The American journal of hospice & palliative care最新文献

{"title":"Nutritional Interventions in Advanced Cancer: Scoping Review.","authors":"Aynur Aktas, Shirley Thomas, Michelle Barrett, Jessica Sui, Jake Waldman, Ciarán Kenny, Jessica Eustice-Cook, Kunal C Kadakia, Declan Walsh","doi":"10.1177/10499091251335249","DOIUrl":"10.1177/10499091251335249","url":null,"abstract":"<p><p><b>Background:</b> It is unclear what evidence supports nutritional advice received by those with advanced cancer. In advanced cancer, the benefits of nutritional interventions are less clear, with no consensus about effectiveness. This uncertainty is compounded by the heterogeneity of nutritional interventions and absence of cohesive, evidence-based approaches. Intervention diversity highlights the need to summarize current dietary and nutritional approaches and their evidence base. <b>Objective:</b> To map and summarize the current evidence base for nutritional interventions in advanced cancer. <b>Methods:</b> A systematic search included studies on nutritional interventions in adults with advanced cancer, excluding enteral/parenteral nutrition. Five databases (CINAHL Ultimate, Embase, Medline, SCOPUS, Web of Science) were searched from inception until 10/20/2023. Four researchers undertook screening and data extraction. Due to the heterogeneous nature of the studies, data synthesis was narrative. <b>Results:</b> The databases search yielded 3290 records. Fifty additional publications were identified through manual searches. Title/abstract screening identified 253 articles for full-text screening, 35 of which met inclusion criteria. Of these, 25 (69%) were randomized controlled trials. The studies were separated into 5 themes: (1) nutraceutical and herbal interventions, (2) ketogenic diet, (3) nutrition advice/support, (4) oral nutrition supplements, (5) other nutritional interventions. Outcome measures reported included anthropometry, biological markers, feasibility, performance status, quality of life, survival, and treatment tolerability. Most provided information about weight and energy intake and a few reported lean body mass. Although some reported positive outcomes, evidence is insufficient for definitive recommendations for any of those interventions. <b>Conclusions:</b> Our scoping review provided limited evidence for various nutritional interventions and dietary approaches. Dietary advice and oral nutritional supplements sometimes appeared to enhance treatment tolerance and improve nutritional status; impact on overall survival was inconsistent. Nutraceutical and herbal interventions showed limited clinical benefits despite apparent biological activity. The variability in outcomes underscores the need for personalized nutritional strategies that consider individual patient factors.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"668-688"},"PeriodicalIF":1.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144045020","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":"Non-Pharmacologic Modalities in Hospice Care: The Use of a Rubik's Cube for Anxiety and Depression: A Case Study.","authors":"David B Brecher, David Anthony Johnson","doi":"10.1177/10499091251330875","DOIUrl":"10.1177/10499091251330875","url":null,"abstract":"<p><p>Psychological issues, especially anxiety and depression, are commonly seen in patients receiving Hospice care. In this case study we report on a 72 year-old male Veteran with metastatic hepatic carcinoma who has been placed in a Veterans Affairs Community Living Center (CLC) for end-of-life care. His flat affect was initially addressed by the Hospice team with psychiatric support and medication. Although suicidal ideation was not present, the Veteran did not want to leave his room or interact with others, and unfortunately, medication, natural light, massage and music were not effective in minimizing his symptoms. Our chaplain offered spiritual support and demonstrated his use of a Rubik's Cube in the hope of reducing the Veteran's stress. The Veteran was fascinated with the Rubik's Cube and the experience helped him become more interactive with staff and fellow patients. Can a Rubik's Cube be another non-pharmacological treatment option?</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"689-691"},"PeriodicalIF":1.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Survey to Enhance Procedural Based Skills in Hospice Education.","authors":"Ivy Akid, Danielle J Doberman","doi":"10.1177/10499091251331214","DOIUrl":"10.1177/10499091251331214","url":null,"abstract":"<p><p>We aimed to conduct a needs assessment survey to better understand the frequency and types of procedures performed in and across hospice educational settings in order enhance the hospice education curriculum across diverse practice settings and communities. We implemented the survey and distributed it to educational leaders in hospice and palliative medicine The survey revealed procedures are being performed in hospice care settings and these are performed at least monthly and highlights a clear need for procedural skills training to be integrated at the curriculum level.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"692-693"},"PeriodicalIF":1.