BACKGROUND: When a child dies in a pediatric intensive care unit (PICU) from a sudden or unexpected cause such as trauma or sepsis, intense grief felt by the child's family can cause sustained psychosocial impacts. Suppo...BACKGROUND: When a child dies in a pediatric intensive care unit (PICU) from a sudden or unexpected cause such as trauma or sepsis, intense grief felt by the child's family can cause sustained psychosocial impacts. Supporting unexpectedly bereaved families with evidence-based bereavement care is key to improving grief outcomes, and understanding their specific needs is essential to inform the delivery of bereavement care in PICUs. AIM: To understand what is known about (1) bereavement care needs of families who have experienced the unexpected death of a child in a PICU, and (2) approaches to address families' needs. METHODS: An integrative review was systematically conducted with the protocol registered a priori on the Open Science Framework. Original peer-reviewed research articles relating to relatives of children who died an unexpected death in a PICU were included from OVID Medline, PsycINFO, CINAHL, SCOPUS, and ProQuest, along with guidelines from Google searching. Articles were critically appraised using Critical Appraisal Skill Program, Mixed Methods Appraisal Tool, and Appraisal of Guidelines, Research and Evaluation II checklists, and data were synthesized using the constant comparison method. RESULTS: Twenty-nine original research articles (15 qualitative, 11 quantitative, 1 mixed method, and 2 secondary analyses) and five guidelines were included in this review. Three original articles focused on unexpected child death exclusively. From the findings of all 34 articles, four linked themes were identified: (1) and (2) with PICU clinicians, (3) of the impacts of unexpected death, and (4) emotional and physical for family members. CONCLUSION: Unexpectedly bereaved family members' needs included close relationships with clinicians and caring support before and after their child's death, including ongoing follow-up from the PICU. Further targeted research is needed to better understand the specific needs of unexpectedly bereaved families, gain diverse and representative evidence in this area, and develop innovative, evidence-based interventions to improve bereavement outcomes for the whole family.
Morbilliform drug eruptions in palliative care are often misattributed to active drugs, leading to inappropriate "opioid allergy" labels. Generic medications contain varying inactive excipients that can trigger delayed h...Morbilliform drug eruptions in palliative care are often misattributed to active drugs, leading to inappropriate "opioid allergy" labels. Generic medications contain varying inactive excipients that can trigger delayed hypersensitivity. A man in his 70s with a prior history of ibuprofen-associated angioedema and metoclopramide-associated rash developed a pruritic morbilliform eruption after switching from a Mallinckrodt hydrocodone-acetaminophen product to a Camber oxycodone-acetaminophen formulation (National Drug Code [NDC] 31722-0951-05). During a washout period, the patient successfully tolerated SpecGx-manufactured morphine (NDC 00406-5118-01) and Aurobindo potassium chloride (NDC 65862-0987-99) while the rash resolved. Comparison of NDC data identified croscarmellose sodium as the likely culprit, as it was unique to the offending formulation. Clinicians should document the NDC rather than broad drug classes when reactions occur after a generic substitution to preserve future therapeutic options and ensure continued access to essential analgesia.
Donation after circulatory death (DCD) has become a key avenue for expanding the organ donor pool. Many DCD protocols include premortem intravenous heparin to reduce microthrombus formation and preserve graft viability....Donation after circulatory death (DCD) has become a key avenue for expanding the organ donor pool. Many DCD protocols include premortem intravenous heparin to reduce microthrombus formation and preserve graft viability. This presents the plausible risk of premortem bleeding from an intervention that offers no direct therapeutic benefit to the donor. Ethical concerns and moral distress can arise when potential donors have a catastrophic intracranial hemorrhage with ongoing physiological concern for bleeding risk that is not survivable, but do not currently meet brain death criteria. While prior analyses describe premortem interventions in DCD in conceptual or protocol-driven terms, this case report considers the ethical concerns inherent in premortem heparin administration and illustrates how multidisciplinary teams can operationalize ethical safeguards, including transparent communication, attention to surrogate understanding, and separation of end-of-life decisions from donation-related interventions, to mitigate concerns and minimize moral distress. These issues are directly relevant to palliative care clinicians, who frequently support families during end-of-life crises and when there is consideration for organ donation. Through a multidisciplinary and ethically guided approach, this case illustrates how collaborative decision-making and transparent communication can uphold both donor dignity and transplant integrity.
