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

A Retrospective Review: Early Versus Late Palliative Care for People With End Stage Liver Disease. 一项回顾性研究：晚期肝病患者的早期与晚期姑息治疗

IF 1.4

The American journal of hospice & palliative care Pub Date : 2026-12-01 Epub Date: 2025-11-11 DOI: 10.1177/10499091251398030

Alexandria Hoy, Vinod Jeyaretnam, Carla Erb, Andrew Clermont, Nathan Haverstick

{"title":"A Retrospective Review: Early Versus Late Palliative Care for People With End Stage Liver Disease.","authors":"Alexandria Hoy, Vinod Jeyaretnam, Carla Erb, Andrew Clermont, Nathan Haverstick","doi":"10.1177/10499091251398030","DOIUrl":"10.1177/10499091251398030","url":null,"abstract":"BackgroundAlthough early palliative care (PC) has been shown to have numerous benefits for critically ill patients, including those with chronic organ failure, its use remains underutilized in patients with decompensated cirrhosis or end-stage liver disease. In this study, we examine the timing of consultations and their correlation to patient outcomes.ObjectivesEvaluate the association between timing of early vs late inpatient PC consults (within or after 72 h since admission) for patients with decompensated cirrhosis on the days from consult to discharge (DCD), length of stay (LOS), and inpatient deaths. Demographics were obtained from the electronic medical records.MethodsThis retrospective cohort study examined 256 inpatient PC encounters admitted with a diagnosis of end-stage liver disease. Patient information was collected from four hospitals in the U.S. from 1/25/2020 to 8/1/2024. Data was analyzed using descriptive statistics, chi-square test, and t-test.ResultsOf the 256 encounters, 142 (55.5%) were in the early cohort. These patients had a significantly lower DCD when compared to the late cohort (P = 0.0045), as well as a significant reduction in LOS (P = 2.09xe-28). Early cohorts had fewer inpatient deaths (28%) compared to late consults (43%). Although not statistically significant, discharges to hospice and home were more likely to have early PC consult compared to late.ConclusionsEarly PC intervention was associated with significantly improved primary and secondary outcomes including DCD, LOS, and inpatient deaths. Further research is needed to focus PC efforts on this high-risk, underserved population.","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"1322-1328"},"PeriodicalIF":1.4,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145491290","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 Social Worker and Nurse Perceptions of the Usability of a Hospice Live Discharge Protocol (LDP). 安宁疗护社工与护士对安宁疗护出院协议可用性的看法。

IF 1.4

The American journal of hospice & palliative care Pub Date : 2026-12-01 Epub Date: 2025-09-23 DOI: 10.1177/10499091251383107

Stephanie P Wladkowski, Susan Enguídanos, Tracy A Schroepfer

{"title":"Hospice Social Worker and Nurse Perceptions of the Usability of a Hospice Live Discharge Protocol (LDP).","authors":"Stephanie P Wladkowski, Susan Enguídanos, Tracy A Schroepfer","doi":"10.1177/10499091251383107","DOIUrl":"10.1177/10499091251383107","url":null,"abstract":"BackgroundLive discharges from hospice are often distressing for patients, caregivers, and hospice providers alike, disrupting care continuity and leading to emotional and logistical challenges. Despite Medicare's discharge planning requirement, no standardized process currently exists for hospice-initiated discharges, resulting in variable quality of care transitions. In response, a Live Discharge Protocol (LDP) was developed; however, the usability of this protocol in practice has not been evaluated.MethodsPurposive, convenience sampling occurred over 1 month. Participants were hospice social workers (n = 10), and hospice nurses (n = 10) recruited through professional networks and social media. Open-ended survey questions were used, and data was analyzed using conventional content analysis.ResultsAcross all four steps of the LDP, no concerns with the clarity of language, instructions, and flow of the LDP were reported; however, challenges in implementation were noted across steps. Specifically, collaboration with team members and having clear roles, managing the logistics of discharge, supporting the patient/caregiver reactions to the discharge, and incorporating a new practice into existing work structure.ConclusionsAn explicit Live Discharge Protocol has strong potential to enhance the quality and consistency of a live discharge from hospice care. The LDP provides a framework to help smooth the transition from hospice care and provides patients and families with post-discharge support. Feedback from hospice professionals affirmed the relevance and usability of each step within the LDP, while also identifying opportunities for refinement for future implementation.","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"1290-1296"},"PeriodicalIF":1.4,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126949","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

