The American journal of hospice & palliative care最新文献

{"title":"Palliative Medicine Consultation Reduces Readmission Significantly in Certain Diagnoses: A Retrospective Analysis.","authors":"Carissa N Depew, Michelle Wood, Jason Walden, Amanda Stevens, Michaela Williamson, Supriya Peshin, Eric McDonald, Saima Rashid, Steven J Baumrucker","doi":"10.1177/10499091251313805","DOIUrl":"https://doi.org/10.1177/10499091251313805","url":null,"abstract":"<p><p>Hospital readmissions within 30 days are a significant concern due to their negative impact on patient outcomes and healthcare system costs.¹ This retrospective study explores the impact of palliative medicine consultation on reducing readmission rates for patients with severe, life-limiting illnesses. Real-world data from a 21-hospital system was analyzed for six specific diagnoses, including heart failure, sepsis, pneumonia, and chronic obstructive pulmonary disease. The study found a statistically significant reduction in readmissions for patients with sepsis, pneumonia, heart failure and (to a lesser extent) stroke who received palliative medicine consultation compared to those who did not. The findings suggest that palliative medicine consultation for these patients leads to reduced readmission and implies potential improved quality outcomes and cost savings. This study highlights the potential of palliative medicine as a multifactorial approach to reduce readmissions and potentially improve patient outcomes in the future.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"10499091251313805"},"PeriodicalIF":0.0,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960830","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":"Associations Between Anticipatory Grief and Post-Bereavement Depression and Post-Loss Grief of Family Members of Dying Patients With Cancer in Palliative Care Units: A Cohort Study.","authors":"Reina Gotoh, Yoichi Shimizu, Akitoshi Hayashi, Maeda Isseki, Tomofumi Miura, Akira Inoue, Mayuko Takano, Kento Masukawa, Maho Aoyama, Tatsuya Morita, Yoshiyuki Kizawa, Satoru Tsuneto, Yasuo Shima, Mitsunori Miyashita","doi":"10.1177/10499091241313299","DOIUrl":"https://doi.org/10.1177/10499091241313299","url":null,"abstract":"<p><p><b>Objectives:</b> Anticipatory grief is associated with post-bereavement grief; however, reports on the influence of pre-loss depression are limited. Therefore, we investigated the association between the anticipatory grief of family members and post-loss and post-depression grief adjusted for pre-loss depression. <b>Methods:</b> This cohort study included the family members of dying patients with cancer. Questionnaires were distributed to them during hospitalization in four inpatient palliative care units from 2016 to 2017. We also administered follow-up questionnaires after their bereavement in 2018. The pre-bereavement questionnaire consisted of three items from the Anticipatory Grief Scale for Families Caring for a Terminally Ill Person for assessing anticipated grief and the Patient Health Questionnaire 9 for assessing depression. The Brief Grief Questionnaire was used to assess post-loss grief. <b>Results:</b> We distributed 181 pre-bereavement questionnaires to the family members; 112 (62%) responded to the pre-bereavement survey, out of which 71 (63%) responded to the post-bereavement survey. Anticipatory grief was significantly associated with pre-loss (ρ = 0.37, ρ < 0.001) and post-loss (ρ = 0.24, <i>P</i> = 0.009) depression and marginally associated with post-loss grief (ρ = 0.15, <i>P</i> = 0.10). Pre-loss depression was also significantly associated with post-loss depression (ρ = 0.50, <i>P</i> < 0.001) and post-loss grief (ρ = 0.41, <i>P</i> < 0.001). However, anticipatory grief was not significantly associated with post-loss depression (<i>P</i> = 0.35) and post-loss grief (<i>P</i> = 0.65) after adjusting for pre-loss depression. <b>Significance of Results:</b> Bereaved families who experienced anticipatory grief had worse post-bereavement depression. However, this association was not statistically significant after adjusting for pre-bereavement depression. Post-bereavement depression may be in a continuum with pre-loss depression, and anticipatory grief does not independently affect post-loss reactions.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"10499091241313299"},"PeriodicalIF":0.0,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960810","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":"Is Routine Discharge Enough? Needs and Perceptions Regarding Discharge and Readmission of Palliative Care Patients and Caregivers.","authors":"Aaron A Kuntz, Victoria H Chen, Leena Ambady, Benjamin Osher, Catherine DesRoches","doi":"10.1177/10499091241311222","DOIUrl":"https://doi.org/10.1177/10499091241311222","url":null,"abstract":"<p><strong>Context: </strong>The hospital discharge process is fraught for patients with serious illness and their caregivers.</p><p><strong>Objectives: </strong>We sought to understand palliative care patient and caregiver concerns regarding the patient-centeredness of the hospital discharge process.