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Due to the importance of religion for 70% of adults in the United States, the prevalence of religious beliefs, and the impact of religious beliefs on health behaviors and health outcomes, palliative care teams must pay attention to the religious dimension of the lives of patients at end-of-life (EOL). We will review the content of some religious beliefs associated with EOL as well as the impact religious beliefs may have on EOL medical care and decision-making. We will also discuss potential pathways for palliative care teams to address the religious beliefs of patients and their loved ones at EOL which promote culturally sensitive and patient-centered care. This is a narrative review. We carried out an electronic PubMed search from 2010 to 2025 utilizing the subsequent words: religious beliefs; end-of-life; palliative care; adult 19+ years. We also integrated a hypothetical case study as well as the experience and proficiency of the authors. Many adult patients at EOL hold religious beliefs which can be facilitated through religious behaviors and belonging. The religious beliefs of patients at EOL have a strong potential to impact their medical care decision-making and outcomes as well as their quality of life. Yet, treatment teams insufficiently address the religious beliefs of patients at EOL. Religious beliefs are often present and can impact EOL medical care. Best practice dictates that an interdisciplinary palliative care team approach should address the religious beliefs and values of patients at EOL through a generalist and specialist spiritual care model. When palliative care teams are willing to engage the religious beliefs and values of patients at EOL, this has the potential to help patients find acceptance and peace in the dying process.
Palliative surgery aims to alleviate symptoms and enhance health-related quality of life (HRQL) for patients with incurable cancer. Standardized patient-reported outcome measures (PROMs) are needed to assess effects of interventions, including HRQL from patient perspectives. A previously published systematic review (Wong et al., 2025) identified studies of palliative cancer surgery; the present study is a secondary scoping review to identify and characterize patient-reported measures of HRQL in these studies. We searched PubMed, EMBASE, and CINAHL databases to identify English-language publications (August 1, 2005-December 31, 2023) reporting palliative thoraco-abdominal procedures for cancer patients. Of these, studies reporting patient-reported HRQL outcomes were secondarily analyzed using descriptive and thematic analysis. Screening of 1,915 unique studies yielded 92 studies of which 16 (17.4%) included a patient-reported HRQL outcome, 11 of which used a total of 13 unique validated PROMs. Five studies which used investigator-developed (non-validated) questionnaires were included to comprehensively map HRQL measures and to identify whether investigator-developed questionnaires captured domains not represented by existing PROMs. Twelve of the identified PROMs were developed or subsequently validated for cancer populations. Items from each PROM were extracted and coded, identifying 62 sub-themes further organized into 6 top-level themes. Content analysis of 242 PROM items across 6 main themes revealed that physical symptoms (76 items, 31.4%) and functional status (50 items, 20.7%) dominate existing measures, while social and structural domains are underrepresented. Fatigue was the most frequently measured sub-theme (11 items), and change in stools, affecting personal relationships, activities of daily living and financial stress were measured by 10 items each. Investigator-developed questionnaires largely overlapped with sub-themes of existing PROMs, identifying only two new sub-themes. Despite improved HRQL being the primary goal of palliative surgery, only 16 of 92 studies measured HRQL outcomes, and amidst these studies, significant heterogeneity exists in measurement approaches, with 11 studies using 13 unique PROMs. High heterogeneity in both PROMs used and subthemes measured demonstrates lack of standardization and highlights need for a validated, surgery-specific PROM that captures relevant priorities across HRQL domains.
Provider experience is critical to the acceptance and sustainability of palliative care delivery models. Compassion satisfaction and burnout make up key components of provider wellbeing and therefore serve as important targets for measurement. Exploring the impact of palliative care interventions on provider experience offers significant potential for innovation. This narrative review surveys existing literature regarding provider-wellbeing outcomes in palliative care delivery. Our primary objectives were to examine the factors and interventions that influence compassion satisfaction and burnout among palliative care providers, as well as explore provider wellbeing outcomes that have been previously measured for patient-centered palliative care interventions. We ultimately propose an underlying conceptual model founded in care ethics to guide further research. We queried PubMed with additional articles found through backwards chaining. No publication timeframe was imposed. Non-English articles were excluded. Previous research has identified various factors associated with compassion satisfaction among palliative care providers, including self-care practices, supportive team dynamics, and organizational support. Moreover, a number of provider-centered interventions have shown potential for decreasing burnout, including professional development time and educational programs. However, relatively little research has explored how patient-centered interventions may affect providers. Prior studies exploring interventions such as targeted skills training, communication tools, and innovations in patient and caregiver end-of-life care education and discussion demonstrate that patient-centered improvements to palliative care delivery may also confer benefits to providers, including those without formal palliative care training. Although compassion fatigue and burnout are well-documented among palliative care providers, research into how patient-centered palliative care interventions affect providers is limited. We propose a model of palliative care innovation that utilizes care ethics to understand the interdependent relationships among patients, caregivers, and providers. Future research should leverage existing tools measuring compassion satisfaction and burnout to better understand how interventions targeting one stakeholder might affect the experiences and outcomes of others. Such an approach may support sustainable adoption of palliative care interventions across multiple domains.
