Bridget J Perry, Tabitha H Kao, Brittney A Mancini, Lisa Moran
{"title":"Factors Influencing Decision Making for Gastrostomy Tube Placement for People Living with Serious Illness: A Scoping Review.","authors":"Bridget J Perry, Tabitha H Kao, Brittney A Mancini, Lisa Moran","doi":"10.1089/jpm.2024.0062","DOIUrl":"10.1089/jpm.2024.0062","url":null,"abstract":"<p><p><b><i>Background:</i></b> Gastrostomy (feeding) tubes are one way of managing swallowing impairments (dysphagia) in patients living with serious illnesses. For patients, families, and health care providers to make well-informed, preference-aligned decisions regarding gastrostomy tube placement, each group must understand the other's goals, concerns, and perspectives. <b><i>Objective:</i></b> Thus, the goal of this scoping review is to characterize the factors influencing gastrostomy tube placement decisions for people with serious illnesses. <b><i>Methods:</i></b> We first identified relevant studies in a systematic manner, using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis flow diagram to model our screening process. We then used deductive thematic analysis to describe major themes, reporting the data with descriptive statistics such as percentages. Studies were categorized by their primary participant populations (patients, caregivers, and health care providers), with subthemes organized within the major themes of goals, concerns, considerations, and decisional preferences. <b><i>Results:</i></b> When considering gastrostomy tube placement, the top themes for patients were extending life (56% of studies), decisional control (56%), quality of life (48%), physical and social limitations and image (44%) and personal factors (44%). For caregivers, the primary themes were decisional control (71% of studies), extending life (50%), personal factors (50%), maintaining nutrition (43%), and knowledge (43%). Finally, health care providers prioritized decisional control (58% of studies), knowledge (53%), quality of life (47%), extending life (42%), and societal factors (42%). <b><i>Conclusions:</i></b> Our results highlight key factors that may help center patient preferences when making gastrostomy tube-related decisions, as well as critical areas where more research is needed to help improve decision-making surrounding gastrostomy tube placement. Providing adequate knowledge and understanding patient preferences is critical for patients to make high-quality medical decisions regarding gastrostomy tubes.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"1258-1273"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143390897","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":"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":"1234-1238"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","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}
Danielle Chammas, Keri Brenner, Amanda Moment, Sarah E Byrne-Martelli, Leah B Rosenberg, Daniel Shalev
{"title":"Integrating Psychotherapeutic Concepts to Enhance Serious Illness Communication: Assessment of a Model Curriculum.","authors":"Danielle Chammas, Keri Brenner, Amanda Moment, Sarah E Byrne-Martelli, Leah B Rosenberg, Daniel Shalev","doi":"10.1089/jpm.2025.0183","DOIUrl":"10.1089/jpm.2025.0183","url":null,"abstract":"<p><p><b><i>Background:</i></b> Serious illness communication training often focuses on sharing medical information, discussing goals of care, and supporting patients and caregivers. Few communication frameworks explicitly integrate psychosocial concepts to improve therapeutic efficacy. <b><i>Objectives:</i></b> To develop, implement, and evaluate a half-day workshop that integrates psychotherapeutic concepts into palliative care communication across four professional settings. <b><i>Methods:</i></b> Using Kern's six-step curriculum development model, we created an interactive workshop focused on psychological formulation and countertransference. The workshop was delivered to four cohorts: a national conference, an international palliative care congress, a fellows' education day, and a social work-focused summit. Pre-, post-, and eight-week follow-up surveys were administered, assessing Kirkpatrick's four levels of training evaluation. <b><i>Results:</i></b> In total, 203 palliative care clinicians completed the presurvey, 168 completed the post-survey, and 79 completed the eight-week follow-up. Knowledge of formulation increased from a median of 3 (interquartile range [IQR] 2-4) preworkshop to 5 (IQR 4-5) at eight weeks (<i>p</i> < 0.001). Knowledge of countertransference increased from 4 (IQR 3-4) to 5 (IQR 4-5) (also <i>p</i> < 0.001). Satisfaction was high (92% satisfied or highly satisfied), and most participants reported meaningful impact on their clinical practice (89%), teaching (93%), and team collaboration (93%) at eight-week follow-up. <b><i>Conclusions:</i></b> A multisite, half-day workshop significantly enhanced palliative care clinicians' knowledge and perceived application of core psychotherapeutic concepts. Future work should explore remote and longitudinal modalities to support ongoing skill integration.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"1202-1209"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094014","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> Response to Feder et al., Use of Hospice and End-of-Life Care Quality Among Medical Centers with High Versus Lower Specialist Palliative Care Reach Among People with Heart Failure: An Observational Study.","authors":"Shelli L Feder, Tracy L Shamas, Kathleen M Akgün","doi":"10.1089/jpm.2025.0317","DOIUrl":"10.1089/jpm.2025.0317","url":null,"abstract":"","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"1141-1142"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144326007","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}
