Williamson B, Merrill G, Slomoff T
… +3 more, Brenner KO, Gamble A, Chammas D
J Palliat Med
· 2026 Jun · PMID 41841463
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Acceptance and commitment therapy (ACT) is a psychotherapeutic model that focuses on developing psychological flexibility by encouraging patients to attune to their present moment experience, cultivate openness to those...Acceptance and commitment therapy (ACT) is a psychotherapeutic model that focuses on developing psychological flexibility by encouraging patients to attune to their present moment experience, cultivate openness to those experiences, and respond to those experiences with committed action that is rooted in their values. By combining the six core processes of ACT (attention to the present moment, self-as-context, defusion, acceptance, values, and committed action) with serious illness communication skills, palliative care clinicians can nurture psychological flexibility for patients facing uncertainty and difficult internal experiences common in serious illness. This article reviews a case study with examples of language and tools clinicians can use to bring these core processes into their work with patients.
Lawton AJ, Zehm A, Dow LA
… +9 more, Webb JA, Malhotra S, Strand JJ, Berns SH, Buss MK, Santivasi WL, Newport KB, Jones CA, Lindenberger EC
J Palliat Med
· 2026 Mar · PMID 41841451
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Most palliative care (PC) physicians will change jobs over the course of their career, yet few supports exist to guide them through this often unfamiliar process. Job transitions frequently elicit stress and uncertainty,...Most palliative care (PC) physicians will change jobs over the course of their career, yet few supports exist to guide them through this often unfamiliar process. Job transitions frequently elicit stress and uncertainty, as individuals balance personal and professional priorities, navigate complex negotiations, and assume the inherent risks of pursuing new opportunities. Yet, when approached intentionally, a job transition can also be a transformative process that allows for self-discovery, cultivation of new skills and connections, and reshaping of one's professional identity. This article, written by a team of PC physicians who have made job transitions themselves, offers 10 tips for navigating this professional step successfully. With emphases on authentic communication, skilled mentorship, relationship building, and exploration of local culture-the article offers practical advice to help PC physicians navigate a job transition confidently, while staying grounded in their personal values and the work they find most meaningful.
Ng SL, Wei Tan FK, Woo YY
… +3 more, Goh SSL, Neo SH, Murugam V
J Palliat Med
· 2026 Mar · PMID 41817184
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Seizures are common at the end of life. Seizures can be especially distressing if they are refractory to conventional antiepileptic treatments. We present the histories of two terminally ill patients with refractory stat...Seizures are common at the end of life. Seizures can be especially distressing if they are refractory to conventional antiepileptic treatments. We present the histories of two terminally ill patients with refractory status epilepticus who did not respond to standard antiepileptic protocols. Seizure control was eventually achieved with the use of parenteral ketamine infusion dosed at 1 mg/kg/hour. Parenteral ketamine infusion is not traditionally used in palliative care for seizure management. However, our experience shows there is promise that it can be a viable option for refractory status epilepticus. For one of the patients, ketamine was initiated in the general ward setting. This highlights that seizure control can be achieved without a transfer to intensive care as such a transfer may not be consistent with a dying patient's goals of care. Further studies should be conducted in palliative care settings to evaluate the use of ketamine for terminal refractory status epilepticus.
Clapham S, Ayalew AA, Redwood L
… +4 more, Yates P, Auret K, Clark K, Currow D
J Palliat Med
· 2026 Jun · PMID 41817176
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Understanding how symptom outcomes vary by care setting helps optimize care.To compare trajectories of severe symptom distress in the final week of life across community and hospital settings.This retrospective consecuti...Understanding how symptom outcomes vary by care setting helps optimize care.To compare trajectories of severe symptom distress in the final week of life across community and hospital settings.This retrospective consecutive cohort study used point-of-care data from the Australian Palliative Care Outcomes Collaboration, which includes the Symptom Assessment Scale and Palliative Care Problem Severity Score. Mixed-effects logistic regression models were adjusted for clinical, demographic and temporal factors.Australian palliative care services ( = 165) contributed data for people who died between July 1, 2019, and June 30, 2024.Of 141,691 patients,73.6% were inpatients; 61.0% had a cancer diagnosis. Severe symptom prevalence was generally low (<5%). After adjusting important factors, inpatients had higher relative odds of severe pain-related (aOR: 1.20, 95% CI: 1.10, 1.30) and breathing-related distress (aOR: 1.55, 95% CI: 1.40, 1.70) compared with community patients; the corresponding absolute risk differences (ARDs) were minimal (pain: +0.36 percentage points; breathing: +0.79 percentage points). Conversely, inpatients had lower relative odds of severe fatigue (aOR: 0.86, 95% CI: 0.79, 0.94) and insomnia (aOR: 0.74, 95% CI: 0.66, 0.84), with small ARDs (fatigue: -0.32; insomnia: -0.26). Over time, severe breathing-related distress increased significantly as death approached, while pain-related distress increased slightly. Inpatients were also less likely to experience family/carer issues (aOR: 0.78, 95% CI: 0.72-0.84), or other symptoms (aOR: 0.57, 95% CI: 0.53-0.61), with small ARDs (family/carer: -0.56; other symptoms: -0.26).While some relative differences were noted between settings, absolute differences were minimal, suggesting clinically comparable outcomes. These national data show that severity of symptoms in the two care settings are similar, reassuring patients, families, and health care professionals.
