Journal of palliative medicine最新文献

Many patients who could benefit from palliative care (PC) do not access it because of the timing and tenor of the introduction provided by their specialist. A barrier to improving specialists' (from disciplines other than PC) engagement with PC services may be an inadequate understanding of how those specialists view PC. As part of a larger project to develop public messaging for advance care planning, PC, and hospice, we conducted a qualitative market research study aimed at identifying the "deep metaphors" held by specialists about PC to provide an empirical foundation for more effective outreach and messaging. To identify deep metaphors, we used the qualitative Zaltman Metaphor Elicitation Technique to uncover thought patterns from participants' images and interview responses, revealing deeper emotional meanings and unconscious mental orientations. We enrolled 20 provider-level clinicians from a variety of professional disciplines and specialties to participate in a one-hour semi-structured interview that required prework. The interviews were videorecorded and transcribed and were analyzed along with images brought by participants using a variation of the constant comparative method. The themes included: Having to tell patients the "right" information and path; Not allowing myself to make mistakes; Depending on algorithms so I can give my patients the best care; Putting the patient in charge can challenge clinical algorithms; Observing that PC seems to lack an objectively "right" decision; Consulting PC invites subjectivity best contained at the end of the algorithm. These themes can inform strategies for outreach and messaging to other serious illness specialist clinicians to lower reluctance to consult PC, increasing patient access.

Even though pruritus affects a significant number of people with chronic disease, it is rarely adequately treated. Drug therapies often rely on antihistamines, which have not shown to be beneficial in systemic pruritus. Hydroxyzine is frequently used to treat pruritus associated with kidney failure. Since Canada's sole manufacturer of hydroxyzine is no longer making this product, this is an ideal time to review the mechanisms of itch in advanced organ failure and the specific therapies that give relief. Although there is literature describing itch in patients with cancer, this article is limited to pathogenesis and treatment of systemic itch secondary to chronic, noncancer diseases. We summarize recent systematic reviews, although the studies included in these reviews are often small, and mostly cohort studies.

Therapeutic clinical relationships and skilled communication are foundational elements of high-quality hospice and palliative care. Both require that we draw on the most valuable, yet limited, resource in our practice: clinician time. As the demand for serious illness care continues to outpace the supply of trained palliative care clinicians, we must consider time-efficiency as a key component of clinical effectiveness. Equally, many skilled interventions, including serious illness communication, can occur during time-efficient encounters, which still preserve compassion and authentic presence. This report invites clinicians to reevaluate the meaning and use of time in modern palliative care practice and offers six strategies to enhance time-efficiency in daily clinical care.

Background: The Triple Aim of health care involves the simultaneous pursuit of improving the individual experience of care, population health, and reducing per capita costs of care. Our institution established a Mortality Review Committee (MRC) to review instances of inpatient mortality as part of continuing quality improvement with the goal of improving goal concordant care. In this article, we report the experience of MRC. Measures/Interventions: In April 2022, an MRC was formed to evaluate inpatient and 30-day hospital mortality mortalities at our institution. The committee was formed with representation across the entire medical staff. The primary feature of each review was to characterize if the episode of care surrounding the mortality had a learning and/or improvement opportunity associated with the episode of care. Opportunities included improvements in documentation, communication between patients and/or care team, medically futile treatments or procedures, and consideration of interventions, adverse medical and surgical complications. Results: Patients with goals of care (GOC) discussion or palliative care visit prior to admission were significantly less likely to have a learning opportunity (29% vs. 51%, p < 0.001) and (37% vs. 48%, p < 0.001), respectively. The frequency of GOC conversations remained stable throughout the course of this intervention, although an increase in hospice referrals ensued. Discussion: The MRC promoted open conversation across an interdisciplinary team to understand how the health system could have better served patients who experienced hospital associated mortality. These meetings frequently gravitated toward documentation and communication with a particular focus on earlier GOC discussions and shared decision making across a patient's disease course. Our MRC committee has helped foster a cultural shift of the integration of advanced care/end of life planning at earlier stages of patients' treatment courses.

Background: Patients report fatigue as the most distressing symptom associated with cancer and treatment. Baduanjin has beneficial effects on reducing fatigue. However, no relevant randomized controlled trials comparing the effects of Baduanjin exercise with routine exercise in patients with lung cancer and fatigue have been reported. Methods: This blinded trial aimed to compare the effect of Baduanjin versus routine exercise on fatigue for patients with lung cancer. Participants in the intervention group received Baduanjin training and performed Baduanjin every week, while those in the control group performed routine exercise at the same frequency. Results: A total of 73 patients were analyzed. After the intervention, patients in the Baduanjin group experienced significant improvement in fatigue and pain (p < 0.05), while no significant difference in Edmonton Symptom Assessment System items were observed among patients in the exercise group. Conclusion: Our study showed that Baduanjin was a better exercise than routine activity in relieving their fatigue.

Mental health issues are widespread and significant among individuals with serious illness. Among patients receiving palliative care (PC), psychiatric comorbidities are common and impact patient quality of life. Despite their prevalence, PC clinicians face challenges in effectively addressing the intricate relationship between medical and psychiatric disorders due to their complex, intertwined and bidirectionally influential nature. This article, created collaboratively with a team of psychiatric-palliative care experts, is the second in a two-part series examining the bidirectional relationship between medical and psychiatric illness in PC. This article explores 10 prevalent psychiatric manifestations associated with severe illness and its treatment. Building upon the first article, which focused on 10 common physical manifestations of psychiatric illness among patients receiving PC, these two articles advocate for an integrated approach to PC that prioritizes mental and emotional wellbeing across the continuum of serious illness.