Despite proven benefit of outpatient specialty palliative care on symptom burden, quality-of-life, and survival, only 20-30% of eligible patients with gynecologic cancers receive a referral, even in high-resource health systems. Socioeconomically disadvantaged and culturally marginalized populations face inequitable access to specialty palliative care. However, the relationships between social determinants of health (SDOH) and palliative care utilization remain understudied. We evaluated rates of outpatient specialty palliative care referral and assessed disparities associated with SDOH. A single institution retrospective cohort quality improvement study evaluated gynecologic oncology patients receiving care in Kansas City, Kansas (midwestern United States) who met American Society of Clinical Oncology (ASCO) criteria for referral to outpatient specialty palliative care from 2019-2022. Eligible patients were stratified based on whether or not they were referred to an outpatient specialty palliative care provider. Groups were compared based on clinical factors [age, cancer site, stage, primary versus recurrent disease status, body mass index (BMI)], and SDOH (race, ethnicity, primary language, insurance status, having a primary care provider (PCP), distance from the hospital, rurality, and Area Deprivation Index (ADI). Descriptive statistics and multivariable logistic regression were performed, and odds ratios were calculated. During the study period, 432 gynecologic oncology patients were eligible for referral to outpatient specialty palliative care, of which 191 (44%) were referred and 146 (34%) ultimately saw a palliative care provider. Patients who received a palliative care referral more frequently had recurrent disease and lower BMI. Patients were referred to a palliative care provider less commonly if they lived in a rural or disadvantaged (>70th percentile ADI) county, lived further from a National Cancer Institute (NCI)-designated cancer center, or if they were established with a PCP. On multivariable logistic regression evaluating rurality, distance, deprivation, and primary care access, only rurality and primary care access remained significant. Rural patients were less likely to be referred to a palliative care provider [odds ratio (OR) 0.3, 95% confidence interval (CI): 0.17-0.54, P<0.001], and patients without a PCP were more likely to be referred to palliative care provider (OR 1.8, 95% CI: 1.1-2.95, P=0.01). Gynecologic cancer patients were less commonly referred to outpatient specialty palliative care if living in a distant, rural or disadvantaged county or if established with primary care. For our patient population, rurality and access to primary care were the primary SDOH driving referral to palliative care. This analysis demonstrates the importance of understanding effects of SDOH to tailor quality improvement interventions to prioritize the most pressing needs of a given patient population in a context-dependent manner.
People with life-threatening illness frequently experience progressive functional decline and shifting priorities that require a flexible, individualized approach to rehabilitation. However, rehabilitation services within palliative care remain underutilized and are often poorly understood. This clinical practice review describes the importance of integrating relationship-centered care principles into palliative rehabilitation to enhance communication, shared decision-making, and alignment of care with patient values. A data-driven case vignette of a hospitalized patient illustrates the complexities and missed opportunities that can occur when rehabilitation care is not guided by relationship-centered principles. A review of the literature was conducted using PubMed, CINAHL, and Google Scholar from 2015 through 2025. Search terms included "palliative rehabilitation, relationship-centered care, shared decision making, communication, person-centered care, interdisciplinary rehabilitation, and advanced illness". Reference lists of key articles and reviews were also examined. Articles were included if they addressed communication, decision-making, or relational aspects of care within rehabilitation or palliative contexts. Both empirical and conceptual papers were reviewed, along with consensus documents from professional and governmental agencies and clinical summaries from authoritative book chapters. Only English-language publications focusing on adult populations were included. The literature indicates that palliative rehabilitation differs from conventional models by emphasizing adaptation to changing patient goals, unpredictable disease trajectories, and the psychosocial realities of serious illness. Relationship-centered care appreciates that rehabilitation care takes place within systemic and relational structures of care such as reimbursement requirements, time pressures, trustworthy relationships and power imbalances. The case vignette demonstrates how collaborative, values-based decision-making is challenging but essential to improve to better align with one's medical circumstances and patient and professional priorities. Literature reviews and our clinical experiences underscore the importance of flexible communication strategies, interdisciplinary collaboration, and an appreciation of the relational dimensions inherent in therapeutic encounters. Palliative rehabilitation represents a critical intersection of physical restoration, emotional support, and relational care. Although these challenges are often most evident during hospitalization, integrating relationship-centered principles into any rehabilitation setting can optimize quality of life, preserve dignity, and improve alignment of care with patient goals. These insights have implications for clinical training, interdisciplinary practice models, and policy initiatives aimed at expanding access to rehabilitation for individuals with advanced disease.