Pelz S, Kobelt I, Schettle M
… +2 more, Hertler C, Blum D
J Palliat Med
· 2026 Jun · PMID 41804819
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BACKGROUND: Palliative care patients often experience sarcopenia, which can cause overestimation of kidney function by creatinine-based estimated glomerular filtration rate (eGFR) and inappropriate drug dosing. Data on c...BACKGROUND: Palliative care patients often experience sarcopenia, which can cause overestimation of kidney function by creatinine-based estimated glomerular filtration rate (eGFR) and inappropriate drug dosing. Data on cystatin C (CysC) use are scarce. OBJECTIVES: To examine intra-individual differences between creatinine- and CysC-based eGFR in palliative patients and assess the frequency of renally eliminated drugs prescribed. DESIGN: Retrospective, single-center cohort study. SETTING/SUBJECTS: All patients admitted in 2023 to the palliative care unit of the University Hospital Zurich, Switzerland. Of 206 patients, 178 had eGFR data, and 144 with consent were included. MEASUREMENTS: Data including creatinine, CysC, and prescribed medications were extracted from electronic records. eGFR was calculated using Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) 2009 (creatinine) and CKD-EPI 2012 (CysC, combined). Intraindividual discrepancies >15 mL/min/1.73m were defined as clinically relevant. RESULTS: Paired values were available for 85 patients; 53% showed clinically relevant discrepancies (median 17 mL/min/1.73m). In 22% of patients the discrepancy exceeded 30 mL/min/1.73m. Diabetes was the only factor associated with differences. Acute kidney injury (AKI) occurred in 32% and was strongly linked to mortality, whereas discrepancies were not. Patients received a median of 19 drugs; of the 20 most frequently prescribed, 7 were renally eliminated. Over one-third with relevant discrepancies received two such drugs. CONCLUSIONS: Clinically relevant eGFR discrepancies are common in palliative care patients and may cause misclassification and dosing errors. CysC testing should be used selectively when prescribing renally eliminated drugs with toxicity risk, underscoring the need for individualized prescribing and prospective validation.
Ito S, Morita T, Mori M
… +10 more, Maeda I, Hatano Y, Yamaguchi T, Otani H, Yamagiwa T, Kizawa Y, Tsuneto S, Shima Y, Masukawa K, Miyashita M
J Palliat Med
· 2026 Jun · PMID 41804809
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BACKGROUND: Sudden unexpected death can occur even among patients with advanced cancer receiving hospice and palliative care. How bereaved families perceive this remains unclear. OBJECTIVES: To investigate the prevalence...BACKGROUND: Sudden unexpected death can occur even among patients with advanced cancer receiving hospice and palliative care. How bereaved families perceive this remains unclear. OBJECTIVES: To investigate the prevalence of sudden unexpected death from bereaved family perspectives, the level of agreement with physician perspectives, and their association with bereaved families' mental health. DESIGN/SETTING/SUBJECTS: We analyzed longitudinally linked data from a prospective cohort of advanced cancer patients in 23 palliative care units in Japan and a nationwide survey of bereaved families. MEASUREMENTS: Sudden unexpected death was assessed using previously reported definitions: (1) "surprise death" and (2) "rapid decline death," evaluated from both physician and bereaved family perspectives, and (3) "performance status-defined sudden death," evaluated only by physicians. Agreement among definitions was analyzed using kappa statistics. Bereaved families' mental health was evaluated using the Patient Health Questionnaire-9. RESULTS: Among 611 cases, "surprise death" and "rapid decline death" were more frequent from bereaved family (46.5% and 51.2%, respectively) than physician (8.2% and 16.5%, respectively) perspectives. Agreement between family and physician perspectives was low (κ = 0.04-0.14). The bereaved family-perceived "rapid decline death" was significantly correlated with depression (adjusted odds ratio = 1.75, = 0.028), whereas physician-perceived sudden unexpected death showed no significant correlation. CONCLUSIONS: Compared with physicians' perspectives, bereaved family members perceive death to be sudden or unexpected more frequently and differently, and their perceptions are associated with postbereavement mental health. Further research is needed to explore strategies to improve communication and support families' psychological preparedness when a patient's death may be sudden and unexpected.
