Journal of palliative medicine最新文献

{"title":"Behavioral-Emotional Functioning of Children of Parents with Early Compared to Advanced Cancer.","authors":"Frances Marcus Lewis, Pamela Ganschow, Deborah Manst, Heather Derry-Vick, Kenneth P Tercyak, Kristin A Griffith, Monica Oxford, Jami Fukui, V K Gadi, Farya Phillips","doi":"10.1089/jpm.2024.0326","DOIUrl":"https://doi.org/10.1089/jpm.2024.0326","url":null,"abstract":"<p><p><b><i>Background:</i></b> Parental cancer represents a substantial psychological threat to children, but little is known about the relative impact of advanced compared to early-stage cancer on children's behavioral-emotional functioning. <b><i>Objectives:</i></b> To compare the behavioral-emotional functioning in children of parents with early compared to advanced cancer. <b><i>Design:</i></b> Single occasion, two-group design with historical comparison group. <b><i>Setting/Participants:</i></b> Participants were recruited through cancer centers, oncologists, service organizations, and self-referrals in the United States. Eligible parents had advanced or early-stage cancer, a child 5-17 years old, and spoke and read English. The Child Behavior Checklist was administered to parents to assess their children's Internalizing and Externalizing Problems. Data were obtained from 236 diagnosed parents, 176 with early and 57 with advanced cancer. <b><i>Results:</i></b> Internalizing and Externalizing Problems and Anxious/Depressed Mood were significantly greater for children of parents with advanced compared to early-stage cancer, even after controlling for covariates. Differences in children's functioning were not affected by parents' anxiety, depressed mood, treatment, or measures of social determinants of health. <b><i>Conclusions:</i></b> This is the first study to systematically compare the effects of parents' stage of cancer on children's behavioral-emotional functioning while controlling for potential confounders. Results demonstrate significantly elevated levels of behavioral-emotional problems in children affected by advanced compared to early-stage cancer that were explained by parents' stage of cancer, not other sources. Future studies need to identify mutable protective and risk factors to reduce the threat of parental cancer.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673977","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":"Improving Transdermal Fentanyl Prescribing Practices Using Electronic Medical Record.","authors":"Vandana Nagpal, Emily Vlass","doi":"10.1089/jpm.2024.0480","DOIUrl":"https://doi.org/10.1089/jpm.2024.0480","url":null,"abstract":"<p><p><b><i>Background:</i></b> Transdermal (TD) fentanyl has a unique place in pain management that is not universally understood, thereby raising concerns for patient safety. This project aimed to improve TD fentanyl prescribing practices through an ordering algorithm in the electronic medical record (EMR). <b><i>Measures:</i></b> The main outcome measure was the percentage of erroneous TD fentanyl orders after EMR order implementation. <b><i>Intervention:</i></b> After a retrospective chart review to assess TD fentanyl orders, a root cause analysis led to the development and introduction of an enhanced ordering algorithm in EMR in January 2023, accompanied by pharmacy education. <b><i>Outcomes:</i></b> After the intervention, a review of TD fentanyl orders over five months showed a reduction in inappropriate ordering from 42.5% to 15.2%. <b><i>Conclusions:</i></b> Standardized EMR order sets, combined with provider education, hold promise for enhancing the quality and safety of chronic pain management with TD fentanyl.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673982","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":"Cultural Adaptation and Pilot Testing of a Basic Palliative Care Curriculum for Practicing Physicians and Nurses in Mainland China.","authors":"Xiaoyan Dai, Xiaohong Ning, Jessica Lin, Jun Jing, Bethany-Rose Daubman, Hsien Seow, Eric L Krakauer, Zhimeng Jia","doi":"10.1089/jpm.2024.0462","DOIUrl":"https://doi.org/10.1089/jpm.2024.0462","url":null,"abstract":"<p><p><b><i>Background:</i></b> To meet the growing palliative care (PC) needs of China's aging population, we culturally adapted and pilot tested an evidence-based basic PC training program for practicing clinicians. <b><i>Design:</i></b> Barrera's framework guided a multistage, surface, and deep structural adaptation of an existing course. We pilot tested the final curricula with 51 participants in September 2022. Participant demographics and postcourse satisfaction survey were descriptively analyzed. <b><i>Results:</i></b> A total of 20 nurses and 29 physicians completed the course and instruments. Majority of participants were between 31 and 50 years old (<i>n</i> = 39, 79.6%), female (<i>n</i> = 41, 83.7%), internal medicine trained (<i>n</i> = 30, 61.2%), and worked in tertiary hospitals (<i>n</i> = 47, 95.9). Most participants considered the course quality to be \"high\" or \"very high\" (<i>n</i> = 47, 95.9%). <b><i>Conclusions:</i></b> Practicing physicians and nurses in mainland China consider this culturally adapted basic PC training to be feasible and acceptable. Future studies should evaluate the effectiveness of PC training and develop strategies to overcome implementation challenges.