Clinical prediction of survival (CPS) in Oncology has rarely been compared among different health care disciplines. Our aim was to evaluate the prognostication ability of multidisciplinary team (MDT) members experienced in providing specialist Palliative Care (PC) and palliative radiotherapy (PRT). We conducted a prospective cohort study in a tertiary cancer center serving the northern half of the Canadian province of Alberta. After usual direct clinical assessment of consecutive patients with any primary histology, survival predictions were independently made by each clinician, and factors influencing predictions were collected from each assessor. CPS was considered correct if within 30 days or 30% of actual survival (AS). Clinicians assessed 980 patients [2010-2014], of whom 944 have died (96.3%) with median AS of 122 days [95% confidence interval (CI): 116-128]. Median Palliative Performance Scale was 62±15. Eleven disciplines, including physicians, nurses, radiation therapists, other allied health professionals and trainees made a total of 2,776 predictions during 1,130 clinic visits. Overall, CPS was significantly longer than AS. On average, 30.7% of predictions were correct (range 20.1-40.6% across disciplines). Survival was more often overpredicted (47.1%) than underpredicted (22.2%). The median number of days overpredicted varied significantly by discipline, from 47 [39-55] to 161 [135-187] days. Differential accuracy persisted after adjustment for primary tumor site, gender and duration of AS. Factors underpinning CPS also varied by discipline. Although all disciplines had a propensity to overpredict survival, each did so with differing accuracy, based on different clinical parameters.
Though especially in the last decade, much work has been done on various aspects of palliative sedation, little attention has been given to the role played by religious beliefs and traditions. Since the attitudes and decisions of patients, family members, and caregivers can be deeply influenced by religion when faced with severe suffering at the end of life, it is important to know the views of these traditions regarding palliative sedation. This study discusses and compares normative views in Christian denominations (Anglicanism, Catholicism, Eastern Orthodoxy, Protestantism) and Indian religions (Hinduism, Buddhism, Sikhism). This study used a scoping study method to analyse religious normative perspectives on palliative sedation. Comprehensive database and grey literature searches were conducted to gather relevant sources from Christian denominations and Indian religions, followed by snowballing and expert consultation. The systematic mapping of views and arguments was followed by a grounded theory analysis of the mapped information and a comparative analysis between the Christian and Indian religious traditions. This manuscript is written following the Scoping Reviews PRISMA-ScR checklist. Christian traditions generally view palliative sedation as a morally acceptable means to relieve suffering, grounded in charity and dignity, but in doing so stress the importance of intent and a clear distinction from euthanasia. Concerns persist regarding the impact of lowered consciousness on the spiritual preparation for death, especially in Eastern Orthodox traditions; Protestant perspectives add the issue of autonomy and personal agency. Indian religions lack robust explicit authoritative statements but commonly value consciousness at the moment of death for spiritual reasons related to rebirth and karma. Palliative sedation could be an option, but Indian religious traditions also emphasize spiritual practices, such as prayer and meditation, to alleviate end-of-life suffering. Religious traditions significantly influence views and practices concerning palliative sedation, shaping both professional and patient decisions in advanced disease care. The major Christian denominations permit palliative sedation with safeguards, while Indian religions generally recommend spiritual awareness at life's end but accept palliative sedation as an option. Recognizing these beliefs deepens understanding of diverse end-of-life values and enhances culturally and religiously sensitive care in palliative settings.
