The American journal of hospice & palliative care最新文献

BackgroundSocial media provides a novel data source for understanding palliative care from the perspectives of patients and their family caregivers. Nonetheless, no study has examined palliative care-related information on Japanese social media. This study aimed to identify the characteristics of palliative care information on Japanese social media.MethodsPosts published on X (formerly Twitter) during the first week of each month from January to June 2024 that included 1 or more of the following terms were manually collected: "palliative care," "end-of-life care," or "palliative medicine." Posts were analyzed inductively. A Japanese sentiment analysis model was applied to assign a sentiment score (0-1) to each post, with higher scores indicating more positive sentiment. The top 50 posts with the highest sentiment scores and the bottom 50 posts were further analyzed using the same qualitative approach.ResultsIn total, 4689 posts were collected; of these, 3806 (81.2%) were related to palliative care. Thirteen categories were identified. The most frequent category was "general explanations about palliative care" (n = 1,280, 27.3%), followed by "sharing information about palliative care services" (n = 757, 16.1%). Posts with the lowest sentiment scores included "opinions or demands toward end-of-life care systems," "opinions or demands towards medical practice and dissemination of palliative care," and "reporting experiences of patients and informal caregivers."ConclusionJapanese social media platforms may provide valuable insights into family caregivers' experiences, potentially representing a resource for assessing the palliative care quality. Future studies should evaluate the validity of palliative care-related information on social media.

Palliative care in most Muslim-majority settings, including the Gulf Cooperation Council (GCC) countries, is underdeveloped despite growing demand. Although Islamic doctrine has a strong bearing on attitudes towards sickness, suffering, and death, a conflict continues between normative guidelines of Islamic bioethics and their implementation in clinical care. This narrative review attempts to fill this gap by formulating a framework that incorporates Islamic bioethical values into palliative care provision in the Middle East. The narrative review was carried out based on databases such as PubMed, Scopus, and Google Scholar for the period 2000-2025. Classical Islamic sources, the Qur'an, Sunnah, Ijmā' (juristic consensus), and Qiyās (analogy), were compared with modern ethical and clinical studies in order to synthesise themes and formulate a practice-focused framework. Islamic bioethics focuses on principles like ḥifẓ al-nafs (protection of life), lā ḍarar (no harm), al-umūr bi-maqāṣidihā (intent counts), and maqāṣid al-sharī'ah (higher purposes of Islamic law). These principles were used to describe 5 domains of palliative care spiritual care, truth-telling and disclosure, advance care planning, pain and suffering, and end-of-life decision-making, to demonstrate their applicability and moral importance. The integrative framework brings faith-based ethics into synergy with evidence-based practice, and guides clinicians on topics like Do-Not-Resuscitate (DNR) orders, removal of futile treatment, palliative sedation, and communication with and engagement of families. The framework also outlines the religious counsellor and ethical consultation roles in facilitating decision-making and policy formation. Clinicians, educators, and policymakers can utilize the suggested framework to implement faith-sensitive palliative care on a systemic level.

BackgroundPediatric palliative care in Mainland China is still developing. Biological, psychological, and social factors may change during the course of illness and after the child's death.ObjectivesThis study examines pediatric end-of-life decision-making in Mainland China across biological, psychological, and social dimensions.MethodsThis study examined illness narratives using a case-based qualitative approach. The analysis included twelve pediatric end-of-life decision-making cases involving children from neonates to 18 years of age.ResultsThe findings indicate that diagnosis- and treatment-related decisions were primarily shaped by the child's biological condition. As time passed, parents' emotions played a larger role in decisions about continuing or stopping treatment and about fulfilling the child's wishes. Social considerations were evident in relation to financial costs, travel burden, and access to care. Following death, bereavement experiences and funeral customs further shaped decision-making, alongside constraints related to limited services and staff shortages.ConclusionsThe findings show that biological, psychological, and social factors changed over the course of illness and bereavement. This suggests a need for better decision support and follow-up bereavement care within pediatric palliative care services in Mainland China.

IntroductionLate hospice referral rates are on the rise and are associated with negative outcomes at the end of life (EoL). Rates of late hospice referral vary drastically from oncologist to oncologist, and behavioral and psychological factors among individual oncologists have been identified as potential contributors to this variability. However, there remains a lack of clarity about how these oncologist-specific factors affect hospice referral practices among oncologists.MethodsThe Communication Optimization and Methodology For Improving Oncologist Hospice Referral Timing (COMFORT) study explored oncologists' perspectives on facilitators of and barriers to timely hospice referral. Semi-structured, qualitative interviews were conducted with 26 practicing oncologists within a large, integrated healthcare system from 6/1/2022 - 8/31/2022. Audio-recorded interviews were transcribed and analyzed using thematic analysis.ResultsMultiple themes emerged related to patient-specific factors, hospital system characteristics, oncologist knowledge of hospice care, and specialty palliative care (SPC) involvement. Commonly described barriers to timely referral included lack of adequate time with patients, challenging family dynamics, the rise of telehealth, and the finite palliative care workforce. Facilitators that were described included the presence of departmental support (nurses, social workers, hospice liaisons), and easy interdepartmental communication with SPC.ConclusionsNumerous factors independent of hospice eligibility were reported to influence hospice referral practices among oncologists. While some factors represent challenging cultural and social barriers to timely hospice referral, other system- and patient-specific barriers offer opportunities for potential interventions.