Evaluation and Treatment of Malignant Neuropathic Pain. 恶性神经性疼痛的评价与治疗。

IF 1.4

The American journal of hospice & palliative care Pub Date : 2026-12-01 Epub Date: 2025-10-17 DOI: 10.1177/10499091251391188

Lillian Boehmer, Belal Dakroub, Glenn Pebanco

{"title":"Evaluation and Treatment of Malignant Neuropathic Pain.","authors":"Lillian Boehmer, Belal Dakroub, Glenn Pebanco","doi":"10.1177/10499091251391188","DOIUrl":"10.1177/10499091251391188","url":null,"abstract":"BackgroundCancer-related neuropathic pain (CRNP) is difficult to identify, assess, and treat, often requiring higher analgesic needs and resulting in poorer outcomes.ObjectivesTo evaluate the effectiveness of guideline-directed therapy for CRNP in veterans treated at the West Palm Beach VA Healthcare System (WPB VAHCS) Hematology/Oncology Center and managed as outpatients by a pain and palliative care clinical pharmacy practitioner (CPP).MethodsThis quality assurance retrospective chart review included patients treated for CRNP with \"Tier 1\" medications (SNRIs, TCAs, or antiepileptics) and/or mixed-mechanism opioids (eg, buprenorphine, tramadol). Primary outcomes were changes in pain and PEG (Pain, Enjoyment, and General Activity) scores. Secondary outcomes included morphine equivalent daily dose (MEDD), emergency department (ED) visits, and medication trends. Data were collected from July 1, 2022, to June 30, 2024.ResultsAmong 144 patients screened, 119 were included. The average age was 70.9 years, and 93.3% were male. Following CPP intervention, pain scores improved from 4.90 to 3.61 (P < 0.001), and PEG scores improved from 6.34 to 4.53 (P < 0.001). Buprenorphine use increased at follow-up while gabapentin use declined. ED visits decreased by 21%, and cost per fill rose 63.5%.ConclusionsCPP-guided use of guideline-directed therapies significantly improved pain intensity and function in veterans with CRNP. Buprenorphine may reduce medication burden in geriatric patients with multimodal pain, reinforcing its value in structured palliative care models.","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"1337-1345"},"PeriodicalIF":1.4,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145314358","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

Perspectives of Hospice Medical Directors on Challenges and Solutions for Improving Care for Persons Living With Dementias (PLWD) and Their Caregivers. 安宁疗护医疗总监对改善失智症患者及其照护者照护的挑战与解决方案的看法。

IF 1.4

The American journal of hospice & palliative care Pub Date : 2026-11-01 Epub Date: 2025-08-20 DOI: 10.1177/10499091251369112

Taeyoung Park, Abhay Tiwari, Elizabeth Luth, Yongkang Zhang, Simone Prather, Micah Toliver, Giancarlo Chuquitarco, Veerawat Phongtankuel

