Palliative medicine reports最新文献

{"title":"End-of-Life Care and Use of Hospital Resources in Radiotherapy-Treated Cancer Patients with Brain Metastases: A Single-Institution Retrospective Study.","authors":"Nelli-Sofia Nåhls, Anu Anttonen, Eliisa Löyttyniemi, Antti Jekunen, Outi Akrén, Tiina Saarto","doi":"10.1089/pmr.2024.0017","DOIUrl":"10.1089/pmr.2024.0017","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this single-institution retrospective study of patients treated with radiotherapy for brain metastases (BM) was to evaluate the timing of the palliative care (PC) decision, the use of health care services, i.e., emergency department (ED) visits and hospitalizations, and the implementation of radiotherapy at the end of life (EOL).</p><p><strong>Methods: </strong>Data on all cancer patients with BM treated in Finland at the Vaasa Central Hospital Radiotherapy Department between March 2011 and November 2020 were retrospectively reviewed. The follow-up period lasted until November 2021. Altogether, 91 patients (54 men, mean age 67 years [range 23-91 years]) were analyzed. Data on timing of PC decision, visits to the PC outpatient unit, and ED and hospitalization periods were collected retrospectively from patients' records.</p><p><strong>Results: </strong>The median overall survival from diagnosis of BM was 3.7 months (range 1-62 months) and, after radiotherapy, 2 months (0-61 months). Thirty-two percent of the patients received radiotherapy in the last month of life. During the last 30 days of life, 44 patients (48%) visited the ED and 38 (42%) were hospitalized. Patients with an early PC decision (>30 days before death) had fewer hospitalizations (22% vs. 53%; <i>p</i> = 0.005) and died less often during the hospitalization period (9% vs. 27%; <i>p</i> = 0.047) at EOL. No significant difference was found in ED visits (41% vs. 53%; <i>p</i> = 0.28).</p><p><strong>Conclusion: </strong>For a large proportion of patients with BM, the prognosis is very poor. It is important to identify these patients and abstain from radiotherapy at EOL to reducing inappropriate health care utilization.</p>","PeriodicalId":74394,"journal":{"name":"Palliative medicine reports","volume":"5 1","pages":"316-323"},"PeriodicalIF":1.1,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11319853/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141984089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Surprise Question and Health-Related Quality of Life in Patients on Hemodialysis: A Cross-Sectional Multicenter Study.","authors":"Jeanette M Wallin, Stefan H Jacobson, Lena Axelsson, Jenny Lindberg, Carina I Persson, Jenny Stenberg, Agneta Wennman-Larsen","doi":"10.1089/pmr.2023.0093","DOIUrl":"10.1089/pmr.2023.0093","url":null,"abstract":"<p><strong>Background: </strong>The Surprise Question (SQ) is a common method aimed at identifying frail patients who need serious illness conversations to integrate a palliative approach. However, little is known about whether the SQ identifies patients on hemodialysis who perceive that they are declining or have low health-related quality of life (HRQoL)-important aspects when considering the need for serious illness conversations.</p><p><strong>Objective: </strong>To explore how nurses and physicians' responses to the SQ are associated with patients' self-reported HRQoL.</p><p><strong>Design: </strong>Cross-sectional study.</p><p><strong>Subjects: </strong>In total, 282 patients on hemodialysis were included.</p><p><strong>Measurements: </strong>One nurse and one physician responded to the SQ for each patient. The patient-reported HRQoL was measured with the RAND 36-Item Health Survey 1.0 (RAND-36) and the EuroQual vertical visual analogue scale (EQ-VAS) from the EuroQual-5 Dimension Questionnaire (EQ-5D).</p><p><strong>Results: </strong>Nurses' responses \"no, not surprised\" to the SQ were associated with patient-reported worsened health compared to one year ago (RAND-36), and lower perceived overall health (EQ-VAS). Physicians' responses \"no, not surprised\" were associated with lower overall health and lower physical functioning. Patient-reported pain, general health, fatigue, and emotional and social aspects were not associated with responses to the SQ.</p><p><strong>Conclusions: </strong>The findings indicate that the SQ identifies patients on hemodialysis who report low overall health and low physical functioning. However, the SQ did not identify patients who reported pain, emotional problems, or fatigue, which are also important aspects to consider in identifying needs for serious illness conversations, symptom management, and to be able to integrate a palliative approach.