The American journal of hospice & palliative care最新文献

{"title":"Serious Illness Communication Tool for Palliative Care Fellows: Development, Implementation, and Lessons Learned.","authors":"Shannon Rose Bell, Daniel M Karlin, Peter G Phung, Christopher J Pietras, Katelyn Dow Stepanyan","doi":"10.1177/10499091241259491","DOIUrl":"10.1177/10499091241259491","url":null,"abstract":"<p><p><b>Introduction:</b> Learning expert communication skills is a core educational goal within palliative care training, yet there are few communication-based educational tools specifically designed for specialty-trained palliative care providers. <b>Objective:</b> To develop and implement a tool to facilitate effective learning of serious illness communication for hospice and palliative medicine fellows. <b>Methods:</b> A novel formative assessment tool was developed within the UCLA Palliative Care Fellowship program, and utilized throughout the academic year on a weekly basis. Focus groups were held for fellows and faculty separately at the end of the academic year in order to gain insight into the experience and effectiveness of the tool. Focus group transcripts were analyzed through thematic analysis. <b>Results:</b> There was a 47% participation rate in the focus groups (n = 7). Qualitative analysis demonstrated positive impact of the tool in identifying learning goals, improving quality of feedback, and in standardizing language around advanced communication skills, with most value in the first half of the fellowship year. Some aspects of the tool were found to increase feedback anxiety, including the competency scoring component, frequency of use, and utilization with individual patient encounters. <b>Conclusion:</b> This novel communication tool provides an important addition to serious illness communication training of specialist palliative care providers, in creating a shared mental model for naming and organizing skills, as well as generating specific high quality learning goals and feedback. Preliminary feedback from our pilot implementation phase provided important information about how to refine the tool and remove components that unnecessarily added to feedback anxiety.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"438-444"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11894902/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141312692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nephrology Provider Engagement in Comprehensive Shared Decision-Making Discussions With Older Adults: Results of a Cross-Sectional Survey.","authors":"Vicki Montoya, Norma Conner","doi":"10.1177/10499091241276537","DOIUrl":"10.1177/10499091241276537","url":null,"abstract":"<p><p><b>Background:</b> The largest patient group initiating dialysis for end-stage renal disease is persons over 75 years. Evidence indicates pre-dialysis shared decision-making discussions between nephrology providers and older adults are infrequent and often do not include an option for conservative management of symptoms without dialysis. <b>Aims</b>: To assess and compare behavioral determinants of nephrology providers' use of comprehensive pre-dialysis shared decision-making discussions with older adults. A secondary aim was to prepare the bases for tailored behavioral intervention(s) for nephrology providers by identifying the determinant(s) that should be targeted to elicit change in comprehensive shared decision-making intentions and the resulting behavior. <b>Methods</b>: A cross-sectional survey based on the Theory of Planned Behavior was completed by nephrologists from a state organization and nephrology advance practitioners from a national organization, either in person or online via Qualtrics. <b>Results:</b> Survey respondents included nephrologists (n=29), and nurse practitioners (n=37) and physician assistants (n=7), combined, were predominantly female (83%) and White American (67%). Spearman rho correlation results showed attitude, social norm, and perceived behavioral control were correlated with shared decision-making behavior for one or both groups. Significant differences were present between the two groups for determinants and behaviors. <b>Conclusion:</b> Based on the determinants predominantly influencing SDM behavior of nephrology advance practitioners, behavioral interventions targeting the determinants of <i>Social Norm</i> and <i>Perceived Behavioral Control</i> are warranted. All determinants can be utilized in behavioral interventions for nephrologists.Opportunity exists for collaboration between providers to develop consistent and effective methods of SDM discussion that fit into a typical workday.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"517-524"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142038074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and Factors Associated With Palliative Care Utilization Among Hospitalized Patients With Gallbladder Cancer- A National Inpatient Sample Analysis.","authors":"Temitope Ajibawo, Oluwatimilehin Okunowo","doi":"10.1177/10499091241262968","DOIUrl":"10.1177/10499091241262968","url":null,"abstract":"<p><p>ObjectivesVarious factors have been associated with palliative utilization in different cancers. However, literature is still lacking on the prevalence and factors associated with palliative care use in gallbladder cancer (GBC). This study aims to determine the prevalence of palliative care utilization and examine the factors associated with palliative care utilization among patients with GBC.MethodsWe conducted a retrospective