The American journal of hospice & palliative care最新文献

BackgroundWhile advance care planning (ACP) can facilitate a "good death" for people living with cancer, there remain gaps in understanding how to optimize ACP for better patient outcomes. This formative research aimed to explore experiences with advance care planning among oncology and primary care practitioners in primary/tertiary care settings.MethodsThe research team conducted structured and semi-structured in-depth interviews with family medicine practitioners (n = 12) and medical oncologists (n = 12) to understand their approaches to ACP.ResultsWhile oncologists and PCPs shared many of the same concerns about advance care planning, their unique contexts and specialties influenced their perspectives on the approach to ACP. Though oncologists and PCPs were both very likely to discuss ACP with their patients, oncologists more often discussed conducting ACP with other members of the health care team (e.g. social workers). Furthermore, disciplines differed in their emphasis on particular types of ACP documentation. Semi-structured interviews also revealed issues related to provider-patient communication as well as institutional challenges. Participants discussed their processes for timing the ACP conversation, addressing language-use challenges, assessing patient goals, and ensuring a good ACP workflow.ConclusionsParticipants recommended areas for institutional support and intervention to improve provider-patient ACP interactions.

Advance care planning (ACP) is critical to patient-centered health care, particularly in hospital settings where acute and end-of-life decisions often occur. As frontline providers, hospitalists are uniquely positioned to initiate and guide ACP discussions. This article explores the role of hospitalists in ACP, identifies barriers to its implementation, and highlights strategies to overcome these challenges. Key barriers include time constraints, lack of formal training, and uncertainty regarding the appropriate timing of discussions. To address these issues, hospitalists can benefit from structured communication training, integration of ACP prompts into electronic health records, and collaboration with multidisciplinary teams. While ACP has demonstrated benefits, including the alignment of care with patient preferences, reduced unnecessary interventions, and improved satisfaction for patients and families, challenges remain in ensuring consistent and culturally sensitive implementation. This article also examines the ongoing debate regarding the advantages of ACP, balancing its potential to enhance care with concerns about emotional discomfort and operational barriers. Ultimately, ACP represents a pivotal opportunity to advance patient autonomy and deliver compassionate care. By addressing barriers and leveraging institutional and policy-level support, hospitalists can lead the charge in making ACP a standard and meaningful aspect of health care delivery.

Background: The progression of end-stage malignant tumors in patients is irreversible, making high-quality hospice care especially critical. Objective: To evaluate the effectiveness of the hospice shared care guided by the structure-process-outcome three-dimensional quality evaluation model compared to the hospice shared care in patients with end-stage malignant tumors. Design: This study is a single-center, open-label, randomized controlled trial, conducted in the Department of Radiation Oncology at the Second People's Hospital of Wuhu City. Methods: The control group adopted the standard hospice shared care, while the intervention group utilized the hospice shared care guided by the structure-process-outcome three-dimensional quality evaluation model. The quality of life, spiritual well-being, psychological distress, and satisfaction of patients were compared between the two groups. Results: After two and four weeks of intervention, there was a significant improvement in quality of life and spiritual health, along with a notable reduction in psychological distress (P < 0.05). Compared with the control group, patients in the intervention group exhibited significantly better quality of life and mental health status, along with lower psychological distress scores (P < 0.05). The satisfaction rate in the intervention group was significantly higher than that in the control group (97.80% vs 92.31%, P = 0.029). Conclusions: Guided by the three-dimensional quality evaluation model of structure-process-outcome, the hospice shared care can significantly improve the quality of life and spiritual health of patients with end-stage malignant tumors, alleviate psychological distress, and enhance patient satisfaction.

