Annals of palliative medicine最新文献

Background: It is common for patients with cancer to present with delirium during cancer treatment due to various causes, such as infection, electrolyte abnormalities, medications, and brain metastasis. Furthermore, delirium may also occur when a patient with cancer develops Trousseau syndrome. Delirium due to Trousseau syndrome in a cancer patient with a history of repeated delirium might be mistaken for previous episodes, which could lead to overlooking a stroke.

Case description: A male aged 90 years with gallbladder cancer was admitted to the hospital. During hospitalization, he experienced recurrent episodes of cholangitis and fever, accompanied by delirium. His inflammatory response decreased, and his fever resolved following antibiotic treatment. After recovery, he experienced a loss of appetite, and olanzapine (2.5 mg/day) was started on Day 17 of hospitalization. However, early on Day 21, he suddenly became restless, moaned loudly, and exhibited signs of delirium. Initially, delirium due to olanzapine or reinfection was suspected. However, a new stroke was suspected because of speech impairment as well as the sudden onset of delirium. Head magnetic resonance imaging revealed a fresh stroke in the right basal ganglia, which was identified as the cause of the delirium.

Conclusions: Patients with cancer are more prone to developing stroke due to the hypercoagulable state associated with malignancy. Even in the absence of obvious neurological signs, such as hemiplegia, the possibility of Trousseau syndrome needs to be considered when a patient presents with atypical or sudden-onset delirium.

Background: Emergency medicine (EM) and internal medicine (IM) physicians care for patients in settings where prompt recognition of and effective communication about acute decompensation and the potential for imminent death is crucial to providing goal-concordant care. Competence in these tasks requires dedicated training and facilitated practice in serious illness communication (SIC). Existing simulation-based SIC curricula typically utilize cases in which the diagnosis and prognosis are already established in a medically stable patient, representing a missed opportunity for learners. To fill this gap, the authors aimed to explore IM and EM resident perceptions of a novel, entirely virtual SIC curriculum, Managing Acute Decompensation in Life-limiting Illness (MADLI), that required participants to assess and manage a clinically decompensating seriously ill patient while simultaneously incorporating newly learned SIC skills.

Methods: Sixteen participants were recruited from the EM and IM residency programs at a large, tertiary, academic medical center. Using a "flipped classroom" approach, residents asynchronously viewed a 20-minute didactic video introducing evidence-based communication frameworks. In small peer groups led by a trained faculty facilitator, they then participated in a 60-minute simulated clinical encounter involving an acutely decompensating patient and their surrogate decision maker, played by an SIC-trained actor. Lastly, residents participated in a 30- to 60-minute semi-structured group interview. Qualitative thematic analysis was performed to identify overarching themes that resulted from the interview data.

Results: Qualitative analysis of group interview transcripts yielded 3 major themes that reflect the trainee experience with the MADLI curriculum: (I) simulation unmasked moral challenges; (II) simulation facilitated safe practice and identification of knowledge gaps for SIC skills; and (III) task switching and case realism were virtual SIC curricular elements that promoted learner engagement and effective learning. Additionally, integrating medical management and SIC tasks was perceived as novel, challenging, and realistic. Residents who completed the MADLI curriculum viewed it as an effective modality to teach SIC.

Conclusions: Simulation-based curricula for EM and IM residents that combine medical management, prognostication, and complex SIC into a single virtual, simulated patient encounter can address critical gaps in resident education related to the management of seriously ill patients at high risk of imminent death. Incorporating a trained actor and task-switching enhanced realism and learner engagement, highlighting the value of this model as a feasible approach to advancing IM and EM resident SIC skills.

Background: Pain is prevalent among cancer patients and impairs quality of life. Telemedicine, including electronic patient-reported outcomes (ePROs), is a promising tool for remote pain management. The objective of this review is to critically analyze studies on the use of telecommunication technologies for pain management in patients with advanced cancer receiving palliative care.

Methods: A systematic search was conducted in PubMed, the Cochrane Library, CINAHL, MEDLINE, Web of Science, and Scopus for literature published up to December 31, 2024. The eligibility criteria were defined based on the PICO framework: P (Population): adult patients with advanced cancer-related pain; I (Intervention): telecommunication technology interventions delivered by healthcare professionals to reduce cancer-related pain; C (Comparison): usual care; O (Outcome): change in pain levels.

