Journal of palliative medicine最新文献

{"title":"End-of-Life Care in Hematology/Oncology Fellowship.","authors":"Madeline J Albert, Yang Liu, Asya Varshavsky, Brian L Egleston, Efrat Dotan, Melissa M McShane, Martin J Edelman, Molly E Collins, Jessica R Bauman","doi":"10.1089/jpm.2024.0198","DOIUrl":"10.1089/jpm.2024.0198","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Aggressive end-of-life (EOL) care for cancer patients can lead to increased hospitalizations and worse quality of death, while goals of care (GOC) discussions including EOL care conversations are associated with fewer hospitalizations and increased hospice use. During hematology-oncology training, fellows should develop communication skills that include eliciting and documenting patients' GOC to provide quality care during EOL. We aimed to determine the frequency of documentation of GOC discussions in fellow's clinics as well as characteristics of EOL care. <b><i>Methods:</i></b> This study was conducted at an academic cancer center where year 1-3 fellows retrospectively reviewed patient medical records from July 2016 to June 2017 to identify patient deaths and collect information on hospitalizations, treatment, and place of death to analyze relationships with GOC discussions. <b><i>Results:</i></b> Out of 103 patient deaths, 48 (47%) had documented GOC discussions, 69 (67%) patients were enrolled on hospice, and 20 (19%) had an advance directive. GOC discussions were associated with higher hospice enrollment and advance directive documentation and lower hospitalizations. <b><i>Conclusions:</i></b> All fellows had at least one patient who died in their patient panels, but less than half of patients had documented GOC discussions. Fellowship programs should consider incorporating quality improvement measures and communication skills training to ensure fellows have competence in GOC communication and EOL care delivery.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"101-104"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142729779","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 to the Editor:</i> Reaching the Public in 2025.","authors":"Anthony Back","doi":"10.1089/jpm.2024.0410","DOIUrl":"10.1089/jpm.2024.0410","url":null,"abstract":"","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"8-9"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621684","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":"Adjunctive Intranasal Esketamine for Comorbid Treatment-Resistant Depression with Suicidal Ideation in Patients Receiving Palliative Care at a Comprehensive Cancer Center: A Case Series.","authors":"Mercy Tomy, William Alexander, Sanjay Gupta, Dylan Schaefer, Amy A Case","doi":"10.1089/jpm.2024.0040","DOIUrl":"10.1089/jpm.2024.0040","url":null,"abstract":"<p><p><b><i>Background:</i></b> The psychiatric needs of those with cancer and other advanced illnesses are becoming increasingly recognized. Ketamine is emerging as a promising treatment option for depressive disorders in psychiatric and palliative care. In the palliative care setting, its study has been hindered by lack of consistent administration routes and dosing. Intranasal (IN) esketamine (Spravato^®) has recently received U.S. Food and Drug Administration (FDA) approval as an adjunctive agent for treatment-resistant depression (TRD) and major depressive disorder (MDD) with suicidal ideation (SI). <b><i>Objective:</i></b> We sought to offer IN esketamine to patients suffering from TRD and SI at a comprehensive cancer center. <b><i>Methods:</i></b> We designed and implemented a protocol to administer IN esketamine and describe three cases in which it was provided to patients with TRD and SI at a palliative care clinic in the United States. <b><i>Results:</i></b> Following treatment, all three patients had substantial reduction in depression severity and no further suicidalideation. These improvements were maintained for up to a year. No serious adverse events occurred. <b><i>Conclusions:</i></b> These cases illustrate the potential utility of IN esketamine in the palliative care setting.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"131-136"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141902092","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":"Research Synthesis Related to Oncology Family Caregiver Spirituality in Palliative Care.","authors":"Betty R Ferrell, Tami Borneman, Marianna Koczywas, Paul Galchutt","doi":"10.1089/jpm.2024.0209","DOIUrl":"10.1089/jpm.2024.0209","url":null,"abstract":"<p><p><b><i>Background:</i></b> Family caregivers are central to the delivery of serious illness care and also have needs related to their role and experience. One aspect of the family caregiver quality of life (QOL) that has received less attention is caregiver spirituality. <b><i>Objectives:</i></b> The research objectives for this analysis were (1) Describe spirituality in oncology family caregivers. (2) Determine the impact of palliative care interventions on spirituality and related variables in oncology family caregivers. (3) Describe findings from the research literature related to spirituality in family caregivers. The authors include two nurse researchers (BF, TB) and a physician (MK) who conducted these studies and a board-certified chaplain (PG) who contributed his expertise in chaplaincy. <b><i>Design:</i></b> This study synthesized data from seven earlier studies by the investigators from their research in family