Attitudes Toward Medical Assistance in Dying Among Swedish Palliative Care Professionals.

The debate over legalizing medical assistance in dying (assisted dying) is ongoing, also in Nordic countries such as Sweden where assisted dying is illegal. A 2020 survey by the Swedish Medical Association highlighted varied perspectives, with 41% of physicians supporting and 34% opposing legalization. Professionals in palliative care were more negative toward it.

Per-Patient Illness Trajectory Analyses.

Summary statistics often hide individual patients' suffering, thereby impeding quality improvement efforts. We aimed to show the experience of a population with health care toward the end of life while preserving the experience of the individual. We developed a data display method called per-patient illness trajectory analysis.

Family Perceptions of Virtual Family-Centered Rounds in a Quaternary Cardiac Intensive Care Unit.

Family-centered rounds (FCR) reduce the risk of psychological comorbidities of family members and improve the quality of communication between providers and families. We conducted a pilot quality improvement study analyzing family perceptions of virtual FCR. Family members of previously admitted cardiac ICU patients who participated in at least one session of virtual FCR between April 2020 and June 2021 at Massachusetts General Hospital were surveyed post-ICU discharge.

Lessons Learned About System-Level Improvement in Serious Illness Communication: A Qualitative Study of Serious Illness Care Program Implementation in Five Health Systems.

Background: Serious illness communication is a key element of high-quality care, but it is difficult to implement in practice. The Serious Illness Care Program (SICP) is a multifaceted intervention that contributes to more, earlier, and better serious illness conversations and improved patient outcomes. This qualitative study examined the organizational and implementation factors that influenced improvement in real-world contexts.

Improving serious illness communication: a qualitative study of clinical culture.

Objective: Communication about patients' values, goals, and prognosis in serious illness (serious illness communication) is a cornerstone of person-centered care yet difficult to implement in practice. As part of Serious Illness Care Program implementation in five health systems, we studied the clinical culture-related factors that supported or impeded improvement in serious illness conversations.

Methods: Qualitative analysis of semi-structured interviews of clinical leaders, implementation teams, and frontline champions.

Aging is not an Illness: Exploring Geriatricians' Resistance to Serious Illness Conversations.

Context: Serious illness conversations help clinicians align medical decisions with patients' goals, values, and priorities and are considered an essential component of shared decision-making. Yet geriatricians at our institution have expressed reluctance about the serious illness care program.

Objectives: We sought to explore geriatricians' perspectives on serious illness conversations.

Assessing the Acceptability and Feasibility of Leveraging Emergency Department Social Workers' Advanced Communication Skills to Assess Elderly Patients' Goals and Values.

The Emergency Department (ED) has increasingly been recognized as an important site of care for older adults with unmet palliative care needs. Despite this, no clear model of care delivery has emerged. To assess the acceptability and feasibility of a scripted palliative care communication intervention in the ED directed by social workers.

Goals of Care Conversations Documented By an Embedded Emergency Department-Palliative Care Team During COVID.

There has been growing interest around integrating palliative care (PC) into emergency department (ED) practice but concern about feasibility and impact. In 2020, as the COVID pandemic was escalating, our hospital's ED and PC leadership created a new service of PC clinicians embedded in the ED. To describe the clinical work of the embedded ED-PC team, in particular what was discussed during goals of care conversations.

Patterns of Communication About Serious Illness in the Years, Months, and Days before Death.

Background: Communication with patients and families about serious illness impacts quality of life and helps facilitate decision-making.

Objective: To elucidate the pattern of communication about serious illness for patients who have died in an inpatient setting.

Design: Three hundred patients from the Swedish Registry of Palliative Care 2015-2017 were randomly selected for manual chart review.

To Accompany, Always: Psychological Elements of Palliative Care for the Dying Patient.

Palliative care clinicians provide psychological support throughout their patients' journeys with illness. Throughout our series exploring the psychological elements of palliative care (PEPC), we suggested that the quality of care is enhanced when clinicians have a deeper understanding of patients' psychological experience of serious illness. Palliative care clinicians are uniquely poised to offer patients a grounded, boundaried, and uplifting relationship to chart their own course through a life-altering or terminal illness.

