Annals of palliative medicine最新文献

{"title":"Environmental sustainability in palliative care: a narrative review.","authors":"Fermin S Hoq, Krista Clement, Rose Hatala, Caroline Mariano, Shilo Lefresne","doi":"10.21037/apm-2025-1-146","DOIUrl":"10.21037/apm-2025-1-146","url":null,"abstract":"<p><strong>Background and objective: </strong>Climate change represents an escalating threat to human health and disproportionately affects vulnerable populations. The healthcare sector contributes significantly to climate change, accounting for approximately 4.4% of greenhouse gas (GHG) emissions globally. While several medical specialties aim to improve sustainability of clinical practice, there is limited literature within palliative medicine. This narrative review aims to identify and evaluate existing work on the ecologic impact of palliative medicine and highlight climate conscious clinical recommendations within palliative care.</p><p><strong>Methods: </strong>Scholarly databases including Medline, Embase, CINAHL, UBC Summon, Health Business Elite, and TRIP Medical and GreenLine were used for the literature search, and articles up to March 2026 were screened. Studies that described environmental sustainability efforts in palliative care were included. Articles underwent title and abstracts screening, followed by full text screening by two independent researchers. The extracted data was analysed thematically and summarized narratively.</p><p><strong>Key content and findings: </strong>A total of 176 articles were identified through database searches. After screening titles, abstracts, and full texts, eight peer-reviewed academic articles were included in the narrative review. Three major themes emerged regarding sustainability in palliative medicine: (I) conservative and goal-concordant prescribing, (II) minimization of low-value investigations and procedures, and (III) intensity of care and care setting optimization.</p><p><strong>Conclusions: </strong>The intersection of patient-centered care and planetary health considerations reveal that providing high quality palliative care has the co-benefit of reducing healthcare-associated GHG emissions and resource consumption. By aligning clinical practice with responsible resource stewardship, palliative care can simultaneously enhance patient outcomes and reduce the environmental footprint of healthcare.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"15 3","pages":"44"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148215702","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":"A retrospective study on the safety of small and large volume paracentesis and risk factors for adverse events in patients with gastrointestinal cancer with malignant ascites.","authors":"Yuri Tsujimoto, Toru Kadono, Shin Kameishi, Nanako Matsuo, Hiroyuki Kodama, Hiroki Yukami, Ken Asaishi, Toshifumi Yamaguchi, Hiroki Nishikawa","doi":"10.21037/apm-2026-1-0002","DOIUrl":"10.21037/apm-2026-1-0002","url":null,"abstract":"<p><strong>Background: </strong>The optimal drainage volume for paracentesis in malignant ascites (MA) has not been established, and identifying risk factors for paracentesis may serve as a guideline for clinical decisions regarding drainage volume in MA patients. Therefore, the aim of this study is to compare the safety of small-volume drainage (SVD) versus large-volume drainage (LVD) in MA patients and to identify risk factors for adverse events (AEs).</p><p><strong>Methods: </strong>This single-center retrospective study analyzed gastrointestinal cancer patients who underwent paracentesis between 2014 and 2023. Patients were categorized into SVD (<3,000 mL) and LVD (≥3,000 mL) groups. The primary endpoint was the incidence of paracentesis-related AEs, including hypotension, infection, renal dysfunction, and hyponatremia. Multivariate logistic regression was used to identify independent risk factors for AEs.</p><p><strong>Results: </strong>Among 89 eligible patients, 58 received SVD and 31 received LVD. The incidence of AEs was significantly higher in the LVD group compared to the SVD group (41.9% vs. 20.7%, P=0.04), particularly for hypotension (12.9% vs. 1.7%, P=0.04). In multivariate analysis, serum albumin <2.5 g/dL [odds ratio (OR) 3.20; 95% confidence interval (CI): 1.06-9.64] and LVD (OR 3.45; 95% CI: 1.20-9.93) were identified as independent risk factors for AEs. There was no significant difference in overall survival (OS; P=0.86) or the interval to subsequent paracentesis (P=0.21) between the groups.</p><p><strong>Conclusions: </strong>Large-volume paracentesis was associated with a higher risk of AEs without additional efficacy in terms of symptom control. SVD appears to be a safer and equally effective option, especially for patients with low serum albumin. These findings support a conservative and individualized approach to fluid removal in patients with MA.