Annals of palliative medicine最新文献

{"title":"Palliative care specialists infrequently discuss driving safety with their patients with cancer when prescribing opioids.","authors":"Patricia S Bramati, Daniel Gilbey, Stephen Nkeonye, Alexandra Cooper, Eduardo Bruera","doi":"10.21037/apm-2026-0050","DOIUrl":"https://doi.org/10.21037/apm-2026-0050","url":null,"abstract":"<p><p>Opioids may impair the ability to drive especially when prescribed for the first time or when the dose is increased. Because driving is closely associated with independence and quality of life, discussions regarding driving safety should be an integral part of prescribing opioids. However, little is known about the frequency with which palliative care specialists address this issue in clinical practice. In this pilot study, an anonymous survey was conducted among palliative care specialists to evaluate whether driving safety is discussed when prescribing opioids. The survey was distributed to advanced practice providers and physicians from a palliative care service of a tertiary cancer center, and 61 of 72 (85%) completed it. Fifty-seven (93%) respondents considered assessing patients' driving status to be important, and 58 (95%) agreed that driving is an important part of the quality of life of the patients. However, only 28 (46%) reported that they often discuss driving safety in general, and responses were lower when patients were on chronic opioids: 24 (39%) when the morphine equivalent daily dose (MEDD) was ≥100 mg whereas only 13 (21%) did so when the MEDD was ≤50 mg. In addition, just 20 (33%) frequently discuss driving safety when the dose is increased, and only 13 (21%) were familiar with local driving regulations regarding opioid prescribing. Despite recognizing the importance of driving safety, palliative care specialists infrequently address driving safety and opioids with their patients. Educational interventions, increased awareness of local regulations, and standardized preprinted information for patients may improve counseling and promote safer opioid prescribing practices.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"15 4","pages":"56"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148705146","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":"Prolonged grief disorder in end-of-life care: current literature and future directions.","authors":"Pelin Sila Gelmez, Ayala Sara Licht-Handler, Rahel Naef, Chenchen Lin, Clare Killikelly","doi":"10.21037/apm-2025-1-148","DOIUrl":"https://doi.org/10.21037/apm-2025-1-148","url":null,"abstract":"<p><p>Prolonged grief disorder (PGD) is a recognized distinct mental health disorder in the DSM-5-TR and ICD-11, characterized by core symptoms such as longing for and preoccupation with the deceased that persist and worsen over time. Family members and caregivers of patients that receive end-of-life care are confronted with imminent bereavement, which emphasizes the importance of bereavement care as a preventive measure and the need for continued support after death beyond the hospital setting. This review discusses bereaved family members' and caregivers' risk factors of developing PGD, screening and assessment tools (i.e., pre-death measures, measures of bereavement risk, and prolonged bereavement measures) for family members and caregivers of patients during end-of-life care to assess anticipatory loss, after the loss to assess grief reaction, and 6 months after the loss to assess prolonged grief. Implications for accurate and timely interventions during end-of-life care and after the patient's death are presented. Furthermore, limitations of current assessment methods and interventions, and barriers to and facilitators of guideline implementation are addressed. Early detection of elevated grief symptoms and potential PGD through ecological methods of studying daily life (e.g., Experience-Sampling Method, Electronically Activated Recorder, Mobile Sensing Methods, wearables) and digital, just-in-time interventions personalized to an individual's needs (i.e., Just-In-Time Adaptive Interventions) present an innovative digital approach for bereavement care in the future.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"15 4","pages":"62"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148705163","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":"Operational phenotyping for chronic low back pain: a narrative review and methodology for developing routing and escalation pathways across spine care.","authors":"Kai-Uwe Lewandrowski, Matthias Pumberger, Friederike Schomig, Biswadjiet Sanjay Harhangi, Alexander R Vaccaro, Morgan P Lorio","doi":"10.21037/apm-2026-1-0026","DOIUrl":"10.21037/apm-2026-1-0026","url":null,"abstract":"<p><strong>Background and objective: </strong>Chronic low back pain (CLBP) is clinically heterogeneous and generates substantial symptom burden, functional limitation, psychological distress, work disability, and health-care utilization. Existing phenotyping approaches often describe subgroups but do not specify how subgroup assignment changes routing, conservative-care dose, imaging, interventional escalation, surgical evaluation, or outcome monitoring. The objective of this narrative review was to define operational phenotyping as a practical method for developing routable, auditable spine-care pathways and to distinguish this methodology from descriptive subgrouping, Subgroups for Targeted Treatment Back Screening Tool (STarT Back)-style risk stratification, and machine-learning phenotyping.