American Journal of Hospice & Palliative Medicine最新文献

{"title":"Are Palliative Care Volunteers Special People? A Comparative Observational Study Exploring Their Sociodemographic Profile and Psychological Resources.","authors":"Caroline Varay, Olivier Lareyre, Carolina Baeza-Velasco","doi":"10.1177/10499091231194036","DOIUrl":"10.1177/10499091231194036","url":null,"abstract":"<p><strong>Background: </strong>Faced with rising needs for patient support, palliative care is shifting towards a more community-based approach. Yet the profile of volunteers in this field is poorly known.</p><p><strong>Aim: </strong>To explore psychosocial characteristics of palliative care volunteers, by comparing them to two groups, volunteers from the health and social sector without contact with palliative patients, and people from the general population without volunteer activity.</p><p><strong>Design: </strong>Observational comparative study. Data were analyzed using descriptive statistics and logistic regression analysis.</p><p><strong>Participants: </strong>The 3 groups of participants were recruited in France between September 2020 and June 2021. They completed an online survey assessing sociodemographic characteristics and psychological resources (self-efficacy, hope, optimism, resilience, mindfulness, self-compassion, empathy, forgivingness, and gratitude).</p><p><strong>Results: </strong>Data from 559 participants were analyzed. Palliative care volunteers had overall significantly higher levels of psychological resources than control groups. Multivariate analysis revealed, among sociodemographic and psychological characteristics that showed differences between groups at the univariate level, the most efficient predictors of group status. The best criteria to distinguish palliative care volunteers from health and social sector volunteers were older age, having received training, and lower levels of self-compassion. To distinguish palliative care volunteers from people with no volunteer activity, older age and non-active professional status were the best criteria.</p><p><strong>Conclusions: </strong>Palliative care volunteers displayed more psychological resources than controls. However, older age and being trained for volunteering, emerged as stronger factors for distinguishing palliative care volunteers from controls. Pursuing research about these volunteers should facilitate recruitment, training, and retention.</p>","PeriodicalId":50810,"journal":{"name":"American Journal of Hospice & Palliative Medicine","volume":" ","pages":"754-761"},"PeriodicalIF":1.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10309329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Technology to Support Older Adults in Home Palliative Care: A Scoping Review.","authors":"Ilaria Basile, Letteria Consolo, Stella Colombo, Daniele Rusconi, Flavia Rampichini, Maura Lusignani","doi":"10.1177/10499091231189502","DOIUrl":"10.1177/10499091231189502","url":null,"abstract":"<p><strong>Background: </strong>Today, many older adults use health technologies, approach their final days with laptops, smartphones, and tablets. <i>Telepalliative care</i> is a service that remotely delivers palliative care through videoconferencing, telephonic communication, or remote symptom monitoring. The service meets the needs of patients who want to die at home and reducing unnecessary hospitalizations. The objective of this study is to map the literature on the use of technology by the terminally ill older adult population being cared for at home, to identify which technology systems are in use, to determine how technology can change communication between palliative care professionals and patients, and to explore the strengths or weaknesses patients perceive regarding the use of technology.</p><p><strong>Methods: </strong>We conducted a scoping review following the methodology of Arksey and O'Malley. A literature search was conducted in the MEDLINE, Embase, Web of Science, SCOPUS, PsycINFO, CINAHL, Ilisi and Google Scholar databases.</p><p><strong>Results: </strong>Fourteen eligible papers identified various tools available in clinical practice and found that most older adults are comfortable and satisfied using them. Despite being physically distanced from clinicians, patients felt cared for even though eye contact was lacking. Being unfamiliar with technology emerged as a barrier to telepalliative care in addition to difficulties caused by screen size and internet connection problems.</p><p><strong>Conclusions: </strong>Older adults in palliative care at home perceive technology as a means of receiving efficient care. However, future research is needed to investigate what they look for in a technological tool and to develop more suitable technologies for them.