Framework for Considering Primary and Subspecialty Palliative Care and Guiding Serious Illness Communication for Patients With Breast Cancer.

Palliative care is a comprehensive approach aimed at enhancing the quality of life of patients and their families living with serious illnesses such as breast cancer. This approach includes assessing and managing pain and other physical symptoms, attending to psychosocial and spiritual aspects of care, fostering effective communication and decision making, and providing support in coordinating care that upholds a person's values and preferences from the time of diagnosis throughout the illness trajectory. This type of care can be provided by palliative care specialists (ideally an interprofessional team) working alongside the oncology team, referred to as subspecialty palliative care.

Expert consensus-based guidance on approaches to opioid management in individuals with advanced cancer-related pain and nonmedical stimulant use.

Background: Clinicians treating cancer-related pain with opioids regularly encounter nonmedical stimulant use (i.e., methamphetamine, cocaine), yet there is little evidence-based management guidance.

Advance care planning and hospital outcomes in solid tumour oncology inpatients.

Objectives: To assess the association between advance care planning (ACP) and outcomes of in-hospital mortality, 30-day hospital readmission and 30-day emergency department (ED) visits among patients with cancer.

Methods: This observational cohort analysis included patients with solid tumour malignancies receiving oncology care and admitted at Yale New Haven Hospital between 1 January 2018 and 31 December 2021.

Results: Among 19 422 patients, 1283 (6.

Lung Cancer Supportive Care and Symptom Management.

Lung cancer carries significant mortality and morbidity. In addition to treatment advances, supportive care may provide significant benefit for patients and their caregivers. A multidisciplinary approach is critical in addressing complications of lung cancer, including disease- and treatment-related complications, oncologic emergencies, symptom management and supportive care, and addressing the psychosocial needs of affected patients.

Association of palliative care and hospital outcomes among solid tumour oncology inpatients.

Objectives: We aimed to explore the association between receiving an inpatient palliative care consultation and hospital outcomes, including in-hospital death, intensive care unit (ICU) use, discharge to hospice, 30-day readmissions and 30-day emergency department (ED) visits.

Methods: We conducted a retrospective chart review of Yale New Haven Hospital medical oncology admissions from January 2018 through December 2021, with and without inpatient palliative care consultations. Hospital outcome data were extracted from medical records and operationalised as binary.

Quality of Telehealth-Delivered Inpatient Palliative Care During the Early COVID-19 Pandemic.

Context: Consequent to increasing COVID-19 infection rates, the Palliative Care (PC) service at a large New England hospital shifted from in-person to telehealth-delivered PC (TPC).

Objectives: We compared the quality of TPC to in-person PC during the early COVID-19 pandemic.

Methods: We conducted an electronic health record review of PC consultations of patients hospitalized during three periods: pre-COVID January, 2020-February, 2020 (in-person); peak-COVID March, 2020-June, 2020 (majority TPC); and post-peak September, 2020-October, 2020 (majority in-person).

COVID-19 Traumatic Disaster Appraisal and Stress Symptoms Among Health Care Workers: Insights From the Yale Stress Self-assessment.

Objective: To determine to what extent did health care workers experience the pandemic as a severe stress event.

Methods: This cross-sectional evaluation of 8299 health care workers, representing a 22% response rate, utilized machine learning to predict high levels of escalating stress based on demographics and known predictors for adverse psychological outcomes after trauma.

Results: A third of health care workers experienced the pandemic as a potentially traumatic stress event; a greater proportion of health care workers experienced high levels of escalating stress.

Improving Breast Cancer Family Caregivers' Palliative Care Literacy: A Pilot Randomized Trial.

Self- and family management (SFM) refers to patients' and family caregivers' activities to co-manage illness. Two barriers to SFM are low palliative care literacy and lack of goals of care communication, which potentially result in SFM activities that are unsupportive of patients' goals. Managing Cancer Care: A Caregiver's Guide (MCC-CG) aims to improve palliative care literacy and communication within a SFM training program.

Integrating Palliative Care Into Self-management of Breast Cancer: A Pilot Randomized Controlled Trial.

Background: Breast cancer patients may not be well-informed about palliative care, hindering its integration into cancer self-management.

Objective: The aim of this study was to test Managing Cancer Care: A Personal Guide (MCC-PT), an intervention to improve palliative care literacy and cancer self-management.

Methods: This was a single-blind pilot randomized controlled trial to evaluate the feasibility/acceptability and intervention effects of MCC-PT on palliative care literacy, self-management behaviors/emotions, and moderation by demographic/clinical characteristics.

Expert Panel Consensus on Management of Advanced Cancer-Related Pain in Individuals With Opioid Use Disorder.

Importance: Opioid use disorder (OUD) is an important comorbidity in individuals with advanced cancer, in whom pain is common. Full-agonist opioid medications are the cornerstone of cancer pain management, but the existing literature does not address how to manage cancer pain in patients with OUD.

Objective: To conduct an expert panel to develop consensus on the appropriateness of management of cancer pain in individuals with co-occurring advanced cancer and OUD.

Reflections on New Evidence on Crisis Standards of Care in the COVID-19 Pandemic.

Crisis standards of care have been widely developed by healthcare systems and states in the United States during the COVID-19 pandemic, and in some rare cases have actually been used to allocate medical resources. All publicly available U.S.

NCCN Guidelines® Insights: Palliative Care, Version 2.2021.

