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":"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":"15 3","pages":"37"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148215933","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 release of clinical information under the 21st century cures act and implications for patients with cancer: a narrative review.","authors":"Cristiane Decat Bergerot, Joseph McCollom, Paulo Gustavo Bergerot, Ameish Govindarajan, Julia Maues, Mazie Tsang, Ryan Nipp","doi":"10.21037/apm-2026-1-0023","DOIUrl":"https://doi.org/10.21037/apm-2026-1-0023","url":null,"abstract":"<p><strong>Background and objective: </strong>The 21st Century Cures Act mandates patient access to electronic health record (EHR) information, including test results, and prohibits practices that interfere with that access. Many health systems operationalized this through patient portals, enhancing transparency and patient engagement. This narrative review synthesizes emerging literature on patients' and clinicians' experiences with portal-based access to oncology test results.</p><p><strong>Methods: </strong>We conducted a narrative review in accordance with the Scale for the Assessment of Narrative Review Articles (SANRA), performing a non-systematic literature search of PubMed/MEDLINE and Google Scholar for studies published between January 2021 and December 2025. We included qualitative, quantitative, and mixed-methods studies, as well as policy analyses, using non-empirical sources for contextualization rather than as primary evidence, with emphasis on high-stakes results and context relevant to metastatic or advanced cancer populations.</p><p><strong>Key content and findings: </strong>Twenty articles were included. Patients consistently valued timely access to their health information and reported increased transparency and engagement, though preferences varied by test type. Evidence regarding potential harms was mixed: some patients reported distress or confusion when accessing complex results, while others reported no changes or felt better prepared for clinical encounters. Clinicians concerns regarding patient distress, portal messaging, and workflow disruption were reported in surveys and qualitative studies, although empirical findings were not uniform across studies. Direct evidence focused specifically on patients with metastatic cancer was limited, with only one study explicitly examining this group.</p><p><strong>Conclusions: </strong>The available literature describes both potential benefits and challenges associated with expanded electronic access to oncology test results. Evidence specific to patients with advanced cancer remains sparse, highlighting an important gap and the need for further research to inform patient-centered disclosure practices in oncology.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"15 3","pages":"42"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148216008","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":"Implementing a risk communication tool to support care planning conversations in long-term care: evaluation of healthcare provider training.","authors":"Ishika Tripathi, Maya Murmann, Jacob Crawshaw, Lauren Konikoff, Sarah Beach, Justin Presseau, Rhiannon Roberts, Cathryn Espadero, Sandra Andreychuk, Celeste Fung, Amy T Hsu","doi":"10.21037/apm-2026-1-0007","DOIUrl":"10.21037/apm-2026-1-0007","url":null,"abstract":"<p><strong>Background: </strong>Embedding a palliative approach into long-term care (LTC) homes can be hindered by poor communication around prognosis and an individual's personal wishes and goals for care. Risk Evaluation for Support: Predictions for Elder life in their Communities Tool (RESPECT) is a risk communication tool that supports earlier identification of palliative care needs. When paired with established resources like the Serious Illness Conversation (SIC) Guide, these tools have the potential to enable more timely, higher-quality goals-of-care conversations in LTC. We sought to evaluate training provided to healthcare providers during the implementation of RESPECT and the SIC Guide in LTC homes in Ontario, Canada.</p><p><strong>Methods: </strong>Pre-post surveys were administered to healthcare providers in LTC who participated in co-administered RESPECT and SIC Guide training. Training evaluation surveys were developed using the Theoretical Domains Framework (TDF) to measure healthcare providers' ability to perform two palliative care behaviours: identifying residents earlier for a palliative approach and capturing goals of care discussions. Surveys were conducted before training, immediately after training, and 6 months post-training.</p><p><strong>Results: </strong>Three Ontario LTC homes took part, with 35 individual participants comprised mostly of physicians (29%) and nurses (51%). While 97% felt palliative care could benefit their residents before training (TDF domain: beliefs about consequences), few felt skilled (43%) and knowledgeable (69%) enough to do this (TDF domains: skills and knowledge). Immediately post-training and 6 months after implementation, skills (post-training: 83%; 6-month: 100%) and knowledge (post-training: 100%; 6-month: 100%) improved substantively. However, six months after training, only 58% felt they had a plan in place to identify residents earlier for palliative care (TDF domain: behavioural regulation), suggesting that behavioural regulation may be a potential barrier. Only 41% felt they received positive reinforcement for doing this behaviour well (TDF domain: reinforcement), and 91% felt competing demands (TDF domain: goals) could act as barriers to sustained practice.</p><p><strong>Conclusions: </strong>Trained staff reported substantial improvements in their skills and knowledge in identifying residents earlier for a palliative approach and capturing goals-of-care discussions. However, environmental barriers, lack of behavioural regulation, and lack of positive reinforcement may impede sustained practice.