BackgroundClinically assisted hydration in advanced cancer remains controversial, with uncertainty regarding potential benefits and harms near the end of life. Hypodermoclysis offers a less invasive alternative to intravenous hydration, yet safety outcomes have not been clearly quantified.MethodsWe conducted a systematic review and meta-analysis following PRISMA 2020 guidelines to evaluate the safety and feasibility of hypodermoclysis in adults with advanced cancer receiving palliative or hospice care. Randomized and observational studies reporting outcomes related to subcutaneous fluid administration were included. Local infusion-site complications and treatment discontinuation were pooled using random-effects meta-analysis when data were comparable.ResultsFive studies met inclusion criteria, including cohort studies and randomized trials conducted in palliative settings, with 3 studies suitable for quantitative synthesis. Pooled analysis estimated that approximately 17% of patients experienced local infusion-site complications, although events were predominantly mild and rarely required treatment discontinuation. Randomized trials did not consistently demonstrate improvements in symptoms or survival associated with clinically assisted hydration.ConclusionsHypodermoclysis appears to be a feasible and generally safe hydration method in advanced cancer care, with complications typically minor. However, evidence supporting routine hydration remains limited, and decisions should be individualized according to patient goals and symptom burden.

BackgroundCompanion animals are common in home hospice and widely viewed as beneficial for patients, yet their presence may affect procedural safety and clinicians' bedside decisions.ObjectivesTo determine whether hospice staff's recognition of pet-related risks predicts their likelihood of requesting temporary separation of the animal during clinical procedures.DesignMulticenter cross-sectional survey.Setting/SubjectsHome hospice clinicians working in three Polish provinces.MeasurementsAn anonymized online questionnaire assessed perceived benefits, risks/burdens, and procedure-related behaviors in homes with patient-owned companion animals. Likert-type items were used to construct composite benefit and risk/burden indices. The primary outcome was clinicians' self-reported propensity to request temporary pet separation during procedures. Ordinal logistic regression adjusted for clinician characteristics was performed.ResultsAmong 81 participating professionals (74% nurses), 98.8% agreed that pets reduced patient anxiety, yet 25.9% reported prior pet-related safety threats and more than half reported requesting temporary separation at least sometimes. Higher recognition of pet-related risk was independently associated with a greater likelihood of requesting separation (odds ratio 2.52 per 1-point increase in risk/burden score; 95% CI 1.38-4.60). General attitudes toward pets and pet ownership were not associated with this behavior.ConclusionsIn home hospice, clinicians' requests for brief pet separation during procedures are driven by professional assessment of bedside risk rather than personal affinity for animals or beliefs about pet benefits. These findings support temporary, situation-specific separation as a pragmatic patient-safety measure and highlight the need for guidance on managing companion animals during home visits.

BackgroundBereavement care in hospice and palliative care settings commonly includes sending letters or cards to bereaved family members and holding memorial services; however, this practice varies widely across facilities and has not been explored in past research in the Japanese context.ObjectiveThis study examines the current practices and bereaved family members' evaluations of letters, cards, and memorial services in hospice and palliative care units in Japan.MethodsA nationwide retrospective survey was conducted as part of the J-HOPE4 study using self-administered questionnaires mailed to the bereaved family members of patients who died in participating palliative care units.ResultsAmong the 563 respondents, 59.9% had received letters and cards. The most positively evaluated content included expressions of appreciation for care during hospitalization, concern for the family's life after discharge, and messages reflecting the patient's personality. The actual and preferred sending times were largely aligned. Only 9% attended memorial services; the key reasons included the desire to meet or talk with clinicians and expectations of emotional comfort. Respondents preferred services that involved opportunities to interact with staff and events that offered emotional support.ConclusionBereaved family members value individualized letters and cards that acknowledge the patient and family context. Although participation in memorial services was low, attendees sought emotional processing and reconnection from clinicians. These findings highlight the importance of individualized relationship-based bereavement support in palliative care.

