The American journal of hospice & palliative care最新文献_第2页

Terminal Hospitalizations in Liver Transplant Recipients: Reducing Costs and High-Intensity Care Through Palliative Care. 肝移植受者的晚期住院：通过姑息治疗降低成本和高强度护理。

IF 1.4

The American journal of hospice & palliative care Pub Date : 2026-07-01 Epub Date: 2025-05-05 DOI: 10.1177/10499091251340685

Stephanie Rodriguez, Spencer R Goble, Thomas M Leventhal

{"title":"Terminal Hospitalizations in Liver Transplant Recipients: Reducing Costs and High-Intensity Care Through Palliative Care.","authors":"Stephanie Rodriguez, Spencer R Goble, Thomas M Leventhal","doi":"10.1177/10499091251340685","DOIUrl":"10.1177/10499091251340685","url":null,"abstract":"IntroductionEnd-of-life care for liver transplant recipients is often characterized by high utilization of invasive procedures, prolonged hospital stays, and elevated health care costs. Despite evidence demonstrating that palliative care can reduce aggressive interventions, improve patient-centered outcomes, and lower costs, its integration into transplant care remains inconsistent.MethodsA retrospective analysis was conducted using the National Inpatient Sample database (2016-2021). Hospitalizations ending in death for liver transplant recipients were compared to non-recipients regarding invasive procedures, health care costs, and the impact of palliative care consultations. Assessed procedures included: mechanical ventilation, tracheostomy, enteral and parenteral nutrition support, red blood cell transfusion, renal replacement therapy, central line placement, and cardiopulmonary resuscitation. Multivariable regression models adjusted for demographic and clinical covariates were utilized.ResultsAmong 4,582,658 terminal hospitalizations, liver transplant recipients (n = 5995) were younger (mean age: 66.0 vs 70.9 years, P < 0.001), had higher comorbidity burdens, and were more likely to have undergone one or more of the assessed procedures (74.7% vs 58.4%, P < .001) compared to non-recipients. Hospitalization costs were increased in transplant recipients ($62,630 vs $46,930, P < .001). Palliative care consultations were associated with reduced procedure utilization (69.9% vs 83.7%, P < .001), shorter hospital stays, and lower costs ($46,930 vs $62,630, P < .001).DiscussionLiver transplant recipients face unique end-of-life care challenges, including greater reliance on high-intensity interventions and associated costs. Palliative care is associated with less invasive procedures and lower costs, highlighting the need for its integration into transplant care pathways.","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"785-791"},"PeriodicalIF":1.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144032478","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}

引用次数: 0

An Analysis of the Clinical Burden and Economic Costs of Venous Thromboembolism During Inpatient Admissions for Pancreatic Cancer in the United States. 美国胰腺癌住院期间静脉血栓栓塞的临床负担和经济成本分析。

IF 1.4

The American journal of hospice & palliative care Pub Date : 2026-07-01 Epub Date: 2025-05-09 DOI: 10.1177/10499091251341453

Osayande Osagiede, Wafa Aldhaleei, Massimo Raimondo, Michael B Wallace, Yan Bi, Frank J Lukens

{"title":"An Analysis of the Clinical Burden and Economic Costs of Venous Thromboembolism During Inpatient Admissions for Pancreatic Cancer in the United States.","authors":"Osayande Osagiede, Wafa Aldhaleei, Massimo Raimondo, Michael B Wallace, Yan Bi, Frank J Lukens","doi":"10.1177/10499091251341453","DOIUrl":"10.1177/10499091251341453","url":null,"abstract":"Objectives: VTE is a frequent complication of pancreatic cancer, but it is often under-reported. VTE is associated with a shorter overall survival and poor quality of life in ambulatory settings. This study aims to examine the clinical burden and costs of newly diagnosed VTE during inpatient admissions for pancreatic cancer. Methods: We conducted a retrospective study of 108,690 pancreatic cancers using the National Inpatient Sample (NIS) database (January 2016 - December 2020). Patient and hospital characteristics, mortality, discharge disposition, length of stay (LOS), hospital costs and charges were compared between pancreatic cancer patients based on VTE occurrence. Multivariate regression was used to evaluate patient outcomes associated with VTE occurrence. Results: A total number of 4520 (4.2%) patients had VTE. Patients with VTE were more likely to have a high comorbidity index ≥3. Patients with VTE displayed higher odds of prolonged hospitalization, discharge to home hospice, and palliative care use, but no difference in in-hospital deaths. The adjusted additional mean hospital charge and cost were higher in patients with VTE by $10,293 (P < 0.001) and $2966 (P < 0.001), respectively. Conclusions: VTE occurrence during acute hospitalizations for pancreatic cancer is associated with significant morbidity, increased resource utilization and economic burden without additional risk for in-hospital mortality.","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"761-767"},"PeriodicalIF":1.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056472","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}

