The American journal of hospice & palliative care最新文献

{"title":"Factors Associated With Clinician Confidence in Communication During Goals of Care Discussions.","authors":"Jessica Ma, Jolie B Wormwood, Melissa W Wachterman, Amy M Linsky","doi":"10.1177/10499091251348457","DOIUrl":"https://doi.org/10.1177/10499091251348457","url":null,"abstract":"<p><p><b>Background:</b> High-quality goals of care (GOC) discussions should be founded on shared decision-making (SDM) - eliciting patients' values and preferences while providing adequate information for patients to make decisions. One metric that can assess GOC discussion quality is the degree to which patients are adequately informed. <b>Objective:</b> Identify clinician GOC discussion attitudes and behaviors associated with clinician confidence that they conveyed adequate information to patients. <b>Methods:</b> We conducted a secondary analysis of national survey data from Veterans Affairs clinicians assessing attitudes toward and behaviors during GOC discussions about life-sustaining therapy. We used stepwise multivariable logistic regression models to identify factors associated with clinician confidence that they provided patients with adequate information to make informed decisions following discussions. <b>Results:</b> Among the 253 clinician respondents, there was high confidence that they provided adequate information (Mean = 4.09 on a 5-point scale, SD = 0.69, Median = 4.0). Higher confidence was associated with practicing in Geriatrics/Palliative Care in bivariate analyses, but not when controlling for clinician behaviors during GOC discussions. In the final multivariable model, two behaviors were statistically significantly associated with increased confidence: \"identify proxy/surrogate\" (β = 0.21, <i>P</i> = 0.015) and \"suggest decision consistent with patients' values\" (β = 0.16, <i>P</i> = 0.045). These behaviors also occurred significantly more often in Geriatrics/Palliative Care compared to other specialties. <b>Conclusion:</b> Specific clinician behaviors in GOC discussions differed across specialties and were significantly associated with clinicians' confidence that they conveyed adequate information. Our findings can inform strategies to enhance communication training across specialties and improve care processes to support clinicians in performing behaviors conducive to high-quality GOC discussions.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"10499091251348457"},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144218003","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":"A Mixed-Methods Evaluation of an Innovative Workshop to Teach Primary Palliative Care Communication Skills to Fourth-Year Medical Students.","authors":"Audrey Covaleski, Michelle M Richardson, Emma Ernst, Charles Linshaw, Poornima Kirby, Tamara Vesel","doi":"10.1177/10499091251346479","DOIUrl":"https://doi.org/10.1177/10499091251346479","url":null,"abstract":"<p><p>BackgroundPhysicians' unpreparedness to conduct conversations around serious illness creates a barrier to initiating effective goals of care conversations. Teaching primary palliative care communication skills in medical school is paramount to overcome this barrier.ObjectiveTo evaluate the effectiveness of an innovative, immersive primary palliative care communication skills workshop for fourth-year medical students and to incorporate professional actors with teaching experience into the medical school curriculum.MethodsAn interactive, scenario-based, day-long workshop utilizing professional actors as faculty was developed and conducted multiple times annually for 4 years. Students completed online surveys before, immediately after, and 3-6 months after the workshop. Likert scales assessed student self-perceived comfort with skills learned and short response queries evaluated student experiences. Descriptive statistics and one-way ANOVA repeated measures test were used. Qualitative data was double coded and thematically analyzed.Results226 students participated in the workshop; 100%. Responded to the pre-survey, 170 (75.2%) responded to the post-survey, and 133 (58.8%) responded to the post-3-6 months survey. The mean self-perceived comfort between the pre-survey and both post- and post-3-6 months surveys was statistically significant (<i>P</i> < 0.05) for all skills taught. Students reported integrating learned skills and found subjective success in their improved approaches to communication with patients.ConclusionAn innovative primary palliative care communication skills workshop using trained professional actors improved and maintained fourth-year medical students' self-perceived primary palliative care communication skills. Widespread education of primary palliative care communication skills to medical students with trained actors as faculty could improve physician-patient communication around goals of care.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"10499091251346479"},"PeriodicalIF":0.