Tracy Fasolino, Benjamin Parry, Alexandra Skrocki, Janice Withycombe, Barry A Garst, Ann Gillard, Ryan J Gagnon, Robert Hollandsworth
{"title":"A Rapid Review Exploring Overnight Camps for Children with Chronic or Serious Illness as a Palliative Care Intervention for Caregivers.","authors":"Tracy Fasolino, Benjamin Parry, Alexandra Skrocki, Janice Withycombe, Barry A Garst, Ann Gillard, Ryan J Gagnon, Robert Hollandsworth","doi":"10.1177/10966218251377082","DOIUrl":"https://doi.org/10.1177/10966218251377082","url":null,"abstract":"<p><p><b><i>Background:</i></b> Strong evidence supports the benefits of overnight camp for children with chronic and serious illness, yet little research exists on the role of these camps as a palliative, non-hospice intervention for caregivers. With nearly 25 million children and youth in the United States with serious illness, family caregivers are in need of resources and services. <b><i>Objective:</i></b> To examine peer-reviewed literature on summer camp as a potential palliative intervention for caregivers of youth with chronic and serious illness and to identify opportunities for future research and policy initiatives. <b><i>Methods:</i></b> This study implemented a rapid review methodology that employs an intentional, time-limited approach to inform research and policy initiatives. The review protocol is registered on an international registry of systematic reviews. Data were extracted about study design, quality-of-life measures, and major study findings specific to the caregiver. Quality appraisal tools from the Joanna Briggs Institute were applied. <b><i>Results:</i></b> The search yielded 1048 articles; 30 articles were selected for full-text screening; 11 articles were included in our review. These articles included eight qualitative, two mixed-methods, and one quantitative study. Several camps focused on education and disease management skills, whereas others offered an environment of relaxation and reconnection for the caregivers. Several positive themes emerged from the review, such as social well-being and psychological impact. <b><i>Conclusions:</i></b> Evidence suggests overnight camps may serve as a palliative intervention for caregivers of children with serious and chronic illnesses. Future research should focus on exploring how family caregivers view overnight camps as a palliative care intervention to improve overall well-being.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":"28 S1","pages":"S17-S26"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145176137","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}
Lucas Xavier Perri, Afolasade Fakolade, Warren Lewin
{"title":"Fast Facts and Concepts #516: Young Carers of Patients with Serious Illness.","authors":"Lucas Xavier Perri, Afolasade Fakolade, Warren Lewin","doi":"10.1177/10966218251376117","DOIUrl":"https://doi.org/10.1177/10966218251376117","url":null,"abstract":"","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958090","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}
Jessica R Bauman, Madeline Albert, Marcin Chwistek, Dylan Sherry, Carolyn Y Fang, Efrat Dotan, Melissa McShane, Martin J Edelman, Brian Egleston, Molly Collins, Mary Buss
{"title":"A Longitudinal, Palliative Care Educational Pilot in Hematology-Oncology Fellowship Training.","authors":"Jessica R Bauman, Madeline Albert, Marcin Chwistek, Dylan Sherry, Carolyn Y Fang, Efrat Dotan, Melissa McShane, Martin J Edelman, Brian Egleston, Molly Collins, Mary Buss","doi":"10.1177/10966218251371126","DOIUrl":"https://doi.org/10.1177/10966218251371126","url":null,"abstract":"<p><p><b><i>Background:</i></b> Despite guidelines advocating that patients with advanced cancer receive dedicated palliative care (PC) services, many patients lack access. Improved training in PC for hematology-oncologists could help, yet studies have shown deficits in PC knowledge and education. We designed a novel longitudinal, PC continuity rotation for hematology-oncology (H/O) fellows and assessed feasibility, acceptability, value, and impact. <b><i>Methods:</i></b> Fellows from a single cancer center in the United States prospectively identified patients with PC needs from their H/O continuity practice and referred them to PC to follow in both clinics. Participation was tracked for feasibility. Pre- and post-rotation surveys on PC knowledge and skill confidence were compared using generalized linear models. Fellows were also surveyed on acceptability and participated in exit interviews. <b><i>Results:</i></b> From 2018 to 2023, 19 fellows participated, each referring 2-4 continuity patients to PC. Fifty-one patients had