Journal of palliative medicine最新文献

{"title":"Sustained Effect of Serious Illness Communication Skills Training on Clinicians' Self-Preparedness in Brain-Death Organ Donation Decision-Making.","authors":"Masaaki Matsuo, Kaori Ito, Misuzu Yuasa, Saaya Morton, Shunichi Nakagawa, Eriko Onishi, Takeshi Uemura, Kei Ouchi","doi":"10.1177/10966218251380477","DOIUrl":"https://doi.org/10.1177/10966218251380477","url":null,"abstract":"<p><p><b><i>Background:</i></b> Clinicians in Japan often report difficulty communicating with families about brain-death organ donation, which may contribute to challenges in supporting families' decision-making at the end of life. <b><i>Objectives:</i></b> To evaluate the impact of a structured serious illness communication workshop on clinicians' self-reported preparedness to engage in donation-related conversations. <b><i>Design:</i></b> Prospective single-arm educational intervention with repeated measures. <b><i>Setting/Subjects:</i></b> Two synchronous web-based workshops were conducted with physicians and nurses from various departments across 13 hospitals in Japan. A total of 58 clinicians participated, and 44 (76%) completed all three surveys. <b><i>Measurements:</i></b> Self-preparedness for the 12 core communication tasks was assessed using a five-point Likert scale at baseline, immediately after the course, and 8 weeks later. Repeated-measures ANOVA and Bonferroni-adjusted paired <i>t</i>-tests were used to assess changes over time. <b><i>Results:</i></b> Preparedness scores improved significantly across all domains immediately after the course (mean increase: 0.48-1.00; all <i>p</i> < 0.01) and were sustained at 8 weeks. In particular, self-perceived preparedness to discuss brain-death organ donation improved from a mean of 2.4 at baseline to 3.3 post-course (<i>p</i> < 0.001) and remained stable at follow-up. <b><i>Conclusions:</i></b> A virtual communication workshop significantly and durably enhanced Japanese clinicians' preparedness to engage in brain-death organ donation discussions. Incorporating such training in clinical education may improve the quality and frequency of end-of-life communication.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145113376","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 Intersection of Indigenous Peoples in Canada and Medical Assistance in Dying: A Scoping Review of the Current Literature.","authors":"Nancy Paris Rosen, Grant Bae, Patricia Farrugia, Laura Banfield","doi":"10.1177/10966218251372355","DOIUrl":"https://doi.org/10.1177/10966218251372355","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Medical assistance in dying (MAID) was legalized in Canada in 2016, creating a significant shift in end-of-life care. However, Indigenous populations face unique challenges with MAID due to historical mistreatment, cultural differences, and systemic barriers within the health care system. <b><i>Objectives:</i></b> By means of this scoping review, we identify the critical gap in understanding Indigenous experiences with MAID. We also seek to identify barriers and facilitators to providing culturally appropriate care and to incorporate Indigenous perspectives into MAID policies and practices. <b><i>Results:</i></b> We identified key themes, including the need for cultural sensitivity and safety, the importance of community and family involvement, communication barriers, and policy and legislative considerations. <b><i>Future Directions:</i></b> From our findings, we highlight the necessity of engaging Indigenous communities in developing MAID services to ensure they are culturally appropriate and respectful. Addressing these needs is essential to providing respectful end-of-life care for Indigenous peoples in Canada. We also highlight significant gaps in the literature and the urgent need for further research to ensure that MAID services are culturally appropriate and aligned with Indigenous values and needs. <b><i>Definition:</i></b> In this article, the term \"Indigenous peoples\" refers to the original peoples of North America and their descendants. The Canadian Constitution recognizes three distinct groups of Indigenous peoples: First Nations, Inuit, and Métis.