</p><p><strong>Methods: </strong>We conducted a narrative review using structured methods. PubMed/MEDLINE was the primary database, supplemented by Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus/Web of Science when available, guideline and trial-registry review, and reference-list screening. Searches covered January 2000 through January 2026. Studies were synthesized using an Inputs-Decision-Pathway-Outcome (IDPO) framework. The Berlin deep-phenotyping program was used as a contextual exemplar of multidomain measurement, not as evidence of treatment efficacy.</p><p><strong>Key content and findings: </strong>The synthesis yielded five operational findings. First, phenotype labels are implementation-ready only when linked to explicit pathway decisions. Second, minimal universal inputs should be separated from targeted add-ons. Third, escalation gates require illustrative thresholds and safety overrides rather than open-ended care drift. Fourth, diagnostic procedures, including diagnostic medial branch blocks, may themselves define a pain generator phenotype and should not be treated only as downstream treatment. Fifth, surgical referral should be framed as entry into shared decision-making evaluation rather than an automatic indication for surgery.</p><p><strong>Conclusions: </strong>Operational phenotyping is best understood as a methodology for developing a field guide rather than a completed field guide for all settings. It translates deep phenotyping and stratified-care concepts into locally deliverable pathways by requiring the same four elements for each phenotype: feasible inputs, explicit decision logic, an actionable pathway, and measurable outcomes.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"15 4","pages":"59"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148705160","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":"Acceptance of the dying process and other risk factors for terminal hyperactive delirium in cancer patients: a multicenter cohort subanalysis.","authors":"Keisuke Ishizuka, Tomofumi Miura, Emi Kubo, Isseki Maeda, Naosuke Yokomichi, Takashi Yamaguchi, Hiroyuki Otani, Tatsuya Morita, Takumi Taniguchi, Masanori Mori","doi":"10.21037/apm-2025-aw-118","DOIUrl":"10.21037/apm-2025-aw-118","url":null,"abstract":"<p><strong>Background: </strong>Delirium is common and distressing in palliative care, particularly near death, but evidence linking difficulty in accepting the dying process to terminal hyperactive delirium is limited. This study aimed to examine the association between difficulty in accepting the dying process and hyperactive delirium in patients receiving palliative care, while accounting for other clinical risk factors.</p><p><strong>Methods: </strong>We performed a subanalysis of a large multicenter cohort study conducted in 23 palliative care units in Japan. Variables were selected from previous studies and extracted from the present data set. The acceptance of the dying process was assessed by the attending palliative care physician. Hyperactive delirium was defined as Memorial Delirium Assessment Scale (MDAS) item 9 of ≥2. Multivariate analysis was performed to identify associations with hyperactive delirium within the last 3 days before death.</p><p><strong>Results: </strong>A total of 1,045 patients were included (mean age was 71.5 years, 49.9% were female). Hyperactive delirium was present in 17.8% of patients. A total of 8.3% of patients had been assessed as having difficulty in accepting the dying process. Factors associated with hyperactive delirium in the last 3 days before death were: difficulty in accepting the dying process [odds ratio (OR): 2.64, 95% confidence interval (CI): 1.60-4.30, P<0.001], Eastern Cooperative Oncology Group Performance Status (ECOG PS) ≤2 (OR: 2.11, 95% CI: 1.21-3.62, P=0.009), ECOG PS =3 (OR: 1.46, 95% CI: 1.02-2.10, P=0.041), no drowsiness (OR: 1.62, 1.03-2.64, P=0.04), oral morphine equivalent daily dose (OMEDD) ≥60 mg (OR: 1.53, 1.01-2.30, P=0.043), and males (1.46, 1.04-2.05, P=0.03).</p><p><strong>Conclusions: </strong>Difficulty in accepting the dying process was associated with hyperactive delirium within the last 3 days of life. These exploratory findings do not establish causality; prospective studies are warranted to determine whether supportive interventions around the dying process could mitigate terminal delirium.