a total of 132 PC visits, and fellows participated in 125 (95%). From pre- to post-rotation, there was improvement in fellows' PC knowledge (mean 6.44/10 to 7.92, <i>p</i> < 0.01). Ratings of skill confidence improved in 14 of 26 items (<i>p</i> < 0.05), including titrating opioids, estimating prognosis, and working with an interdisciplinary team. Seventeen fellows completed the post-assessment, and 100% agreed it changed clinical practice. In exit interviews, fellows reflected on how meaningful the rotation was. <b><i>Conclusion:</i></b> Our novel, longitudinal, PC continuity rotation for H/O fellows was highly feasible, acceptable, and meaningful. The rotation improved PC skills and changed clinical practice, serving as a national model for integrating PC education into H/O fellowship.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958166","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}
Mackenzie Goertz, Jordan Bauman, Danielle Jarvis, Diane Lahmann, Natalie McAndrew
{"title":"A Case of Mistaken Identity: The Importance of Interdisciplinary Communication in the Discharge Process.","authors":"Mackenzie Goertz, Jordan Bauman, Danielle Jarvis, Diane Lahmann, Natalie McAndrew","doi":"10.1089/jpm.2025.0042","DOIUrl":"10.1089/jpm.2025.0042","url":null,"abstract":"<p><p>Effective communication is a critical component of quality health care. In the setting of hospital admissions, communication among patients and the health care team is necessary for all stages of treatment, including discharge planning. Communication includes delivering relevant health information, discussing available options for continued care, and eliciting the patient's choices. The following case discussion describes a lapse in provider-patient communication that resulted in ruptured rapport and delayed discharge. Specifically, we reflect on a case in which a patient was erroneously identified as a registered sex offender, including the communication errors that stalled clarification of this misinformation, hindered eligibility for placement at appropriate care facilities, and ultimately delayed a timely hospital discharge. Discussion includes consideration for (a) the role of context and diffusion of responsibility, (b) stigma and unconscious bias, and (c) lack of standard operating procedure for information regarding criminal justice involvement. We conclude with recommendations for improving practice.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"1283-1286"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772014","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 Dual Framework: Understanding Psychological Processes in Patients Facing Serious Illness #508.","authors":"Kari N Brown, Juliet Jacobsen, Robert M Arnold","doi":"10.1089/jpm.2025.0210","DOIUrl":"10.1089/jpm.2025.0210","url":null,"abstract":"","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"1274-1275"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970549","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}
Caroline Nattinger, Sarah Nouri, David L O'Riordan, Michael W Rabow
{"title":"Disparities Among Asian and Black Patients with Cancer in Receipt of Palliative Care in a Single Urban Academic Cancer Center.","authors":"Caroline Nattinger, Sarah Nouri, David L O'Riordan, Michael W Rabow","doi":"10.1089/jpm.2024.0470","DOIUrl":"10.1089/jpm.2024.0470","url":null,"abstract":"<p><p><b><i>Background:</i></b> Research examining racial-ethnic disparities in palliative care (PC) receipt has produced mixed results. <b><i>Objectives:</i></b> To examine racial disparities in PC receipt with a large-scale study in a well-established outpatient cancer PC program. <b><i>Design:</i></b> We performed a multivariable analysis to test the association of race-ethnicity with PC receipt, adjusting for age, sex, stage, cancer, and insurance type. Exploratory analyses included association of race-ethnicity with reason for referral, functional status, and time to death. <b><i>Setting/Subjects:</i></b> Using a cancer registry in an urban academic medical center in the United States, we performed a retrospective cohort study of cancer decedents from May 2007 to December 2021. <b><i>Results:</i></b> Of 18,797 eligible patients, 7.9% (<i>n</i> = 1484) received PC. In adjusted analyses, compared with White patients, Asian patients had higher odds of PC receipt (odds ratio [OR] = 1.42; 95% confidence interval [CI], 1.21-1.66), but there were no significant differences for Latino/a or Black patients. Asian patients received PC significantly closer to death compared with White patients (9.6 vs. 12.08 months, <i>p</i> = 0.02). Compared with White patients, Black patients were more likely to be referred to PC for pain (OR, 1.81; 95% CI, 1.07-3.06). <b><i>Conclusion:</i></b> Asian patients had higher odds, yet a shorter duration of PC receipt, suggesting delayed referrals. Black patients were more likely to be referred to PC for pain. Development of structural changes to PC referrals and tailored pain interventions may help ensure more equitable PC access and care.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"1193-1201"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159703","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}