analysis using the National Inpatient Sample between 2016 and 2018. Descriptive statistics were used to characterize the study population. We explored factors associated with palliative care utilization among hospitalized GBC patients using logistic regression.ResultsOf the 20280 GBC hospitalizations, 18.0 % utilized palliative care. Multivariable analysis revealed that treatment at urban teaching hospitals, or treatment at urban nonteaching hospitals, Medicare insurance, other insurance coverage, transfer to a facility/discharge with home health, and death during hospital stay were associated with higher utilization of palliative care. In contrast, non-elective admissions were associated with decreased odds of palliative care utilization.ConclusionPalliative care use among GBC patients is still low at 18.0%. Palliative care use was associated with insurance disparities, discharge disposition, hospital location, and type of admission. Therefore, concerted efforts to address these disparities in palliative care utilization are needed to improve the quality of care for this population.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"445-451"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141332789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring Misconceptions of Palliative Care Among Patients With Hepatocellular Carcinoma: A Pilot Study.","authors":"Mostafa Abasseri, Shakira Hoque, Kim Caldwell, Linda Sheahan, Slavica Kochovska, Meera Agar, Amany Zekry","doi":"10.1177/10499091241268423","DOIUrl":"10.1177/10499091241268423","url":null,"abstract":"<p><p>BackgroundHepatocellular carcinoma is a burdensome form of liver cancer with an increasing global prevalence. Emerging evidence has shown that early palliative care introduction at diagnosis of any life-limiting illness improves patient and carer outcomes. Despite this, patients with hepatocellular carcinoma usually receive palliative care late. These patients are important stakeholders in the provision of palliative care, but their perceived barriers regarding its delivery are poorly defined.AimThis <b>pilot</b> study aimed to identify the barriers perceived by patients to integrating palliative care into the hepatocellular carcinoma treatment algorithm.DesignPatients living with hepatocellular carcinoma undertook semi-structured interviews about their perceptions of palliative care. We compared these perceptions before and after providing a brief explanation of palliative care. Interview data was inductively coded in NVivo 12 (2018) and thematically analysed.ResultsTwenty-one patients were interviewed. 16 perceived palliative care to mean end-of-life therapy, and nine participants had no prior knowledge of palliative care. After hearing a definition of palliative care, 17 participants reported changed positive attitudes. Seven participants supported a name change, including four participants who continued to reject palliative care following the explanation due to the negative stigma associated with the term 'palliative care'.ConclusionThere is significant misperception about the purpose of palliative care among patients with hepatocellular carcinoma, constituting a barrier to early integration. This can be feasibly addressed with a two-folded educational and renaming initiative to dispel patient misconceptions regarding palliative care. Effective strategies to achieve this should be developed and tested with relevant stakeholders, particularly patients.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"467-476"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11894838/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142001612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"End of Life Care Practices at a Tertiary Cancer Centre in India: An Observational Study.","authors":"Bhanu P Maurya, Raghav Gupta, Puneet Rathore, Seema Mishra, Sachidanand J Bharati, Vinod Kumar, Nishkarsh Gupta, Rakesh Garg, Sushma Bhatnagar","doi":"10.1177/10499091241268585","DOIUrl":"10.1177/10499091241268585","url":null,"abstract":"<p><p>PurposeTo assess the End of life care (EOLC ) practices and the magnitude of futile care in a tertiary cancer center. To find out the barriers in provision of good EOLC in cancer patients.MethodsAn observational study was done on 129 patients. Patients were enrolled using the palliative prognostic index (PPI) in the end of life stages. Socio-demographic and clinical details were recorded. Detailed counselling done by the palliative physician or the oncologist was recorded. The barriers in provision of care were recorded.ResultsIn this study initial experience of 129 patients were analyzed. PPI score was >6 (survival shorter than 3 weeks) in 85 (65.89%) ; 34 (26.36%) had PPI score between >4 to 6 (survival between 3 to 6 weeks); and 10 (7.75%) patients had PPI score less than equal to 4( survival more than 6 weeks).77 (59.69%) patients preferred home as their place for EOLC while 41(31.78%) preferred hospital, 7 (5.43%) preferred hospice while 4 (3.10%) opted ICU for their EOLC . The most common barrier associated was caregiver related in 34 case, followed by physician related in 14 cases and patients related in 3 cases, because of hope of being cured in hospital, social stigma, fear of worsening of symptoms at home, denial.ConclusionEOLC is the least studied part of patient care with various barriers. With proper communication and a good palliative care support, futile treatment can be avoided. With healthy communication we can empower family members and patients for a good EOLC.