</p><p><strong>Methods: </strong>We conducted semi-structured interviews with 11 patients receiving palliative care and 4 caregivers. Caregivers were interviewed with patient or alone, for a total of 13 interviews. Interviews were focused on the patient-centeredness of the discharge process, completeness of discharge education, and readmission. Transcripts were analyzed using an inductive approach with open coding.</p><p><strong>Results: </strong>We identified four themes: (i) symptoms, (ii) relationship to illness, (iii) variance in patient-provider alignment, and (iv) discharge readiness, including readmission. Physical and non-physical symptoms were common, though non-pain symptoms were more frequently concerns. Illness understanding and empowerment by the discharge process were low, with participants seeking more information. Alignment varied by provider with closer relationships with bedside nurses and outpatient providers, especially oncologists, than inpatient providers. Readmission was not perceived to be avoidable but was associated with symptom burden. Discharge readiness was mixed; common concerns included lack of clarity regarding next steps and post-discharge services. Up to 40% of participants reported incomplete education on given topics.</p><p><strong>Conclusion: </strong>Our qualitative study of patients and caregivers receiving palliative care identified unmet needs in the discharge process: non-pain symptom burden, gaps in empowerment and illness understanding, and mixed discharge readiness. Relationship to care informs subsequent engagement with care and medical decision-making. Future interventions should focus on strengthening patient and caregiver empowerment and illness understanding.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"10499091241311222"},"PeriodicalIF":0.0,"publicationDate":"2025-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933863","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":"Factors Associated With Prolonged Survival in Colorectal Cancer Patients Admitted to Palliative Care: An Exploratory Study.","authors":"José António Ferraz-Gonçalves, Áurea Lima, Álvaro José Silva, Rita Calisto","doi":"10.1177/10499091241313224","DOIUrl":"10.1177/10499091241313224","url":null,"abstract":"<p><strong>Objective: </strong>A recently published study concerning variables associated with survival longer than one year in palliative care included several types of cancer. A secondary analysis limited to patients with colorectal cancer was performed to analyze a more homogeneous group of patients.</p><p><strong>Methods: </strong>Patients were identified through electronic records from 2012 to December 2018. All patients were over 18 years old and deceased. Cases were defined as patients who survived ≥1 year after being admitted to the palliative care service (PCS), while controls were those who had survived ≤6 months.</p><p><strong>Results: </strong>The study includes 33 patients as cases and 119 as controls. 82 (54%) were male, and the median age was 78.5 years (49 to 95). In the univariable analysis, the variables associated with a low probability of living ≥1 year were an ECOG performance status ≥2, liver metastases, and pain. The variables associated with a survival ≥1 year were the neutrophil count ≤5.66 x 10⁹/L and a neutrophil/lymphocyte ratio ≤3.59. In the multivariable analysis, only pain and liver metastases were associated with a low probability, and the neutrophil/lymphocyte ratio ≤3.59 with a high likelihood of living one year or more.</p><p><strong>Conclusion: </strong>The data of this study suggests that in colorectal cancer patients admitted to a PCS, the presence of pain, liver metastases, and a high neutrophil/lymphocyte ratio negatively impact the probability of living ≥1 year.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"10499091241313224"},"PeriodicalIF":0.0,"publicationDate":"2025-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933904","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":"Medical Professionals' Perceptions of and Experiences With Terminally Ill Orthodox Jewish Patients.","authors":"Moshe C Ornstein, David Harris","doi":"10.1177/10499091241312395","DOIUrl":"https://doi.org/10.1177/10499091241312395","url":null,"abstract":"<p><p>Orthodox Jewish patients with terminal illnesses have unique goals and desires, often driven by <i>halakha</i> (Jewish law and ethics) and cultural norms. We conducted a quality improvement project investigating the baseline perceptions and experiences of medical professionals who care for Orthodox Jewish patients with terminal illnesses. The survey included health care professionals who cared for Orthodox Jewish patients as part of Intensive Care Unit (ICU), Oncology, or Palliative Care and Hospice teams. The three main elements of the survey included respondent demographics, multiple choice selections, and a free-text section. A total of 73 medical professionals responded to the survey. Several important findings were noted. Compared to the general population, Orthodox Jewish patients with terminal illnesses are more likely to request aggressive measures at end-of-life and are less likely to have completed advanced directives and health care power of attorney documentation. They also do not always have a rabbinic authority involved in decision-making. Health care professionals highlighted strong religious and community support as positive elements of caring for this population and recommend that medical teams establish early and direct communication with rabbinic authorities for those patients for whom a rabbi's involvement is desired. These data inform ongoing next steps to improve the quality of care for these patients and their families.