J Palliat Med
· 2026 Jun · PMID 41936555
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INTRODUCTION: Nutrition impact symptoms (NIS) are defined as symptoms that may adversely affect an individual's health and increase the risk of malnutrition and adverse clinical outcome. OBJECTIVE: To examine factors ass...INTRODUCTION: Nutrition impact symptoms (NIS) are defined as symptoms that may adversely affect an individual's health and increase the risk of malnutrition and adverse clinical outcome. OBJECTIVE: To examine factors associated with longitudinal changes in the number of NIS over time in outpatients with advanced cancer receiving oral nutritional supplements (ONS) or enteral nutrition (EN). METHODS/APPROACH: This prospective longitudinal study included adults with advanced cancer referred for exclusive palliative care at a national cancer center in Brazil. NIS was assessed using the Patient-Generated Subjective Global Assessment Short Form. Generalized estimating equations (GEE) were used to model changes in the number of NIS across three time points: baseline (T0), a median of 23 days (T1), and a median of 49 days (T2). Explanatory variables included demographic, clinical, inflammatory, and functional parameters. RESULTS: A total of 244 patients were included in the analysis (69.7% ≥60 years; 50.4% women). The most common primary tumor sites were head and neck (32.4%), upper gastrointestinal (18.0%), and gynecological cancers (13.9%). At baseline, 78.3% had ≥1 NIS. The prevalence of most NIS decreased significantly from T0 to T1, with no additional reductions from T1 to T2. In the multivariable GEE model, factors independently associated with a reduction in the number of NIS over time included receiving ONS rather than EN (β = -0.441; < 0.001), higher Karnofsky Performance Status (β = -0.113; < 0.001), and higher serum albumin values (β = -0.120; = 0.049). Reductions in NIS were also associated with improvements in global quality of life. CONCLUSION: In outpatients with advanced cancer starting exclusive palliative care, the route of nutritional support, functional status, and albumin levels were independently associated with changes in NIS over time. These findings underscore the importance of early, individualized, and multimodal nutritional strategies to support symptom management.
J Palliat Med
· 2026 Mar · PMID 41913510
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BACKGROUND: Despite evidence supporting the benefits of Patient-Reported Outcome Measures (PROMs) in palliative care, their widespread implementation remains unrealized. This article aims to provide key insights and reco...BACKGROUND: Despite evidence supporting the benefits of Patient-Reported Outcome Measures (PROMs) in palliative care, their widespread implementation remains unrealized. This article aims to provide key insights and recommendations to aid the implementation of PROMs in health care services by addressing the question: What are the attitudes of health care professionals toward PROMs in palliative care, as reported in the qualitative literature? METHODS: We conducted a systematic search with a narrative synthesis of the findings. Systematic searches of Medline, EMBASE, CINAHL, and PsycInfo were undertaken for studies with qualitative evidence, published between June 2013 and January 2025. Included studies were primary studies using qualitative methods to explore health care professionals' attitudes and experiences with PROMs in adult palliative care settings. Study quality was appraised using the Critical Appraisal Skills Program checklist, and findings were synthesized using thematic analysis informed by a hermeneutic framework. RESULTS: Nineteen studies met the inclusion criteria and were included for analysis. We identified three central themes regarding the attitudes of health care professionals toward PROMs: (1) the effect of PROMs on the provision of health care, (2) the contribution of PROMs in delivering patient-centered care, and (3) the integration of PROMs into clinical practice. CONCLUSIONS: Given the ongoing challenges in integrating PROMs into routine palliative care, a systematic implementation approach is imperative. Our findings highlight important areas that require detailed consideration to enhance routine PROM implementation in clinical care, by reducing barriers and attending to clinician concerns.