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"15 3","pages":"34"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148216111","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":"Advancing global health economics and policy of palliative and end-of-life care: insights from Ireland, Norway, Finland, Argentina, and India.","authors":"Claudia Fischer, Gudrun Waaler Bjørnelv, Rui Dang, Peter May, Preeti Pushpalata Zanwar","doi":"10.21037/apm-2025-1-142","DOIUrl":"https://doi.org/10.21037/apm-2025-1-142","url":null,"abstract":"","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"15 3","pages":"30"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148216114","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":"Artificial intelligence in home-based serious illness care: a scoping review of applications supporting quality palliative care.","authors":"Chunhong Xiao, Arie Nakhmani, Ashmita Thapa, Kimberly Kopecky, Joel G Anderson, Robert L Davis, Tami H Wyatt, Niki Cobb, Cynthia J Brown, J Nicholas Odom, Avery C Bechthold","doi":"10.21037/apm-2025-1-139","DOIUrl":"10.21037/apm-2025-1-139","url":null,"abstract":"<p><strong>Background: </strong>Artificial intelligence (AI) has emerged as a promising tool to address gaps in palliative care access and delivery for adults with serious illness and their family caregivers, particularly in home-based settings where access to specialty care is limited. AI-driven tools, including machine learning, natural language processing, and decision-support systems may enable proactive, personalized, and efficient approaches to addressing several domains of quality palliative care, as defined by the National Consensus Project (NCP), including continuity of care, symptom relief, emotional support, and family caregiver assistance. This scoping review aimed to systematically map the evidence on AI applications designed to assist home-based care for adults with serious illness and their family caregivers, with a focus on their potential role in enhancing palliative care delivery.</p><p><strong>Methods: </strong>Six databases were searched from inception to August 2025 using terms related to AI, serious illness, home care, self-care, and caregiving. Eligible studies included peer-reviewed empirical research among adults (≥18 years) with serious illness and/or family caregivers, focusing on AI as a tool to support home-based self-care or caregiver contributions to self-care.</p><p><strong>Results: </strong>Of 1,791 articles screened, 24 met inclusion criteria. Qualitative content analysis identified six themes: (I) personalization and contextual adaptation; (II) multimodal and accessible interfaces; (III) emotional and relational dimensions; (IV) predictive and proactive care; (V) daily routines and care ecosystems; and (VI) equity and access. Personalization emerged as a critical feature, with culturally tailored AI tools improving trust and usability. Limitations of the evidence are that most studies emphasized feasibility, usability, and user experience, over clinical or psychosocial outcomes, limiting insight into AI's real-world impact on palliative care. Evidence was further constrained by heterogeneous designs, language restrictions, and the scarcity of research published in palliative care journals, highlighting the need for more rigorous, context-specific studies.</p><p><strong>Conclusions: </strong>Findings underscore AI's capacity to address core components of palliative care, including predicting and managing symptoms and addressing psychosocial needs. However, the evidence base remains early-stage. Future research should prioritize rigorous evaluation of clinical and psychosocial outcomes, along with co-design with patients, caregivers, and clinicians to ensure alignment between AI innovation and core principles of palliative care.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"15 3","pages":"48"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148216091","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":"Place of death outcomes of home ventilation patients in Singapore: a retrospective cohort study using a linked database.","authors":"Michelle Jessica Pereira, Riyin Tay, Pann Pei Chieh, Joseph Antonio D Molina, Tao Sun, Adrian Kok Heng Tan, Yeow Chan, Woan Shin Tan","doi":"10.21037/apm-25-94","DOIUrl":"10.21037/apm-25-94","url":null,"abstract":"<p><strong>Background: </strong>Singapore's Home Ventilation and Respiratory Support Service (HVRSS) provides care for patients with chronic respiratory failure needing long-term home ventilation. Currently, data on the distribution of places of death (PODs) among these patients is lacking. We examined the distribution of POD among deceased HVRSS patients over a 10-year period and explored clinical factors potentially associated with specific death locations. Additionally, we assessed the agreement between patients' preferred POD (PPOD), as documented in Advance Care Planning (ACP), and their actual POD.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of patients with at least one HVRSS encounter and who had died by 2019. Death-related information was obtained from an administrative dataset and linked with socio-demographic, clinical, and ACP data from other sources. Logistic regression was used to identify clinical factors associated with specific POD. Agreement analysis between actual POD and PPOD was performed among decedents with valid ACP documentation.</p><p><strong>Results: </strong>Among 118 patients studied, 44% died at home, 53% in hospitals, and 3% elsewhere. ACP documentation was available for 52 patients (44.1%), with 73.1% of those preferring home as their POD. Clinical factors associated with home as POD included diagnosis of motor neuron disease (MND) [odds ratio (OR) =5.6; 95% confidence interval (CI): 1.2-25.0; P=0.02], ventilation status at death (OR =14.9; 95% CI: 3.8-58.3; P<0.001), and feeding type at death (OR =3.8; 95% CI: 1.0-14.0; P=0.044). The percentage agreement between actual POD and PPOD was 57.1% (95% CI: 43-72%; P<0.001) with a Gwet's AC1 coefficient of 0.49 (95% CI: 0.31-0.66; P<0.001), indicating moderate agreement.