Journal of palliative medicine最新文献

The Journal of Palliative Medicine's "Tell Us More: The Palliative Care Oral History Project," seeks to tell the story of Hospice and Palliative Care through informal interviews with pivotal leaders in the field. In each episode, hosts Drs. Ricky Leiter and Billy Rosa, along with research assistant Dr. Yilong Peng, sit down with an HAPC luminary and do what our field does best-ask questions, listen, and reflect. In the third episode, Drs. Leiter and Rosa interviewed Ms. Shirley Otis-Green, founder of Collaborative Caring and a pioneer in palliative social work. What follows is a transcript of their conversation, edited lightly for clarity.

Background: While virtual reality (VR) is a valuable therapeutic tool, its utility for hospice and palliative care (HPC) is understudied.

Objectives: We explored the use of VR with patients receiving inpatient HPC.

Design: Mixed methods study examining feasibility and clinical outcomes of a VR program.

Setting/subjects: Twenty-five veterans with complex medical and psychiatric comorbidities at a Veterans Affairs hospital participated. Data related to self-reported pain and well-being, as well as session feedback, were gathered.

Results: Despite some challenges with setup, 91% reported enjoyment, and 90% would participate again. Travel experiences were most popular, allowing reminiscence and touring of bucket-list destinations. Program feedback suggested improvements in anxiety, mood, and boredom.

Conclusions: Results demonstrate the use of VR to facilitate meaningful engagement and improve psychological well-being for veterans receiving HPC. Additionally, opportunities for socialization and reminiscence, even while bedbound, increased. These findings support further exploration of VR as an intervention in HPC.

Background: Children with medical complexity (CMC) have chronic conditions often involving technology assistance, care from family caregivers and clinicians, and substantial health care needs. Previous studies have identified communication gaps between family caregivers of CMC and their child's clinicians, as well as a need for clinicians to better understand their lived experience. Approaches using photos may be a way for CMC and their family caregivers to share their experience with clinicians.

Objective: To conduct a scoping review of the literature and describe findings from studies using photo-based approaches with CMC, their family caregivers, and clinicians.

Methods: PubMed, PsycInfo, and Web of Science were searched following Joanna Briggs Institute scoping review guidelines. Abstract screening and full-text reviews were performed using Covidence software. Studies were eligible if they: (1) included CMC up to age 25, and/or their family caregivers, and/or clinicians; (2) used a photo-based approach (photo-elicitation, photovoice, photo-narrative); (3) were published in the last 20 years; and (4) were written in English.

Results: One hundred twenty-three studies were identified, including 83 identified through an initial search with a research center librarian, with additional studies identified through hand-searching. A final of 25 studies were included. Participants found photo-based approaches to sharing their experience to be both useful and enjoyable. A synthesis of the data presented in these studies yielded nine themes/dimensions describing the multidimensional experience of CMC, their family caregivers, and clinicians. These dimensions were organized into three areas: relational (independence vs. dependency, deepening relationships vs. straining relationships, and inclusion vs. stigmatization), navigational (feeling typical vs. feeling different, advocacy vs. subjugation, and participation vs. barriers), and emotional (predictability vs. uncertainty, well-being vs. exhaustion, and growth vs. loss).

Conclusion: This scoping review describes how photo-based approaches may be used to explore the multidimensional experience of CMC, their family caregivers, and clinicians.

As hospice and palliative care (HPC) expands, it faces the challenge of serving patients from diverse cultural and religious backgrounds. Understanding these communities' unique values during critical life transitions is essential. This article presents two case narratives illustrating reservations toward HPC in South Asian Muslim (SAM) communities, highlighting challenges and proposing strategies for culturally sensitive care. The first case demonstrates that, even with evidence-based and empathetic approaches, hesitancy toward HPC may persist. This underscores the need for (1) community-level initiatives leveraging religious and cultural platforms to educate and engage communities, and (2) greater awareness among healthcare professionals of these values to minimize conflict and reduce provider distress. In the second case, Islamic scholars were consulted regarding the use of sedative medicines at the end of life. They agreed such use is permissible under the principle of medical necessity, emphasized deference to medical expertise, and stressed preserving the patient's ability to recite the Shahadah (testimony of faith) in their final moments.

Background: Artificial intelligence (AI) is transforming health care by enhancing diagnostics, improving patient outcomes, and reducing administrative burdens through advanced algorithms, with applications in medical imaging, virtual care, and automated data analysis. However, its role in palliative and hospice care remains underexplored.

Aim: This review synthesizes research on AI applications in palliative and hospice care, examining its technological and clinical contributions to inform future research and guide clinical implementation.

Design: An integrative literature review, guided by Whittemore and Knafl's framework, analyzed qualitative, quantitative, and mixed-method studies. Registered with PROSPERO.

Data sources: A comprehensive search across 11 databases: Academic Search Complete, CINAHL, Cochrane Library, PubMed, Medline, Web of Science, Scopus, PsycINFO, ProQuest Dissertations & Theses Global, ACM Digital Library, and IEEE Xplore, identified English-language studies published from 2010 to 2024. Studies on AI applications in clinical settings, model validation, and key findings were included, with quality assessed using the Mixed Methods Appraisal Tool.

Results: Seventy studies (2018-2024) were included, primarily quantitative analyses of retrospective clinical and administrative data. AI applications supported mortality prediction, symptom monitoring, patient needs identification, communication facilitation, care planning, and resource allocation. Early tools included rule-based and structured-data models, while more recent approaches integrate unstructured clinical notes, wearable devices, and multimodal data for individualized prognostication and timely interventions. Key barriers included reliance on retrospective or single-center datasets, limited generalizability, ethical and equity concerns, and challenges in integrating AI into clinical workflows.

Conclusions: AI holds potential in enhancing timely, patient-centered palliative and hospice care, supporting prognostication, symptom management, and decision-making. Successful integration requires attention to clinician trust, workflow alignment, equity, and ethical considerations. To maximize its impact on underutilization, future research should focus on multicenter validation, representative datasets, ethical deployment, and seamless integration into clinical practice.

Background: Physician-assisted death (PAD) is a controversial practice, legal in mostly wealthy European countries and U.S. states with a lower-than-average proportion of Black residents. Although studies report lower support for PAD among Black Americans, a comprehensive review of the association between PAD attitudes and race and ethnicity is lacking. This narrative review sought to clarify the association between race and/or ethnicity and attitudes toward PAD, while exploring possible explanatory factors.

Methods: A comprehensive search of PubMed, Web of Science Core Collection, and PsycINFO databases through December 2024, supplemented by citation follow-up and manual searches.

Results: The search yielded 64 eligible studies. These studies varied in sampling method, populations, studied, survey questions, and timing. To account for quality, studies were grouped into those employing random (38) versus nonrandom (26) sampling. Across both categories, White respondents consistently demonstrated higher support for PAD than racial and ethnic minority groups, particularly Black Americans, in both unadjusted and adjusted analyses. Although some studies show adding religion variables eliminates this association, the largest and most methodologically rigorous studies still show that race and ethnicity retain an independent association with PAD attitudes. Notably, there was a paucity of studies examining trust in the health care system as a potential factor.

Conclusions: Overall, the evidence suggests lower support for PAD among racial and ethnic minority groups that may reflect, in part, distinct sociocultural factors extending beyond religion or socioeconomic status. This review highlights the need for more research on trust in health care and nuanced understanding to guide discussions on PAD policy and practice in diverse populations.