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If a Tree Falls?: Using the Electronic Medical Record to Understand How Patients Self-Advocate for Their Health and Quality of Life.
IF 2.2 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-02-10 DOI: 10.1089/jpm.2024.0548
Sneha Padamati, Teresa Hagan Thomas
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引用次数: 0
Factors Influencing Decision Making for Gastrostomy Tube Placement for People Living with Serious Illness: A Scoping Review.
IF 2.2 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-02-10 DOI: 10.1089/jpm.2024.0062
Bridget J Perry, Tabitha H Kao, Brittney A Mancini, Lisa Moran

Background: Gastrostomy (feeding) tubes are one way of managing swallowing impairments (dysphagia) in patients living with serious illnesses. For patients, families, and health care providers to make well-informed, preference-aligned decisions regarding gastrostomy tube placement, each group must understand the other's goals, concerns, and perspectives. Objective: Thus, the goal of this scoping review is to characterize the factors influencing gastrostomy tube placement decisions for people with serious illnesses. Methods: We first identified relevant studies in a systematic manner, using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis flow diagram to model our screening process. We then used deductive thematic analysis to describe major themes, reporting the data with descriptive statistics such as percentages. Studies were categorized by their primary participant populations (patients, caregivers, and health care providers), with subthemes organized within the major themes of goals, concerns, considerations, and decisional preferences. Results: When considering gastrostomy tube placement, the top themes for patients were extending life (56% of studies), decisional control (56%), quality of life (48%), physical and social limitations and image (44%) and personal factors (44%). For caregivers, the primary themes were decisional control (71% of studies), extending life (50%), personal factors (50%), maintaining nutrition (43%), and knowledge (43%). Finally, health care providers prioritized decisional control (58% of studies), knowledge (53%), quality of life (47%), extending life (42%), and societal factors (42%). Conclusions: Our results highlight key factors that may help center patient preferences when making gastrostomy tube-related decisions, as well as critical areas where more research is needed to help improve decision-making surrounding gastrostomy tube placement. Providing adequate knowledge and understanding patient preferences is critical for patients to make high-quality medical decisions regarding gastrostomy tubes.

{"title":"Factors Influencing Decision Making for Gastrostomy Tube Placement for People Living with Serious Illness: A Scoping Review.","authors":"Bridget J Perry, Tabitha H Kao, Brittney A Mancini, Lisa Moran","doi":"10.1089/jpm.2024.0062","DOIUrl":"10.1089/jpm.2024.0062","url":null,"abstract":"<p><p><b><i>Background:</i></b> Gastrostomy (feeding) tubes are one way of managing swallowing impairments (dysphagia) in patients living with serious illnesses. For patients, families, and health care providers to make well-informed, preference-aligned decisions regarding gastrostomy tube placement, each group must understand the other's goals, concerns, and perspectives. <b><i>Objective:</i></b> Thus, the goal of this scoping review is to characterize the factors influencing gastrostomy tube placement decisions for people with serious illnesses. <b><i>Methods:</i></b> We first identified relevant studies in a systematic manner, using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis flow diagram to model our screening process. We then used deductive thematic analysis to describe major themes, reporting the data with descriptive statistics such as percentages. Studies were categorized by their primary participant populations (patients, caregivers, and health care providers), with subthemes organized within the major themes of goals, concerns, considerations, and decisional preferences. <b><i>Results:</i></b> When considering gastrostomy tube placement, the top themes for patients were extending life (56% of studies), decisional control (56%), quality of life (48%), physical and social limitations and image (44%) and personal factors (44%). For caregivers, the primary themes were decisional control (71% of studies), extending life (50%), personal factors (50%), maintaining nutrition (43%), and knowledge (43%). Finally, health care providers prioritized decisional control (58% of studies), knowledge (53%), quality of life (47%), extending life (42%), and societal factors (42%). <b><i>Conclusions:</i></b> Our results highlight key factors that may help center patient preferences when making gastrostomy tube-related decisions, as well as critical areas where more research is needed to help improve decision-making surrounding gastrostomy tube placement. Providing adequate knowledge and understanding patient preferences is critical for patients to make high-quality medical decisions regarding gastrostomy tubes.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143390897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Prediction of Next-Day Survival in Imminently Dying Cancer Patients: A Multicenter Cohort Study.
IF 2.2 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-02-10 DOI: 10.1089/jpm.2024.0334
Masanori Mori, Takuhiro Yamaguchi, Isseki Maeda, Yutaka Hatano, Shih-Wei Chiu, Takashi Yamaguchi, Kengo Imai, Naosuke Yokomichi, Hiroyuki Otani, Jun Hamano, Satoru Tsuneto, David Hui, Tatsuya Morita