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210605","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 Use of Biased Language in the Care of Seriously Ill Children: A Pilot Study.","authors":"Terri Major-Kincade, Erin Kim, Cameron A Price, Ankona Banerjee, Nikashia Franklin, Israel Castañeda Almendárez, Jaime Jump, Jared Rubenstein, Jill Ann Jarrell","doi":"10.1177/10499091251345723","DOIUrl":"https://doi.org/10.1177/10499091251345723","url":null,"abstract":"<p><p>BackgroundImplicit bias pervades health care, decreases quality of care, and disproportionately affects health outcomes for persons of color. Little is known about the use of biased language in the care of seriously ill children as documented in the electronic health record (EHR).ObjectiveTo describe the use of biased language in the EHR of critically ill pediatric patients and to assess if there is a difference based on patient demographics and clinical characteristics.Setting/ParticipantsA retrospective review of EHRs was conducted on patients admitted to a Pediatric Intensive Care Unit (PICU) with a palliative care consult at a large, urban academic center in the United States in 2019.MeasurementsDemographics and clinical characteristics were compared between patients with and without biased language in their EHR in univariate and multivariate analyses. Frequencies of descriptor usage and health care team members using the descriptor were recorded. Exemplar quotes using biased language were recorded.ResultsIn 63 patients, no differences were found in demographic or clinical characteristics between patients with and without positively and negatively biased language. In adjusted analysis, there was no effect of demographics or clinical characteristics on the odds of having at least 1 instance of negatively biased language. Physicians and social workers used more biased language than other health care team members.ConclusionDespite no statistically significant difference noted in this pilot study, linguistic biases exist in the EHR of seriously ill children, which may lead to testimonial injustice. Efforts to combat bias and racism in pediatric health care documentation may focus on revising note templates and educating across disciplines.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"10499091251345723"},"PeriodicalIF":0.0,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210606","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":"Palliative Care Utilization Among Hospitalized Patients With Hepatocellular Cancer: A Nationwide Study in the Pandemic Era (2019-2021).","authors":"Kim Abbegail Tan Aldecoa, Chef Stan L Macaraeg, Marwan S Abougergi, Geetha Krishnamoorthy, Camelia Arsene","doi":"10.1177/10499091241271371","DOIUrl":"10.1177/10499091241271371","url":null,"abstract":"<p><p><b>Background:</b> Palliative care addresses a range of needs, from symptom management to providing support to patients with hepatocellular cancer (HCC) and their families throughout the illness. However, research on palliative care in HCC remains limited, particularly during the COVID-19 pandemic. This study investigates the healthcare utilization associated with palliative care referral among patients with HCC. <b>Methods:</b> This is a retrospective cross-sectional analysis conducted using the National Inpatient Sample (NIS) database from 2019 to 2021 among patients with HCC age ≥18 years. <b>Results:</b> Among the 35,220 hospitalizations with HCC as the principal diagnosis, 18.7% received inpatient palliative care referrals. Factors associated with increased palliative care referrals included age ≥65 years, Midwest region, Charlson Comorbidity Index (CCI) score ≥3, and end-of-life care, as reflected by discharge resulting in death. No racial or insurance disparities were observed. Palliative care consultations were associated with lower total hospital costs ($20,573 vs $26,035, <0.0001). A higher prevalence of \"do-not-resuscitate\" status was also found among patients with palliative care referrals. <b>Conclusion:</b> The study provides an understanding of palliative care utilization across pre-pandemic and pandemic periods. Factors such as advanced age, hospital region, and underlying comorbidities influenced the likelihood of referral, with no discernible racial or insurance disparities identified. Palliative care involvement has also been shown to provide cost-effective supportive care with lower hospital costs. These findings provide invaluable guidance for optimizing the integration of palliative care alongside HCC management.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"571-579"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141977599","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":"Longitudinal Analysis of Cancer Family Caregiver Perception of Sleep Difficulty During Home Hospice.","authors":"William Hull, Gary Donaldson, Kristin G Cloyes, Lee Ellington, Kathryn Lee, Kathleen Mooney","doi":"10.1177/10499091241265404","DOIUrl":"10.1177/10499091241265404","url":null,"abstract":"<p><p>BackgroundSleep difficulty in caregivers is associated with poor physical and psychological outcomes. The purpose of this study was to describe family caregivers' perception of sleep difficulty through the hospice trajectory after a cancer diagnosis as predicted by age, sex, self-report of anxiety or depression, and cohabitation.MethodsWe conducted a secondary analysis of longitudinal data using multilevel modeling with nested model comparisons. Beginning with an unconditional growth model, predictors were added to nested models to test differential impact.ResultsCaregivers (n = 164) were predominately white (n = 160; 97%) and female (n = 113, 69%). We hypothesized that age, sex, history of anxiety or depression, and cohabitation would predict sleep difficulty. The cohabitation predictor model was a statistically significant model for caregiver perception of sleep difficulty that worsened throughout hospice caregiving (<i>b</i> = .184, <math><mrow><mi>χ</mi></mrow></math>² = 7.199, <i>P</i> = 0.027) but age, sex, and history of depression or anxiety did not improve model fit.ConclusionOur findings indicate that family caregivers who cohabitate exhibit increased perception of sleep difficulty over the course of hospice. Future studies and interventions for hospice family caregivers' sleep should consider cohabitation between the patient and the caregiver as a significant predictor of sleep difficulty to observe and potentially mediate the negative outcomes associated with caregiver sleep difficulty. Further, determining the underlying reasons for sleep difficulty in cohabitation (e.g., patient symptoms or treatments) should be explored.