Results: Ten studies met the predetermined eligibility criteria. Among these, eight studies demonstrated a statistically significant between-group effect of the interventions on pain reduction, while two of four studies reported time-series effects of telemedicine, although these effects were not significantly different from those observed in the control group. In the latter group, symptom self-reporting via an ePRO system was utilized, and the collected information was incorporated into pain management strategies. Among the eight studies demonstrating the effectiveness of ePRO-based pain management, five involved patients reporting their pain status to healthcare providers and receiving advice and education on pain management. Three of these studies incorporated real-time responses from healthcare providers. The duration of the interventions varied across studies: one study lasted 1 week, two studies lasted 4 weeks, one study lasted 8 weeks, and one study extended to 6 months. The frequency of intervention also varied: three studies employed daily interventions, one used twice-weekly interventions, and one study also used twice-weekly interventions. Interventions were delivered by healthcare professionals such as pharmacists, nurses, physical therapists, and researchers.

Conclusions: A wide range of intervention durations, healthcare professionals, and methods utilizing telecommunication technologies for cancer pain management were identified. The use of ePRO systems by healthcare providers for patients with advanced cancer shows potential; however, a consensus on the optimal approach remains lacking, highlighting the need for further validation.

Background and objective: Provider experience is critical to the acceptance and sustainability of palliative care delivery models. Compassion satisfaction and burnout make up key components of provider wellbeing and therefore serve as important targets for measurement. Exploring the impact of palliative care interventions on provider experience offers significant potential for innovation. This narrative review surveys existing literature regarding provider-wellbeing outcomes in palliative care delivery. Our primary objectives were to examine the factors and interventions that influence compassion satisfaction and burnout among palliative care providers, as well as explore provider wellbeing outcomes that have been previously measured for patient-centered palliative care interventions. We ultimately propose an underlying conceptual model founded in care ethics to guide further research.

Methods: We queried PubMed with additional articles found through backwards chaining. No publication timeframe was imposed. Non-English articles were excluded.

Key content and findings: Previous research has identified various factors associated with compassion satisfaction among palliative care providers, including self-care practices, supportive team dynamics, and organizational support. Moreover, a number of provider-centered interventions have shown potential for decreasing burnout, including professional development time and educational programs. However, relatively little research has explored how patient-centered interventions may affect providers. Prior studies exploring interventions such as targeted skills training, communication tools, and innovations in patient and caregiver end-of-life care education and discussion demonstrate that patient-centered improvements to palliative care delivery may also confer benefits to providers, including those without formal palliative care training.

Conclusions: Although compassion fatigue and burnout are well-documented among palliative care providers, research into how patient-centered palliative care interventions affect providers is limited. We propose a model of palliative care innovation that utilizes care ethics to understand the interdependent relationships among patients, caregivers, and providers. Future research should leverage existing tools measuring compassion satisfaction and burnout to better understand how interventions targeting one stakeholder might affect the experiences and outcomes of others. Such an approach may support sustainable adoption of palliative care interventions across multiple domains.

Background: Are signs and symptoms overlooked in patients who have cancer and who identify as transgender or nonbinary? Because clinicians seem unaware of hiccups and because patients who identify as transgender or nonbinary appear at especially high risk for having their medical signs/symptoms overlooked, this study focused on hiccups as a bellwether sign/symptom.

Methods: The medical records of 126 patients who had cancer and who identified as transgender or nonbinary were reviewed in detail. A literature-based, incidence rate of hiccups of 9% served as a benchmark.

Results: The median age was 42 years (range, 18-78 years). Fifteen self-identified as transgender men, 41 as transgender women, and 70 as nonbinary. Seven patients, or 6%, had hiccups (this observation was below the benchmark). The incidence of hiccups was 0% (0/15), 12% (5/41), and 3% (2/70) among transgender men, transgender women, and nonbinary individuals, respectively. In 3 patients, the hiccups appeared to go unaddressed.

Conclusions: These findings suggest signs/symptoms might be overlooked in gender diverse patients with cancer. Additionally, these findings should prompt efforts to identify and palliate signs/symptoms-including hiccups but, of course, others as well-in patients who have cancer and who identify as transgender or nonbinary.