The American journal of hospice & palliative care最新文献

{"title":"Effects of Integrating Palliative Care in Patients With Advanced Cancer: A Systematic Review and Meta-Analysis of Quality of Life and Psychological Outcomes.","authors":"Husam Bader, Husam Farraj, Saif Yamin, Hamzeh Feras Alshahwan, Joud Maghnam, Rafina Khateeb","doi":"10.1177/10499091241297924","DOIUrl":"https://doi.org/10.1177/10499091241297924","url":null,"abstract":"<p><p><b>Background:</b> Patients with advanced cancer frequently have a wide range of mental and physical symptoms, making it difficult for them to communicate and make informed decisions. Necessitating the incorporation of palliative care in this population to meet their supportive care requirements. <b>Objective:</b> To investigate the effects of integrating Palliative care in advanced cancer patients. <b>Methods:</b> PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar databases were comprehensively and systematically searched for Randomized clinical trials (RCTs) published up to February 2024. According to the PICOS criteria, trials enrolling adult patients with advanced cancer subjected to PC were included. Moreover, a risk of bias assessment was performed using the Cochrane Risk of Bias tool, and statistical analyses were performed using the Review Manager software. <b>Results:</b> Only 13 RCTs with 3,294 advanced cancer patients were included in the final analysis. A pooled analysis of data from these trials revealed that patients subjected to PC had improved quality of life (QoL) scores than those receiving standard care (SMD: 0.18; 95% CI: 0.07 - 0.30; p = 0.002). However, no significant difference was observed in depression (SMD: -0.03; 95% CI: -0.16 - 0.10; p = 0.63), anxiety (SMD: - 0.04; 95% CI: -0.23 - 0.15; p = 0.69), and survival (OR: 0.81; 95% CI: 0.56 - 1.16; p = 0.25). <b>Conclusion:</b> Integrating PC in patients with advanced cancer results in improved QoL with limited effect on psychological distress symptoms.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"10499091241297924"},"PeriodicalIF":0.0,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142690191","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":"Facing Illness Together: Understanding the Role of the Couple in Palliative Care.","authors":"Danielle Chammas, Anne Fishel, Margaret Kramer, Keri O Brenner, Leah B Rosenberg","doi":"10.1177/10499091241302413","DOIUrl":"https://doi.org/10.1177/10499091241302413","url":null,"abstract":"<p><p>Serious illness is rarely experienced by patients in isolation.  Many patients present to palliative care (PC) accompanied by their intimate partner. The intimate partnership is a critical axis around which many patients' experiences of serious illness revolve. However, there is a lack of literature and training on how PC clinicians can effectively support couples as a unit. Many existing PC communication strategies can be expanded to the dyadic unit, offering more holistic support for patients, partners, and the entity of their relationship. This paper integrates concepts from couples therapy, psychology, and PC communication to provide insights into the emotional, psychological, interpersonal, and practical challenges couples face during serious illness, as well as opportunities for growth and resilience. Key strategies for PC clinicians include helping couples navigate shifts in relational identity, share the \"emotional housework,\" and transform conflict into connection. Concrete techniques are illustrated throughout this manuscript, employing clinical micro-vignettes to demonstrate their practical application in PC practice. Recognizing the couple as a unified entity empowers clinicians to foster open communication, helping couples maintain connection and evolve intimacy throughout the illness journey. By applying relational concepts and acknowledging the couple's shared experience, PC clinicians can enhance the quality of life for both patients and their partners. Conceptualizing the couple as a distinct entity within PC practice can deepen clinician-patient communication and improve therapeutic effectiveness.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"10499091241302413"},"PeriodicalIF":0.0,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142684007","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":"Association of Palliative Care With Readmission and Resource Utilization in Patients With Ovarian Cancer: A National Perspective.","authors":"Alex A Francoeur, Nikhil Chervu, Alexandra L Mardock, Samantha Solaru, Sara Sakowitz, Peyman Benharash, Tiffany S Lai","doi":"10.1177/10499091241301753","DOIUrl":"https://doi.org/10.1177/10499091241301753","url":null,"abstract":"<p><strong>Objective: </strong>Palliative care (PC) utilization in cancer care has been shown to alleviate symptoms, increase goals of care discussions, and reduce invasive end of life measures. This study examined the association of inpatient PC consultation with readmission and hospitalization costs among patients with ovarian cancer.