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

Pediatric Oncology Hospice: A Comprehensive Review. 儿科肿瘤临终关怀：全面回顾。

The American journal of hospice & palliative care Pub Date : 2024-12-01 Epub Date: 2024-01-15 DOI: 10.1177/10499091241227609

Ali Tafazoli, Katharine Cronin-Wood

{"title":"Pediatric Oncology Hospice: A Comprehensive Review.","authors":"Ali Tafazoli, Katharine Cronin-Wood","doi":"10.1177/10499091241227609","DOIUrl":"10.1177/10499091241227609","url":null,"abstract":"Pediatric hospice is a new terminology in current medical literature. Implementation of pediatric hospice care in oncology setting is a vast but subspecialized field of research and practice. However, it is accompanied by substantial uncertainties, shortages and unexplored sections. The lack of globally established definitions, principles, and guidelines in this field has adversely impacted the quality of end-of-life experiences for children with hospice needs worldwide. To address this gap, we conducted a comprehensive review of scientific literature, extracting and compiling the available but sparse data on pediatric oncology hospice from the PubMed database. Our systematic approach led to development of a well-organized structure introducing the foundational elements, highlighting complications, and uncovering hidden gaps in this critical area. This structured framework comprises nine major categories including general ideology, population specifications, role of parents and family, psychosocial issues, financial complications, service locations, involved specialties, regulations, and quality improvement. This platform can serve as a valuable resource in establishing a scientifically reliable foundation for future experiments and practices in pediatric oncology hospice.","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11425979/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139473136","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

Compassionate Presence in Seriously Ill Cancer Patients. 对重症癌症患者给予同情。

The American journal of hospice & palliative care Pub Date : 2024-12-01 Epub Date: 2024-01-19 DOI: 10.1177/10499091241226629

M Renz, C Gloggner, D Bueche, U Renz

{"title":"Compassionate Presence in Seriously Ill Cancer Patients.","authors":"M Renz, C Gloggner, D Bueche, U Renz","doi":"10.1177/10499091241226629","DOIUrl":"10.1177/10499091241226629","url":null,"abstract":"Background: Compassion is a relational response to patients' suffering. Palliative care focuses not only on skills but also on compassion. Nevertheless, incorporated patient perspectives are largely missing from existing research. Aim: Our mixed-method exploratory study in a major Swiss cancer center sought to better understand compassionate presence, its benefits and challenges for patients and providers (ie, close relatives, close friends, and professionals-all referred to here as providers). It also investigated providers' motivation. Method: Twelve multidisciplinary, specially trained professionals interviewed 50 patients who had received compassionate presence. All patients had advanced cancer with risk of death. Providers were also interviewed. Data on the positive and burdensome effects of compassionate presence on patients and providers were gathered using a specific protocol. This also served to record patients' characteristics and providers' motivations to give compassion and whether providers felt sustained (eg, by nature). Results: The study suggests a high impact of compassionate presence with benefits on patients (50/50) and on providers (49/50). Enhanced connectedness was evident not only in the patient-provider relationship (38/50) but also, for instance, in an increased ability to love (8/50) or in an intensified solidarity (29/50). A considerable number of patients and providers experienced mental-spiritual change but also burdensome effects (eg, ambivalences). Providers showed a range of motivations. Conclusion: Compassion is not only necessary in existential crises and near death, but also happens and takes considerable effects precisely in such situations.","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139503312","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

Oncology and Palliative Care Integration Model: A Cost Analysis Study in a Brazilian Hospital Setting. 肿瘤学与姑息治疗整合模式：巴西一家医院的成本分析研究。

The American journal of hospice & palliative care Pub Date : 2024-12-01 Epub Date: 2024-02-20 DOI: 10.1177/10499091241232401

Tânia V V Guimarães, Alessandro G Campolina, Luciana M Rozman, Toshio Chiba, Patrícia C de Soárez, Maria D P Estevez Diz