Artificial intelligence (AI) has emerged as a promising tool to address gaps in palliative care access and delivery for adults with serious illness and their family caregivers, particularly in home-based settings where access to specialty care is limited. AI-driven tools, including machine learning, natural language processing, and decision-support systems may enable proactive, personalized, and efficient approaches to addressing several domains of quality palliative care, as defined by the National Consensus Project (NCP), including continuity of care, symptom relief, emotional support, and family caregiver assistance. This scoping review aimed to systematically map the evidence on AI applications designed to assist home-based care for adults with serious illness and their family caregivers, with a focus on their potential role in enhancing palliative care delivery. Six databases were searched from inception to August 2025 using terms related to AI, serious illness, home care, self-care, and caregiving. Eligible studies included peer-reviewed empirical research among adults (≥18 years) with serious illness and/or family caregivers, focusing on AI as a tool to support home-based self-care or caregiver contributions to self-care. Of 1,791 articles screened, 24 met inclusion criteria. Qualitative content analysis identified six themes: (I) personalization and contextual adaptation; (II) multimodal and accessible interfaces; (III) emotional and relational dimensions; (IV) predictive and proactive care; (V) daily routines and care ecosystems; and (VI) equity and access. Personalization emerged as a critical feature, with culturally tailored AI tools improving trust and usability. Limitations of the evidence are that most studies emphasized feasibility, usability, and user experience, over clinical or psychosocial outcomes, limiting insight into AI's real-world impact on palliative care. Evidence was further constrained by heterogeneous designs, language restrictions, and the scarcity of research published in palliative care journals, highlighting the need for more rigorous, context-specific studies. Findings underscore AI's capacity to address core components of palliative care, including predicting and managing symptoms and addressing psychosocial needs. However, the evidence base remains early-stage. Future research should prioritize rigorous evaluation of clinical and psychosocial outcomes, along with co-design with patients, caregivers, and clinicians to ensure alignment between AI innovation and core principles of palliative care.
In today's increasingly complex and fragmented healthcare system, patient navigation has emerged as a strategy to improve access to palliative care and reduce health inequities among historically marginalized populations. This narrative review aims to examine the evolution of patient navigation and its implementation across care settings to identify key themes and opportunities to optimize outcomes and reduce disparities in patients with serious illnesses. A literature search was conducted in PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL) Ultimate, and Google Scholar by three independent investigators on articles related to patient navigation in palliative care and patients with serious illnesses. A total of 49 academic articles and 5 additional articles were included. A review of the literature revealed a number of diverse models of care navigation and implementation strategies. Navigation models involved varying degrees of community-based personnel and healthcare professionals from a range of disciplines. Through culturally informed support, education, and empowerment, many of these programs demonstrated improved patient outcomes such as reduced symptom burden, increased advance care planning, improved hospice referrals, more goal-concordant care at the end of life, reduced end-of-life cost expenditure, hospitalizations and emergency room visits. Integration of navigation across both medical and community settings also helped to reduce health disparities by addressing barriers across multiple levels of influence. However, in order for such models to be successful, understanding and integration of cultural values, trusted community figures, and strategies for addressing language barriers are essential. While a variety of approaches to patient navigation can help improve care for seriously ill patients, common themes of effective interventions include social connection, engagement in what is most meaningful to the patient, identification of patient needs, access to culturally grounded resources, patient advocacy and empowerment, incorporation of navigators embedded within the local community, and support from key stakeholders.
Palliative radiotherapy (RT) plays a key role in managing advanced, recurrent, and metastatic head and neck cancers (HNCs), aiming to relieve symptoms and improve quality of life (QOL). The Quad Shot (QS) regimen, delivering 14.0 to 14.8 Gy in 4 fractions over 2 days repeated every 3 to 4 weeks, has emerged as an attractive treatment option. This review evaluates the efficacy, toxicity, and convenience of QS compared to other palliative RT regimens. We performed a narrative review of published literature on QS and other palliative RT regimens for HNC. Studies evaluating symptom relief, tumor response, toxicity profiles, and treatment logistics were included. QS achieves rapid symptom relief with minimal toxicity, with reported partial or complete response rates of 60% to 85% and palliative symptom control in over 70% of patients. Compared to conventional and stereotactic regimens, QS offers shorter treatment duration, favorable tolerance, and repeatability. Two case reports are described in this review, and appropriate patient selection, institutional target volume definitions, prescription doses, and recommended dose constraints are discussed. Future directions of QS include combination immunotherapy, minibeam RT, personalized ultrafractionated stereotactic adaptive RT, and reirradiation with particle therapy (e.g., proton and carbon ion). The QS regimen is an effective, convenient, and well-tolerated palliative RT approach for advanced HNC, particularly for patients with significant comorbid conditions or poor prognosis. Ongoing studies will clarify the role of QS alongside systemic therapies and advanced technologies.