</p><p><strong>Methods: </strong>All records for women (≥18 years) hospitalized with a diagnosis of ovarian cancer were tabulated from the 2010-2020 Nationwide Readmissions Database. Multivariable logistic, Poisson, and linear regressions were used to evaluate the association of PC consultation during index hospitalization with length of stay, rates of 30-day non-elective readmission, time to readmission, as well as overall number of readmissions and hospitalization costs.</p><p><strong>Results: </strong>Of an estimated 285,487 patients included, 25,957 (9.0%) received a PC consultation, with an increase from 5.1 to 11.7% (<i>P</i> < 0.001) across the period. Factors associated with use of PC included: increasing age (AOR 1.03/yr, 95% CI 1.03-1.03, <i>P</i> < 0.001) and Elixhauser comorbidity index (AOR 1.19/point, 95% CI 1.17-1.21). PC was associated with lower risk adjusted rates of 30 day (11.63%, 95% CI 11.0-12.3 vs 20.25%, 95% CI 20.0-20.6) non-elective readmission (<i>P</i> < 0.001). The adjusted incident rate ratio of readmission after PC consultation was 0.41 [0.38-0.43], <i>P</i> < 0.001. Patients receiving PC additionally had less cost associated with their index hospital stay; -$2,407 [-$2,669.86- -$2,144.43], <i>P</i> < 0.001).</p><p><strong>Conclusions: </strong>Inpatient PC consults appear to be associated with reduced medical readmissions for patients with ovarian cancer, as well as decreased hospital resource use, however disparities exist. Continued increase in access and early PC referral should be considered.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"10499091241301753"},"PeriodicalIF":0.0,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142678132","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":"Concurrent Hospice in a Veteran's Affairs Dialysis Unit: A Single Center Experience and Lessons Learned over 4 Years.","authors":"Eric Magliulo, Ketki Tendulkar, Kaeli Samson, Saber Khan, Nathan Birch","doi":"10.1177/10499091241301754","DOIUrl":"10.1177/10499091241301754","url":null,"abstract":"<p><p>End stage kidney disease (ESKD) patients until recently have been effectively excluded from receiving hospice benefits unless they withdraw from renal replacement therapy. Policy change has allowed select populations to receive concurrent hospice and hemodialysis. We conducted a retrospective analysis of all deaths occurring from 2019 to 2022 among outpatient hemodialysis patients at our VA medical center. We compared clinical data and resource utilization between patients that were enrolled in concurrent hospice vs patients that were not enrolled in hospice. Our data suggests that among the hemodialysis population, enrollment in concurrent hospice services was not associated with increased healthcare resource utilization. This information may help increase enrollment in hospice among dialysis patients and promote optimal end of life care.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"10499091241301754"},"PeriodicalIF":0.0,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142669806","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":"10499091241302044"},"PeriodicalIF":0.0,"publicationDate":"2024-11-19","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":"Early Palliative Care in Advanced Non-Small Cell Lung Cancer Patients: A Meta-Analysis.","authors":"Jie Liu, Wei Cheng, Jie Du, Yamin Li","doi":"10.1177/10499091241300530","DOIUrl":"https://doi.org/10.1177/10499091241300530","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to assess the efficacy of Early Palliative Care (EPC) in non-small cell lung cancer (NSCLC) through a meta-analysis approach.</p><p><strong>Methods: </strong>A computerized search was conducted in databases such as PubMed, Cochrane Library, Scopus, Embase, and Web of Science for prospective randomized controlled trials (RCTs) investigating the application of EPC in advanced NSCLC. Outcome measures including Overall Survival (OS), quality of life, and psychological status were extracted and subjected to pooled analysis.</p><p><strong>Results: </strong>After the computerized search, a total of 7 studies comprising 1185 participants were included, with 597 patients receiving EPC intervention and 588 patients receiving Standard Care (SC) intervention. Three studies reported OS after the intervention, demonstrating a significant improvement in OS for patients receiving EPC (pooled HR = 1.60, 95% CI: 1.22, 1.98). Five studies analyzed the Functional Assessment of Cancer Therapy (FACT) scores after the intervention, revealing a significant improvement in FACT scores for patients receiving EPC (pooled SMD = 1.18, 95% CI: 1.04, 1.31). No significant differences were found in anxiety and depression scores between the 2 interventions in the 5 studies.