引用次数: 0

Intensity of Care at the End-of-Life in Pediatrics: A Single Center Analysis With Implications for Advanced Care Planning in Saudi Arabia. 儿科学临终关怀的强度：沙特阿拉伯高级护理计划的单中心分析。

IF 1.4

The American journal of hospice & palliative care Pub Date : 2026-06-01 Epub Date: 2025-05-19 DOI: 10.1177/10499091251339615

Kim Sadler, Lama Altarifi, Steven Callaghan, Saadiya Khan, Khaled AlGhamdi, Tareq Mohammed Alayed, Raghad Alhuthil, Abdulrahman Amer Alshehri, Maryam A Altassan, Musab Aldhari, Haifaa Hamzah Hussain, Mohammed Baragaa

{"title":"Intensity of Care at the End-of-Life in Pediatrics: A Single Center Analysis With Implications for Advanced Care Planning in Saudi Arabia.","authors":"Kim Sadler, Lama Altarifi, Steven Callaghan, Saadiya Khan, Khaled AlGhamdi, Tareq Mohammed Alayed, Raghad Alhuthil, Abdulrahman Amer Alshehri, Maryam A Altassan, Musab Aldhari, Haifaa Hamzah Hussain, Mohammed Baragaa","doi":"10.1177/10499091251339615","DOIUrl":"10.1177/10499091251339615","url":null,"abstract":"Background: Advances in medicine have altered the progression of several pediatric disorders. However, this progress also comes with medical, economic, and ethical challenges, which can negatively affect children's quality of life. Objective: This study examines the quality of care of children with malignant and non-malignant conditions at the end of life. Design: A two-year cohort retrospective analysis was conducted. Setting/Subjects: The study included all children who died between December 1, 2021, and December 1, 2023, in a tertiary center in Saudi Arabia. Measurements: Data included. information on children's demographics, medical history, EOL care, and healthcare services utilization. Results: A total of 302 deaths were analyzed, 42% of infants. The most frequent conditions were cardiac diseases (30.1%) and malignancy (20.9%). Two-thirds had a Do-Not-Attempt-Resuscitation (DNAR) (66.6%), with most officialized in the Intensive Care Unit (ICU). Two-thirds had no advanced directives (66.9%). A majority of children died in the ICU (64.6%), with a significant number receiving intensive care until the very end of life. The Palliative Care Team was involved in only 27.9% of cases, with a median of 47 days between referral and death. Conclusion: These findings highlight the paucity of advanced care planning, delays in goals of care discussion at the end of life, and suboptimal use of specialized palliative care resources early in the disease trajectory. These gaps impact children's symptom burden, family psychological distress, and unattained children and families' last wishes.","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"568-577"},"PeriodicalIF":1.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144096617","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}

引用次数: 0

Self-Care for Psychosocial and Palliative Care Clinicians: Stakeholder-Informed Recommendations for Medical Education and Clinical Training. 心理社会和姑息治疗临床医生的自我保健：利益相关者知情的医学教育和临床培训建议。

IF 1.4

The American journal of hospice & palliative care Pub Date : 2026-06-01 Epub Date: 2025-05-09 DOI: 10.1177/10499091251339745

Greta J Khanna, Timothy S Sannes, Douglas E Brandoff, Jane deLima Thomas, Richard E Leiter, Sue E Morris

