Journal of palliative medicine最新文献

{"title":"Palliative Care Screening Without Consultation: An Implementation Gap in Geriatric Emergency Department Palliative Care Screening.","authors":"Lindsey Yourman, Nicholas Tom, Jennifer Clay, Marielle Bolano, Vaishal Tolia, Kyle Edmonds","doi":"10.1177/10966218261496668","DOIUrl":"https://doi.org/10.1177/10966218261496668","url":null,"abstract":"<p><strong>Context: </strong>The Palliative Care and Rapid Emergency Screening (P-CaRES) tool identifies emergency department (ED) patients with unmet palliative care needs. Whether a documented positive screen changes consultation when no referral pathway is attached has not been reported.</p><p><strong>Objectives: </strong>To describe inpatient specialty palliative care consultation after P-CaRES screening in a geriatric ED where results generated no alert, order set, or referral.</p><p><strong>Methods: </strong>Retrospective cohort study of patients 65+ screened with P-CaRES from 2019 to 2024, comparing P-CaRES-positive and -negative patients; the primary outcome was inpatient specialty palliative care consultation.</p><p><strong>Results: </strong>Of 421 patients, 115 (27.3%) screened positive; they were older with longer hospitalizations. Consultation rates were nearly identical between positive and negative patients (13.9% vs. 13.7%, <i>p</i> = 1.00).</p><p><strong>Conclusion: </strong>P-CaRES identified older adults with serious illness but showed no meaningful difference in consultation (95% confidence interval [CI] excluded differences >8 points), indicating that a passively documented positive screen was not associated with specialty consultation.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"10966218261496668"},"PeriodicalIF":1.8,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149171068","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":"Ambivalence: Motivational Interviewing Informed Communication for Serious Illness Care.","authors":"Mike Polisso, Danielle Chammas, Caroline Nattinger, Keri O Brenner, Jennifer DiBiase, Sarah Byrne-Martelli, Brianna Williamson","doi":"10.1177/10966218261492375","DOIUrl":"https://doi.org/10.1177/10966218261492375","url":null,"abstract":"<p><p>Patients facing serious illness may experience ambivalence about important treatment decisions, sharing information with loved ones, or, perhaps most consequentially, living in a way that is aligned with their values. Motivational interviewing (MI) is a collaborative, person-centered communication style that explores ambivalence by eliciting a patient's motivations, values, and goals. MI offers a practical framework for serious illness communication (SIC), when patients and families often experience competing priorities and uncertainty. Through a clinical case, this article explores the four fundamental processes of MI-engaging, focusing, evoking, and planning-and reframes these concepts through a SIC lens. We highlight the application and adaptation of micro-skills (open-ended questions, affirmations, reflective listening, and summaries) to deepen understanding, explore ambivalence, and support values-concordant decision making. Integrating MI-informed communication strategies into serious illness care provides clinicians with practical tools to navigate ambivalence, foster collaboration, and evoke a patient's intrinsic motivation for decisions aligned with their values.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"10966218261492375"},"PeriodicalIF":1.8,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167215","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 Rhythm We Could Not Keep.","authors":"Belete A Desimmie","doi":"10.1177/10966218261496675","DOIUrl":"https://doi.org/10.1177/10966218261496675","url":null,"abstract":"","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"10966218261496675"},"PeriodicalIF":1.8,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127900","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":"Efficacy of Nonopioid Analgesics (Acetaminophen and NSAIDs) Used Alone or in Combination with Opioids for Cancer Pain: Latest Updates on the Evidence Supporting the Guidelines.","authors":"Yuki Ozawa, Junya Sato, Shinya Kajiura, Emi Kubo, Sakiho Noda, Suguru Ogihara, Hironori Mawatari","doi":"10.1177/10966218261494269","DOIUrl":"https://doi.org/10.1177/10966218261494269","url":null,"abstract":"<p><p>Cancer pain significantly impairs patients' quality of life. Although the World Health Organization recommends nonopioid analgesics for pain management in this context, previous systematic reviews have been limited to the qualitative synthesis of oral formulations published up to 2017. To address these limitations and update the clinical guidelines of the Japanese Society of Palliative Medicine (JSPM), we conducted a comprehensive review and a meta-analysis including intravenous formulations with the latest evidence through 2025. We included relevant studies published before 2018 that were cited in the clinical guidelines of JSPM (2020, 3rd