The American journal of hospice & palliative care最新文献

{"title":"Evaluating Performance of the Surprise Question to Predict 12-Month Mortality in Patients With End-Stage Liver Disease.","authors":"Sarah Homann, Jamie Pfaff, Elizabeth Stovicek, Rajiv Agarwal, Sumathi K Misra, Jill M Pulley, Justin K Siemann, Ashley Spann, Stacey Tillman, Cheryl L Gatto, Mohana Karlekar","doi":"10.1177/10499091251320057","DOIUrl":"https://doi.org/10.1177/10499091251320057","url":null,"abstract":"<p><strong>Introduction: </strong>Patients diagnosed with end-stage liver disease (ESLD) often struggle with a heavy symptom burden that compromises their quality of life. Introduction of specialty palliative care (PC) may help address these issues but is underutilized in ESLD. This study aimed to assess the performance of the surprise question (SQ) in this population as a potential screen to identify patients with a life expectancy of less than 12 months.</p><p><strong>Methods: </strong>A retrospective cohort analysis was performed. In a previous study (COMPASS Trial, NCT03022630), attending hepatologists were asked the SQ: \"Would you be surprised if this patient were to die in the next 12 months?\" as a prompt to consider consultation to specialty PC. Here, we consider the full collection of SQ answers and reconcile against record of death to examine the accuracy of the SQ as a predictor in this patient population.</p><p><strong>Results: </strong>The SQ had high sensitivity (93%) but low specificity (38%) for predicting 12-month mortality in ESLD patients. The SQ also had a positive predictive value of 42% and a negative predictive value of 92%. Patients who were SQ+ (physician responded: No, I would not be surprised) were more likely to die within the year than those who were SQ-.</p><p><strong>Conclusion: </strong>In ESLD, the SQ may serve as a useful screening test to identify patients at higher risk of mortality which may prompt PC engagement.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"10499091251320057"},"PeriodicalIF":0.0,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426677","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":"Exploring the Role of Language in Spiritual Health Consultations: Insights From an Ecological Model of Recovery on Depression and Anxiety.","authors":"Samuel Tercyak, Ishani Vyas, Deanna M Kaplan, Patricia K Palmer, Maureen Shelton, Charles L Raison, George H Grant, Ellen Idler, Jennifer S Mascaro","doi":"10.1177/10499091251320410","DOIUrl":"https://doi.org/10.1177/10499091251320410","url":null,"abstract":"<p><strong>Objective: </strong>Consultations conducted by spiritual health clinicians (SHC; also known as healthcare chaplains) offer a unique context for patients to express themselves and are associated with reduced stress and enhanced satisfaction. The language used during these consults may provide insights into emotions and recovery trajectories. This study aimed to characterize patient language in spiritual health consults and examine its relationship to mental health outcomes, evaluated within the Ecological Model of Recovery (EMR) framework.</p><p><strong>Methods: </strong>SHCs conducted consultations with 212 patients in five acute-care hospitals in the urban south. Pre-consult distress and post-consult anxiety and depression were measured. Consults were audio recorded, transcribed, and analyzed using Linguistic Inquiry and Word Count (LIWC-22). Linguistic indicators of emotion and EMR-related variables were examined. Spearman's rank-order correlation and Mann-Whitney U tests assessed the relationship between patient language and mental health outcomes.</p><p><strong>Results: </strong>Language reflecting confidence and discussions about lifestyle and religious topics were associated with lower post-consult anxiety and depression, highlighting the importance of positive self-perception and structured, meaningful activities in recovery. Language related to social connections was negatively associated with depression, while language indicative of differentiation or conflict correlated with higher depression levels.</p><p><strong>Conclusion: </strong>This study underscores the relationship between patient language during spiritual health consultations and mental health outcomes, emphasizing the therapeutic value of expressive communication. Verbal expression plays a crucial role in emotional recovery, as linguistic patterns in healthcare settings can reflect and influence psychological well-being. Prospective research is needed to fully explore these effects.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"10499091251320410"},"PeriodicalIF":0.0,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412226","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":"Impact of Patient and Caregiver Beliefs on Utilization of Hospice and Palliative Care in Diverse Patients With Advanced Lung Cancer.","authors":"Melanie Besculides, Melissa B Mazor, Carolina Moreno Alvarado, Mayuri Jain, Lihua Li, Jose Morillo, Juan P Wisnivesky, Cardinale B Smith","doi":"10.1177/10499091251318992","DOIUrl":"https://doi.org/10.1177/10499091251318992","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the impact of patient and caregiver hospice care (HC) and palliative care (PC) beliefs and patient/caregiver belief-agreement on subsequent utilization of HC/PC among racially and ethnically diverse patients.