caregiving and also compared findings to the literature. <b><i>Setting/Subjects:</i></b> Subjects were family caregivers (<i>n</i> = 1039) of patients with cancer from studies conducted primarily in the Western United States. <b><i>Measurements:</i></b> The key spirituality instruments used were the Functional Assessment of Chronic Illness Therapy tool and the City of Hope QOL tool. Results: Spirituality was identified as important to family caregivers and most caregivers reported a religious affiliation. Living with uncertainty was consistently reported as the worst aspect of QOL/spirituality. Having a sense of purpose and meaning was the highest rated area. <b><i>Conclusions:</i></b> The authors' research synthesis and the literature support the importance of additional research and clinical focus in family caregiver spirituality in serious illness care.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"77-85"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468148","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":"Safety and Prognostic Factor for Survival in Patients with PleurX Drain for Malignant Ascites: AscitX Study.","authors":"Aurélien Proux, Yanis Dahel, Alexandre de Nonneville, Géraldine Capodano, Nathalie Ramirez, Anne-Deborah Bouhnik, Vanessa Collin, Michaël Dassa, Nassima Daidj","doi":"10.1089/jpm.2024.0217","DOIUrl":"10.1089/jpm.2024.0217","url":null,"abstract":"<p><p><b><i>Background:</i></b> Malignant ascites (MA) represents 10% of all causes of ascites and is associated with a poor prognosis. The PleurX tunneled peritoneal catheter is a device that allows the management of MA at home in a palliative care context (renamed AscitX catheter for this work). The objective of this study was to analyze real-world data of AscitX use for cancer patients with MA, to describe complications associated with the insertion of this device, and to identify factors influencing patient outcomes. <b><i>Methods:</i></b> Fifty-six patients with AscitX catheter insertion between October 2018 and October 2022 in our comprehensive cancer center were retrospectively analyzed. Computed tomography (CT) scans were reviewed by two radiologists to determine the presence of liver and peritoneal metastases and to identify portal hypertension. <b><i>Results:</i></b> The majority of patients were followed for pancreatic cancer (39%), followed by ovarian cancer (18%). We identified four cases of severe infections post-insertion and two moderate infections. The median survival time after AscitX insertion was 18 days. A Kaplan-Meier analysis did not identify differences in survival time between patients with peritoneal metastases and those with liver metastases. In contrast, CT-diagnosed portal hypertension and the absence of diuretic treatment were independently associated with a better prognosis. Regarding post-catheter end-of-life management, 41% of the patients died at home. <b><i>Conclusions:</i></b> AscitX catheter safety appears to be acceptable and most of the palliative care patients included in our study died at home. We identified CT-diagnosed portal hypertension as associated with better prognosis, as well as the absence of diuretic treatment.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"69-76"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142522189","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":"Association Between Current Medical Decision-Making Participation Self-Efficacy and Advance Care Planning Engagement Among Older Adults: Baseline Findings from a Nationwide Longitudinal Cohort Study.","authors":"Cheng-Pei Lin, Jung-Yu Liao, Chi-Hsien Huang, Shao-Yi Cheng, Wei-Zhe Tseng, Masanori Mori, Hsien-Cheng Chang, Chia-Ming Li, Wen-Jung Sun, Chien-Yi Wu, Hung-Yi Chiou, Sang-Ju Yu, Chao A Hsiung, Ping-Jen Chen","doi":"10.1089/jpm.2024.0106","DOIUrl":"10.1089/jpm.2024.0106","url":null,"abstract":"<p><p><b><i>Background and Objectives:</i></b> Misconceptions of and cultural differences in aging influence older adults' medical decision-making self-efficacy and engagement in advance care planning (ACP). This study aims to investigate the association between current medical decision-making participation self-efficacy and ACP engagement among older individuals receiving home-based medical care (HBMC) in Taiwan. <b><i>Design:</i></b> Baseline data analysis of a nationwide cohort study. <b><i>Setting and Participants:</i></b> Patients aged ≥50 years who had been consistently receiving HBMC for > two months between November 2019 and December 2022 were recruited. Study recruitment took place at six hospitals and 12 community home care institutions. <b><i>Measurement and Analysis:</i></b> A structured questionnaire was used to collect data on sociodemographic characteristics, decision-making participation self-efficacy, and ACP engagement. Descriptive, stratified, and multivariate logistic regression analyses were performed. <b><i>Results:</i></b> In total, 408 HBMC recipients were enrolled (average age: 80.4 years; 55% women). The respondents reported moderate decision-making participation self-efficacy but low ACP engagement. In light of the transtheoretical model of behavior change, participants with moderate or high self-efficacy had a significantly higher chance of reaching the \"contemplation stage\" for ACP decisions (odds ratio or OR 4.06-27.13). Participants were more likely to reach the \"preparation and action stages\" for ACP decisions only when they had high self-efficacy (OR 2.76-14.73). <b><i>Conclusions:</i></b> Although participants with better current medical decision-making self-efficacy were more likely to contemplate ACP, many did not take action beyond appointing a medical surrogate(s). Strategies to enhance decisional self-efficacy, thereby increasing timely ACP discussions among older adults in home settings in Chinese culture, are warranted. Trial registration number: ClinicalTrials.gov Identifier is NCT04250103 which has been registered on 31st January 2020.