The American journal of hospice & palliative care最新文献

{"title":"Burnout Prevalence and Associated Factors Among Palliative and Hospice Care Professionals During the COVID-19 Endemic: An Exploratory Survey.","authors":"Wan Ru Ng, Nur Hamizah, Xiangyi Chen, Zhi Zheng Yeo, Keng Chuan Soh, Poh Heng Chong","doi":"10.1177/10499091241257958","DOIUrl":"10.1177/10499091241257958","url":null,"abstract":"<p><strong>Background: </strong>Burnout is a significant issue for palliative and hospice professionals, exacerbated by the impact of Coronavirus Disease 2019 (COVID-19) on healthcare professionals. It is crucial to update our understanding of prevalence data, identify associated factors, and evaluate support resources during the COVID-19 pandemic.</p><p><strong>Methods: </strong>We aimed to explore the prevalence of burnout among palliative and hospice care workers, 2 years into the COVID-19 pandemic by using the Maslach's Burnout Inventory; anxiety, using General Anxiety Disorder-7 (GAD-7), workload, risk perception of COVID-19, confidence in protective measures (personal, workplace, and government), and usage and perceived helpfulness of support resources. Univariate logistic regression analysis was conducted to analyse burnout against these factors.</p><p><strong>Results: </strong>Of the 115 respondents encompassing doctors, nurses and social workers (76.5% female; average age 40.9), 48.7% experienced burnout. Burnout correlated with increased anxiety, higher COVID-19 risk perception, heavier workload, and reduced confidence in protective measures. Peer support, COVID information, and psychological programs were rated as the most effective for coping.</p><p><strong>Conclusion: </strong>The study indicates considerable levels of burnout among palliative and hospice care workers, linked to workload, anxiety, and perceived risk. Traditional mental health interventions had limited efficacy; respondents favoured peer support and organisational changes. The findings stress the need for a holistic approach, including diverse resources, workload management, and regular mental health assessments.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"365-371"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141428598","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":"End-Of-Life Symptoms and Symptom Management in Older Adults With Stroke Versus Cancer.","authors":"Hanna Ramsburg, Meredith MacKenzie Greenle, Janice L Hinkle","doi":"10.1177/10499091241261304","DOIUrl":"10.1177/10499091241261304","url":null,"abstract":"<p><p><b>Background:</b> Little is known about the end-of-life (EOL) experience in older adults with stroke or how similar the EOL experience is in older adults with stroke when compared to those with cancer. <b>Purpose:</b> We utilized data from the National Health and Aging Trends Study (NHATS) to compare symptoms, symptom management, and overall rating of care in the last month of life between older adults diagnosed with stroke and those diagnosed with cancer. <b>Methods:</b> Logistic regression was used to examine the associations between diagnosis and symptom prevalence, symptom management, and overall care quality, adjusting for care intensity, place of death, and demographic covariates. <b>Results:</b> A total of 747 NHATS participants diagnosed with stroke or cancer were identified. Diagnosis of stroke was associated with whether the symptoms of pain (OR .46, 95% CI .26-.83), dyspnea (OR .32, 95% CI .17-.64), and emotional distress were documented (OR .57, 95% CI .33-.98). Diagnosis was not associated with pain management (OR .85, 95% CI .48-1.48), dyspnea management (OR .97, 95% CI .47-2.03), or emotional distress management (OR 1.02, 95% CI .53-1.97). Correlates of overall care quality included place of death and diagnosis, with patients with stroke more likely to report poorer care quality (OR 1.77, 95% CI 1.03-3.04) as well as those who died in the hospital (OR 2.18, 95% CI 1.26-3.77). <b>Conclusions:</b> Older adults with stroke are at risk for inadequate symptom assessment and documentation, as well as poorer symptom management and poorer overall care quality.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"382-388"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141302352","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":"\"What you Say Matters\": Review of Clinical Outcome of Advanced Medical Directives Between Cancer and Non-cancer Patients in a Chinese Culture Society.","authors":"Ka Po Chan, Wai Kei Chung, Dany Young Hsu, Shun Yin Kong, Winnie Tin, Chun Hung Chan, Elaine Hwang, Oi Man Chan, Ruby Chui, Hon Wai Benjamin Cheng","doi":"10.1177/10499091241268304","DOIUrl":"10.1177/10499091241268304","url":null,"abstract":"<p><strong>Introduction: </strong>Advance medical directives (AMD) are statements made by individuals indicating the life-sustaining treatment that they would refuse in the future when they lost their mental capacity for medical decisions. While the proposal for the AMD legislation is ongoing locally in Hong Kong SAR, there are limited reviews on the clinical outcomes associated with it.</p><p><strong>Objective: </strong>To provide a comprehensive review on clinical outcomes of signed AMD.</p><p><strong>Methodology: </strong>Retrospective, multi-center study, which includes AMD signed within five cluster hospitals. Records of signed AMD from 1^st JAN 2020 to 31^st DEC 2022 were retrieved from a central registry. Clinical information of each patient was obtained from the electronic patient record.</p><p><strong>Result: </strong>456 patients with documented AMD were included in the study. 91.6% of AMD were signed by palliative care (PC) team. Majority (74.6%) of the patients were accompanied by family members or friends when AMD were signed. The concordance rate between the AMD and the medical care received was 89.5%. No patient revoked their AMD. Cancer and non-cancer patients showed similar rates of AMD concordance, frequency of Accident & Emergency Department (AED) visits or acute ward admissions, duration of hospital stays in the 30 days before death, and prevalence of receiving invasive or intensive treatments.