Sally Banfield, Sarah Dunlop, Olivia Wyss, Bronwyn Peirce, Mohamed Estai, Megan B Sands
{"title":"Community Palliative Care Patients Attending a Regional Emergency Department: A Retrospective Observational Study.","authors":"Sally Banfield, Sarah Dunlop, Olivia Wyss, Bronwyn Peirce, Mohamed Estai, Megan B Sands","doi":"10.1177/10966218251372727","DOIUrl":"https://doi.org/10.1177/10966218251372727","url":null,"abstract":"<p><p><b><i>Background:</i></b> Emergency department (ED) presentations are common for people in their last year of life, but the characteristics of these presentations by regional patients known to palliative care services are limited. <b><i>Objectives:</i></b> To identify the characteristics and communication that occur when community-based palliative care (CBPC) patients present to the ED. <b><i>Design:</i></b> A retrospective, cross-sectional study of CBPC presentations to the ED over 12 months. <b><i>Setting:</i></b> Eligible participants were all regional CBPC patients who attended the index Australian ED between June 1, 2022, and May 31, 2023. <b><i>Measurements:</i></b> Data acquired included demographics, presentation details, documented communication, and ED discharge information. <b><i>Results:</i></b> An overall 235 CBPC patients presented to the index ED at least once (427 presentations), constituting 1.23% of all adult ED presentations. The median age was 75 years (interquartile range 65-82), and 82.6% had a primary diagnosis of cancer. The most common ED discharge diagnoses were symptom-related (78/427, 18.3%) and respiratory disease (77/427, 18%). Most (300/427, 70.3%) were admitted. Communication between ED and palliative care services was documented in 18.9% of presentations (81/427). Communication was more likely in patients who were admitted (88.9% vs. 11.1%), in work hours (55.6% vs. 44.4%), or in those with a cancer diagnosis (93.8% vs. 6.2%). <b><i>Conclusion:</i></b> CBPC patients presented to the ED with a high admission rate, which may indicate appropriate ED presentations. Coordinated care through communication was evident in only a minority of cases. Further studies to explore the complex palliative care needs of patients presenting to the ED and barriers to integrated care between services are vital to providing optimal care.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145015621","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}
Alan Noll, Arpan A Patel, Rene Claxton, Robert M Arnold, Shari S Rogal, Amar D Bansal
{"title":"GITalk: Communication Skills Training for Gastroenterology Fellows Improves Self-Assessed Preparedness for Serious Illness Conversations.","authors":"Alan Noll, Arpan A Patel, Rene Claxton, Robert M Arnold, Shari S Rogal, Amar D Bansal","doi":"10.1177/10966218251376431","DOIUrl":"https://doi.org/10.1177/10966218251376431","url":null,"abstract":"<p><p><b><i>Background:</i></b> Despite caring for patients with serious illnesses, gastroenterology (GI) fellows rarely receive training in serious illness conversations (SIC). <b><i>Objectives:</i></b> To describe the development, implementation, and assessment of GITalk, a novel SIC training for GI fellows. <b><i>Design:</i></b> GITalk was based on the REMAP framework and involved two simulated encounters. One case involved a patient with decompensated cirrhosis, and the other case was about feeding tube placement in someone with moderate to severe dementia. <b><i>Setting and Subjects:</i></b> GI fellows in an academic medical center in the USA. <b><i>Measurements:</i></b> Demographics of the participants, evaluation of the course content, and self-assessed preparedness for SIC. <b><i>Results:</i></b> A total of 23 GI fellows participated over 4 consecutive years. Participants had significantly higher mean post-training self-assessed preparedness scores compared to pre-training across all 9 survey questions. 91% of participants strongly agreed with the statement: \"I would recommend this training to other fellows.\" <b><i>Conclusions:</i></b> Participants in GITalk reported substantial improvement in self-assessed preparedness for navigating SIC.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145000843","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":"Animal-Assisted Therapy in Palliative Care #519.","authors":"Sean Z Hutchinson","doi":"10.1177/10966218251377190","DOIUrl":"10.1177/10966218251377190","url":null,"abstract":"","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958116","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":"Using the Word <i>Want</i> in Health Care May Leave Patients Wanting.","authors":"Ambereen K Mehta, Suzana Makowski, Farrah N Daly","doi":"10.1177/10966218251376728","DOIUrl":"10.1177/10966218251376728","url":null,"abstract":"<p><p>All clinicians engage in discussions about complex decision-making and advance care planning for people living with serious illnesses; however, not all clinicians have the same training, experience, or comfort with this type of communication, which requires awareness of and attention to specific words and phrases. In this article, we present a case that highlights the clinical impact language, such as the use of the word <i>want,</i> can have on patient-related outcomes.