</p><p><strong>Clinical trial registration: </strong>The protocol of this study has been published in the Open Science Framework (OSF) preregistrations at https://osf.io/acv7q to enhance replicability and transparency and reduce any publication or reporting bias.</p>","PeriodicalId":50810,"journal":{"name":"American Journal of Hospice & Palliative Medicine","volume":" ","pages":"673-690"},"PeriodicalIF":1.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11032634/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9845746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cancer Patient Perspectives on the Meaning of Healing and the Clinician as a Healer.","authors":"Cindy Y Yang, Thomas J Smith, Amy R Knowlton","doi":"10.1177/10499091231191697","DOIUrl":"10.1177/10499091231191697","url":null,"abstract":"<p><strong>Background: </strong>The experience of living with cancer is marked by suffering and loss, which creates a need for healing. Understanding what healing means to patients and how clinicians can play a role in the healing process is essential to holistic cancer care.</p><p><strong>Objective: </strong>The aim of this study was to explore the perspectives of cancer patients on the meaning and experiences of healing and the qualities of a clinician and the clinician-patient relationship that are healing.</p><p><strong>Methods: </strong>A qualitative study was conducted using semi-structured interviews with 14 cancer patients. Participants were asked about their illness experience, definition of healing, qualities of a healer, and relationships with clinicians that were healing. Interview transcripts were coded, and qualitative analysis was conducted to identify major themes.</p><p><strong>Results: </strong>Participants defined the nature of healing as comprising aspects of physical, mental, emotional, and spiritual well-being. Participants described healing as alleviating pain and symptoms; promoting mental strength, emotional comfort, and spiritual connection; restoring and adapting to losses; and improving quality of life. The qualities of a clinician that contributed to a healing relationship included listening, empathy and compassion, understanding patients' values and goals, and caring for the patient as a whole person.</p><p><strong>Conclusion: </strong>Participants viewed healing as physical, psychosocial, and spiritual in nature and an important part of their cancer experience with an emphasis on quality of life. Clinicians played an important role beyond treating the cancer by helping in the healing process through their humanistic qualities and holistic approach to patient care.</p>","PeriodicalId":50810,"journal":{"name":"American Journal of Hospice & Palliative Medicine","volume":" ","pages":"658-663"},"PeriodicalIF":1.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9864961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Change in U.S. Hospice Quality Measure Scores During the COVID-19 Pandemic and Correlation With Exposure to State Policies for Protection of Older Adults.","authors":"Janna Baker Rogers, John Cagle","doi":"10.1177/10499091231194726","DOIUrl":"10.1177/10499091231194726","url":null,"abstract":"<p><strong>Background: </strong>To limit spread of COVID-19, many U.S. states adopted policies affecting access to older adults, including those in hospice. This study aimed to assess differences in hospice quality measures from before COVID-19 to during the COVID-19 pandemic and to evaluate for any correlation with these state policies.</p><p><strong>Methods: </strong>Scores (treatment preferences, believes/values, pain screening and assessment, dyspnea screening and treatment, bowel regimen, and a composite score) and Denominators (population being measured) for CMS's Hospice Item Set were compared using a paired <i>t</i>-test between a pre-pandemic period (01/2019-12/2019) and a period early in the pandemic in the U.S (7/2020-6/2021). Correlations between HIS composite scores from 9 months (7/2020-3/2021) and exposure to state policies for older adult protection, and covariates, were assessed by linear regression.</p><p><strong>Results: </strong>Data were collected on 3535 hospices. Seven of 8 HIS scores increased during the pandemic period. The remaining score was unchanged. All Denominators decreased. There was negative correlation between composite score (7/2020-3/2021) and exposure to state policies for protecting older adults. There were positive correlations with hospice age, for-profit status, 2019 average daily census, and 2019 composite score.</p><p><strong>Conclusion: </strong>Most HIS scores increased during this COVID-19 pandemic period; there was a small, significant negative correlation between the composite quality score and exposure to state policies for older adult protection. Further research is needed to better understand the effects of the COVID-19 pandemic on hospice care in the U.S. and globally, and future additions in quality reporting may facilitate real-time assessment during future public health emergencies.