Climate change represents an escalating threat to human health and disproportionately affects vulnerable populations. The healthcare sector contributes significantly to climate change, accounting for approximately 4.4% of greenhouse gas (GHG) emissions globally. While several medical specialties aim to improve sustainability of clinical practice, there is limited literature within palliative medicine. This narrative review aims to identify and evaluate existing work on the ecologic impact of palliative medicine and highlight climate conscious clinical recommendations within palliative care. Scholarly databases including Medline, Embase, CINAHL, UBC Summon, Health Business Elite, and TRIP Medical and GreenLine were used for the literature search, and articles up to March 2026 were screened. Studies that described environmental sustainability efforts in palliative care were included. Articles underwent title and abstracts screening, followed by full text screening by two independent researchers. The extracted data was analysed thematically and summarized narratively. A total of 176 articles were identified through database searches. After screening titles, abstracts, and full texts, eight peer-reviewed academic articles were included in the narrative review. Three major themes emerged regarding sustainability in palliative medicine: (I) conservative and goal-concordant prescribing, (II) minimization of low-value investigations and procedures, and (III) intensity of care and care setting optimization. The intersection of patient-centered care and planetary health considerations reveal that providing high quality palliative care has the co-benefit of reducing healthcare-associated GHG emissions and resource consumption. By aligning clinical practice with responsible resource stewardship, palliative care can simultaneously enhance patient outcomes and reduce the environmental footprint of healthcare.
Patients with cancer often experience weight loss, which contributes to a decreased quality of life and signals a poor prognosis. The objective of this retrospective study is to investigate whether the self-reported race/ethnicity of patients undergoing palliative care is associated with weight loss. The charts of 1,253 patients with advanced lung cancer who had a Palliative Medicine consultation, during 2022, were identified and random sample of 94 Asian, 94 Black, 87 Hispanic and 91 non-Hispanic-White patients were selected for evaluation. Patient demographics, the Eastern Cooperative Oncology Group (ECOG) performance status, body mass index (BMI), weight history, symptom burden measured by the Edmonton Symptom Assessment System (ESAS), cancer treatments provided (chemotherapy, radiation, surgery, or immunotherapy), prescription of appetite stimulants [megestrol acetate, steroids, olanzapine, cannabinoids, metoclopramide, or mirtazapine), and nutritional laboratory markers (albumin, protein level, neutrophile-to-lymphocyte ratio (NLR)] were collected. Univariate and multivariable regression linear analysis were performed to explore whether a patient's self-identified race/ethnicity was an independent predictor of weight loss. Among the different self-identified racial/ethnic groups of patients, no significant differences in age, gender, appetite stimulants received, and NLR were noted. The Asian and Hispanic cohort had significantly lower weight and BMI at first encounter, Palliative Medicine consultation, and final recorded visit compared to all other groups (P<0.01). The median time from the first encounter to the last recorded weight was 6.7 months for the whole cohort. Asian patients had significantly less total weight loss (8.2 kg) compared to Black (13.4 kg), Hispanic (9.1 kg), and non-Hispanic White (10.2 kg) patients (P=0.04); but all four groups experienced similar proportion of weight loss (%) (12.8 vs. 14.9 vs. 12.2 vs. 12.9; P=0.79), respectively. Asian patients had a higher median household income (P<0.001), less likely to live alone (P=0.02), and more likely to be married or have a significant other (P<0.001). In a multivariate analysis, the weight at first encounter but not race/ethnicity was the only independent predictor of percentage weight loss. In patients with advanced lung cancer, BMI and total weight loss but not percentage change in weight was significantly associated with self-identified race/ethnicity at the time of Palliative Medicine consultation. On multivariate analysis, the percentage loss in weight was significantly influenced by the weight at first encounter but not race/ethnicity. Racial/ethnic variations in BMI but not percentage weight loss should be accounted for when diagnosing cancer cachexia and more research is needed.