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958151","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":"Grief and Depression Among Bereaved Parents Who Have Lost an Adult Child to Cancer: A National Death Follow-Up Study.","authors":"Ayumi Sugimura, Kazuki Sato, Arisa Kawashima, Yoko Nakazawa, Mitsunori Miyashita, Tatsuya Morita, Yasuyiki Okumura, Yoshiyuki Kizawa, Shohei Kawagoe, Hiroshi Yamamoto, Emi Takeuchi, Risa Yamazaki, Asao Ogawa","doi":"10.1177/10966218251368494","DOIUrl":"10.1177/10966218251368494","url":null,"abstract":"<p><p><b><i>Background:</i></b> Parents who have lost their children to death often experience high levels of grief and depression. However, studies on the grief and depression experienced by parents who have lost an adult child to cancer are scarce. <b><i>Objectives:</i></b> To clarify the risk and characteristics of grief and depression in parents who have lost an adult child to cancer. <b><i>Design:</i></b> A nationwide mortality follow-back survey was conducted in Japan with participants identified using death certificate data for cancer. Between February 2019 and February 2020, a questionnaire was distributed to 110,990 bereaved family members; 60,797(63.1%) responses were received, and 50,639 were analyzed. <b><i>Setting/Subjects:</i></b> The participants included Japanese bereaved families who lost a family member between 2017 and 2018, that is, 13-25 months before initiating this study. At the time of their child's death, the parents were the primary caregivers. <b><i>Measurements:</i></b> Data on key factors such as patient and bereaved family background, family caregiving burden, and bereaved family grief and depression were collected. <b><i>Results:</i></b> Bereaved parents who had lost their adult children had a higher likelihood of experiencing grief and depression than those who had lost other family members (adjusted odds ratio: 2.0, 95% confidence interval: 1.71, 2.34). Furthermore, factors such as motherhood and death at home increased the likelihood of grief and depression among bereaved parents. <b><i>Conclusions:</i></b> The results suggest that early support is needed for mothers experiencing strong grief and depression, as well as for parents whose adult children die at home.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958155","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":"Beyond Bars: Evaluating End-of-Life Care and Surrogate Decision-Making for Hospitalized Incarcerated Persons.","authors":"Zack Watson, Julie Brown, Abhinav Vyas, Stacey Tillman, Sumi Misra, Rajiv Agarwal, Cheryl Gatto, Allison McCarthy, Mohana Karlekar","doi":"10.1177/10966218251376433","DOIUrl":"10.1177/10966218251376433","url":null,"abstract":"<p><p>Incarcerated persons (IPs) retain the constitutional right to health care, yet they face unique challenges in accessing palliative care (PC) and designating surrogates, especially when incapacitated. We present two cases of hospitalized IPs with life-limiting illnesses who experienced significant barriers in identifying and engaging surrogates. Both cases underscore the effect of delays in communication with surrogates and restricted end-of-life (EOL) visitation due to correctional policies. These delays limited the delivery of optimal interdisciplinary PC and bereavement support. Despite clear legal guidance under the Tennessee Health Care Decisions Act, misinformation and procedural ambiguity among medical and correctional staff impeded timely and appropriate care. Our findings highlight the need for improved institutional policies and training to ensure IPs receive adequate EOL care. Enhanced awareness of legal frameworks, clearer surrogate identification protocols, and collaboration between health care and correctional systems are essential to upholding the rights and dignity of IPs facing serious illness or death.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958092","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}
Wei Lee, Brian Draper, Meera R Agar, David C Currow
{"title":"When Prognosis Is Extremely Short: Approach to Depression Care in the Last Days to Weeks of Life.","authors":"Wei Lee, Brian Draper, Meera R Agar, David C Currow","doi":"10.1089/jpm.2024.0420","DOIUrl":"10.1089/jpm.2024.0420","url":null,"abstract":"<p><p>Clinically significant depressive symptoms are prevalent in advanced life-limiting illnesses. The assessment and management of such illness can be challenging for clinicians when prognoses are extremely short (days to weeks). Currently, evidence to guide practice is lacking, and there exists no guideline that specifically addresses depression care in this patient population. An approach, illustrated by the mnemonic \"SCREENIN,\" is proposed in this commentary to optimize the care of individuals with depression when prognoses are extremely short. Even when prognosis is short, depression should still be routinely screened and promptly assessed, with proactive care delivered. There is an urgent need for clinician training, service linkage, research, and cultural change in this area through better collaboration between palliative care and psychiatry.