</p><p><strong>Conclusions: </strong>This is the first study in Singapore to characterise POD patterns and associated factors among home ventilation patients, as well as to evaluate alignment between preferred and actual POD. These findings may inform policy and end-of-life care practices to better support HVRSS patients, particularly at their chosen POD.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"15 3","pages":"33"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148215936","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":"Changes in opinions on intentional or unintentional hastening of death from graduation to 6 years as a physician-a follow-up cohort study.","authors":"Milja Vettenmaa, Reetta P Piili, Saila Haapasalmi, Riina Metsänoja, Pirkko-Liisa I Kellokumpu-Lehtinen, Juho T Lehto","doi":"10.21037/apm-2025-aw-128","DOIUrl":"10.21037/apm-2025-aw-128","url":null,"abstract":"<p><strong>Background: </strong>Physicians' decision-making in end-of-life care involves many challenging ethical, legal, medical and psychological aspects including the possibility of hastening death. Hastened death is a complex ethical issue as it may cover both intentional assistance in death through euthanasia or physician-assisted suicide and the possibility of unintentional hastening of death through intensive management of suffering (the doctrine of double effect). The research question in our study was: Do views on unintentional or intentional hastening of death, and the factors behind them, change during the first 6 years as a physician?</p><p><strong>Methods: </strong>The same questionnaire, including hypothetical patient scenario, was answered by 227 Finnish physicians twice: at the time of their graduation in 2015 and after 6 years as a physician in 2021. The scenario presented in this study was a cancer patient requesting to increase his morphine dose to a potentially lethal level. The responders were asked whether they accepted this increment or not. Opinions on euthanasia, assisted suicide and several other attitudes were asked separately with a visual analogue scale. General life values and background factors were queried as well.</p><p><strong>Results: </strong>The proportion of physicians accepting the increase in morphine dosing was 25% in 2015 and 31% in 2021 (P=0.06). No significant change in the opinion about the reprehensibility of euthanasia and assisted suicide was found. However, withdrawal of life-sustaining treatments was considered less reprehensible in 2021. In regression analysis, male gender, being single, believing in God, not considering assisted suicide reprehensible, and not feeling burned out were associated with the acceptance of increased morphine dosing in 2021.</p><p><strong>Conclusions: </strong>Acceptance of intentional or unintentional hastening of death presented in the survey did not significantly change after the first 6 years working as a physician, although a nonsignificant trend towards more accepting views was seen. Nevertheless, physicians' attitudes on this issue seemed to remain divided. Our results highlight the need for respectful discussion and education on ethics among medical profession to help physicians struggling with this demanding topic starting from medical school.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"15 3","pages":"38"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148216069","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 C2-3 medial branches/third occipital nerve to treat cervicogenic headache.","authors":"Alaa Abd-Elsayed, Kylie K Ruprecht, Nina Hashimoto, Jacob Ludwig","doi":"10.21037/apm-25-114","DOIUrl":"10.21037/apm-25-114","url":null,"abstract":"<p><p>Cervicogenic headache (CGH) is a secondary headache disorder arising from dysfunction of the C2-3 facet joint. First-line management options include conservative and multidisciplinary therapies including physical therapy, pharmacologic analgesic agents, and other noninvasive modalities. However, some patients experience persistent, refractory pain despite first-line management options. More invasive, interventional approaches including nerve blocks and steroid injections targeting the C2-3 joint have demonstrated relief, but their limited duration poses a challenge for managing chronic pain. Radiofrequency ablation (RFA) has emerged as a promising, minimally invasive, treatment for chronic pain relief in CGH. In this technical report, we describe the use of cooled RFA targeting the third occipital nerve (TON) and, when applicable, the C2 medial branch, for the treatment of chronic refractory CGH. We review relevant anatomy of the C2-3 facet joint implicated in CGH, as well as the anatomic variability of it is innervation, the TON and C2 medial branch, which can influence procedural efficacy. Compared with other RFA methods such as thermal or pulsed, cooled RFA allows for the creation of more precise treatment areas with the goal of improving efficacy and pain relief. A thorough understanding of anatomy, visualization, and procedural technique are important in optimizing outcomes and minimizing adverse effects. By generating more precise and effective lesion fields, cooled RFA may enhance treatment success. This report highlights cooled RFA as a promising treatment option for patients with CGH refractory to more conservative therapies and aims to provide a framework that promotes safe implementation and future research into its effectiveness.