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"477-482"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141790745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Importance of Providing Training to Informal Caregivers of Hospice Patients: Caregiver Experience With Hospice Care Based on Consumer Assessment of Healthcare Providers & Systems Surveys.","authors":"Tami M Videon, Robert J Rosati, Stephanie Finn","doi":"10.1177/10499091241262804","DOIUrl":"10.1177/10499091241262804","url":null,"abstract":"<p><p>BackgroundInformal caregivers aid hospice patients at the end of life. Little is known of their preparation and confidence in providing care, and how this relates to experiences of hospice care.ObjectiveExamine factors associated with informal caregivers' rating of home hospice care.MethodsData come from 828 completed CAHPS® surveys mailed between January 2022 and December 2023 from a single non-profit Hospice organization. Multivariate logistic regression analyses examined the independent influence of various aspects of hospice care on ratings of hospice.ResultsNine of every 10 respondents rated hospice care high (9 or 10). Most aspects of hospice care were rated favorably. Nearly all respondents felt the patient was treated with dignity and respect (96%). The measure with the greatest room for improvement was getting help as soon as needed (82% \"always\"). Multivariate analyses revealed 6 factors that independently predicted overall rating of hospice care. The strongest predictor was always getting help as soon as needed, followed by believing the hospice team cared about the patient. Three measures of caregiver training were significantly associated with higher ratings of hospice care being trained to: safely move the patient, what to do if patient became restless, and on pain medications.ConclusionsWhen informal caregivers feel trained to assess and manage the symptoms, they rate hospice care more favorably. Greater attention to informal caregiver training and support are imperative to improving hospice care.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"459-466"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141433724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics of Patients With Amyotrophic Lateral Sclerosis Followed by a Home Palliative Care Team.","authors":"Sebastiano Mercadante, Antonino Petronaci, Angela Terranova, Alessandra Casuccio","doi":"10.1177/10499091241266985","DOIUrl":"10.1177/10499091241266985","url":null,"abstract":"<p><p>BackgroundInformation about patients with amyothrophic lateral sclerosis (ALS) followed at home is limited.ObjectivesTo assess patients's characteristics at admission to a home palliative care program based on a multidisciplinary team, and the temporal course along the trajectory of ALS disease.DesignRetrospective. Setting/subjects: Charts of a consecutive number of ALS patients who were referred to a specialistic home palliative care were reviewed.MeasurementGeneral data, referral, start of home palliative care, use of ventilator support and nutritional support, were recorded. The existence of advance directives and shared care planning was also collected.Results82 patients were examined; 31 patients died before the term of the study and 51 patients were still living. No patient anticipately expressed their will regarding their treatments. However, a certain number of patients shared a care planning with ALS team, generally after starting home care. Most patients did not have ventilatory support at the beginning of home care assistance, but progressively received ventilatory support by NIV or MV, particularly those who were still living. NIV at start of home care was negatively correlated to frontotemporal dementia. (<i>P</i> = 0.015), and directly correlated to referral from hospital and GP (<i>P</i> = 0.031) and awareness of disease (<i>P</i> = 0.034). Gastrostomy at start of home care was positively correlated to referral from hospital (<i>P</i> = 0.046). Gastrostomy during home care was correlated to bulbar SLA (<i>P</i> = 0.017). The use of NIV during home care was positively correlated to shared care planning (<i>P</i> = 0.001).ConclusionThe continuous presence of a multi-specialist team may provide timely intervention, guarantee and trust on the part of the patient and family members.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"483-488"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141725430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Congruence Between Older Chinese Immigrants and Their Adult Children on Hospice Attitudes and Preferences: An Actor-Partner Interdependence Model.","authors":"Xiaofang Liu, Cathy Berkman","doi":"10.1177/10499091241265100","DOIUrl":"10.1177/10499091241265100","url":null,"abstract":"<p><p><b>Objectives:</b> This study investigates the alignment of awareness, attitudes, and preferences regarding hospice care between older Chinese immigrants and their adult children. <b>Methods:</b> Forty older Chinese immigrants and their adult children in New York City were assessed for their awareness, attitudes, and preferences for hospice care. McNemar's and Cohen's Kappa tests examined differences and congruence within parent-child dyads. The Actor-Partner Interdependence Model (APIM) was employed for dyadic analysis using structural equation modeling (SEM). <b>Results:</b> Discrepancies were observed between older parents and adult children, with the latter showing higher awareness and more positive attitudes toward hospice care compared to their parents. While 84.2% of older