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"1230-1233"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700702","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 Prevalence and Risk Factors of Physical Restraint Among Patients Under Palliative Care in Taiwan.","authors":"Cheng-Han Tsai, Ruoh-Lih Lei, Shu-Yi Wang, Hsin-En Ho, Chiu-Min Su, Lung-Chun Lee, Cheng-Fu Lin, Wei-Min Chu","doi":"10.1177/10966218251367327","DOIUrl":"10.1177/10966218251367327","url":null,"abstract":"<p><p><b><i>Background:</i></b> Physical restraint for patients approaching their end of life may induce distress and impair dignity. Limited studies have been reported on the frequency and factors influencing restraint application during terminal phases of patients in hospital settings. <b><i>Objective:</i></b> We aimed to study the occurrence and factors that predict utilization of physical restraints in hospitalized terminally-ill adults. <b><i>Setting/Subjects:</i></b> We collected data from a single regional hospital in central Taiwan. All terminally ill patients admitted to the palliative care unit (PCU) from January 2019 to September 2023 were enrolled. <b><i>Measurements:</i></b> Physical restraint was defined as being physically restrained during hospitalization for >8 hours under medical order. We retrospectively identified potential risk factors for restraint use from a number of variables, including the type of primary diagnosis, medications used including benzodiazepine (BZD) and strong opioid, procedures involving nasogastric (NG) tube, Foley insertion, reason of discharge, and the specialty of attending physician. Multivariate logistic regression was used to analyze the risk factors predicting the use of physical restraint. <b><i>Results:</i></b> From 2019 to 2023, 688 patients with an average age of 82.1 years (standard deviation: 13.1) were included for the final analysis. Of them, 69% were male, and 9.5% received physical restraint during hospitalization. After adjusting for multiple confounding factors, the use of BZD (odds ratio [OR]: 2.34, 95% confidence interval [CI]: 1.32-4.15) and NG tube (OR: 2.53, 95% CI: 1.38-4.65) were identified as significant risk factors predicting the application of physical restraint. Subgroup analyses showed that female gender with cancer (OR: 5.43, 95% CI: 1.01-29.05) was another significant risk factor, apart from the use of BZD and NG tube. <b><i>Conclusions:</i></b> This is the first study on risk factors predicting the use of physical restraint in a palliative care setting. Palliative care professionals should carefully deliberate the use of BZD and NG tubes among terminally ill patients in PCU.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"1175-1184"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958153","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":"How Does the Media Represent Women and Voluntary Assisted Dying? Lexical and Thematic Analyses of Media Accounts.","authors":"Ann Dadich, Danielle Ní Chróinín","doi":"10.1089/jpm.2025.0016","DOIUrl":"https://doi.org/10.1089/jpm.2025.0016","url":null,"abstract":"<p><p><b><i>Background:</i></b> There is a limited understanding of how the media represents women and voluntary assisted dying. Given the media can shape public perceptions, this potentially contributes to health care inequities among women. <b><i>Objectives:</i></b> To analyze media accounts of women and voluntary assisted dying. <b><i>Design:</i></b> Guided by agenda-setting theory, lexical and thematic analyses were conducted of 163 media articles about women and voluntary assisted dying. <b><i>Setting:</i></b> The media articles were published in Australian and New Zealand publications, given the introduction of voluntary assisted dying in these nations. <b><i>Measurements:</i></b> The lexical analysis involved the use of Leximancer to establish patterns in the discourse, while thematic analysis was used to construct themes from the patterns identified. <b><i>Results:</i></b> The lexical concept map was devoid of a theme that denoted women or carers. Furthermore, the lexical analysis suggested that, when the articles made references to a \"woman,\" they were likely to refer to the act of intentionally ending a person's life or a person's age, while unlikely to refer to acts of support. Complementing these findings, four themes were constructed from the media articles using thematic analysis-namely, advocacy, autonomy and choice, quality of life, and support, largely from family members and friends. <b><i>Conclusions:</i></b> With few exceptions, women did not feature prominently in discourse on voluntary assisted dying within the media articles. Given agenda-setting theory, this finding is important as there are missed opportunities to harness the media's influence on societal views about women and voluntary assisted dying, and promote death literacy, particularly among women.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":"28 S1","pages":"S7-S16"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145176080","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}