Background: Accurate prediction of next-day survival in imminently dying patients is crucial for facilitating timely end-of-life decisions. Objectives: To develop diagnostic models for predicting next-day survival in cancer patients with a Palliative Performance Scale (PPS) score of ≤20. Design: A multicenter, prospective, observational study. Setting/subjects: We enrolled advanced cancer patients at 23 palliative care units across Japan. Measurements: Clinical signs of impending death were recorded daily after patients' PPS scores decreased to ≤20, continuing until death or for up to 14 days. The developed models included the prediction of one-day survival-decision tree (P1d-Survival-DT), based on recursive partitioning analysis, the P1d-Survival-organ system score, which utilized a scoring system across four clinical systems (nervous/cardiovascular/respiratory/musculoskeletal), and the early signs model that focused on the absence of two early signs (altered consciousness and liquid dysphagia). Results: Of the 1896 patients included in the study, 1396 (74%) reached PPS ≤20. The average age was 73 ± 12 years, with 49% being female. The P1d-Survival-DT model showed next-day survival rates of 91.6% for patients with a response to verbal stimuli and no peripheral cyanosis, and 37.1% for those with no response to verbal stimuli and respiration with mandibular movement. The P1d-Survival-organ system score model revealed a 95.9% survival rate for score = 0, decreasing progressively to 46.7% for score = 4. The early signs model predicted a 95.2% survival rate in patients with normal consciousness and no liquid dysphagia. Conclusions: This study successfully developed three distinct models to predict next-day survival in cancer patients with PPS ≤20, offering vital tools for informed decision making in palliative care settings.

{"title":"Prediction of Next-Day Survival in Imminently Dying Cancer Patients: A Multicenter Cohort Study.","authors":"Masanori Mori, Takuhiro Yamaguchi, Isseki Maeda, Yutaka Hatano, Shih-Wei Chiu, Takashi Yamaguchi, Kengo Imai, Naosuke Yokomichi, Hiroyuki Otani, Jun Hamano, Satoru Tsuneto, David Hui, Tatsuya Morita","doi":"10.1089/jpm.2024.0334","DOIUrl":"https://doi.org/10.1089/jpm.2024.0334","url":null,"abstract":"<p><p><b><i>Background:</i></b> Accurate prediction of next-day survival in imminently dying patients is crucial for facilitating timely end-of-life decisions. <b><i>Objectives:</i></b> To develop diagnostic models for predicting next-day survival in cancer patients with a Palliative Performance Scale (PPS) score of ≤20. <b><i>Design:</i></b> A multicenter, prospective, observational study. <b><i>Setting/subjects:</i></b> We enrolled advanced cancer patients at 23 palliative care units across Japan. <b><i>Measurements:</i></b> Clinical signs of impending death were recorded daily after patients' PPS scores decreased to ≤20, continuing until death or for up to 14 days. The developed models included the prediction of one-day survival-decision tree (P1d-Survival-DT), based on recursive partitioning analysis, the P1d-Survival-organ system score, which utilized a scoring system across four clinical systems (nervous/cardiovascular/respiratory/musculoskeletal), and the early signs model that focused on the absence of two early signs (altered consciousness and liquid dysphagia). <b><i>Results:</i></b> Of the 1896 patients included in the study, 1396 (74%) reached PPS ≤20. The average age was 73 ± 12 years, with 49% being female. The P1d-Survival-DT model showed next-day survival rates of 91.6% for patients with a response to verbal stimuli and no peripheral cyanosis, and 37.1% for those with no response to verbal stimuli and respiration with mandibular movement. The P1d-Survival-organ system score model revealed a 95.9% survival rate for score = 0, decreasing progressively to 46.7% for score = 4. The early signs model predicted a 95.2% survival rate in patients with normal consciousness and no liquid dysphagia. <b><i>Conclusions:</i></b> This study successfully developed three distinct models to predict next-day survival in cancer patients with PPS ≤20, offering vital tools for informed decision making in palliative care settings.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Aftermath.
IF 2.2 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-02-10 DOI: 10.1089/jpm.2024.0495
Danielle Ní Chróinín
{"title":"Aftermath.","authors":"Danielle Ní Chróinín","doi":"10.1089/jpm.2024.0495","DOIUrl":"https://doi.org/10.1089/jpm.2024.0495","url":null,"abstract":"","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Clinical Implications of the C-Reactive Protein-Albumin Ratio as a Prognostic Marker in Terminally Ill Patients with Cancer.
IF 2.2 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-02-10 DOI: 10.1089/jpm.2024.0471
Koji Amano, Satomi Okamura, Tomofumi Miura, Vickie E Baracos, Naoharu Mori, Tatsuma Sakaguchi, Yu Uneno, Hiroto Ishiki, Yusuke Hiratsuka, Naosuke Yokomichi, Jun Hamano, Mika Baba, Masanori Mori, Tatsuya Morita