BACKGROUND: Levetiracetam (LEV) continuous subcutaneous (SC) infusion (CSCI) is increasingly used in Australian patients receiving palliative care; however, evidence is limited for the stability and compatibility of LEV...BACKGROUND: Levetiracetam (LEV) continuous subcutaneous (SC) infusion (CSCI) is increasingly used in Australian patients receiving palliative care; however, evidence is limited for the stability and compatibility of LEV administered alone or with other medications. Understanding current prescribing practices and clinicians' research priorities is essential for guiding clinically relevant laboratory testing to support best practice. AIMS: To examine current LEV infusion practices in Australian adult palliative care settings and identify clinician-prioritized drug combinations for future stability and compatibility testing. METHODS: A cross-sectional online survey was distributed to palliative care clinicians across Australia. LEV administration practices, including doses, infusion volumes, diluents, devices, infusion durations, and drug combinations, were assessed. Clinician-reported rankings of priority medications for binary stability and compatibility testing with LEV were summarized. RESULTS: Among 62 respondents representing each Australian state and territory (primarily doctors, nurses, and pharmacists), LEV was predominantly administered as a continuous 24-hour SC infusion. Reported total daily doses ranged from 250 to 4000 mg, with infusion volumes between 10 and 120 mL. 0.9% sodium chloride and water for injection were the only diluents used. Morphine and hydromorphone were the most frequently reported coadministered medications and ranked as the highest priorities for future stability and compatibility testing with LEV. CONCLUSION: LEV was administered via CSCI over a wide range of doses. Clinician-identified priorities for binary stability and compatibility testing were hydromorphone or morphine combinations with LEV. These findings provide a practice-informed foundation for targeted laboratory studies to support safe, efficient, and evidence-based clinical practice both in Australia and internationally.
BACKGROUND: Opioids are widely used for cancer-related pain but are associated with serious adverse events, making appropriate prescription auditing essential. In Japan, most outpatient opioid prescriptions are dispensed...BACKGROUND: Opioids are widely used for cancer-related pain but are associated with serious adverse events, making appropriate prescription auditing essential. In Japan, most outpatient opioid prescriptions are dispensed at community pharmacies, where pharmacists play a key role. However, the content and clinical significance of opioid-related prescription audits have not been fully elucidated. OBJECTIVES: To evaluate the content, clinical significance, and impact of prescription inquiries by community pharmacists on outpatient opioid prescriptions. DESIGNS: This single-center retrospective cohort study analyzed prescription inquiries related to outpatient opioid prescriptions issued by the National Cancer Center Hospital East between September 2023 and March 2025. Inquiry contents were classified according to drug therapy problems related to efficacy and safety. MEASUREMENT: Pharmacist interventions were evaluated using established rating instruments for medication-order error severity and clinical value. RESULTS: During the study period, 184,688 prescriptions were issued; 10,153 (5.4%) involved inquiries from community pharmacies, including 391 (0.2%) related to opioids, of which 341 (87%) resulted in prescription modifications. Inquiries related to efficacy and safety accounted for 48%, with dosage errors (23%) and treatment duration errors (23%) most common. Overall, 180 cases (46%) were classified as potentially lethal, serious, or significant medication-order errors, and 46% of pharmacist interventions were rated as significant or higher, most frequently involving dosage errors with high severity and clinical value. CONCLUSIONS: These findings highlight the critical role of community pharmacists in ensuring safe and appropriate opioid therapy and underscore the importance of collaboration between hospital and community pharmacists in outpatient cancer care.