</p>","PeriodicalId":74394,"journal":{"name":"Palliative medicine reports","volume":"5 1","pages":"306-315"},"PeriodicalIF":1.1,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11319855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141984095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pilot Study: Moving Towards a Scalable Intervention for Postgraduate Communication Skills Training.","authors":"Warren Lewin, Helen James, Nikolina Mizdrak, Ben Kaasa, Shira A Strauss, J Thomas Toguri","doi":"10.1089/pmr.2024.0006","DOIUrl":"10.1089/pmr.2024.0006","url":null,"abstract":"<p><strong>Background: </strong>Communication skills are foundational to the practice of medicine and training to build them is recommended. Serious illness communication skills (SICSs) teaching is inconsistently and sparsely taught in postgraduate training and residents report feeling inadequately trained to have difficult conversations. The authors developed an e-module demonstrating high-yield communication skills from a known evidence-based training program to standardize core SICS teaching and questioned how using it before skills practice impacted comfort and preparedness for residents to complete advance care planning (ACP).</p><p><strong>Methods: </strong>Family medicine residents at an academic hospital in Toronto, Canada, completed a novel e-module that replaced a typical didactic-lecture introducing core SICS relevant to ACP conversations. Residents then discussed the skills, followed by practicing them deliberately in a structured role-play simulation with feedback by trained facilitators. Residents completed pre- and post-intervention attitudinal surveys.</p><p><strong>Results: </strong>Residents preferred a combination of learning modalities and welcomed online and virtual teaching methods for learning SICS. Residents reported higher levels of preparedness for engaging in ACP, delivering serious news, and discussing goals of care post-intervention. Residents showed more interest in discussing ACP post-intervention but questioned feasibility for doing so in busy ambulatory clinics.</p><p><strong>Conclusion: </strong>Scalable time-efficient teaching strategies are needed to fill a known education gap. This study demonstrated benefits of incorporating brief e-module learning into residents' preparation for SICS training using deliberate practice simulation training. The online, interactive virtual training improved resident readiness and comfort for ACP, an area often overlooked in medical education. Moreover, it provides an evidence-informed standardized tool for clinician teachers to seamlessly incorporate into their teaching practices.</p>","PeriodicalId":74394,"journal":{"name":"Palliative medicine reports","volume":"5 1","pages":"293-300"},"PeriodicalIF":1.1,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11301697/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141903892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient Outcomes of a Virtual Reality-Based Music Therapy Pilot in Palliative Care.","authors":"Adreanne Brungardt, Angela Wibben, Prajakta Shanbhag, Debra Boeldt, Jeanie Youngwerth, Amanda Tompkins, Abigail J Rolbiecki, Heather Coats, A Blythe LaGasse, Jean S Kutner, Hillary D Lum","doi":"10.1089/pmr.2024.0022","DOIUrl":"10.1089/pmr.2024.0022","url":null,"abstract":"<p><strong>Background: </strong>Hospitalized patients with palliative care needs often have high levels of physical and psychological symptom distress. Virtual reality (VR) with a music therapy intervention may improve physical and psychological symptoms.</p><p><strong>Objectives: </strong>To assess symptom distress and quality of life (QOL) among hospitalized palliative care patients who participated in a virtual reality-based music therapy (VR-MT) intervention, and to explore VR-MT from the perspectives of health care professionals involved in their care.</p><p><strong>Design: </strong>Single-arm pilot study of a two-day VR-MT intervention.</p><p><strong>Setting/participants: </strong>Patients seen by an inpatient palliative care consultation service at a U.S. hospital could participate in the VR-MT intervention. Participants created a customized soundtrack with a music therapist and then listened to it while experiencing a 360-degree VR nature-based environment of their choice.