</p><p><strong>Conclusion: </strong>Our study demonstrated that PC team currently plays a pivotal role in AMD completion, and AMD remains important in ensuring patients' care preferences are executed across different medical conditions. With the upcoming AMD legislation in Hong Kong SAR, adequate promotion and education should be launched.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"355-364"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141763670","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":"Identifying Prevalence and Potential Predictors of Do-Not-Attempt-Resuscitation Orders to Facilitate Preoperative Discussions on Code Status.","authors":"Kelly Cheung, Alex Saffran, Ashton Engdahl, Benjamin Chiang, Joseph Boyle, Perry Taylor, Paul Murphy","doi":"10.1177/10499091241268589","DOIUrl":"10.1177/10499091241268589","url":null,"abstract":"<p><strong>Background: </strong>Do Not Attempt Resuscitation (DNAR) orders allow patients with life-threatening conditions to decline resuscitation efforts should the need arise. The American Society of Anesthesiologists (ASA) recommends discussions with patients on their code status to clarify and honor their goals of care perioperatively. This project sought to determine the prevalence of DNAR orders and to identify the demographics and potential clinical predictors of DNAR status at the beginning and end of admission, which would help anesthesiologists at our center facilitate these discussions.</p><p><strong>Methods: </strong>Factors associated with DNAR status at beginning and at end of hospital stay were determined through univariate logistic regressions. For DNAR status at beginning and end of hospital admission, variables assessed were age at arrival, race, sex, palliative consult, use of palliative care service, length of stay in days, presence of surgery, presence of emergent surgery, care level, and medical service.</p><p><strong>Results: </strong>Approximately 2.4 percent of the sample had an active DNAR order at the beginning of their hospital admission compared to 7.4 percent at the end of hospital admission. Factors significantly associated with DNAR status at the beginning of the hospital stay were consistent with prior literature (age, palliative care consult or service). However, factors significantly associated with DNAR status at the end of hospital stay that were notable included length of stay, undergoing emergent surgery, higher level of care, and being on the oncology service and medical respiratory intensive care unit.</p><p><strong>Conclusions: </strong>This retrospective study allows anesthesiologists at our institution to identify patients who may benefit from a more comprehensive perioperative discussion about code status based on certain clinical characteristics, which may improve quality of care by preventing unwanted resuscitative measures that do not align with a patient's goals of care.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"396-403"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141794459","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":"Patient Perceptions of the Palliative Recovery Engagement Program (P-REP) Clinic, a Novel Outpatient Model for Patients With Advanced Illness and Substance Misuse.","authors":"Angeline Zhou, Megan Hamm, Jessica S Merlin, Julie W Childers","doi":"10.1177/10499091251328977","DOIUrl":"https://doi.org/10.1177/10499091251328977","url":null,"abstract":"<p><p>Substance use disorder in patients with cancer and other advanced illness is increasingly recognized as an emergent problem, and it has been associated with significant morbidity and mortality. The Palliative Recovery Engagement Program (P- REP) at the University of Pittsburgh Medical Center (UPMC), U.S.A, is an interdisciplinary clinic housed within an outpatient addiction program. It was formed in 2020 to care for individuals who have advanced illness, primarily cancer, who also experience substance misuse. We conducted semi-structured interviews with clinic patients to better understand their experience with pain management prior to arrival and while at P-REP. We identified factors that can influence the therapeutic relationship in this setting where conflict often predominates, such as a patient's coping mechanisms, their prior experiences with stigma, recovery programs, buprenorphine, and their ideas about abstinence, recovery, and the safety of their own patterns of opioid use. Notably, we found that clinicians who are familiar with these factors may feel more prepared to facilitate conversations, negotiate through shared decision making, and help maintain the therapeutic relationship, even when the provider and patient strongly disagree.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"10499091251328977"},"PeriodicalIF":0.0,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744564","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":"Combating Burnout Amongst Residents Through Fostering Resilience: A Systematic Review.","authors":"Le Xuan Shannon Tan, Jiayan Ding, Timothy Xuxian Neo, Vincent Sixian Chen, Charmaine Shi Mei Lee, Nur Amira Binte Abdul Hamid, Yun Ting Ong, Lalit Kumar Radha Krishna","doi":"10.1177/10499091251331150","DOIUrl":"https://doi.org/10.1177/10499091251331150","url":null,"abstract":"<p><p>BackgroundBurnout, marked by emotional exhaustion, depersonalization and depletion of professional efficacy, is rampant among residents. With deleterious effects on productivity, conduct and patient care, resident programs have increasingly emphasized resilience training to combat burnout. However, the personalized nature of burnout complicates the effective design of such programs. Premised on recent works that identify burnout as a result of shifting personhood, this study utilizes the Ring Theory of Personhood to guide the conceptualization of resilience training programs that address changes in the belief systems shaping one's self-concept.MethodsA systematic scoping review to explore how resilience is addressed and assessed amongst medical residents was conducted. Guided by the PRISMA-compliant Systematic