Bernhard T, Dickerman M, Levy C
… +2 more, Miller EG, Chain G
J Palliat Med
· 2026 Mar · PMID 41766382
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Pediatric palliative care (PPC) supports complex decision-making for seriously ill children. This process requires compassionate and skillful communication with a child's caregivers, most often the parents. When a caregi...Pediatric palliative care (PPC) supports complex decision-making for seriously ill children. This process requires compassionate and skillful communication with a child's caregivers, most often the parents. When a caregiver is incarcerated, there is an additional layer of complexity in navigating these difficult conversations. We present the case of an infant with complex congenital heart disease, severe neurological impairment, and respiratory failure whose parents were faced with the decision to pursue life-prolonging medical care with a tracheostomy or end-of-life care with compassionate extubation. We describe how our interdisciplinary team recognized and navigated the teams' biases, knowledge gaps, and logistical complexities to provide optimal decisional support to parents affected by incarceration. We aim for this case to raise awareness of an underexplored issue in the literature.
Franczak S, Ginsburg AD, Carpenter KP
… +4 more, Bellolio F, Klassen AB, Mullan A, McGuire SS
J Palliat Med
· 2026 Jun · PMID 41766378
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OBJECTIVES: To determine the frequency with which emergency medical services (EMS) clinicians recognize patients enrolled in hospice and describe their prehospital management. METHODS: Observational cohort study of patie...OBJECTIVES: To determine the frequency with which emergency medical services (EMS) clinicians recognize patients enrolled in hospice and describe their prehospital management. METHODS: Observational cohort study of patients enrolled in hospice who were transported by EMS within a health system between May 5, 2018, and June 4, 2023. Two physicians reviewed each encounter to determine whether interventions were comfort-focused (hospice philosophy) or life-sustaining care. Interrater reliability was 100% (k = 1.0). Descriptive statistics are provided. RESULTS: EMS clinicians identified hospice enrollment in 51% ( = 46) of 88 encounters. Most patients (90%, = 79) received comfort-focused care. Life-sustaining care was provided to four patients identified as hospice-enrolled and included cardiopulmonary resuscitation, an advanced airway, and vasopressors ( = 1, 25%); spinal immobilization ( = 2, 50%), and naloxone ( = 1, 25%). CONCLUSION: Most patients received care consistent with the philosophy of hospice. However, EMS clinicians may have only identified half of patients enrolled in hospice. This demonstrates an opportunity to improve recognition of patients' care preferences, starting in the out-of-hospital setting.
J Palliat Med
· 2026 Mar · PMID 41766369
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Emerging evidence suggests that researchers studying sensitive topics are prone to secondary emotional distress, and graduate students and trainees are particularly vulnerable as novice researchers. While many studies ac...Emerging evidence suggests that researchers studying sensitive topics are prone to secondary emotional distress, and graduate students and trainees are particularly vulnerable as novice researchers. While many studies account for potential emotional distress in participants of research on sensitive topics, very few include considerations for mitigating emotional harm to researchers. Therefore, this article examines the experiences of graduate research assistants in a study on live discharge from hospice care. Distress stemmed from repeated exposure to sensitive narratives, blurred role boundaries, and personal identity challenges, with prolonged participant engagement deepening the emotional impact. Coping strategies included debriefs, mentorship, and self-care practices. These findings highlight the ethical need to integrate researcher well-being into study design, especially for novice researchers. Institutions and principal investigators might use protocols including training, boundary-setting guidance, and mental health resources to protect researchers' mental health.
J Palliat Med
· 2026 Jun · PMID 41766351
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Twenty years have passed since Dignity Therapy was introduced as a brief psychotherapeutic intervention grounded in the Model of Dignity in the terminally ill. Designed to address threats to personhood by supporting gene...Twenty years have passed since Dignity Therapy was introduced as a brief psychotherapeutic intervention grounded in the Model of Dignity in the terminally ill. Designed to address threats to personhood by supporting generativity, meaning, and legacy, it invites patients to create enduring documents that reflect their values, identities, and life narratives. Although initially conceived for end-of-life care, Dignity Therapy has since been adapted for diverse populations, including children, individuals with non-malignant illness, those experiencing cognitive decline, people who are grieving; and has been implemented across varied cultural and linguistic contexts. It is now among the most extensively studied non-pharmacological interventions in palliative care. This article reflects on two decades of experience with Dignity Therapy, examining feasibility, cost considerations, potential risks, and sources of variability in outcomes. Beyond measurable effects, Dignity Therapy exemplifies a narrative-informed, person-centered approach, which underscores the centrality of attending to patients' stories as an integral component of compassionate palliative care.