</p><p><strong>Conclusion: </strong>In advanced NSCLC, EPC provides benefits in terms of increased survival rates and improved quality of life. EPC should be considered as part of multidisciplinary treatment for patients with advanced NSCLC.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"10499091241300530"},"PeriodicalIF":0.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142640527","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":"Experiences of Migrant Live-in Caregivers in Caring for Patients With Advanced Cancer - A Qualitative Study.","authors":"Gillian Li Gek Phua, You Kai Poh, Beverly Shu Ong, Jasmine Yun Ting Tan, Audrey Rui Xuan Koh, Grace Meijuan Yang","doi":"10.1177/10499091241300694","DOIUrl":"https://doi.org/10.1177/10499091241300694","url":null,"abstract":"<p><strong>Introduction: </strong>Foreign domestic workers are increasingly hired in Singapore as live-in caregivers for patients with advanced cancer. Language barriers and different cultural backgrounds can make caregiving potentially challenging. This study aims to explore the experiences of migrant live-in caregivers caring for patients with advanced cancer.</p><p><strong>Method: </strong>Semi-structured interviews were conducted to explore: the challenges and needs of migrant live-in caregivers caring for patients with advanced cancer, what enables their cancer caregiving work, and their motivations. Participants were recruited from inpatient oncology wards of an acute tertiary hospital. Inclusion criteria included: (i) migrant live-in caregiver caring for a patient with stage IV solid organ cancer; (ii) age ≥21 years; (iii) conversant in English, Mandarin or Burmese. Twelve female caregivers participated in the study. Their mean age was 35.4 years, 4 were from Indonesia, 3 from Myanmar and 5 from the Philippines.</p><p><strong>Results: </strong>Four main themes emerged: (1) Wide-ranging work responsibilities that could be challenging, (2) Treating and being treated like family, (3) Having access to multiple sources of support and (4) Motivated by being able to provide for their own family of origin.</p><p><strong>Conclusion: </strong>Migrant live-in caregivers face various challenges in cancer caregiving. Having a good relationship with patients, adequate employer and peer support and being able to provide for their family helped to motivate them. Efforts to support them can include formal training, better delineation of job scope and hours, and resources to address psycho-emotional needs. Further research could focus on knowledge gaps for cancer caregiving, psychosocial and post-bereavement needs.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"10499091241300694"},"PeriodicalIF":0.0,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142635339","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":"Certified Child Life Specialists in Hospice and Palliative Care Organizations: A State of the Profession.","authors":"Jennifer Mangers-Deans, Alyssa Friedberg, Kimberly Downing, Lisa C Lindley","doi":"10.1177/10499091241300126","DOIUrl":"https://doi.org/10.1177/10499091241300126","url":null,"abstract":"<p><strong>Background: </strong>Certified Child Life Specialists (CCLSs) provide developmentally appropriate psychosocial care to children to promote positive coping. However, little is known about the current professional landscape and opportunities for professional growth, especially in hospice and palliative care.</p><p><strong>Objectives: </strong>To conduct a needs assessment among CCLS and examine the role in hospice and palliative care.</p><p><strong>Methods: </strong>CCLSs were surveyed on their experience and needs in providing care in hospice and palliative care organizations. The online survey contained questions about demographics and work environment. The survey included multiple choice, yes/no, and open-ended questions. Descriptive statistics were generated from the survey items and comments/open-ended questions were coded and assessed for themes.</p><p><strong>Results: </strong>Among the 191 respondents, most were females (96.3%), under 40 years of age (63.8%), Caucasian (87.4%), and non-Hispanic (95.3%) with under 12 years of full-time work experience (57.0%). CCLSs commonly worked in urban/suburban (67.5%) pediatric programs (62.3%) with clients ranging from perinatal (33.5%) to adult caregivers of children (60.2%). Themes from the open-ended questions were: (a) role clarification, (b) staffing, (c) funding, (d) training/education, (e) professionality, and (f) self-care.