Kajiura S, Chikaoka S, Yagi Y
… +12 more, Ryu N, Matsushita T, Kurokawa M, Yoshida A, Kanai N, Mizuno Y, Yuki R, Nagata K, Motoo I, Ando T, Yasuda I, Hayashi R
J Palliat Med
· 2026 Jun · PMID 41700913
·
Publisher ↗
BACKGROUND: Opioid-induced constipation (OIC) limits opioid titration in cancer care. Before the use of peripherally acting μ-opioid receptor antagonists (PAMORAs), OIC often required switching from oxycodone to lower-ri...BACKGROUND: Opioid-induced constipation (OIC) limits opioid titration in cancer care. Before the use of peripherally acting μ-opioid receptor antagonists (PAMORAs), OIC often required switching from oxycodone to lower-risk opioids, such as transdermal fentanyl. Whether naldemedine allows oxycodone escalation without switching remains unclear. We evaluated the maximum scheduled daily oxycodone dose as a surrogate for maintaining therapy without constipation-driven switching. METHODS: We retrospectively reviewed adults with cancer pain who initiated oral oxycodone at Toyama University Hospital between June 2017 and December 2018. Patients receiving naldemedine were classified as Group A; others as Group B. The primary endpoint was the maximum scheduled controlled-release oxycodone dose during follow-up; rescue doses were excluded. RESULTS: Among 217 patients, the median maximum dose was higher with naldemedine (40 mg/day [range 10-480] versus 20 mg/day [10-320]; < 0.0001). CONCLUSIONS: Naldemedine enabled higher oxycodone dosing, suggesting OIC management reduces opioid switching.
Gelfman LP, Zeng L, Bergland K
… +5 more, Rizzo E, Higgins C, Doucette C, Chokshi K, Chai E
J Palliat Med
· 2026 May · PMID 41700908
·
Publisher ↗
BACKGROUND: Hospitalized patients with serious illness often face delayed or limited access to palliative care. Embedded hospital primary palliative care (HPPC), led by social workers and nurse practitioners, may deliver...BACKGROUND: Hospitalized patients with serious illness often face delayed or limited access to palliative care. Embedded hospital primary palliative care (HPPC), led by social workers and nurse practitioners, may deliver more timely, needs-based support compared with referral-based specialty palliative care (SPC). OBJECTIVE: To compare demographics, clinical characteristics, acute care utilization, and sustainability of an embedded HPPC model versus SPC in hospital medicine. METHODS: We conducted a retrospective cohort study of adults receiving palliative care consults at a New York City academic medical center during two periods: March 2019-February 2020 (HPPC1 vs. SPC) and June 2021-May 2022 (HPPC2 vs. SPC). Variables included demographics, Karnofsky Performance Status (KPS), comorbidities, mortality index, goals-of-care documentation, ICU admission, length of stay, discharge disposition, and 30-day readmissions. Outcomes were compared across groups and periods. RESULTS: HPPC patients were older (mean 69.6 vs. 65.2 years; 71.7 vs. 65.0 years), had higher KPS, lower predicted mortality, and more often pursued life-prolonging goals than SPC patients. ICU admissions and hospital stays were consistently lower in HPPC cohorts. Demographic diversity was similar, with ∼27% Black, 23% Latinx, and 30% Medicaid-insured patients in HPPC groups. Volume, patient mix, and utilization outcomes were consistent across HPPC1 and HPPC2, demonstrating sustainability. CONCLUSIONS: An embedded SW/NP-led palliative care model in hospital medicine improves access, reduces acute care use, and is sustainable over time. This approach supports timely, culturally sensitive, needs-based palliative care and may be scalable for hospital-based delivery.
