The American journal of hospice & palliative care最新文献

{"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":"10.1177/10499091241312685","url":null,"abstract":"<p><p>IntroductionVirtual 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?.ObjectiveThrough qualitative inquiry, we aim to explore and understand user preferences for VR distraction therapies to mitigate cancer-related pain.MethodsWe 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.ResultsParticipants 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.ConclusionPatients 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":"1181-1186"},"PeriodicalIF":1.4,"publicationDate":"2025-11-01","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":"Making Community-Based Palliative Care Eligibility Determinations: Palliative Care Team Member Perspectives on Access to Information and Algorithm Use.","authors":"Kira G Sheldon, Kathryn H Bowles, Carolyn Sage, June Stanley, Elizabeth A Luth","doi":"10.1177/10499091241302044","DOIUrl":"10.1177/10499091241302044","url":null,"abstract":"<p><strong>Background: </strong>Seriously ill older adults have high risk of mortality, symptom burden, and compromised functional status, and may benefit from community-based palliative care (\"palliative care\"). However, identifying potentially eligible individuals is challenging.</p><p><strong>Objectives: </strong>Identify how a palliative care team makes eligibility determinations, including the use of a mortality risk algorithm.</p><p><strong>Design: </strong>Semi-structured focus groups were conducted with palliative care providers to understand how health information is used to assess Medicare Advantage plan patients' eligibility for palliative care. Transcripts were analyzed to identify categories related to how participants used health information in making eligibility determinations.</p><p><strong>Setting/participants: </strong>All outreach and care management team members and nurse practitioners (n = 7) working for a palliative care program at a not-for-profit health care agency.</p><p><strong>Results: </strong>The palliative care team used information on symptoms, diagnoses, and acute care utilization when making eligibility determinations. The algorithm generated lists of potentially eligible patients but was deemed not useful because it provided limited information about current health status and was not well integrated into existing health record systems. Participants would like information to be current, detailed, and presented in one location.</p><p><strong>Conclusions: </strong>Palliative care team members used a variety of indicators of unmet care needs to make eligibility determinations. A mortality risk algorithm to identify potentially eligible patients was insufficiently detailed to be useful in final eligibility determinations. These findings provide insights into how health data can be presented to better integrate health information from mortality risk algorithms into existing workflows to support palliative care eligibility decision making.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"1187-1195"},"PeriodicalIF":1.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142669811","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":"Understanding Staff Needs for Improving End-Of-Life Care in Critical Care Units: A Qualitative Focus Group Analysis and Service Evaluation.","authors":"Simon Tavabie, Stephen Pearson, Janet Balabanovic, Anna Batho, Manoj Juj, Priscilla Kastande, Joanne Bennetts, Emily Collis, Tim Bonnici","doi":"10.1177/10499091251316492","DOIUrl":"10.1177/10499091251316492","url":null,"abstract":"<p><p><b>Objectives:</b> Critical care is a place of frequent death, up to a quarter of those admitted die during admission. Caring for dying people provides many challenges, practically, professionally and personally. The aim of this study was to better understand the perspectives of staff caring for dying people in critical care and identify their priorities for improvement. <b>Method:</b> Three multidisciplinary focus groups of critical care staff at a large central London hospitals trust were facilitated with a semi structured format and digitally transcribed. Inductive thematic analysis was conducted to extract themes. <b>Results:</b> N = 34 (18 nursing, 7 allied health professionals, 6 medical, 3 clerical/administrative). The five themes were structured as priority statements: \"We need to recognise\" included the subthemes of being \"sick enough to die\" and potential rapid deteriorations in this setting; \"We need to understand\" with subthemes of perspectives on dying and prioritising time for conversations; \"We need to connect\" with subthemes of therapeutic relationship and physical presence; \"We need to collaborate\" with subthemes of critical care working and empowerment, and cross teams working; \"We need support\" with themes of experiencing support and making time to support others. <b>Conclusion:</b> We present an approach to identifying critical care departmental priorities for an end-of-life care improvement programme. The themes extracted will be used to evaluate systems for dying in critical care, aiming to empower staff to provide excellent care every time they look after a dying person. <b>Relevance to Practice:</b> This service evaluation identifies key priorities among critical care staff regarding end-of-life care. The insights can guide service improvements, such as tailored training and enhanced support for staff, to ensure better communication, collaboration, and quality care for patients at the end of life.