Journal of palliative medicine最新文献

Introduction: Interhospital transfer (IHT) can be lifesaving but is associated with longer length of stay, higher costs, and increased inpatient mortality. Little is known about communication and decision-making processes surrounding IHT. Methods: We conducted semi-structured interviews with the surrogate decision-makers of 32 patients who died after IHT, examining perspectives on end-of-life preparations and their impact on the transfer decision-making process and surrogate coping. Results: Several themes emerged surrounding the role of end-of-life planning in IHT: (1) although end-of-life (EOL) planning practices were heterogeneous, respondents reported limited direct insight into transfer preferences; (2) surrogates extrapolated from information about other EOL care preferences to guide transfer decision-making; and (3) serious illness communication and advance care planning (ACP) played a role in surrogate coping. Conclusion: IHT is often not treated as a preference-sensitive decision; however, there is likely a role for improvements in ACP conversations to guide patients and families through goal-concordant transfer decision-making.

Background: Access to specialized palliative care (SPC) has improved but continues to be a concern. For-profit (FP) hospitals are less likely to offer SPC than hospitals with other ownership types, though the reason for this is not well understood. Objectives: The primary objective was to introduce a new measure of access, percent of patients admitted to hospitals offering SPC, and to estimate SPC access for each state. Secondary objectives were to examine availability of other low revenue services as well as high-revenue services, and to explore availability of SPC within multihospital systems. Design: The 2021 American Hospital Association Annual Survey provided data on hospital characteristics and service offerings. These data were used to estimate access measures. Correlations between ownership type and service offering were estimated using logistic regression. Subjects: Acute care hospitals in the United States. Results: Nationally 81% of hospitalized patients were admitted to hospitals offering SPC. Only 48% of hospitals offered these services. Not-for-profit and public hospitals had higher adjusted odds of offering SPC and other low-revenue, high-value services (adjusted odds ratios ranged from 1.33 to 4.50). Their odds of offering most high-revenue, low-value services were lower or did not have statistically significant differences. Multihospital FP systems varied in the percent of their hospitals offering SPC. Conclusions: The majority of hospitalized patients have access to SPC, even in many states where less than 50% of hospitals offer it. Financial characteristics of SPC contribute to its low uptake by for-profit hospitals. Multihospital systems differ in their adoption of SPC.

Background: Children who lose a sibling often receive inadequate attention, leading to lasting psychological and emotional challenges. Health care providers recognize the importance of comprehensive bereavement support but may lack knowledge for effective delivery. Aim: This study sought to analyze and synthesize primary research on children bereaved by a sibling to gain insight into their actual grieving experiences. Methods: A systematic review of qualitative studies was conducted following the Joanna Briggs Institute (JBI) methodology. The review protocol was registered on PROSPERO (CRD42022289604). Electronic databases including MEDLINE, CINAHL, PsycInfo, Scopus, and Igaku Chuo Zasshi were searched from inception to April 15, 2024. Critical appraisal was performed using the JBI Critical Appraisal Checklist for Qualitative Research. Results: Twenty-three articles met inclusion criteria, synthesizing experiences of 466 children. Four synthesized findings were generated: Children recognized internal and external changes in themselves after losing their siblings; children found it hard to believe their sibling had died, experienced feelings of loss and fear of death, and sometimes hid their emotions; various types of grief work allowed children to find their place after the loss, but ineffective grief work led to prolonged grief; and children's relationships with others were either strengthened or weakened depending on others' understanding and reactions to the loss. Conclusions: This review highlights the complex nature of sibling grief in children. It emphasizes the importance of recognizing children's unique grief experiences, facilitating effective grief work, and providing appropriate support from family, friends, and health care professionals. The findings suggest a need for tailored grief support programs for children who have lost siblings, considering their cultural backgrounds. However, the low ConQual score of the synthesized findings indicates that recommendations should be considered with caution.