Horowitz RK, Rosa WE, Zarrabi AJ
… +1 more, Swogger MT
J Palliat Med
· 2026 Mar · PMID 41783943
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BACKGROUND: Psychospiritual distress (PSD) causes profound suffering in people with serious illness, yet treatment options are few and evidence of their efficacy is modest. Although high-level evidence is limited, decade...BACKGROUND: Psychospiritual distress (PSD) causes profound suffering in people with serious illness, yet treatment options are few and evidence of their efficacy is modest. Although high-level evidence is limited, decades of preliminary research suggest that psychedelic-assisted psychotherapy (PAP), including ketamine-assisted psychotherapy (KAP), may alleviate the anxiety, depression, and existential distress associated with PSD. However, clinical examples and published implementation frameworks for integrating these interventions into palliative care are scarce. To help bridge this gap, we describe the development and delivery of a palliative care-embedded KAP program at an academic medical center. OBJECTIVE: To describe the design, implementation, and clinical experience of Pal-KAP, a safety-centered and equitably accessible KAP program embedded in outpatient palliative care. METHODS: We detail the program's origins, team composition and training, operational model, patient selection and consent process, session structure, safety protocols, and financial model. We summarize patient characteristics and treatment patterns and share illustrative clinical vignettes from the program's first 28 months. RESULTS: Between May 2023 and September 2025, 59 patients were referred for Pal-KAP screening; 43 met the eligibility criteria, and 30 elected to participate. Patients (age 19-76, mean 53) completed a median of 1.5 medicine sessions (range 1-5). Most had cancer (80%) or neurological disease (13.3%). Ketamine dose averaged 0.93 mg/kg intramuscularly, with minor adverse effects (anxiety, headache, nausea, insomnia, dizziness) and no serious adverse events. CONCLUSION: To our knowledge, this is the largest published cohort of KAP in an academic palliative care context. Our Pal-KAP experience suggests that KAP can be delivered safely and ethically, providing a practical blueprint for programs exploring innovative ways to address PSD.
May P, Nikram E, Johansson T
… +5 more, Clarke G, Mitchell S, Higginson IJ, Sleeman KE, Murtagh FEM
Palliat Med
· 2026 Jul · PMID 41782312
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BACKGROUND: High-quality evidence suggests that specialist palliative care reduces the odds of dying in hospital. The economic implications have not been established. AIM: To evaluate the cost-effectiveness of home- and...BACKGROUND: High-quality evidence suggests that specialist palliative care reduces the odds of dying in hospital. The economic implications have not been established. AIM: To evaluate the cost-effectiveness of home- and hospital-based specialist palliative care for adults with poor prognosis in England. DESIGN: Health-economic decision-modelling using five-state Markov cohort models with a 24-h cycle and lifetime horizon. SETTING/PARTICIPANTS: We evaluated home- and hospital-based care separately. We modelled counterfactuals using Cochrane review evidence of treatment effects on place of death and quality of life. We estimated place of death distributions, utilisation, quality-adjusted life years, and unit and intervention costs from the literature. RESULTS: Home-based care was associated with reduced costs of £7908 per person (95% confidence interval: -18,044 to 395) and increased quality-adjusted life years by 0.035 per person (0.033 to 0.037). Hospital-based care reduced costs by £6480 per person (-11,482 to -1671) and increased quality-adjusted life years by 0.033 per person (0.031 to 0.035). We estimated that for England in 2022, specialist palliative care supported over 20,000 people to die outside of hospital, saved approximately 1.5 million hospital bed days and reduced system expenditures by £817 million. CONCLUSION: Specialist palliative care reduces hospital bed days, deaths in hospital and healthcare costs, as well as improving quality of life, among adults in England. A minority who might benefit currently receive specialist palliative care and needs are growing rapidly. Expanding access may yield further gains, but bridging current gaps in access also requires new approaches to reaching and meeting the needs of underserved groups.
BACKGROUND: The end-of-life experience is a multidimensional concept that involves multiple domains, such as physical, social, caregiving, and environmental aspects, but previous studies have examined only individual fac...BACKGROUND: The end-of-life experience is a multidimensional concept that involves multiple domains, such as physical, social, caregiving, and environmental aspects, but previous studies have examined only individual factors. Analyzing the heterogeneity of older adults' end-of-life experiences via comprehensive evaluation indicators can enhance understanding of the end-of-life process and inform the development of personalized care strategies. AIM: To identify end-of-life experience patterns among older adults via comprehensive evaluation indicators.Design, setting/participants:In this cross-sectional study, Chinese Longitudinal Healthy Longevity Survey (CLHLS) data were used. Older adults (aged 65 years and older) who died between 2008 and 2018 were selected. Data on the physical condition, family support, caregiving, and place of death of older adults were extracted to perform a latent class analysis to identify end-of-life experience patterns. A multinomial logistic regression was employed to explore the association between demographic characteristics and class membership, and an ordinal logistic regression was used to examine the relationship between class membership and pain near death. RESULTS: A total of 15,844 deceased older adults were included in the study. Latent class analysis identified three end-of-life experience patterns: 'limited companionship-institutional death' (14.28%), 'functional disability-family care' (60.70%), and 'living well-affordable caregiving' (25.02%). Females who lived in cities were more likely to belong to the functional disability-family care class. The living well-affordable caregiving class was associated with the lowest level of pain near death. CONCLUSIONS: Further strategies need to be implemented to address gender and urban‒rural inequities in end-of-life care. It is crucial to prioritize expanding access to community-based healthcare resources and offering comprehensive training for family caregivers.
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.