Understanding and Addressing Mental Health Disparities and Stigma in Serious Illness and Palliative Care.

Patients receiving palliative care experience stigma associated with their illness, personal identity, and healthcare utilization. These stigmas can occur at any stage of the disease process. Varying stigmas combine to cause palliative care patients to feel misunderstood, contribute to treatment barriers, and further negative stereotypes held by clinicians.

Mirtazapine: A One-Drug Intervention for the Physical and Psychological Symptoms of End-Stage Renal Disease (ESRD).

Patients with end-stage renal disease (ESRD), especially those on dialysis, experience myriad medical and psychological symptoms that impact theirquality of life. These symptoms range from nausea, emesis, and insomnia to pruritus, anxiety, depression, and loss of appetite. These symptoms often require multiple medications (e.

Telehealth vs In-Person Early Palliative Care for Patients With Advanced Lung Cancer: A Multisite Randomized Clinical Trial.

Importance: Numerous studies show that early palliative care improves quality of life and other key outcomes in patients with advanced cancer and their caregivers, although most lack access to this evidence-based model of care.

Objective: To evaluate whether delivering early palliative care via secure video vs in-person visits has an equivalent effect on quality of life in patients with advanced non-small cell lung cancer (NSCLC).

Design, Setting, And Participants: Randomized, multisite, comparative effectiveness trial from June 14, 2018, to May 4, 2023, at 22 US cancer centers among 1250 patients within 12 weeks of diagnosis of advanced NSCLC and 548 caregivers.

Project Respect: experiences of seriously ill LGBTQ+ patients and partners with their health care providers.

Discrimination against lesbian, gay, bisexual, transgender, and queer (LGBTQ+) persons in health care creates barriers to serious illness care, including patients avoiding or delaying necessary care, providers disrespecting wishes of surrogates, and adverse outcomes for patients and families. A cross-sectional mixed-methods study using an online survey was used to determine the extent to which LGBTQ+ patients and spouses, partners, and widows experienced disrespectful or inadequate care due to sexual orientation or gender identity. A total of 290 LGBTQ+ patients and partners reported high levels of disrespectful and inadequate care, including 35.

Examining Moderation of Dignity Therapy Effects by Symptom Burden or Religious/Spiritual Struggles.

Context: Dignity therapy (DT) is a well-researched psychotherapeutic intervention but it remains unclear whether symptom burden or religious/spiritual (R/S) struggles moderate DT outcomes.

Objective: To explore the effects of symptom burden and R/S struggles on DT outcomes.

Methods: This analysis was the secondary aim of a randomized controlled trial that employed a stepped-wedge design and included 579 participants with cancer, recruited from six sites across the United States.

Engaging Mortality: Effective Implementation of Dignity Therapy.

Patients consider the life review intervention, Dignity Therapy (DT), beneficial to themselves and their families. However, DT has inconsistent effects on symptoms and lacks evidence of effects on spiritual/existential outcomes. To compare usual outpatient palliative care and chaplain-led or nurse-led DT for effects on a quality-of-life outcome, dignity impact.

Disrespectful and inadequate palliative care to transgender persons.

Objectives: The purpose of this study was to describe disrespectful, inadequate, and abusive care to seriously ill patients who identify as transgender and their partners.

Methods: A cross-sectional mixed methods study was conducted. The sample included 865 nurses, physicians, social workers, and chaplains.

Disrespectful and inadequate palliative care to lesbian, gay, and bisexual patients.

Objectives: The study aims to describe inadequate, disrespectful, and abusive palliative and hospice care received by lesbian, gay, and bisexual (LGB) patients and their spouses/partners due to their sexual orientation or gender identity.

Methods: A national sample of 865 healthcare professionals recruited from palliative and hospice care professional organizations completed an online survey. Respondents were asked to describe their observations of inadequate, disrespectful, or abusive care to LGB patients and their spouses/partners.

Death Anxiety and Correlates in Cancer Patients Receiving Palliative Care.

Death anxiety is powerful, potentially contributes to suffering, and yet has to date not been extensively studied in the context of palliative care. Availability of a validated Death Anxiety and Distress Scale (DADDS) opens the opportunity to better assess and redress death anxiety in serious illness. We explored death anxiety/distress for associations with physical and psychosocial factors.

Emotion Dysregulation and Workplace Satisfaction in Direct Care Worker Burnout and Abuse Risk.

Background/objectives: Direct care workers frequently encounter difficult interactions with the patients they serve and experience frustration and burnout. The current study tested a hypothesized model in which predictors of caregiver abuse risk (emotional dysregulation, difficulty managing patient behavior, and workplace satisfaction) were mediated by symptoms of burnout.

Design: The study used an online cross-sectional survey design.