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"1144-1150"},"PeriodicalIF":1.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143026243","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":"Structuring Palliative Care Education for Medical Students: Impact of a Novel Framework and Pocket Card.","authors":"Margot Manning, Logan N Beyer, Dorothy W Tolchin","doi":"10.1177/10499091251315152","DOIUrl":"10.1177/10499091251315152","url":null,"abstract":"<p><p>IntroductionPalliative care (PC) education is not uniformly provided across U.S. medical schools. While PC competencies for medical students have been articulated, no student-facing, unifying framework for competency-based PC learning exists.MethodsIn 2022, we developed a student-facing organizing framework (the \"6 Ps\") based on existing PC competencies and created a pocket card introducing foundational PC concepts organized within the 6 Ps framework. In 2023, we provided a mandatory 15-minute session to introduce the 6 Ps and pocket card to the first-year class of our large, urban medical school. We provided voluntary pre- and post- session surveys to evaluate usability and impact of the framework and pocket card.ResultsOne hundred-twenty students of the 204-student class (59%) attended. Survey response rate was 106/120 (88%) pre-session and 101/120 (84%) post-session. Following the session, students agreed the 6 Ps was a good framework for conceptualizing PC (95/101; 94%), that the pocket card was understandable (96/101; 95%), and they would use the pocket card to teach fellow students about PC (85/101; 84%). Nearly all students endorsed learning novel concepts (95/100; 95%). Pre/post session comparison of self-assessed confidence approaching hypothetical clinical tasks, such as educating a patient about PC and hospice, revealed significant improvement (<i>P</i> < .01).DiscussionFirst-year medical students were able to use the 6 Ps framework and pocket card after a brief introduction, endorsing new learning and demonstrating significant gains in knowledge and self-assessed confidence. Medical educators across schools may consider adopting this novel tool and approach to introduce or support student learning about PC.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"1120-1127"},"PeriodicalIF":1.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143019432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examining 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":"https://doi.org/10.1177/10499091251383051","url":null,"abstract":"<p><p>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% (<i>n</i> = 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.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"10499091251383051"},"PeriodicalIF":1.4,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145254371","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":"Live Discharges of Patients in Hospice Home Settings-Relief or Grief: A Narrative Study.","authors":"Jacek T Soroka, Amanda L Paulson-Blom, Alla Blotsky, Jennifer L Derrick, Margaret T Mudroch","doi":"10.1177/10499091251387261","DOIUrl":"https://doi.org/10.1177/10499091251387261","url":null,"abstract":"<p><p>BackgroundApproximately 20% of hospice patients in the US are discharged alive, often due to Medicare regulations. Such discharges are frequently perceived by caregivers as abandonment or expulsion, especially when they occur without follow-up or planning for care transition.MethodsThis study explored caregiver experiences with live hospice discharge through 2 narrative interviews and institutional data from a Midwest medical center (January 2020 through December 2022). Caregiver stories were analyzed thematically to identify emotional and logistical challenges. Retrospective patient data were also reviewed to provide descriptive statistics on patient volume.ResultsOf 1556 hospice patients discharged, 107 (6.9%) were discharged alive, with a mean length of stay of 205 days-substantially longer than that for the general hospice population. Most patients were women who were diagnosed with cerebrovascular or neurologic conditions and discharged from skilled-care facilities. One of the caregivers described discharge as distressing and poorly coordinated; the other reported a positive experience shaped by prior knowledge and financial resources. Both emphasized the importance of clear communication, care planning (eg, to avoid loss of durable medical equipment), and interdisciplinary support. The caregiver's financial stability likely influenced discharge decisions and preparedness.ConclusionsLive hospice discharge can cause emotional and practical disruption, especially when not accompanied by a care transition plan or access to durable medical equipment. This study highlights the need for team-based communication, sensitivity in language, and continued support. Engaging all members of the interdisciplinary team and ensuring access to essential resources may improve caregiver confidence and continuity of care.