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673980","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":"Community Health Workers and Technology Interventions' Impact on Palliative Support Globally: A Scoping Review of Randomized Controlled Trials.","authors":"Alekhya Gunturi, Margarita Pertierra, Irma Elizabeth Huayanay Espinoza, Maya Kavita Ramachandran, Mpho Ratshikana Moloko, Karl A Lorenz","doi":"10.1089/jpm.2024.0382","DOIUrl":"https://doi.org/10.1089/jpm.2024.0382","url":null,"abstract":"<p><p><b><i>Background:</i></b> Palliative care has the potential to relieve burdened global health systems but is in short supply in many low-resource settings. Community health workers (CHWs) and digital health tools/telephonic support have the potential to scale scarce palliative care resources and improve outcomes for seriously ill adults in home/community settings. <b><i>Aim:</i></b> To describe the utilization of CHWs and digital health/telephony in the palliative care of seriously ill adults in these settings. <b><i>Design:</i></b> We conducted a scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews guidelines. Search terms were developed with a health sciences librarian. <b><i>Data Sources:</i></b> The databases PubMed, EMBASE, LILACS, and CINAHL were searched for articles published from January 1, 2012, to December 30, 2023. <b><i>Results:</i></b> A total of 31 articles out of 7518 screened were included in the final analysis. Studies were mostly conducted in the United States. Most interventions were remote, with only four addressing rural or minority populations. Nineteen targeted advanced cancer, with others focusing on chronic obstructive pulmonary disease, heart failure, renal disease, and hospice care. CHWs and digital health/telephony were commonly used for physical and psychological care. Culturally tailored interventions with CHWs were few but effective. Patient quality of life, health care utilization, and caregiver outcomes were significantly impacted. <b><i>Conclusions:</i></b> CHWs and digital health/telephony can improve quality of life, health care use, and caregiver support. Most research focuses on physical and psychological aspects of care instead of cultural aspects of care. Future research is needed to explore culturally tailored interventions in minority populations and low- and middle-income countries, as well as investigate emerging remote technologies to allow for scaling palliative care into home/community settings.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670272","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":"Variability of the Analgesia Nociception Index During Painful Procedures in Noncommunicative Patients at the End of Life: A Prospective, Observational Pilot Study.","authors":"Chloé Prod'homme, Anne Wojtanowski, Mathilde Herbet, Emeline Cailliau, Licia Touzet, Claire Pasqualini, Philippe Sabot, François Puisieux, Magali Pierrat","doi":"10.1089/jpm.2024.0510","DOIUrl":"https://doi.org/10.1089/jpm.2024.0510","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Monitoring parasympathetic activity by the Analgesia Nociception Index (ANI) is reliable for assessing nociception during general anesthesia or in sedated critically ill patients. The aim of our study is to evaluate the variability of the ANI during painful procedures in noncommunicative patients at the end of life (EOL). <b><i>Methods:</i></b> This study was a blinded, prospective, observational study. Consecutive noncommunicative EOL patients were recruited from the palliative care unit. The minimum ANI score and the Critical Care Pain Observation Tool (CPOT) scale were collected before, during, and after a painful procedure. <b><i>Results:</i></b> Twenty patients were included; five were sedated. We found that ANI scores decreased significantly (<i>p</i> < 0.001) and CPOT scores increased (<i>p</i> = 0.006) during painful procedures. ANI changed more frequently than CPOT. There was no correlation between ANI and CPOT scores. <b><i>Conclusion:</i></b> In this preliminary study, we found that the ANI was effective in detecting discomfort during painful procedures at the EOL.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670197","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 a Standardized Palliative Care Pharmacist Deprescribing Assessment.","authors":"Ibtihal I Makki, Heather K Cook, Nicole Bartell, Mary Lynn McPherson, Lauren R Bangerter, Kathryn A Walker","doi":"10.1089/jpm.2024.0215","DOIUrl":"https://doi.org/10.1089/jpm.2024.0215","url":null,"abstract":"<p><p><b><i>Background:</i></b> Palliative care (PC) patients are at high risk of polypharmacy, thereby imposing a substantial burden on patients, including increased pill burden, adverse drug events, and falls. PC pharmacists play a critical role in deprescribing and aligning medications with goals of care for this population, but few studies demonstrate deprescribing opportunities. <b><i>Objectives:</i></b> The purpose of this study was to (1) summarize deprescribing opportunities among a sample of hospitalized PC patients, (2) identify patient variables associated with deprescribing opportunities, and (3) summarize deprescribing