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"15 3","pages":"36"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148215824","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":"Evaluation of Advanced Practice Radiation Therapist integration in an inpatient palliative radiation therapy service: a single-center prospective observational mixed-methods study.","authors":"Danielle McDonagh, Mayuri Jain, Audrey Saitta, Sheryl Green, Karyn Goodman, Clodagh Starrs, Samantha Skubish, Kavita Dharmarajan","doi":"10.21037/apm-2025-1-144","DOIUrl":"10.21037/apm-2025-1-144","url":null,"abstract":"<p><strong>Background: </strong>In the United States context, Advanced Practice Radiation Therapists (APRTs) are emerging roles designed to support time-sensitive, non-billable clinical tasks in complex radiation oncology settings. This study evaluated the integration of an APRT into an inpatient palliative radiation therapy (PRT) service at a large academic medical center.</p><p><strong>Methods: </strong>This 24-month, single-center observational study assessed associations between APRT integration, clinician well-being, and departmental quality improvement/quality assurance (QI/QA) key performance indicators (KPIs). Clinician well-being was assessed at 6, 12, 18, and 24 months post-integration using the American Medical Association (AMA) Mini-Z 2.0 survey. Quantitative items were summarized descriptively with trend testing and correlation analyses. Free-text responses (including APRT integration prompts and workflow burden prompts) were analyzed using inductive qualitative content analysis appropriate for brief survey data. Departmental QI/QA KPIs-including simulation eligibility, simulation completion, treatment initiation, completion of the prescribed course, documentation compliance, and communication-related safety entries-are compared across intervals.</p><p><strong>Results: </strong>A total of 23 clinicians [13 radiation oncologists (ROs), and 10 residents] were invited to participate in the survey. Response rates ranged from 48% to 79% across the four follow-up time points. Burnout decreased among respondents over time and perceptions of a supportive practice environment increased, while job satisfaction and perceived stress did not change significantly. The electronic medical record (EMR) burden was consistently associated with burnout. Departmental KPIs improved over time, including higher simulation eligibility, higher simulation completion, and higher completion of the prescribed course; treatment initiation remained consistently high. Documentation compliance remained high throughout the study period. Qualitative feedback described improved coordination, communication, and physician support, with most respondents reporting a positive APRT impact throughout the study period.</p><p><strong>Conclusions: </strong>APRT integration within an inpatient PRT service was associated with improved departmental KPIs and favorable clinician-reported trends, while persistent EMR burden remained a key correlation of burnout. Given the observational design and variable response rates, findings should be interpreted as associative and hypothesis-generating. These results support further evaluation of APRT models using designs with higher response capture and linkable longitudinal measurement.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"15 3","pages":"39"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148215646","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 evolving role and impact of patient navigators in serious illness care: a narrative review.","authors":"Jennifer A Wylie, Crystal Diaz, Audry S Sebikali-Potts, Fabian M Johnston","doi":"10.21037/apm-2025-1-140","DOIUrl":"10.21037/apm-2025-1-140","url":null,"abstract":"<p><strong>Background and objective: </strong>In today's increasingly complex and fragmented healthcare system, patient navigation has emerged as a strategy to improve access to palliative care and reduce health inequities among historically marginalized populations. This narrative review aims to examine the evolution of patient navigation and its implementation across care settings to identify key themes and opportunities to optimize outcomes and reduce disparities in patients with serious illnesses.</p><p><strong>Methods: </strong>A literature search was conducted in PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL) Ultimate, and Google Scholar by three independent investigators on articles related to patient navigation in palliative care and patients with serious illnesses. A total of 49 academic articles and 5 additional articles were included.</p><p><strong>Key content and findings: </strong>A review of the literature revealed a number of diverse models of care navigation and implementation strategies. Navigation models involved varying degrees of community-based personnel and healthcare professionals from a range of disciplines. Through culturally informed support, education, and empowerment, many of these programs demonstrated improved patient outcomes such as reduced symptom burden, increased advance care planning, improved hospice referrals, more goal-concordant care at the end of life, reduced end-of-life cost expenditure, hospitalizations and emergency room visits. Integration of navigation across both medical and community settings also helped to reduce health disparities by addressing barriers across multiple levels of influence. However, in order for such models to be successful, understanding and integration of cultural values, trusted community figures, and strategies for addressing language barriers are essential.</p><p><strong>Conclusions: </strong>While a variety of approaches to patient navigation can help improve care for seriously ill patients, common themes of effective interventions include social connection, engagement in what is most meaningful to the patient, identification of patient needs, access to culturally grounded resources, patient advocacy and empowerment, incorporation of navigators embedded within the local community, and support from key stakeholders.