The American journal of hospice & palliative care最新文献

{"title":"Exploring the Feasibility of the LEAD Trial: Online Dyadic Dementia Care Planning for Early Alzheimer's and Other Dementias.","authors":"Eli Iacob, Rebecca L Utz, Katherine P Supiano, Jordana L Clayton, Nancy Aruscavage, Sara G Bybee, Sharon E Bigger, Kara B Dassel","doi":"10.1177/10499091251379840","DOIUrl":"10.1177/10499091251379840","url":null,"abstract":"<p><p>ObjectivesPeople with dementia often lose decisional capacity before death, underscoring the need for dementia-focused advance care planning (ACP) tools. In cooperation with our Community Advisory Board, we developed LEAD (<u>L</u>ife-Planning in <u>E</u>arly <u>A</u>lzheimer's and Other <u>D</u>ementias), a Web-based, self-guided, dementia-focused ACP intervention for care partners and persons with preclinical or mild dementia. This study evaluated the feasibility and initial efficacy of the LEAD intervention.MethodsCommunity-based dyads (N = 48) of one care recipient (person with or at risk for dementia) and one care partner completed the intervention and study surveys assessing decision-making self-efficacy, relationship quality, and medical advance directive completion. We utilized mixed-effects repeated measures models to explore changes in outcome variables over time in care recipients and care partners.ResultsSixty-four percent of dyads completed the intervention. There was a significant increase in decision-making self-efficacy scores among care recipients and care partners (<i>P</i> < .001) and a decrease in relationship strain among care partners (<i>P</i> < .05). There were no changes in positive relationship domains. Of the 23 dyads that did not have a completed medical advance directive prior to the study, 13 dyads (50.0%) completed this document during the intervention.DiscussionOur findings suggest the LEAD intervention is feasible and demonstrates initial efficacy in promoting dementia-focused ACP. The LEAD intervention has the potential to reduce relationship strain and help care partners improve their confidence as proxy decision-makers for people with dementia who cannot make independent medical decisions.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"1281-1289"},"PeriodicalIF":1.4,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13326734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088791","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":"The Impact of \"Death Rattle\" on Patients, Informal Caregivers and Healthcare Professionals: A Scoping Review.","authors":"Norah Fagan, Michael Connolly, Nessa Keane, Andrew Davies","doi":"10.1177/10499091251382508","DOIUrl":"10.1177/10499091251382508","url":null,"abstract":"<p><p>BackgroundAudible upper airway secretions (\"death rattle\") is a common problem in patients in the last days of life. The objectives of this scoping review was to determine the impact of death rattle on patients, informal caregivers, and healthcare professionals.MethodsThe scoping review used standard methods, and involved searching Medline (Ovid), Embase, CINAHL, PsycInfo, and the Cochrane Library. Studies were included if they reported original data on the impact of death rattle on 1 or more of the specified populations. Hand searching was also undertaken to identify further studies.ResultsFourteen original studies were identified: 2 studies focused on patients, 7 on informal caregivers, and 5 on healthcare professionals. The impact of death rattle was somewhat variable, although related distress was common amongst informal carers, and also amongst healthcare professionals. The impact of death rattle on patients was less well described, although there was a consensus that death rattle is not distressing to affected patients (but may be distressing to other patients). Various beliefs were associated with distress amongst informal carers, and these may be amenable to educational interventions about the nature of death rattle.ConclusionDeath rattle is frequently distressing, and strategies need to be developed to mitigate the distress experienced by informal carers, and equally healthcare professionals. Further research is needed to determine the effect on patients experiencing the problem, and also patients witnessing the problem.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"1376-1384"},"PeriodicalIF":1.4,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13675527/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194303","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":"Enhancing Palliative Care Integration in the Cardiac Surgical Intensive Care Unit: A Multidisciplinary Quality Improvement Project.","authors":"Crystal Hope Bennett Schiano","doi":"10.1177/10499091251387260","DOIUrl":"https://doi.org/10.1177/10499091251387260","url":null,"abstract":"<p><p>ObjectiveThe rate of unmet palliative care (PC) needs is high in critical care areas, especially in the surgical patient population, where PC involvement is notoriously late in the patient's clinical progression. This quality improvement project aimed to evaluate the ability of education, workflow delineation, and an evidence-based assessment tool to improve the integration of PC in a cardiac surgical intensive care unit (TICU).MethodsThis 12-week project utilized a pre-post intervention design to improve PC integration in a 16-bed TICU that serves cardiac, vascular and thoracic surgical, critical care patients. The intervention included education, workflow