Annals of palliative medicine最新文献

{"title":"Preferences for life and functional prognostic information among Japanese patients undergoing first-time chemotherapy.","authors":"Hiroyuki Yamamoto, Yuko Kitamura","doi":"10.21037/apm-2025-1-145","DOIUrl":"https://doi.org/10.21037/apm-2025-1-145","url":null,"abstract":"<p><strong>Background: </strong>Prognostic information is paramount in the decision-making of patients with cancer. Furthermore, the type of information required depends on cancer progression. However, preferences for such information among patients undergoing cancer chemotherapy for the first time have not been well-elucidated. This study aimed to identify patient preferences for prognostic information to improve informational support provided by healthcare providers.</p><p><strong>Methods: </strong>This study was conducted as part of a longitudinal study and analyzed data on preferences for prognostic information collected after one course of cancer chemotherapy. A questionnaire was used to assess preferences for prognostic information (life and functional prognoses), knowledge of chemotherapy, anxiety about adverse events (AEs), and information-seeking behaviors. Patient characteristics were collected, and the relationships between variables and preferences for prognostic information were analyzed.</p><p><strong>Results: </strong>Fifty-four patients participated in the study (mean age: 66.0 years; 55.6% male). Regarding prognosis, 40.7% of patients answered \"strongly agree\" or \"agree\" on a six-point scale to the degree to which they wanted to know their life prognoses, whereas 31.5-50.0% wanted to know their functional prognosis. No significant differences were observed in the types of prognostic information; however, each prognostic variable exhibited a positive correlation (r=0.60-0.89, P<0.001). Subgroup analyses were performed according to treatment intent (adjuvant, life-sustaining/palliative). In the life-sustaining/palliative group, a statistically significant association was observed between the propensity to seek information regarding life prognosis and the execution of information-seeking behavior among participants (P=0.04), and correlation analysis revealed a positive correlation between older adult-only households and thinking (r=0.40, P=0.02) and eating prognoses (r=0.38, P=0.03). In the adjuvant group, age exhibited a negative correlation with life prognosis (r=-0.59, P=0.009).</p><p><strong>Conclusions: </strong>In Japanese patients undergoing cancer chemotherapy for the first time, both functional and life prognoses are important. Patients who wanted to know about one type of prognosis also tended to want information about another. For patients receiving life-sustaining/palliative care, life prognosis was important, and these patients tended to seek information. Being in an older adults-only household was significantly correlated with the desire for prognostic information, particularly thinking and eating habits. We speculated that this tendency would be observed only in the life-sustaining/palliative group, as these patients were more aware of approaching the end of life. In the adjuvant group, a tendency for decreased prognostic awareness was suggested in older adults, which may reflect a change in treatment values with age,","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147670155","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":"Multidisciplinary clinical prediction of survival of patients attending Palliative Radiation Oncology and Palliative Care clinics: a prospective cohort study.","authors":"Hassan Shahzad, Vickie E Baracos, Brock Debenham, Sharon M Watanabe, Ann Huot, Alysa Fairchild","doi":"10.21037/apm-25-108","DOIUrl":"10.21037/apm-25-108","url":null,"abstract":"<p><strong>Background: </strong>Clinical prediction of survival (CPS) in Oncology has rarely been compared among different health care disciplines. Our aim was to evaluate the prognostication ability of multidisciplinary team (MDT) members experienced in providing specialist Palliative Care (PC) and palliative radiotherapy (PRT).</p><p><strong>Methods: </strong>We conducted a prospective cohort study in a tertiary cancer center serving the northern half of the Canadian province of Alberta. After usual direct clinical assessment of consecutive patients with any primary histology, survival predictions were independently made by each clinician, and factors influencing predictions were collected from each assessor. CPS was considered correct if within 30 days or 30% of actual survival (AS).</p><p><strong>Results: </strong>Clinicians assessed 980 patients [2010-2014], of whom 944 have died (96.3%) with median AS of 122 days [95% confidence interval (CI): 116-128]. Median Palliative Performance Scale was 62±15. Eleven disciplines, including physicians, nurses, radiation therapists, other allied health professionals and trainees made a total of 2,776 predictions during 1,130 clinic visits. Overall, CPS was significantly longer than AS. On average, 30.7% of predictions were correct (range 20.1-40.6% across disciplines). Survival was more often overpredicted (47.1%) than underpredicted (22.2%). The median number of days overpredicted varied significantly by discipline, from 47 [39-55] to 161 [135-187] days. Differential accuracy persisted after adjustment for primary tumor site, gender and duration of AS. Factors underpinning CPS also varied by discipline.