The American journal of hospice & palliative care最新文献

BackgroundIn their care of terminally ill patients, palliative care physicians and oncologists are increasingly predisposed to physical and emotional exhaustion, or compassion fatigue (CF). Challenges faced by physicians include complex care needs; changing practice demands, and sociocultural contextual factors. Efforts to better understand CF have, however, been limited. We propose a systematic scoping review (SSR) to determine "What is known about theories of CF in physicians?".MethodsGuided by the PRISMA-based Systematic Evidence-based Approach (SEBA) methodology, our SSR comprised searches for articles published between 1 January 2000 and 31 December 2023 on MEDLINE, EMBASE, PsycINFO, Wiley, CINAHL and Google Scholar databases. Both thematic and content analyses were carried out.ResultsOf the 10 505 titles identified, 80 articles were included. 15 current theories of CF were evaluated, leading to two key domains: theories of CF and theories related to the costs of caring. Overall, theories of CF evolved from Figley's model with gradual encompassing of moral distress, vicarious trauma and burnout, alongside the inclusion of individual characteristics, decisioning and nous in later theories.ConclusionCF was found to be part of a wider cost of caring that links clinical experiences with self-concepts of personhood and identity. The Ring Theory of Personhood has been able to shed light on how physicians will respond to such experiences and is key to guiding physician support and the creation of nurturing working environments.

BackgroundPatients enrolling in hospice care are asked their preferences for antibiotic treatment. There is little information regarding which patients are more likely to receive antibiotics. To better inform discussions, we sought to characterize the use of antibiotics in the outpatient hospice setting.MethodsWe performed a retrospective review of patients enrolled in outpatient hospice within the Mayo Clinic Health System from 1/1/2017 through 1/1/2023. We calculated what percent of patients received antibiotics based on Hospice Qualifying Condition (HQC), age at enrollment, sex, survival time, and Charlson Comorbidity Index and calculated adjusted odds ratios (aOR). We documented which antibiotics were prescribed based on HQC.ResultsOf 6452 patients identified, 1259 (19.5%) received antibiotic prescriptions. Cephalosporins were the most common class of antibiotics prescribed (22.8% of antibiotics prescribed), followed by fluoroquinolones (20.3%) and penicillin derivatives (14.9%). Patients with Pulmonary HQCs were most likely to receive antibiotics (28.6% aOR 1.85 [1.51-2.25]), those with neurologic HQCs were least likely (14.9% aOR 0.66 [0.53-0.83]). There was no difference of age for those receiving antibiotics (80.7 yr) vs those not receiving (80.3 yr [P = 0.25]), or for sex (male vs female aOR 1.10 [0.96-1.26). 4.6% of those surviving <7d received antibiotics (aOR .22 [0.17-0.29]), compared to 47.7% of those surviving >6mo (aOR 4.46 [3.50-5.69]).Discussion19.5% of patients will receive antibiotics during their hospice course, with more frequent prescriptions in those surviving longer periods and those enrolled for pulmonary conditions. It is important to clarify patient preferences regarding antimicrobial utilization at the time of hospice enrollment.

IntroductionPatient attitude to death is associated with outcomes in hospice care settings. This Korean study investigated the association between terminal cancer patient death acceptance and symptom control and quality of care (QoC) as perceived by family caregivers (FCs).MethodsA multicenter cross-sectional survey was conducted in nine inpatient hospice care units, and the data of 108 dyads (terminal cancer patients who responded to the revised Death Attitude Profile and their primary FCs) were analyzed. Dyads were dichotomized into high and low groups by death-acceptance level. Multivariate regression models were used to examine the association between death acceptance and symptom severity/QoC as perceived by FCs.ResultsPatients in the high acceptance group were younger, educated to a higher level, more religious, and had better-functioning families. Patients with severe shortness of breath were less likely to accept the inevitability of death. FCs of patients with high acceptance of death were more satisfied with QoC, particularly in domains of individualized care and family relationships. In addition, the positive association between patient acceptance and FC satisfaction with care was significant in dyads of young or female patients, patients with a low education level, and patients not cared for by a spouse.ConclusionTerminal cancer patient death acceptance is associated with symptom control and FC perceived QoC.

