Journal of palliative medicine最新文献

{"title":"Predictors of Death Rattle Development in Patients with Advanced Cancer: A Multicenter Prospective Cohort Study.","authors":"Takashi Yamaguchi, Naosuke Yokomichi, Harriette Johanna van Esch, Isseki Maeda, Ryo Matsunuma, Yutaka Hatano, Yukako Tanaka-Yagi, Asami Akatani, Tatsuya Morita, Masanori Mori","doi":"10.1177/10966218251376430","DOIUrl":"https://doi.org/10.1177/10966218251376430","url":null,"abstract":"<p><p><b><i>Background:</i></b> A death rattle, characterized by noisy breathing due to accumulated secretions, is a common symptom in terminally ill patients with cancer; however, its predictive factors have yet to be fully elucidated. <b><i>Objectives:</i></b> This study aimed to identify predictors for developing a death rattle in patients with advanced cancer. <b><i>Design:</i></b> This is a secondary analysis of a multicenter prospective cohort study. <b><i>Setting/Subjects:</i></b> We enrolled 1633 patients with advanced cancer admitted to 23 palliative care units throughout Japan. <b><i>Measurements:</i></b> We examined associations between patient characteristics, comorbidities, and treatments and the development of a death rattle (Back score ≥2) when Palliative Performance Scale scores dropped to 20 or less using logistic regression analysis. <b><i>Results:</i></b> A death rattle developed in 196 patients (12.0%). Multivariate analysis revealed that smoking history, cerebrovascular disease/congestive heart failure history, lung metastasis, moderate-to-severe edema on admission, symptomatic pleural effusion, high-dose antipsychotics, and hydration volume ≥200 mL/day when the performance status score was ≤20 was significantly associated with death rattle development. Moderate-to-severe edema and high-dose antipsychotics were predictors for a type 1 rattle (predominantly pharyngeal secretions), whereas smoking history was a predictor for a type 2 rattle (predominantly bronchial secretions). <b><i>Conclusions:</i></b> Volume overload, dysphagia, and factors related to sputum production were identified as predictors for death rattle development in terminally ill patients with cancer.</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":"145033485","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 Clinical Reasoning of Generative AI in Palliative Care: A Comparison with Five Years of Pharmacy Learners.","authors":"Mikaila T Lane, Toluwalase A Ajayi, Kyle P Edmonds, Rabia S Atayee","doi":"10.1177/10966218251376436","DOIUrl":"https://doi.org/10.1177/10966218251376436","url":null,"abstract":"<p><p><b><i>Context:</i></b> Artificial intelligence (AI), particularly large language models (LLMs), offers the potential to augment clinical decision-making, including in palliative care pharmacy, where personalized treatment and assessments are important. Despite the growing interest in AI, its role in clinical reasoning within specialized fields such as palliative care remains uncertain. <b><i>Objectives:</i></b> This study examines the performance of four commercial-grade LLMs on a Script Concordance Test (SCT) designed for pharmacy students in a pain and palliative care elective, comparing AI outputs with human learners' performance at baseline. <b><i>Methods:</i></b> Pharmacy students from 2018 to 2023 completed an SCT consisting of 16 clinical questions. Four LLMs (ChatGPT 3.5, ChatGPT 4.0, Gemini, and Gemini Advanced) were tested using the same SCT, with their responses compared to student performance. <b><i>Results:</i></b> The average score for LLMs (0.43) was slightly lower than that of students (0.47), but this difference was not statistically significant (<i>p</i> = 0.55). ChatGPT 4.0 achieved the highest score (0.57). <b><i>Conclusions:</i></b> While LLMs show potential for augmenting clinical decision-making, their limitations in patient-centered care highlight the necessity of human oversight and reinforce that they cannot replace human expertise in palliative care. This study was conducted in a controlled research setting, where LLMs were prompted to answer clinical reasoning questions despite default safety restrictions. However, this does not imply that such prompts should be used in practice. Future research should explore alternative methods for assessing AI decision-making without overriding safety mechanisms and focus on refining AI to better align with complex clinical reasoning. In addition, further studies are needed to confirm AI's comparative effectiveness, given the sample size limitations.