</p><p><strong>Conclusions: </strong>Although all disciplines had a propensity to overpredict survival, each did so with differing accuracy, based on different clinical parameters.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":" ","pages":"22"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147430309","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":"Radiofrequency ablation of the superior cluneal nerves to treat chronic low back pain: a description of a novel technique.","authors":"Alaa Abd-Elsayed, Madelyn Reilly, Geovany Riad","doi":"10.21037/apm-25-111","DOIUrl":"10.21037/apm-25-111","url":null,"abstract":"<p><p>Superior cluneal nerve (SCN) entrapment is an often-overlooked cause of chronic axial low back and gluteal pain. Recent cadaveric findings demonstrate that the SCN originates from T11-L5 with variable branching across the posterior iliac crest. This technical report describes a method for treating low back and gluteal pain using fluoroscopy-guided radiofrequency ablation (RFA) for SCN pain and summarizes the relevant anatomical sites. For the RFA procedure, under a combination of fluoroscopic and ultrasound-guided imaging, an 18-22-gauge cannula is advanced to the osseoaponeurotic orifice 6-8 cm lateral to the midline. Sensory stimulation is utilized to confirm pain reproduction, while motor testing verifies the absence of distal activation. RFA is performed at 80 ℃ for 90 seconds, and additional lesions are added as needed due to anatomical variability. With minimal complications, peer-reviewed studies show significant but preliminary pain reduction and improved function after SCN-targeted RFA. Accuracy in probe placement, achieved through the use of fluoroscopic and ultrasound-guided imaging and stimulation testing, enhances both reproducibility and safety. SCN-targeted RFA offers a minimally invasive treatment for patients with refractory axial low back pain. Moderate-quality evidence suggests a therapeutic benefit, although current data are obtained from observational studies. Detailed attention to anatomic variability and technique is crucial for achieving consistent outcomes and ensuring patient safety.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":" ","pages":"26"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147430357","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 do student and educator perspectives reveal about assisted dying in the UK medical curriculum? A narrative review.","authors":"Benjamin Smith, Megan Roberts, Saarah Talha","doi":"10.21037/apm-2025-1-138","DOIUrl":"https://doi.org/10.21037/apm-2025-1-138","url":null,"abstract":"<p><strong>Background and: </strong></p><p><strong>Objective: </strong>Assisted dying is a highly complex and evolving ethical area in the United Kingdom (UK) healthcare, with ongoing legislative developments creating urgency. UK medical students, potentially the first generation to navigate its legalisation, face an inconsistent curriculum. This review examined the inclusion and quality of assisted dying education in UK undergraduate medical schools, analysing curricular extent and alignment with General Medical Council (GMC) end-of-life care expectations.</p><p><strong>Methods: </strong>A narrative literature review was conducted. Searches of PubMed and Scopus (2004-2025) focused on assisted dying, palliative care, and UK medical undergraduate education. Six publications were included and analysed thematically regarding student attitudes, ethical education, and curricular gaps.</p><p><strong>Key content and findings: </strong>Teaching on assisted dying is fragmented, inconsistent, and often superficial, typically confined to isolated workshops. Active-learning modules improve ethical reasoning, but general progression often conveys only current legal frameworks. Student attitudes are diverse, influenced by religious background and clinical exposure. A major finding is the scarcity of robust UK-specific research on implementation. This deficiency risks future doctors being unprepared to professionally and ethically navigate the evolving legal landscape.</p><p><strong>Conclusions: </strong>The UK medical education system lacks a standardised, integrated approach to teaching assisted dying. The curriculum is insufficiently robust, and evidence for implementation is scarce. Medical schools must be proactive to potential legislative change. A standardised framework incorporating case discussions, dedicated ethics/law sessions, and communication skills training is essential to prepare the future workforce for this challenging issue.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"15 2","pages":"24"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147637712","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":"Community-based management of gastrointestinal symptoms at end-of-life in scleroderma using subcutaneous medication: a case report.","authors":"Amanda Landers, Rebecca Davey, Hamish Farquhar","doi":"10.21037/apm-2025-aw-131","DOIUrl":"10.21037/apm-2025-aw-131","url":null,"abstract":"<p><strong>Background: </strong>Systemic sclerosis (SSc) is a rare autoimmune connective tissue disorder often associated with severe gastrointestinal symptoms. At the end of life, managing these symptoms in the community can be challenging, particularly when patients are unable to take oral medications and wish to avoid hospital admission. This case describes the use of subcutaneous omeprazole in a community setting to manage refractory upper gastrointestinal symptoms in a patient with SSc during the final days of life.