Mahoney AB, Akard TF, Cowfer BA
… +4 more, Newton J, Walker H, Dietrich MS, Gilmer MJ
J Palliat Med
· 2026 Mar · PMID 41700892
·
Publisher ↗
BACKGROUND: Children with advanced cancer and their caregivers experience significant stress, which can diminish quality of life (QoL). Animal-assisted interaction (AAI) is beneficial in pediatric populations but less we...BACKGROUND: Children with advanced cancer and their caregivers experience significant stress, which can diminish quality of life (QoL). Animal-assisted interaction (AAI) is beneficial in pediatric populations but less well studied in children with advanced cancer. OBJECTIVES: To (i) evaluate the effect of AAI on QoL and depressive symptoms in children with advanced cancer and on stress in their caregivers, and to (ii) evaluate the feasibility of measuring stress hormones in AAI. DESIGN: Longitudinal cohort study. SETTING/SUBJECTS: Children (n = 29) and caregivers (n = 29) participated in up to eight weeks of AAI during routine oncology clinic visits or admissions at an academic children's hospital in Southeast United States. MEASURES: Child participants completed surveys to evaluate QoL and depressive symptoms at baseline and weeks 4 and 8 post-AAI. Caregivers completed surveys to evaluate parental stress, as well as proxy forms for child QoL and depressive symptoms at the same time points. Salivary cortisol and serum epinephrine and norepinephrine were obtained from child participants at baseline and pre- and post-AAI sessions at weeks 4 and 8. RESULTS: Child overall and physical QoL scores improved, while caregiver-proxy scores for children's QoL improved overall and within physical, psychosocial, school, and emotional domains. There was a statistically significant decrease in caregiver stress over time. Salivary cortisol and serum epinephrine levels were feasible to collect and demonstrated statistically significant decreases both over time and before and after AAI sessions. CONCLUSION: The results indicated that AAI improved child QoL over an 8-week period and reduced caregiver stress. Collecting salivary cortisol and serum epinephrine and norepinephrine was feasible during visits. While decreases in cortisol, epinephrine, and norepinephrine were demonstrated following sessions, the implication of these findings on child physiological stress requires further study.
Gately ME, Shirk SD, Canell A
… +3 more, Laffer A, Corle M, Dillon K
J Palliat Med
· 2026 Jun · PMID 41661112
·
Full text
BACKGROUND: While virtual reality (VR) is a valuable therapeutic tool, its utility for hospice and palliative care (HPC) is understudied. OBJECTIVES: We explored the use of VR with patients receiving inpatient HPC. DESIG...BACKGROUND: While virtual reality (VR) is a valuable therapeutic tool, its utility for hospice and palliative care (HPC) is understudied. OBJECTIVES: We explored the use of VR with patients receiving inpatient HPC. DESIGN: Mixed methods study examining feasibility and clinical outcomes of a VR program. SETTING/SUBJECTS: Twenty-five veterans with complex medical and psychiatric comorbidities at a Veterans Affairs hospital participated. Data related to self-reported pain and well-being, as well as session feedback, were gathered. RESULTS: Despite some challenges with setup, 91% reported enjoyment, and 90% would participate again. Travel experiences were most popular, allowing reminiscence and touring of bucket-list destinations. Program feedback suggested improvements in anxiety, mood, and boredom. CONCLUSIONS: Results demonstrate the use of VR to facilitate meaningful engagement and improve psychological well-being for veterans receiving HPC. Additionally, opportunities for socialization and reminiscence, even while bedbound, increased. These findings support further exploration of VR as an intervention in HPC.
The "Tell Us More: The Palliative Care Oral History Project," seeks to tell the story of Hospice and Palliative Care through informal interviews with pivotal leaders in the field. In each episode, hosts Drs. Ricky Leite...The "Tell Us More: The Palliative Care Oral History Project," seeks to tell the story of Hospice and Palliative Care through informal interviews with pivotal leaders in the field. In each episode, hosts Drs. Ricky Leiter and Billy Rosa, along with research assistant Dr. Yilong Peng, sit down with an HAPC luminary and do what our field does best-ask questions, listen, and reflect. In the third episode, Drs. Leiter and Rosa interviewed Ms. Shirley Otis-Green, founder of Collaborative Caring and a pioneer in palliative social work. What follows is a transcript of their conversation, edited lightly for clarity.