BackgroundPatients in intensive care units (ICU) frequently face severe distress and complex ethical dilemmas, underscoring the critical role of palliative care. Despite growing international attention on ICU-based palliative care, the attitude of palliative care specialists remains unclear. In Japan, although ICU physicians express willingness to collaborate, actual engagement with palliative care teams is limited. To support palliative care integration in the ICU, understanding specialists' perspectives on its provision to ICU patients is critical.ObjectivesWe examined the attitudes, confidence, motivation, and perceived barriers among Japanese palliative care specialists regarding their provision of care in the ICU.DesignWe conducted a nationwide cross-sectional survey.Setting/SubjectsConducted in Japan in June 2023, targeting 335 board-certified palliative care physicians.MeasurementsAttitudes, confidence, motivation, and perceived barriers were assessed using a self-administered questionnaire with five-point Likert scales. Descriptive statistics with 95% confidence intervals were generated.ResultsResponses from 218 physicians were received (65.0% valid response rate). Among these, although 65.5% agreed that palliative care is important even when curative goals are present, <30% reported confidence in prognostication, symptom management, or understanding ICU culture. Motivation to engage in ICU care was also limited. Primary barriers identified were lack of reimbursement (77.2%) and insufficient ICU-specific education (72.5%).ConclusionDespite acknowledging its importance, Japanese palliative care specialists demonstrate limited preparedness for ICU-based palliative care. Our findings highlight an urgent need for specialized education, improved interdisciplinary collaboration, and removal of financial disincentives, including the absence of reimbursement for ICU palliative care consultations under Japan's health insurance system.

ObjectiveReview the current teaching methods, curricula, and assessment tools for pediatric palliative care (PPC) within the pediatric s intensive care setting for pediatric critical care medicine (PCCM) trainees as it pertains to the following domains: (1) Symptom management, (2) Communication, (3) Spiritual/Psychosocial, (4) End of Life (EOL).Data SourcesPubMed, Cochrane CENTRAL, EMBASE, and PsycINFO were searched for articles reporting on PPC educational curricula or interventions for residents and fellows in pediatric intensive care settings. The search strategy used a combination of MeSH terms and keywords to search for items that addressed intensive care, pediatrics, palliative care, residents or fellows, and education.Study SelectionCurricula that includes PCCM trainees (fellows and residents) nationally and internationally.Data ExtractionCovidence.Data SynthesisOf 105 articles reviewed, 6 articles addressed PPC education in the PICU between 2015 and 2025. All 6 articles were United States-based and included simulation curricula focused on communication regarding EOL care. Evaluation tools varied across articles. There is a paucity of data around complex symptom management, communication on topics other than EOL, and spiritual and psychosocial education.ConclusionsSimulation focused on communication and EOL care is frequently used to teach PPC knowledge and skills to PCCM fellows and residents. Currently varied evaluation methods exist with limited PPC domains. This review highlights the need for future PPC curricula development for PCCM trainees.

BackgroundPalliative care in community settings can support seriously ill individuals to reduce symptoms and maintain quality of life. However, many individuals decline palliative care, even when they have health concerns. Differences in understanding how palliative care can help manage serious illness may contribute to declining.ObjectiveThis study explores the relationship between individuals' understanding of palliative care, their health concerns, and education levels (a proxy for health literacy).MethodsWe use survey responses from a validated instrument assessing palliative care knowledge and information from semi-structured interviews for 21 seriously ill individuals (n = 3) and family caregivers (n = 18) who were eligible for community-based palliative care services and declined. We explore the relationship between respondents' education, understanding of palliative care, and their concerns about their or their loved one's health.ResultsAmong participants, twelve had a bachelor's degree or more; nine had some college or less. Six participants with some college or less expressed concerned about stress from serious illness. Of these, half (n = 3) did not understand palliative care could help. Conversely, five participants with a bachelor's degree concerned about stress understood palliative care could help. Seven participants with some college or less expressed concerned about medication side effects; four did not understand palliative care could help. Conversely, three participants with a bachelor's degree concerned about medication knew that palliative care could help.ConclusionAssessing health concerns and explaining how palliative care can address those concerns may reduce barriers to accepting palliative care, particularly among individuals with lower levels of education.

IntroductionCaring for chronically or terminally ill individuals comes with unique challenges and circumstances that are specific to each situation and individual involved. Studies on caregiving have often concentrated on the negative physical and emotional impacts on caregivers, while more recent literature depicts a more complex and multidimensional experience. The purpose of the current study was to better elucidate the scope of challenges and benefits attributed to caring for a loved one with a serious, life-limiting illness.MethodsA total of 18 informal family caregivers were enrolled in this study, which used a semi-structured interview format. Interviews were conducted at the participants' place of residence, all within New York State (United States of America). All interviews were audio-recorded, transcribed, and analyzed using inductive thematic analysis with consensual qualitative research components. The qualitative analysis team was comprised of three core members and one outside auditor.ResultsFour main themes emerged: (1) Burdens on the Caregiver, (2) Navigating Caregiving, (3) The Positives, and (4) Evolution of Relationships. Additionally, the latent theme of Cognitive Dissonance was identified across interviews.DiscussionFindings suggest that family caregivers of individuals with terminal or life-limiting illness experience complex, and often contradictory feelings, which may differ from perceptions by those not providing similar care to a loved one. The data suggest that clinicians working with the caregiving population should explore the duality of caregiving beyond just the anticipated negative impacts.