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033473","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":"Is Training Alone Enough? A Comparison of Serious Illness Communication Training With and Without Implementation Strategies.","authors":"Samantha X Y Wang, Rebecca Fong, Felicia Hui, Briththa Seevaratnam, Duy Nguyen, Winifred Teuteberg","doi":"10.1177/10966218251376726","DOIUrl":"https://doi.org/10.1177/10966218251376726","url":null,"abstract":"<p><p><b><i>Background:</i></b> Communication skills training alone has shown limited impact on improving the frequency and quality of serious illness conversations (SICs). Implementing structured support strategies may enhance both adoption and sustained use in clinical practice. <b><i>Design:</i></b> Retrospective review of the impact of Serious Illness Care Program (SICP) training and implementation in outpatient and inpatient settings at a single academic center. <b><i>Setting:</i></b> Stanford Health Care is a health system affiliated with the Stanford School of Medicine, with 2 hospital campuses and 60 ambulatory practices throughout the San Francisco Bay Area. <b><i>Participants:</i></b> Physicians, physicians-in-training, advanced practice providers, and allied health professionals (occupational therapists, dieticians, social workers, and case managers) across departments. <b><i>Intervention:</i></b> From October 2020 to May 2023, our institution implemented the SICP, offering two communication skills training modalities: (1) Training Only and (2) Training with Implementation support, which included patient identification, data feedback, coaching, and department-specific quality improvement incentives. <b><i>Analysis:</i></b> We compared the adoption of SICs by examining the documentation frequencies of trained clinicians. Clinicians were categorized as never user (0 conversations), seldom users (1-4 conversations), occasional users (5-11 conversations), and frequent users (12 or more conversations) according to the number of documented SICs within one year after training. We also assessed the number of sustained users, defined as clinicians who documented SICs at least once a month over a six-month period following training. <b><i>Results:</i></b> Within the first 12 months of training, the Training Only group had a significantly higher percentage of never users compared with the Training with Implementation cohort (78.9% vs. 57.6%, <i>p</i> < 0.01). The Training with Implementation group had higher SICs documented across all other usage categories: seldom users (23.5% vs. 14.6%, <i>p</i> < 0.01), occasional users (10.2% vs. 4.2%, <i>p</i> < 0.01), and frequent users (8.5% vs. 2.2%, <i>p</i> < 0.01). Compared with the Training Only group, the Training with Implementation group also had more sustained users (9.4% vs. 1.6%, <i>p</i> < 0.01) who consistently documented SIC monthly for six months. <b><i>Conclusion:</i></b> Implementation support strategies enhance both the initial adoption and sustained use of SICs beyond training alone.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033522","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":"https://doi.org/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":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-09","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":"Breaking Barriers in Scientific Dissemination: Preliminary Results of the Interactive Infographic Summaries to Share International Palliative Care Projects.","authors":"Marina Martínez, Alazne Belar, Sandra Rubio, Álvaro Montero, Eduardo Garralda, Ana Paula Salas Moreira, María Arantzamendi, Carlos Centeno Cortés","doi":"10.1177/10966218251377188","DOIUrl":"https://doi.org/10.1177/10966218251377188","url":null,"abstract":"<p><p><b><i>Background:</i></b> International research projects, such as Horizon 2020 (H2020) and ERASMUS+, generate numerous scientific and educational outcomes. However, these are often disseminated in fragmented formats, limiting long-term access and impact. Language barriers further complicate the dissemination in professional communities that do not speak English. Interactive infographic summaries (IISs) offer an innovative solution to these challenges. <b><i>Objectives:</i></b> To describe the development of the IIS as a tool to present key findings from three European palliative care projects and the preliminary results of the dissemination. <b><i>Methods:</i></b> The IISs developed for three European projects (<i>H2020 Palliative Sedation</i>, <i>ERASMUS+ Research for Palliative Care Clinicians [RESPACC]</i>, and <i>ERASMUS+ E-Learning on Palliative Care for International Students [ELPIS]</i>) were selected. These documents were designed using visual communication principles and included interactive elements, such as links to additional resources (videos, articles, and tools). The infographics were translated into multiple languages, and their effectiveness was evaluated based on web traffic, downloads, and readers' feedback. <b><i>Results:</i></b> The infographics in 11 languages were shared via project websites, online repositories, and social media. The <i>H2020 Palliative Sedation</i> infographic reached thousands of downloads. The <i>RESPACC</i> infographic allowed free access to research tools in four languages. The <i>ELPIS</i> infographic showcased seven educational projects and was published by all participating universities. <b><i>Conclusions:</i></b> IISs facilitate the dissemination of an extensive body of complex scientific information, overcoming barriers of fragmentation and language. They should be considered an essential component in future projects for broadening accessibility and engagement with research findings in palliative care.