{"title":"Self-Care for Psychosocial and Palliative Care Clinicians: Stakeholder-Informed Recommendations for Medical Education and Clinical Training.","authors":"Greta J Khanna, Timothy S Sannes, Douglas E Brandoff, Jane deLima Thomas, Richard E Leiter, Sue E Morris","doi":"10.1177/10499091251339745","DOIUrl":"10.1177/10499091251339745","url":null,"abstract":"BackgroundDespite overwhelming evidence for work-related stress and burnout, health care clinicians receive little training in self-care.ObjectivesWe explored training and current self-care satisfaction of psychosocial and palliative care clinicians.DesignForty-one psychosocial and palliative care clinicians (18 physicians, 16 social workers, and 7 others [nurse practitioners, psychologists, pharmacists, and physician assistants]) who care for adult oncology patients at a large U.S. academic cancer center, completed an online survey about well-being, including their prior training, current satisfaction, and barriers to self-care.ResultsThis cross-sectional mixed-methods study found that clinicians felt that their graduate training did not prepare them very well to look after themselves in their professional roles (m = 1.71 [SD = 1.25]), where zero corresponded to \"not well at all\" and 4 to \"extremely well.\" Open-ended responses highlighted potential gaps in self-care training: (1) Institutional support; (2) Information and education; (3) Self-care techniques and support; (4) Expectations; and (5) Managing boundaries. Clinicians rated their satisfaction with their current self-care practices as \"moderately satisfied\" (m = 2.10 [SD = 0.92]). Participants also noted barriers to self-care: (1) Time; (2) Competing demands and priorities between work and home; (3) Work culture, including pace and load; (4) Energy, motivation, and awareness; and (5) New methods and tools.ConclusionsThe findings highlight gaps in clinical education and training about self-care practices for health care clinicians, especially for those who care for seriously ill and dying patients. We discuss training implications and propose possible interventions, to strengthen the existing models of self-care for health care clinicians.","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"578-584"},"PeriodicalIF":1.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144036361","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}

引用次数: 0

Psychosocial Screening by Inpatient Palliative Care Teams: Patient Characteristics and Outcomes. 住院姑息治疗团队的社会心理筛查：患者特征和结果。

IF 1.4

The American journal of hospice & palliative care Pub Date : 2026-06-01 Epub Date: 2025-05-14 DOI: 10.1177/10499091251343213

Chelsea K Brown, Laura A Schoenherr, Steven Z Pantilat, Cara L Wallace, Bridget Sumser, Sarah Peck, David L O'Riordan

{"title":"Psychosocial Screening by Inpatient Palliative Care Teams: Patient Characteristics and Outcomes.","authors":"Chelsea K Brown, Laura A Schoenherr, Steven Z Pantilat, Cara L Wallace, Bridget Sumser, Sarah Peck, David L O'Riordan","doi":"10.1177/10499091251343213","DOIUrl":"10.1177/10499091251343213","url":null,"abstract":"Context: Palliative care (PC) teams are structured as interprofessional so that patient and caregiver distress can be assessed and treated across all bio-psychosocial-spiritual-cultural domains. The National Consensus Project's Clinical Practice Guidelines for Quality Palliative Care call for all PC team members to be competent at screening patients for psychosocial needs so that urgent referrals can be appropriately triaged to a PC social worker for follow-up assessment and intervention. Objectives: To understand patient characteristics and PC outcomes of hospitalized patients who are screened for psychosocial needs and subsequently receive psychosocial interventions during inpatient PC consultation. Methods: We analyzed data from 44,586 inpatient palliative care consultations by 11 Palliative Care Quality Network (PCQN) teams across various states between 01/01/2017 and 12/31/2021. Results: Overall, 81.5% (n = 36,332) of consults included a screen for psychosocial needs. Of those patients with an identified psychosocial need, (n = 25,661), 91.6% (n = 23,503) received a psychosocial intervention. Patients who spoke Spanish were less likely to receive a psychosocial screen than English-speaking patients (OR = 0.62, CI = 0.54-0.71). Patients who screened positive for a psychosocial need and identified as Hispanic/Latinx were less likely than those who identified as White to receive a follow-up psychosocial intervention (OR = 0.68, 95% CI = 0.57-0.80). Conclusion: 4 out of 5 patients were screened for psychosocial needs. When a psychosocial need was identified, the majority of patients received a follow-up psychosocial intervention. There was disparate delivery of psychosocial care for patients who identify as Hispanic/Latinx and/or Spanish-speaking, indicating a key area for improvement and further exploration.","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"595-605"},"PeriodicalIF":1.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056475","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}

