BACKGROUND: The aim of this retrospective study was to describe the course of patients with opioid use disorders (OUD) admitted to an acute palliative care unit (APCU) for managing pain and nonmedical use of prescribed t...BACKGROUND: The aim of this retrospective study was to describe the course of patients with opioid use disorders (OUD) admitted to an acute palliative care unit (APCU) for managing pain and nonmedical use of prescribed transmucosal fentanyl products. METHODS: Briefly, 11 patients underwent opioid switching and initiation of medications for OUD, primarily using methadone and buprenorphine. RESULTS: In total, 11 patients were included in this series. The clinical protocol, which integrated opioid rotation with the use of adjunctive medications such as olanzapine and ketamine, resulted in a significant reduction in pain and withdrawal symptoms. Methadone and buprenorphine, used to manage pain while avoiding access to fentanyl products and monitoring withdrawal symptoms with subsequent dose tapering, were effective in an APCU providing comprehensive palliative care treatment. CONCLUSION: The proper and flexible use of methadone and buprenorphine in an APCU can help patients who were prescribed fentanyl products improperly.
BACKGROUND: Previous studies show ambiguous results concerning quality of palliative care among patients with severe mental disorders, defined as schizophrenia, moderate to severe depression, and bipolar disorders. AIM:...BACKGROUND: Previous studies show ambiguous results concerning quality of palliative care among patients with severe mental disorders, defined as schizophrenia, moderate to severe depression, and bipolar disorders. AIM: To investigate quality in specialist palliative care among Danish patients with pre-existing severe mental disorders using data from the Danish Palliative Database. DESIGN: Danish cohort study linking data from the Danish Palliative Database and hospital medical files. SETTING/PARTICIPANTS: All adult decedents in 2023 from Central Denmark Region affiliated with specialist palliative care. Hospital records were screened for severe mental disorders. Quality indicators included: Place-of-death, days from referral to death, specialist palliative care waiting time, discussion at multidisciplinary conferences and completion of symptom assessment. RESULTS: Of 1869 patients, 80 (4.3%) had pre-existing severe mental disorders. Compared to patients without mental disorders, these patients died younger and more often from non-cancer conditions. They were less likely to complete symptom assessment (Risk Ratio (RR): 1.49 (95% CI: 1.15;1.95)). Those who also received active psychiatric treatment experienced longer waiting times for specialist palliative care (Mean ratios (MR): 3.48 (95% CI: 1.06;11.39)) and shorter palliative care pathways (MR: 0.44 (95% CI: 0.20;0.96)) than patients without active psychiatric treatment. CONCLUSION: Danish patients with active severe mental disorders were less likely to complete symptom assessment, had longer waiting times and shorter specialist palliative care pathways. Future efforts should focus on timely access to specialist palliative care and health professionals supporting completion of symptom assessments in this population.
Oncology and palliative care staff frequently encounter death yet often lack structured opportunities for reflection following these experiences. This study asked: How can we develop and implement a reflective practice p...Oncology and palliative care staff frequently encounter death yet often lack structured opportunities for reflection following these experiences. This study asked: How can we develop and implement a reflective practice program for oncology and palliative care staff to support them with patient death? Reflective practice is recognized as a valuable tool to support staff well-being; however, there is limited literature describing how such interventions are implemented in the hospital setting. A participatory insider-action research approach was undertaken to codevelop a reflective practice program. A multidisciplinary Action Research Group collaborated through a series of meetings to codesign the program. The data consisted of contemporaneous notes capturing group discussions on what was needed to develop the program. Thematic analysis was used to identify key ideas and patterns that emerged from these discussions, enabling the group to identify factors required to develop a format to support guided reflection. Key themes included the importance of language, timing and location, facilitation and structure, and case selection. The final outcome was a practical, semistructured format for reflective practice sessions for staff to follow as a framework to support reflection and emotional processing in response to patient death. Using an insider action research approach, this staff-led project offers an adaptable framework for structured reflection in acute hospital settings and represents an important initial step towards embedding reflective practice into the culture of health care.