Psycho-oncological support is crucial for palliative cancer patients and their families, helping them to cope with psychosocial distress. Currently, this support is most often provided in inpatient settings or during regular outpatient appointments. A decline in general health and the cessation of tumour-specific treatment often lead to an abrupt end of the established therapeutic relationship, creating a gap in care precisely when patients and their families face a particularly burdensome situation. Specialist palliative home care (SPHC) offers comprehensive physical and psychosocial support within a home-based environment. This project aims to investigate whether pre-existing psycho-oncological care can be continued and integrated into home care with the help of SPHC logistics, focusing on feasibility and implementation. Therefore, psycho-oncologists who typically provide care for patients in a clinical setting will perform home visits for palliative cancer patients. Data will be collected through semi-structured interviews with patients, their relatives, psycho-oncologists, and SPHC staff to assess the feasibility of providing home-based psycho-oncological care. The interviews will explore factors such as the acceptability, satisfaction, and practicability of the intervention, while also identifying key facilitators and barriers to successful implementation. By identifying facilitating and hindering factors, this study aims to determine how home-based psycho-oncological care can be implemented successfully using SPHC infrastructure. The findings can contribute to advancing research on appropriate psycho-oncological care for palliative patients in their homes and to establishing corresponding care structures. The study was registered at German Clinical Trials Register, ID: DRKS00034896.
Metastatic breast cancer (MBC) remains incurable, but as survival improves, individuals are living longer and experience complex, evolving needs that span medical, psychosocial, and existential domains. These needs are often inadequately addressed by existing care models. Survivorship programs frequently exclude those with incurable disease, while palliative care is commonly delayed due to stigma, misperceptions, and systemic barriers. This paper explores the critical intersection of survivorship and palliative care in the context of MBC, advocating for an integrated, person-centered model that combines the strengths of both approaches. A blended model offers a comprehensive framework that prioritizes quality of life, enhances care coordination, and ensures timely, values-aligned interventions across the full course of illness. Key components of this approach include interprofessional collaboration, proactive needs assessment, caregiver inclusion, and culturally responsive support. Successful implementation depends on clear role definition among providers, sustainable system-level investment, and the active involvement of patients and caregivers in designing flexible and inclusive care pathways. This model reframes MBC as a long-term condition that requires sustained, holistic support rather than being seen solely as a terminal diagnosis. By doing so, it enables individuals to receive the care they need to live with dignity, purpose, and consistent support throughout their journey.
Solid organ transplant has increased within the last 50 years, particularly as surgical procedures, transplant outcomes, brain death criteria, and immunosuppressive therapies are improving. While transplant programs have specific criteria to help identify ideal transplant candidates, some programs are recognizing the emotional and physical burden that transplant candidates have leading up to the transplant decision; as such, a multidisciplinary approach to candidate evaluation which involves social work, psychiatry, nursing, and other disciplines is necessary for transplant success. Due to the complex nature of medical illnesses that lead to solid organ transplant, and the significant impact on quality of life, palliative care involvement both pre-transplant and post-transplant has been identified as a helpful support for patients. This narrative review summarizes relevant literature on the involvement of palliative care in transplant and provides a conversation guide for supporting patients through the transplant process from a palliative lens. Authors ran a narrative review search in the National Library of Medicine (NLM) PubMed database. The search was restricted to English language articles, and publication date filters limited the results from January 1, 2015 to the day the search was run on April 2, 2026. An effort was made to exclude animal studies. Search terms included Medical Subject Headings (MeSH) terms as well as keywords, including terms for palliative care, palliative medicine, transplantation, solid organ transplant, conversation guide, heart transplant, liver transplant, lung transplant, kidney transplant, attitudes, perspectives, trajectory, utilization, outpatient, inpatient, early palliative care, referral, cost-savings, and their synonyms. While palliative care involvement in transplantation has been well studied, only certain transplant groups, particularly heart and liver, have formally updated guidelines to reflect this. Palliative care providers should continue to partner with transplant teams in order to better support patients and caregivers throughout all stages of end-stage disease, particularly pre- and post-transplant. Further consideration should be given to healthcare outcomes with palliative team involvement in transplant populations. More research is needed to determine optimal timing, setting, and resource availability of palliative teams.