</p>","PeriodicalId":50810,"journal":{"name":"American Journal of Hospice & Palliative Medicine","volume":" ","pages":"840-847"},"PeriodicalIF":1.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9974637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"NeoTalk: Communication Skills Training for Neonatal Clinicians.","authors":"Katherine F Guttmann, Malorie Meshkati, Julia Frydman, Cardinale B Smith, Lindsay Dow, Andrea S Weintraub","doi":"10.1177/10499091231198507","DOIUrl":"10.1177/10499091231198507","url":null,"abstract":"<p><strong>Background: </strong>Despite proven benefit, pediatric subspecialists often have not been offered formal serious illness communication skills training. We sought to: 1) develop and evaluate the impact of a communication skills course, based on the VitalTalk framework, on Neonatal Intensive Care Unit (NICU) clinicians; 2) evaluate provider comfort with key serious illness communication skills and frequency of use of those skills, before and after \"NeoTalk\" and; 3) explore differences and similarities between adult and pediatric serious illness communication skills courses.</p><p><strong>Methods: </strong>We developed a NICU specific communication skills course and surveyed course participants to evaluate comfort with key communication skills before and after course participation, and frequency of use of key skills before and 2 months after our course. Wilcoxon signed rank tests and Kruskal-Wallis tests were performed to compare participant responses across time points.</p><p><strong>Results: </strong>34 providers completed NeoTalk training. Complete pre- and post-course data was available for 29 participants. Participants reported increased comfort with skills including 'sharing difficult news' (<i>P</i> = .018), and 'responding to emotion' (<i>P</i> = .002). Participants did not report increased frequency in using target skills 2 months after training.</p><p><strong>Conclusions: </strong>A multi-disciplinary cohort of NICU providers endorsed increased confidence in key communication skills but not increased skill application 2-months post-course completion. While a single course can successfully teach skills, additional exposure may be necessary to build new communication habits. Our experience developing NeoTalk helped elucidate some of the ways in which conversations about seriously ill infants may be different from conversations about seriously ill adults.</p>","PeriodicalId":50810,"journal":{"name":"American Journal of Hospice & Palliative Medicine","volume":" ","pages":"651-657"},"PeriodicalIF":1.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10067728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of Palliative Care Knowledge and Symptom Burden Among Female Veterans With Serious Illness: A Cross-Sectional Study.","authors":"Brandon M Varilek, Patricia Da Rosa","doi":"10.1177/10499091231187341","DOIUrl":"10.1177/10499091231187341","url":null,"abstract":"<p><p><b>Background:</b> The female Veteran population is rapidly growing, as is their use of Veterans Affairs (VA) medical centers (VAMCs). Additionally, 90% of female Veterans are under 65 years old, meaning healthcare providers at VAMCs must be ready to manage the complex serious illnesses that affect female Veterans as they age. These serious illnesses require proper medical management, which can include palliative care. However, little palliative care research includes female Veterans. <b>Aims:</b> The aims of this cross-sectional study were to examine palliative care knowledge and symptom burden among female Veterans' and examine factors associated a symptom burden scale. <b>Methods:</b> Consenting participants completed online questionnaires, including the Palliative Care Knowledge Scale (PaCKS), Condensed Memorial Symptom Assessment Scale (CMSAS), and demographics. Descriptive statistics characterized the sample, bivariate association were carried out with a Chi-square and <i>t</i> test. A generalized linear model explored associations between CMSAS and its subscales with sociodemographic, number of serious illnesses, and facility type (VAMC vs civilian facility). <b>Results:</b> 152 female Veterans completed the survey. PaCKS scores were consistent across our sample. Physical symptoms were rated higher for those receiving care at VAMCs compared to civilian facilities (<i>P</i> = .02) in the bivariate analysis. The factors associated with CMSAS were age, employment status and number of serious illnesses (all <i>P</i> < .05). <b>Conclusions:</b> Palliative care can assist female Veterans with serious illness. More research is needed to further explore variables associated with symptom burden among female Veterans such as age, employment status, and number of serious illnesses.</p>","PeriodicalId":50810,"journal":{"name":"American Journal of Hospice & Palliative Medicine","volume":" ","pages":"641-650"},"PeriodicalIF":1.