BackgroundHospice-eligible patients are vulnerable to adverse medication effects given their advanced illnesses and general older age. It is not known how often medications are not renal dose adjusted in hospice-eligible patients and which are frequently problematic. This study aims to identify commonly prescribed medications with significant renal clearance that are dosed too high and patient characteristics that increase the likelihood of occurrence.MethodsThis is a retrospective chart review of adult patients admitted to hospice care. Data collected included clinical/demographic data, renally cleared medications taken at time of hospice admission, and calculated renal function using several formulas. Descriptive statistics and binomial logistic regression were used to analyze data.ResultsOf 283 included charts, 27% had ≥1 medication dosed too high for renal function. The most common medications prescribed and not renal dose adjusted included tramadol, gabapentin, duloxetine, loratadine, cetirizine, famotidine, apixaban, rivaroxaban, metformin, trospium, and most antimicrobials. Increasing serum creatinine values and increasing number of renally cleared medications were associated with a higher likelihood of a medication dosed too high [OR, 1.702, 95% CI (1.257, 2.305), P < 0.001] and [OR, 1.856, 95% CI (1.517, 2.271), P < 0.001] respectively. Residing at home vs a facility was associated with a reduced likelihood of having a medication dosed too high [OR, 0.30, 95% CI (0.134, 0.673), P = 0.003.].ConclusionsHospice-eligible patients frequently have renally cleared medications prescribed and at doses too high for their renal function. Analgesics, over-the-counter antihistamines, anticoagulants, anticholinergics have potential for significant adverse effects and higher vigilance is needed.

BackgroundIntensive end-of-life (EOL) care is emotionally and financially burdensome, disproportionally negatively impacting racial and ethnic minorities, rural residents, and lower socioeconomic seniors.ObjectivesTo evaluate the impact of race, ethnicity, and rural residency on EOL Intensive Care Unit (ICU) stays, emergency department (ED) visits, 30-day readmissions, and Advanced Care Planning (ACP) in Colorado residents when controlling for comorbidities.MethodsThis retrospective cohort study analyzed data from the Colorado All-Payer Claims Database for 92,975 severely or chronically ill individuals (2018-2021). It used logistic regression models to evaluate associations between demographic variables and EOL health care utilization outcomes.ResultsICU Stays: Hispanic/Latino, Asian, and Black members had increased ICU stays compared to Whites (Adj. OR: 1.24;1.34;1.28: 95% CI). However, members without ACP and rural residents had lower ICU stays (Adj. OR: 0.67; 0.89: 95% CI). ED Visits: Hispanic/Latino, Asian, Black members, non-dually eligible members (Medicare Fee for Service (MFFS) + Medicaid), and rural residents had increased ED visits (Adj. OR: 1.29; 1.39; 1.19; 1.17; 2.04: 95% CI). Meanwhile, members without ACP or hospice care had lower ED visits (Adj. OR: 0.70; 0.75: 95% CI). 30-day Readmissions: Asian members and rural residents had increased 30-day readmissions (Adjusted OR: 2.42; 1.06: 95% CI). In contrast, those on MFFS and not on Medicaid, members without ACP, and those not in hospice care had decreased 30-day readmissions (Adj. OR: 0.69; 0.47; 0.83: 95% CI).ConclusionEOL racial, geographic, and socioeconomic disparities exist in Colorado, requiring urgent interventions for a more equitable health care system.

IntroductionAmerican Indian/Alaska Native (AI/AN) persons disproportionately suffer from end-stage kidney disease caused by diabetes (ESKD-D). Kidney transplant is the most desirable option to treating ESKD-D, but remains unattainable for many AI/AN persons, especially in rural South Dakota (SD). Additionally, palliative and hospice care options for AI/AN with any serious illness in SD are largely inaccessible. Moreover, receiving kidney transplant potentially affects hospice referral because of the desire to prolong transplant function. Therefore, the purpose of this study was to compare hospice use rates among AI/AN and non-Hispanic White (NHW) persons with ESKD-D prior to death and determine if differences in referral rates are present for those with and without a prior kidney transplant.MethodsRetrospective cohort analysis of United States Renal Data System data from 2000-2021. Data for persons with hospice care, transplant status, place of death, and race were analyzed using chi-squared tests with Yates' continuity correction and the Cochran-Mantel-Haenszel test.ResultsAI/AN persons with ESKD-D were less likely to receive hospice care prior to death compared to NHW persons in both transplant (P < 0.001) and non-transplant (P < 0.001) groups. When comparing transplant and non-transplant groups by hospice use, persons with no previous transplant were more likely to receive hospice care prior to death (P < 0.001).ConclusionThese results confirm the assumptions of significant differences in hospice care use among AI/AN vs NHW who have ESKD-D, including differences between those with a prior transplant. There is a need to expand palliative/hospice care services for persons with a prior kidney transplant.