Background: Few studies investigated the clinical implications of C-reactive protein-albumin ratio (CAR) in palliative care. Objectives: To determine the association of CAR with overall survival among terminally ill patients with cance. Design: Datasets were obtained through two multicenter prospective cohort studies. Setting/Subjects: Patients newly referred to palliative care. Measurements: Physicians recorded measures at the baseline. Patients were followed up to their death or observed for 6 months. The patients in cohort 2 were divided using the CAR cutoffs detected using a piecewise linear hazards model in cohort 1. We performed time-to-event analyses using the Kaplan-Meier method and log-rank tests and univariate and multivariate Cox regression analyses for patients in cohort 2. Results: A total of 1554 patients in cohort 1 and 1517 patients in cohort 2 were eligible. The cutoffs were 0.1, 1.2, and 6.4. The patients in cohort 2 were divided into four categories (<0.1 [n = 103], 0.1-1.2 [n = 433], 1.2-6.4 [712], and ≥6.4 [n = 269]). The adjusted p values of the log-rank tests were <0.001. Significantly higher risks of mortality were observed in the Cox proportional hazard model for the higher categories than in the lowest category (CAR 0.1-1.2: adjusted hazard ratio [HR] 1.49, 95% confidence interval [CI] 1.18-1.89; CAR 1.2-6.4: adjusted HR 2.08, 95% CI 1.65-2.62; CAR ≥6.4: adjusted HR 2.94, 95% CI 2.29-3.79). Conclusions: Patients with a higher CAR had significantly higher risks of mortality than those with a lower CAR.

