Outpatient Training During Hospice and Palliative Medicine Fellowship: A National Survey.

Context: Outpatient palliative care (PC) has strong evidence demonstrating impact across serious illnesses, resulting in growing demand for skilled outpatient PC clinicians. However, there is limited literature examining the existing state and quality of outpatient PC education during postgraduate training.

Objectives: Characterize the current state of outpatient training in United States (US) Hospice and Palliative Medicine (HPM) physician fellowships and elicit perceptions regarding quality of outpatient PC education.

Palliative Medicine Fellows' Discussions, Perceptions, and Training Regarding Medical Cannabis.

Context: Medical cannabis is increasingly considered for palliation of pain, nausea/vomiting, anorexia, and other symptoms.

Objectives: We aimed to determine whether training in hospice and palliative medicine (HPM) adequately prepares fellows to counsel patients about medical cannabis.

Methods: A previously validated questionnaire was adapted for HPM fellows.

Integrating palliative care into the evolving landscape of oncology.

Patients with cancer have many palliative care needs. Robust evidence supports the early integration of palliative care into the care of patients with advanced cancer. International organizations, such as the American Society of Clinical Oncology (ASCO) and the European Society for Medical Oncology (ESMO), have recommended early, longitudinal integration of palliative care into oncology care throughout the cancer trajectory.

Perceptions and Reality of Antimicrobial Prescribing During the Transition to Comfort Measures Only at an Academic Medical Center.

Background: Little is known about antimicrobial prescribing when patient care is transitioned to comfort measures only (CMO). We used a multidisciplinary survey and retrospective cohort study to gain insight into antimicrobial prescribing in this population at an academic medical center to inform future antimicrobial stewardship interventions.

Methods: A survey focusing on antimicrobial prescribing during the transition to CMO was electronically distributed to providers in medical subspecialities and responses were compared across specialties.

Should Outpatient Palliative Care Clinics in Cancer Centers be Stand Alone or Embedded?

Outpatient palliative care facilitates timely symptom management, psychosocial care and care planning. A growing number of cancer centers have either stand-alone or embedded outpatient palliative care clinics. In this "Controversies in Palliative Care" article, three groups of thought leaders independently answer this question.

Does Use of Information Sources Outside the Treating Oncologist Influence Patient Decision-Making in Patients Receiving Non-Curative Intent Therapy for Advanced Cancer.

Background: Patients' decision-making and perceptions of outcomes may be impacted by information sources. We investigated use of information by patients and tested the association with patients' perception of treatment outcomes.

Methods: We prospectively surveyed patients with advanced solid cancers and their oncologists regarding benefits/risks of non-curative cancer therapies.

Delivering Palliative Care to Hospitalized Oncology Patients: A Scoping Review.

Context: Early, longitudinal integration of palliative care (PC) is recommended for patients with advanced cancer, in both inpatient and outpatient settings. Despite the growth of specialty PC teams in the last decade, the majority of PC is still delivered in the inpatient setting using a traditional referral-based consult delivery model. However, traditional consultation can lead to significant variation or delay in inpatient PC utilization.

Pro-active Palliative Care for Hospitalized Primary Care Patients.

Background: Early integration of palliative care (PC) improves outcomes for patients with cancer and heart failure. Data on the role of PC in complex general medicine patients is scant.

Measures: We identified high-mortality risk patients from our primary care practice by screening with mortality indices upon hospital admission.

Are Opioid Infusions Used Inappropriately at End of Life? Results From a Quality/Safety Project.

Context: Opioid continuous infusions are commonly used for end-of-life (EOL) symptoms in hospital settings. However, prescribing practices vary, and even the recent literature contains conflicting protocols and guidelines for best practice.

Objectives: To determine the prevalence of potentially inappropriate opioid infusion use for EOL comfort care at an academic medical center, and determine if inappropriate use is associated with distress.

Moral Distress and Moral Injury Among Attending Neurosurgeons: A National Survey.

Background: "Moral distress" describes the psychological strain a provider faces when unable to uphold professional values because of external constraints. Recurrent or intense moral distress risks moral injury, burnout, and physician attrition but has not been systematically studied among neurosurgeons.

Objective: To develop a unique instrument to test moral distress among neurosurgeons, evaluate the frequency and intensity of scenarios that may elicit moral distress and injury, and determine their impact on neurosurgical burnout and turnover.

