The American journal of hospice & palliative care最新文献

{"title":"Informal Caregivers' Administration of Opiate, Benzodiazepine, and Antipsychotic Medications to Home Hospice Patients Experiencing Hyperactive Delirium in the Last Week of Life.","authors":"Hannah B Kimball, Carol S Weisse, Georgia Doing, Kelly Melekis","doi":"10.1177/10499091261500745","DOIUrl":"https://doi.org/10.1177/10499091261500745","url":null,"abstract":"<p><p>PurposeWhile hospice-prescribed comfort medications are used to manage hyperactive delirium (HD), the relationship between caregivers' administration of these medications and HD is not well established, especially for patients receiving care in home settings.MethodsA retrospective chart review was conducted on medication records of home-hospice patients (N = 19) experiencing HD in the last week of life. Medication use included scheduled and prn medications administered and converted to opiate, benzodiazepine, and antipsychotics dose equivalencies. A binomial generalized linear model predicting HD incidents by dose equivalencies and time from death was followed by Spearman correlation lag analyses to characterize associations between HD and medications.ResultsThere were 2016 documented medication administrations and 133 HD incidents in the last week of life. After adjusting for covariation in measurements by patient, no medication class was a strong, independent predictor of HD. Opioid dose had a significant but modest positive association with HD incidents, but trends varied across patients. Shift-level lag analyses revealed HD episodes correlated with opioid and benzodiazepine doses in subsequent shifts more so than with doses in prior shifts, but neither lag transformation correlated more strongly than concurrent shift dose administration and HD.ConclusionsThe results highlight the intensity of pharmacologic management informal caregivers can face when managing HD in the last week without clinical staff on site. None of the 3 drug classes studied showed an inverse relationship to HD, raising questions about the efficacy of these medications for managing HD at the very end-of-life.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"10499091261500745"},"PeriodicalIF":1.4,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149231076","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":"Racial Composition and Single-Input Dominance in the First Hospice Special Focus Program Cohort.","authors":"Wenhan Guo, Yusheng Jia, Zijing Cheng","doi":"10.1177/10499091261500742","DOIUrl":"https://doi.org/10.1177/10499091261500742","url":null,"abstract":"<p><p>BackgroundFederal quality oversight increasingly uses composite algorithms built from administrative counts and caregiver-reported experience, but are rarely tested against actual enforcement cohorts. In December 2024, the Hospice Special Focus Program (SFP) selected 50 hospices for intensified oversight and possible Medicare termination; the program was paused in 2025 amid litigation.ObjectivesTo assess associations between SFP selection and hospice size, patient racial composition, and independently measured quality, and whether selection reflected broad or narrow underperformance.MethodsCross-sectional analysis of all 7115 active hospices in the November 2024 CMS Provider Data Catalog. Selection was modeled with logistic regression adjusting for size, ownership, patient mix, and Hospice Visits in the Last Days of Life (HVLDL), a publicly reported measure not used by the algorithm. Composite scores for the 50 selected hospices were decomposed into standardized inputs.ResultsSelected and non-selected hospices did not differ in size (median, 152 vs 134; <i>P</i> = .64), although after adjustment for patient mix and quality, each doubling of size increased selection odds (adjusted odds ratio [aOR], 1.33; 95% CI, 1.03-1.71). Selectees served more non-White patients (median, 35% vs 17%; <i>P</i> < .001), an association persisting after HVLDL adjustment (aOR per percentage point, 1.03; 95% CI, 1.01-1.05) and carried by Black share. Lower HVLDL independently predicted selection (aOR, 0.97; 95% CI, 0.95-0.98). For 48 of 50 selectees, a single input accounted for most of the score-worsening contribution; a two-domain requirement would have excluded 29 (58%).ConclusionSFP selection identified hospices with worse independent quality but usually reflected a single input and disproportionately affected Black-serving hospices.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"10499091261500742"},"PeriodicalIF":1.4,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149221254","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":"Rapid-Onset Opioid-Induced Neurotoxicity During Morphine Therapy.","authors":"Erica Weilein, Magdelene Doris Amoateng, Eduardo Bruera","doi":"10.1177/10499091261498828","DOIUrl":"https://doi.org/10.1177/10499091261498828","url":null,"abstract":"<p><p>PurposeOpioid therapy is central to cancer pain management and aims to provide effective analgesia while minimizing neurotoxic adverse effects; however, cognitive dysfunction, delirium, and hallucinations continue to be significant complications.SummaryOpioid-induced neurotoxicity (OIN) has been associated with higher opioid doses, poor functional status, and advanced disease burden, and is frequently an underrecognized contributor to delirium. We describe an unusual case of visual and auditory hallucinations shortly after morphine exposure, with prompt reversibility after opioid rotation and recurrence upon rechallenge.ConclusionThis case strengthens the causal association between morphine exposure and hallucinations and emphasizes the importance of early recognition and opioid rotation in reversing opioid-related neurotoxicity.