{"title":"Perspectives of Hospice Medical Directors on Challenges and Solutions for Improving Care for Persons Living With Dementias (PLWD) and Their Caregivers.","authors":"Taeyoung Park, Abhay Tiwari, Elizabeth Luth, Yongkang Zhang, Simone Prather, Micah Toliver, Giancarlo Chuquitarco, Veerawat Phongtankuel","doi":"10.1177/10499091251369112","DOIUrl":"10.1177/10499091251369112","url":null,"abstract":"BackgroundPersons living with dementia (PLWD) on hospice care face unique end-of-life (EoL) care challenges. A larger proportion of PLWD outlive the 6-month hospice eligibility requirement compared to other terminally ill patients, which leads to high rates of hospice live discharge. Hospice medical directors (HMDs) are physicians with unique insights into both the clinical aspects of care and the administrative and regulatory guidelines of hospice care delivery. Given their role as frontline clinicians and systems-level leaders, HMDs are uniquely positioned to provide insights into the challenges of caring for PLWD and identify potential solutions to improve hospice care.ObjectiveTo characterize the perspectives of HMDs regarding (1) the challenges of providing hospice care to PLWD and their caregivers and (2) suggestions to improve hospice care for this population.MethodsSemi-structured interviews with certified HMDs (N = 17) were conducted. Data were analyzed using thematic analysis.ResultsHMDs expressed concern about (1) caregiver burnout, (2) caregiver-initiated live discharge, and (3) hospice-initiated live discharge in PLWD and their caregivers. To address these challenges, HMDs suggested (1) establishing a dementia-specific hospice program, (2) extending hospice benefit availability for PLWD, and (3) creating a step-down service for families experiencing live discharge from hospice.ConclusionHMD participants suggested providing additional supports and/or reforming the current Medicare hospice benefits to better address end-of-life care for PLWD, who may require prolonged and intensive end-of-life support. Further research is needed to assess the feasibility of the improvements to hospice care proposed by HMDs.","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"1203-1211"},"PeriodicalIF":1.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144884710","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

Intimate Partner Violence: A Mixed Methods Case Series that Focuses on a Subgroup of Minority Patients With Cancer. 亲密伴侣暴力：一个混合方法的案例系列，重点关注少数群体癌症患者。

IF 1.4

The American journal of hospice & palliative care Pub Date : 2026-11-01 Epub Date: 2025-09-26 DOI: 10.1177/10499091251381773

Sanjna Rajput, Aminah Jatoi, Elizabeth J Cathcart-Rake

{"title":"Intimate Partner Violence: A Mixed Methods Case Series that Focuses on a Subgroup of Minority Patients With Cancer.","authors":"Sanjna Rajput, Aminah Jatoi, Elizabeth J Cathcart-Rake","doi":"10.1177/10499091251381773","DOIUrl":"10.1177/10499091251381773","url":null,"abstract":"BackgroundSexual and gender diverse (SGD) individuals comprise nearly 10% of the United States' population but remain underrepresented in cancer research, particularly in intimate partner violence (IPV) studies. Although IPV rates are comparable or higher in SGD individuals than in non-SGD individuals, the literature on IPV in SGD patients with cancer remains sparse.MethodsThis qualitative study was conducted within a Mayo Clinic IRB-approved parent database on SGD patients with cancer. Eligible patients were adults who self-identified as non-heterosexual or non-cisgender, had an invasive cancer diagnosis, and reported IPV via a four-question screening tool. A detailed medical review was performed to extract qualitative data related to IPV and other violence. Two investigators employed thematic analyses to understand these qualitative data.ResultsAmong 258 SGD patients whose medical records were screened, 13 (5%) reported IPV. Six key themes emerged: (1) IPV co-occurred with other violence (childhood, workplace, sexual violence); (2) IPV was associated with mental health conditions (depression, PTSD, suicidality); (3) Unhealthy coping mechanisms (substance use, risky behaviors) were common; (4) Social isolation and lack of support exacerbated challenges; (5) Internalized stigma influenced self-perception, relationships, healthcare experiences; (6) Chronic stress from cumulative trauma negatively impacted cancer care.ConclusionIPV was reported by a small proportion of SGD cancer patients, and cause and effect associations been IPV and the above themes have not been demonstrated. These findings suggest a need for trauma-informed, culturally competent interventions to address IPV and its broader psychosocial effects in these underserved populations.","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"1212-1218"},"PeriodicalIF":1.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145180772","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