</p><p><strong>Methods: </strong>A prospective cohort study of newly diagnosed patients ≥18 years old with advanced lung cancer and their caregivers was conducted. Participants completed validated surveys at multiple points and electronic health records were reviewed to evaluate utilization. Logistic regression models were used: (i) to estimate the association between caregiver health belief composite scores and utilization of HC or PC; and (ii) to estimate the association between level of agreement between patient and caregivers, and utilization of HC or PC.</p><p><strong>Results: </strong>Among the 43 patient/caregiver dyads enrolled in the study, 27 (63%) identified as Black and/or Latino (minoritized) and 16 (37%) as Non-Hispanic White (non-minoritized). Mean age was 65.2 ± 10.2 and 52.1 ± 15.2 years among patients and caregivers, respectively. Minoritized patients held more negative health beliefs (2.7 ± 6.7 vs. 7.1 ± 4.9; <i>p</i> = 0.02) than their non-minoritized counterparts however, they were more likely to use HC and/or PC (67% vs. 25%; <i>p</i> = 0.02). Level of health belief agreement between patients and caregivers was lower in minoritized vs non-minoritized dyads (mean (SD) Kappa: 0.31 (0.18) vs. 0.18 (0.18); <i>p</i> < 0.01). Caregiver beliefs and patient/caregiver agreement in beliefs did not predict utilization of HC/PC.</p><p><strong>Conclusion: </strong>Minoritized lung cancer patients held more negative beliefs about HC/PC yet were more likely to receive HC/PC. Further work is needed to understand factors that impact utilization among diverse patients with advanced cancer.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"10499091251318992"},"PeriodicalIF":0.0,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143367204","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":"Determinants of Antibiotic Prescription in Outpatient Hospice: A Regional Observational Study.","authors":"Patrick D Crowley, Francis X Whalen, Leslie R Siegel, Douglas W Challener","doi":"10.1177/10499091251317662","DOIUrl":"https://doi.org/10.1177/10499091251317662","url":null,"abstract":"<p><strong>Background: </strong>Patients enrolling in hospice care are asked their preferences for antibiotic treatment. There is little information regarding which patients are more likely to receive antibiotics. To better inform discussions, we sought to characterize the use of antibiotics in the outpatient hospice setting.</p><p><strong>Methods: </strong>We performed a retrospective review of patients enrolled in outpatient hospice within the Mayo Clinic Health System from 1/1/2017 through 1/1/2023. We calculated what percent of patients received antibiotics based on Hospice Qualifying Condition (HQC), age at enrollment, sex, survival time, and Charlson Comorbidity Index and calculated adjusted odds ratios (aOR). We documented which antibiotics were prescribed based on HQC.</p><p><strong>Results: </strong>Of 6452 patients identified, 1259 (19.5%) received antibiotic prescriptions. Cephalosporins were the most common class of antibiotics prescribed (22.8% of antibiotics prescribed), followed by fluoroquinolones (20.3%) and penicillin derivatives (14.9%). Patients with Pulmonary HQCs were most likely to receive antibiotics (28.6% aOR 1.85 [1.51-2.25]), those with neurologic HQCs were least likely (14.9% aOR 0.66 [0.53-0.83]). There was no difference of age for those receiving antibiotics (80.7 yr) vs those not receiving (80.3 yr [<i>P</i> = 0.25]), or for sex (male vs female aOR 1.10 [0.96-1.26). 4.6% of those surviving <7d received antibiotics (aOR .22 [0.17-0.29]), compared to 47.7% of those surviving >6mo (aOR 4.46 [3.50-5.69]).</p><p><strong>Discussion: </strong>19.5% of patients will receive antibiotics during their hospice course, with more frequent prescriptions in those surviving longer periods and those enrolled for pulmonary conditions. It is important to clarify patient preferences regarding antimicrobial utilization at the time of hospice enrollment.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"10499091251317662"},"PeriodicalIF":0.0,"publicationDate":"2025-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082435","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":"Terminally Ill Patients: Self-Care Abilities and Compassion in Nurses and Informal Caregivers.","authors":"Dilek Baykal, Ezgi Nur Akar, Aysenur Sahin Eraslan, Mihriban Yilmaz","doi":"10.1177/10499091251317585","DOIUrl":"https://doi.org/10.1177/10499091251317585","url":null,"abstract":"<p><strong>Background: </strong>Palliative care units are centers where comprehensive care is provided, primarily by nurses, but also by informal caregivers who are usually the patients' relatives. The difference is that nurses fulfill this duty professionally, and their levels of self-care and compassion are not expected to be affected by their work. In this regard, comparing the levels of compassion and self-care in patients' relatives and nurses will provide evidence to help raise awareness and support both groups.