Giannelli A, Ostan R, Pannuti R
… +3 more, Biasco G, Varani S, Clinical Supervision Study Group
J Palliat Med
· 2026 Jun · PMID 41766339
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BACKGROUND: Health care professionals (HCPs) in home palliative care (PC) face emotionally demanding situations, increasing their risk of burnout, compassion fatigue, and reduced work engagement. Clinical supervision is...BACKGROUND: Health care professionals (HCPs) in home palliative care (PC) face emotionally demanding situations, increasing their risk of burnout, compassion fatigue, and reduced work engagement. Clinical supervision is a recommended supportive intervention, but longitudinal evidence is limited. OBJECTIVES: To assess, over 2 years, the professional quality of life-burnout, secondary traumatic stress (STS), and compassion satisfaction (CS)-of HCPs providing home PC and receiving monthly clinical supervision. Secondary aims were to evaluate coping strategies and work engagement. DESIGN: Nonprofit longitudinal study with assessments at baseline, after one year, and after two years. SETTING/SUBJECTS: In total, 285 HCPs from 20 multidisciplinary teams across 11 Italian regions. Analyses focused on 112 participants who completed all assessments and attended ≥80% of supervision sessions. MEASUREMENTS: Professional Quality of Life Scale, Coping Inventory for Stressful Situations, and Utrecht Work Engagement Scale questionnaires were administered. Data were analyzed using generalized estimating equation models and repeated measures of general linear models. RESULTS: At baseline, HCPs reported medium-high CS, low-medium burnout, and STS, with no significant changes over time. Task-oriented coping was predominant and stable. Work engagement remained moderate. Burnout positively correlated with age and years of PC experience and negatively with work engagement. CONCLUSION: Regular clinical supervision may help preserve the professional quality of life of PC HCPs, maintaining stable levels of burnout, CS, and work engagement over time. Findings support integrating a supervision program within a wider organizational strategy aimed at ongoing monitoring and promoting staff well-being.
J Palliat Med
· 2026 Jun · PMID 41766331
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BACKGROUND: Delirium affects most patients with advanced cancer and is a major source of distress, especially in its hyperactive subtype. Pharmacologic options are limited for patients who cannot take oral medications. O...BACKGROUND: Delirium affects most patients with advanced cancer and is a major source of distress, especially in its hyperactive subtype. Pharmacologic options are limited for patients who cannot take oral medications. OBJECTIVES: To evaluate the effectiveness and safety of a transdermal blonanserin patch for managing hyperactive delirium in patients with advanced cancer admitted to a palliative care unit. DESIGN: Retrospective observational study. SETTINGS/SUBJECTS: Consecutive patients with advanced cancer admitted to a palliative care unit in Japan between July 2023 and July 2025. Among 60 patients exhibiting agitation (Richmond Agitation-Sedation Scale-Palliative Version [RASS-PAL] ≥ +1), 21 received a 40-mg blonanserin patch. Eighteen patients who completed the 7-day assessment were analyzed. MEASUREMENTS: The primary endpoint was the change in RASS-PAL score from day 0 to day 7. Safety events and the need for additional antipsychotics were recorded. RESULTS: The median RASS-PAL score decreased from 2.0 to 0.5, and the mean score decreased from 1.9 to 0.6 ( = 0.0019). One patient developed reversible excessive sedation. No extrapyramidal symptoms, neuroleptic malignant syndrome, or cardiopulmonary events occurred. The median time from patch initiation to death was 24 days. Five patients required rescue antipsychotics, and no recurrence of the initial severity of delirium was observed. CONCLUSIONS: The transdermal blonanserin patch appears to be an effective and well-tolerated option for hyperactive delirium in patients with advanced cancer who cannot take oral antipsychotics. Larger prospective studies are warranted to confirm effectiveness and guide optimal use.