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033467","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 New Curriculum for Palliative Undergraduate Medical Education in Finland: A Qualitative Documentary Analysis.","authors":"Aija Vanhanen, Minna Hökkä, Annamarja Lamminmäki, Leila Niemi-Murola, Outi Akrén, Reino Pöyhiä","doi":"10.1177/10966218251377193","DOIUrl":"https://doi.org/10.1177/10966218251377193","url":null,"abstract":"<p><p><b><i>Background:</i></b> A new, national competence-based curriculum of palliative medicine (PM) undergraduate teaching has recently been created to support mandatory PM education in Finnish medical schools. <b><i>Objectives:</i></b> To analyze the Finnish curriculum (FC) of PM and compare it with the European EDUPALL curriculum. <b><i>Material and Methods:</i></b> A qualitative documentary analysis was used to compare contents, learning methods, and delivery of teaching recommended in both curricula. <b><i>Results:</i></b> The FC provides practical and detailed instructions for learning core, important, and good-to-know knowledge of PM, both in a dedicated course and within other subjects. The structure of the FC is in accordance with EDUPALL. The FC (81 hours) makes up 1% of the total teaching volume of a six-year Finnish medical degree and is larger than EDUPALL (72 hours). <b><i>Conclusions:</i></b> The new FC aligns with the updated European Association for Palliative Care curriculum. The FC provides graduating physicians with sufficient basic knowledge of PM.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033488","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":"Why Filmmaking Can Be Just as Healing as Good Medicine.","authors":"Jessica Zitter","doi":"10.1177/10966218251377538","DOIUrl":"https://doi.org/10.1177/10966218251377538","url":null,"abstract":"","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033538","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":"Process Rounds to Elevate Psychological Skills in Palliative Care.","authors":"Danielle Chammas, Leah B Rosenberg, Amanda Moment, Daniel Shalev, Keri Brenner","doi":"10.1177/10966218251376725","DOIUrl":"https://doi.org/10.1177/10966218251376725","url":null,"abstract":"<p><p><b><i>Background:</i></b> A half-day workshop improved palliative care clinicians' ability to integrate psychological concepts into serious illness communication but created demand for longitudinal learning. <b><i>Objective:</i></b> To pilot \"Process Rounds,\" a four-session, case-based, adapted psychotherapeutic supervision group reinforcing formulation, countertransference, and mindful intervention. <b><i>Methods:</i></b> Workshop graduates from four cohorts were invited; 25/143 enrolled. Each cohort met for four 60-minute sessions over 6-8 weeks. Eight-week postworkshop surveys included specific items for Process Rounds participants. Facilitators were interviewed about their experiences and themes. <b><i>Results:</i></b> Participants were highly satisfied with the Process Rounds. Compared with nonparticipants, Process Rounds attendees reported greater improvement in comfort teaching formulation (<i>p</i> = 0.013) and stronger clinical impact (<i>p</i> = 0.028). Participants and facilitators found value in the structured format; scheduling conflicts were the chief barrier. <b><i>Conclusions:</i></b> Process Rounds, an adapted model of psychotherapeutic supervision, was acceptable to palliative care clinicians and deepened learning about psychologically informed serious illness communication.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033592","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":"Insensible Losses.","authors":"Phoebe Prioleau","doi":"10.1177/10966218251377192","DOIUrl":"https://doi.org/10.1177/10966218251377192","url":null,"abstract":"","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145015708","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> Addressing the Global Burden of Suffering: The Need to Advance Symptom Science.","authors":"David C Currow, Steven Z Pantilat, Joseph Clark, Patrica M Davidson","doi":"10.1177/10966218251365266","DOIUrl":"https://doi.org/10.1177/10966218251365266","url":null,"abstract":"","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145015658","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}