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733643","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":"Development and Validation of Machine Learning Algorithms for Predicting Prolonged Postoperative Opioid Use in Spinal Metastatic Disease.","authors":"Renuka Chintapalli, Philip Heesen, Atman Desai","doi":"10.1177/10499091251341450","DOIUrl":"10.1177/10499091251341450","url":null,"abstract":"<p><p>IntroductionOperative management of spinal metastatic disease is largely for symptom palliation and revolves around the expectation that postoperative survival will exceed the recovery period. Long-term postoperative opioid use is a clinically useful indicator of recovery. Few studies have developed machine learning models to predict this outcome in spinal metastatic disease patients.MethodsThe Merative™ Marketscan® Commercial Database and Medicare Supplement were analyzed to identify adult patients who underwent surgery for extradural spinal metastatic disease between 2006 and 2023. Patients were required to have at least 6 months of continuous preadmission data, and 6 months of continuous post-discharge follow-up. The primary outcome was prolonged opioid use, defined as filling a perioperative prescription followed by another between 90- and 180-days post-discharge. Cumulative days of postoperative opioid supply was assessed as a secondary outcome. Five models (stochastic gradient boosting, support vector machine, neural network, random forest and penalized logistic regression) were trained on a 70% training sample and validated on the withheld 30%.ResultsA total of 732 patients were included, of which 341 (46.6%) had prolonged post-discharge opioid use. The random forest algorithm had the best predictive performance in terms of discrimination (area under the curve [AUC]: 0.611), calibration (intercept: 0.18, slope: 0.613) and overall accuracy (Brier score: 0.24).ConclusionWe developed and validated parsimonious predictive models to estimate risk of prolonged opioid use after surgery for extradural spinal metastatic disease. Integrating these models into physician- and patient-facing interfaces may improve prognostication, enhance clinical decision-making, and ultimately optimize pain management to support more tailored postoperative care strategies.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"660-667"},"PeriodicalIF":1.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029261","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":"Barriers and Practices of Intensivists and Nurses in Family Conferences and Ethical Climate in Intensive Care Units.","authors":"Tetsuharu Kawashima, Kaoru Ashida, Yasuyo Yoshino, Satomi Kinoshita","doi":"10.1177/10499091251343211","DOIUrl":"10.1177/10499091251343211","url":null,"abstract":"<p><p><b>Introduction:</b> The death of a patient can cause families long-term psychological effects. Providing high-quality family conferences (FCs) and fostering an ethical climate are essential to reduce the psychological burden on patients, families, and health care professionals. Aim: To clarify the barriers and practices regarding FCs and the ethical climate in the intensive care unit (ICU) from the perspectives of intensivists and nurses. <b>Methods:</b> We conducted interviews based on an interview guide and analyzed the narrative data of participants using thematic analysis. Participants were intensivists and nurses working in ICUs in Japan who had experience in ICU practice and were involved in FCs. <b>Results:</b> Core themes of lack of communication, lack of education, climate where it is difficult to speak up, differences in opinion and thinking among intensivists and attending physicians, differences in opinion and thinking among professions and individuals, and ethical dilemma were found as barriers for physicians and nurses in FCs and the ethical climate in the ICU. For FC and ethical climate related practices of intensivists and nurses in the ICU, core themes were facilitating communication, promoting education, understanding and respect for other professions and individuals, and addressing ethical matters. <b>Conclusions:</b> This study enabled us to organize the barriers and practices of intensivists and nurses in FCs and the ethical climate in ICUs. These results allow us to consider interventions to build better FCs and ethical climate in ICUs, which may contribute to reducing the psychological burden on patients, families, and health care professionals.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"647-659"},"PeriodicalIF":1.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144083046","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":"Advance Care Planning and Unlimited Treatment Preferences in Dementia Scenarios: Insights From Community-Dwelling Adults.","authors":"Yuchi Young, Yichun Liu, Yufang Tu, Wan-Yu Chiu, Ashley Shayya, Thomas O'Grady","doi":"10.1177/10499091251334090","DOIUrl":"10.1177/10499091251334090","url":null,"abstract":"<p><p><b>Introduction:</b> Dementia leads to progressive cognitive decline, impairing self-care and decision making. Advance directives (AdvDirs) enable individuals to document healthcare preferences while cognitively capable, ensuring value-aligned care and reducing caregiver burden. This study explores factors influencing preferences for unlimited medical treatment in hypothetical Alzheimer's disease/dementia scenarios among community-dwelling adults. <b>Methods:</b> This cross-sectional study surveyed 163 community-dwelling adults (18+), using structured questionnaires to collect sociodemographic, health, and AdvDir-related data. Key predictors included attitudes toward life-sustaining treatments, comfort