BackgroundPalliative care units are centers where comprehensive care is provided, primarily by nurses, but also by informal caregivers who are usually the patients' relatives. The difference is that nurses fulfill this duty professionally, and their levels of self-care and compassion are not expected to be affected by their work. In this regard, comparing the levels of compassion and self-care in patients' relatives and nurses will provide evidence to help raise awareness and support both groups.AimsThis study aimed to determine the relationship between the self-care abilities and compassion of nurses and informal caregivers.DesignThis was a descriptive, cross-sectional study.Settings/ParticipantsThe study was conducted between August 2023 and July 2024 in palliative care units in Istanbul. A total of 98 nurses and 96 informal caregivers participated in the study. They were administered the Exercise of Self-Care Agency Scale and the Compassion Scale.ResultsThe mean compassion scores of the informal caregivers and nurses were high, with no significant difference (P > .05). However, a significant difference was observed in their self-care ability scores, with nurses scoring lower in self-care compared to informal caregivers (P < .05).ConclusionsNurses working in palliative care had a similar level of compassion as the primary relatives of the patients. However, it is concerning that the nurses had less ability to engage in self-care than the informal caregivers. This result indicates that nurses need support to enhance their self-care.

BackgroundAs cancer remains a leading cause of death for older adults, ensuring high-quality end-of-life (EOL) care is a critical component of cancer care. Prior studies have predominantly assessed EOL care for racial and ethnic disparities or among one cancer type. Therefore, using a population-based sample, our objective was to describe EOL care among decedents with cancer across various social and clinical characteristics.MethodsThis retrospective cohort study used 2003-2019 data from The University of North Carolina at Chapel Hill Cancer Information and Population Health Resource, which links cancer registry to administrative claims data in North Carolina. We examined five EOL practices within the last 30 days of life including: >1 emergency department (ED) visit, intensive care unit (ICU) admission, hospital admission, intravenous (IV) chemotherapy, and no hospice use. We assessed in-hospital death and late hospice initiation in the last 3 days of life. We descriptively assessed differences in EOL by various demographic characteristics.ResultsAmong 150 412 decedents, 48% were female, 23% were non-Hispanic Black, and 61% were Medicare beneficiaries. The most frequent EOL care practice was hospital admission (54%). Over time, no hospice use, ICU admission, hospital admissions, and in-hospital deaths decreased. However, in 2019, hospital admissions and no hospice use were still high (52% & 38%, respectively). Compared to patients with other insurance, Medicaid decedents had the best quality EOL care: ED visit (9%), hospital admission (45%), and hospice initiation in the last 3 days (6%).ConclusionsAdditional research is needed to understand what could be driving these observed differences. Interventions, such as EOL patient navigation, could improve upon EOL care in patients with cancer.

BackgroundChemotherapy at the end of life may not extend survival and can diminish quality of life. Understanding patterns of use is critical to ensuring equitable, patient-centered care.ObjectiveTo examine racial and ethnic disparities in chemotherapy receipt within 30 days of death among patients with colon cancer, and whether these disparities changed over time.DesignWe conducted a retrospective cohort study using the National Cancer Database, identifying patients with colon cancer who died within 30 days between 2004 and 2021. The final sample included 43 490 patients. The primary outcome was chemotherapy receipt within 30 days of death. Multivariable logistic regression adjusted for demographics, insurance, comorbidities, facility characteristics, and socioeconomic factors. A difference-in-differences approach compared 2 periods: 2004-2012 and 2013-2021.ResultsAmong 43 490 patients (mean age, 75.6 years; 51.1% female), 1275 (2.9%) received chemotherapy near death. Adjusted analyses found no statistically significant racial or ethnic differences in use. However, Asian American patients had a marginally increased likelihood of receiving chemotherapy over time compared with non-Hispanic White patients (interaction OR, 2.25; 95% CI, 0.95-5.32; P = .065). Older age (≥80 years: OR, 0.12), higher comorbidity burden (Charlson-Deyo score ≥2: OR, 0.61), and uninsured status were associated with lower odds of treatment. Private insurance (OR, 1.67) and treatment at comprehensive cancer centers were associated with higher odds.ConclusionWhile overt racial disparities were not observed, disparities by insurance and facility type point to structural inequities that should be addressed in future quality improvement efforts.