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091835","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":"Taking Care of Patients with a Live Hospice Discharge #521.","authors":"Ankita Mehta, Cara L Wallace, Patrick White, Robert M Arnold","doi":"10.1177/10966218251382001","DOIUrl":"https://doi.org/10.1177/10966218251382001","url":null,"abstract":"","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091818","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":"Patient Needs and Palliative Care Psychosocial Interventions among a Primarily Hispanic Hepatology Clinic Population at a Large Public Hospital: A Qualitative Chart Review.","authors":"Susan Enguidanos, Zachary Song, Mekiayla Singleton, Alicia Flores, Aaron D Storms, Carin van Zyl","doi":"10.1177/10966218251379989","DOIUrl":"https://doi.org/10.1177/10966218251379989","url":null,"abstract":"<p><p><b><i>Background and Aims:</i></b> Advanced liver disease is the ninth leading cause of death in the United States and the seventh leading cause of death among Hispanic individuals. This study aimed to identify the needs of a predominantly Hispanic patient population with advanced liver disease and the social work interventions provided as part of a palliative care team intervention integrated within a hepatology clinic at a large urban public hospital. <b><i>Methods:</i></b> We conducted a retrospective qualitative analysis of palliative care social work medical record entries from a palliative care intervention embedded in a hepatology clinic in the United States. The palliative care social worker was the primary person responsible for the provision of follow-up and case management of patients. Using content analysis, three researchers coded the data; two members of the research team each coded half of the patient records, while the third researcher coded all patient records. Researchers met to reconcile codes and identify themes. <b><i>Results:</i></b> Patient stressors included physical symptoms, financial hardship, and challenges related to immigration status. Palliative care psychosocial interventions included psychosocial counseling, end-of-life care planning, social service referrals, substance use support, and help navigating the health care system. <b><i>Conclusions:</i></b> Findings illustrate the complex interplay between social determinants of health and disease management for Hispanic patients with advanced liver disease as well as the role of palliative care in providing tailored psychosocial and medical support.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091542","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>Corrigendum to:</i> Top Ten Tips Palliative Care Clinicians Should Know About the Future of Artificial Intelligence.","authors":"","doi":"10.1177/10966218251380248","DOIUrl":"https://doi.org/10.1177/10966218251380248","url":null,"abstract":"","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091605","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":"Characterizing Interdisciplinary U.S. Hospice Clinician Presence During Patient Self-Administration of Medical Aid in Dying Medication.","authors":"Todd D Becker, Denae J Gerasta, Grant Yoder, Daniel D Matlock, Elissa Kozlov, Stacy M Fischer, Karla T Washington","doi":"10.1177/10966218251378209","DOIUrl":"https://doi.org/10.1177/10966218251378209","url":null,"abstract":"<p><p><b><i>Background:</i></b> Despite emerging as a clinical and scholarly focus in medical aid in dying (MAID)-related care, limited data exist to characterize hospice clinician presence while patients self-administer the medication to hasten their death. <b><i>Objectives:</i></b> To explore (1) the proportion and (2) correlates of interdisciplinary hospice clinician presence during patient self-administration of MAID medication. <b><i>Design:</i></b> Exploratory secondary analysis of cross-sectional survey data. <b><i>Setting/Subjects:</i></b> Convenience sample of interdisciplinary U.S. hospice clinicians reporting permissive state and organizational MAID policy. <b><i>Measurements:</i></b> We assessed the proportion of the sample ever having been present during patient self-administration of MAID medication via frequency and percentage. We examined personal, professional, organizational, and MAID-specific characteristics as correlates via multiple logistic regression analysis adjusted for small sample bias. <b><i>Results:</i></b> Our sample included 100 hospice physicians, nurses, social workers, and chaplains. Descriptive results revealed that just over one-third of the sample had ever been present during patient self-administration of MAID medication. Regression results indicated that being a chaplain and working for a hospice with a policy permitting full MAID participation were each significantly associated with greater odds of ever having been present. Conversely, never having provided end-of-life care beyond information provision related to a hospice patient's use of MAID was significantly associated with lower odds of ever having been present. <b><i>Conclusions:</i></b> Hospice clinician presence during patient self-administration of MAID medication appears relatively common and related to select professional, organizational, and MAID-specific characteristics. Improved annual state reporting practices and expanded replication efforts are warranted.