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"10499091261498828"},"PeriodicalIF":1.4,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198468","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":"Perceived Quality of Care: A Comparison Between a Previous Non-Palliative Hospital Admission and Admission to an Acute Palliative Care Unit. A Mixed-Methods Observational Study.","authors":"Sebastiano Mercadante, Patrizia Ferrera, Sofia Settepani, Alessio Lo Cascio","doi":"10.1177/10499091261500128","DOIUrl":"https://doi.org/10.1177/10499091261500128","url":null,"abstract":"<p><p>BackgroundPatient satisfaction complements clinical outcomes, but few studies compare, within the same patient, a previous non-palliative admission with a subsequent admission to an acute palliative care unit (APCU).MethodsSingle-centre, observational, mixed-methods, within-subject study with prospective enrolment. All patients admitted to a hospital-based APCU were screened; eligible patients had a previous admission elsewhere within the preceding month. The primary outcome was overall satisfaction; other outcomes were exploratory.ResultsOf 374 consecutive admissions (316 patients) screened, 38 patients completed data collection. Length of stay did not differ significantly (<i>P</i> = 0.736). Overall satisfaction was higher for the APCU admission (median 4 [IQR 4-5] vs 4 [2.25-4]; <i>P</i> = 0.0005, Holm-adjusted <i>P</i> = 0.005). In exploratory, unadjusted analyses, participants also reported greater ability to share personal worries (<i>P</i> = 0.021) and clearer answers (<i>P</i> = 0.013). The same proportion of participants reported at least one unsatisfactory aspect (57.9% for both admissions), but its content shifted from relational/environmental to mainly organisational issues - timeliness of nursing assistance and food - while staff courtesy was mentioned more often for the APCU (11 vs 2 patients).ConclusionsParticipants reported more favourable experiences on selected measures, most consistently overall satisfaction, during their APCU admission than during their most recent non-palliative admission. Residual concerns related mainly to timeliness of assistance and food, which overlap with relational aspects of care. The reasons for these differences require further investigation in larger, multi-centre studies.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"10499091261500128"},"PeriodicalIF":1.4,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149208404","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":"Associations of Patient- and Physician-Related Factors With the Optimism of Prognostic Prediction in Patients With Terminal Cancer.","authors":"Yoko Ohba, Hironori Ohinata, Isao Yokota, Teruaki Tanaka, Chizuko Takigawa","doi":"10.1177/10499091261498180","DOIUrl":"https://doi.org/10.1177/10499091261498180","url":null,"abstract":"<p><p>BackgroundAccurate prediction of one-month survival is important for end-of-life care planning. However, clinical prediction of survival tend to be optimistic, and the reasons for this, particularly physician-related factors, remain unclear.ObjectiveThis study aims to identify patient- and physician-related factors associated with optimistic prediction of one-month survival.MethodsWe investigated terminally ill cancer patients referred to the palliative care unit at the Medical Center between July 2023 and June 2025 who died within one month after referral. The patients' treating physicians completed a survey regarding the rationale for their prognostic predictions. Patients were classified into an accurate group if predicted survival was within one month and an optimistic group if predicted survival exceeded one month. Physician-reported rationale was categorized into five domains: Tumor Progression, Symptoms, General Condition/Functional Status, Biologic Factors, and Prognostic Prediction Models. We analyzed associations between patient- and physician-related factors and optimistic prognostic predictions.ResultsAmong the 173 patients, 100 (58%) had optimistic prognostic predictions. General Condition/Functional Status and Tumor Progression were the most frequently cited rationale domains, whereas Prognostic Prediction Models were least frequently cited. Oral intake of more than a few mouthfuls, intake of only a few mouthfuls or less, resting dyspnea, and edema were associated with a lower risk of optimistic prognostic prediction (Odds ratio 0.038, 0.002, 0.028, and 0.022, respectively). No physician-related factors were associated with optimism.ConclusionsPrognostic accuracy was associated with patient-related factors but not physician-related factors. Future studies should evaluate strategies to reduce prognostic optimism in routine clinical practice.