van Breemen C, Liversidge S, Zeng C
… +2 more, Zheng J, Andrews G
J Palliat Med
· 2026 Jun · PMID 42373532
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BACKGROUND: Children with life-limiting conditions often have complex care needs, and their caregivers require expert clinical support after-hours and over weekends to support care at home. OBJECTIVES: This quality impro...BACKGROUND: Children with life-limiting conditions often have complex care needs, and their caregivers require expert clinical support after-hours and over weekends to support care at home. OBJECTIVES: This quality improvement initiative examined usage patterns and impact on caregiving of the nurse-led 24-Hour Clinical Care Line initiated in 2018 by the Canuck Place Children's Hospice, which provides inpatient and community-based pediatric palliative care and respite for children with life-limiting conditions in British Columbia and the Yukon in Canada. METHODS: Phone call tracking logs and clinical profiles were analyzed to examine user demographics, temporal usage patterns, and reasons for calling. Families were asked to provide feedback on the service for quality improvement. RESULTS: From June 2020 to March 2024, 194 families placed 1106 calls. Mothers/foster mothers made 67% of the calls. Caregivers of children with central nervous system (CNS) and metabolic conditions made a significantly higher number of calls per child on average. Caregivers calling about children aged <1 year represented a disproportionately large group of callers. Parents of children >15 years made significantly fewer calls. The most common call reason was family support (73.1%), followed by providing an update on child status (58.5%), pain and symptom management (50.9%), and care planning (10.9%). Call volume peaked at bedtime and was consistent over nighttime hours and weekends. Late winter and spring were the most popular seasons for calls, following typical temporal influenza patterns.
R R P, Sultana R, Longo M
… +3 more, Chua Wan Ying G, Rawlinson F, Chan MY
J Palliat Med
· 2026 Jun · PMID 42366601
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BACKGROUND: Pain is a common symptom for children and adolescents with treatment-refractory cancers at the end of life (EoL). Palliative radiotherapy (RT) is a noninvasive, outpatient therapy with an acceptable safety pr...BACKGROUND: Pain is a common symptom for children and adolescents with treatment-refractory cancers at the end of life (EoL). Palliative radiotherapy (RT) is a noninvasive, outpatient therapy with an acceptable safety profile that helps to mitigate physical pain. It has been proven as an essential treatment modality for symptom control at EoL in the adult population. While the efficacy of palliative RT is well-established in adults, evidence in the pediatric population remains limited. This systematic review aimed to identify and evaluate the current evidence on palliative RT for the treatment of cancer pain in children and adolescents. METHODS: Five databases were searched for pediatric empirical quantitative studies. Inclusion criteria include children and adolescents aged ≤21 years old with terminal cancer who received palliative RT for pain relief, single- or multicenter studies with ≥10 cases published in English. The primary outcome was pain control postpalliative RT, and secondary outcomes included reduction in opioid usage. RESULTS: Seven observational retrospective studies ( = 63 patients/235 metastatic sites/139 palliative RT courses), published between 2003 and 2024, were included. Palliative RT was associated with a 77.9% (95% confidence interval [CI] 71.2-84.6, = 0.4) reduction in pain when used as an adjuvant therapy across all seven studies. A reduction in opioid use was observed in 43.2% (95% CI 31.8-54.7, = 0.4) across two studies ( = 52 patients/17 palliative RT courses). These were not statistically significant results. The subgroup analysis showed that it was associated with 80.0% (95% CI 69.9-90.1, = 0.9) reduction of pain in patients with bony lesions across two studies ( = 19 metastatic sites/41 courses). CONCLUSION: While our meta-analysis does not provide sufficient evidence to show that palliative RT reduced pain in children and adolescents with terminal cancer, it adds to the growing body of evidence supporting integrated approaches to symptom control in pediatric oncology. Further research is needed to substantiate its clinical benefits in augmenting and facilitating optimal EoL care in children and adolescents with advanced malignancies.
