing of order before and after intervention.</p><p><strong>Results: </strong>Of 713 patients with prior DNAR or partial code status, the percentage with an active code status order increased following implementation (96.4% vs. 89.6%, <i>p</i> < 0.001). Only 6.1% of code status orders were placed within five minutes of alert. Median time from admission to first order increased post-implementation (eight vs. seven hours, <i>p</i> = 0.03).</p><p><strong>Conclusions: </strong>An EHR alert to prompt code status discussions in patients with prior DNAR or partial code status increased code status order documentation. Further studies could explore expanding alerts to other services and assessing impact on goal-concordant care.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"1298-1302"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148317747","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}