{"title":"Oncology and Palliative Care Integration Model: A Cost Analysis Study in a Brazilian Hospital Setting.","authors":"Tânia V V Guimarães, Alessandro G Campolina, Luciana M Rozman, Toshio Chiba, Patrícia C de Soárez, Maria D P Estevez Diz","doi":"10.1177/10499091241232401","DOIUrl":"10.1177/10499091241232401","url":null,"abstract":"Background: In 2019, the São Paulo State Cancer Institute (ICESP) implemented a novel model integrating Oncology with Palliative Care specialists. We evaluated the impact of this model on healthcare resource utilization and costs. Methods: We analyzed data from all patients who passed away in February (1 month prior to implementation) and November (8 months after model implementation group) at ICESP, Brazil. Healthcare utilization data, including emergency department visits, hospital and intensive care unit admissions, chemotherapy, and radiotherapy use, were retrieved from Electronic Medical Records. Unit cost values were obtained from the administrative database. Results: A total of 198 patients who died in February and 196 in November were included in the analysis. Groups exhibited similarities in sex, age, ECOG, cancer type, previous outpatient palliative care consultations, and place of death (ward: 56.6% pre-intervention, 50% post-intervention). The mean cost per patient was US$13,226.29 pre-intervention and US$11,445.82 post-intervention (P = .007). Statistically significant differences were noted in days hospitalized in the surgical ward (227 vs 115), emergency department visits (233 vs 45), chemotherapy sessions (140 vs 26), and radiotherapy sessions (146 vs 10). Excluding outpatient treatments, the total costs for chemotherapy and radiotherapy in the last 30 days of life were US$16,924.45 pre-intervention and US$7851.65 post-intervention. Reductions were more pronounced in patients with ECOG 3-4 (P = .039). Conclusion: Our data suggests that the integration model was associated with a reduction in potentially inappropriate treatments during the last month of life, leading to decreased healthcare utilization and costs.","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139914375","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

Is This a Deceased Loved One That I See Before Me or Am I Only Dreaming? 我眼前看到的是已故亲人，还是我在做梦？

The American journal of hospice & palliative care Pub Date : 2024-12-01 Epub Date: 2024-03-06 DOI: 10.1177/10499091241237257

Stephen Claxton-Oldfield

引用次数: 0

Promising Impact of Telenovela Intervention for Caregivers of Hospice Patients: A Pilot Study. 对临终关怀病人的护理人员进行电视连续剧干预的预期效果：试点研究。

The American journal of hospice & palliative care Pub Date : 2024-12-01 Epub Date: 2024-02-06 DOI: 10.1177/10499091241228835

Dulce M Cruz-Oliver, Gabrielle E Milner, Kelsea Mensh, Marielle Bugayong, Marcela D Blinka, Nowella Durkin, Martha Abshire Saylor, Chakra Budhathoki, Debra Parker Oliver

{"title":"Promising Impact of Telenovela Intervention for Caregivers of Hospice Patients: A Pilot Study.","authors":"Dulce M Cruz-Oliver, Gabrielle E Milner, Kelsea Mensh, Marielle Bugayong, Marcela D Blinka, Nowella Durkin, Martha Abshire Saylor, Chakra Budhathoki, Debra Parker Oliver","doi":"10.1177/10499091241228835","DOIUrl":"10.1177/10499091241228835","url":null,"abstract":"Background: Hospice family caregivers (HFCGs) support the needs of their loved ones but are at risk of developing distress and anxiety. NOVELA is a four-chapter telenovela-style educational video to support topics related to hospice caregiving. Telehealth visits are scheduled in 4 weekly sessions consisting of a chapter and subsequent discussion with an interventionist. This feasibility pilot study tested NOVELA's effect to change HFCGs' outcomes, session and outcome measure completion (defined a priori as >70%).Methods: This is a single-group pretest-posttest study of HFCGs of care recipients with PPS score >20% from 3 hospices in the U.S. Mid-Atlantic region. At baseline and at final posttest, participants completed a web-based survey assessing 3 outcomes: anxiety, self-efficacy, and satisfaction with intervention. Descriptive, t-test, and chi-square statistics were computed.Results: Participants in our study (N = 59) were mainly collage educated, White, female, adult children of home-bound people with a non-cancer diagnosis. Outcomes changed in the expected direction (P > .05) with higher self-efficacy (Cohen's d = -.08 [95% CI -.4 to .2) and lower anxiety (Cohen's d = .2 [95% CI -.1 to .5]) scores from final to baseline, 86% of HFCGs were satisfied or very satisfied with NOVELA, session (33/59) and outcome measure (43/59) completion averaged 68%.Conclusion: Encouraging trends in NOVELA's estimation of effect suggests that NOVELA may buffer stressful aspects of hospice caregiving. However, further refinement of NOVELA is needed. Supporting HFCGs through supportive educational interventions may reduce distress and anxiety with broad implications for quality improvement.","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139699199","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