</p><p><strong>Aims: </strong>This study aimed to determine the relationship between the self-care abilities and compassion of nurses and informal caregivers.</p><p><strong>Design: </strong>This was a descriptive, cross-sectional study.</p><p><strong>Settings/participants: </strong>The study was conducted between August 2023 and July 2024 in palliative care units in Istanbul. A total of 98 nurses and 96 informal caregivers participated in the study. They were administered the Exercise of Self-Care Agency Scale and the Compassion Scale.</p><p><strong>Results: </strong>The mean compassion scores of the informal caregivers and nurses were high, with no significant difference (<i>P ></i> .05). However, a significant difference was observed in their self-care ability scores, with nurses scoring lower in self-care compared to informal caregivers (<i>P</i> < .05).</p><p><strong>Conclusions: </strong>Nurses working in palliative care had a similar level of compassion as the primary relatives of the patients. However, it is concerning that the nurses had less ability to engage in self-care than the informal caregivers. This result indicates that nurses need support to enhance their self-care.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"10499091251317585"},"PeriodicalIF":0.0,"publicationDate":"2025-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082396","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":"Embracing Inclusivity in Hospice Care: A Case Study in Supporting HIV Patients.","authors":"Jeff Clyde G Corpuz","doi":"10.1177/10499091241240132","DOIUrl":"10.1177/10499091241240132","url":null,"abstract":"<p><p>Despite the growing prevalence of human immunodeficiency virus (HIV) and acquired immunodefiency syndrome (AIDS) in the Philippines and the psychosocial challenges it engenders, there remains a dearth of research on the intersection of HIV and hospice care. Stigma and discrimination further compound the challenges of providing inclusive hospice care to HIV patients in the country. Drawing upon the results of a recently published article centered on a Veteran assigned male at birth who expressed a desire for gender reassignment while receiving end-of-life care, this paper highlights the importance of sensitivity, understanding, and affirmation in hospice settings for HIV patients in the Philippines.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"217-218"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140178547","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":"New Graduate Nurses' Approaches to Death and Dying Patients and the Relationship Between Death Anxiety and Death Awareness: A Cross-Sectional Study.","authors":"Merve Tarhan, Pinar Dogan","doi":"10.1177/10499091241243196","DOIUrl":"10.1177/10499091241243196","url":null,"abstract":"<p><strong>Background: </strong>One of the challenges experienced by new graduate nurses during the transition into practice is caring for dying patients. This study aimed to determine new graduate nurses' approaches to death and dying patients and the relationship between death anxiety and death awareness.</p><p><strong>Methods: </strong>This descriptive, cross-sectional study was conducted with 226 new graduate nurses in Istanbul, Türkiye. A personal and work environment characteristics form, the Approach to Death and Dying Patients Attitude Scale, Templer's Death Anxiety Scale, and Multidimensional Mortality Awareness Measure were used to collect data.</p><p><strong>Results: </strong>Hardness in communicating with the dying patients (hardness: meaning difficulty) and their relatives and avoiding death and dying patients were considered moderate, with mean scores of 2.64 ± .63 and 2.45 ± .40, out of 4. Death anxiety accounted for approximately 7% of the variance of hardness in communicating with dying patients and their relatives, which is statistically significant. Death awareness statistically significantly explained 9.7% of avoiding death and dying patients.</p><p><strong>Conclusion: </strong>For new graduate nurses, besides simulation-based training on end-of-life care, approaches to sharing their experiences about death and programs to determine a value system related to death may be recommended.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"155-162"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140308437","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":"Survey of NCI-Designated Cancer Centers on the Utilization of Palliative Care in Pancreatic Cancer Patients.","authors":"Anjali Goyal, Amir Steinberg","doi":"10.1177/10499091241242811","DOIUrl":"10.1177/10499091241242811","url":null,"abstract":"<p><p>Recognized as one of the deadliest cancers, pancreatic cancer underscores an urgent need for palliative care. We surveyed palliative care directors at all 65 National Cancer Institute (NCI) cancer centers to assess the utilization and timing of palliative care involvement in pancreatic cancer patients. 