</p><p><strong>Case description: </strong>A 51-year-old patient with advanced SSc experienced significant upper gastrointestinal symptoms, including gastro-oesophageal reflux, haematemesis, and gastric discomfort. Oral administration of medication became unreliable, and parenteral medication was clinically indicated. Hospital admission for intravenous therapy was inconsistent with the patient's preference to remain at home. Although alternative anti-secretory agents were available, the patient specifically requested omeprazole. A continuous subcutaneous infusion of omeprazole was initiated in the home setting following consultation with clinical colleagues and reference to limited published reports supporting this route. In negotiation with the family, the medication was trialled by the subcutaneous route as an infusion. The patient reported significant improvements in symptoms with the medication, which recurred when the omeprazole was reduced and improved when increased again.</p><p><strong>Conclusions: </strong>This case illustrates the safe and effective use of subcutaneous omeprazole for managing upper gastrointestinal symptoms at the end of life in a community setting. It supports the role of flexible prescribing and individualised care to respect patient preferences. Due the unpredictable physiology of people at the end-of-life and the challenges in palliative care research, case reports and expert opinion remain vital evidence for clinical practice.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":" ","pages":"28"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147430119","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":"\"Black box\" artificial intelligence for mortality prediction: a mixed-methods study of palliative care team, patient, and caregiver perspectives.","authors":"Beatrice Bridge, Ahmed Y Alasmar, Lauren Gunn-Sandell, Regina M Fink, Stacy M Fischer, Elizabeth Juarez-Colunga, Eric G Campbell, Matthew DeCamp","doi":"10.21037/apm-2025-1-137","DOIUrl":"10.21037/apm-2025-1-137","url":null,"abstract":"<p><strong>Background: </strong>New artificial intelligence (AI)-based mortality prediction algorithms could support both patients' prognostic awareness and person-centered palliative care. Although they promise accuracy, their outputs can be hard to explain-potentially affecting whether patients and care teams use them. To investigate perspectives on the explainability of AI algorithms in palliative care, we conducted a sequential mixed-methods study.</p><p><strong>Methods: </strong>We interviewed 30 palliative care physicians and nurses; 15 social workers, spiritual care providers, psychologists, and others; and 35 patients and caregivers at four U.S. academic centers (total n=80). The 53 interviews containing data on explainability were analyzed thematically to understand reasons for concern or unconcern. We randomly sampled and surveyed n=2,500 palliative care physicians (overall adjusted response rate, 32.6%). The 537 surveys with complete responses on explainability items were analyzed descriptively; a multivariable model examined predictors of concern.</p><p><strong>Results: </strong>Among 53 interviewees, 18 expressed only concern about black box AI-based prognostication, 17 expressed only unconcern, and 18 interviewees expressed mixed sentiments. Reasons for concern related to: data transparency, mistrust of machines or their creators, patient-clinician communication, bias, and accuracy. Reasons for unconcern related to: inexplicability not unique to AI, greater accuracy, not using AI in isolation, trust in science, and being evidence-based. Notably, \"accuracy\" and \"trust\" appeared in both. Overall, 75% of physicians (n=396/528) reported being at least \"moderately concerned\" about unexplainable AI algorithms. Male physicians were less likely to be strongly concerned [adjusted odds ratio (aOR) 0.57; 95% confidence interval (CI): 0.36, 0.89; P=0.01] about explainability. Those who perceived AI mortality prediction to be inaccurate were more likely to be concerned (aOR 2.06; 95% CI: 1.27, 3.41; P=0.003).</p><p><strong>Conclusions: </strong>Our findings suggest that if a black box model is perceived as accurate, there may be less demand for explainability. Nevertheless, in palliative care-where communication is key-explainability may still be central. Future efforts should seek to create models that are both accurate and explainable at the point-of-care.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":" ","pages":"20"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147429902","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":"Public health palliative care and compassionate communities.","authors":"Luc Deliens, Bert Quintiens","doi":"10.21037/apm-25-75","DOIUrl":"https://doi.org/10.21037/apm-25-75","url":null,"abstract":"","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"15 2","pages":"18"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147637704","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":"Social determinants of health, disparities, and outpatient specialty palliative care in patients with gynecologic malignancies.","authors":"Charles B Simone","doi":"10.21037/apm-2026-02","DOIUrl":"https://doi.org/10.21037/apm-2026-02","url":null,"abstract":"","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"15 2","pages":"29"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147637726","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":"End-of-life predictions in advanced cancer: nurses' perspectives and the possible role of contact-free vital sign monitoring-a prospective exploratory observational study.","authors":"Dai Suganuma, Natsuko Nozaki-Taguchi, Akiko Yoshimura, Yoshihiko Sakashita, Masami Fujisato, Yasunori Sato, Shiroh Isono","doi":"10.21037/apm-25-95","DOIUrl":"10.21037/apm-25-95","url":null,"abstract":"<p><strong>Background: </strong>Experienced nurses working in palliative care units might sense patients approaching death. This study aimed to identify the most frequent characteristic actions exhibited by nurses two weeks prior to death and the physical changes observed in patients for whom the approach of death was predicted.