Is Primary Care Physician Involvement Associated with Earlier Advance Care Planning?: A Study of Patients in an Academic Primary Care Setting.

Advance care planning (ACP) is important to improving end-of-life care. Few studies have examined the impact of primary care physician (PCP) involvement in ACP. To determine whether complete ACP, defined as health care proxy (HCP), provider orders for life-sustaining treatment (POLST), and documented goals-of-care (GOC) conversations, would occur earlier when the PCP was involved in POLST and/or GOC conversations.

Death by Chocolate: The Palliative Management of Dysphagia.

Among patients seen by palliative care, dysphagia is prevalent and can lead to disturbing symptoms and challenges in medical decisions for patients and families. Our patient, AP, an 88-year-old woman with a history of thyroid cancer and esophageal dysmotility, was nearing end of life. She wanted nothing more than to eat her chocolate cake in peace.

Different Associations Between Inpatient or Outpatient Palliative Care and End-of-Life Outcomes for Hospitalized Patients With Cancer.

Purpose: Palliative care (PC) improves outcomes in advanced cancer, and guidelines recommend early outpatient referral. However, many PC teams see more inpatient than outpatient consults. We conducted a retrospective study of hospitalized patients with cancer to quantify exposure to inpatient and outpatient PC and describe associations between PC and end-of-life (EOL) quality measures.

Palliative Care Education for Surgical Residents: Current Practices and Future Directions.

Despite the benefits and increased clinical application of primary palliative care principles within surgery, palliative care education among surgical trainees remains varied and poorly defined. Through a survey of general surgery program directors, this perspective highlights current palliative care educational practices of general surgery residencies and existing curricula. Although program directors deemed palliative care education important to surgical training, barriers to improving resident education included limited overall educational time, few available palliative care experts, and the lack of a dedicated curriculum.

Patient Perceptions of Treatment Benefit and Toxicity in Advanced Cancer: A Prospective Cross-Sectional Study.

Purpose: Prior studies show that many patients receiving palliative cancer therapies misperceive likelihood of cure. Patients' understanding of treatment benefits and risks beyond cure is unknown. We explore patient perceptions of palliative treatment in the novel therapeutic era.

Communication Skills Training for Internal Medicine Residents Using a Brief Animated Video.

Patient communication courses are time-intensive, making incorporation into residency curricula challenging. Using a short video could be an efficient means to teach residents communication skills. We created a 4-min animated video focused on the "ask more and summarize technique".

Phase II Study of Avelumab in Patients With Mismatch Repair Deficient and Mismatch Repair Proficient Recurrent/Persistent Endometrial Cancer.

Purpose: Despite the tissue-agnostic approval of pembrolizumab in mismatch repair deficient (MMRD) solid tumors, important unanswered questions remain about the role of immune checkpoint blockade in mismatch repair-proficient (MMRP) and -deficient endometrial cancer (EC).

Methods: This phase II study evaluated the PD-L1 inhibitor avelumab in two cohorts of patients with EC: (1) MMRD/ (polymerase ε) cohort, as defined by immunohistochemical (IHC) loss of expression of one or more mismatch repair (MMR) proteins and/or documented mutation in the exonuclease domain of ; and (2) MMRP cohort with normal IHC expression of all MMR proteins. Coprimary end points were objective response (OR) and progression-free survival at 6 months (PFS6).

Managing Opioid Use Disorder in the Setting of a Terminal Disease: Opportunities and Challenges.

Opioids have long been a mainstay of symptom management in palliative care (PC), allowing patients with terminal illnesses to have an improved quality of life. Unfortunately, these same medications have contributed to the explosion of the opioid epidemic. This article explores the case of a patient with opioid use disorder (OUD) and pancreatic cancer.

Palliative Care and Communication Training in Neurosurgery Residency: Results of a Trainee Survey.

Objective: Neurosurgeons care for critically ill patients near the end of life, yet little is known about how well their training prepares them for this role. We surveyed a random sample of neurosurgery residents to describe the quantity and quality of teaching activities related to serious illness communication and palliative care, and resident attitudes and perceived preparedness to care for seriously ill patients.

Methods: A previously validated survey instrument was adapted to reflect required communication and palliative care competencies in the 2015 the Accreditation Council for Graduate Medical Education (ACGME) Milestones for Neurological Surgery.