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"15 4","pages":"53"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148705167","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":"Palliative care involvement in solid organ transplant: a narrative review.","authors":"Zaheera Lukman, Maisha T Robinson, Molly M Kilpatrick","doi":"10.21037/apm-2026-1-0024","DOIUrl":"10.21037/apm-2026-1-0024","url":null,"abstract":"<p><strong>Background and objective: </strong>Solid organ transplant has increased within the last 50 years, particularly as surgical procedures, transplant outcomes, brain death criteria, and immunosuppressive therapies are improving. While transplant programs have specific criteria to help identify ideal transplant candidates, some programs are recognizing the emotional and physical burden that transplant candidates have leading up to the transplant decision; as such, a multidisciplinary approach to candidate evaluation which involves social work, psychiatry, nursing, and other disciplines is necessary for transplant success. Due to the complex nature of medical illnesses that lead to solid organ transplant, and the significant impact on quality of life, palliative care involvement both pre-transplant and post-transplant has been identified as a helpful support for patients. This narrative review summarizes relevant literature on the involvement of palliative care in transplant and provides a conversation guide for supporting patients through the transplant process from a palliative lens.</p><p><strong>Methods: </strong>Authors ran a narrative review search in the National Library of Medicine (NLM) PubMed database. The search was restricted to English language articles, and publication date filters limited the results from January 1, 2015 to the day the search was run on April 2, 2026. An effort was made to exclude animal studies. Search terms included Medical Subject Headings (MeSH) terms as well as keywords, including terms for palliative care, palliative medicine, transplantation, solid organ transplant, conversation guide, heart transplant, liver transplant, lung transplant, kidney transplant, attitudes, perspectives, trajectory, utilization, outpatient, inpatient, early palliative care, referral, cost-savings, and their synonyms.</p><p><strong>Key content and findings: </strong>While palliative care involvement in transplantation has been well studied, only certain transplant groups, particularly heart and liver, have formally updated guidelines to reflect this. Palliative care providers should continue to partner with transplant teams in order to better support patients and caregivers throughout all stages of end-stage disease, particularly pre- and post-transplant.</p><p><strong>Conclusions: </strong>Further consideration should be given to healthcare outcomes with palliative team involvement in transplant populations. More research is needed to determine optimal timing, setting, and resource availability of palliative teams.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"15 4","pages":"57"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148705149","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":"The impact of religion and spirituality on medical decision making by patients at the end of life.","authors":"Charles B Simone","doi":"10.21037/apm-2026-03","DOIUrl":"https://doi.org/10.21037/apm-2026-03","url":null,"abstract":"","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"15 4","pages":"65"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148705108","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":"The right to function at end of life: aligning advance care planning with palliative rehabilitation.","authors":"Christopher M Wilson, Ann M Henshaw, Mark C Navin","doi":"10.21037/apm-2026-1-0022","DOIUrl":"10.21037/apm-2026-1-0022","url":null,"abstract":"<p><p>Movement and bodily autonomy are integral to life and participation in meaningful activities. Current advance care planning (ACP) and advance directive processes do not consistently elicit discussions or documentation about these topics. The problem is especially serious when continued movement increases the risk of falling or other negative health events. This review article integrates available evidence and the authors' clinical experience to argue that ACP should include functional goals and that rehabilitation professionals should be regular members of end-of-life care teams. We address clinical, ethical, and system-level barriers to change and we present a composite case vignette to illustrate the implications and complexities that can occur when function and bodily autonomy are not considered during ACP activities. Rehabilitation providers such as physical therapists, occupational therapists, and speech-language pathologists provide support and interventions to help mitigate risk while facilitating functional independence. However, because discussions around mobility goals at the end of life do not consistently occur, rehabilitation professionals are inconsistently involved as care team members for people who are dying. Without access to rehabilitation, patients may face well-intentioned but overly restrictive care decisions that limit their participation in meaningful life activities. Including functional priorities in ACP, and rehabilitation professionals on care teams, will better align end-of-life care with what dying patients value.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"15 4","pages":"60"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148705113","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":"Association between moral distress and burnout syndrome at a Palliative Care Unit in federal district-Brazil.","authors":"Andrea Maria Praciano Job, Helton Saulo Bezerra Dos Santos, Sérgio Rogério de Araújo Mendes Filho, Alfredo Nicodemos da Cruz Santana","doi":"10.21037/apm-2026-1-0016","DOIUrl":"10.21037/apm-2026-1-0016","url":null,"abstract":"<p><strong>Background: </strong>Healthcare professionals face stressful situations, especially in palliative care settings, where they are exposed to ethical dilemmas. This study aims to assess the association between moral distress and burnout syndrome among working at a Palliative Care Unit.