ObjectivesAs the number of physician associates (PAs) in hospice and palliative medicine (HPM), understanding their professional needs is vital. This exploratory study (n = 49) aimed to identify factors to inform strategic initiatives for the Physician Associates in Hospice and Palliative Medicine (PAHPM) organization.MethodsThis descriptive, cross-sectional study utilized a 17-question survey distributed in December 2024 to PAs via PAHPM and social media. Data included demographics, training, and open-ended questions regarding professional obstacles. Qualitative data were analyzed via thematic analysis.ResultsRespondents were primarily female (89.8%) and hospital-based (57.1%), with 73.5% less than or equal to 10 years of experience in the specialty. While 55.1% had specialized training, only 16.3% were specialty certified. Qualitative analysis identified five challenges: regulatory and policy hurdles, workforce disparities compared to other APPs, misconceptions about the PA role, education gaps, and emotional strain.ConclusionThese preliminary findings suggest a need for targeted organizational support in advocacy, particularly regarding legislative efforts for hospice inclusive, and professional development to bridge the certification gap.

Objectives: In Italy a recent law was approved for providing patients' wishes regarding end of life issues, commonly referred internationally to as "living wills", (Dichiarazione anticipata di trattamento, DAT). Regardless of this official document, advance care planning (ACP) is often used in a palliative care setting to share the treatments to start, to continue, to withdraw, thus preventing the stress on an acute decision. The aim of this study was to assess DAT and ACP in patients with amyotropic lateral sclerosis admitted to home palliative care. Methods: Patients consecutively admitted to speciliazed home palliative care were prospectively assessed. The presence of DAT or ACP was recorded. Results: Sixty-eight patients were enrolled in the period taken into consideration. No patient had drown up DAT, and only one patient provided his ACP prior to home palliative care admission. Along the course of home palliative care care assistance, 30.9% of patients provided their ACP. Discussion: In Italy DAT resulted scarcely widespread, despite an existing law, as no patient officially provided their indication on end of life issues. In addition, ACP was given only after starting specialized home palliative care in less than 1/3 of patients. Home palliative care seems to be a fundamental resource for improving communication and soliciting expression of patients' wishes regarding end of life issues.

Objectives: Anticipatory grief is associated with post-bereavement grief; however, reports on the influence of pre-loss depression are limited. Therefore, we investigated the association between the anticipatory grief of family members and post-loss and post-depression grief adjusted for pre-loss depression. Methods: This cohort study included the family members of dying patients with cancer. Questionnaires were distributed to them during hospitalization in four inpatient palliative care units from 2016 to 2017. We also administered follow-up questionnaires after their bereavement in 2018. The pre-bereavement questionnaire consisted of three items from the Anticipatory Grief Scale for Families Caring for a Terminally Ill Person for assessing anticipated grief and the Patient Health Questionnaire 9 for assessing depression. The Brief Grief Questionnaire was used to assess post-loss grief. Results: We distributed 181 pre-bereavement questionnaires to the family members; 112 (62%) responded to the pre-bereavement survey, out of which 71 (63%) responded to the post-bereavement survey. Anticipatory grief was significantly associated with pre-loss (ρ = 0.37, ρ < 0.001) and post-loss (ρ = 0.24, P = 0.009) depression and marginally associated with post-loss grief (ρ = 0.15, P = 0.10). Pre-loss depression was also significantly associated with post-loss depression (ρ = 0.50, P < 0.001) and post-loss grief (ρ = 0.41, P < 0.001). However, anticipatory grief was not significantly associated with post-loss depression (P = 0.35) and post-loss grief (P = 0.65) after adjusting for pre-loss depression. Significance of Results: Bereaved families who experienced anticipatory grief had worse post-bereavement depression. However, this association was not statistically significant after adjusting for pre-bereavement depression. Post-bereavement depression may be in a continuum with pre-loss depression, and anticipatory grief does not independently affect post-loss reactions.