引用次数: 0

Unmet Needs of Palliative Cancer Patients: A Grounded Theory Study. 姑息性癌症患者未被满足的需求：一个扎根的理论研究。

IF 1.4

The American journal of hospice & palliative care Pub Date : 2026-06-01 Epub Date: 2025-04-18 DOI: 10.1177/10499091251336452

Ilaria Basile, Letteria Consolo, Anita Bellani, Daniele Rusconi, Simonetta Zappata, Augusto Caraceni, Maura Lusignani

{"title":"Unmet Needs of Palliative Cancer Patients: A Grounded Theory Study.","authors":"Ilaria Basile, Letteria Consolo, Anita Bellani, Daniele Rusconi, Simonetta Zappata, Augusto Caraceni, Maura Lusignani","doi":"10.1177/10499091251336452","DOIUrl":"10.1177/10499091251336452","url":null,"abstract":"BackgroundAdult patients in oncological palliative care often do not readily express their concerns to physicians or nurses, leading to the oversight of needs that remain unexplored and require additional support. These needs that remain unaddressed are classified as unmet needs.AimThis study aimed to construct a conceptual framework of the unmet needs of cancer patients in palliative care settings. Method: Charmaz's constructivist grounded theory approach was adopted. Semi-structured interviews were conducted with eligible patients until theoretical saturation was reached, as outlined by the methodology. The interviews were transcribed and analyzed through two coding cycles: line-by-line coding and focused coding, using NVIVO 14 software.Setting/participantsA total of 29 patients were recruited from home palliative care, hospice, and outpatient settings at the Istituto Nazionale dei Tumori of Milan's Palliative Care - Hospice, Pain Therapy, and Rehabilitation Complex Unit.ResultsThis process led to the identification of five categories: Seeking Empowerment Through Daily Support, Need to Contain the Risk of Losing Dignity, Support in Managing the Progression of the Disease, Understanding and Openness to the Future, and Seeking Existential Support, along with a core category defined as the Need for Acknowledgment. The core category encompasses patients' need to express their most intimate needs, emphasizing how crucial it is for them to be seen and understood not only as individuals facing illness but as people with unique, complex life stories.ConclusionsThe conceptual model developed enabled the identification of these hidden needs, providing a deeper understanding of the emotional and psychological dimensions that shape the experience of advanced illness.","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"585-594"},"PeriodicalIF":1.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13053869/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060074","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}

引用次数: 0

The Prevalence of Social Isolation and Loneliness Among Older Adults Residing in Rural Utah Communities. 居住在犹他州农村社区的老年人的社会隔离和孤独的流行。

IF 1.4

The American journal of hospice & palliative care Pub Date : 2026-06-01 Epub Date: 2025-04-24 DOI: 10.1177/10499091251337722

Lynn F Reinke, Malek Alnajar, Xiaoming Sheng, Katherine Supiano

{"title":"The Prevalence of Social Isolation and Loneliness Among Older Adults Residing in Rural Utah Communities.","authors":"Lynn F Reinke, Malek Alnajar, Xiaoming Sheng, Katherine Supiano","doi":"10.1177/10499091251337722","DOIUrl":"10.1177/10499091251337722","url":null,"abstract":"An estimated 24% of community-dwelling older adults experience social isolation defined as infrequent social contact or having few social relationships, and 35% of adults aged >45 report being lonely, a subjective feeling of isolation or lack of social contact. Social isolation and loneliness are associated with poor physical and mental health. The purpose of our study was to assess the prevalence of social isolation and loneliness among older adults receiving home health services in rural Utah communities. We conducted a cross-sectional study with 41 persons at the onset of enrollment in home care services in 2 rural counties in Utah. We assessed loneliness, social support and quality of life using validated surveys. We conducted descriptive statistics to describe the participants demographics and Pearson's Correlation Coefficients to assess a relationship between loneliness and quality of life and satisfaction with health. Participants were predominately older, with an average age of 75.6 years (range 59-93 years.) The majority of participants were female 27 (65.8%) and identified as White 36 (87.8%). Overall, the average loneliness score was 1.51 (0.67 SD) indicating the prevalence of loneliness was low among our study population. We found statistically significant correlation among participants who rated their loneliness higher with lower rates of satisfaction with their health and overall quality of life. Future research is needed with larger sample sizes to validate our findings which may inform policy changes including standardizing assessment of social isolation and loneliness and offering person-centered interventions to prevent the physical and psychological consequences of social isolation.","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"622-629"},"PeriodicalIF":1.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061260","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}

