Journal of palliative medicine最新文献

Context: Psychiatric and existential distress are common and difficult-to-treat symptoms that are frequently encountered in the palliative care setting; current treatment options are limited in efficacy and tolerability. Psychedelic-assisted therapies (PAT) have gained public and scientific interest in their potential to induce rapid and effective reductions in psychiatric and existential distress in patients with serious medical illness, but remain available only in the research setting. Ketamine as a pharmacologic agent has a large body of evidence in the treatment of refractory depression. Objectives: To review the evidence that exists for use of ketamine or ketamine-assisted psychotherapy (KAP) for psychiatric and existential distress in patients with serious medical illness, aiming to identify therapeutic signals and gaps in research. Methods: A literature search identified publications of (1) ketamine or KAP, (2) psychiatric or existential distress, and (3) palliative care or patients with serious medical illness. Identified reports were carefully reviewed with attention to population and treatment-related factors, which were described in a narrative and aggregate format. Results: Nine studies and 12 case reports were identified that reported positive results and a good safety profile. There was significant variation in patient population, setting, route of administration, dosing schedule, and concurrent treatments. Most reports were of ketamine as a pharmacologic agent for symptoms of psychiatric distress. Conclusion: Evidence suggests that ketamine may induce rapid and transient improvements in psychiatric symptoms in patients with serious medical illness. A large gap in research exists for KAP and symptoms of existential distress. There is a signal that suggests ketamine could be used in a psychedelic therapy model with potential benefits over classical psychedelics.

Systemic autoimmune rheumatic diseases (SARDs) consist of a broad range of immune-mediated multisystem diseases. They are chronic, incurable illnesses that often present in early to mid-life and can be associated with a high symptom burden, disability, and early mortality. Treatment guidelines for similar chronic, life-limiting conditions with uncertain disease courses now recommend palliative care (PC) assessment at the time of diagnosis. Recently, the first rheumatology treatment guidelines to recommend PC were also published. Integration of PC into rheumatology offers an opportunity to improve quality of life and deliver better goal-concordant care for people with severe rheumatic disease. This article provides 10 tips to guide PC clinicians when caring for people with rheumatic diseases.

Background: Acute leukemia (AL) affects patients' well-being and inflicts substantial symptom burden. We evaluated palliative care needs and symptom burden in adult patients with AL from diagnosis through fourth week of induction chemotherapy. Methods: Newly diagnosed adult patients with AL scheduled for curative-intent treatments, prospectively completed Functional Assessment of Cancer Therapy-Leukemia questionnaire at diagnosis and postinduction therapy. Subscale scores identified domains with major needs, with lower scores signifying higher needs, while Leu-subscale assessed leukemia-specific symptom burden. Results: One hundred patients were enrolled. Upon diagnosis and four weeks into induction phase, respectively, patients exhibited the lowest scores in physical (17 ± 8.75; 16 ± 11; p < 0.05), functional (16.5 ± 10.75; 11 ± 12.2; p < 0.05), and leukemia-specific (43 ± 16.75; 41.48 ± 11.68; p > 0.05) domains. Predominant symptoms were "getting tired easily" (91%) at diagnosis and "unable to do usual activities" (92.3%) after induction. Conclusion: Patients with AL demonstrated substantial physical, functional, and leukemia-specific symptom needs at diagnosis, which intensified postinduction, highlighting the necessity for palliative care integration from diagnosis.

Introduction: High-quality communication and shared decision making (SDM) are crucial elements of effective patient care. SDM conversations are intimate and logistically challenging to capture. Evaluating alternative methods to effectively observe how physicians conduct these conversations may improve research efforts in this core discipline of medicine. Methods: In two distinct qualitative studies (A and B), subspecialist physicians participated in a telemedicine encounter with a simulated patient facing a high-stakes treatment decision. Results: Thirty-seven transplant hematologists (A) and 21 medical oncologists (B) from across the United States successfully completed a telemedicine encounter with a trained actor, allowing for qualitative analysis of their SDM conversations. Discussion: Simulated telemedicine encounters are a feasible method for studying how a broad sample of subspecialty physicians conduct difficult conversations, such as emotionally fraught SDM conversations. This model could improve understanding of the current practice of SDM, identify opportunities for improvement, and serve as a framework for ongoing research of physician communication practices.