The American journal of hospice & palliative care最新文献

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.

BackgroundThis study examined racial and socioeconomic disparities in hospice utilization among deceased older adults in the United States. Hospice care provides comfort-oriented support at the end of life, yet access remains uneven across social groups.MethodsI used retrospective data from the 2020 RAND Health and Retirement Study (HRS) Exit Interview file in this cross-sectional study. I included 6800 deceased older adults in the analytic sample. I measured hospice use as a binary outcome indicating whether the respondent received hospice care in the final month of life. Key predictors included race/ethnicity, educational attainment, household wealth quintiles, Medicaid enrollment, and private insurance coverage. I used logistic regression models to examine disparities in hospice use, including interaction terms to assess whether SES moderated the effects of race/ethnicity. I computed marginal effects to estimate predicted probabilities.ResultsNon-Hispanic Black and Hispanic older adults were significantly less likely to use hospice services compared to non-Hispanic White peers. After adjusting for SES and health covariates, the disparity for Black adults was no longer statistically significant, but the gap for Hispanic adults persisted (OR = 0.76; 95% CI: 0.60-0.96). Lower education, low household wealth, and Medicaid enrollment were associated with reduced odds of hospice use. Interaction analysis revealed that Hispanic individuals in the lowest SES group had the lowest predicted probability of hospice enrollment (40%; 95% CI: 0.35-0.45).ConclusionFindings reveal persistent hospice disparities among marginalized older adults, underlining the need for interventions addressing structural barriers to end-of-life care.

Background and PurposeSevere acute brain injury (SABI) often occurs suddenly, profoundly impacting patients and their families. During the ICU stay, critical treatment decisions have to be made in the setting of prognostic uncertainty. We aimed to better understand the experiences of surrogate decision makers (SDMs) specifically regarding longer-term treatment decisions such as tracheostomy, gastrostomy, and withdrawal of life-sustaining treatment (WLST).MethodsWe interviewed SDMs of adult patients admitted between 2021 and 2022 with SABI (traumatic brain injury or stroke) who were initially mechanically ventilated and either underwent tracheostomy or WLST after 7 days. We developed an interview guide in collaboration with five SDMs for former patients to explore the ICU experience and reflections on treatment decisions. SDMs were contacted 12-36 months post-SABI. Common themes were identified after a review of transcripts by six authors.ResultsAfter contacting the primary caregivers for 18 eligible patients, six SDMs consented to participate. Interviewees included SDMs to four patients who underwent tracheostomy and two who died after a decision to pursue WLST; median time from hospital discharge to interview was 29 months. SDMs expressed sources of struggle in the decision-making process including the novelty of the role, perceived time pressure to make decisions, and prognostic uncertainty. Post-acute discharge needs were also unanticipated and overwhelming.ConclusionThe reflections from SDMs highlighted the significant multifaceted difficulties experienced by SDMs of patients with SABI. More research is needed to understand how to best support those who support our patients.

Advance care planning (ACP) completion rates are higher in patients with serious illness compared to the general population, however, ACP is overall under-utilized and sub-optimal, especially for patients with hematologic malignancies. This patient population can experience unique and significant physical and psychological symptoms due to their illness and the treatment, resulting in high rates of aggressive end of life care. This high healthcare utilization pattern often triggers ACP conversations and documentation, often facilitated by specialty palliative care clinicians. This review article examines existing literature about ACP for patients with hematologic malignancies with the intent to inform future prospective research to improve values-based patient care.

Multiple myeloma (MM) is a hematologic malignancy characterized by a significant symptom burden and a complicated disease trajectory, highlighting the necessity for early integration of palliative care (PC). This study assessed the effects of a nurse-led, integrative early palliative care intervention in comparison to standard care for patients with multiple myeloma. The intervention included weekly symptom tracking, structured follow-ups, and proactive symptom management. Patient-reported outcomes were assessed at baseline, 3 months, and 6 months using validated instruments. The number of emergency department (ED) visits and hospitalizations were assessed to measure the burden to the health care system.The integrated model improved anxiety as measured by HADS (P = .01), quality of life (P < .001) and reduced pain (P < .01), fatigue (P < .01), drowsiness (P = .007), and depression (P = .04). Nausea, shortness of breath, and loss of appetite remained unchanged. These findings highlight the benefits of a nurse-led, integrative PC approach in reducing symptom burden and enhancing psychological well-being among patients with MM. Early integration of this model within hematology services has the potential to improve patient outcomes, although institutional adaptations may be needed to optimize its effect on health care utilization.