</p><p><strong>Measurements: </strong>Patients completed the Edmonton Symptom Assessment System, revised version (ESAS-r) and McGill Quality of Life, revised version (MQOL-R) before and after VR-MT. Members of the participants' health care teams were interviewed.</p><p><strong>Results: </strong>Seventeen patients completed VR-MT (range 20-79 years of age, 59% women). Moderate clinical improvements were observed for total ESAS-r score (Cohen's <i>d</i> effect size, 0.68), physical distress subscale (0.52), and psychological distress subscale (0.60); small improvements were observed in total MQOL-r score (0.26) and the existential subscale (0.27). Health care team members described the value of VR-MT as facilitating meaningful conversations.</p><p><strong>Conclusions: </strong>This pilot study of VR combined with a music therapy intervention for hospitalized patients with palliative care needs supports opportunities for future study of potential improvements in symptom distress and QOL.</p>","PeriodicalId":74394,"journal":{"name":"Palliative medicine reports","volume":"5 1","pages":"278-285"},"PeriodicalIF":1.1,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11271146/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141790198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Regional Survey of Attitudes and Experiences in Determining When to Prescribe Intranasal Naloxone for Patients Seen in Palliative Care Clinics in the United States of America.","authors":"Sean Marks, Divya Patel, Rabia Amjad, April Dawson, Rebekah J Walker, Drew A Rosielle","doi":"10.1089/pmr.2024.0027","DOIUrl":"10.1089/pmr.2024.0027","url":null,"abstract":"<p><strong>Background: </strong>Published guidelines that help clinicians identify patients who would benefit from the co-prescription of intranasal naloxone (IN) exclude \"palliative care patients.\" In the absence of clear care standards, palliative care (PC) clinicians may experience uncertainty in how to approach IN co-prescriptions.</p><p><strong>Objective: </strong>Explore the attitudes of PC clinicians in the United States of America who work at regional health care institutions regarding IN prescriptions for patients they prescribe opioids for.</p><p><strong>Methods: </strong>An 18-question electronic survey was distributed to PC clinicians that practice at institutions in Wisconsin or Minnesota with at least 10 other PC clinicians between February and May 2023. The survey explored clinical scenarios in which respondents would and would not prescribe IN.</p><p><strong>Results: </strong>Fifty-six PC clinicians responded to the survey-response rate 41%. Most respondents (90.9%) did not feel IN prescriptions should be reserved for patients with a full code status; 67.9% of respondents felt that IN prescriptions are reasonable for certain patients with a terminal illness and comfort goals of care. Neither prognosis, duration of opioid therapy, nor dose of opioid therapy were significant factors in determining whether most respondents prescribed IN for their patients. Most respondents (81.8%) felt clinician counseling and patient consent were essential before prescribing IN.</p><p><strong>Conclusion: </strong>Most PC clinicians in our survey felt that IN prescriptions can be appropriate for patients they prescribe opioids for. Bystander safety was an emerging rationale for why respondents chose to prescribe IN for their patients. Despite public health efforts to make IN more freely available, most respondents felt clinician counseling was essential before prescribing IN for their patients.</p>","PeriodicalId":74394,"journal":{"name":"Palliative medicine reports","volume":"5 1","pages":"286-292"},"PeriodicalIF":1.1,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11271067/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141790196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Appropriate Timing of End-of-Life Care: A Dutch Policy Analysis and Opportunities for Improvement.","authors":"Wim J J Jansen, Jos G C Lerou, Patrick R Schober, Karolina M Szadek, Bregje A A Huisman, Monique A H Steegers","doi":"10.1089/pmr.2023.0087","DOIUrl":"10.1089/pmr.2023.0087","url":null,"abstract":"<p><strong>Background: </strong>The Exceptional Medical Expenses Act (EMEA) guaranteed public financing for the costs of end-of-life care in The Netherlands until 2015. A life expectancy shorter than three months was a prerequisite for a patient to qualify.</p><p><strong>Objective: </strong>To estimate survival and its potential predictors using the start date of EMEA funded end-of-life care as time origin, and to calculate the ensuing costs.