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"10499091241312395"},"PeriodicalIF":0.0,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928899","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 Qualitative Inquiry of Patients Using Virtual Reality to Mitigate Cancer Pain.","authors":"Hunter Groninger, Nadia Ali, Kylie Gomes, Diana Violanti","doi":"10.1177/10499091241312685","DOIUrl":"https://doi.org/10.1177/10499091241312685","url":null,"abstract":"<p><strong>Introduction: </strong>Virtual reality (VR) is a rapidly evolving technology that has been shown to improve pain severity in different disease states, including cancer. To date, VR pain studies have used off-the-shelf products for pain distraction. What are user preferences for VR content to mitigate cancer pain?.</p><p><strong>Objective: </strong>Through qualitative inquiry, we aim to explore and understand user preferences for VR distraction therapies to mitigate cancer-related pain.</p><p><strong>Methods: </strong>We conducted semi-structured interviews of 12 patients participating in a VR cancer pain therapy clinical trial. Using a grounded theory approach, emerging themes and subthemes were analyzed to elucidate patient experiences and preferences for VR content.</p><p><strong>Results: </strong>Participants described distinct themes related to VR use, specifically experiences of immersion, distraction, relaxation, and safety. Higher experience of immersion and distraction were associated with improvement in cancer pain severity. Some participants had to adapt to VR technology to use it successfully. Regarding future VR content development, participants voiced preferences for content related to home, childhood, natural environments, and family and friends.</p><p><strong>Conclusion: </strong>Patients associate higher levels of virtual immersion and familiar, natural virtual experiences with successful VR distraction therapy for cancer pain analgesia.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"10499091241312685"},"PeriodicalIF":0.0,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928922","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":"Nursing Practices for Preventing Delirium in Patients with Cancer with Prognoses of Months and Weeks: A Multi-Site Cross-Sectional Study in Japan.","authors":"Yusuke Kanno, Kimiko Nakano, Kohei Kajiwara, Masamitsu Kobayashi, Miharu Morikawa, Yoshinobu Matsuda, Jun Kako","doi":"10.1177/10499091241312344","DOIUrl":"https://doi.org/10.1177/10499091241312344","url":null,"abstract":"<p><strong>Background: </strong>Delirium is a condition characterized by an acute and transient disturbance in attention, cognition, and consciousness. It is increasingly prevalent at the end of life in patients with cancer. While non-pharmacological nursing interventions are essential for delirium prevention, their effectiveness in terminally ill patients with cancer remains unclear.</p><p><strong>Objectives: </strong>This study examined the nursing support practices employed to prevent delirium in terminally ill patients with cancer in palliative care units (PCUs) in Japan.</p><p><strong>Methods: </strong>This cross-sectional study administered an online survey to 2448 nurses from 162 institutions with PCUs in Japan.</p><p><strong>Results: </strong>Regarding nursing practices with patients with a prognosis of months and weeks, multi-component intervention, family support, and dehydration prevention were practiced frequently, whereas bright light therapy was practiced less frequently. The specialist team approach was practiced by approximately 50% of participants. Regarding multicomponent intervention in cases with a prognosis of months and weeks, adjustments in the sleep environment and pain management were practiced by more than 90% of the participants, whereas early exercise, vision or hearing assistance, and patient education on delirium were implemented by less than 50%. The management of intravenous injection routes and catheters was implemented by participants approximately 20% more frequently in cases with a prognosis of weeks than those with a prognosis of months.</p><p><strong>Conclusion: </strong>The primary methods of nursing support for preventing delirium in patients with terminal cancer were multicomponent intervention, family support, and dehydration prevention. Further research is necessary to develop and implement appropriate nursing support strategies.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"10499091241312344"},"PeriodicalIF":0.0,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928901","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":"Health Care Worker Education for Palliative Care in Africa: Narrative Review.","authors":"Claire Beecher, David Holmes","doi":"10.1177/10499091241239645","DOIUrl":"10.1177/10499091241239645","url":null,"abstract":"<p><p>The demand for palliative care for terminally ill patients is rising globally. This review examines the potential of health worker education to enhance palliative care in Africa. A search of PubMed yielded 32 relevant articles published in English from 2013 to 2023 focused on African countries with WHO-categorized palliative care development and health care worker training. The findings underscore the pivotal role of health care worker education in elevating palliative care standards. Targeted initiatives equip health care workers with vital skills in pain management, symptom control, and communication. The integration of palliative care into public health systems is important for the sustainability of end-of-life care for terminally ill patients in Africa and around the world.