Optimizing Palliative Cancer Surgery Trial Completion: Lessons Learned From Qualitative Content Analysis of S1316 - Comparative Effectiveness Trial for Malignant Bowel Obstruction. 优化姑息性癌症手术试验完成：从S1316的定性内容分析中吸取的教训-恶性肠梗阻的比较疗效试验。

IF 1.4

The American journal of hospice & palliative care Pub Date : 2026-11-01 Epub Date: 2025-10-29 DOI: 10.1177/10499091251391420

Mohammad Saad Farooq, Neda Amini, Virginia Sun, Gary B Deutsch, Jeremiah L Deneve, Marcia Grant, Kathryn B Arnold, Angeles Alvarez Secord, Garnet Anderson, Robert S Krouse

{"title":"Optimizing Palliative Cancer Surgery Trial Completion: Lessons Learned From Qualitative Content Analysis of S1316 - Comparative Effectiveness Trial for Malignant Bowel Obstruction.","authors":"Mohammad Saad Farooq, Neda Amini, Virginia Sun, Gary B Deutsch, Jeremiah L Deneve, Marcia Grant, Kathryn B Arnold, Angeles Alvarez Secord, Garnet Anderson, Robert S Krouse","doi":"10.1177/10499091251391420","DOIUrl":"10.1177/10499091251391420","url":null,"abstract":"BackgroundMalignant bowel obstruction (MBO) is a complex clinical entity and there remains a relative lack of high-quality comparative trials on surgical management, in part due to a heterogeneous patient population and different treatment modalities which contribute to challenges in trial design and completion. SWOG S1316 is the only prospective randomized trial evaluating surgical vs non-surgical management of MBO and involved a trial framework in which patients were recruited for a randomization pathway as well as a patient choice pathway. Importantly, successful completion of S1316 required numerous amendment modifications to the trial during its course. We aimed to highlight aspects of S1316 trial design, execution, and modification that potentially contributed to trial completion.MethodsIterative qualitative content analysis of trial modification amendments through the course of the trial from 2015 to 2020.Results133 unique amendments were made to S1316 from 2015 to 2020. We found four dominant domains for the amendments: Accrual Barriers, Study Design Changes, Data Collection Issues, and Clarifications. Accrual amendments were essential to completing the trial and included increasing participating sites from six to 30 (including international sites) and the inclusion of Spanish-speaking participants (11% of final study population).ConclusionsContent analysis of S1316 trial amendments highlighted that Accrual amendments were important in trial completion. Future investigators may benefit from better anticipating trial modifications as they design their studies. It is likely that rapid initiation of trial amendments can lead to improved accrual and study completion.","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"1238-1243"},"PeriodicalIF":1.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13598305/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145396078","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

Cardiac Medications Continuation Versus Discontinuation at End-of-Life: A Retrospective Analysis of Clinical Outcomes. 心脏药物在生命末期继续与停止：临床结果的回顾性分析。

IF 1.4

The American journal of hospice & palliative care Pub Date : 2026-11-01 Epub Date: 2025-08-23 DOI: 10.1177/10499091251369010

Steven Saunders, Jessica Chin, Vidhi Patel, Monica Pelaez Benjumea, Christopher J Magalee, Sima Parikh, Santiago Lopez