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"15 3","pages":"45"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13285210/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148216022","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":"Immune-related adverse effects in palliative care clinic.","authors":"Kathryn DeCarli, Matthew Hadfield, Teniola Ayeni, Mazie Tsang, Justine V Cohen","doi":"10.21037/apm-25-112","DOIUrl":"https://doi.org/10.21037/apm-25-112","url":null,"abstract":"","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"15 3","pages":"51"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148215810","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":"Religious beliefs at end-of-life: implications for palliative care providers-a narrative review.","authors":"Michael Mercier, Jane Maglio, Nouran Ibrahim, Rebecca MacDonell-Yilmaz, Dana Guyer","doi":"10.21037/apm-25-89","DOIUrl":"10.21037/apm-25-89","url":null,"abstract":"<p><strong>Background and objective: </strong>Due to the importance of religion for 70% of adults in the United States, the prevalence of religious beliefs, and the impact of religious beliefs on health behaviors and health outcomes, palliative care teams must pay attention to the religious dimension of the lives of patients at end-of-life (EOL). We will review the content of some religious beliefs associated with EOL as well as the impact religious beliefs may have on EOL medical care and decision-making. We will also discuss potential pathways for palliative care teams to address the religious beliefs of patients and their loved ones at EOL which promote culturally sensitive and patient-centered care.</p><p><strong>Methods: </strong>This is a narrative review. We carried out an electronic PubMed search from 2010 to 2025 utilizing the subsequent words: religious beliefs; end-of-life; palliative care; adult 19+ years. We also integrated a hypothetical case study as well as the experience and proficiency of the authors.</p><p><strong>Key content and findings: </strong>Many adult patients at EOL hold religious beliefs which can be facilitated through religious behaviors and belonging. The religious beliefs of patients at EOL have a strong potential to impact their medical care decision-making and outcomes as well as their quality of life. Yet, treatment teams insufficiently address the religious beliefs of patients at EOL.</p><p><strong>Conclusions: </strong>Religious beliefs are often present and can impact EOL medical care. Best practice dictates that an interdisciplinary palliative care team approach should address the religious beliefs and values of patients at EOL through a generalist and specialist spiritual care model. When palliative care teams are willing to engage the religious beliefs and values of patients at EOL, this has the potential to help patients find acceptance and peace in the dying process.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"15 3","pages":"43"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148216026","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":"COVID-19 revisited: evolving insights and perspectives across the care continuum.","authors":"Shweta Kapur, Prateek Lohia","doi":"10.21037/apm-2026-1-0011","DOIUrl":"https://doi.org/10.21037/apm-2026-1-0011","url":null,"abstract":"","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"15 3","pages":"31"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148215573","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":"Christian and Indian religions on palliative sedation: a scoping study.","authors":"Nele De Weyer, Jonathan Lambaerts, Bert Broeckaert","doi":"10.21037/apm-2025-aw-129","DOIUrl":"10.21037/apm-2025-aw-129","url":null,"abstract":"<p><strong>Background: </strong>Though especially in the last decade, much work has been done on various aspects of palliative sedation, little attention has been given to the role played by religious beliefs and traditions. Since the attitudes and decisions of patients, family members, and caregivers can be deeply influenced by religion when faced with severe suffering at the end of life, it is important to know the views of these traditions regarding palliative sedation. This study discusses and compares normative views in Christian denominations (Anglicanism, Catholicism, Eastern Orthodoxy, Protestantism) and Indian religions (Hinduism, Buddhism, Sikhism).</p><p><strong>Methods: </strong>This study used a scoping study method to analyse religious normative perspectives on palliative sedation. Comprehensive database and grey literature searches were conducted to gather relevant sources from Christian denominations and Indian religions, followed by snowballing and expert consultation. The systematic mapping of views and arguments was followed by a grounded theory analysis of the mapped information and a comparative analysis between the Christian and Indian religious traditions. This manuscript is written following the Scoping Reviews PRISMA-ScR checklist.</p><p><strong>Results: </strong>Christian traditions generally view palliative sedation as a morally acceptable means to relieve suffering, grounded in charity and dignity, but in doing so stress the importance of intent and a clear distinction from euthanasia. Concerns persist regarding the impact of lowered consciousness on the spiritual preparation for death, especially in Eastern Orthodox traditions; Protestant perspectives add the issue of autonomy and personal agency. Indian religions lack robust explicit authoritative statements but commonly value consciousness at the moment of death for spiritual reasons related to rebirth and karma. Palliative sedation could be an option, but Indian religious traditions also emphasize spiritual practices, such as prayer and meditation, to alleviate end-of-life suffering.</p><p><strong>Conclusions: </strong>Religious traditions significantly influence views and practices concerning palliative sedation, shaping both professional and patient decisions in advanced disease care. The major Christian denominations permit palliative sedation with safeguards, while Indian religions generally recommend spiritual awareness at life's end but accept palliative sedation as an option. Recognizing these beliefs deepens understanding of diverse end-of-life values and enhances culturally and religiously sensitive care in palliative settings.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"15 3","pages":"47"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148215628","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 for patients with haematologic malignancies: challenges and opportunities.","authors":"Joanne Droney, Jennifer Vidrine","doi":"10.21037/apm-2026-1-0014","DOIUrl":"10.21037/apm-2026-1-0014","url":null,"abstract":"","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"15 3","pages":"50"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148215871","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}