引用次数: 0

Hospice Use by Cause of Death: A Cohort Study Using Utah Population Database. 临终关怀使用的死因：犹他州人口数据库的队列研究。

IF 1.4

The American journal of hospice & palliative care Pub Date : 2026-06-01 Epub Date: 2025-04-29 DOI: 10.1177/10499091251338254

Rebecca L Utz, Michael Hollingshaus, Attrayee Bandyopadhyay, Kathie Supiano, Margaret Clayton, Katherine A Ornstein, Djin Tay, Eli Iacob, Ken Smith, Caroline Stephens

{"title":"Hospice Use by Cause of Death: A Cohort Study Using Utah Population Database.","authors":"Rebecca L Utz, Michael Hollingshaus, Attrayee Bandyopadhyay, Kathie Supiano, Margaret Clayton, Katherine A Ornstein, Djin Tay, Eli Iacob, Ken Smith, Caroline Stephens","doi":"10.1177/10499091251338254","DOIUrl":"10.1177/10499091251338254","url":null,"abstract":"PurposeIllnesses such as cancer often follow a predictable trajectory of decline, while others, such as Alzheimer's Disease and Related Dementias (ADRD) and Chronic Obstructive Pulmonary Disease (COPD), follow a more dwindling and protracted decline. Hospice, a form of EOL palliative care for individuals with less than 6 months of remaining life, was originally created for patients with life-limiting cancer but is increasingly used by all patients with all types of life-limiting diagnoses. This study assesses whether hospice use differs by the underlying cause of death and whether current hospice eligibility and practices provide optimal EOL to all causes of death.MethodBased on data from 17,321 hospice users drawn from the Caregiver Population Science (C-PopS) decedent cohort of the Utah Population Database (UPDB), we used multinomial regression analyses and Kaplan-Meier Survival Curves to model hospice length-of-stay by cause of death, in order to identify patterns of hospice use by patients who have different underlying causes of death.Major FindingsNon-cancer decedents were more likely to have sub-optimal patterns of hospice care, including minimal use, lasting less than a week, and extended use, lasting more than 6 months. Stroke decedents were the most likely to have minimal-use patterns of hospice, whereas dementia and COPD decedents were most likely to have extended use.ConclusionNew models of hospice-like EOL care that can accommodate both short-term and long-term palliative care needs may help meet the diverse needs of patients and families facing different EOL trajectories associated with common causes of death.","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"613-621"},"PeriodicalIF":1.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056347","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}

引用次数: 0

Advance Care Planning Engagement of Older Adults in the Emergency Department. 急诊科老年人的提前护理计划参与

IF 1.4

The American journal of hospice & palliative care Pub Date : 2026-06-01 Epub Date: 2025-04-24 DOI: 10.1177/10499091251338252

Adrian D Haimovich, Kenji Numata, Justin Wolozin, Zara Foroohar, Carlo Ottanelli, Ryan C Burke, Erin K Kross, Rebecca L Sudore, Nathan I Shapiro, Mara A Schonberg, Kei Ouchi