delineation, and an evidence-based frailty assessment (FA) implementation. PC consultation rate, advance care planning (ACP) note completion rate, and FA completion rate were measured to assess the feasibility and impact of this intervention on PC integration.ResultsA total of 313 patients were enrolled in this project. There was a 53.5% increase in palliative care consultation (<i>P</i> = 0.16), however the ACP note completion rate remained unchanged. The rate of FA completion rose from 0% to 30.4% (<i>P</i> < 0.0001).ConclusionFA is important in the setting of critical care, surgical patients. The outcomes of this project were similar to those of the existing literature, further revealing that ICUs are challenging care settings in which to connect patients with PC for the first time. Future studies on the effects of FA in the cardiac surgical patient population are warranted to find the most appropriate settings for assessment and associated interventions based on identifying a patient's frailty.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":"43 12","pages":"1297-1304"},"PeriodicalIF":1.4,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229616","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":"Bridging Gaps in Palliative Care for Undocumented Immigrants Using the Social Determinants of Health Framework.","authors":"Lisa Cross, Rachael Salguero","doi":"10.1177/10499091251378640","DOIUrl":"10.1177/10499091251378640","url":null,"abstract":"<p><p>BackgroundSystemic policies and inequities, rather than immigration status itself, create barriers to health. In the United States, an estimated 11 million individuals live without legal authorization, a population that faces profound challenges in accessing equitable care. These barriers pose particular difficulties for palliative care nurses in recognizing and addressing the needs of undocumented immigrants.AimThe aim of this article is to examine palliative needs through the lens of the Social Determinants of Health framework.MethodA case study was designed to guide this discussion.ConclusionsIdentifying nursing interventions in this manner aligns with the overarching goals of the American Nurses Association and reflects the principles of ethical compassionate palliative nursing. Future research may explore targeted nursing interventions and programs that promote equitable access to palliative care for undocumented populations.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"1385-1390"},"PeriodicalIF":1.4,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145025032","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 Communication Skills Training Curriculum Customized for Pulmonary and Critical Care Medicine Fellows.","authors":"Luyi Xu, Anup Bharani, Sakshi Dua, Ankita Mehta","doi":"10.1177/10499091251390778","DOIUrl":"10.1177/10499091251390778","url":null,"abstract":"<p><p>IntroductionCommunication regarding serious illness is an integral part of Pulmonary and Critical Care Medicine (PCCM) fellows' day-to-day practice, however routine communication skills training is not consistently built in PCCM fellowship curricula nationwide. <i>Geritalk</i>, a previously validated interactive curriculum, can be adapted to address unique communication challenges in critical illness.MethodsIn 2024, after performing a needs assessment among PCCM fellows at Mount Sinai Hospital, a two-part curriculum was adapted from <i>Geritalk</i> through collaborations between PCCM and palliative care specialists. The curriculum consisted of a one-hour didactic followed by a one-hour small group workshop with case discussion and role-play. Pre- and post-curricular surveys were conducted among the fellows to assess changes in self-reported comfort levels in different components of communication during a family meeting.ResultsAmong 17 eligible PCCM fellows, a total of 14 (82.4%) fellows completed the pre-curricular survey, and 8 fellows (47.1%) completed the curriculum and post-curricular survey. Prior to the curriculum, fellows reported lower comfort levels in communicating prognosis (mean[SD] 3.8[1.0] on a 5-point Likert scale), responding to emotions (mean[SD] 4.0[0.8]), eliciting values (mean[SD] 3.8[0.8]), and describing comfort care (mean[SD] 3.9[1.0]). After the training, fellows reported moderate to significant increase in comfort levels, especially in responding to emotions (mean[SD] 4.3[0.7]) and eliciting values (mean[SD] 4.4[0.5]).ConclusionA two-part, critical care-focused curriculum adapted from <i>Geritalk</i> showed feasibility in communication training among PCCM fellows with improved self-assessed comfort levels in leading a family meeting. Future studies should incorporate objective assessment of competency and evaluate generalizability to other training programs.