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145075178","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":"Increase in Hospice Agency Providers as Primary Hospice Attending: A Five-Year Retrospective Chart Review.","authors":"Mary Onderdonk, Adam Herman, Erin Klinkman","doi":"10.1177/10966218251379992","DOIUrl":"https://doi.org/10.1177/10966218251379992","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> The hospice attending physician plays an essential role in the management and delivery of hospice care. In this role, the attending physician is chosen by the patient or health care surrogate and is a resource regarding the patient's medical condition and needs. Nurse practitioners and physician assistants may also act in this capacity. Research recognizes the importance of the relationship between the patient and hospice attending through the end of life, but often the hospice attending role is filled by an attending from the hospice agency who generally does not have a prior relationship with the patient. <b><i>Methods:</i></b> We conducted a retrospective chart review for all patients enrolled in Rochester Regional Hospice (RRH) Care from 2020 to 2024 in Rochester, New York. <b><i>Results:</i></b> We conducted a comprehensive review of 12,328 hospice admissions from 2020 to 2024, encompassing patients receiving both routine and inpatient hospice care, with no exclusions applied. The annual average admissions totaled 2465. Over this five-year period, hospice admissions electing to use hospice agency providers as their primary attending physicians increased by 26.7%, indicating a significant upward trend in this care model. <b><i>Conclusions:</i></b> The results demonstrate a consistent increase in patients choosing hospice agency physicians as their primary hospice attending providers. Further investigation is warranted to identify the factors influencing this selection and to better understand its implications for hospice care delivery.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145075198","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 Cost-Effectiveness of the Cancer Home-Life Intervention: An Economic Evaluation Alongside a Randomized Clinical Trial with a Six-Month Time Frame.","authors":"Lisa Gregersen Oestergaard, Karen la Cour, Line Elisabeth Lindahl-Jacobsen, Åse Brandt, Marc Sampedro Pilegaard","doi":"10.1177/10966218251374527","DOIUrl":"https://doi.org/10.1177/10966218251374527","url":null,"abstract":"<p><p><b><i>Background:</i></b> People with advanced cancer often face significant challenges in everyday activities, especially within their home environments, where they spend most of their time. The Cancer Home-Life Intervention is an occupational therapy-based program supporting everyday activities in people with advanced cancer living at home. <b><i>Aim:</i></b> To examine the cost-utility and cost-effectiveness of the Cancer Home-Life Intervention compared to usual care over six months. <b><i>Methods:</i></b> This economic evaluation with a societal perspective was conducted alongside a randomized controlled trial (ClinicalTrials.gov: NCT02356627). Quality-adjusted life years (QALYs) and activities of daily living motor ability accounted for the outcome. Costs included primary and secondary health care, domestic care, assistive devices, and participants' out-of-pocket costs. A total of 242 adults with advanced cancer were included from two Danish University Hospitals and randomized 1:1 to the Cancer Home-Life Intervention or usual care. Primary analysis included 172 participants alive at six months follow-up. <b><i>Results:</i></b> The intervention showed no statistically significant improvement in either QALYs or activities of daily living motor ability compared to usual care. However, the cost-utility analysis revealed a 72% probability of the intervention being cost-effective, regardless of the willingness-to-pay threshold per QALY gained. The probability of cost-effectiveness for activities of daily living motor ability started at 26% and increased to 58%. Sensitivity analyses supported these findings. <b><i>Conclusion:</i></b> The Cancer Home-Life Intervention showed limited potential for cost-effectiveness compared to usual practice. The cost-utility analysis revealed a 72% probability of cost-effectiveness. However, these findings should be interpreted cautiously due to small, nonstatistically significant improvements in QALYs.