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"10499091251387261"},"PeriodicalIF":1.4,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145246234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving Communication Competencies in Neonatology: A Multimodal Simulation-Based Palliative Care Workshop.","authors":"Samira Abudinen Vasquez, Rachana Singh, Jaclyn Boulais, Brooke Krbec","doi":"10.1177/10499091251386410","DOIUrl":"https://doi.org/10.1177/10499091251386410","url":null,"abstract":"<p><p>BackgroundEffective communication between providers and parents is fundamental in critical care provision. Particularly when discussing goals of care and delivering bad news, which is often complicated by differing values and beliefs. Many trainees lack formal education in communication skills for end-of-life care. Implementing a formal curriculum may improve physician-patient relationships, parents' mental health, and overall patient care.ObjectiveTo assess the impact of an integrative multimodal simulation-based palliative care workshop experience combining simulated complex medical cases with challenging conversations to mirror real life scenarios on clinicians' knowledge, attitudes and communication skills.Study DesignThree simulation scenarios were conducted, combining medical management of a high-fidelity mannequin with challenging conversations with actors portraying as parents. Changes in participants' attitudes, knowledge, and communication skills were assessed pre- and post-intervention using both subjective and objective measures. Data was analyzed using chi-square tests, and paired-sample t-tests.ResultsTwenty-two participants completed the scenarios with a significant improvement in verbal and non-verbal communication skills, between the first and second case. There was improvement in participants' competency in delivering bad news, discussing death with parents, and disclosing medical errors.ConclusionAn integrative palliative care workshop combining high-fidelity medical management with concurrent emotionally challenging conversations improved clinicians' knowledge, attitudes, and communication skills. This real-time approach reflects the complexity of critical care and supports its incorporation into training to enhance clinician preparedness for simultaneous medical and communication demands during intense, life-threatening clinical scenarios.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"10499091251386410"},"PeriodicalIF":1.4,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pathologist-Led Support in Palliative Cancer Care: A Consultative Approach to Enhancing Patient Understanding, Concerns, and Autonomy.","authors":"Yumiko Ogushi, Noriyuki Sato, Toshiro Kusakabe","doi":"10.1177/10499091251385972","DOIUrl":"https://doi.org/10.1177/10499091251385972","url":null,"abstract":"<p><p>IntroductionThis report introduces a unique outpatient service led by a pathologist at a cancer palliative care-specialized hospital in Japan. Since 2015, the \"Knowing the Disease Well\" clinic has aimed to enhance patients' understanding of their disease-an essential foundation for envisioning their future-and to support the cultivation of autonomy in decision-making.MethodsThe clinic offers weekly one-hour sessions, free of charge, for cancer patients and their families. Consultations cover medical explanations (diagnosis, pathological findings, test interpretation, treatment plans, disease trajectory) as well as emotional and existential concerns such as anxiety, prognosis, and family relationships.ResultsBetween May 2015 and March 2025, 37 cancer patients aged 30-80 years attended the clinic (Table 1). Over the past decade, 452 consultations were conducted, with family members present in some cases. Patients often reported relief, clarity, and strengthened autonomy. A representative case of a breast cancer survivor illustrates how tailored communication helped restore emotional balance and confidence in her future.ConclusionsThese findings suggest that counseling by pathologists can serve as a meaningful and underutilized component of comprehensive palliative care. Further study is needed to evaluate its broader impact and to explore its potential in other clinical settings.