BACKGROUND: Music therapy is one palliative care approach to improve physical and psychological outcomes for cognitively impaired children with medical complexity (CMC), their parents, and families. However, CMC are ofte...BACKGROUND: Music therapy is one palliative care approach to improve physical and psychological outcomes for cognitively impaired children with medical complexity (CMC), their parents, and families. However, CMC are often excluded because some specialist services may not accommodate cognitively impaired and nonverbal children and are generally only available within metropolitan areas (large hospitals/cities). Many CMC are at home and cannot access such interventions. This study examined the feasibility and acceptability of a home-based, remote music therapy (RemoteMT) intervention for cognitively impaired CMC receiving palliative or complex care. DESIGN: One-group pre-/post-intervention study design. SETTING/SUBJECTS: Seventeen CMC receiving palliative/complex care and their parents ( 17 dyads) participated in the study. All study activities took place in participant homes in the United States. MEASUREMENTS: Parents completed measures at T1 pre- (baseline) and T2 post-intervention (six weeks post-baseline) to assess CMC outcomes of physical stress and sleep disturbance; parent outcomes of anxiety, sleep disturbance, and perceived stress; and family outcomes of family adaptability and cohesion. RESULTS: Results demonstrated improved child, parent, and family outcomes (e.g., 0.027 for child physical stress, 0.095 for family cohesion, 0.105) and feasible recruitment, data collection and intervention delivery. CONCLUSIONS: RemoteMT was a feasible and acceptable intervention for cognitively impaired CMC and their parents. Results indicate strong promise for benefits to child and parent outcomes. Full-scale efficacy testing is warranted.
Smirnova N, Batieste T, Cross SH
… +4 more, Jamdar S, Peterson CS, Vaughan CP, Kavalieratos D
J Palliat Med
· 2026 Apr · PMID 41974615
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BACKGROUND: Chronic obstructive pulmonary disease (COPD) has an unpredictable trajectory and high symptom burden, complicating end-of-life (EOL) decisions around place of death and hospice use. Little is known about how...BACKGROUND: Chronic obstructive pulmonary disease (COPD) has an unpredictable trajectory and high symptom burden, complicating end-of-life (EOL) decisions around place of death and hospice use. Little is known about how families navigate these decisions. METHODS: We conducted semi-structured interviews with bereaved caregivers of people with COPD who received pulmonary care at a U.S. academic center and died within 12 months. Two investigators performed template analysis to identify themes. RESULTS: We interviewed 18 caregivers (median age 58; 50% Black; 89% female). Fifty-six percent of decedents received hospice; 33% died at home. Caregivers described five themes: missed prognostic cues and poor communication; hospice as both loss and relief; home as ideal but hospital as default; financial influences on decisions; and mismatch between hospice and COPD needs. CONCLUSIONS: Caregivers identified a readiness gap driven by prognostic uncertainty, communication challenges, and financial constraints. Clearer communication and hospice models better aligned with COPD are needed.
Gaysynsky A, Muro A, Senft Everson N
… +2 more, Iles I, Chou WS
J Palliat Med
· 2026 Apr · PMID 41963247
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BACKGROUND: AI-generated images can support or impede health communication efforts and influence perceptions of health-related topics, making it important to evaluate how these images portray topics like palliative care...BACKGROUND: AI-generated images can support or impede health communication efforts and influence perceptions of health-related topics, making it important to evaluate how these images portray topics like palliative care (PC) and hospice care (HC), which are characterized by limited public understanding (e.g., regarding where these services are delivered) and misperceptions (e.g., widespread conflation of these services). OBJECTIVES: To examine characteristics of AI-generated PC and HC images. DESIGN: Three generative AI tools (ChatGPT, DreamStudio, and Midjourney) were used to generate 40 images each for the prompts "a photograph of palliative care" and "a photograph of hospice care" ( = 240). Images were coded for features such as the setting and the characteristics of people in the image (patients, providers, and caregivers). Code frequencies and percentages were calculated using STATA. Differences were assessed across prompts and AI tools. RESULTS: PC images more often depicted medical settings (PC = 37.5%, HC = 27.5%) and medical equipment (PC = 67.5%, HC = 50.0%). DreamStudio images were the most medicalized. When included, patients were generally presented as White (PC = 85.0%, HC = 91.0%), female (PC = 81.0%, HC = 75.3%), and older (PC = 88.0%, HC = 94.4%) and rarely had negative affect (PC = 5.0%, HC = 2.2%) or looked ill (PC = 4.0%, HC = 2.2%). Providers were more racially diverse (PC = 41.1%, HC = 48.4% non-White), but nearly all were women (PC = 95.9%, HC = 96.9% female). Providers displayed supportive touch frequently (PC = 72.6%, HC = 71.9%) but were rarely shown engaging in medical tasks (PC = 12.3%, HC = 6.3%). Caregivers were infrequently included in either PC or HC images. CONCLUSIONS: The few substantial differences identified between PC and HC images could reinforce conflation between these services. Some image features could also create additional misperceptions (e.g., regarding the role of caregivers).