parents expressed willingness to accept hospice care, only 65.7% of their children believed their parents would desire hospice, and only 39.5% of children expressed a preference for hospice care for their parents. Kappa coefficients indicated poor-to-slight agreement within parent-child dyads, but there was a fair level of agreement in children's perceptions of their parents' preferences and their own preferences for parents. APIM revealed significant actor effects but nonsignificant partner effects, suggesting that parents' and children's preferences are influenced by their own attitudes, but not by those of other family members within the parent-child dyads. <b>Conclusion:</b> The incongruence in attitudes and preferences for hospice care between Chinese immigrant older adults and their children emphasizes the need for culturally-informed education and interventions to facilitate open conversations and ensure patient-centered end-of-life care for older Chinese immigrants.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"508-516"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141763671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dangerous Variation or Patient-Centered Care? Palliative Care and Pain Providers' Comfort, Experiences, and Approaches when Treating Cancer Pain With Coexisting Aberrant Behaviors.","authors":"Rachel A Hadler, Rachel Klinedinst, Christopher A Jones, Yuhua Bao, Ravi Pathak, Ali J Zarrabi, William E Rosa","doi":"10.1177/10499091241259034","DOIUrl":"10.1177/10499091241259034","url":null,"abstract":"<p><p>BackgroundPatients with cancer-related pain are at high risk for aberrant drug use behaviors (ADB), including self-escalation, diversion and concurrent illicit substance or opioid misuse; however, limited evidence is available to guide opioid prescribing for patients with life-limiting illness and concurrent or suspected ADB. We sought to characterize how specialists evaluate for and manage these high-risk behaviors in patients with cancer-related pain.MethodsWe conducted telephonic semi-structured interviews with palliative care and pain medicine providers. Participants discussed their own comfort and experience level with identifying and managing ADB in patients with life-limiting illness. They were subsequently presented with a series of standardized scenarios and asked to describe their concerns and management strategies.Results95 interdisciplinary pain and palliative care specialists were contacted; 37 agreed to participate (38.9%). Analysis of interview contents revealed several central themes: (1) widespread discomfort and anxiety regarding safe and compassionate opioid prescribing for high-risk patients, (2) belief that widely used risk-mitigation tools such as opioid contracts and urine drug screens provided inadequate support for decision-making, and (3) lack of institutional and organizational support and guidance for safe prescribing strategies. Most clinicians reported self-education regarding addiction and alternative prescribing/pain management strategies. Providers varied widely in their willingness to discontinue opioid prescribing in a patient with aberrant behavior and pain associated with life-limiting illness.ConclusionProviders caring for patients demonstrating ADB and cancer-related pain struggle to balance safe prescribing with symptom management. Increased guidance is needed regarding opioid prescribing, monitoring, and discontinuation in high-risk patients.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"489-503"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11612028/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141238644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating an Interventional Pain Management Curriculum in Hospice and Palliative Medicine Fellowship Training: A Feasibility Study.","authors":"Emily Marquez Campbell, Chaitanya Konda, Kelsey Lau, Winnie Wang","doi":"10.1177/10499091241268597","DOIUrl":"10.1177/10499091241268597","url":null,"abstract":"<p><p>BackgroundPain is a common symptom for patients with cancer. Hospice and Palliative Medicine (HPM) physicians are expected to be experts in both pharmacologic and non-pharmacologic treatment of pain for this patient population. Insufficient knowledge of non-pharmacologic, interventional approaches to pain management is a barrier to providing optimal care. This study assesses the feasibility and effectiveness of an interventional pain management curriculum on HPM fellow knowledge at a single institution.ObjectivesThe primary objective was to implement an interventional pain management curriculum for HPM fellows' and secondly to measure its effects on their knowledge and confidence in interventional pain management approaches.MethodsWe executed an interventional pain management curriculum for HPM fellows. The curriculum consisted of 6 fifty-minute virtual lectures. Anonymous pre- and post-curriculum surveys were used to assess curricular impact.ResultsPost-course surveys showed a significant increase in HPM fellows' knowledge and confidence in interventional pain management techniques.ConclusionsAn interventional pain management curriculum for HPM fellows is a feasible and promising intervention to significantly impact fellows' knowledge and confidence in non-pharmacologic treatment of cancer pain.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"504-507"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11894826/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141794460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}