Towards a Clinically Relevant Appreciation of the Cost of Caring: A Study of Palliative Care Physicians in Malaysia. 实现对护理成本的临床相关认识：马来西亚姑息关怀医生研究》。

The American journal of hospice & palliative care Pub Date : 2024-11-07 DOI: 10.1177/10499091241298281

Yun Ting Ong, Annushkha Sinnathamby, Jun Hao Tan, Nila Ravindran, Shu Xian Lim, Aaron Wi Han Hiew, Sing Yee Ng, Simon Yew Kuang Ong, Lalit Kumar Radha Krishna

{"title":"Towards a Clinically Relevant Appreciation of the Cost of Caring: A Study of Palliative Care Physicians in Malaysia.","authors":"Yun Ting Ong, Annushkha Sinnathamby, Jun Hao Tan, Nila Ravindran, Shu Xian Lim, Aaron Wi Han Hiew, Sing Yee Ng, Simon Yew Kuang Ong, Lalit Kumar Radha Krishna","doi":"10.1177/10499091241298281","DOIUrl":"https://doi.org/10.1177/10499091241298281","url":null,"abstract":"Background: The cost of caring for patients and their families in the midst of interconnected resource, ethical, moral, legal and practical considerations compromises a physician's emotional and physical well-being and therefore patient care. Whilst the cost of caring is historically best associated with compassion fatigue, data has suggested that this may extend to other related concepts, such as vicarious trauma, secondary traumatic stress and burnout. In particular, palliative care physicians are especially vulnerable as they witness and encounter more cases of death and dying. Methods: This study aims to provide a more clinically relevant notion of the cost of caring amongst palliative care physicians in Malaysia. 11 physicians underwent semi-structured interviews as part of the Systematic Evidence-Based Approach (SEBA) for prospective studies. Results: Analysis of the interview transcripts revealed the following domains: (1) conceiving the costs of caring; (2) risk factors; and (3) support mechanisms. Conclusion: This SEBA-guided study into the cost of caring amongst Malaysian palliative care physicians suggests that the costs of caring extend beyond encapsulating moral distress, compassion fatigue, vicarious trauma, secondary traumatic stress and burnout. Rather, the data suggests a personalized notion that varies with individual and contextual factors which are in flux and change over time. A longitudinal, personalized and holistic mentoring program is therefore proposed to counter this cost.","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592349","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

Facilitated Advance Care Planning Interventions: A Narrative Review. 促进预先护理规划干预：叙述性综述。

The American journal of hospice & palliative care Pub Date : 2024-11-03 DOI: 10.1177/10499091241298677

Akhila Penumarthy, Seth N Zupanc, Michael K Paasche-Orlow, Angelo Volandes, Joshua R Lakin