Higgins N, Ahmed A, Tran W
… +5 more, Lau R, Lai JC, Schairer S, Gianella S, Dubé K
J Palliat Med
· 2026 May · PMID 41766328
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BACKGROUND: End-of-life HIV research places emotional demands on staff, yet evidence for brief compassion training to enhance resilience is limited. OBJECTIVES: To assess the feasibility and impact of a four-week compass...BACKGROUND: End-of-life HIV research places emotional demands on staff, yet evidence for brief compassion training to enhance resilience is limited. OBJECTIVES: To assess the feasibility and impact of a four-week compassion training program on self-compassion and professional well-being. DESIGN: Prospective, single-group, repeated-measures pilot with surveys at baseline (T1), post-program (T2), and 12-week follow-up (T3). SETTING/PARTICIPANTS: Twenty-four professionals from the UC San Diego Last Gift program (83% women, 63% aged 25-44 years). MEASUREMENTS: Validated scales assessed self-compassion, compassion for others, professional quality of life, and work climate; changes were analyzed with Friedman and Bonferroni-adjusted Wilcoxon tests. RESULTS: Over-identification ( = 0.002), workplace joy ( = 0.005), and supportive work environment ( = 0.003) improved. Meditation frequency increased from T1 to T2 ( < 0.001) and remained higher at T3 ( = 0.006). CONCLUSIONS: A brief compassion program was feasible and improved over-identification and work-climate measures, supporting further evaluation of compassion support training in palliative and end-of-life research settings.
J Palliat Med
· 2026 May · PMID 41733503
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Medicine finds itself on the brink of an artificial intelligence (AI) revolution, promising to transform what it means to be human and thus what it means to encounter humans with serious illness. The character of such tr...Medicine finds itself on the brink of an artificial intelligence (AI) revolution, promising to transform what it means to be human and thus what it means to encounter humans with serious illness. The character of such transformation in pain management remains yet to be determined, leaving open to what extent AI might exacerbate or resolve challenges confronting pain management. In this article, I aim to clarify what might be expected from AI in pain management on a conceptual level and proceed by problematizing the tension between, on the one hand, representing the range of incipient AI applications relevant to pain and, on the other hand, representing the core principles and concepts of pain management in palliative medicine. This helps to elucidate those aspects of pain most amenable to automation, generating a call to action within pain research and presenting an opportunity for palliative clinicians to steer AI implementation.
Afezolli D, Bharani A, Rousseau CP
… +5 more, Popp B, Meier D, Morrison RS, Arnold R, Pelleg A
J Palliat Med
· 2026 Jun · PMID 41733485
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BACKGROUND: As specialty palliative care (SPC) programs expand nationwide, variability in referral criteria and care scope has led to inconsistent care delivery and confusion among clinicians and patients. As demand for...BACKGROUND: As specialty palliative care (SPC) programs expand nationwide, variability in referral criteria and care scope has led to inconsistent care delivery and confusion among clinicians and patients. As demand for SPC increases, workforce limitations necessitate prioritization frameworks. DESIGN: The Brookdale Department of Geriatrics and Palliative Medicine at the Mount Sinai Health System convened a task force of six palliative care physicians to reach consensus on SPC scope of practice. The group conducted a literature review, surveyed department clinicians, and solicited input from 10 peer academic institutions to inform guideline development. The task force met four times over three months and finalized the guideline through departmental review and leadership endorsement. RESULTS: Findings highlighted wide variation in definitions of "serious illness" and appropriateness for SPC. Most surveyed clinicians supported a definition requiring both high mortality risk and negative impact on quality of life or caregiver burden. The resulting institutional guideline emphasizes prioritization of patients with serious illness and high risk of mortality, explicitly excluding patients with chronic pain or psychosocial distress in the absence of a serious illness. The guideline also addresses safe opioid prescribing and recommends tracking "non-eligible" referrals to identify unmet system needs. CONCLUSIONS: This initiative offers the first SPC scope guideline. Ongoing discussions, both at individual institutions and nationally, may be necessary to determine the importance of consistency in defining and communicating the scope of SPC. Health care leaders can use this guideline to address resource allocation, health policy, workforce education, and public understanding of palliative care.