1) Does your palliative care team have a policy to get involved with every pancreatic cancer patient? a. Yes b. No 2) When palliative care is involved with pancreatic cancer patients, in what setting are you typically/primarily first asked to be involved? a. Early in the patient's treatment journey (focusing on symptom management) b. Later in the patient's treatment journey (focusing on end-of-life discussions and explaining hospice) All 65 NCI-designated centers responded, achieving 100% of the targeted sample. Among these centers, 64 lacked a policy for palliative care involvement with every pancreatic cancer patient. Additionally, 38 centers initiated intervention early, focusing on symptom management, while 15 centers started palliative care late in the treatment journey, emphasizing end-of-life discussions. Furthermore, 12 centers initiated intervention both early and late when treating pancreatic cancer. There is an increasing recognition among medical centers of palliative care's necessity for pancreatic cancer, with a rising trend toward early integration. Variation in the timing and emphasis of palliative care involvement remains. Future research should explore barriers to accessing palliative care and compare outcomes of early versus late intervention. By addressing these areas, healthcare providers can potentially improve outcomes for pancreatic cancer patients.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"168-171"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140320338","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":"\"COVID-19 and the New Hidden Curriculum of Moral Injury and Compassion Fatigue\".","authors":"Ishani Joshi, Rachel Zemel","doi":"10.1177/10499091241253283","DOIUrl":"10.1177/10499091241253283","url":null,"abstract":"<p><p>Medical students are educated through two dichotomous curriculums, the formal, planned curriculum and the hidden curriculum unintentionally taught through socialization within the culture of medicine. As a consequence of shared trauma amongst the physician workforce during the COVID-19 pandemic, moral injury (MoI) and compassion fatigue (CoF) have become prevalent within the health care system, including palliative care medicine, with echoing ramifications on the observing trainee population. Thus, it is imperative to determine risk factors, protective factors and targeted interventions to offset MoI and CoF within the health care workforce and trainee population. Methods of strengthening personal and institutional resilience are vital to developing long-term structural change replacing the hidden curriculum of MoI and CoF with one of resilience and support. As palliative care providers are especially vulnerable to MoI and CoF, this article will examine the impact of the COVID-19 pandemic on MoI, CoF, and resilience within the hidden curriculum through the lens of palliative care.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"133-139"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141072320","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":"Repeated Filling of Elastomeric Pumps for Home-Based Subcutaneous Infusions: A Cost Analysis of 240 Devices.","authors":"Carolina Simões, Miguel Julião, Patrícia Calaveiras, Elisabeth Costa, Eduardo Bruera","doi":"10.1177/10499091241239929","DOIUrl":"10.1177/10499091241239929","url":null,"abstract":"<p><strong>Background: </strong>The use of continuous subcutaneous infusion of drugs using the repeated filling of elastomeric infuser pumps (EIP) has gained clinical recognition for palliative care at home. However, to date, there has been a notable absence of research examining the cost implications associated with the repeated EIP filling procedure. We aimed to evaluate the cost associated to the repeated filling of EIP used in a home-based palliative care team.</p><p><strong>Methods: </strong>We conducted an analysis of the cost associated to the repeated filling of 240 EIP (1-day, n = 136; 2-day, n = 102; 7-day, n = 2) (110 patients).</p><p><strong>Results: </strong>The refilling procedure led to a reduction in the utilization of 409 devices, resulting in savings of €4.031. EIP refilling did not result in a decrease in the number of home visits, the duration of each visit, the expenses associated with transportation to patients' residences, or the nurse-to-hour cost.</p><p><strong>Conclusion: </strong>Refilling EIPs reduces costs by reducing the number of devices purchased. No additional cost savings were noted in nursing time, number of home visits and duration, and expenses with transportation. Further cost savings could be realized by training laycarers to refill EIP at home independently. Future research should assess the feasibility of laycarers training programs on performing EIP filling at home.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"140-144"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140178549","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}