Evidence-Based Approach (SEBA), searches for relevant articles published between 1st January 2000 and 4th November 2024 on PubMed, Embase, Scopus, ERIC and PsycINFO were performed. The SEBA methodology facilitated the integration of the themes and categories identified using thematic and content analyses.ResultsOf 15 953 abstracts screened, 666 articles were reviewed and 69 full-text articles were included. Three domains were identified: guiding theories; methods of teaching resilience; and assessment.ConclusionThe reliance on individual or societal theories has constrained the understanding, design and assessment of resilience programs. Current approaches, including mindfulness workshops, self-care initiatives and organization-led resilience training, are neither timely nor focused on the needs of each resident. To mitigate burnout, personalized, longitudinal and timely support is essential. Mentoring offers a more suitable alternative, providing culturally sensitive, resource-appropriate, sustainable and clinically relevant support to build resilience effectively.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"10499091251331150"},"PeriodicalIF":0.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744559","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 and the Cost of Caring Amongst Medical Oncologists in Singapore.","authors":"Varsha Rajalingam, Yutian Yu, Yun Ting Ong, Annushkha Sinnathamby, Nila Ravindran, Nagavalli Somasundaram, Simon Yew Kuang Ong, Lalit Kumar Radha Krishna","doi":"10.1177/10499091251330607","DOIUrl":"https://doi.org/10.1177/10499091251330607","url":null,"abstract":"<p><p>BackgroundMoral distress (MD), the notion of not being permitted to act in a morally and ethically correct manner, is evident amongst oncologists caring for terminally ill patients. Oncologists often contend with complex decisions, such as withholding treatment and managing family distress. Sociocultural and individual considerations also influence an oncologist's perception of MD, which can vary in severity due to changing ethical, practical, clinical, moral and professional considerations and shifting contextual circumstances. Their impact compromises an oncologist's wellbeing, patient outcomes and care of their family. Recent data suggests long-term consequences to MD and alludes to a broader cost of caring that encompasses compassion fatigue, vicarious trauma, secondary traumatic stress and burnout.MethodsThis study aims to determine how oncologists in Singapore experience MD and the costs of caring through secondary analysis of interviews with 12 oncologists.ResultsAnalysis of the interview transcripts revealed the following domains: 1) sources of MD; 2) sources of the costs of caring; and 3) protective factors.ConclusionThis secondary analysis of Singaporean oncologists suggests that MD is not frequently an isolated experience; rather, it leads to growing distress amongst oncologists-contributing to a wider cost of caring. This then impacts oncologists' decisioning, actions, practice and career trajectories. Longitudinal structured training, establishing personalised support for all oncologists and creating a safe working environment supported by the host organisation are thus critical to ensure sustainable practice.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"10499091251330607"},"PeriodicalIF":0.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733726","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":"https://doi.org/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":"10499091251331214"},"PeriodicalIF":0.0,"publicationDate":"2025-03-27","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":"Listening to the Patient: Holistic Assessment to Reveal and Manage Breathlessness.","authors":"Meena Kalluri, Charlotte Pooler","doi":"10.1177/10499091251329920","DOIUrl":"https://doi.org/10.1177/10499091251329920","url":null,"abstract":"<p><p>BackgroundBreathlessness is a distressing and prevalent symptom in fibrotic interstitial lung disease. Dyspnea management requires systematic assessment including patients' lived experiences; however, most dyspnea tools are point-in-time numerical severity scales. The Edmonton Dyspnea Inventory was developed to assess severity at rest, during activities of daily living and self-reported activities. It enables documentation of crisis dyspnea episodes and triggers clinicians to guide action plans and dyspnea management. This study is part of a larger project to validate the tool. The purpose was to describe patient perceptions of assessment of breathlessness of patient use of the tool.MethodsPatients with fibrotic interstitial lung disease were invited to share their perceptions and experiences of breathlessness and the tool. Focus groups were led on Zoom©, with patient-participants in their homes. Data were analysed with inductive content analysis for development of themes.ResultsThirteen patients participated in 2 focus groups. There were 4 major themes, each with minor themes: physicians need to explicitly ask about breathlessness; the tool conveys breathlessness and disease progression; the tool increases self-awareness of breathlessness and complexity; and the tool helps prevent crises and manage breathlessness. Patient-participants perceived the tool provided the needed language and means to focus and relay their breathlessness to others.ConclusionPatient-participants reported the tool was easy to understand and integrate in daily living. They recommended its use for general and specialized practitioners. Developed to assess breathlessness, the tool may provide a framework to promote patient self-awareness, describe individual progression, and tailor breathlessness self-management.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"10499091251329920"},"PeriodicalIF":0.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733696","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":"https://doi.org/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":"10499091251330618"},"PeriodicalIF":0.0,"publicationDate":"2025-03-25","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}