</p><p><strong>Conclusions: </strong>Key insights into the profession, along with challenges and opportunities of working within the hospice and palliative care setting were identified. The findings highlighted the unique need for professional development among CCLSs.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"10499091241300126"},"PeriodicalIF":0.0,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142635326","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":"Gender Disparities in Advanced Lung Diseases: do They Persist Towards the End of Life?","authors":"Xinye Chen, Nicole Goh, Sadie Dunn, Natasha Smallwood","doi":"10.1177/10499091241299776","DOIUrl":"https://doi.org/10.1177/10499091241299776","url":null,"abstract":"<p><strong>Background: </strong>Advanced lung diseases are prevalent in women, yet are underrecognized and under-treated due to differing epidemiology and pathophysiology.</p><p><strong>Aim: </strong>To investigate any gender differences in access to palliative care and end-of-life management for patients with advanced lung diseases.</p><p><strong>Methods: </strong>A post-hoc analysis was conducted using three datasets that included information regarding the provision of palliative care to patients with advanced lung diseases - chronic obstructive pulmonary disease (COPD), fibrotic interstitial lung diseases (f-ILD) or non-small cell lung cancer (NSCLC) in tertiary and regional hospitals in Victoria, Australia, from 2004 to 2019.</p><p><strong>Results: </strong>343 patients with advanced COPD, 67 with f-ILD and 1022 with NSCLC were included. Compared to men, women with COPD (n = 126, 36.7%) were less likely to have smoked (<i>P</i> = 0.024), had significantly worse lung function (<i>P</i> < 0.001), and were more likely to receive non-invasive ventilation at end of life (<i>P</i> = 0.021). Women with fibrotic ILDs (n = 30, 44.8%) had significantly worse lung function (<i>P</i> < 0.001) and were more likely to experience exacerbations during their last two years of life (<i>P</i> < 0.001). Women with NSCLC (n = 457, 44.7%) were significantly younger (<i>P</i>< 0.001), less likely to have smoked (<i>P</i> < 0.001) or had asbestos exposure (<i>P</i> < 0.001). There were no significant differences between men and women with advanced lung diseases regarding referral to palliative care services (<i>P</i> = 0.369), hospital place of death (<i>P</i> = 0.915), or end-of-life management.</p><p><strong>Conclusions: </strong>Despite differences in lung function, exacerbations and targeted therapies, men and women with advanced lung diseases received equal access to symptom palliation and palliative care services towards the end of life.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"10499091241299776"},"PeriodicalIF":0.0,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142635347","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":"Formulation in Palliative Care: Elevating Our Potential for Therapeutic Communication.","authors":"Danielle Chammas, Amanda Moment, Leah Rosenberg, Daniel Shalev, Keri O Brenner","doi":"10.1177/10499091241300614","DOIUrl":"https://doi.org/10.1177/10499091241300614","url":null,"abstract":"<p><p>A fundamental principle of clinical reasoning is that assessment precedes plan; clinicians are taught to base interventions on the presumed etiology of a presentation. A notable exception is in the domain of communication education, where training is focused heavily on tools and interventions, with minimal focus on the assessment that informs which tools or strategies to select with a given patient. The concept of formulation (foundational in psychotherapy education) provides a framework with which to address this gap, enhancing a clinician's ability to be more therapeutically effective with the communication tools at their disposal. Our formulation serves as the compass that guides our decisions around communication, allowing us to conceptualize communication as a therapeutic intervention and align our approach to communication with the broader philosophy of clinical reasoning. This manuscript explores the concept of formulation, the direct relevance and applicability to palliative care, sample cases to underscore the impact of this framework, and high-yield tips for use of formulation in general palliative care practice. Palliative care clinicians and IDTs can readily apply formulation in synergy with the communication tools they already possess, elevating their ability to address patients' psychological needs.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"10499091241300614"},"PeriodicalIF":0.0,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142635342","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}