Dussault N, Morphew J, Nwagwu V
… +9 more, Gatta B, Richardson A, Payne N, White-Chu EF, Wilson L, Dalton H, Winstead-Derlega CE, Ramos K, Jones CA
J Palliat Med
· 2026 Mar · PMID 41913502
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Wounds are a common and burdensome problem for patients with serious illness receiving palliative care and hospice services. Declining mobility, functional impairment, malnutrition, progression of underlying disease, and...Wounds are a common and burdensome problem for patients with serious illness receiving palliative care and hospice services. Declining mobility, functional impairment, malnutrition, progression of underlying disease, and age-related skin changes all increase risk. Wound management can therefore be challenging for clinicians, patients, and caregivers. Symptoms such as pain, odor, drainage, functional limitations, and psychological distress can substantially worsen suffering. Optimal care requires an interdisciplinary approach that considers the patient's underlying illness, prognosis, and goals of care. Palliative care clinicians are well-positioned to reduce this distress and improve comfort through goal-concordant wound-care strategies. Given the high prevalence of wounds in palliative care populations and the need for skilled, patient-centered management, we convened a panel of palliative care clinicians, geriatricians, geropsychologists, and wound-care specialists to identify core principles and practical strategies for supporting patients with wounds. In this article, we outline key tips for assessing and managing wounds, including understanding prognosis and goals of care, evaluating care settings, tailoring management to the underlying disease process, and addressing symptoms such as pain, odor, and psychosocial distress. A thoughtful, interdisciplinary approach is essential to reduce the physical and emotional burden wounds place on patients and caregivers.
Hawley CN, Alcantra N, Chen C
… +8 more, Feng Y, Lattimore K, Oh S, Rajeeva B, Robinson FI, Shenbanjo M, Oslin E, Bogetz J
J Palliat Med
· 2026 Mar · PMID 41883017
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BACKGROUND: Palliative care interventions for children with serious illness require real-world design expertise to bring research to the bedside in ways that are engaging, effective, and feasible. OBJECTIVE: To describe...BACKGROUND: Palliative care interventions for children with serious illness require real-world design expertise to bring research to the bedside in ways that are engaging, effective, and feasible. OBJECTIVE: To describe the collaborative process of bringing an evidence-based humanistic care intervention, photo-narratives, through practical user experience (UX) design for future implementation at a children's hospital. METHODS: The collaborative design process was completed at an academic university. Researchers at the affiliated children's hospital approached two teams of UX design graduate students to (1) further refine and (2) develop a technology-integrated implementation strategy for the photo-narrative intervention. RESULTS: The researchers and teams met weekly to follow a project-specific seven-step UX design approach, including (1) framing project timeline and deliverables, (2) regulatory and access considerations, (3) understanding the problem and intervention, (4) data collection, (5) design constraints (information technology considerations, workflow), (6) low-fidelity prototyping, and (7) usability testing and high-fidelity prototyping. CONCLUSION: Collaboration between researchers and UX design teams can further the critical intervention design and prototyping that is essential to implementing successful real-world palliative care interventions.
Sagin A, Musheno-King R, Olenik JM
… +4 more, Bennett NL, Dine CJ, Dingfield L, Balmer DF
J Palliat Med
· 2026 Mar · PMID 41873231
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BACKGROUND: As more medical schools implement longitudinal palliative care (PC) curricula, the need for robust evaluation that demonstrates curricular outcomes has become increasingly important. OBJECTIVES: The authors p...BACKGROUND: As more medical schools implement longitudinal palliative care (PC) curricula, the need for robust evaluation that demonstrates curricular outcomes has become increasingly important. OBJECTIVES: The authors prospectively evaluated a PC curriculum at the University of Pennsylvania's Perelman School of Medicine, using the Context, Input, Process, Product model. DESIGN: Between 2021 and 2025, data that provided evidence of value were generated from a variety of sources and stakeholders to address evaluation questions about acceptability, student knowledge and attitudes about PC topics and engagement in PC opportunities. Both qualitative and quantitative data were collected with an assortment of tools including evaluation scores, focus groups, interviews, written reflections, quiz scores, and medical record notes. RESULTS: Results of this evaluation indicated that the curriculum achieved the intended outcomes of acceptance to diverse stakeholders, improved student knowledge and attitudes about PC, and increased student engagement in PC. Unanticipated impacts of the curriculum were also captured. CONCLUSIONS: The evaluation provided multisource evidence of the value of a longitudinal curriculum in PC and may serve as an example for others charged with evaluating longitudinal PC curricula in medical school.