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"10499091251385972"},"PeriodicalIF":1.4,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145215046","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":"Moral Distress in Pediatric Palliative Care: A Cross-Sectional Study with Brazilian Professionals.","authors":"Julianna Rodrigues Beltrão, Kelly Sales Zem, Luana da Rocha Celli, Carla Corradi-Perini","doi":"10.1177/10499091251384586","DOIUrl":"https://doi.org/10.1177/10499091251384586","url":null,"abstract":"<p><p>IntroductionHealthcare professionals caring for children with life-threatening illnesses face frequent bioethical conflicts, often leading to moral distress. In pediatric palliative care (PPC), this can compromise both professional well-being and quality of care.ObjectiveTo analyze moral distress among professionals in PPC and identify associated factors.MethodCross-sectional study using the Measure of Moral Distress for Healthcare Professionals - Brazilian Version (MMD-HP BR) scale, applied online to PPC professionals.ResultsA total of 112 professionals participated, mean age 41 years (±9.1), predominantly female (90.2%) and from the Southeast region (49%). Average professional experience was 15 years (±9.2), with 6 years (±4.3) in PPC. Most participants were physicians (55.4%) and nurses (13.4%). The mean MMD-HP BR score was 104.2 (±74.8), significantly correlated with profession (<i>P</i> = 0.045). Nursing technicians had lower distress compared to nurses (<i>P</i> = 0.014), physiotherapists (<i>P</i> = 0.02), physicians (<i>P</i> = 0.002) and psychologists (<i>P</i> = 0.014). Higher scores were found among professionals who had considered leaving, had left, or were considering leaving their jobs. The most impactful items were: \"I observe health professionals communicating 'false hopes' to the patient or family\" and \"I observe poor quality care due to lack of communication between team members\".ConclusionMoral distress in PPC is strongly linked to communication difficulties, a critical factor in professionals' experiences. The scarcity of studies in pediatrics, especially in Brazil, highlights the need for further research to develop strategies that support team well-being and improve the quality of care provided to children and families.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"10499091251384586"},"PeriodicalIF":1.4,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214981","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":"Affirming Healthcare Experiences Among Older Black- and White-Identifying Gay Men Living With Serious Illness: A Qualitative Study in the Deep South.","authors":"Korijna Valenti, Michael Barnett, Stacy Smallwood, Ronit Elk","doi":"10.1177/10499091251380779","DOIUrl":"https://doi.org/10.1177/10499091251380779","url":null,"abstract":"<p><p><b>Background:</b> Older gay men living with serious illness often face challenges related to identity, disclosure, and relational recognition in healthcare settings. These challenges are particularly acute in the Deep South, where affirming care remains inconsistent, and disparities persist.<b>Objective:</b> To examine serious illness care experiences among older Black- and White-identifying gay men and their caregivers, with attention to how communication, inclusion, and identity disclosure shaped patient-clinician interactions.<b>Design:</b> Using a community-based participatory research framework, we partnered equitably with a Community Advisory Board of older gay men to guide study design, interview development, recruitment, and analysis. Semi-structured interviews were conducted with 16 participants (11 patients and 5 caregivers), intentionally sampling both Black- and White-identifying gay men. Reflexive thematic analysis was used to identify patterns in care experiences.<b>Results:</b> Three main themes were identified: (1) Experiences of Inclusion and Visibility, (2) Positive Communication, and (3) Sharing Sexuality and Effect on Care. Participants described moments of interpersonal connection and respect that fostered trust and comfort. Clear communication, honesty, and opportunities to ask questions were critical in navigating medical decisions. Discussions of sexual orientation were context-dependent and often shaped by perceptions of safety. Recognition of chosen family members, particularly partners, was central to participants' sense of dignity and affirmation in care.<b>Conclusions:</b> Findings highlight the importance of visibility, clinician-patient communication, and relationship recognition in serious illness care for older gay men. Culturally responsive, identity-affirming practices are essential to delivering equitable palliative and hospice care, particularly in underserved regions of the U.S. South.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"10499091251380779"},"PeriodicalIF":1.4,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214994","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}