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"10499091261498180"},"PeriodicalIF":1.4,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198327","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":"Parents' Attributed Gains in Participating in a Telephone-delivered Educational Counseling Program: A Qualitative Study.","authors":"Ellen H Zahlis, Frances M Lewis","doi":"10.1177/10499091261498819","DOIUrl":"https://doi.org/10.1177/10499091261498819","url":null,"abstract":"<p><p>PurposeTo describe gains child-rearing parents with advanced cancer attributed to their participation in a telephone-delivered educational counseling program on parenting.MethodsParents were eligible if they were diagnosed with advanced stage cancer, rearing a child 5-17 years of age, spoke English among their languages, and had access to a telephone. Single occasion descriptive interview data were obtained from 23 parents in which parents were asked what they gained from the program. Transcribed interviews were analyzed using inductive coding methods derived from grounded field theory. Trustworthiness of study results was protected by coding to consensus, peer debriefing, and maintaining an audit trail.ResultsThe core construct, a Different Way of Parenting, explained parents' attributed gains which included six domains: <i>Focusing on Myself</i>; <i>Building on My Listening Skills</i>; <i>Starting a Conversation with My Child</i>; <i>Inviting a Dialogue</i>; <i>Learning about my Child's Feling</i>s; and <i>Becoming an Observer of My Child's Behavior.</i>ConclusionsA brief, scripted program for parents with advanced cancer added to parents' self-reported gains in their self-care and parenting competencies.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"10499091261498819"},"PeriodicalIF":1.4,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198378","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 End-Of-Life Indicators for Dialysis Patients: A National Consensus Study in Taiwan.","authors":"Hung-Bin Tsai, Chia-Ter Chao, Shao-Yi Cheng, Kuan-Yu Hung, Feng-Jung Yang, Ray-E Chang","doi":"10.1177/10499091261496806","DOIUrl":"https://doi.org/10.1177/10499091261496806","url":null,"abstract":"<p><p>BackgroundIdentifying end-of-life (EOL) dialysis patients who may benefit from palliative care remains challenging in Asian healthcare settings where relational autonomy predominates over individual decision-making. We conducted a national consensus study in Taiwan during 2015-2016 to develop validated EOL indicators for dialysis patients, with findings subsequently validated through a decade of clinical experience including the COVID-19 pandemic.MethodsWe conducted a three-phase study: (1) systematic literature review; (2) two-round expert focus groups using the RAND/UCLA Appropriateness Method with 15 multidisciplinary experts; and (3) national survey of nephrologists from 624 dialysis facilities. Nine indicators were evaluated using 9-point Likert scales. Exploratory and confirmatory factor analyses identified latent constructs.ResultsOf 624 facilities, 337 responded (54.0%), yielding 254 nephrologists with complete responses (22.6% of registered specialists). Two indicators achieved high consensus (≥90%) for both hospice/dying care and advance care planning: prolonged mechanical ventilation (PMV) with dialysis in unconscious state, and PMV with multi-organ failure. Factor analysis identified three EOL patient subgroups: ventilator-dependent, critically ill, and functionally dependent, with acceptable CFA model fit (χ² = 27.6, df = 19, <i>P</i> = 0.091; RMSEA = 0.042; CFI = 0.99). ACP ratings yielded a two-factor structure with adequate fit (χ² = 35.5, df = 20, <i>P</i> = 0.018; RMSEA = 0.055).ConclusionsDialysis patients with PMV combined with unconsciousness or multi-organ failure represent the highest-consensus EOL indicators in Taiwan. These validated findings offer actionable guidance for hospice and end-of-life care referral within healthcare systems characterized by relational autonomy and collective family-patient-clinician deliberation.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"10499091261496806"},"PeriodicalIF":1.4,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198362","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":"Pediatric Palliative Care Knowledge Among Health Professionals: Baseline Assessment and Pilot of a Digital Educational Intervention.","authors":"Catarina Ferreira Nunes, João Pedro Valente, Constança Vasconcelos, Maria Ravara, André Garrido, Marta Moniz","doi":"10.1177/10499091261498809","DOIUrl":"https://doi.org/10.1177/10499091261498809","url":null,"abstract":"<p><p>BackgroundPediatric palliative care (PPC) requires specific knowledge and skills, yet healthcare professionals often report limited training. This study assessed baseline PPC knowledge among professionals and the impact of a brief digital educational intervention.ObjectiveTo assess healthcare professionals' knowledge of PPC and identify knowledge gaps, and explore the feasibility and effect of a non-formal digital educational intervention.MethodsA quasi-experimental pre-test/post-test pilot study was conducted in a pediatric department of a level II hospital in Lisbon, Portugal, between 2024 and 2025. Physicians and nurses completed a questionnaire assessing PPC knowledge, previous training, and perceived barriers. A digital educational campaign was implemented, followed by reassessment using the same theoretical questions. Paired analyses were performed. Data was analyzed using JASP®.Results43 professionals completed the baseline questionnaire, 21 completed both phases. Baseline theoretical knowledge was generally high, with a mean score of 86.6% ± 5.7, but lower scores were observed in symptom management. Post-intervention scores showed small numerical improvements in selected domains, although not statistically significant. Among participants with lower baseline knowledge, the overall score improved significantly after the intervention. Participants identified barriers to PPC, including negative family perceptions (65.1%), lack of support services (55.8%), and funding and resource limitations (46.5%).ConclusionsHealthcare professionals demonstrated good baseline theoretical knowledge of pediatric palliative care, although important gaps were identified. The digital flashcard-based intervention was feasible and associated with improvements in selected domains, especially among participants with lower baseline knowledge. These findings may support the value of targeted, accessible, and continuous educational strategies.