Background: The imperative to integrate primary palliative care (PPC) into primary health care provides a compelling rationale for U.S.-based educational initiatives to prepare frontline health providers to deliver PPC across settings. Physicians, advanced practice registered nurses (APRNs), and physician assistants (PAs) are positioned as autonomous decision-makers. Therefore, their education should include PPC fundamentals critical to high-quality serious illness care. Objective: To conduct an integrative review of best teaching practices in PPC education for medical, APRN, and PA students preparing for frontline provider roles in the United States. Methods: A systematic search of peer-reviewed literature published between 2011 and 2025 was conducted. Studies describing PPC educational interventions or curricula for medical, APRN, or PA students were included. Data extraction and thematic synthesis were guided by the National Consensus Project Clinical Practice Guidelines for Quality Palliative Care and Kirkpatrick's model of assessing educational outcomes. Results: A total of 1691 articles were identified. After screening 1256 titles and abstracts and reviewing 292 full-text articles, 64 studies met inclusion criteria. Most studies focused on medical students (94%), with fewer addressing APRN (13%), PA (2%), or interprofessional cohorts (16%). A majority were descriptive or nonempirical (88%) and focused on structural and process-oriented components of PPC education (89%). Eighty-four percent employed multifaceted teaching approaches. Five consensus themes emerged as best practices: (1) multifaceted teaching strategies, (2) interprofessional education, (3) reflective and/or humanities-based experiences, (4) early and repeated exposure, and (5) availability of teaching resources. Conclusion: While the literature supports improvements in learners' knowledge, skills, and attitudes, few studies evaluate higher-level outcomes such as long-term skill retention or impact on patient and system-level care. This review provides lessons learned and evidence-informed recommendations to guide curricular development and identifies key gaps to inform future educational research to better prepare frontline health professions students in delivering high-quality PPC.

Bereavement is a significant social stressor associated with heightened mortality risk. To date, the role of social health in this relationship remains unclear. This systematic scoping review synthesizes the literature examining the association between social health and mortality risk among bereaved individuals. A comprehensive literature search was performed in the following databases from inception-July 2024: Ovid MEDLINE, Ovid EMBASE, CINAHL, AgeLine, PsycINFO, Web of Science, and Scopus. The study was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) methodological framework. A total of 23 studies with significant heterogeneity in measurement methods and contexts met the criteria for inclusion in this review. Overall, the literature suggests the social health of bereaved individuals is associated with both increased and decreased mortality risk; often dependent on social contexts and/or based on certain factors (e.g., sex, time since death). Higher and consistent levels of perceived social support were associated with reduced mortality risk. Declining support trajectories and perceived isolation were linked to increased risk. Remarriage and diverse network connections (e.g., family and nonfamily support) were protective, but this association varied by gender and cause of death. Limited sampling of non-Western populations, inconsistent use of validated tools, and a focus on spousal bereavement represent limitations of research conducted to date. Results suggest that bereavement-related mortality risk associated with social structural factors (e.g., remarriage) may be promising avenues of future research. Future research should explore mechanisms of these associations and expand to diverse populations and bereavement types to advance understanding of the role of social health in bereavement-related mortality risk.

Background: Patients with end-stage kidney disease (ESKD) face significant barriers to accessing hospice services in the United States, where Medicare Local Coverage Determination (LCD) guidelines significantly contribute to establishing hospice eligibility, ostensibly by identifying patients with an estimated life expectancy of six months or less. Objective: Researchers sought to determine whether LCD guidelines for ESKD accurately identified patients with a six-month prognosis. Design: This study utilized a retrospective cohort design. Setting/Subjects: Medicare beneficiary data from a large midwestern Accountable Care Organization, collected between October 2017 and May 2024, were included in study analyses. Data were included for decedent patients who had chronic kidney disease at the time of death, met LCD guidelines for ESKD at the time of death, and had laboratory testing completed in the 180 days prior to death. Data Analysis: Data were analyzed via nonparametric maximum likelihood survival analyses to assess the length of time the patients had met LCD guidelines for ESKD prior to death. Results: Among 769 patients who met LCD guidelines for ESKD at the time of death, the probability of a patient meeting LCD guidelines for ESKD for at least one month prior to death was 0.28 (95% confidence interval [CI]: 0.24, 0.32), the probability of meeting these guidelines for at least six months prior to death was 0.05 (95% CI: 0.03, 0.09), and the median time of meeting these guidelines was nine days prior to death. Conclusions: Results indicated that hospice LCD guidelines inaccurately predicted six-month life expectancy for patients with ESKD, suggesting they may be inappropriate for use in determining hospice eligibility.