edition). Additionally, we searched CENTRAL, PubMed, and ICHUSHI for relevant randomized controlled trials published between January 2018 and December 2025. These combined data were used for an integrated meta-analysis. The review's primary outcome was pain relief. Effect sizes were evaluated using Hedges' g. We included five studies for acetaminophen (<i>n</i> = 253) and 17 for nonsteroidal anti-inflammatory drugs (NSAIDs) (<i>n</i> = 1493). Acetaminophen coadministered with opioids did not show a statistically significant effect on pain relief (Hedges' <i>g</i> = 0.18; 95% confidence intervals [CI]: -0.08-0.44). In contrast, the combination of NSAIDs and opioids demonstrated a medium and significant effect compared to opioids alone (Hedges' <i>g</i> = 0.58; 95% CI: 0.07-1.09). However, considerable heterogeneity was observed in the NSAID combination group (<i>I</i>² <i>=</i> 82%), and five of the seven studies were judged to have a high risk of bias. This study summarizes the evidence regarding the use of nonopioid analgesics. While a robust effect of acetaminophen coadministered with opioids was not demonstrated, NSAIDs combined with opioids showed a potentially beneficial pooled effect on pain relief; however, the certainty of the evidence was very low and the findings should be interpreted cautiously. Further high-quality research is warranted to confirm these effects and to optimize personalized pain management strategies.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"10966218261494269"},"PeriodicalIF":1.8,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127856","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 Caring for People Receiving Critical Care for Cardiovascular Disease.","authors":"Anne Song, Shelli L Feder, Omar Elmadhoun, Ankita Mehta, Stephanie P Wladkowski, Donald R Sullivan, Christina Creel-Bulos, Allison J Applebaum, Sarah E Byrne-Martelli, Justyna Swol, Roberto Lorusso, Holger Thiele, Christophe Vandenbriele, Sarah J Godfrey, Jason N Batten, William E Rosa, Patrick M Wieruszewski, Gregg A Robbins-Welty, Jacopo D'Andria Ursoleo","doi":"10.1177/10966218261496677","DOIUrl":"https://doi.org/10.1177/10966218261496677","url":null,"abstract":"<p><p>Cardiovascular disease (CVD) remains the leading cause of death worldwide and is a major driver of critical illness, resulting in admission to cardiac intensive care units (CICUs). Patients with acute, life-threatening CVD often experience episodes of acute decompensation characterized by high symptom burden that may portend progressive loss of function, significantly impair quality of life (QOL), and involve high-intensity, technologically advanced therapies to sustain life. Despite these advances, up to 30% of patients die during CICU hospitalizations, and those who survive may subsequently face persistent functional impairment and psychosocial distress. During critical CVD (CCVD), patients often endure prognostic uncertainty and face complex decisions regarding life-sustaining therapies alongside refractory symptoms. Thus, care that focuses exclusively on disease-directed or life-prolonging therapies is often insufficient to address the full spectrum of patient and caregiver needs. When integrated alongside intensive cardiovascular care, palliative care (PC) offers a complementary and essential approach to the management of CCVD to inform therapeutic decisions, improve QOL, and address psychosocial and spiritual well-being. In this article, a multidisciplinary team featuring PC clinicians (physicians, nurse practitioners, social worker, psychologist, and chaplain), cardiologists, cardiac surgeons, cardiothoracic anesthesiologists, and intensivists present evidence-based guidance in a \"Top Ten Tips\" format to support PC clinicians caring for CICU patients and their caregivers.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"10966218261496677"},"PeriodicalIF":1.8,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127871","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> Early Integration Should Guide Specialist Palliative Care Referral.","authors":"Vera Peuckmann-Post, Per Sjøgren, Geana Paula Kurita","doi":"10.1177/10966218261492788","DOIUrl":"https://doi.org/10.1177/10966218261492788","url":null,"abstract":"","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"10966218261492788"},"PeriodicalIF":1.8,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127934","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 Role of Specialty Pediatric Palliative Care in Pulmonary Hypertension: A Case Series.","authors":"Sandra Aziz, Joshua Roy, Elise Whalen, Nidhy Paulose Varghese, Jill Ann Jarrell","doi":"10.1177/10966218261494685","DOIUrl":"https://doi.org/10.1177/10966218261494685","url":null,"abstract":"<p><p>Comprehensive care of pediatric Pulmonary Hypertension (PH) patients may include multiple subspecialty and supportive services, including specialized pediatric palliative care (PPC). PPC is interdisciplinary, patient- and family-centered care that supports the physical, emotional, and spiritual well-being of children with serious illnesses to promote quality of life. We present a case series of three patients that highlight several of the unique approaches used by specialized PPC in pain and symptom management, assessing patient and caregiver coping, advance care planning, care coordination, complex medical decision-making, end-of-life care, and grief and bereavement support. Our aim is to define the role of PPC in the longitudinal care of PH patients and to initiate discussions on best practices and optimal outcomes in this population.