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"15 3","pages":"40"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148215945","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":"Metastatic brachial plexopathy presenting as radiation-induced plexopathy in metastatic lung cancer: a case report and literature review.","authors":"Laurens Vandenbussche, Louis Degryse, Els Wauters, Christophe Dooms, Maarten Lambrecht, Christophe M Deroose, Patrick Berkovic","doi":"10.21037/apm-2026-0028","DOIUrl":"10.21037/apm-2026-0028","url":null,"abstract":"<p><strong>Background: </strong>Metastatic brachial plexopathy (MBP) is a rare but debilitating complication of advanced malignancies, most commonly associated with lung and breast carcinomas. Distinguishing MBP from radiation-induced brachial plexopathy (RIBP) represents a significant clinical challenge due to their overlapping clinical presentations and similar appearances on structural imaging. While magnetic resonance imaging (MRI) is considered the gold standard for evaluating the brachial plexus (BP), it often lacks the sensitivity required to definitively differentiate between malignant infiltration and post-radiation fibrosis.</p><p><strong>Case description: </strong>A 75-year-old male with a history of cT4N3M1c squamous cell lung carcinoma was treated with chemo-immunotherapy followed by consolidating radiotherapy (46.75 Gy in 17 fractions). After 2 years of maintenance pembrolizumab and achieving a complete response, the patient presented with progressive right arm paralysis and neuropathic pain. Initial electromyography and MRI were inconclusive, with the latter suggesting RIBP as a potential etiology. However, a subsequent [18F]fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) revealed intense hypermetabolic uptake along the C4-C5 nerve roots extending into the right BP, confirming a diagnosis of MBP. The patient subsequently underwent palliative radiotherapy (30 Gy in 10 fractions) targeted at the [18F]FDG-avid lesion. This intervention resulted in substantial pain relief, although the motor deficits remained persistent.</p><p><strong>Conclusions: </strong>This case highlights an atypical presentation of MBP that closely mimicked RIBP through its slowly progressive nature. It underscores the pivotal role of [18F]FDG-PET/CT in establishing the correct diagnosis and guiding palliative management.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"15 3","pages":"49"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148215770","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":"Patient-reported outcome measures used in studies of palliative surgery in cancer care: a scoping review.","authors":"Bonnie O Wong, Sophie Nader, Jolene Si Min Wong, Xinyi Casuarine Low, Orly N Farber, Jason B Liu, Elizabeth J Lilley","doi":"10.21037/apm-2025-1-147","DOIUrl":"10.21037/apm-2025-1-147","url":null,"abstract":"<p><strong>Background: </strong>Palliative surgery aims to alleviate symptoms and enhance health-related quality of life (HRQL) for patients with incurable cancer. Standardized patient-reported outcome measures (PROMs) are needed to assess effects of interventions, including HRQL from patient perspectives. A previously published systematic review (Wong et al., 2025) identified studies of palliative cancer surgery; the present study is a secondary scoping review to identify and characterize patient-reported measures of HRQL in these studies.</p><p><strong>Methods: </strong>We searched PubMed, EMBASE, and CINAHL databases to identify English-language publications (August 1, 2005-December 31, 2023) reporting palliative thoraco-abdominal procedures for cancer patients. Of these, studies reporting patient-reported HRQL outcomes were secondarily analyzed using descriptive and thematic analysis.</p><p><strong>Results: </strong>Screening of 1,915 unique studies yielded 92 studies of which 16 (17.4%) included a patient-reported HRQL outcome, 11 of which used a total of 13 unique validated PROMs. Five studies which used investigator-developed (non-validated) questionnaires were included to comprehensively map HRQL measures and to identify whether investigator-developed questionnaires captured domains not represented by existing PROMs. Twelve of the identified PROMs were developed or subsequently validated for cancer populations. Items from each PROM were extracted and coded, identifying 62 sub-themes further organized into 6 top-level themes. Content analysis of 242 PROM items across 6 main themes revealed that physical symptoms (76 items, 31.4%) and functional status (50 items, 20.7%) dominate existing measures, while social and structural domains are underrepresented. Fatigue was the most frequently measured sub-theme (11 items), and change in stools, affecting personal relationships, activities of daily living and financial stress were measured by 10 items each. Investigator-developed questionnaires largely overlapped with sub-themes of existing PROMs, identifying only two new sub-themes.</p><p><strong>Conclusions: </strong>Despite improved HRQL being the primary goal of palliative surgery, only 16 of 92 studies measured HRQL outcomes, and amidst these studies, significant heterogeneity exists in measurement approaches, with 11 studies using 13 unique PROMs. High heterogeneity in both PROMs used and subthemes measured demonstrates lack of standardization and highlights need for a validated, surgery-specific PROM that captures relevant priorities across HRQL domains.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"15 3","pages":"46"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148215924","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":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147979795","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}