PurposeTo identify disparities in access, utilization, and quality of end-of-life (EOL) and palliative care services for American Indians and Alaska Natives (AIAN) with cancer in the US.MethodsSystematic searches were conducted in PubMed/MEDLINE, Embase, and Scopus. English-language original research studies reporting any quantitative estimates of measures of care quality or utilization for EOL and palliative care for AIAN individuals with cancer compared to other races were included (2014-2025). Screening and data extraction were conducted by two independent reviewers and discrepancies were resolved through consensus. Findings were synthesized through iterative team discussions.ResultsOf 1693 unique records, 153 underwent full-text review, and 22 met inclusion criteria. Considerable heterogeneities were observed in EOL care outcomes and covariates included in multivariable regression models assessing disparities: Compared to White individuals, AIAN individuals with cancer had significantly lower in-home or hospice and higher medical facility deaths (9/11 studies); higher acute care use (3/4 studies); lower hospice use (2/4 studies); lower anxiolytic medication use (1/1 study); and higher receipt of any palliative treatment (3/6 studies); but no differences in late hospice initiation (0/3 studies); or aggressive treatment near the EOL period (0/6 studies).ConclusionsAIAN individuals with cancer appear more likely to experience a medicalized death. Mechanisms underlying these disparities remain poorly understood. Future studies should provide greater clarity in analytical methods to improve interpretability of disparities measures, use more consistent measures of EOL care quality, explore within-AIAN variation such as regional, tribal, and rural-urban differences, as well as cultural implications for the delivery of appropriate EOL care.

BackgroundLife Review Interventions (LRI) are gaining attention in palliative care as a therapeutic approach to support psychological and spiritual needs. However, their effectiveness remains uncertain.ObjectivesThis systematic review aimed to analyze the effects of LRI in adults with advanced chronic or terminal illness receiving palliative or end-of-life care.MethodsMEDLINE, Scopus, Cochrane Library, and Web of Science were searched for English-language articles (2018-2024). Included studies involved adults with advanced chronic illness receiving any form of LRI; control groups, where applicable, received usual care. Primary outcomes were symptom burden, spiritual well-being (SWB), and quality of life (QOL). Studies were critically appraised. Due to heterogeneity, a narrative synthesis was conducted. The review was registered in PROSPERO.ResultsEight studies were included, most of moderate to high methodological quality. Half were conducted in North America, with the remainder from Europe and Asia. The total sample comprised 598 participants, 89% of whom had cancer. The review identified eight distinct LRI, each with varying formats and delivery methods. For symptom-related outcomes (n = 8), four studies reported significant improvements in anxiety, depression, or general well-being. For SWB (n = 6), three studies demonstrated positive effects. Regarding QOL (n = 4), only one study showed meaningful improvement; the others found no significant change.ConclusionsLRI may provide psychological and spiritual benefits in palliative and end-of-life care. However, current evidence for their effectiveness in improving QOL is limited, highlighting the need for further high-quality research.

Hospice can improve end-of-life (EOL) outcomes in U.S. nursing homes (NHs). However, only one-third of eligible residents enroll, and substantial variation exists within and across NHs related to resident-, NH-, or community-level factors. We conducted a review of English-language, peer-reviewed articles 2008 to 2023 describing this variation in NH hospice use to characterize disparities and inform educational and quality initiatives to improve EOL care in NHs. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We screened 1595 records, reviewed 82 articles and included 13 articles. Eleven used pre-2009 data. Six evaluated national data and 7 used regional (n = 1), state (n = 4), or local (n = 2) data. One assessed hospice referral, 10 hospice use, and 3 length-of-stay. Twelve conducted regression analyses; 1 stratified by race, another evaluated interaction terms, and a third compared racial differences within-and between-facilities. Unadjusted and adjusted differences were evaluated by resident race-and-ethnicity (n = 6 unadjusted, n = 10 adjusted, respectively), sex (n = 5, n = 9), or payor (n = 1, n = 4), or by NH race-mix (n = 1, n = 2), ownership (n = 1, n = 7), payor-mix (n = 1, n = 5), or urban/rural location (n = 1 adjusted). Unadjusted differences showed lower hospice use by Non-White residents and varied results by sex. Studies adjusting for resident-, NH-, and community-level factors found lower hospice use among male residents, Black/Non-White residents, and residents of rural NHs, with mixed results by payor and ownership. Results were mixed for hospice referral and length-of-stay. These findings suggest complex influences on NH hospice use. Further study is warranted to identify targets for improving hospice access.

Context: Serious illnesses like cancer disproportionately affect American Indians and Alaska Native (AI/AN) Peoples. AI/AN patients deserve culturally responsive healthcare at all times, and especially when journeying through serious illness. Objectives: To learn about specific clinician-related factors that AI/AN cancer survivors, caregivers, Tribal leaders, and traditional healers want from their clinicians while experiencing cancer. Methods: We utilized qualitative interviews and Indigenous talking circles to explore perspectives on what type of clinician education, communication approaches, and clinical resources are desired so that clinicians may provide culturally responsive care to AI/AN peoples experiencing cancer. Analysis was completed via a team of Native and non-Native researchers analyzing narrative data from AI/AN cancer survivors, caregivers, Tribal leaders, and traditional healers. Results: Interviews and talking circle qualitative analysis revealed 3 major themes related to clinician needs: cultural considerations, psychosocial support, and trust. Conclusion: Any clinician caring for AI/AN peoples with serious illness such as cancer needs to understand clinician-related factors that AI/ANs say impact their care when experiencing serious illness. It is important for clinicians to engage in cultural education and work to improve systemic deficiencies such as a lack of psychosocial support. An overarching theme was also the need for clinicians to seek to develop trustworthiness and earn trust when caring for AI/AN patients experiencing serious illness.