{"title":"Facilitated Advance Care Planning Interventions: A Narrative Review.","authors":"Akhila Penumarthy, Seth N Zupanc, Michael K Paasche-Orlow, Angelo Volandes, Joshua R Lakin","doi":"10.1177/10499091241298677","DOIUrl":"https://doi.org/10.1177/10499091241298677","url":null,"abstract":"Introduction: Multiple interventions have been designed to employ facilitators to address gaps in Advance Care Planning (ACP). Objective: To collect and review available evidence related to facilitated ACP interventions. Methods/Design: Narrative review using a previously described framework for scoping reviews. We searched PubMed using structured criteria and report synthesized themes detailing the design, target populations, methods, and outcome measurements for interventions in which a facilitator-who may or may not be clinical staff-engaged a patient and/or a patient's caregiver in some part of the ACP process. Results: Of 1492 articles discovered on our search, 28 met the inclusion criteria. Twelve (42.9%) studies utilized a nurse facilitator, two (7.1%) utilized trained social workers, and one (3.6%) embedded multiple facilitators. The remaining 13 (46.4%) utilized facilitators from other various professional and community backgrounds, such as lay navigators, care coordinators, and peer mentors. Twenty-five (89.2%) studies included patients with serious or chronic illness, at the end-of-life, or having a high risk of need for medical care. Four (14.3%) articles focused on marginalized populations. Intervention settings varied notably across studies. Eighteen (64.3%) integrated interventions into existing clinical workflows. Primary outcomes were measured in one of three ways: documentation in the Electronic Health Record (EHR) (25.0%); questionnaires, scales, patient reports, or non-EHR documentation (64.3%); or multiple measures (10.7%). Twenty-three (82.1%) of the studies were determined a success by study authors. Conclusion: We identified a variety of key characteristics that can be modified to target facilitated ACP interventions towards gaps in current applications of ACP.","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570847","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

Exploring the Role of Genetic Testing in Decisions to Redirect Care in Critically Ill Infants. 探索基因检测在重症婴儿重新护理决策中的作用。

The American journal of hospice & palliative care Pub Date : 2024-11-02 DOI: 10.1177/10499091241296544

Ashley Mowery, Bob Wong, Jamie Seale, Luca Brunelli

{"title":"Exploring the Role of Genetic Testing in Decisions to Redirect Care in Critically Ill Infants.","authors":"Ashley Mowery, Bob Wong, Jamie Seale, Luca Brunelli","doi":"10.1177/10499091241296544","DOIUrl":"https://doi.org/10.1177/10499091241296544","url":null,"abstract":"Objective: Genetic disorders are a major determinant of morbidity and mortality within neonatal intensive care units (NICUs). Studies have found genetic testing in critically ill infants may lead to changes in clinical decisions such as pursuing end of life care. This study surveyed palliative care providers to explore the influence of genetic testing on decisions to redirect care in critically ill infants.Methods: This study was conducted retrospectively on cases who were admitted to the Level IV NICU at Primary Children's Hospital, underwent redirection to end of life care, and whose death date was between 2019-2023. A review of the case's electronic medical record was performed to construct a clinical case summary. The clinical summary and questionnaire were sent to the case's palliative care provider.Results: Fifty-six cases were included in this study and 73% had genetic testing completed. Our results suggest the information from genetic testing played a relatively minor role in the decision to redirect care for cases with negative or uncertain genetic testing and positive genetic testing results, although the influence appeared higher in the latter group.Conclusion: Our results suggest the assumptions of several studies that genetic testing is responsible for changes in clinical management and cost savings, especially in cases of redirection of care may have been overestimated. Our results fill a critical gap in current literature and demonstrate the need for further investigation to clarify the direct role of genetic testing in clinical decisions in the NICU, especially related to redirection of care.","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142565162","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 in Patients with Suspected or Proven COVID: Are We Meeting Our Own Standards? 对疑似或确诊的COVID患者进行预先护理规划:我们是否达到了自己的标准?

The American journal of hospice & palliative care Pub Date : 2024-11-01 Epub Date: 2023-11-30 DOI: 10.1177/10499091231218476

Oyungerel Byambasuren, Jananee Myooran, Aishah Virk, Rida Hanna, Onur Tanglay, Sarah Younan, Nikk Moore, Paul Middleton, Danielle Ní Chróinín