J Palliat Med
· 2026 Jun · PMID 42363745
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BACKGROUND: Hospice use is higher in the growing Medicare Advantage (MA) program compared to Traditional Medicare (TM). It is uncertain if this is due to different hospice referral patterns. OBJECTIVES: To compare hospic...BACKGROUND: Hospice use is higher in the growing Medicare Advantage (MA) program compared to Traditional Medicare (TM). It is uncertain if this is due to different hospice referral patterns. OBJECTIVES: To compare hospice use patterns in MA versus TM across beneficiary characteristics. DESIGN: Retrospective cohort study. SETTING/SUBJECTS: United States decedents in the Medicare Current Beneficiary Survey (2010-2022). MEASUREMENTS: We employed a counterfactual modeling approach: among those in MA, we estimated the association between hospice use and sociodemographic, health, and regional characteristics. We then applied these coefficients to the TM population to predict hospice use had they been enrolled in MA. RESULTS: Among 5153 decedents, 35.3% were in MA at death. Compared to TM decedents, MA decedents were younger, more likely to be Hispanic, less likely to reside in a facility, and less likely to report serious illnesses (dementia, cancer, stroke, heart disease, and lung disease). We estimated that if decedents had been enrolled in MA, hospice use would have been 6.1% higher (95% confidence interval, CI, 3.4%-8.8%) versus observed hospice use in TM. This difference was pronounced among those with higher education and serious illnesses in TM: for example, 10.1% higher for those with dementia (95% CI 6.9%-13.3%) versus without dementia (2.5% higher, 95% CI 1.2% lower-6.1% higher). CONCLUSIONS: Relative to TM, hospice use is highest among MA beneficiaries with higher education and specific serious illnesses. Future work needs to assess the drivers of this difference (e.g., palliative care, networks).
Chen J, Afezolli D, Ahmed E
… +9 more, Bullock K, Easton E, Fisher L, Ho JJ, Paice J, Rodin R, Smith G, Robbins-Welty G, Gelfman L
J Palliat Med
· 2026 Jun · PMID 42363735
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Opioid management for symptom relief in serious illness is a core aspect of palliative care (PC) practice, with additional complexities to consider when prescribing in the outpatient setting. Safe and timely access to ne...Opioid management for symptom relief in serious illness is a core aspect of palliative care (PC) practice, with additional complexities to consider when prescribing in the outpatient setting. Safe and timely access to necessary opioids for patients depends on clinicians writing accurate prescriptions, navigating health care insurance(s), planning for potential medication shortages, and close collaboration with outpatient pharmacies. Access should be supported by, and balanced with, appropriate risk-mitigation strategies, including regular clinical assessments, thoughtful medication selection to minimize adverse effects, and ongoing education for patients and clinicians. This article-written by an interprofessional team of PC-trained physicians, nurse practitioners, pharmacists, clinical practice nurses, and social workers-summarizes ten practical tips for navigating outpatient opioid prescribing.