BACKGROUND: Ambulatory palliative care (PC) focuses on managing complex symptoms, yet assessment relies on recall during infrequent visits to manage daily fluctuating symptoms. We aimed to design a PC-anchored remote sym...BACKGROUND: Ambulatory palliative care (PC) focuses on managing complex symptoms, yet assessment relies on recall during infrequent visits to manage daily fluctuating symptoms. We aimed to design a PC-anchored remote symptom assessment (RSA) tool with patients and clinicians. METHODS: We used user-centered, Agile design to develop and iteratively refine EMA-PAL, a web-based RSA prototype. Patients and clinicians ( = 14) from an ambulatory PC clinic participated in staged prototype development and testing through focus groups and interviews. RESULTS: EMA-PAL features patient- and provider-facing interfaces that visualize daily Edmonton Symptom Assessment System (ESAS) scores, highlight severe symptoms, and support shared review during visits. Participants endorsed EMA-PAL's potential to enhance communication and workflow efficiency and identified priorities for future development (medication tracking and workflow integration). CONCLUSION: This exploratory pilot suggests that PC-anchored RSA tools such as EMA-PAL may help address gaps in symptom assessment and timelier and patient-centered symptom management in ambulatory PC.
BACKGROUND: Clinical guidelines recommend naldemedine for opioid-induced constipation in patients with cancer, either with conventional laxatives or as a first-choice option. Making prophylactic naldemedine a new standar...BACKGROUND: Clinical guidelines recommend naldemedine for opioid-induced constipation in patients with cancer, either with conventional laxatives or as a first-choice option. Making prophylactic naldemedine a new standard treatment for opioid-induced constipation requires a demonstration of its value for money. OBJECTIVES: We aimed to evaluate the cost-effectiveness of prophylactic naldemedine in patients with cancer initiating strong opioid therapy. DESIGN: We conducted a cost-effectiveness analysis of prophylactic naldemedine replacing standard, nonprophylactic use from the payer's perspective, using a decision tree model based on data from a multicenter, double-blind, randomized controlled trial in Japan. SETTING/SUBJECTS: The study population included patients aged ≥20 years and initiating strong opioid therapy for the first time. RESULTS: The incremental cost-effectiveness ratio of prophylactic naldemedine for opioid-induced constipation was 1,445,276 Japanese yen (¥) or 9,635 United States dollars (USD) with an exchange rate of 1 USD = 150 ¥ per quality-adjusted life year. Using the official value of social willingness-to-pay threshold in Japan of 5 million ¥ or 33,333 USD per quality-adjusted life year gained, prophylactic naldemedine was found to be cost-effective. CONCLUSIONS: This is the first global cost-effectiveness analysis of prophylactic naldemedine in patients with cancer. Prophylactic naldemedine for opioid-induced constipation in patients with cancer initiating strong opioid therapy could be justifiable as an efficient use of finite health care resources.
Rossy Parés C, van Poecke N, Fernández-Capo M
… +3 more, Crespo I, Scherer-Rath M, van Laarhoven HWM
Palliat Med
· 2026 Jul · PMID 41958176
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BACKGROUND: While forgiveness is linked to emotional and physical benefits at the end of life, little is known about how it is understood or addressed by palliative care professionals. Spiritual caregivers, especially in...BACKGROUND: While forgiveness is linked to emotional and physical benefits at the end of life, little is known about how it is understood or addressed by palliative care professionals. Spiritual caregivers, especially in the Netherlands where formal training is growing, may be well-placed to support such conversations, yet their experiences remain underexplored. AIM: To explore how Dutch spiritual caregivers perceive and engage with forgiveness at the end of life, including their potential role in facilitating it. DESIGN: This qualitative study used interpretative phenomenological analysis. In-person, semi-structured interviews were analyzed through reflexive thematic analysis. SETTING/PARTICIPANTS: Eleven interviews were conducted with spiritual caregivers from various hospitals across the Netherlands. Interviews took place in hospitals ( = 6), caregivers' homes ( = 2), via Zoom ( = 2), and by phone ( = 1). Due to conceptual differences related to religious and existential backgrounds, nine interviews were finally selected, focusing on the Christian (Catholic = 4, Protestant = 4) and non-affiliated ( = 1) ones. RESULTS: Four main themes emerged: (1) concept of forgiveness according to spiritual caregivers; (2) forgiveness as a theme in the conversation between spiritual caregivers and patients, (3) barriers to talking about forgiveness, and (4) the role of spiritual caregivers in addressing forgiveness. CONCLUSION: Spiritual caregivers acknowledged forgiveness as beneficial but noted challenges-logistical, cultural, and personal-that make direct conversations difficult. As a result, they often adopt a subtle, indirect approach, using rituals and attentive listening to address forgiveness with patients nearing the end of life.