Journal of palliative medicine最新文献

Background: Despite caring for patients with serious illnesses, gastroenterology (GI) fellows rarely receive training in serious illness conversations (SIC). Objectives: To describe the development, implementation, and assessment of GITalk, a novel SIC training for GI fellows. Design: GITalk was based on the REMAP framework and involved two simulated encounters. One case involved a patient with decompensated cirrhosis, and the other case was about feeding tube placement in someone with moderate to severe dementia. Setting and Subjects: GI fellows in an academic medical center in the USA. Measurements: Demographics of the participants, evaluation of the course content, and self-assessed preparedness for SIC. Results: A total of 23 GI fellows participated over 4 consecutive years. Participants had significantly higher mean post-training self-assessed preparedness scores compared to pre-training across all 9 survey questions. 91% of participants strongly agreed with the statement: "I would recommend this training to other fellows." Conclusions: Participants in GITalk reported substantial improvement in self-assessed preparedness for navigating SIC.

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 Dr. Ricky Leiter, Dr. Billy Rosa, and 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 first episode, Drs. Leiter and Rosa interviewed Dr. Charles von Gunten, Clinical Professor of Medicine at the University of California, San Diego, and Editor Emeritus of JPM. What follows is a transcript of their conversation, edited lightly for clarity.

Background and Objective: Palliative care (PC) has demonstrated the ability to improve patient outcomes and quality of life among patients with life-threatening diseases. The current study aimed to investigate the impact of inpatient PC on health care utilization and expenditure among patients with advanced gastrointestinal (GI) cancer. Methods: Patients diagnosed with advanced GI cancer (2007-2019) were identified from the SEER-Medicare database in the United States. Multivariable regression with entropy balancing was used to analyze the association between inpatient PC and outcomes, including readmission, length of stay (LOS), and expenditure. Results: Among 48,100 patients diagnosed with advanced GI cancer (colon: n = 23,080, 48.0%; pancreas: n = 12,280, 25.5%; rectum: n = 6497, 13.5%; biliary: n = 3551, 7.3%; liver: n = 2692, 5.6%), 1277 (2.65%) received PC. Median patient age was 77 (72-83) with most being female (n = 25,687, 53.4%). Patients with PC were more likely to be discharged to skilled nursing facility (SNF) (42.3% vs. 17.9%) and less likely to get readmitted within 30 days (18.2% vs. 28.1%). On adjusted analysis, patients with PC had higher costs at index admission (mean difference [β]: $1,494, 95% confidence interval [CI] $1,394-$1,594) but lower 90-day expenditure (β: -$3,037, 95% CI: -$3,279 to -$2,796). PC was also linked with lower odds of readmission (odds ratio 0.39, 95% CI: 0.33-0.46) and cumulative 90-day LOS (β: -1.31, 95% CI: -1.62 to -0.99). Conclusion: Following inpatient PC, patients with advanced GI cancer experienced fewer readmissions, days in hospital, and lower costs. Integrating PC into cancer care is vital to enhance patient outcomes while alleviating the strain on health care resources.

Background: People with advanced cancer often face significant challenges in everyday activities, especially within their home environments, where they spend most of their time. The Cancer Home-Life Intervention is an occupational therapy-based program supporting everyday activities in people with advanced cancer living at home. Aim: To examine the cost-utility and cost-effectiveness of the Cancer Home-Life Intervention compared to usual care over six months. Methods: This economic evaluation with a societal perspective was conducted alongside a randomized controlled trial (ClinicalTrials.gov: NCT02356627). Quality-adjusted life years (QALYs) and activities of daily living motor ability accounted for the outcome. Costs included primary and secondary health care, domestic care, assistive devices, and participants' out-of-pocket costs. A total of 242 adults with advanced cancer were included from two Danish University Hospitals and randomized 1:1 to the Cancer Home-Life Intervention or usual care. Primary analysis included 172 participants alive at six months follow-up. Results: The intervention showed no statistically significant improvement in either QALYs or activities of daily living motor ability compared to usual care. However, the cost-utility analysis revealed a 72% probability of the intervention being cost-effective, regardless of the willingness-to-pay threshold per QALY gained. The probability of cost-effectiveness for activities of daily living motor ability started at 26% and increased to 58%. Sensitivity analyses supported these findings. Conclusion: The Cancer Home-Life Intervention showed limited potential for cost-effectiveness compared to usual practice. The cost-utility analysis revealed a 72% probability of cost-effectiveness. However, these findings should be interpreted cautiously due to small, nonstatistically significant improvements in QALYs.

Background: International research projects, such as Horizon 2020 (H2020) and ERASMUS+, generate numerous scientific and educational outcomes. However, these are often disseminated in fragmented formats, limiting long-term access and impact. Language barriers further complicate the dissemination in professional communities that do not speak English. Interactive infographic summaries (IISs) offer an innovative solution to these challenges. Objectives: To describe the development of the IIS as a tool to present key findings from three European palliative care projects and the preliminary results of the dissemination. Methods: The IISs developed for three European projects (H2020 Palliative Sedation, ERASMUS+ Research for Palliative Care Clinicians [RESPACC], and ERASMUS+ E-Learning on Palliative Care for International Students [ELPIS]) were selected. These documents were designed using visual communication principles and included interactive elements, such as links to additional resources (videos, articles, and tools). The infographics were translated into multiple languages, and their effectiveness was evaluated based on web traffic, downloads, and readers' feedback. Results: The infographics in 11 languages were shared via project websites, online repositories, and social media. The H2020 Palliative Sedation infographic reached thousands of downloads. The RESPACC infographic allowed free access to research tools in four languages. The ELPIS infographic showcased seven educational projects and was published by all participating universities. Conclusions: IISs facilitate the dissemination of an extensive body of complex scientific information, overcoming barriers of fragmentation and language. They should be considered an essential component in future projects for broadening accessibility and engagement with research findings in palliative care.