Berner-Sharma JM, Berner-Sharma A, Arnold T
… +2 more, Bausewein C, Rémi C
J Palliat Med
· 2026 Jun · PMID 42363367
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BACKGROUND: Nausea and vomiting are distressing symptoms in palliative care. Due to a heterogeneous population and limited evidence, clinical management remains challenging. Guidelines often recommend an etiology-based t...BACKGROUND: Nausea and vomiting are distressing symptoms in palliative care. Due to a heterogeneous population and limited evidence, clinical management remains challenging. Guidelines often recommend an etiology-based treatment approach, but supporting evidence is scarce, particularly for noncancer patients. OBJECTIVES: Evaluating the impact of a structured, etiology-based treatment pathway on nausea and vomiting burden and treatment quality in palliative care patients. SETTING/SUBJECTS: Single-center, before-after study in adult patients on a German tertiary palliative care unit, comparing symptom burden and treatment quality before (Phase 1, 15 months) and after (Phase 2, 12 months) implementation of the pathway. MEASUREMENTS: Outcome measures were change in symptom burden score on day 3 (Integrated Palliative Care Outcome Scale ([IPOS]), treatment quality (quality indicator [QI]; burden reduction on IPOS), and duration of symptoms (days). Significance level was set at α < 0.01. RESULTS: In Phase 1, 172/330 patients (52.1%) experienced 230 episodes of nausea/vomiting, versus 139/280 patients (49.6%) with 178 episodes in Phase 2. On day 3, symptom burden scores for nausea decreased to a greater extent in Phase 2 ( = 0.007); vomiting showed a nonsignificant reduction ( = 0.021). The QI (nausea) was met in 124/178 (69.7%) versus 129/156 (82.7%) ( = 0.0056), and the QI (vomiting) was met in 66/93 (71.0%) versus 81/95 (85.3%) ( = 0.0176) episodes. Symptom duration decreased from 3 (0-25) to 2 (0-23) days ( < 0.001). CONCLUSIONS: The systematic etiology-based pathway significantly improved cause identification and treatment quality. While benefits were more pronounced in cancer patients, this structured approach provides a robust framework for enhancing antiemetic management in the palliative care setting. Further studies should investigate antiemetic treatment in noncancer patients.
Lehenaff R, Oltmann C, Robbins-Welty GA
… +6 more, Scheiner N, Carter K, Moreno PI, Robinson S, Young R, Pinto Taylor E
J Palliat Med
· 2026 Jun · PMID 42359596
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Suicidal ideation (SI) is a complex phenomenon occurring across populations and is especially prevalent among patients with serious illness. Palliative care (PC) clinicians often care for patients at elevated risk for SI...Suicidal ideation (SI) is a complex phenomenon occurring across populations and is especially prevalent among patients with serious illness. Palliative care (PC) clinicians often care for patients at elevated risk for SI and are well positioned to identify and respond to suicidality. Clinical encounters may require distinguishing passive wishes for death from active suicidal intent, addressing modifiable sources of suffering, and supporting patients and families through emotionally complex conversations. Practical, evidence-informed guidance can help clinicians approach these encounters with greater clarity and confidence. In this article, an interdisciplinary group of PC, psychiatry, psychology, social work, and chaplaincy clinicians shares ten tips for caring for patients with serious illness who experience SI.
Dy S, Keller C, Fazio EM
… +2 more, Eldadah BA, Bakos A
J Palliat Med
· 2026 Jun · PMID 42359530
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BACKGROUND: Palliative care research encompasses varied topics, disciplines, settings, populations, and diseases. The National Institutes of Health (NIH) is a major funder of palliative care research and researcher caree...BACKGROUND: Palliative care research encompasses varied topics, disciplines, settings, populations, and diseases. The National Institutes of Health (NIH) is a major funder of palliative care research and researcher career development. AIM: To characterize 10 years of NIH-supported palliative care research and identify research gaps and opportunities that could improve access, use, and quality of palliative care for individuals with serious illness. DESIGN: We used keywords to identify new palliative care awards and publications from 2014 to 2024. We screened titles and abstracts using NIH iSearch tools for eligibility, yielding 899 awards and 1703 publications, then abstracted and analyzed research type, population, setting, and National Consensus Project for Quality Palliative Care (NCP) domain. RESULTS: Palliative care research awards nearly doubled from 2014 to 2024 across 17 NIH institutes. Over 40% included clinical trials, and nearly 30% were career development or training awards. Most addressed the NCP domains of Structure and Processes (35.3%) and Physical Symptoms (20.4%). Publication influence was above average, measured by relative citation ratio. Most articles reported on data collection (36.9%) or secondary analysis (37.9%); few reported clinical trials (9.2%). Over 80 articles leveraged NIH-funded infrastructure. Few awards (7.8%) or publications (6.3%) addressed health disparities. CONCLUSIONS: NIH investment in palliative care research increased over the period of interest. Increased support for the breadth of palliative care research beyond end-of-life care, clinical trials and intervention development, studies focused on caregivers and palliative care for persons living with Alzheimer's and related dementias, research and data infrastructure, and inclusion of palliative care-relevant content in large center and network awards are clear successes. While many 2004 NIH research priorities were addressed, gaps remain. Sustained investment with increased coordination could systematically accelerate translation of high-quality palliative care into widespread real-world practice.