discussing death, religious practices, and interest in quality-of-life information related to end-of-life care. The primary outcome was preference for unlimited medical treatment in hypothetical dementia scenarios. Bivariate and multivariate logistic analyses assessed associations, adjusting for covariates. <b>Results:</b> In the dementia scenario, 26.9% of participants preferred unlimited medical treatment. This preference was strongly associated with a pre-existing attitude favoring life-sustaining treatments (OR = 4.24, 95% CI: 1.73 - 10.37, <i>P</i> = 0.002) and religious beliefs (OR = 5.68, 95% CI: 1.51-21.43, <i>P</i> = 0.01). Conversely, an interest in learning about quality of life at the end of life was negatively associated with preferring unlimited treatment (OR = 0.29, 95% CI: 0.09-0.89, <i>P</i> = 0.03). <b>Discussion:</b> Our findings highlight the need to align advance care planning with individuals' values, beliefs, and religious practices. Raising awareness of quality-of-life considerations in end-of-life care may lead to a shift in preference toward palliative care rather than aggressive treatment. Healthcare providers should discuss treatment trade-offs with cultural and religious sensitivity to support informed decision making.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"639-646"},"PeriodicalIF":1.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060059","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":"Addressing Sexual Toxicity Among Cancer Survivors: Clinicians Challenges and Potential Interventions.","authors":"Katherine Gerber, Mehek Thapar, Melissa Lazar, Nicole Baker, M Judy Lubas, Katherine Sherif, Ayesha Ali, Norman G Rosenblum, Pramila Anne, Nicole L Simone","doi":"10.1177/10499091261450884","DOIUrl":"https://doi.org/10.1177/10499091261450884","url":null,"abstract":"<p><p>PurposeSexual health is often negatively impacted by cancer treatment. Despite its importance, discussions regarding this topic are not uniformly performed between clinicians and patients. We designed a survey to determine how oncologists manage the sexual health concerns of cancer patients.MethodsAn IRB-approved electronic survey was administered to oncologists from 2017-2019 using a web-based platform. The survey assessed how clinicians approach the topic, identify common concerns, and determine various resources for their patients. Associations between physician characteristics and questions of interest were investigated using Chi-square tests, or Fisher's exact tests with significance set as <i>P</i> < .05.Results388 physicians responded. 56.5% were male, 52.5% had practiced for more than 10 years, and 49% practiced in an academic hospital. Specialties included 25.7% urology, 27.3% medical oncology, 15.1% radiation oncology, and 13.7% gynecological oncology. 75.1% of respondents stated that they discuss sexual health with patients. 74.4% did not provide standardized sexual health assessments. 81.9% reported that they had not received formal training surrounding sexual health communication. Common complaints from patients included sexual desire (68.7%), vaginal dryness (64.7%), erectile dysfunction (61.7%), painful intercourse (60.4%), and fertility (52%). Educational resources included therapists (72.5%), pamphlets (41.8%), support groups (39.6%), and websites (32.3%). Physicians who treated patients for prostate cancer were more likely to discuss sexual health and provide standardized assessments than those who treated patients with various female cancers.ConclusionAlthough most clinicians discuss sexual health with patients, many do not use standardized assessments, nor have formal training in sexual health issues.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"10499091261450884"},"PeriodicalIF":1.4,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147848238","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":"Testing Near-Field Radio-Frequency Sensors to Predict Respiratory Distress in Patients Living With Dementia: A Pilot Feasibility and Acceptability Study.","authors":"Kapil Gangwar, Taeyoung Park, Jamuna Krishnan, Bradley Hayward, Thomas Bradley Conroy, Micah Denzel Toliver, Shanyna Joasil, Elaine Yu, Chnidcar Fortune, McKenzie Smith, Vanessa Liao, Edwin Chihchuan Kan, Veerawat Phongtankuel","doi":"10.1177/10499091261450897","DOIUrl":"https://doi.org/10.1177/10499091261450897","url":null,"abstract":"<p><p>BackgroundPeople living with dementia (PLWD) with advanced illness are prone to respiratory distress yet often cannot self-report dyspnea, delaying recognition and treatment. Near-field radio-frequency (NFRF) sensors offer touchless, covert cardiopulmonary monitoring that may be better tolerated than tethered devices.ObjectivesTo assess the feasibility and acceptability of NFRF bed sensor for home monitoring of PLWD and to estimate machine-learning (ML) performance for detecting respiratory distress.MethodsIn a 48-hour pilot study, PLWD were recruited from a geriatrics practice. A lab-designed NFRF bed sensor recorded cardiopulmonary waveforms. Recorded video enabled minute-level Respiratory Distress Observation Scale scoring as reference. Feasibility outcomes included adverse events, acceptability, and percentage of usable data. ML classifiers (eg, random forest, k-nearest neighbors) were evaluated using 5-fold cross-validation, and class imbalance was addressed through data augmentation.ResultsTen patient-legally authorized representative dyads were enrolled. No adverse events were reported, and no participants intentionally removed the sensor. Usable data averaged 52% (range 34-68%). Caregivers reported minimal burden and no patient distress. With augmented data, the random forest performed best, achieving 74.6% sensitivity and 95.5% specificity in detecting RDOS scores.ConclusionsNFRF bed sensors were feasible and acceptable to implement in the home setting with PLWD, with promising ML-based detection of respiratory distress. Larger, longer studies with a broader range of RDOS severity are needed to validate performance and refine deployment. As this technology develops and matures, it could provide a method for non-invasive continuous monitoring to detect respiratory distress in PLWD in palliative care settings.