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"10966218261494685"},"PeriodicalIF":1.8,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127897","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> Beyond Financial Toxicity: Recognizing Financial Distress as Clinical Suffering in Advanced Cancer.","authors":"Sulistyowati Sulistyowati, Nila Zaimatus Septiana, Achmad Yasin, Dwi Sri Rahayu","doi":"10.1177/10966218261448674","DOIUrl":"10.1177/10966218261448674","url":null,"abstract":"","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"1361-1362"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816663","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 Pilot Curriculum on Physician-Assisted Dying for Hospice and Palliative Medicine Fellows.","authors":"Antoinette R Esce, James Cescon, Melanie Koren, Edith Meyerson, Mollie A Biewald, Robert M Arnold, Anup Bharani, Laura Belland","doi":"10.1177/10966218261460505","DOIUrl":"10.1177/10966218261460505","url":null,"abstract":"<p><strong>Introduction: </strong>Physician-assisted dying (PAD) is legal in an increasing number of jurisdictions across the United States. Despite this, formal hospice and palliative medicine (HPM) fellowship curricula on PAD are lacking. To address this, a neutral (nonadvocacy) PAD pilot curriculum was developed and implemented in one large HPM fellowship program.</p><p><strong>Methods: </strong>A five-lecture curriculum was developed by an interdisciplinary group using Kern's six-step method. Comfort, knowledge, and satisfaction were assessed.</p><p><strong>Results: </strong>17 fellows were eligible to complete curriculum assessments with a 76% response rate on the postcurriculum survey (<i>N</i> = 13). Self-reported comfort improved significantly across all measured domains. Ninety-two percent of respondents were very or somewhat satisfied; 85% of respondents agreed the curriculum maintained a neutral tone.</p><p><strong>Conclusion: </strong>HPM fellows value PAD education, even when practicing in a state where it is illegal. A neutral curriculum is feasible, improves comfort, and is well received. This offers a model for integrating PAD education into HPM training.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"1438-1443"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148264677","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":"Help Is a Phone Call Away: A 24-Hour Nurse-Led Pediatric Hospice Clinical Care Line.","authors":"Camara van Breemen, Stephanie Liversidge, Christina Zeng, Jason Zheng, Gail Andrews","doi":"10.1177/10966218261460532","DOIUrl":"10.1177/10966218261460532","url":null,"abstract":"<p><strong>Background: </strong>Children with life-limiting conditions often have complex care needs, and their caregivers require expert clinical support after-hours and over weekends to support care at home.</p><p><strong>Objectives: </strong>This quality improvement initiative examined usage patterns and impact on caregiving of the nurse-led 24-Hour Clinical Care Line initiated in 2018 by the Canuck Place Children's Hospice, which provides inpatient and community-based pediatric palliative care and respite for children with life-limiting conditions in British Columbia and the Yukon in Canada.</p><p><strong>Methods: </strong>Phone call tracking logs and clinical profiles were analyzed to examine user demographics, temporal usage patterns, and reasons for calling. Families were asked to provide feedback on the service for quality improvement.</p><p><strong>Results: </strong>From June 2020 to March 2024, 194 families placed 1106 calls. Mothers/foster mothers made 67% of the calls. Caregivers of children with central nervous system (CNS) and metabolic conditions made a significantly higher number of calls per child on average. Caregivers calling about children aged <1 year represented a disproportionately large group of callers. Parents of children >15 years made significantly fewer calls. The most common call reason was family support (73.1%), followed by providing an update on child status (58.5%), pain and symptom management (50.9%), and care planning (10.9%). Call volume peaked at bedtime and was consistent over nighttime hours and weekends. Late winter and spring were the most popular seasons for calls, following typical temporal influenza patterns.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"1402-1409"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148352075","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}