Annals of palliative medicine最新文献

People with life-threatening illness frequently experience progressive functional decline and shifting priorities that require a flexible, individualized approach to rehabilitation. However, rehabilitation services within palliative care remain underutilized and are often poorly understood. This clinical practice review describes the importance of integrating relationship-centered care principles into palliative rehabilitation to enhance communication, shared decision-making, and alignment of care with patient values. A data-driven case vignette of a hospitalized patient illustrates the complexities and missed opportunities that can occur when rehabilitation care is not guided by relationship-centered principles. A review of the literature was conducted using PubMed, CINAHL, and Google Scholar from 2015 through 2025. Search terms included "palliative rehabilitation, relationship-centered care, shared decision making, communication, person-centered care, interdisciplinary rehabilitation, and advanced illness". Reference lists of key articles and reviews were also examined. Articles were included if they addressed communication, decision-making, or relational aspects of care within rehabilitation or palliative contexts. Both empirical and conceptual papers were reviewed, along with consensus documents from professional and governmental agencies and clinical summaries from authoritative book chapters. Only English-language publications focusing on adult populations were included. The literature indicates that palliative rehabilitation differs from conventional models by emphasizing adaptation to changing patient goals, unpredictable disease trajectories, and the psychosocial realities of serious illness. Relationship-centered care appreciates that rehabilitation care takes place within systemic and relational structures of care such as reimbursement requirements, time pressures, trustworthy relationships and power imbalances. The case vignette demonstrates how collaborative, values-based decision-making is challenging but essential to improve to better align with one's medical circumstances and patient and professional priorities. Literature reviews and our clinical experiences underscore the importance of flexible communication strategies, interdisciplinary collaboration, and an appreciation of the relational dimensions inherent in therapeutic encounters. Palliative rehabilitation represents a critical intersection of physical restoration, emotional support, and relational care. Although these challenges are often most evident during hospitalization, integrating relationship-centered principles into any rehabilitation setting can optimize quality of life, preserve dignity, and improve alignment of care with patient goals. These insights have implications for clinical training, interdisciplinary practice models, and policy initiatives aimed at expanding access to rehabilitation for individuals with advanced disease.

Metastatic breast cancer (MBC) remains incurable, but as survival improves, individuals are living longer and experience complex, evolving needs that span medical, psychosocial, and existential domains. These needs are often inadequately addressed by existing care models. Survivorship programs frequently exclude those with incurable disease, while palliative care is commonly delayed due to stigma, misperceptions, and systemic barriers. This paper explores the critical intersection of survivorship and palliative care in the context of MBC, advocating for an integrated, person-centered model that combines the strengths of both approaches. A blended model offers a comprehensive framework that prioritizes quality of life, enhances care coordination, and ensures timely, values-aligned interventions across the full course of illness. Key components of this approach include interprofessional collaboration, proactive needs assessment, caregiver inclusion, and culturally responsive support. Successful implementation depends on clear role definition among providers, sustainable system-level investment, and the active involvement of patients and caregivers in designing flexible and inclusive care pathways. This model reframes MBC as a long-term condition that requires sustained, holistic support rather than being seen solely as a terminal diagnosis. By doing so, it enables individuals to receive the care they need to live with dignity, purpose, and consistent support throughout their journey.

Background: Persistent postural-perceptual dizziness (PPPD) is a chronic vestibular disorder with psychological components. Cognitive behavioral therapy (CBT) is commonly used to manage its emotional aspects; however, emotional freedom techniques (EFT)-which combine cognitive reframing with acupoint tapping-have shown efficacy in various psychiatric conditions. Despite its potential, EFT has not been evaluated for PPPD. This study aims to address this gap through a pragmatic clinical trial.

Methods: Thirty patients aged 19-65 years diagnosed with PPPD will be recruited from multiple centers and randomly assigned (1:1) in a blinded manner to either an intervention group or a control group. Key exclusion criteria are severe psychiatric or neurological disorders. The intervention group will receive EFT alongside conventional treatment, including acupuncture and herbal medicine, while the control group will receive conventional treatment alone. The study will last 4 to 8 weeks, comprising nine visits. All treatments will adhere to standardized protocols across centers.

Discussion: PPPD is associated with substantial functional and psychological burden, highlighting the need for effective non-pharmacological interventions. Given prior evidence supporting EFT in conditions involving emotional dysregulation, its application to PPPD warrants systematic evaluation. Although the sample size in this pilot trial is limited, the study is designed to assess the feasibility and potential clinical value of EFT, and its findings may serve as foundational data for future large-scale confirmatory research.

Trial registration: Clinical Research Information Service, Republic of Korea. Identifier: KCT0010114. Registered on 09 December 2024.

Background and objective: The increasing legalization of medical marijuana in the United States (US) has spurred ongoing interest in its clinical application for the management of cancer-related pain. Although medical marijuana is legal in 40 states and the District of Columbia, its effect on pain pathways and variability in patient responses remain key areas of investigation. The purpose of this narrative review was to examine the prevalence and efficacy of marijuana use in the treatment of cancer-related pain.