Jones KF, Wormwood JB, Becker WC
… +9 more, Gurewich D, Linsky AM, Meier DE, Merlin JS, Silveira MJ, Skarf LM, Pattison D, Wyse JJ, Schwartz AW
J Palliat Med
· 2026 Mar · PMID 41858238
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BACKGROUND: Buprenorphine is an underused opioid therapy for patients with serious illnesses. Using the principles of implementation science, we developed, distributed, and tested a Buprenorphine Pocket Card and Tool Kit...BACKGROUND: Buprenorphine is an underused opioid therapy for patients with serious illnesses. Using the principles of implementation science, we developed, distributed, and tested a Buprenorphine Pocket Card and Tool Kit (Bupe PC&TK). OBJECTIVES: We conducted an online survey to assess buprenorphine learning needs, confidence, and knowledge. We then tested the impact of the Bupe PC&TK using a pre-/poststudy design. SETTING/SUBJECTS: Palliative care clinicians located throughout the United States. MEASUREMENT: Investigator-initiated online mixed-methods survey at baseline and six weeks following distribution of a Bupe PC&TK. RESULTS: Among the 179 baseline participants, most were physicians ( = 114) with more than six years of opioid prescribing experience ( = 99). The majority rated buprenorphine prescribing as an important skill, but only 15 participants reported they were very confident in prescribing or managing buprenorphine, and inaccurate knowledge was common. Participants reported that information on buprenorphine dosing and initiation would be most helpful in a Bupe PC&TK. Fifty-six participants completed the follow-up survey; the majority were physicians ( = 33). Most participants used the Bupe PC&TK ( = 47) and rated it as helpful or very helpful ( = 45). A paired samples -test revealed that participants were significantly more confident after receiving the Bupe PC&TK ( < 0.001). Knowledge accuracy improved for buccal buprenorphine ( = 0.003) and formulations for opioid use disorder ( < 0.001). CONCLUSION: Palliative care clinicians ascribe a large degree of importance to prescribing buprenorphine but have knowledge and confidence gaps. The Bupe PC&TK can be readily implemented to increase clinician confidence and knowledge in prescribing buprenorphine to patients with serious illness.
J Palliat Med
· 2026 May · PMID 41858215
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Patients facing serious illness may respond to distressing medical information with avoidance or denial, limiting their ability to engage in values-based decision-making. Exposure therapy-an evidence-based psychological...Patients facing serious illness may respond to distressing medical information with avoidance or denial, limiting their ability to engage in values-based decision-making. Exposure therapy-an evidence-based psychological treatment for anxiety disorders-offers conceptual tools that can inform communication and therapeutic approaches with patients who struggle with avoidance in the context of serious illness. This article describes the care of a patient with advanced cancer who declined prognostic and hospice conversations due to death-related anxiety. Drawing on core exposure therapy principles-including safety, individualization, titration, and enhancement of coping-we illustrate how serious illness communication strategies can be intentionally adapted to support patient engagement, reduce distress, and strengthen psychological resilience. Through techniques such as progressive disclosure, calibration of language potency, and the "container" metaphor, clinicians can match communication to patients' emotional readiness, enhancing tolerance over time. Integrating exposures-informed approaches into palliative care practice helps bridge the gap between emotional avoidance and values-concordant care.