Baumgarten NE, Jonas DF, Oslin E
… +5 more, Ayala E, Nogle C, Pollack A, Mendelson A, Bogetz J
J Palliat Med
· 2026 Feb · PMID 41661093
·
Publisher ↗
BACKGROUND: Children with medical complexity (CMC) have chronic conditions often involving technology assistance, care from family caregivers and clinicians, and substantial health care needs. Previous studies have ident...BACKGROUND: Children with medical complexity (CMC) have chronic conditions often involving technology assistance, care from family caregivers and clinicians, and substantial health care needs. Previous studies have identified communication gaps between family caregivers of CMC and their child's clinicians, as well as a need for clinicians to better understand their lived experience. Approaches using photos may be a way for CMC and their family caregivers to share their experience with clinicians. OBJECTIVE: To conduct a scoping review of the literature and describe findings from studies using photo-based approaches with CMC, their family caregivers, and clinicians. METHODS: PubMed, PsycInfo, and Web of Science were searched following Joanna Briggs Institute scoping review guidelines. Abstract screening and full-text reviews were performed using Covidence software. Studies were eligible if they: (1) included CMC up to age 25, and/or their family caregivers, and/or clinicians; (2) used a photo-based approach (photo-elicitation, photovoice, photo-narrative); (3) were published in the last 20 years; and (4) were written in English. RESULTS: One hundred twenty-three studies were identified, including 83 identified through an initial search with a research center librarian, with additional studies identified through hand-searching. A final of 25 studies were included. Participants found photo-based approaches to sharing their experience to be both useful and enjoyable. A synthesis of the data presented in these studies yielded nine themes/dimensions describing the multidimensional experience of CMC, their family caregivers, and clinicians. These dimensions were organized into three areas: relational (independence vs. dependency, deepening relationships vs. straining relationships, and inclusion vs. stigmatization), navigational (feeling typical vs. feeling different, advocacy vs. subjugation, and participation vs. barriers), and emotional (predictability vs. uncertainty, well-being vs. exhaustion, and growth vs. loss). CONCLUSION: This scoping review describes how photo-based approaches may be used to explore the multidimensional experience of CMC, their family caregivers, and clinicians.
Mushtaq A, Tareen M, Samala RV
… +1 more, LeGrand SB
J Palliat Med
· 2026 Feb · PMID 41661086
·
Publisher ↗
As hospice and palliative care (HPC) expands, it faces the challenge of serving patients from diverse cultural and religious backgrounds. Understanding these communities' unique values during critical life transitions is...As hospice and palliative care (HPC) expands, it faces the challenge of serving patients from diverse cultural and religious backgrounds. Understanding these communities' unique values during critical life transitions is essential. This article presents two case narratives illustrating reservations toward HPC in South Asian Muslim (SAM) communities, highlighting challenges and proposing strategies for culturally sensitive care. The first case demonstrates that, even with evidence-based and empathetic approaches, hesitancy toward HPC may persist. This underscores the need for (1) community-level initiatives leveraging religious and cultural platforms to educate and engage communities, and (2) greater awareness among healthcare professionals of these values to minimize conflict and reduce provider distress. In the second case, Islamic scholars were consulted regarding the use of sedative medicines at the end of life. They agreed such use is permissible under the principle of medical necessity, emphasized deference to medical expertise, and stressed preserving the patient's ability to recite the Shahadah (testimony of faith) in their final moments.
Lemieux L, Nichol K, Rao P
… +3 more, Biondo P, Simon J, Archibald D
J Palliat Med
· 2026 Jun · PMID 41636768
·
Publisher ↗
BACKGROUND: Simulation-based learning is increasingly integrated into medical education; however, the use of simulation in palliative medicine is generally limited to communication skills and pain management. There is a...BACKGROUND: Simulation-based learning is increasingly integrated into medical education; however, the use of simulation in palliative medicine is generally limited to communication skills and pain management. There is a recognized need for a structured approach to a simulation-based curriculum aligned with the unique challenges in complex symptom management and emergencies in palliative medicine specialty training. OBJECTIVES: To identify and prioritize key clinical topics for a simulation curriculum for palliative medicine specialty training. METHODS: Using Kern's six-step approach to curriculum development, we conducted a two-phase needs assessment. Phase 1 was a survey of 101 palliative care practitioners to identify topics appropriate for more intensive training. Phase 2 applied the Delphi method with 46 participants to achieve consensus on priorities. RESULTS: Ten high-priority simulation topics emerged: dyspnea crisis, complex pain management, acute pain crisis, terminal agitated delirium, airway obstruction, existential distress, palliative sedation, intractable nausea and vomiting, opioid use disorder, and ventilatory support withdrawal. These aligned with competency-based and entrustable professional activities. CONCLUSIONS: This study addresses the gaps in simulation use for complex and emergent clinical situations. Next steps include validation with residency program directors, mapping existing resources, and developing new content, supporting a collaborative approach to advancing palliative specialty education.