</p><p><strong>Methods: </strong>This prospective observational study included 40 adult patients with advanced cancer who were admitted to the palliative care ward of a Japanese cancer hospital. Nurses' nine actions, possibly associated with the prediction of approaching death, were predetermined, and their timing and frequency were determined by chart review. A contact-free non-restraining bed sensor system (BSS) was used to continuously measure vital signs, including respiratory and pulse rates and activity patterns from admission to discharge due to death.</p><p><strong>Results: </strong>Thirty-five patients were successfully analyzed. Radial artery palpation (57%) was the nurse's action with the highest frequency during the 3-14 days before death among the nine actions. Comparison of physical and physiological variables detected by the non-contact monitoring device three days prior to the day of radial artery palpation revealed increases in nocturnal body movement activity (51 vs. 55 g/s, P=0.046), respiratory rate instability (11.5% vs. 11.9%, P=0.02), and time spent in bed during the day (98.2% vs. 98.8%, P=0.008).</p><p><strong>Conclusions: </strong>Radial artery palpation is a key action performed when nurses sense approaching death within 3-14 days. Non-contact continuous physical monitoring may increase the accuracy of nurses' predictions of approaching death and help medical personnel provide excellent care.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":" ","pages":"21"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147430255","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":"Percutaneous tumor ablation techniques for palliative cancer pain: a narrative review.","authors":"Rodrigo Díez-Tafur, Flor Montenegro Torres, María José Quiroga Reategui","doi":"10.21037/apm-2025-aw-121","DOIUrl":"10.21037/apm-2025-aw-121","url":null,"abstract":"<p><strong>Background and objective: </strong>Cancer-related pain remains a prevalent and debilitating symptom in patients with advanced malignancy, often inadequately controlled with systemic analgesics, radiotherapy, or surgery due to limited efficacy, delayed onset, or treatment-related toxicity. Percutaneous image-guided tumor ablation has emerged as a minimally invasive option capable of providing effective pain palliation while preserving quality of life. The objective of this narrative review is to summarize and critically appraise tumor ablation techniques relevant to palliative and interventional pain care, with particular focus on analgesic outcomes, mechanisms of pain relief, and clinical applicability.</p><p><strong>Methods: </strong>A narrative literature review was conducted using PubMed, Scopus, and Embase to identify English-language studies published between 2000 and 2025 evaluating percutaneous tumor ablation for cancer-related pain. Search terms included radiofrequency ablation, microwave ablation, cryoablation, laser ablation, irreversible electroporation, high-intensity focused ultrasound, and cancer pain. Priority was given to recent systematic reviews and key clinical studies published between 2023 and 2025.</p><p><strong>Key content and findings: </strong>The review encompasses both thermal (radiofrequency, microwave, cryoablation, and laser) and non-thermal [irreversible electroporation (IRE)] ablation modalities. Across the literature, tumor ablation is associated with meaningful reductions in pain intensity, decreased opioid requirements, and improvements in functional status and quality of life. Radiofrequency (RFA) and microwave ablation (MWA) are commonly utilized for painful bone and soft-tissue metastases, while cryoablation offers improved visualization and is preferred for lesions in proximity to neural or critical structures. Laser ablation and IRE may be advantageous when thermal injury is a concern. When performed with appropriate imaging guidance and patient selection, reported complication rates are low. Emerging approaches, including bipolar RFA, often combined with vertebral augmentation, have demonstrated particular benefit in painful spinal metastases.</p><p><strong>Conclusions: </strong>Percutaneous tumor ablation represents a valuable adjunct in multidisciplinary palliative pain management. By synthesizing current evidence, this review may assist clinicians in selecting appropriate ablative strategies, support earlier integration of minimally invasive interventions into palliative care pathways, and inform future research focused on standardized pain outcomes, comparative effectiveness, and guideline development.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":" ","pages":"25"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147430314","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}