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"50-58"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785991","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":"Acknowledgment of Reviewers 2024.","authors":"","doi":"10.1089/jpm.2024.06325.revack","DOIUrl":"https://doi.org/10.1089/jpm.2024.06325.revack","url":null,"abstract":"","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":"28 1","pages":"139-141"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007071","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":"Per-Patient Illness Trajectory Analyses.","authors":"Juliet Jacobsen, Karin Boo Hammas, Mikael Segerlantz, Joakim Ekstrand, Sanjoy Mahajan, Jenny Klintman","doi":"10.1089/jpm.2024.0181","DOIUrl":"10.1089/jpm.2024.0181","url":null,"abstract":"<p><p><b><i>Background:</i></b> Summary statistics often hide individual patients' suffering, thereby impeding quality improvement efforts. <b><i>Objectives:</i></b> We aimed to show the experience of a population with health care toward the end of life while preserving the experience of the individual. <b><i>Design:</i></b> We developed a data display method called per-patient illness trajectory analysis. We tested it using a demonstration cohort of 192 patients with cancer referred to a regional Swedish specialized home-based palliative care practice. Chart review provided detailed information about illness trajectory events with a focus on unplanned hospitalization. <b><i>Results:</i></b> We created per-patient timelines spanning from cancer diagnosis until death and using a logarithmic scale: Compared with a conventional, linear timescale, this scale expands the time resolution toward the end of life. The method fosters the assessment of unmet palliative care need and care quality for individuals, small high-need groups, and populations. <b><i>Conclusion:</i></b> In populations of up to 200 people, per-patient illness trajectory analysis is feasible and promising. Using random sampling, it could be extended to larger populations.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"86-91"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621934","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 to the Editor:</i> Levetiracetam as an Alternative for Refractory Confusional Syndromes: A Case Series.","authors":"Fernando Elhordoy, Katherine Baz, Eduardo Bruera","doi":"10.1089/jpm.2024.0406","DOIUrl":"10.1089/jpm.2024.0406","url":null,"abstract":"","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"6-7"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502397","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":"Hospital Palliative Care Team Involvement in Inpatients with Hematologic Malignancies: A Retrospective Study.","authors":"Anja M Caspers, Dennis A Eichenauer, Anne Pralong, Steffen T Simon","doi":"10.1089/jpm.2024.0265","DOIUrl":"10.1089/jpm.2024.0265","url":null,"abstract":"<p><p><b><i>Background:</i></b> Data on the involvement of hospital palliative care teams (HPCT) in the management of patients with hematologic malignancies (HM) are limited. <b><i>Objectives:</i></b> To describe characteristics, symptom burden according to the German Hospice and Palliative Care Evaluation assessment tool, and course of inpatients with HM who were referred to a HPCT, and compare them with their counterparts with solid tumors (ST). <b><i>Design:</i></b> Retrospective analysis. <b><i>Setting/Subjects:</i></b> Inpatients with HM and ST who were referred to the HPCT of a comprehensive cancer center in Germany between January 1, 2015, and December 31, 2019. <b><i>Results:</i></b> The analysis included 2885 patients; 412 (14.3%) had HM and 2473 (85.7%) had ST. Patients with HM more often experienced depression (<i>p</i> = 0.003), tension (<i>p</i> < 0.001), and disorientation (<i>p</i> = 0.003); pain (<i>p</i> = 0.029), nausea (<i>p</i> = 0.003), weakness (<i>p</i> < 0.001), loss of appetite (<i>p</i> = 0.005), tiredness (<i>p</i> < 0.001), and need for assistance with activities of daily living (<i>p</i> < 0.001) were more common in patients with ST. Patients with HM were more often admitted to the intensive care unit (ICU) (<i>p</i> < 0.001), had longer ICU stays (<i>p</i> = 0.005), and had a higher death rate (<i>p</i> < 0.001) during their last stay in the hospital. The time between the first contact with the HPCT and death was shorter for patients with HM (<i>p</i> < 0.001). Patients with HM also had a shorter overall time of care by the HPCT (<i>p</i> < 0.001). <b><i>Conclusions:</i></b> As compared with their counterparts with ST, inpatients with HM were closer to death at referral to the HPCT, experienced a comparable overall symptom burden, and were admitted to the ICU more frequently after HPCT involvement.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"26-34"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348583","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}