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"1305-1310"},"PeriodicalIF":1.4,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145305179","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":"Examining Antidepressant Discontinuation Syndrome (ADS) Among Hospice Patients in the Last Week of Life.","authors":"Mridula Shanker, Jasmine Choi, Carol S Weisse","doi":"10.1177/10499091251381304","DOIUrl":"10.1177/10499091251381304","url":null,"abstract":"<p><p>BackgroundTerminal symptoms at the end-of-life (EOL) can be distressing to hospice patients and to caregivers who often manage symptoms in a home setting. Identifying potential contributors of these symptoms is key to quality patient- and family-centered care. Disruptions in antidepressants can lead to antidepressant discontinuation syndrome (ADS), a condition characterized by unpleasant symptoms such as agitation, restlessness, nausea, and insomnia.ObjectivesUsing a retrospective review of hospice patients' medication records, this study examined whether patients experiencing disruptions in their antidepressant regimen needed additional comfort medication to manage terminal symptoms consistent with ADS.MethodsAn existing data registry of 356 home hospice patients was queried to identify patients who were administered antidepressants whose regimens were disrupted in the last week of life. Patterns of comfort medication administration in these patients were compared to comfort medication usage in patients whose antidepressant regimens were not disrupted and to patients who were not prescribed antidepressants. Symptoms of ADS were assessed by comparing doses of liquid morphine, lorazepam, and haloperidol pre- and post-discontinuation of an antidepressant.ResultsAnalyses revealed significant increases in liquid morphine and lorazepam administration among patients who experienced disruptions to their antidepressant regimen, and that the increased overall utilization of these comfort medications was higher than that of control patients whose antidepressants were not disrupted or of those who were not prescribed antidepressants at all. These results warrant further exploration to determine whether distressing EOL symptoms may be indicative of ADS.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"1329-1336"},"PeriodicalIF":1.4,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145082142","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 Impact of Early Palliative Care Consultation on Length of Stay for Critically Ill Adults in the Intensive Care Unit.","authors":"Sophie Caplan, Patricia C Pawlow","doi":"10.1177/10499091251388625","DOIUrl":"10.1177/10499091251388625","url":null,"abstract":"<p><p>Palliative Care Consultation (PCC) is an established intervention that prioritizes goals of care conversations and assists patients with complex medical decision-making. Evidence suggests that PCC can reduce the amount of non-goal concordant care patients receive such as fewer invasive procedures, less mechanical ventilation, and quicker transition to hospice and referral to appropriate resources, if that aligns with patient wishes. This results in decreased resource utilization, reduced anxiety for patients and their family members, and decreased moral distress for the health care team. Studies generally agree that benefits of PCC are greater the quicker the time to intervention, but results are mixed regarding hospital and intensive care unit (ICU) length of stay (LOS). LOS is a surrogate marker for goal-concordant care, and shorter LOS has been associated with decreased health care costs. This systematic literature review seeks to clarify the effects of early PCC versus standard PCC on length of stay. From an extensive search of CINAHL, EMBASE, Scopus, and PubMed, 17 articles met criteria to be reviewed. These articles include 2 randomized controlled trials (RCTs), 6 prospective cohort studies, and 9 retrospective cohort studies. Nine studies found statistically significant results linking early PCC with shorter length of stay. These results indicate that a change in practice could be considered given the multiple positive outcomes associated with early PCC. Further research is recommended with larger sample sizes across multiple institutions to improve generalizability of these initial findings, and to examine the different modalities of implementing early PCC into existing ICU workflows.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"1362-1375"},"PeriodicalIF":1.4,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13675563/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145380728","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":"Achieving Goal-Concordant Care With Goals of Care Consultations in the Emergency Department.","authors":"Stacy Nilsen, Diane Wintz, Kelly Wright, Debra Poeltler","doi":"10.1177/10499091251393371","DOIUrl":"10.1177/10499091251393371","url":null,"abstract":"<p><p>IntroductionTime constraints may be prohibitive to adequate goals of care (GOC) discussions and could delay critical decision making in urgent or emergent situations. Foregoing these discussions could misalign GOC with the medical care plan, including admission level of care, diagnostics or therapeutics. This team wanted to determine if there was improvement in length of stay, intensive care utilization (ICU), or cost in assuring the discussion upon admission.MethodsA retrospective record review was conducted for patients 65 and older at a single community hospital between January and December 2023. Included patients had at least one GOC documented discussion with a nursing team called Advanced Illness Management (AIM) and were admitted or placed in observation.Results3377 patients met the inclusion criteria. When AIM was initiated in ED (AIM ED), the median LOS was 3 days shorter as compared to those patients having AIM GOC consultation initiated past 24 hours (AIM IP) (AIM ED = 3 vs AIM IP = 6, <i>P</i> < 0.001). Of patients requiring intensive care, the median ICU hours were significantly less in the early AIM consult group (AIM ED = 18.5 vs AIM IP = 40, <i>P</i> < 0.001). The median direct cost of care was significantly less for the ED consult group (AIM ED $8470 vs AIM IP $15,406, <i>P</i> < 0.0001).ConclusionsThere were positive findings in LOS, ICU, and cost with AIM consultation within 24 hours of presenting to the ED, when compared to waiting for a later consultation, supporting consideration of forward-placement of GOC discussion.