J Palliat Med
· 2026 Jun · PMID 41849216
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Inpatient clinicians may experience distress when providing complex care for the millions of Americans with serious illness hospitalized yearly. Understanding the types and clinical impact of clinician distress when cari...Inpatient clinicians may experience distress when providing complex care for the millions of Americans with serious illness hospitalized yearly. Understanding the types and clinical impact of clinician distress when caring for seriously ill inpatients can inform supportive interventions to minimize burnout symptoms. This study aims to identify distinct distress trajectories among clinicians caring for seriously ill inpatients over time using mobile ecological momentary assessments (mEMAs).We performed latent class cluster analysis of clinicians' prospective serial mEMAs to identify unique distress trajectories and estimated univariate ordinal logistic regression models using generated estimating equations methods to explore the relationship between distress type and patient and clinician characteristics.We identified four distinct clinician distress trajectories from clinician responses ( = 142): low distress (23.2%), moderate distress (33.1%), high distress (23.9%), and variable distress (19.7%). The majority of patients had a primary malignancy (77.9%). Clinicians self-reported multiple symptoms: fatigue (59.3%), stress (57.4%), worry (47.2%), insomnia (33.3%), anger (13.9%), sadness (9.3%), and pain (4.6%). Clinicians' discipline (advanced practice provider [APP] vs. physician; = 9.11, = 0.0025) and emotions ( = 11.29, = 0.0008) were significantly associated with the distress trajectory. Clinicians who had an increase in reported emotions were likely to be in a higher distress trajectory (odds ratio [OR] 1.90, = 0.001), as were APPs compared with physicians (OR 6.16, = 0.003).Clinicians experience distinct trajectories of distress while caring for seriously ill inpatients. While all groups experienced degrees of distress, identifying clinicians with high distress may enable health systems to target supportive interventions and resources in a timely manner to mitigate potential burnout and other emotional states.
J Palliat Med
· 2026 Mar · PMID 41849215
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Survivors of human trafficking experience profound trauma with long-lasting psychological, physical, and social consequences that can complicate medical care, particularly in the context of serious illness. This case hig...Survivors of human trafficking experience profound trauma with long-lasting psychological, physical, and social consequences that can complicate medical care, particularly in the context of serious illness. This case highlights the palliative care approach to a 38-year-old woman with metastatic cervical cancer and a history of trafficking-related trauma. The clinical team encountered nuanced challenges, including disrupted trust, limited social support, high symptom burden, and distress related to bodily autonomy. A trauma-informed, multidisciplinary team-comprised of palliative care, gynecological oncology, psychiatry, and social work-prioritized safety, choice, and trust-building to align care with the patient's values and goals. Despite significant health inequities and psychosocial vulnerabilities, individualized care planning and intentional communication supported dignity, symptom control, and emotional safety during a prolonged hospitalization. This case illustrates the ethical and relational dimensions of caring for survivors of trafficking and underscores the importance of trauma-informed care principles, cultural humility, and interdisciplinary collaboration in palliative settings.
Alexander S, St Louis J, Rapoport A
… +4 more, Horan R, Korenblum C, Weingarten K, Widger K
J Palliat Med
· 2026 May · PMID 41849212
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BACKGROUND: Adolescents living with serious illness have unique developmental and psychosocial needs that require special consideration and care. This population faces an increased risk of isolation, depression, and anxi...BACKGROUND: Adolescents living with serious illness have unique developmental and psychosocial needs that require special consideration and care. This population faces an increased risk of isolation, depression, and anxiety. Virtual reality (VR) may provide an opportunity for adolescents living with serious illness to interact with peers, mitigating loneliness. OBJECTIVES: We evaluated the feasibility, acceptability, and potential impact of a VR social support group for adolescents living with serious illness. SETTING/SUBJECTS: This research took place at a quaternary children's hospital in Canada. Participants were nine adolescents with serious illness, who attended at least one VR social support group and four of their caregivers. MEASUREMENTS: Interviews took place prior to the first session, then after the first, second, and fifth sessions attended, as well as at three and six months after the first session regardless of the number of sessions attended. At each interview, adolescents completed the UCLA Loneliness Scale, and both adolescents and caregivers answered questions about the adolescents' experiences using VR. RESULTS: We met five of eight a priori criteria for feasibility and acceptability of the intervention. While loneliness scores did not change, the opportunities for social connection and feelings of belonging were evident. Minor technical difficulties with the VR equipment were mostly resolved independently. Attendance varied, primarily due to illness. Feedback showed unanimous support and excitement for continuing and further developing this intervention. CONCLUSIONS: VR technology is a new platform with promising opportunities for social support for seriously ill adolescents.