Xu T, Liu C, Li L
… +3 more, Song D, Rose GM, Zhu S
J Palliat Med
· 2026 Feb · PMID 41636764
·
Publisher ↗
BACKGROUND: Artificial intelligence (AI) is transforming health care by enhancing diagnostics, improving patient outcomes, and reducing administrative burdens through advanced algorithms, with applications in medical ima...BACKGROUND: Artificial intelligence (AI) is transforming health care by enhancing diagnostics, improving patient outcomes, and reducing administrative burdens through advanced algorithms, with applications in medical imaging, virtual care, and automated data analysis. However, its role in palliative and hospice care remains underexplored. AIM: This review synthesizes research on AI applications in palliative and hospice care, examining its technological and clinical contributions to inform future research and guide clinical implementation. DESIGN: An integrative literature review, guided by Whittemore and Knafl's framework, analyzed qualitative, quantitative, and mixed-method studies. Registered with PROSPERO. DATA SOURCES: A comprehensive search across 11 databases: Academic Search Complete, CINAHL, Cochrane Library, PubMed, Medline, Web of Science, Scopus, PsycINFO, ProQuest Dissertations & Theses Global, ACM Digital Library, and IEEE Xplore, identified English-language studies published from 2010 to 2024. Studies on AI applications in clinical settings, model validation, and key findings were included, with quality assessed using the Mixed Methods Appraisal Tool. RESULTS: Seventy studies (2018-2024) were included, primarily quantitative analyses of retrospective clinical and administrative data. AI applications supported mortality prediction, symptom monitoring, patient needs identification, communication facilitation, care planning, and resource allocation. Early tools included rule-based and structured-data models, while more recent approaches integrate unstructured clinical notes, wearable devices, and multimodal data for individualized prognostication and timely interventions. Key barriers included reliance on retrospective or single-center datasets, limited generalizability, ethical and equity concerns, and challenges in integrating AI into clinical workflows. CONCLUSIONS: AI holds potential in enhancing timely, patient-centered palliative and hospice care, supporting prognostication, symptom management, and decision-making. Successful integration requires attention to clinician trust, workflow alignment, equity, and ethical considerations. To maximize its impact on underutilization, future research should focus on multicenter validation, representative datasets, ethical deployment, and seamless integration into clinical practice.
Amato S, Sguanci M, Napolitano D
… +3 more, Lo Cascio A, Piredda M, De Marinis MG
J Palliat Med
· 2026 Feb · PMID 41636367
·
Publisher ↗
Palliative care (PC) aims to enhance quality of life and alleviate suffering in patients with advanced or degenerative diseases. Oral disorders (ODs) are common among PC patients, often impairing essential functions such...Palliative care (PC) aims to enhance quality of life and alleviate suffering in patients with advanced or degenerative diseases. Oral disorders (ODs) are common among PC patients, often impairing essential functions such as chewing, swallowing, and communication. The use of natural treatments for these conditions appears promising. This systematic review aimed to evaluate the efficacy, acceptability, and potential adverse events (AEs) and oral tolerability profiles of natural products used for managing ODs in patients undergoing PC. We conducted the review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered it in International Prospective Register of Systematic Reviews (protocol number: CRD42024591279). A comprehensive literature search was performed on multiple biomedical databases (PubMed, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Scopus, and Cochrane Library), applying rigorous inclusion criteria. Included studies were assessed for quality using the Joanna Briggs Institute (JBI) Critical Appraisal Tools and the Oxford Centre for Evidence-Based Medicine levels of evidence. Out of 1075 identified records, 7 studies met the inclusion criteria, mostly randomized controlled trials ( = 5) with 522 PC patients. The studies had moderate to high methodological quality (mean = 88.4%, range = 64%-100%). Glycerol, , and peppermint mini ice cubes relieved oral symptoms. Glycerol gave rapid, short-lived relief; salvia improved dryness versus saline; peppermint cubes reduced dry mouth and thirst and were preferred. Cannabinoid trials did not prospectively assess ODs but were retained only as contextual evidence on oral AEs/tolerability and the feasibility of the oro-buccal route. Natural interventions may relieve xerostomia and improve comfort, but generalizability remains limited; future randomized trials with oral-specific endpoints, transparent dosing, and longer follow-up are required.