Brain Death Determination and Communication: An Innovative Approach Using Simulation and Standardized Patients.

Context: Palliative medicine clinicians in hospital settings are often involved in the care of patients dying in critical care settings, with a subset from brain death. Brain death is a complex concept, not only for families, but also for clinicians. There is wide variability in adhering to formalized guidelines for brain death determination.

The Effect of Triggered Palliative Medicine Consults on Nurse Moral Distress in the Medical Intensive Care Unit.

Purpose: Moral distress in the intensive care unit contributes to negative emotional experiences in nurses and adversely affects patient care. This prospective cohort study evaluates an intervention designed to improve nurse moral distress in the medical intensive care unit and assesses patient outcomes which may improve moral distress.

Methods: Nurse moral distress was measured before and after an intervention of triggered palliative consults and scheduled family meetings in the intensive care unit during the COVID-19 pandemic.

Practice Improvement Projects in an Interdisciplinary Palliative Care Training Program.

Context: Demand for palliative care (PC) continues to increase with an insufficient number of specialists to meet the need. This requires implementation of training curricula to expand the workforce of interdisciplinary clinicians who care for persons with serious illness.

Objectives: To evaluate the impact of utilizing individual practice improvement projects (PIP) as part of a longitudinal PC curriculum, the Coleman Palliative Medicine Training Program (CPMTP-2).

Improving the Hospice and Palliative Care Experiences of LGBTQ Patients and Their Caregivers.

Primary care providers often express a desire to be more involved with their patients as they transition to hospice care. Given that these providers have a central role in the care of their patients, they have the potential to significantly improve the experiences of lesbian, gay, bisexual, transgender, and queer patients who face serious illnesses. This article discusses the barriers to quality hospice and palliative care experienced by many sexual and gender minorities, as well as specific ways in which primary care physicians can promote equitable end-of-life care.

Differences in Family Involvement in the Bedside Care of Patients in the ICU Based on Self-Identified Race.

Objectives: Being a caregiver for a patient in the ICU can place emotional burden on families and engaging families in caregiving can reduce psychological distress. Our goal was to observe support methods used by families in the ICU and identify differences between race/ethnicity.

Design: A secondary analysis of a multicenter before-and-after clinical trial.

Association of Race with End-of-Life Treatment Preferences in Older Adults with Cancer Receiving Outpatient Palliative Care.

End-of-life discussions and documentation of preferences are especially important for older cancer patients who are at high risk of morbidity and mortality. To evaluate influence of demographic factors such as religiosity, education, income, race, and ethnicity on treatment preferences for end-of-life care. A retrospective observational study was performed on baseline data from a multisite randomized clinical trial of Dignity Therapy in 308 older cancer patients who were receiving outpatient palliative care (PC).

Interim Analysis of Attrition Rates in Palliative Care Study on Dignity Therapy.

A routine threat to palliative care research is participants not completing studies. The purpose of this analysis was to quantify attrition rates mid-way through a palliative care study on Dignity Therapy and describe the reasons cited for attrition. Enrolled in the study were a total of 365 outpatients with cancer who were receiving outpatient specialty palliative care (mean age 66.

Experiential Avoidance and Post-traumatic Stress Symptoms Among Child Abuse Counselors and Service Workers: A Brief Report.

Professionals who counsel and serve survivors of childhood abuse may be at risk of experiencing symptoms of post-traumatic stress disorder (PTSD), which can be exacerbated by cognitive and emotional processes. It is hypothesized that (1) a significant proportion of professionals who primarily serve child abuse survivors experience elevated levels of PTSD symptoms and (2) elevated PTSD symptoms are associated with psychological inflexibility processes, specifically increased experiential avoidance, cognitive fusion, and emotion regulation difficulties. Child abuse counselors and service workers ( = 31) in a major metropolitan area were recruited for a small pilot study.

Expanding the Interdisciplinary Palliative Medicine Workforce: A Longitudinal Education and Mentoring Program for Practicing Clinicians.

Context: The disparity between gaps in workforce and availability of palliative care (PC) services is an increasing issue in health care. To meet the demand, team-based PC requires additional educational training for all clinicians caring for persons with serious illness.

Objectives: To describe the educational methodology and evaluation of an existing regional interdisciplinary PC training program that was expanded to include chaplain and social worker trainees.

Racial and ethnic disparity in palliative care and hospice use.

Objectives: Prior research has demonstrated differences across race and ethnicity, as well as across geographic location, in palliative care and hospice use for patients near the end of life. However, there remains inconsistent evidence regarding whether these disparities are explained by hospital-level practice variation. The goals of this study were to evaluate whether inpatient palliative care consultation use and discharge to hospice differed by race/ethnicity and whether hospital-level variations explained these differences.