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"10499091261498809"},"PeriodicalIF":1.4,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187298","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":"Measuring Patient Satisfaction With Advanced Practice Clinicians: Identifying a Critical Gap in Palliative Care Measurement Instruments.","authors":"Ryan Baldeo","doi":"10.1177/10499091261498818","DOIUrl":"https://doi.org/10.1177/10499091261498818","url":null,"abstract":"<p><p>ContextMedical advancements have led to patients living longer, often with serious illness(es), making palliative care involvement prudent. To address the deficit of specialty palliative care clinicians, the integration of advanced practice clinicians (APCs) alongside physicians is a critical workforce shortage solution. However, a gap exists in the standardized methods for evaluation of patient satisfaction with APCs in this setting.ObjectivesThis paper evaluates the existing instruments measuring patient satisfaction with APCs to highlight the current gap in palliative care-specific tools and assess their potential for adaptation.MethodsTo identify appropriate instruments focused on patient satisfaction with APCs a literature review was completed searching for instruments pertaining to patient experience and satisfaction with APCs. Three relevant instruments were identified: the Nurse Practitioner Satisfaction Survey (NPSS), the Art of Medicine Survey, and Patient Satisfaction Survey with Physician Assistants in a Fast Track Emergency Department.ResultsOf these, only the NPSS underwent formal psychometric testing, demonstrating both validity and internal consistency.ConclusionsThe review identified a paradox in which the validated instrument, NPSS, was utilized much less than the non-validated Art of Medicine survey. This review also highlights a significant gap in validated and reliable instruments to measure patient satisfaction with APCs, particularly in the palliative care context. There is a critical need to develop or adapt a psychometrically sound instrument for the palliative care patient population to ensure high-quality, patient-centered care.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"10499091261498818"},"PeriodicalIF":1.4,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187289","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":"Palliative Care Education for Spiritual Care Providers and Faith Leaders: A Global Integrative Review.","authors":"Giovanna Sirianni, Somaya Abdullah, Kalli Stilos, Anna Peeler, Vanessa Cunha, Andrea Weiss, Marina Englesakis, Siona Phadke, Abigail Kusi-Amponsah Diji, Mawuli Kotope Gyakobo, Karla Gonzalez Pallares, Salman Bahammam, Kirsten Wentlandt","doi":"10.1177/10499091261482143","DOIUrl":"https://doi.org/10.1177/10499091261482143","url":null,"abstract":"<p><p>BackgroundSpiritual care is a core component of palliative care (PC), yet the education and training of spiritual care practitioners and faith leaders (SCP) remain inconsistently described. This integrative review mapped global PC education for SCP, examining educational content, delivery models, evaluation strategies, and gaps relevant to practice and policy.MethodsAn integrative review was conducted using comprehensive searches across medical, psychosocial, and regional databases from inception to May 21, 2024. Studies describing PC education involving SCP were included for review. A structured data extraction form was utilized and reported as per PRISMA-ScR. Outcomes were categorized using descriptive data, qualitative summaries and the Kirkpatrick evaluation framework.ResultsFrom 40 388 articles, 138 (9.4%) met inclusion criteria for SCP PC education. Most studies focused on interprofessional continuing education, rather than SCP-specific training programs. SCP education programs emphasized spiritual care and communication competencies, while core clinical domains were only addressed in interprofessional programs. Content related predominantly to adult patients. SCP-focused studies did not address pediatric subject matter. Few studies reported the religious affiliations of the participants. When religious affiliation was reported, most participants were of the Christian faith. Evaluations focused on attitudes and knowledge, with minimal assessment of behavior change or patient/system-level outcomes. Few studies (13.8%) incorporated education theory in their design or evaluation.ConclusionsPC education for SCP is expanding but remains variable and clinically narrow. Strengthening clinically integrated, theory-informed curricula, broadening faith representation, improving evaluation rigor and addressing pediatric and non-cancer contexts is needed to prepare SCP for interdisciplinary PC practice.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"10499091261482143"},"PeriodicalIF":1.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187279","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}