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"1355-1361"},"PeriodicalIF":1.4,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145369400","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 Needs in Patients With Early-Onset Alzheimer's Disease: A Cross-Sectional Report.","authors":"María Alejandra Tabares-Villamizar, Paola Gallo-Henao, Luisa Londoño, Isabel Márquez-Lugo, Karen Castaño, Manuela Pabón, María Upegui, Manuela Gomez-Vega, Sofia Rassi-Vargas, Daniel Vasquez-Botero, María Zuluaga-Patiño, Juan Felipe Quintero-Moreno, David Aguillón-Niño, Alicia Krikorian, John Jairo Vargas, Lucía Madrigal-Zapata, Francisco Lopera-Restrepo","doi":"10.1177/10499091251393485","DOIUrl":"10.1177/10499091251393485","url":null,"abstract":"<p><p>BackgroundEarly-onset Alzheimer's disease is a rapidly progressing condition that severely disrupts quality of life. Early palliative care incorporation helps identify patients' needs and facilitates family decision-making and advanced care planning for later stages.AimThe study aimed to assess palliative care needs, level of suffering, and most frequent symptoms in Early-onset Alzheimer's patients.MethodsWe present a preliminary observational analysis as part of a larger, 18-month longitudinal study of patients with early-onset Alzheimer's disease. Patients with the PSEN1-E280 A variant of Early-onset Alzheimer's disease attending the Antioquia Neuroscience Group at the University of Antioquia in Medellín, Colombia, participated. Data were collected using NECPAL, Edmonton Symptom Assessment System Revised, Global Deterioration Scale/Functional Assessment Staging (GDS/FAST), Pain Assessment in Advanced Dementia (PAINAD), and a numeric rating scale. Regarding data analyses from visit 1 (V1), variables were described according to their nature. A Poisson regression was performed, and prevalence ratios, 95% confidence intervals, and <i>P</i> values were obtained. Statistical significance was defined with an alpha value of 5%.ResultsThirty-six patients participated in V1. Median age was 53. Most of them were women and lived in urban areas. The prevalence of palliative care needs was 22.22%. Poisson regression showed an association between clinician-perceived need for palliative care and dysphagia, pressure ulcers, asthenia, insomnia, functional decline, resource utilization, positive surprise question in NECPAL instrument, and scores of the PAINAD and GDS/FAST scales.ConclusionPatients with Early-onset Alzheimer's have palliative care needs associated with symptoms related to disease progression, prognosis, resource utilization, and pain.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"1346-1354"},"PeriodicalIF":1.4,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145380633","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":"Improving Communication Competencies in Neonatology: A Multimodal Simulation-Based Palliative Care Workshop.","authors":"Samira Abudinen Vasquez, Rachana Singh, Jaclyn Boulais, Brooke Krbec","doi":"10.1177/10499091251386410","DOIUrl":"10.1177/10499091251386410","url":null,"abstract":"<p><p>BackgroundEffective communication between providers and parents is fundamental in critical care provision. Particularly when discussing goals of care and delivering bad news, which is often complicated by differing values and beliefs. Many trainees lack formal education in communication skills for end-of-life care. Implementing a formal curriculum may improve physician-patient relationships, parents' mental health, and overall patient care.ObjectiveTo assess the impact of an integrative multimodal simulation-based palliative care workshop experience combining simulated complex medical cases with challenging conversations to mirror real life scenarios on clinicians' knowledge, attitudes and communication skills.Study DesignThree simulation scenarios were conducted, combining medical management of a high-fidelity mannequin with challenging conversations with actors portraying as parents. Changes in participants' attitudes, knowledge, and communication skills were assessed pre- and post-intervention using both subjective and objective measures. Data was analyzed using chi-square tests, and paired-sample t-tests.ResultsTwenty-two participants completed the scenarios with a significant improvement in verbal and non-verbal communication skills, between the first and second case. There was improvement in participants' competency in delivering bad news, discussing death with parents, and disclosing medical errors.ConclusionAn integrative palliative care workshop combining high-fidelity medical management with concurrent emotionally challenging conversations improved clinicians' knowledge, attitudes, and communication skills. This real-time approach reflects the complexity of critical care and supports its incorporation into training to enhance clinician preparedness for simultaneous medical and communication demands during intense, life-threatening clinical scenarios.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"1311-1321"},"PeriodicalIF":1.4,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240731","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}