Stroke patients have complex clinical conditions, thus requiring a palliative care approach to help improve quality of life. Interprofessional Collaboration (IPC) in health care services has been recognized as an effective approach to enhance the quality and effectiveness of palliative care. However, palliative care implementation in Indonesia remains limited. Therefore, this study aims to explore the implementation of IPC in the hospital setting for stroke patients receiving palliative care in Indonesia. A qualitative study using a descriptive-phenomenological approach was conducted in November 2025 through in-depth interviews and observations at a hospital in Indonesia. A total of 15 participants were purposively selected, comprising physicians, nurses, nutritionists, physiotherapists, psychologists, and chaplains involved in the care of stroke patients. Thematic analysis was used to analyze the data, and triangulation was used to enhance the study's credibility. This study identified 3 main themes, namely: (1) the importance of interprofessional team collaboration in palliative care; (2) integrated communication to support collaboration; (3) leadership as the key factor in the implementation of collaboration. These findings indicate that IPC is a crucial element in ensuring the fulfillment of the physical, psychological, social, and spiritual needs of stroke patients. Health care facilities, particularly hospitals, play an important role in developing and implementing IPC in palliative care for stroke patients in an optimal manner, including providing IPC and leadership training to ensure the sustainability of collaborative practices and improvements in the quality of care and the quality of life of stroke patients.

BackgroundThere is strong evidence of discriminatory healthcare to seriously ill lesbian, gay, bisexual, transgender, and queer people, plus other sexual and gender identities (LGBTQ+).AimThe aim is to describe positive, affirming, and culturally competent healthcare to seriously ill LGBTQ+ patients and their spouses, partners, and widows.DesignThe authors conducted a cross-sectional study using an online survey. The data for this report are the responses to three open-ended questions describing care that was respectful, affirming, and competent provided the data.Settings/SubjectsThere were 290 LGBTQ+ persons with a serious illness and their spouses, partners, and widows, recruited from a wide range of organizations in the U.S. that serve LGBTQ+ communities.ResultsThere were numerous reports of respectful, affirming, and competent care, including: healthcare providers who were open about discussing a respondent's LGBTQ+ identity and their specific health concerns; intake and assessment forms that included pre-specified choices for sexual orientations and gender identities; using correct names, pronouns, and gender; healthcare providers who identified as LGBTQ+ or signaled being an ally; and treating spouses, partners, and widows respectfully and including them in decision-making.ConclusionCulturally competent care is important for all individuals with a serious illness, particularly for those who identify as LGBTQ+. Such care builds trust, minimizes misunderstandings, and encourages meaningful communication with patients, thus increasing treatment effectiveness and patient satisfaction. Healthcare providers and healthcare systems are encouraged to become informed about caring for LGBTQ+ patients. Technology and inclusive intake forms and assessments may also contribute to making patients feel validated by using questionnaires that include questions about sexual orientation and gender identity. More can be done to educate healthcare professionals to provide culturally competent care to LGBTQ+ people and there are models for such training.

BackgroundLoneliness exacerbates symptom burden and reduces quality of life in serious illness. Social prescribing-linking patients to non-clinical community activities-offers a novel approach to address loneliness in palliative care.ObjectivesTo describe demographic, clinical, and psychosocial characteristics of oncology patients identified as lonely and referred to Art Pharmacy, an arts-based social prescribing program, within a palliative care setting.MethodsA retrospective chart review was conducted for 48 patients referred to Art Pharmacy's social prescribing services at the Georgia Cancer Center of Excellence at Grady Memorial Hospital. Demographics, mental and physical well-being scores, social determinants of health, and healthcare utilization data were analyzed.ResultsMost patients were older, non-Hispanic Black women experiencing financial strain, food insecurity, and transportation barriers. Anxiety exceeded depression severity; mood disorders, loneliness, and social isolation were leading referral reasons.DiscussionFindings characterize loneliness in a safety-net palliative oncology population. Social prescribing may help alleviate this burden, warranting further evaluation.