{"title":"Advance Care Planning in Patients with Suspected or Proven COVID: Are We Meeting Our Own Standards?","authors":"Oyungerel Byambasuren, Jananee Myooran, Aishah Virk, Rida Hanna, Onur Tanglay, Sarah Younan, Nikk Moore, Paul Middleton, Danielle Ní Chróinín","doi":"10.1177/10499091231218476","DOIUrl":"10.1177/10499091231218476","url":null,"abstract":"Objective: Given the importance of advance care planning (ACP) in the context of a pandemic, we aimed to assess current adherence to local policy recommending ACP in all hospitalised adult patients with suspected or proven COVID-19 at Liverpool Hospital, Sydney, Australia.Design: A retrospective cohort study.Setting: A tertiary referral and teaching hospital.Participants: A select sample of adult patients admitted to Liverpool Hospital in 2019-2021 with suspected or proven COVID-19.Main outcome measures: Proportion of patients with documented ACP and format of ACP.Results: Amongst 209 patients with proven or suspected COVID-19 hospitalised between March 2019 through to September 2021, median frailty score was 3, the median Charlson Comorbidity Score was 4, median age of the patients was 71 years, and median length of hospital stay was 5 days (range 0-98 days). Almost all patients were tested for COVID-19 (n = 207, 99%) of which 15% (31) were positive. Fewer than a quarter of the patients had documented ACPs (50, 24%) and 17 patients had existing formal advance care directives. Patients who had ACP were older, more likely to be frail and more likely to have higher rates of comorbidity compared to those without ACP. ACP was more commonly discussed with family members (41/50) than patients (25/50) and others (5/50).Conclusion: Adherence to the local ACP policy mandating such discussions was low. This reinforces the need for prioritising ACP discussions, especially for unwell patients such as those with COVID, likely involving further input to improve awareness and rates of formal documentation.","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138465295","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

"Postponing it Any Later Would not be so Great": A Cognitive Interview Study of How Physicians Decide to Initiate Goals of Care Discussions in the Hospital. "再拖下去就没那么好了"：关于医生如何决定在医院内启动护理目标讨论的认知访谈研究》（Cognitive Interview Study of How Physicians Decide to Initiate Goals of Care Discussions in the Hospital）。

The American journal of hospice & palliative care Pub Date : 2024-11-01 Epub Date: 2023-12-18 DOI: 10.1177/10499091231222926

Elizabeth Chuang, Sabrina Gugliuzza, Ammar Ahmad, Michael Aboodi, Michelle Ng Gong, Amber E Barnato

{"title":"\"Postponing it Any Later Would not be so Great\": A Cognitive Interview Study of How Physicians Decide to Initiate Goals of Care Discussions in the Hospital.","authors":"Elizabeth Chuang, Sabrina Gugliuzza, Ammar Ahmad, Michael Aboodi, Michelle Ng Gong, Amber E Barnato","doi":"10.1177/10499091231222926","DOIUrl":"10.1177/10499091231222926","url":null,"abstract":"Background: There are missed opportunities to discuss goals and preferences for care with seriously ill patients in the acute care setting. It is unknown which factors most influence clinician decision-making about communication at the point of care.Objective: This study utilized a cognitive-interviewing technique to better understand what leads clinicians to decide to have a goals of care (GOC) discussion in the acute care setting.Methods: A convenience sample of 15 oncologists, intensivists and hospitalists were recruited from a single academic medical center in a large urban area. Participants completed a cognitive interview describing their thought process when deciding whether to engage in GOC discussions in clinical vignettes.Results: 6 interconnected factors emerged as important in determining how likely the physician was to consider engaging in GOC at that time; (1) the participants' mental model of GOC, (2) timing of GOC related to stability, acuity and reversibility of the patient's condition, (3) clinical factors such as uncertainty, prognosis and recency of diagnosis, (4) patient factors including age and emotional state, (5) participants' role on the care team, and (6) clinician factors such as emotion and communication skill level.Conclusion: Participants were hesitant to commit to the present moment as the right time for GOC discussions based on variations in clinical presentation. Clinical decision support systems that include more targeted information about risk of clinical deterioration and likelihood of reversal of the acute condition may prompt physicians to discuss GOC, but more support for managing discomfort with uncertainty is also needed.","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11182887/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138812115","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