</p><p><strong>Methods: </strong>This is a cross-sectional analytical observational study conducted in a specialized Palliative Care Unit in Brazil. Between June and November 2024, a questionnaire was applied to healthcare professionals, collecting sociodemographic data, the Measure of Moral Distress for Healthcare Professionals-Brazilian version (MMD-HP BR) and the OLdenburg Burnout Inventory (OLBI) scales.</p><p><strong>Results: </strong>A total of 100 healthcare professionals were included, with a mean age of 39.79±10.23 years. The majority were female (82%), physicians (24%), had no palliative care formation (79%) and worked for less than 11 years (75%). The MMD-HP BR scale ranged from 0 to 309 (median =98), while the OLBI scale ranged from 36 to 65 (median =49). Burnout was associated with age (coefficient β=-0.11, P=0.02) and the intention to leave the job (coefficient β=2.81, P=0.01); however, there was no statistically significant association between burnout and moral distress.</p><p><strong>Conclusions: </strong>There was no association between moral distress and burnout in our study. This may be due to the interdisciplinary nature of palliative care helping mitigate this impact. Nevertheless, the association between Burnout, professionals' age, and the desire to leave their jobs highlights workforce overload. Broader studies are needed to enhance understanding and help to prevent and control these phenomena.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"15 4","pages":"55"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148705102","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":"Disparities in palliative care utilization among patients with acute-on-chronic liver failure in the United States: a retrospective analysis.","authors":"Rahul Chikatimalla, Carol Singh, Anya Khurana, Saniya Jiwani, Aalam Sohal, Mohanad Al-Qaisi, Nilofar Najafian","doi":"10.21037/apm-2026-0029","DOIUrl":"https://doi.org/10.21037/apm-2026-0029","url":null,"abstract":"<p><strong>Background: </strong>Acute-on-chronic liver failure (ACLF) is associated with high short-term mortality, yet palliative care (PC) remains underutilized. Critically, the extent of this underutilization has not been rigorously quantified among patients who ultimately die during hospitalization. Characterizing PC utilization and its predictors in this terminal cohort is essential to identify disparities and improve end-of-life care quality. This study aimed to quantify PC utilization among terminal ACLF hospitalizations in the United States and identify demographic, clinical, and hospital-level factors associated with its use.</p><p><strong>Methods: </strong>The National Inpatient Sample Database (2016-2022) was used to identify adult terminal ACLF hospitalizations. Patients were divided into two groups, stratified by PC utilization. Data were obtained on patient demographics, underlying liver disease, liver-related decompensations, comorbidities, and clinical outcomes. Multivariate logistic and linear regression analyses were used to identify predictors of PC utilization in patients with ACLF and to assess the impact of PC on resource utilization.</p><p><strong>Results: </strong>Of the total 163,060 terminal ACLF hospitalizations ending in in-hospital mortality, only 75,365 (46.2%) received PC. Among those who received PC, the majority were male (60.9%), White (67.3%), and had Medicare insurance (42.7%). Compared to Whites, Black/African Americans and Hispanics had 29% and 34% lower odds of receiving PC, respectively. There was an incremental increase in PC use across income quartiles, with patients in the highest quartiles having 32% higher odds of receiving PC than those in the lowest quartile. Patients who had a history of liver transplantation were less likely to receive PC (adjusted odds ratio, 0.51; P=0.001). There were no significant differences in the length of stay; however, the use of PC was associated with lower total hospitalization charges (adjusted coefficient, -$7,942.93; 95% CI: -$14,065.26 to -$1,820.59; P=0.01).</p><p><strong>Conclusions: </strong>Our study highlights significant racial, regional, socioeconomic, and clinical disparities in PC utilization with respect to in-hospital mortalities with terminal ACLF hospitalizations. These findings suggest that PC resources are not being equitably provided, underscoring the need for targeted interventions to address these gaps.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"15 4","pages":"54"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148705143","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":"Introduction to the special series: multidisciplinary and holistic palliative care.","authors":"Eva Oldenburger, Johan Menten","doi":"10.21037/apm-2026-0048","DOIUrl":"10.21037/apm-2026-0048","url":null,"abstract":"","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"15 4","pages":"52"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148705083","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}