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"602-609"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141736226","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":"\"I Often Just Don't Know what to Say!\": Variations in Multidisciplinary Palliative Care Clinicians' Confidence and Needs Related to Spiritual Care.","authors":"Megan Miller, William E Rosa, Haley Buller, Meghan McDarby, Betty R Ferrell","doi":"10.1177/10499091241265108","DOIUrl":"10.1177/10499091241265108","url":null,"abstract":"<p><p>BackgroundSpiritual care is a core component of high-quality palliative care, yet gaps exist in spiritual care provision. Understanding clinicians' levels of confidence around spiritual care and their perceptions of necessary knowledge/skills to enhance their ability to provide spiritual care is foundational for improving delivery of spiritual care in practice.ObjectivesTo understand confidence levels with providing spiritual care and perceived needs in relation to the provision of spiritual care among palliative clinicians (nurses, social workers, chaplains).DesignN = 260 clinicians participating in interprofessional communication and end-of-life care training programs completed a structured survey.MeasurementsClinicians responded to 42 closed-ended questions assessing their confidence in engaging in spiritual care across 6 dimensions, and one open-ended question: \"What areas of knowledge or skill would best help to improve your ability to provide spiritual care across diverse populations?\"ResultsFindings reveal varied levels of confidence with spiritual care across dimensions. Chaplains reported the highest levels of confidence compared with nurses and social workers. Key areas of knowledge/skills to improve spiritual care provision were: (1) Training and support for clinicians in spiritual care; (2) Strategies for providing spiritual care to patients from diverse cultural and/or religious backgrounds; (3) Better understanding of specific populations and contexts that may affect spiritual care provision; and (4) Clinicians' personal growth & practices to improve spiritual care.ConclusionsAdditional support with spiritual care provision is needed, especially among spiritual care generalists. A focus on culturally attuned care is needed, honoring unique patient contexts and centering patient and family priorities.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"560-570"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11751129/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141750122","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":"Stop Asking How Much Information Your Patient Wants Before Discussing Serious News.","authors":"Natalie K Munger, Julia H Vermylen, Laurie M Aluce, Melanie M Smith, Gordon J Wood","doi":"10.1177/10499091241268536","DOIUrl":"10.1177/10499091241268536","url":null,"abstract":"<p><p>Discussing serious news is a fundamental communication skill, and many clinicians have been taught to ask their patients how much detail they want to hear before sharing difficult information. Over the past decade, we have taught hundreds of medical students how to discuss serious news and reviewed hundreds of their recorded conversations. We've found that asking how much detail a patient wants to hear often results in confusion and is not an effective way to understand their communication preferences. Instead of asking how much detail your patient wants to hear, we propose an alternative way to tailor information to their needs when discussing serious news. By asking permission to share, presenting the news in a succinct, jargon-free headline, and providing emotional support and expert guidance at the right times, you can give the correct amount of detail while avoiding unnecessary confusion resulting in high-quality, patient centered communication every time you discuss serious news.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"529-531"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141763672","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":"Impairments of Human Dignity at the End of Life Quantitatively Assessed by Health Care Professionals: A Pilot Study From Germany.","authors":"Florian Derler, Emilia L Mielke","doi":"10.1177/10499091241268573","DOIUrl":"10.1177/10499091241268573","url":null,"abstract":"<p><p>BackgroundEmpirical investigations on health care professionals' (HCPs) perception of dignity have already spotted common themes in preserving dignity in end-of-life care. However, heterogenic assessment results of varying HCP groups exist. This pilot study wants to provide further evidence on HCPs' rating of dignity-impairing aspects based on a patient-centered concept, especially regarding different underlying job profiles and other professional characteristics.MethodsIn