</p><p><strong>Design: </strong>Retrospective observational study using data retrieved from multiple datasets of the national statistical office Statistics Netherlands (https://www.cbs.nl/en-gb/).</p><p><strong>Setting: </strong>Included were all adult patients, who received EMEA funded end-of-life care in hospice units in nursing homes and homes for the elderly in The Netherlands between January 1, 2009, and December 31, 2014.</p><p><strong>Results: </strong>In 40,659 patients (median age 79 years), the distribution of survival was extremely skewed. Median, 95%, and maximum survival times were 15 (95% confidence interval [CI] = 15-15), 219 (210-226), and 2,006 days, respectively. The 90-day and 180-day survival rates were 12.4 (12.1-12.7)% and 6.2 (6.0-6.5)%, respectively. Although age, gender, diagnosis, and start year of end-of-life care were statistically significant independent predictors, clinical significance is limited. End-of-life care was delivered for a total of 1,720,002 days, costing almost 440 million Euros. Fifty-nine percent of the costs was for barely 11% of patients, i.e., those who received end-of-life care for more than 90 days.</p><p><strong>Conclusion: </strong>The use of life expectancy is a weak basis for the appropriate timing of end-of-life care. Further research should evaluate potential tools to improve the timing of end-of-life care, while using available resources efficiently.</p>","PeriodicalId":74394,"journal":{"name":"Palliative medicine reports","volume":"5 1","pages":"269-277"},"PeriodicalIF":1.1,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11271145/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141790197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trajectories of Activities of Daily Living for Patients with Advanced Cancer Beyond the Last Eight Weeks of Life. Implications for Palliative Rehabilitation.","authors":"Deidre D Morgan, Jennifer J Tieman, Magnus P Ekström, David C Currow","doi":"10.1089/pmr.2024.0034","DOIUrl":"10.1089/pmr.2024.0034","url":null,"abstract":"","PeriodicalId":74394,"journal":{"name":"Palliative medicine reports","volume":"5 1","pages":"258-260"},"PeriodicalIF":1.1,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11262571/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141753536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the Utility of the Surprise Question Among General Physicians for Appropriate Palliative Care Indication in Brazil.","authors":"Gabriel Barros Furtado Leão Borges, Cristiane Bitencourt Dias","doi":"10.1089/pmr.2024.0003","DOIUrl":"10.1089/pmr.2024.0003","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to assess the agreement between established tools, such as the Palliative Performance Scale (PPS) and Brazilian version of the Supportive and Palliative Care Indicators Tool (SPICT-BR), and the subjective assessment of palliative care (PC) need using the Surprise Question (SQ) administered by resident physicians. This assessment was conducted among hospitalized patients, with and without cancer, to determine the efficacy of these tools in indicating the need for PC.</p><p><strong>Methods: </strong>A six-month cross-sectional study in 2019 of medical records of patients hospitalized in a single center in IAMSPE-Brazil. The SPICT-BR and PPS were applied to the medical record data, and the SQ was posed to each resident physician. Comparisons for categorical data were made using the chi-square test, with <i>p</i> < 0.05 considered statistically significant.</p><p><strong>Results: </strong>Of 203 patients evaluated, 57.6% were male and 81.2% were older adults (≥60 years). The mean age was 67.40 ± 9.72 years. Chronic disease was nonneoplastic in 78.32% of patients, and 56.65% had not been hospitalized in the preceding year. The PPS score was <70% in 69.4% of patients, and 51.2% met at least one SPICT-BR criterion. Among patients with cancer, 40.9% had over two positive SPICT-BR criteria; 97.5% of these patients received NO responses to SQ by residents (<i>p</i> < 0.0001). Similarly, 90.6% of patients with one SPICT-BR criterion received NO responses to SQ, with no significant difference between groups.</p><p><strong>Conclusion: </strong>The SQ proved to be a valuable tool for PC indication, particularly when administered by untrained professionals. Consistent with SPICT-BR findings, our study highlights the SQ's role in facilitating early identification of patients in need of PC.