{"title":"Cardiac Medications Continuation Versus Discontinuation at End-of-Life: A Retrospective Analysis of Clinical Outcomes.","authors":"Steven Saunders, Jessica Chin, Vidhi Patel, Monica Pelaez Benjumea, Christopher J Magalee, Sima Parikh, Santiago Lopez","doi":"10.1177/10499091251369010","DOIUrl":"10.1177/10499091251369010","url":null,"abstract":"BackgroundInformation regarding cardiac medication management for patients with Heart Failure, Atrial Fibrillation, and Coronary Artery Disease at end of life (EOL) is limited. This study evaluated symptoms and medication utilization patterns at EOL.MethodsRetrospective review of cardiac patients admitted to a palliative care unit (PCU) at a quaternary center in New York. Demographics, length of stay, LACE score, utilization of cardiac and symptom medications, and oral morphine equivalents (OME) were collected. Respiratory Distress Observations Scale (RDOS) and pain assessment in advanced dementia (PAINAD) evaluated symptoms.ResultsAmong 176 patients (median age 82.0 years [IQR 75.0-89.0], 50% males, 69.9% white), 53.4% discontinued cardiac medications prior to or on PCU admission, 24.4% during PCU stay, 7.4% showed mixed patterns, and 14.8% continued medications. Multivariate analysis revealed significant interactions between heart failure status and discontinuation patterns (β = 0.224, p = 0.012). Patients discontinuing medications during PCU showed higher rates of severe pain (PAINAD ≥6: 37.2% vs 3.8% in continuation group, RR = 9.79, 95% CI: 2.47-38.82). Both early discontinuation and during-PCU discontinuation groups demonstrated significantly larger increases in opioid doses (median increases 28 mg and 36.6 mg respectively vs 14 mg and 11 mg in continuation groups, p < 0.001), a pattern most pronounced in heart failure patients, with the model explaining 46.3% of variance in final opioid requirements.ConclusionWhile most cardiac medications were discontinued before PCU, discontinuation was associated with higher opioid requirements and pain scores, particularly in heart failure patients. These findings challenge current practices and highlight the need for evidence-based protocols for cardiac medication management at EOL.","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"1144-1153"},"PeriodicalIF":1.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144984616","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

Survival Variations Based on Hospice Qualifying Condition: A Retrospective Review. 基于安宁疗护资格条件之生存变异：回顾回顾。

IF 1.4

The American journal of hospice & palliative care Pub Date : 2026-11-01 Epub Date: 2025-08-26 DOI: 10.1177/10499091251374172

Patrick D Crowley, Leslie R Siegel, Francis X Whalen

{"title":"Survival Variations Based on Hospice Qualifying Condition: A Retrospective Review.","authors":"Patrick D Crowley, Leslie R Siegel, Francis X Whalen","doi":"10.1177/10499091251374172","DOIUrl":"10.1177/10499091251374172","url":null,"abstract":"BackgroundPatients are enrolled into hospice for a variety of conditions. There are few recent data on the differences of survival duration after hospice enrollment, particularly regarding age, sex, and reason for hospice admission.MethodsUsing previously obtained data, we calculated age at enrollment, reported sex, and classified patients into nine classes of hospice-qualifying conditions (HQC). We then applied Wilcoxon rank-sum analysis comparing median survival and the percent of patients surviving at least 6 months.Findings53.38% of patients were female. The median age was 83.03 years. The median survival duration overall was 17.36 days (Inter-quartile range 5.35-62.08). Median survival was lowest for \"Infectious\" HQC (4.69d) and highest for \"Other\" (28.53d). Women survived longer than men (19.34 vs 15.37 days). Those older than median survived longer (20.51 days vs 15.03). Overall, 9.47% of enrollees survived at least 6 months. This was more common for women (10.99%), those older than 83 (12.44%), and those enrolled for dementia (16.46%).DiscussionRelevant information of what can be expected after hospice enrollment is crucial for families and patients. These differences also indicate potential bias in assessment of hospice applicability, enrolling women, older patients, and patients with specific diagnoses earlier in their disease course.","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"1154-1158"},"PeriodicalIF":1.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144984433","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

Transitioning From Curative to Palliative Care Goals in Pediatrics: Common Pitfalls and Clinical Pearls. 从治疗到姑息治疗目标在儿科的过渡：常见的陷阱和临床珍珠。

IF 1.4

The American journal of hospice & palliative care Pub Date : 2026-11-01 Epub Date: 2025-10-17 DOI: 10.1177/10499091251380675

Kim Sadler, Saadiya Khan, Amrita Sarpal, Khaled Alghamdi, Qutaibah Alotaibi, Spandana Rayala, Wejdan Alghamdi