a quantitative study design, the rating of dignity-impairing factors in end-of-life care via an adapted version of the <i>Patient Dignity Inventory</i> (aPDI) was assessed. Participants of the relevant professional groups were recruited via convenience sampling from a region of Germany.ResultsFrom the final sample of participants, 229 questionnaires were analyzed. The overall importance of each dignity-impairing aspect in end-of-life care was considered to be very high by all different HCP groups. Nonetheless, ratings differed between professions: nursing staff had the highest ratings of importance compared to both physicians and individuals with multiple occupations. Participants with previous knowledge in bioethics also rated some aspects as more important compared to those without this feature.ConclusionWith the findings of this investigation, an insight of how professionals rate impairments of dignity at the end of life based on a patient-centered concept is given. Thus, a link between empirical research and medical ethics is added. Potential normative implications for HCPs in practice of a dignified care can be derived, consisting of actively addressing social topics as well as further stressing ethics as a fundamental subject in the training and continuing education.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"580-586"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11915758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141899274","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":"Impact of Palliative Care Referral on End-of-Life Outcomes for Patients With Hematologic Malignancy.","authors":"Olivia M Seecof, Charley Jang, Maher Abdul Hay","doi":"10.1177/10499091241266991","DOIUrl":"10.1177/10499091241266991","url":null,"abstract":"<p><p>ContextCompared to patients with solid malignancies, less is known about the role of palliative care in patients with hematologic malignancies, leading to underutilization of palliative care.ObjectivesEvaluate the timing and impact of palliative care referrals on end-of-life outcomes over a 5-year period with intent to improve the utilization of palliative care in patients with advanced hematologic malignancies.MethodsA retrospective cohort of patients from an urban, NCI-designated comprehensive cancer center, aged 18 years and older with a diagnosis of an advanced hematologic malignancy were separated into groups of early, late, very late, or no specialty palliative care. Logistic regression models were constructed to examine variables associated with timing of palliative care referral. Groups were compared using the Kruskal Wallis test and Dunn's test with a Bonferroni correction method.Results222 patients with advanced hematologic malignancies who died between July 1, 20218 and June 30, 2023 were included. 50 (23%), 41 (18%), and 51 (23%) patients received an early, late, and very late palliative care referral, respectively and 80 (36%) patients did not receive a palliative care referral. There was a significantly high completion of ACP documentation among the palliative care cohorts. There was no significant difference among all cohorts in end-of-life outcomes in the last 14 or 30 days of life.ConclusionACP documentation improved with palliative care, however, end-of-life outcomes did not. These results are likely due to the majority of late, inpatient palliative care referrals. Future studies with targeted interventions are needed to improve these outcomes.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"550-559"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141750123","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":"Reducing Racial Disparities at End-of-life: Using Narratives to Build Trust and Promote advance Care Planning.","authors":"Donna Ewy","doi":"10.1177/10499091241268566","DOIUrl":"10.1177/10499091241268566","url":null,"abstract":"<p><p>Black Americans are less likely than White Americans to have advance directives, die while receiving hospice services, or have their end-of life wishes honored. The root causes of disparities include imbalance of resources, lack of trust in health care institutions, lack of adequate education regarding end-of-life options, communication differences of health care providers with black vs white patients, variable access to hospice services in different communities, and poorer pain management for Black patients compared to White patients. Because root causes are numerous, comprehensive solutions are required. When advance care planning is in place, people are more likely to choose care focused on priorities and comfort than on seeking aggressive, sometimes futile, interventions in the last weeks of life. One important component of the solution should include listening to narrative stories of Black people as they encounter life-limiting diagnoses. Gathering the stories about life events and how strength was found through adversities can be a tool for growing trusting relationships and engaging in shared decision-making. Health care professionals should invite Black patients with serious illnesses to explore the sources of their strengths and identify their core values to work toward developing directives for the nature and place of their end-of-life and help to mitigate disparities in high quality end-of-life care.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"532-537"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141877106","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}