Patient Perspectives on Serious Illness Conversations in Primary Care.

The Serious Illness Care Program has been shown to improve quality and feasibility of value-based end-of-life conversations in primary care. To elicit patients' perspectives on serious illness conversations conducted by primary care clinicians. Telephone interviews were conducted with patients at an academic center in the United States, who had a recent serious illness conversation with their primary care clinician.

Turning the Lens Inward: The Psychological Elements of Clinician Well Being.

This is the seventh entry in the (PEPC) series. Previous articles have focused on the psychological elements of the care we provide patients and the relationships we build with our referring clinician colleagues. In this entry, we focus on how the PEPC also impact clinician well being.

Referral Relationship: Illuminating the Ways Palliative Care Creates a Holding Environment for Referring Clinicians.

Palliative care supports referring colleagues in multiples ways. This support to referring colleagues is not often explored in the literature, yet the psychological concept that best describes it is the holding environment. The holding environment is the relational space palliative care offers referring clinicians for processing emotions and information.

(Don't) Leave Me Alone: Attachment in Palliative Care.

This is the fifth article in the psychological elements of palliative care series. This series focuses on how key concepts from psychotherapy can be used in the context of palliative care to improve communication and fine tune palliative care interventions. In this article, we discuss attachment-the system by which people form bonds in relationships.

One Hospital's Response to the Institute of Medicine Report, "Dying in America".

Background: In response to the Institute of Medicine (IOM) report, Dying in America, we undertook an institution wide effort to improve the experience of patients and families facing serious illness by engaging leadership and developing a program to promote the practice of generalist palliative care.

Measures: The impact of the program was measured with process measures related to its' three parts.

Intervention: We developed a three-part generalist palliative care program that focuses on 1) instructional design, 2) advance care planning, and 3) engagement.

Improving Serious Illness Communication: Testing the Serious Illness Care Program with Trainees.

Background: Early conversations about patients' goals and values improve care, but clinicians struggle to conduct them. The systems-based Serious Illness Care Program (SICP) helps clinicians have more, better, and earlier conversations. Central to this approach is a clinician conversation guide for patient encounters.

Defining Clinical Attunement: A Ubiquitous But Undertheorized Aspect of Palliative Care.

Attunement, the process of understanding and responding to another's spoken and unspoken needs, is a fundamental concept of human development and the basis of meaningful relationships. To specialize the concept of attunement for palliative care, this article introduces clinical attunement. This term accounts for how palliative care clinicians must repeatedly balance patients' readiness to talk about the future with the cadence of the illness and need for medical decision making.

Development of a Prognostic Awareness Impact Scale for Patients with Advanced Cancer.

No reliable instruments exist to measure prognostic awareness and its psychological and behavioral impacts for patients with advanced cancer. We developed the Prognostic Awareness Impact Scale (PAIS) using a qualitative approach. During phase 1, we convened a working group with a transdisciplinary team of clinicians from oncology ( = 2), psychology ( = 2), psychiatry ( = 1), palliative care ( = 3), and survey development ( = 1) to identify key domains of PAIS.

Foundations for Psychological Thinking in Palliative Care: Frame and Formulation.

This is the second article in the psychological elements of palliative care (PEPC) series. This series focuses on how key concepts from psychotherapy can be used in the context of palliative care to improve communication and fine tune palliative care interventions. In this article, we introduce two foundational concepts: frame and formulation.

The Meaning of Together: Exploring Transference and Countertransference in Palliative Care Settings.

Establishing an empathic clinical relationship is a cornerstone of high-quality palliative care. More than simply approaching patients with a pleasant affect or "being nice," we propose that skilled clinicians routinely employ distinct psychological elements when creating effective bonds with seriously ill patients and their families. Palliative care involvement has been shown to improve a variety of outcomes for patients with serious cancer, and yet the components of this salutary effect are still becoming known in the literature.