Noorulhuda M, Sullivan C, Johnson KS
… +1 more, Kim SYH
J Palliat Med
· 2026 Feb · PMID 41636347
·
Publisher ↗
BACKGROUND: Physician-assisted death (PAD) is a controversial practice, legal in mostly wealthy European countries and U.S. states with a lower-than-average proportion of Black residents. Although studies report lower su...BACKGROUND: Physician-assisted death (PAD) is a controversial practice, legal in mostly wealthy European countries and U.S. states with a lower-than-average proportion of Black residents. Although studies report lower support for PAD among Black Americans, a comprehensive review of the association between PAD attitudes and race and ethnicity is lacking. This narrative review sought to clarify the association between race and/or ethnicity and attitudes toward PAD, while exploring possible explanatory factors. METHODS: A comprehensive search of PubMed, Web of Science Core Collection, and PsycINFO databases through December 2024, supplemented by citation follow-up and manual searches. RESULTS: The search yielded 64 eligible studies. These studies varied in sampling method, populations, studied, survey questions, and timing. To account for quality, studies were grouped into those employing random (38) versus nonrandom (26) sampling. Across both categories, White respondents consistently demonstrated higher support for PAD than racial and ethnic minority groups, particularly Black Americans, in both unadjusted and adjusted analyses. Although some studies show adding religion variables eliminates this association, the largest and most methodologically rigorous studies still show that race and ethnicity retain an independent association with PAD attitudes. Notably, there was a paucity of studies examining trust in the health care system as a potential factor. CONCLUSIONS: Overall, the evidence suggests lower support for PAD among racial and ethnic minority groups that may reflect, in part, distinct sociocultural factors extending beyond religion or socioeconomic status. This review highlights the need for more research on trust in health care and nuanced understanding to guide discussions on PAD policy and practice in diverse populations.
Takeuchi M, Miyoshi T, Kako J
… +5 more, Matsuda Y, Inoue S, Tanimukai H, Wada S, Hasegawa T
J Palliat Med
· 2026 Feb · PMID 41636337
·
Publisher ↗
BACKGROUND: Delirium is a common and distressing complication in terminally ill patients with advanced cancer, often impairing communication and decision-making, and diminishing the quality of the remaining life. Effecti...BACKGROUND: Delirium is a common and distressing complication in terminally ill patients with advanced cancer, often impairing communication and decision-making, and diminishing the quality of the remaining life. Effective symptom management is essential; however, current clinical guidelines offer limited recommendations, and supporting evidence remains insufficient. OBJECTIVES: This scoping review systematically mapped the existing literature on pharmacological and nonpharmacological interventions for delirium symptom management in terminally ill patients with cancer and identified gaps in the evidence base. METHODS: Following the framework proposed by Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews guidelines, we conducted a comprehensive literature search of PubMed, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Ichushi-Web of the Japan Medical Abstract Society for studies published up to August 31, 2023. Subsequently, two updated searches were conducted using the same procedure with the first covering studies published between September 1, 2023, and September 30, 2024, and the second covering studies published between October 1, 2024, and September 30, 2025. Eligible studies evaluated interventions for delirium in adults with terminal cancer with a life expectancy of one month or less. Two reviewers independently screened the studies for inclusion. RESULTS: Of the 1640 articles identified, seven met the inclusion criteria including four randomized controlled trials on pharmacologic interventions, one randomized controlled trial on hydration, and two observational studies on opioid switching. All studies targeted terminally ill patients with advanced cancer and assessed the outcomes related to delirium symptom relief. CONCLUSIONS: This review revealed that the literature addressing delirium symptom management in terminally ill patients with cancer is limited and heterogeneous. Further research is warranted to strengthen the evidence base and to inform clinical practice guidelines for the care of this vulnerable population.