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069784","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":"Body Positioning for Dyspnea in Patients with Cancer with Unilateral Pleural Effusion: A Pilot Trial.","authors":"Jun Kako, Yoshinobu Matsuda, Tomoo Ikari, Kozue Suzuki, Ryo Tachikawa, Yoshihisa Matsumoto, Satoru Miwa, Masanori Mori, Tetsu Kobayashi, Hajime Fujimoto, Atsushi Tomaru, Hitoshi Sumitani, Akira Inoue, Rintaro Koike, Shota Kobayashi, Shunsuke Oyamada, Keisuke Ariyoshi, Takashi Yamaguchi","doi":"10.1177/10966218251377535","DOIUrl":"https://doi.org/10.1177/10966218251377535","url":null,"abstract":"<p><p><b><i>Background:</i></b> Dyspnea is common in advanced cancer, especially with unilateral pleural effusion. Lateral positioning is widely used, but evidence of effectiveness is limited. <b><i>Objectives:</i></b> To assess the feasibility and short-term effects of affected-side-down (PLEUR-DOWN) versus affected-side-up (PLEUR-UP) positioning for dyspnea relief. <b><i>Design:</i></b> Multicenter randomized crossover pilot trial. <b><i>Setting/Subjects:</i></b> Ten patients with cancer with dyspnea were enrolled at seven hospitals in Japan. <b><i>Methods:</i></b> Patients (numerical rating scale [NRS] ≥ 3) were randomized to two sequences. Each position was maintained for five minutes within a washout period. The primary outcome was feasibility, assessed by completion, absence of carryover/period effects, and adherence. Secondary outcomes included NRS changes, patient preference, and safety. <b><i>Results:</i></b> All patients completed the trial. No significant carryover (<i>p</i> = 0.57) or period effects (<i>p</i> = 0.25) were found. Mean NRS difference favored PLEUR-DOWN (-0.9; <i>p</i> = 0.34). Half preferred PLEUR-DOWN. No adverse events occurred. <b><i>Conclusions:</i></b> The trial confirmed feasibility and supports further research.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145075127","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":"Examining Public-Facing Hospice Medical Aid in Dying Participation Policies in Legalizing U.S. Jurisdictions.","authors":"Todd D Becker, Paul Duberstein, Elizabeth A Luth, Sanjana Kumar, Samuel Nemeth, Kira Phillips, Veda Kota, Elissa Kozlov","doi":"10.1177/10966218251377534","DOIUrl":"https://doi.org/10.1177/10966218251377534","url":null,"abstract":"<p><p><b><i>Background:</i></b> Nearly 9 in 10 patients in the United States who use medical aid in dying (MAID) are enrolled in hospice. Jurisdictions have increasingly mandated that health organizations publicly report their MAID participation policies. Yet comprehensive examination of the prevalence and characteristics of public-facing MAID policies in U.S. hospice providers is lacking. <b><i>Objective:</i></b> The objective of this study was to comprehensively characterize the availability and content of hospices' public-facing MAID participation policies in the 11 U.S. jurisdictions where MAID is legal. <b><i>Design:</i></b> We adopted a cross-sectional design. <b><i>Setting/Subjects:</i></b> We used the Centers for Medicare & Medicaid Services' Hospice - General Information data set to identify Medicare-certified hospices in all 11 U.S. jurisdictions where MAID is legal. <b><i>Measurements:</i></b> Policy availability was assessed via the presence or absence of online hospice MAID participation policies. Policy content was extracted to identify and subsequently categorize clinical domains of MAID participation. <b><i>Results:</i></b> Only 39 of 724 hospices (5.4%) published a public-facing MAID participation policy. Policy availability was low even within the two jurisdictions mandating hospice online publication (0 of 52 from New Mexico [0.0%]; 14 of 389 from California [3.6%]). Moreover, even when published, policy content was highly variable and often too vague to discern which MAID-related activities were permitted. For instance, 18 of 39 policies (46.2%) did not report whether or not physicians were permitted to prescribe MAID medication. <b><i>Conclusions:</i></b> The lack of availability and specificity in hospices' public-facing MAID participation policies may jeopardize patient access to legal end-of-life care options. Irrespective of jurisdictional mandates, greater organizational transparency is needed to support informed decision making.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033519","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}