{"title":"Clinical Implications of the C-Reactive Protein-Albumin Ratio as a Prognostic Marker in Terminally Ill Patients with Cancer.","authors":"Koji Amano, Satomi Okamura, Tomofumi Miura, Vickie E Baracos, Naoharu Mori, Tatsuma Sakaguchi, Yu Uneno, Hiroto Ishiki, Yusuke Hiratsuka, Naosuke Yokomichi, Jun Hamano, Mika Baba, Masanori Mori, Tatsuya Morita","doi":"10.1089/jpm.2024.0471","DOIUrl":"https://doi.org/10.1089/jpm.2024.0471","url":null,"abstract":"<p><p><b><i>Background:</i></b> Few studies investigated the clinical implications of C-reactive protein-albumin ratio (CAR) in palliative care. <b><i>Objectives:</i></b> To determine the association of CAR with overall survival among terminally ill patients with cance. <b><i>Design:</i></b> Datasets were obtained through two multicenter prospective cohort studies. <b><i>Setting/Subjects:</i></b> Patients newly referred to palliative care. <b><i>Measurements:</i></b> Physicians recorded measures at the baseline. Patients were followed up to their death or observed for 6 months. The patients in cohort 2 were divided using the CAR cutoffs detected using a piecewise linear hazards model in cohort 1. We performed time-to-event analyses using the Kaplan-Meier method and log-rank tests and univariate and multivariate Cox regression analyses for patients in cohort 2. <b><i>Results:</i></b> A total of 1554 patients in cohort 1 and 1517 patients in cohort 2 were eligible. The cutoffs were 0.1, 1.2, and 6.4. The patients in cohort 2 were divided into four categories (<0.1 [<i>n</i> = 103], 0.1-1.2 [<i>n</i> = 433], 1.2-6.4 [712], and ≥6.4 [<i>n</i> = 269]). The adjusted <i>p</i> values of the log-rank tests were <0.001. Significantly higher risks of mortality were observed in the Cox proportional hazard model for the higher categories than in the lowest category (CAR 0.1-1.2: adjusted hazard ratio [HR] 1.49, 95% confidence interval [CI] 1.18-1.89; CAR 1.2-6.4: adjusted HR 2.08, 95% CI 1.65-2.62; CAR ≥6.4: adjusted HR 2.94, 95% CI 2.29-3.79). <b><i>Conclusions:</i></b> Patients with a higher CAR had significantly higher risks of mortality than those with a lower CAR.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143390866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Development and Validation of Integrated Palliative Care Outcome Scale Short Form for Efficient Specialist Palliative Care Screening in Oncology (ScreeningPALL): A Cross-Sectional Study.
IF 2.2 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-02-10 DOI: 10.1089/jpm.2024.0343
Evelyn Müller, Michael J Müller, Paul Sölder, Beate Rautenberg, Maryam En-Nosse, Gerhild Becker

Background: Widespread implementation of specialist palliative care screening in oncology can be facilitated by efficient screening tools. It has been shown that patient-reported outcome measures are useful as screening tools and might reduce staff effort. Short forms could further improve feasibility. Objective: Development and validation of a short form of the Integrated Palliative Care Outcome Scale (IPOS) for use as a screening tool for specialist palliative care need in patients with incurable cancer. Design: In a cross-sectional study, patients completed the IPOS. In an independent process, the palliative care consultation service assessed specialist palliative care need in each patient through multiprofessional case review (reference standard). Statistical analysis included bootstrapping and binary logistic regression to select suitable items for an IPOS short form and receiver operating characteristics analyses for validation. Setting/Subjects: The analysis included 205 hospital episodes of 194 inpatients and outpatients with incurable cancer (prognosis <2 years) at a German Comprehensive Cancer Center. Results: Possible IPOS short forms of two to eight items showed acceptable or excellent accuracy in predicting specialist palliative care need. A six-item IPOS short form that included the most predictive items of each of the three IPOS dimensions identified specialist palliative care need with 87.5% sensitivity (specificity = 56.4%; area under the curve = 0.786). Conclusions: IPOS short forms can facilitate efficient screening for specialist palliative care need, and the validation results are comparable to the full version of IPOS. Results also indicate which symptoms and problems might be most relevant as red flags in routine data or staff-based screening approaches.