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9690155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Canadian Undergraduate Perspectives on Medical Assistance in Dying for Mental Illness: Does Psychiatric Illness Type, Age, and Exposure to Information Influence Acceptance of MAiD?","authors":"Lori Harper, Christina A. Tomaras, Russell A. Powell, John R. Reddon, Erin Hawrelak","doi":"10.1177/10499091241247835","DOIUrl":"https://doi.org/10.1177/10499091241247835","url":null,"abstract":"Background and ObjectivesIn 2027, Canadians whose only medical condition is an untreatable mental illness and who otherwise meet all eligibility criteria will be able to request Medical Assistance in Dying (MAiD). This study investigates the attitudes of undergraduate students towards widening the scope of MAiD for physical illness for certain psychiatric conditions. We were interested in understanding if age, information, and type of mental illness influenced undergraduates’ acceptance or rejection of MAiD for mental illness (MAiD-MI).Method413 undergraduate students participated in this study which examined the factors that correlate with the acceptance or rejection of MAiD-MI. Four scenarios were presented in which age (older or younger) and illness type (depression or schizophrenia) were manipulated. Demographic questions and measures assessing personality, religion, and attitudes towards euthanasia were administered. Questions assessing participants’ general understanding of MAiD and their life experiences with death and suicide were also asked.ResultsMost of the participants accepted MAiD-MI for both depression and schizophrenia. As hypothesized, support for MAiD-MI was higher for patients with schizophrenia than for depression. Also as hypothesized, support was higher for older patients than for younger patients. Variables such as religion, personality and political affiliation were also associated with acceptance or rejection of MAiD-MI. Finally, consistent with our hypotheses, participants’ understanding of MAiD and experiences with death and suicide was predictive of support for MAiD-MI.","PeriodicalId":50810,"journal":{"name":"American Journal of Hospice & Palliative Medicine","volume":"21 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140836961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Overall US Hospice Quality According to Decedent Caregivers-Natural Language Processing and Sentiment Analysis of 3389 Online Caregiver Reviews.","authors":"Jason Hotchkiss, Emily Ridderman, William Buftin","doi":"10.1177/10499091231185593","DOIUrl":"10.1177/10499091231185593","url":null,"abstract":"<p><p><b>Objectives:</b> With an untapped quality resource in online hospice reviews, study aims were exploring hospice caregiver experiences and assessing their expectations of the hospice Medicare benefit. <b>Methods:</b> Topical and sentiment analysis was conducted using natural language processing (NLP) of Google and Yelp caregiver reviews (n = 3393) between 2013-2023 using Google NLP. Stratified sampling weighted by hospice size to approximate the daily census of US hospice enrollees. <b>Results:</b> Overall caregiver sentiment of hospice care was neutral (S = .14). <i>Therapeutic, achievable expectations</i> and <i>misperceptions, unachievable expectations</i> were, respectively, the most and least prevalent domains. Four topics with the highest prevalence, all had moderately positive sentiments: <i>caring staff</i>, <i>staff professionalism and knowledge</i>; <i>emotional, spiritual, bereavement support</i>; and <i>responsive, timely or helpful</i>. Lowest sentiments scores were <i>lack of staffing</i>; <i>promises made, but not kept</i>, <i>pain, symptoms and medications; sped-up death, hasted, or sedated;</i> and <i>money, staff motivations</i>. <b>Significance of Results:</b> Caregivers overall rating of hospice was neutral, largely due to moderate sentiment on achievable expectations in two-thirds of reviews mixed with unachievable expectations in one-sixth of reviews. Hospice caregivers were most likely to recommend hospices with caring staff, providing quality care, responsive to requests, and offering family support. Lack of staff, inadequate pain-symptom management were the two biggest barriers to hospice quality. All eight CAHPS measures were found in the discovered review topics. Close-ended CAHPS scores and open-ended online reviews have complementary insights. Future research should explore associations between CAHPS and review insights.