Hamza Habib M, Fontanesi L, Motiwala ZY
… +16 more, Çöltekin A, Misra S, MacLullich A, Vinay R, Hertler C, Blum D, Singler K, Simões C, Frisardi V, Boccardi V, Bellelli G, Koca M, Kerr CW, Jones CA, Peng-Keller S, Schlögl M
J Palliat Med
· 2026 Jun · PMID 42343105
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BACKGROUND: End-of-life dreams and visions (ELDVs) are vivid, often subjective experiences that occur during the dying process. Even though the patient and family experiences of ELDVs are well documented, there is limite...BACKGROUND: End-of-life dreams and visions (ELDVs) are vivid, often subjective experiences that occur during the dying process. Even though the patient and family experiences of ELDVs are well documented, there is limited knowledge regarding the perspectives, preparedness, and perceived needs of health care professionals. ELDVs also remain insufficiently addressed in clinical care. OBJECTIVE: To describe how frequently clinicians encounter ELDVs, perceived preparedness/training, and approaches to clinician and family education and communication. METHODS: We conducted a survey to explore health care professional's perspectives and experiences surrounding ELDVs. The was followed. Our survey included 30 items across 7 sections. Professionals that take care of patients with serious or terminal illness were eligible for the study. We utilized a structured multimodal dissemination to achieve maximum diversity in participants. RESULTS: Briefly, 247 participants were eligible for analysis. Frequent encounters for ELDVs were reported by participants. Participants perceived positive effects on patients more frequently than negative effects (W = 446.0, < 0.001, r = 0.64). Clinical challenges were rated differently across categories (χ = 160.97, < 0.001, Kendall's W = 0.13). The most commonly endorsed clinical challenges were lack of institutional protocols and lack of standardized diagnostic criteria, both rated significantly higher than all other challenges (Bonferroni-corrected Wilcoxon tests: All < 0.001). Participants endorsed multidisciplinary involvement and formal policy implementation. CONCLUSION: ELDVs are common, but clinicians feel underprepared to respond to them. There is a need for structured training and institutional protocols. Future studies should include patients and their families and analyze how their experiences are shaped by physician responses.
Jacobson E, Harris A, Tian S
… +3 more, Shrestha S, Seiler M, Khateeb R
J Palliat Med
· 2026 Jun · PMID 42343081
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BACKGROUND: Hospitalized patients with serious illnesses often lack code status documentation, increasing the risk of goal-discordant care during hospitalization. LOCAL PROBLEM: Patients with a prior preference for do-no...BACKGROUND: Hospitalized patients with serious illnesses often lack code status documentation, increasing the risk of goal-discordant care during hospitalization. LOCAL PROBLEM: Patients with a prior preference for do-not-attempt-resuscitation (DNAR) sometimes lacked a code status order during subsequent encounters, creating a patient safety risk of undesired resuscitation in the event of cardiac arrest. INTERVENTION: In May 2025, we developed an electronic health record (EHR) alert to prompt code status discussion for hospitalized medicine patients with prior DNAR or partial code. METHODS: We compared the proportion of patients with active code status during admission and timing of order before and after intervention. RESULTS: Of 713 patients with prior DNAR or partial code status, the percentage with an active code status order increased following implementation (96.4% vs. 89.6%, < 0.001). Only 6.1% of code status orders were placed within five minutes of alert. Median time from admission to first order increased post-implementation (eight vs. seven hours, = 0.03). CONCLUSIONS: An EHR alert to prompt code status discussions in patients with prior DNAR or partial code status increased code status order documentation. Further studies could explore expanding alerts to other services and assessing impact on goal-concordant care.