recommendations, implementation, and short-term clinical harm outcomes. <b><i>Design:</i></b> We conducted a retrospective review of the electronic health record. <b><i>Setting/Subjects:</i></b> All adult patients across six hospitals in Washington, DC, and Maryland referred to inpatient PC consultation service during the study period were included in this study. <b><i>Results:</i></b> Among 125 patients referred to the PC service, 84.5% were evaluated by a PC pharmacist for deprescribing opportunities, and 39.2% were appropriate for deprescribing. There was an average of 3.4 deprescribing recommendations made per patient. White patients and patients with higher severity of illness were significantly more likely to be deprescribing appropriately. The most commonly deprescribed medication classes were bowel regimens and electrolyte repletion, vitamins, and fluids. Deprescribing recommendations were widely accepted by inpatient primary care teams and patients and their caregivers. No short-term clinical harm was observed for patients with deprescribing recommendations implemented. <b><i>Conclusion:</i></b> Approximately two in five PC patients in this study were appropriate for deprescribing. PC pharmacists are effective at assessing and implementing deprescribing opportunities.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670274","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 Last Companion.","authors":"Diane Portman","doi":"10.1089/jpm.2025.0112","DOIUrl":"https://doi.org/10.1089/jpm.2025.0112","url":null,"abstract":"","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657553","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 Used to Feel my Child Was...the Property of the Hospital\": An Examination of an Ethic of Care for Pediatric Home-Based Hospice and Palliative Care.","authors":"Julie M Aultman, Max F Gilliland, Brianna M Bish, Steven Smith, Sarah Friebert, Daniel H Grossoehme","doi":"10.1089/jpm.2024.0358","DOIUrl":"https://doi.org/10.1089/jpm.2024.0358","url":null,"abstract":"<p><p><b><i>Background:</i></b> Home-based hospice and/or palliative care (HBHPC) is an important pediatric care modality offering continuity of care and a deeper understanding of patient and family needs. There is limited guidance to address multi-faceted approaches to care in home-based settings through a care ethics model. <b><i>Objectives:</i></b> Qualitatively examine patient and family home-based care experiences to formalize care ethics guidance for HBHPC. <b><i>Design:</i></b> Secondary thematic analysis of semi-structured, transcribed interviews (<i>n</i> = 14) of 18 participants. <b><i>Setting/Subjects:</i></b> A group of 17 family caregivers and one adolescent/young adult patient receiving HBHPC provided by two regional pediatric health systems in the United States. <b><i>Measurements:</i></b> Three stages of thematic analysis were conducted: line-by-line coding of text, descriptive theme development, and analytic theme generation. <b><i>Results:</i></b> Transcripts from 18 participants (88% female; 12% male) were analyzed. Four descriptive themes were generated through deductive analysis: relationships; home health environment; ways of caring; and values. Several analytic themes (<i>n</i> = 22) and sub-themes (<i>n</i> = 90) emerged and provided contextual meaning centered on a care ethic. <b><i>Conclusion:</i></b> A care ethic model is present in HBHPC experiences and, with validation, can offer guidance in the acknowledgment and delivery of care among professional and family caregivers.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649383","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 Dysphagia and Adult Swallowing Interventions in Serious Illness.","authors":"Sanora Yonan, Taylor Wilde, Alexa Rogers, Kelly J Trumpatori, Kristie Calix, Christina Barnes, Terri Durkin, Eric Mecusker, Christopher A Jones, Caitlyn M Moore, Laura Chahda, Amanda Stead, Lisa A LaGorio, Paula Leslie","doi":"10.1089/jpm.2025.0119","DOIUrl":"https://doi.org/10.1089/jpm.2025.0119","url":null,"abstract":"<p><p>This article highlights the important role of speech-language pathologists (SLPs) in palliative care (PC), emphasizing their contribution to supporting people with eating, drinking, and swallowing difficulties during serious illnesses and at the end of life. The recommendations underscore the necessity of interdisciplinary collaboration among SLPs and other PC team members, the importance of patient and caregiver education, and the application of patient-centered, comfort-focused approaches to dysphagia intervention. Drawing on current research and expert insights, this article explores the use of SLP services in PC, as well as the challenges in supporting people with eating and drinking difficulties in advanced stages of illness, embedded with practical tips for clinicians.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623405","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":"Now, the War Is Finally Over for Him: Memory, War, and Grief.","authors":"J Scott Janssen","doi":"10.1089/jpm.2025.0080","DOIUrl":"https://doi.org/10.1089/jpm.2025.0080","url":null,"abstract":"","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623403","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}