{"title":"Development and Validation of Integrated Palliative Care Outcome Scale Short Form for Efficient Specialist Palliative Care Screening in Oncology (ScreeningPALL): A Cross-Sectional Study.","authors":"Evelyn Müller, Michael J Müller, Paul Sölder, Beate Rautenberg, Maryam En-Nosse, Gerhild Becker","doi":"10.1089/jpm.2024.0343","DOIUrl":"https://doi.org/10.1089/jpm.2024.0343","url":null,"abstract":"<p><p><b><i>Background:</i></b> Widespread implementation of specialist palliative care screening in oncology can be facilitated by efficient screening tools. It has been shown that patient-reported outcome measures are useful as screening tools and might reduce staff effort. Short forms could further improve feasibility. <b><i>Objective:</i></b> Development and validation of a short form of the Integrated Palliative Care Outcome Scale (IPOS) for use as a screening tool for specialist palliative care need in patients with incurable cancer. <b><i>Design:</i></b> In a cross-sectional study, patients completed the IPOS. In an independent process, the palliative care consultation service assessed specialist palliative care need in each patient through multiprofessional case review (reference standard). Statistical analysis included bootstrapping and binary logistic regression to select suitable items for an IPOS short form and receiver operating characteristics analyses for validation. <b><i>Setting/Subjects:</i></b> The analysis included 205 hospital episodes of 194 inpatients and outpatients with incurable cancer (prognosis <2 years) at a German Comprehensive Cancer Center. <b><i>Results:</i></b> Possible IPOS short forms of two to eight items showed acceptable or excellent accuracy in predicting specialist palliative care need. A six-item IPOS short form that included the most predictive items of each of the three IPOS dimensions identified specialist palliative care need with 87.5% sensitivity (specificity = 56.4%; area under the curve = 0.786). <b><i>Conclusions:</i></b> IPOS short forms can facilitate efficient screening for specialist palliative care need, and the validation results are comparable to the full version of IPOS. Results also indicate which symptoms and problems might be most relevant as red flags in routine data or staff-based screening approaches.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143390870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Fast Facts and Concepts #501: Antidepressant Pharmacogenomics.
IF 2.2 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-02-06 DOI: 10.1089/jpm.2025.0038
Cari Low
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引用次数: 0
My Dad-the Hospice Graduate….
IF 2.2 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-02-03 DOI: 10.1089/jpm.2025.0011
Michael J Zoosman
{"title":"My Dad-the Hospice Graduate….","authors":"Michael J Zoosman","doi":"10.1089/jpm.2025.0011","DOIUrl":"https://doi.org/10.1089/jpm.2025.0011","url":null,"abstract":"","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143079897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Top Ten Tips Palliative Care Clinicians Should Know About Caring for Patients with Myeloproliferative Neoplasms. 姑息治疗临床医生应了解的护理骨髓增生性肿瘤患者的十大技巧。
IF 2.2 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-02-01 Epub Date: 2024-08-20 DOI: 10.1089/jpm.2024.0221
Jill Brennan-Cook, Lindsay Rein, Andrew Kuykendall, Natasha Johnson, Amie Koch, Allison O Taylor, Christopher A Jones, Thomas W Leblanc

Myeloproliferative neoplasms (MPNs) are a group of rare chronic progressive blood cancers that vary widely in clinical presentation, yet all patients have a risk of disease progression and thrombotic complications. Diseases include primary myelofibrosis, polycythemia vera, and essential thrombocythemia. With current treatment approaches, most patients live a prolonged life, but many experience a complex of symptoms that negatively influence their functional status and quality of life. Although significant advances have been made in preventing arterial and venous complications while mitigating inflammatory processes, comprehensive palliative care can help address unmet complex physical and psychosocial needs on a long-term basis. This article, created by a multidisciplinary group of providers, offers an overview of MPNs so palliative care clinicians can better support patients with these hematologic cancers.

骨髓增生性肿瘤(MPNs)是一组罕见的慢性进展性血癌,临床表现千差万别,但所有患者都有疾病进展和血栓并发症的风险。这些疾病包括原发性骨髓纤维化、真性多血细胞增多症和原发性血小板增多症。通过目前的治疗方法,大多数患者可以延长寿命,但许多患者会出现一系列症状,对其功能状态和生活质量造成负面影响。尽管在预防动脉和静脉并发症以及减轻炎症过程方面已经取得了重大进展,但全面的姑息治疗有助于解决长期未得到满足的复杂生理和心理需求。本文由一个多学科医疗小组撰写,概述了多发性骨髓瘤,以便姑息关怀临床医生能够更好地为这些血液肿瘤患者提供支持。
{"title":"Top Ten Tips Palliative Care Clinicians Should Know About Caring for Patients with Myeloproliferative Neoplasms.","authors":"Jill Brennan-Cook, Lindsay Rein, Andrew Kuykendall, Natasha Johnson, Amie Koch, Allison O Taylor, Christopher A Jones, Thomas W Leblanc","doi":"10.1089/jpm.2024.0221","DOIUrl":"10.1089/jpm.2024.0221","url":null,"abstract":"<p><p>Myeloproliferative neoplasms (MPNs) are a group of rare chronic progressive blood cancers that vary widely in clinical presentation, yet all patients have a risk of disease progression and thrombotic complications. Diseases include primary myelofibrosis, polycythemia vera, and essential thrombocythemia. With current treatment approaches, most patients live a prolonged life, but many experience a complex of symptoms that negatively influence their functional status and quality of life. Although significant advances have been made in preventing arterial and venous complications while mitigating inflammatory processes, comprehensive palliative care can help address unmet complex physical and psychosocial needs on a long-term basis. This article, created by a multidisciplinary group of providers, offers an overview of MPNs so palliative care clinicians can better support patients with these hematologic cancers.</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"257-264"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142004403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Palliative Care and End-of-Life Care in Metastatic Pancreatic Cancer. 转移性胰腺癌的姑息治疗和临终关怀。
IF 2.2 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-02-01 Epub Date: 2024-12-05 DOI: 10.1089/jpm.2024.0313
Jenny O'Brien, Brenton Halsey, Meghan Connors, Mengying Deng, Elizabeth Handorf, Giuliana Berardi, Shannon Lynch, Kristen Sorice, Sanjay Reddy, Joshua Meyer, Jessica Bauman, Efrat Dotan