{"title":"Advance Care Planning Engagement of Older Adults in the Emergency Department.","authors":"Adrian D Haimovich, Kenji Numata, Justin Wolozin, Zara Foroohar, Carlo Ottanelli, Ryan C Burke, Erin K Kross, Rebecca L Sudore, Nathan I Shapiro, Mara A Schonberg, Kei Ouchi","doi":"10.1177/10499091251338252","DOIUrl":"10.1177/10499091251338252","url":null,"abstract":"BackgroundAdvance care planning (ACP) helps older adults make end-of-life medical decisions. While ACP discussions are associated with improved patient outcomes, overall engagement remains low in the emergency department (ED).ObjectivesThis study assessed ACP engagement in older ED patients.MethodsWe conducted a questionnaire study among adults ≥65 in a Boston ED (July-Oct 2023). Our primary outcome was ACP Engagement as measured by a validated 9-item instrument with three ACP self- efficacy and six ACP readiness questions. Secondary outcomes included participants' preferences for learning about five ACP topics in the ED-medical decision makers, what matters most, leeway and flexibility for decision makers, sharing wishes, and asking questions)-as well as their favored learning formats (eg, pamphlets, videos, clinician conversations). Each was rated on a 5-point Likert scale. We examined the relationship between ACP engagement and existing electronic health record (EHR) documentation.ResultsNinety-nine older adults participated (mean age 75.5; 53.5% women). On the 9-item ACP Engagement Survey, participants reported high overall scores with a mean of 4.1 (95% CI: 4.0-4.2). Among ACP readiness topics, 80 (81.6%) named a decision-maker; 37 (40.2%) discussed end-of-life wishes with doctors. Participants preferred ED team conversations. Among the 51 participants who reported having signed paperwork regarding end-of-life wishes, only 7 (13.7%) had forms documented in the EHR.ConclusionsAmong older adults in a large Boston-based ED, ACP engagement was high, but few patients had documentation of end-of-life wishes available in the EHR. Findings highlight the need for better ACP documentation in EDs.","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"606-612"},"PeriodicalIF":1.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12377290/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050937","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}

引用次数: 0

Sex and Racial/Ethnic Differences in End-of-Life Care in Texan Medicare Colorectal Cancer Decedents. 性别和种族/民族差异在临终关怀的德州医疗大肠癌死者。

IF 1.4

The American journal of hospice & palliative care Pub Date : 2026-06-01 Epub Date: 2025-05-23 DOI: 10.1177/10499091251344948

Myrna Katalina Serna, Bethany Leach, Efstathia Polychronopoulou, Sean O'Mahoney, Mukaila Raji, Yong-Fang Kuo

{"title":"Sex and Racial/Ethnic Differences in End-of-Life Care in Texan Medicare Colorectal Cancer Decedents.","authors":"Myrna Katalina Serna, Bethany Leach, Efstathia Polychronopoulou, Sean O'Mahoney, Mukaila Raji, Yong-Fang Kuo","doi":"10.1177/10499091251344948","DOIUrl":"10.1177/10499091251344948","url":null,"abstract":"BackgroundThere are known sex and racial/ethnic differences in colorectal cancer care. The purpose of this study is to investigate these differences in end-of-life health care utilization, advance care planning, and associated outcomes among Texan Medicare colorectal cancer decedents.MethodsIn this retrospective case control study, we used the Texas Cancer Registry linked with Medicare data for patients (n = 5757) aged ≥66 years who died 6 months to 5 years after receiving a diagnosis of primary colorectal cancer from 2010-2018. We used chi-square tests, t-tests, or ANOVA as appropriate for outcomes in the last 30 days of life to assess sex and racial/ethnic differences. Multivariable logistic regression models were used to assess differences in the odds of inpatient admission and hospice enrollment.ResultsSignificantly more female decedents were hospice enrolled. Non-Hispanic Black decedents, and to a lesser extent Hispanic decedents, had greater health care utilization, including inpatient stays, and less hospice enrollment compared to non-Hispanic White decedents. Advance care planning was low (≤2.2%) across all groups, with no significant differences. Multivariable logistic regression models showed that female decedents had greater odds of hospice enrollment compared to male decedents, and non-Hispanic Black decedents had greater odds of inpatient stays and decreased odds of hospice enrollment compared to non-Hispanic White decedents.ConclusionSex and racial/ethnic disparities in care highlight opportunities for process and quality improvement and suggest a need for practice changes to improve access to quality end-of-life care. More work is needed to incorporate advance care planning and billing into regular workflows.","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"630-638"},"PeriodicalIF":1.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13053865/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136633","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}

引用次数: 0