Palliative care has evolved to be an integral part of comprehensive cancer care with the goal of early intervention to improve quality of life and patient outcomes. The NCCN Guidelines for Palliative Care provide recommendations to help the primary oncology team promote the best quality of life possible throughout the illness trajectory for each patient with cancer. The NCCN Palliative Care Panel meets annually to evaluate and update recommendations based on panel members' clinical expertise and emerging scientific data.

An observational case series of targeted virtual geriatric medicine and palliative care consults for hospitalized older adults with COVID-19.

Background: COVID-19 presents unique challenges to the care of hospitalized older adults, including fractured lines of communication and uncertainty surrounding long term trajectories in cognition and function. Geriatric medicine and palliative care clinicians bring specialized training in facilitating communication in the face of uncertainty. Insurance expansion of virtual visits enabled inpatient virtual consultation, which can preserve personal protective equipment and minimize exposure to clinicians.

Mobilizing an institutional supportive response for healthcare workers and other staff in the context of COVID-19: The Yale experience.

The burden of the COVID-19 pandemic upon healthcare workers necessitates a systematic effort to support their resilience. This article describes the Yale University and Yale New Haven Health System effort to unite several independent initiatives into a coherent integrated model for institutional support for healthcare workers. Here, we highlight both opportunities and challenges faced in attempting to support healthcare workers during this pandemic.

Developing a Triage Protocol for the COVID-19 Pandemic: Allocating Scarce Medical Resources in a Public Health Emergency.

The coronavirus disease-2019 (COVID-19) has caused shortages of life-sustaining medical resources, and future waves of the virus may cause further scarcity. The Yale New Haven Health System developed a triage protocol to allocate scarce medical resources during the COVID-19 pandemic, with the primary goal of saving the most lives possible, and a secondary goal of making triage assessments and decisions consistent, transparent, and fair. We outline the process of developing the triage protocol, summarize the protocol itself, and discuss the major ethical challenges encountered, along with our answers to these challenges.

Patterns of Opioid Prescribing among Medicare Advantage Beneficiaries with Pain and Cardiopulmonary Conditions.

Pain is common among patients with cardiopulmonary conditions; however, there are increasing concerns, but limited research, regarding use of opioids for pain in patients with noncancer conditions. To compare patterns of opioid prescribing among older adults reporting pain with cardiopulmonary conditions and/or cancer. Observational study using data from the Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey resource linked to Medicare Part D prescription claims.

Severe functional limitation due to pain & emotional distress and subsequent receipt of prescription medications among older adults with cancer.

Background: Certain cancer types and subsequent treatment can cause or worsen pain and emotional distress, leading to functional limitation, particularly among a growing population of older adults with cancer.

Methods: We constructed a national sample of older adult Medicare beneficiaries with cancer using the 2007-2012 Surveillance, Epidemiology and End Results (SEER)-Medicare Health Outcomes Survey (MHOS) database linked to Medicare Part D enrollment and prescription claims data. MHOS survey responses described functional limitations due to pain and emotional distress.

Patterns of pain medication use associated with reported pain interference in older adults with and without cancer.

Context: Concerns about the adequacy of pain management among older adults are increasing, particularly with restrictions on opioid prescribing.

Objectives: To examine associations between prescription pain medication receipt and patient-reported pain interference in older adults with and without cancer.

Methods: Using the 2007-2012 Surveillance Epidemiology and End Results (SEER)-Medicare Health Outcomes Survey (MHOS) database linked to Medicare Part D prescription claims, we selected MHOS respondents (N = 15,624) aged ≥ 66 years, ≤ 5 years of a cancer diagnosis (N = 9105), or without cancer (N = 6519).

Managing Chronic Pain in Cancer Survivors Prescribed Long-Term Opioid Therapy: A National Survey of Ambulatory Palliative Care Providers.

Context: Chronic pain, or pain lasting more than three months, is common among cancer survivors, who are often prescribed long-term opioid therapy (LTOT).

Objective: Our objective was to explore palliative care providers' experiences with managing chronic pain in cancer survivors prescribed LTOT, specifically in ambulatory palliative care settings, and their strategies for overcoming challenges.

Methods: We recruited providers through leading national palliative care organizations who manage chronic pain in cancer survivors.

Advance Care Planning in Cognitively Impaired Older Adults.

Older adults with cognitive impairment face many healthcare challenges, chief among them participating in medical decision-making about their own health care. Advance care planning (ACP) is the process whereby individuals communicate their wishes for future care with their clinicians and surrogate decision-makers while they are still able to do so. ACP has been shown to improve important outcomes for individuals with cognitive impairment, but rates of ACP for these individuals are low because of individual-, clinician-, and system-related factors.

Palliative care in decompensated cirrhosis: A review.

Decompensated cirrhosis is an illness that causes tremendous suffering. The incidence of cirrhosis is increasing and rates of liver transplant, the only cure, remain stagnant. Palliative care is focused on improving quality of life for patients with serious illness by addressing advanced care planning, alleviating physical symptoms and providing emotional support to the patient and family.

NCCN Guidelines Insights: Palliative Care, Version 2.2017.

The NCCN Guidelines for Palliative Care provide interdisciplinary recommendations on palliative care for patients with cancer. These NCCN Guidelines Insights summarize and provide context for the updated guidelines recommendations regarding hospice and end-of-life (EOL) care. Updates for 2017 include revisions to and restructuring of the algorithms that address important EOL concerns.