Hagemann M, Schwenkglenks M, Stalder O
… +2 more, Eychmüller S, Maessen M
J Palliat Med
· 2026 Jun · PMID 42343072
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BACKGROUND: Early integration of specialist palliative care (sPC) improves patient-centered outcomes, but its impact on hospital costs during terminal admissions remains insufficiently studied. AIM: To compare total and...BACKGROUND: Early integration of specialist palliative care (sPC) improves patient-centered outcomes, but its impact on hospital costs during terminal admissions remains insufficiently studied. AIM: To compare total and daily hospital costs associated with early versus late initiation of sPC during the terminal hospital admission of patients who died in hospital. DESIGN: Retrospective cohort study using routinely collected administrative and clinical hospital data. Costs were analyzed using generalized linear models adjusted with inverse probability of treatment weighting. Bias-corrected mean ratios with 95% confidence interval (CI) calculated from 2,000 bootstrapped samples were presented. SETTING/PARTICIPANTS: The study was conducted at a single Swiss tertiary care hospital and included adults aged ≥18 years who died during their terminal hospitalization between 2016 and 2022 and received sPC. Early sPC was defined as initiation within three days of admission. Patients with refusal of data use, external causes of death, perioperative death in otherwise healthy individuals, or incomplete cost data were excluded. RESULTS: The cohort comprised 790 patients (397 early sPC; 393 late sPC). Adjusted total hospital costs were substantially lower among patients receiving early sPC (CHF, 22,999; 95% CI: 21,149-25,072) compared with late sPC (CHF, 60,691; 95% CI: 55,186-67,165). Patients receiving early sPC also had lower daily costs. The largest cost differences occurred in pharmacy, laboratory, material, and room categories, whereas staff costs were similar between groups. CONCLUSIONS: Early initiation of sPC during terminal hospitalizations is associated with markedly lower hospital costs without increased staff expenditures. Additional studies are needed to establish whether this association is causal. Nonetheless, these findings suggest that providing patients with the benefits of sPC earlier during terminal hospitalization may be possible without increasing overall hospital costs and may have important implications for health care resource utilization.
J Palliat Med
· 2026 Jun · PMID 42343070
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INTRODUCTION: Clinical reasoning is essential for hospice and palliative medicine (HPM) fellows, yet structured assessment tools are lacking. The Assessment of Reasoning Tool (ART) has shown positive results for early le...INTRODUCTION: Clinical reasoning is essential for hospice and palliative medicine (HPM) fellows, yet structured assessment tools are lacking. The Assessment of Reasoning Tool (ART) has shown positive results for early learners but has not been applied to advanced learners. METHODS: We conducted an 18-month mixed-methods study at a single academic center. Seven fellows and seven faculty participated. Faculty used the ART every day during clinical teaching rounds on a fellow's inpatient rotation. Pre- and post-intervention surveys assessed the ART via 4-point Likert scale and free-response questions. RESULTS: Fellows reported increased feedback on clinical reasoning (2.33 vs. 3.25; = 0.05) and reflection on cognitive bias (2.67 vs. 2.81; = 0.02), and no difference in satisfaction with feedback, comfort with clinical reasoning terminology, and time spent on feedback. Faculty reported no difference across all areas. Both groups cited time constraints and a need for clearer guidance on effective use as barriers to using the ART. Qualitative themes highlighted the ART as a diagnostic versus management reasoning tool, limited application to non-symptom-based case scenarios, and persistent faculty discomfort despite training. CONCLUSION: This study suggests the ART is feasible for HPM fellowship training and may enhance certain aspects of clinical reasoning assessment for fellows, particularly during early fellowship. However, its broader utility is limited by the absence of faculty-perceived benefit, persistent faculty discomfort with implementation, and the tool's emphasis on diagnostic rather than management reasoning. Further research on effective faculty development and assessment tools tailored to management reasoning would help define the optimal role of the ART in HPM training.