Methods: A research librarian conducted a literature search in PubMed and EMBASE for articles published between January 01, 2018 and August 2025. Search terms included but were not exclusive to cancer Cannabis AND cancer pain; Marijuana AND cancer pain management; Cannabinoids AND cancer-related pain; Medical cannabis AND oncology pain; THC CBD AND cancer pain relief. Twenty articles were identified and three database reviewers (A.M.M., A.N., and L.R.K.) independently screened titles and abstracts for relevance. Full-text articles were then reviewed with full consensus for final inclusion.

Key content and findings: This narrative review examines the current understanding of the mechanisms of action and clinical efficacy of medical marijuana for cancer pain. We explore the pharmacological mechanisms underlying its analgesic properties, including its interaction with cannabinoid receptors and modulation of pain-related pathways. We also review and synthesize existing clinical evidence on the effectiveness of medical marijuana in reducing pain, improving quality of life, and minimizing opioid use in cancer patients.

Conclusions: Overall, there continues to be limited evidence to support the use of medical cannabis for treatment of cancer-related pain. While significant progress has been made in this domain of pain management research, current federal regulations classifying marijuana as a Schedule I substance continue to limit large research studies. As the legal landscape evolves, an emphasis on future randomized controlled trial studies focused on the challenges related to medical marijuana dosing, side effects, and long-term safety will help advance the field and future cancer patients.

Catatonia is a severe and potentially life-threatening but often reversible neuropsychiatric syndrome. While commonly associated with psychiatric disorders, it is increasingly recognized in medically ill populations, including patients with serious illness. Catatonia frequently overlaps with delirium, dementia, and end-of-life changes, and can mimic irreversible decline, contributing to missed diagnoses and goal-discordant care. Palliative care (PC) clinicians are uniquely positioned to identify and treat catatonia in this context, yet awareness and familiarity with its assessment and management remain limited outside of psychiatric settings. This review aims to synthesize current evidence and provide practical guidance to help PC clinicians recognize, assess, and manage catatonia in patients with serious illness. We highlight the epidemiology, pathophysiology, clinical features, assessment and management of catatonia in seriously ill patients, with a focus on practical application for PC clinicians. We also provide guidance on screening, diagnosis, and treatment-emphasizing the use of bedside tools such as the Bush-Francis Catatonia Rating Scale and the lorazepam challenge-and review first-line and adjunctive therapies, including benzodiazepines and electroconvulsive therapy. Clinical overlap with delirium and other forms of altered mental status is discussed, as is the importance of incorporating catatonia into routine diagnostic frameworks and prognostic conversations. Recognizing and treating catatonia can relieve suffering, restore communication, and shift clinical trajectories in ways that support patients' goals of care. Awareness of catatonia among PC teams can lead to earlier diagnosis, effective treatment, and better alignment of care with patient values.

Background: Palliative radiotherapy (RT) is commonly used to relieve symptoms and improve quality of life (QOL) for patients with metastatic cancer. Timely recognition of treatment related symptoms and adverse events (AEs), however, remains challenging, as reporting often depends on clinic visits and patient recall. This study explores the feasibility of integrating biometric monitoring, specifically the smart shirt from the Hexoskin Medical System (HMS), to monitor patients with metastatic cancer receiving palliative RT for symptom management. This is complemented by Zamplo, a digital health platform to allow patients and caregivers to report symptoms and well-being.

Methods: The PROMPT trial is a prospective observational feasibility study that aims to recruit 100 patients with metastatic cancer undergoing palliative RT. Adult patients with a confirmed cancer diagnosis who can wear the HMS shirt and use the Zamplo platform are included. To improve accessibility and trial opportunity, patients are fitted with one of 11 sex-adjusted HMS shirt sizes, provided a smartphone, and taught to use Zamplo account. Patients are encouraged to wear the HMS shirt for a minimum of 4 hours daily at baseline, during RT and periodically during follow-up. Patient-reported outcomes (PROs) are being collected using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), the EuroQol 5-Dimension 5-Level, the Person-Centred Coordinated Care Experiences Questionnaire for Cancer Patients (PCC-CA-6), and Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events through Zamplo at baseline and on days 30, 90 and 365, and through ad-hoc patient entries. Zamplo data are complemented with routine clinical symptom screening using ESAS. The primary endpoint is to recruit 100 patients within a 12-month period and to report the frequency of grade 2 or above AEs within 30 days of RT.

Discussion: HMS shirt may improve detection and timely management of RT-related AEs and help identify key biometric variables that predict or correspond to AEs and changes in patient well-being. Whereas patients typically accept wearing wrist-worn activity trackers (ATs), this study will determine whether remote monitoring using the HMS shirt is acceptable and feasible in a palliative cancer population.

Trial registration: ClinicalTrials.gov, NCT04983199.