Background: Patients with metastatic pancreatic cancer (mPC) have a five-year survival of 2.7%. Studies have shown that patients with mPC receive aggressive care at the end of life (EOL), which has been associated with worse quality of life for patients and high use of health care resources when they are least likely to benefit patients. Multiple studies suggest that integration of palliative care (PC) teams often leads to less aggressive EOL care. Methods: A retrospective database of patients with mPC treated at a tertiary cancer center between 2010 and 2021 was analyzed for utilization of PC consultation and EOL care. Results: We identified 610 patients with mPC, of whom 39% were seen by PC, 56% were referred to hospice, and 91.8% are deceased. The average time from mPC diagnosis to PC consult was 232 days, the average time from PC consult to death was 121 days. Patients who had PC consultations were less likely to receive chemotherapy within 14 days of death (7.7% vs. 13.3%, p = 0.05), more likely to have a do not resuscitate (DNR) code status (83.3% vs. 44.5%, p < 0.0001), and more likely to be referred to hospice (83.9% vs. 35.9%, p < 0.0001). The average length of time on hospice was 24 days with no difference between those who saw PC and those who did not. Patients who were referred to hospice were also less likely to receive chemotherapy within 14 days of death (6.7% vs. 19.8%, p < 0.0001). Lastly, no significant difference was observed in mean overall survival from time of diagnosis in patient referred to PC and those who were not (349.4 vs. 349.6 days, p = 0.992). Conclusions: Patients with mPC who had a PC team involved in their care were significantly less likely to receive aggressive EOL care.

背景:转移性胰腺癌(mPC)患者的5年生存率为2.7%。研究表明,mPC患者在生命末期(EOL)接受积极的护理,这与患者的生活质量下降和医疗资源的高度使用有关,而这些资源最不可能使患者受益。多项研究表明,姑息治疗(PC)团队的整合往往导致较少侵略性的EOL护理。方法:回顾性分析2010年至2021年在某三级肿瘤中心治疗的mPC患者的PC咨询和EOL护理的利用情况。结果:我们发现610名mPC患者,其中39%接受PC治疗,56%转介安宁疗护,91.8%死亡。从mPC诊断到PC会诊的平均时间为232天,从PC会诊到死亡的平均时间为121天。接受PC会诊的患者在死亡后14天内接受化疗的可能性较小(7.7%比13.3%,p = 0.05),更有可能出现不复苏(DNR)代码状态(83.3%比44.5%,p < 0.0001),更有可能转到安宁疗护(83.9%比35.9%,p < 0.0001)。接受临终关怀的平均时间为24天,在接受PC治疗的患者和没有接受PC治疗的患者之间没有差异。转介至安宁疗护的患者在死亡后14天内接受化疗的可能性也较低(6.7%比19.8%,p < 0.0001)。最后,诊断为PC的患者与未诊断为PC的患者的平均总生存时间无显著差异(349.4天对349.6天,p = 0.992)。结论:有PC团队参与治疗的mPC患者接受积极的EOL治疗的可能性显着降低。
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Journal of palliative medicine
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