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"121-128"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140121726","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":"Facts to Snacks. Evaluating the Effectiveness of Bite-Sized Animations in Teaching Palliative Care to Medical Students.","authors":"Kai Lin Megan Chua, Jin Qi Valerie Chan, Laurence Lean Chin Tan, James Alvin Low","doi":"10.1177/10499091241240053","DOIUrl":"10.1177/10499091241240053","url":null,"abstract":"<p><strong>Background: </strong>Current palliative care training in medical school is inadequate in preparing doctors to provide quality palliative care. Little attention is paid to determining effective methods of training.</p><p><strong>Objective: </strong>To assess the use of bite-sized animations in improving the confidence, knowledge and attitudes of medical students towards palliative care.</p><p><strong>Methods: </strong>A mixed methods cohort study was adopted for the study. 50 medical students without prior palliative training completed questionnaires before and after watching a 12-part animated palliative care video series called PowerFacts. Of these participants, 18 underwent semi-structured interviews.</p><p><strong>Results: </strong>The quantitative results showed that animations are effective in improving the confidence (<i>P</i> < .001) and knowledge (<i>P</i> < .001), but not the attitudes (<i>P</i> = .183) of medical students. Confidence, knowledge and attitudes were not correlated. Analysis of follow-up interviews of a convenience sample of participants showed that animations can be effective in teaching knowledge and does fill some gaps in palliative education for medical undergraduates. However, the content delivered as a sole learning tool is inadequate in preparing medical students for clinical practice.</p><p><strong>Conclusion: </strong>All participants achieved level 1 (reaction), some achieved level 2 (learning) but most did not achieve level 3 (behaviour) of the Kirkpatrick's model. There is a need for a multimodal approach in the comprehensive teaching of palliative care in undergraduate medical training to achieve all four levels of the Kirkpatrick Model.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"32-40"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140195337","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":"Implementing a Palliative Care Junior Faculty Visiting Professor Program: Pearls and Pitfalls.","authors":"Jennifer B Seaman, Teresa H Thomas, Risa L Wong, David I Lazris, Maria Belin, Yael Schenker","doi":"10.1177/10499091241244815","DOIUrl":"10.1177/10499091241244815","url":null,"abstract":"<p><strong>Motivation: </strong>Palliative Care (PC) is a small, relatively young interprofessional sub-specialty; hence mentorship for early-career research faculty is widely dispersed across schools and universities. We developed the Junior Visiting Professor Program (JVPP) to provide junior faculty in palliative care (PC) with opportunities to meet multidisciplinary PC researchers from other institutions and to advance their research through networking and presenting their work. We describe how we designed and implemented the program, and we report on the first cohort of participants.</p><p><strong>Methods: </strong>We invited PC research groups from US schools of medicine and nursing to participate in this 5-year interprofessional exchange program by nominating junior faculty and serving as hosts. We matched nominees to host institutions based on nominee training experiences, nominee research interests, and host institution faculty expertise. In addition, we provided logistical guidance on visit planning. Post-visit, we surveyed both hosts and junior visiting professors (JVPs) regarding their satisfaction, perceived value, and suggestions regarding the program.</p><p><strong>Results: </strong>We recruited 13 schools to participate and matched 10 nominees to host institutions in our first year. Nine JVPs completed their visit; 6 JVPs and 8 host faculty/staff responded to the post-visit survey. Overall, JVPs were highly satisfied with their matches and the visiting professor experience. Hosts were generally satisfied with their matches and believed the program to be mutually beneficial. The most frequent suggestion was for greater administrative support to plan visits.</p><p><strong>Conclusions: </strong>Structured, well-supported opportunities for networking across institutions is beneficial for emerging PC researchers and for building PC research capacity.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"80-84"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140874224","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}