{"title":"Transitioning From Curative to Palliative Care Goals in Pediatrics: Common Pitfalls and Clinical Pearls.","authors":"Kim Sadler, Saadiya Khan, Amrita Sarpal, Khaled Alghamdi, Qutaibah Alotaibi, Spandana Rayala, Wejdan Alghamdi","doi":"10.1177/10499091251380675","DOIUrl":"10.1177/10499091251380675","url":null,"abstract":"If recent medical advances have positively impacted children's lives, access to this new knowledge and technology raises ethical questions. Medical progress has also contributed to prolonging suffering in those afflicted with life-limiting conditions. Despite the growing tension between the need to discuss end-of-life issues, particularly advanced directives, and the widespread discomfort in engaging in such discussions, the question of death remains frequently evaded. The transition from curative to palliative goals is fraught with misunderstandings and moral distress. This transition of care is complex, and there is limited knowledge about the best approach to proceed. However, when not done effectively, the process carries risks of trauma for patients, families, and healthcare providers. In this article, common pitfalls during the care transition from curative to palliative goals are identified and deconstructed in light of the most recent evidence-based references in the field, along with the input of pediatric palliative care experts, to guide healthcare providers in addressing these challenges. Effective communication models exist and should be taught and utilized. Understanding how children perceive illness and death can guide the delicate task of including them in care planning. Shifting the goals of care from curative to palliative is not giving up on hope. It is about establishing a shared-decision approach to goal-concordant care that considers the non-curative nature of the illness and ensures that children receive compassionate and personalized care. Lastly, healthcare providers must engage in self-monitoring to remain present while delivering care in such a unique and emotionally challenging context.","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"1219-1229"},"PeriodicalIF":1.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145314389","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

Examining Compassion Satisfaction and Work-Related Stress Within a Hospice for the Homeless (H4H) Organization: Results From a Multi-Method Survey. 无家可归者安宁疗护（H4H）组织内的同情心满意度与工作压力之研究：多方法调查之结果。

IF 1.4

The American journal of hospice & palliative care Pub Date : 2026-11-01 Epub Date: 2025-10-09 DOI: 10.1177/10499091251383051

Celina Carter, Mary Anne Olalia, Justine Giosa

{"title":"Examining Compassion Satisfaction and Work-Related Stress Within a Hospice for the Homeless (H4H) Organization: Results From a Multi-Method Survey.","authors":"Celina Carter, Mary Anne Olalia, Justine Giosa","doi":"10.1177/10499091251383051","DOIUrl":"10.1177/10499091251383051","url":null,"abstract":"PurposeCommunities in Canada have created targeted hospice palliative care strategies such as facility-based hospices for the homeless (H4H) to promote equitable access to care. To ensure the sustainability of H4H programs, there is a need to prevent and mitigate burnout and enhance workplace wellbeing. The objectives for this study were to, (1) develop a better understanding of H4H staff and volunteers' experiences of stress and wellbeing; and (2) explore opportunities for additional resources to support workplace wellbeing.MethodsWe developed and administered an anonymous 26-item survey to 104 providers including both staff (eg, nurses, administrators) and volunteers at a facility-based H4H in Ontario. The survey gathered open and closed-ended data on sociodemographic information, compassion satisfaction, and H4H stories of workplace experiences.FindingsThe response rate was 56% (n = 58). Most respondents had high compassion satisfaction. However, multiple factors causing stress at work across the socio-ecological model were discussed. Requests for additional resources to foster workplace wellbeing included educational, process-related, spiritual/psychological, and social supports. Respondents storied that positive workplace wellbeing includes being able to provide quality care, and having supportive relationships, personal fulfillment, and a respectful culture within the workplace.ConclusionProvider participants were satisfied with their ability to be effective carers, yet chronic multi-level work-related stressors can erode a sense of meaning in H4H work. A multi-faceted evidence-based approach to supporting workplace wellbeing is needed in H4H settings. Research has shown that mindfulness could be an effective strategy, as it can decrease burnout and promote coping, team connection, and anti-oppressive care.","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"1193-1202"},"PeriodicalIF":1.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13598312/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145254371","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