</p>","PeriodicalId":74394,"journal":{"name":"Palliative medicine reports","volume":"5 1","pages":"261-268"},"PeriodicalIF":1.1,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11262583/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141753532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adapting an Intervention to Address Barriers to Pain Management in Hospice: Formative Research to Inform EMPOWER-D for Dementia Caregivers.","authors":"Karla T Washington, Morgan L Van Vleck, Todd D Becker, George Demiris, Debra Parker Oliver, Paul E Tatum, Jacquelyn J Benson, John G Cagle","doi":"10.1089/pmr.2024.0024","DOIUrl":"10.1089/pmr.2024.0024","url":null,"abstract":"<p><strong>Background: </strong>Nearly half of more than 1.7 million older Americans who receive hospice care each year have a primary or comorbid diagnosis of dementia. Pain is often undertreated in this patient population owing to myriad factors, including unmet informational needs among family caregivers.</p><p><strong>Objective: </strong>We sought to inform the adaptation of a pain education intervention for hospice family caregivers to the context of dementia by eliciting feedback on the educational content covered in adapted intervention materials.</p><p><strong>Design: </strong>We conducted a multimethod, formative research study to inform the adaptation of an existing, evidence-based intervention.</p><p><strong>Setting/subjects: </strong>The study included a purposively recruited sample (<i>n</i> = 33) of hospice professionals (<i>n</i> = 18) and family caregivers (<i>n</i> = 15) from across the United States.</p><p><strong>Measurements: </strong>Participants quantitatively rated the importance of each of the eight pain concerns presented in the adapted intervention materials (1 = not important to 3 = very important) and provided qualitative feedback via Zoom interview on the acceptability, clinical accuracy, and potential benefits of the adapted content. We analyzed quantitative data via descriptive statistics and qualitative data via content analysis.</p><p><strong>Results: </strong>Participants rated the adapted educational content as highly important (range_mean = 2.56-3.00), particularly regarding concerns about caregivers' pain assessment, communicating with the hospice team about pain, and addressing misinformation regarding pain medication outcomes. Participants also provided suggestions to strengthen specific educational messages to improve comprehension and uptake.</p><p><strong>Conclusions: </strong>Findings support the continued development and testing of the adapted intervention.</p>","PeriodicalId":74394,"journal":{"name":"Palliative medicine reports","volume":"5 1","pages":"238-246"},"PeriodicalIF":1.1,"publicationDate":"2024-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11262577/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141753481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Informed Consent and Surrogate Interference at the Initiation of Community-Based Palliative Care Services.","authors":"John C Stys","doi":"10.1089/pmr.2024.0018","DOIUrl":"10.1089/pmr.2024.0018","url":null,"abstract":"<p><p>Community-based palliative care (CBPC) clinicians sometimes contend with an ethically charged scenario when they encounter patients for the first time: The patient's spouse, or other loved one or caregiver, revokes the patient's valid informed consent to initiate care. While surrogates are usually motivated by protective instincts, there are other situations where surrogates act out of self-interest. This article considers whether it is ever ethically justified for an adult to revoke another adult's valid informed consent to initiate palliative care services. The article examines this scenario from three perspectives: the patient's capacity to give or relinquish informed consent, the surrogate's intent and use of substituted judgment or best interest, and the clinician's duty to provide clinical care. This ethical analysis argues that CBPC clinicians have an ethical responsibility to provide palliative care services for patients who have given valid informed consent for those services even when a surrogate acts as an interfering or oppositional force.</p>","PeriodicalId":74394,"journal":{"name":"Palliative medicine reports","volume":"5 1","pages":"234-237"},"PeriodicalIF":1.1,"publicationDate":"2024-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11262575/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141753807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}