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"10499091261450897"},"PeriodicalIF":1.4,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147848188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Meaning-Making Conversation: A Formative Mixed Method Pilot Study of a Brief Intervention for Patients Living Long-Term With Incurable Cancer.","authors":"Anna Visser, Lenneke Post, Joost Dekker, Lia van Zuylen, Inge R Konings","doi":"10.1177/10499091261444921","DOIUrl":"https://doi.org/10.1177/10499091261444921","url":null,"abstract":"<p><p>BackgroundMany patients with incurable cancer are expected to live for a considerable period of time, yet with the knowledge of their disease's inevitable end-of-life outcome. This duality can lead to existential concerns. A single one-hour meaning-making conversation was developed in which a patient explores their sources of meaning together with a spiritual counselor.AimTo explore how patients experience and benefit from a conversation aimed at supporting meaning-making, in order to inform further refinement of this intervention.DesignWe conducted a formative mixed method pilot study. Evaluation interviews assessed patients' experience and reported benefits. A reflexive thematic analysis was conducted. Key themes were compared and contrasted by intervention timing and patients' experience of existential concerns. Validated questionnaires were administered to assess patients' existential wellbeing, problems, and needs pre- and post-intervention.Setting/ParticipantsTwenty-one patients with advanced solid malignancies and a prognosis >1 year participated at two different hospitals.ResultsAll patients experiencing existential concerns appreciated the meaning-making conversation and reported benefits, such as reflection, validation, insight and actions related to sources of meaning. Half of the those not experiencing existential concerns reported no benefits, and some reported a negative experience. Quantitative data suggest a decrease in most existential problems and needs post-intervention. Existential wellbeing increased post-intervention.ConclusionsA meaning-making conversation can support the process of meaning-making for patients living long-term with incurable cancer. Refinement of the intervention should focus on targeting patients experiencing existential concerns.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"10499091261444921"},"PeriodicalIF":1.4,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147825150","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":"The Use of a Prayer Tree to Support the Emotional and Spiritual Needs of Visitors to Critical Care Units in the Deep South Region of the United States.","authors":"Rachel Ashcraft, Maria G Jimenez, Helene Taylor, Emily Delzell, Kimberly Kirklin, Lauren Edwards, Hon K Yuen","doi":"10.1177/10499091251330618","DOIUrl":"10.1177/10499091251330618","url":null,"abstract":"<p><p>ObjectivesThis study aims to understand specific spiritual expressions by visitors of patients in intensive care units (ICUs) made through an inclusive art installation called a Prayer Tree.MethodsThe Prayer Tree was a two-dimensional plastic or painted tree affixed to a window in the ICU waiting area. Waiting areas of the neuroscience ICU and the trauma-burn ICU at a tertiary care hospital had a Prayer Tree. Visitors wrote a prayer, a hope, or a wish on a piece of paper for their relatives and friends who were patients in an ICU and hung it on a Prayer Tree. These notes were collected between the beginning of 2018 to mid-July 2023. All notes (N = 3673) were compiled and subjected to qualitative analysis.ResultsNotes were categorized into seven themes: Healing, Faith, Love, Thankfulness, Encouragement, Grief, and Prayer of Acknowledgement. The predominant spiritual expressions in the notes were prayers requesting healing by a higher power, faith, love, and thankfulness.ConclusionThe large number of notes left on the Prayer Tree indicates that many visitors chose to engage with the Prayer Tree. Themes of prayers identified in this study align with similar prayer themes in related studies. Findings from this study support that an art-based art environmental intervention in the form of a Prayer Tree to ICU waiting areas provides a needed outlet for visitors' emotional and spiritual expression. By identifying commonly expressed themes among ICU visitors, this study has enhanced understanding of their spiritual needs and expressions.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"547-552"},"PeriodicalIF":1.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702616","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}