</p>","PeriodicalId":50810,"journal":{"name":"American Journal of Hospice & Palliative Medicine","volume":" ","pages":"527-544"},"PeriodicalIF":1.9,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9662059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What Patients Facing Cancer and Caregivers Want From Communication in Times of Crisis: A Qualitative Study in the Early Months of the COVID-19 Pandemic.","authors":"Nainwant Singh, Karleen F Giannitrapani, Raziel C Gamboa, Claire E O'Hanlon, Soraya Fereydooni, Laura M Holdsworth, Charlotta Lindvall, Anne M Walling, Karl A Lorenz","doi":"10.1177/10499091231187351","DOIUrl":"10.1177/10499091231187351","url":null,"abstract":"<p><strong>Background: </strong>Interpersonal communication is a cornerstone of patient-centered care. We aimed to identify what patients with cancer and caregivers may want from communication during a public health crisis.</p><p><strong>Methods: </strong>We interviewed 15 patients (8 Veteran, 7 non-Veteran) and caregivers from regionally, racially, and ethnically diverse backgrounds across the US about serious illness care and quality of care during the COVID-19 pandemic Using an iterative, inductive and deductive process, 2 coders analyzed content associated with the code \"Communication,\" which appeared 71 times, and identified 5 themes.</p><p><strong>Results: </strong>Participants identified as White (10), Latino/a (3), Asian (1), and Black (1). (1) Help patients and caregivers prepare for care during crisis by communicating medical information directly and proactively. (2) Explain how a crisis might influence medical recommendations and impact on recovery from illness. (3) Use key messengers to improve communication between primary teams, patients, and caregivers. (4) Include caregivers and families in communication when they cannot be physically present. (5) Foster bidirectional communication with patients and families to engage them in shared decision-making during a vulnerable time.</p><p><strong>Conclusion: </strong>Communication is critical during a public health crisis yet overwhelmed clinicians may not be able to communicate effectively. Communicating with caregivers and family, transparent and timely communication, ensuring diverse providers are on the same page, and effective listening are known gaps even before the COVID-19 pandemic. Clinicians may need quick interventions, like education about goals of care, to remind them about what seriously ill patients and their caregivers want from communication and offer patient-centered care during crises.</p>","PeriodicalId":50810,"journal":{"name":"American Journal of Hospice & Palliative Medicine","volume":" ","pages":"558-567"},"PeriodicalIF":1.5,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10315453/pdf/10.1177_10499091231187351.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9741879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations Between Certificate of Need Policies and Hospice Quality Outcomes.","authors":"Arlen G Gaines, John G Cagle","doi":"10.1177/10499091231180613","DOIUrl":"10.1177/10499091231180613","url":null,"abstract":"<p><strong>Background: </strong>Certificate of need (CON) laws are state-based regulations requiring approval of new healthcare entities and capital expenditures. Varying by state, these regulations impact hospices in 14 states and DC, with several states re-examining provisions.</p><p><strong>Aim: </strong>This cross-sectional study examined the association of CON status on hospice quality outcomes using the hospice item set metric (HIS).</p><p><strong>Design: </strong>Data from the February 2022 Medicare Hospice Provider and General Information reports of 4870 US hospices were used to compare group means of the 8 HIS measures across CON status. Multiple regression analysis was used to predict HIS outcomes by CON status while controlling for ownership and size.</p><p><strong>Results: </strong>Approximately 86% of hospices are in states without a hospice CON provision. The unadjusted mean HIS scores for all measures were higher in CON states (M range 94.40-99.59) than Non-CON (M range 90.50-99.53) with significant differences in all except treatment preferences. In the adjusted model, linear regression analyses showed hospice CON states had significantly higher HIS ratings than those from Non-CON states for beliefs and values addressed (β = .05, <i>P</i> = .009), pain assessment (β = .05, <i>P</i> = .009), dyspnea treatment (β = .08, <i>P</i> < .001) and the composite measure (β = .09, <i>P</i> < .001). Treatment preferences, pain screening, dyspnea screening, and opioid bowel treatment were not statistically significant (<i>P</i> > .05).</p><p><strong>Conclusion: </strong>The study suggests that CON regulations may have a modest, but beneficial impact on hospice-reported quality outcomes, particularly for small and medium-sized hospices. Further research is needed to explore other factors that contribute to HIS outcomes.</p>","PeriodicalId":50810,"journal":{"name":"American Journal of Hospice & Palliative Medicine","volume":" ","pages":"471-478"},"PeriodicalIF":1.9,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9557263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}