Abstract
Letter to the Editor
A secondary analysis of the data generated as part of a national survey of hospice and palliative care (HPM) clinicians regarding behavioral health in palliative care to fill these knowledge gaps. We sought to understand how often HPM prescribers are responsible for substance use disorder care and their comfort level in providing this care. (page 714)
Brief Report
Mixed methods study examines feasibility and clinical outcomes of a virtual reality program for veterans with complex medical and psychiatric comorbidities at a Veterans Affairs Hospital. (page 801)
Fast Facts
#526: Provider Assisted Death by Prescription in the United States: Part II (page 828)
#527: Vocalization and Communication Pearls for Patients with Complex Airways (page 830)
Personal Reflection
Leah, in her mid-50s, has amyotrophic lateral sclerosis (ALS). She knew I was from the palliative care team and likely to raise topics she was not ready to confront: her goals, values, the trajectory of ALS, and choices about what interventions she might want or not want. She had no interest in such a conversation. (page 832)
Case Discussions
Rates of chronic and life-limiting illness among incarcerated people are expected to increase, leading to a concurrent rise in the need for palliative care services within this population. In this report, the authors present the case of a patient with newly diagnosed cancer admitted to the hospital from the carceral system. (page 836)
Book and Media
(page 840)
Original Article Key Points
As specialty palliative care grows, the scope of practice clarity will ensure appropriate referrals and sustainable practice. We present a guideline developed through institutional consensus building. This guideline, prioritizing patients with serious illness and high mortality risk, can serve as a starting point for discussions. (page 733)
In this cohort, more than half of palliative care patients showed clinically relevant discrepancies between creatinine- and cystatin C-based eGFR, risking kidney function misclassification and medication dosing errors. Selective cystatin C testing before prescribing renally eliminated drugs may improve safety and support individualized prescribing in this vulnerable population. (page 723)
Transdermal blonanserin may offer a practical, well-tolerated, and effective option for managing hyperactive delirium in patients with advanced cancer who are unable to take oral medications, providing meaningful symptom reduction with minimal adverse effects. (page 739)
This article identifies factors associated with a lower increase in the number of nutrition impact symptoms over time in outpatients with advanced cancer during the early phase of palliative care, specifically receiving oral nutritional supplements, having a better Karnofsky Performance Status, and presenting higher serum albumin levels. (page 744)
Regular clinical supervision may help keep burnout at a manageable level while sustaining compassion satisfaction and work engagement. Supporting staff well-being through integrated individual and organizational strategies is essential to ensure compassionate care in emotionally demanding settings. (page 754)
Bereaved families perceive death to be sudden or unexpected more frequently than physicians. Addressing this discrepancy is critical for improving the quality of both palliative care and bereavement support. (page 763)
Real-time assessment revealed four distinct distress trajectories among clinicians caring for seriously ill hospitalized patients, with nearly half experiencing high or variable distress. Advanced practice providers and those reporting multiple emotions faced greater distress. Identifying at-risk clinicians enables health care systems to deliver timely interventions preventing burnout. (page 770)
This large, national study found that the absolute differences in severe symptom prevalence between inpatient and community palliative care patients, after adjusting for key clinical and demographic factors, were minimal. These findings suggest comparable symptom outcomes across settings, offering system-level insight into palliative care outcomes across care contexts. (page 781)