Cancer-related pain remains a prevalent and debilitating symptom in patients with advanced malignancy, often inadequately controlled with systemic analgesics, radiotherapy, or surgery due to limited efficacy, delayed onset, or treatment-related toxicity. Percutaneous image-guided tumor ablation has emerged as a minimally invasive option capable of providing effective pain palliation while preserving quality of life. The objective of this narrative review is to summarize and critically appraise tumor ablation techniques relevant to palliative and interventional pain care, with particular focus on analgesic outcomes, mechanisms of pain relief, and clinical applicability. A narrative literature review was conducted using PubMed, Scopus, and Embase to identify English-language studies published between 2000 and 2025 evaluating percutaneous tumor ablation for cancer-related pain. Search terms included radiofrequency ablation, microwave ablation, cryoablation, laser ablation, irreversible electroporation, high-intensity focused ultrasound, and cancer pain. Priority was given to recent systematic reviews and key clinical studies published between 2023 and 2025. The review encompasses both thermal (radiofrequency, microwave, cryoablation, and laser) and non-thermal [irreversible electroporation (IRE)] ablation modalities. Across the literature, tumor ablation is associated with meaningful reductions in pain intensity, decreased opioid requirements, and improvements in functional status and quality of life. Radiofrequency (RFA) and microwave ablation (MWA) are commonly utilized for painful bone and soft-tissue metastases, while cryoablation offers improved visualization and is preferred for lesions in proximity to neural or critical structures. Laser ablation and IRE may be advantageous when thermal injury is a concern. When performed with appropriate imaging guidance and patient selection, reported complication rates are low. Emerging approaches, including bipolar RFA, often combined with vertebral augmentation, have demonstrated particular benefit in painful spinal metastases. Percutaneous tumor ablation represents a valuable adjunct in multidisciplinary palliative pain management. By synthesizing current evidence, this review may assist clinicians in selecting appropriate ablative strategies, support earlier integration of minimally invasive interventions into palliative care pathways, and inform future research focused on standardized pain outcomes, comparative effectiveness, and guideline development.
New artificial intelligence (AI)-based mortality prediction algorithms could support both patients' prognostic awareness and person-centered palliative care. Although they promise accuracy, their outputs can be hard to explain-potentially affecting whether patients and care teams use them. To investigate perspectives on the explainability of AI algorithms in palliative care, we conducted a sequential mixed-methods study. We interviewed 30 palliative care physicians and nurses; 15 social workers, spiritual care providers, psychologists, and others; and 35 patients and caregivers at four U.S. academic centers (total n=80). The 53 interviews containing data on explainability were analyzed thematically to understand reasons for concern or unconcern. We randomly sampled and surveyed n=2,500 palliative care physicians (overall adjusted response rate, 32.6%). The 537 surveys with complete responses on explainability items were analyzed descriptively; a multivariable model examined predictors of concern. Among 53 interviewees, 18 expressed only concern about black box AI-based prognostication, 17 expressed only unconcern, and 18 interviewees expressed mixed sentiments. Reasons for concern related to: data transparency, mistrust of machines or their creators, patient-clinician communication, bias, and accuracy. Reasons for unconcern related to: inexplicability not unique to AI, greater accuracy, not using AI in isolation, trust in science, and being evidence-based. Notably, "accuracy" and "trust" appeared in both. Overall, 75% of physicians (n=396/528) reported being at least "moderately concerned" about unexplainable AI algorithms. Male physicians were less likely to be strongly concerned [adjusted odds ratio (aOR) 0.57; 95% confidence interval (CI): 0.36, 0.89; P=0.01] about explainability. Those who perceived AI mortality prediction to be inaccurate were more likely to be concerned (aOR 2.06; 95% CI: 1.27, 3.41; P=0.003). Our findings suggest that if a black box model is perceived as accurate, there may be less demand for explainability. Nevertheless, in palliative care-where communication is key-explainability may still be central. Future efforts should seek to create models that are both accurate and explainable at the point-of-care.
The increasing legalization of medical marijuana in the United States (US) has spurred ongoing interest in its clinical application for the management of cancer-related pain. Although medical marijuana is legal in 40 states and the District of Columbia, its effect on pain pathways and variability in patient responses remain key areas of investigation. The purpose of this narrative review was to examine the prevalence and efficacy of marijuana use in the treatment of cancer-related pain. A research librarian conducted a literature search in PubMed and EMBASE for articles published between January 01, 2018 and August 2025. Search terms included but were not exclusive to cancer Cannabis AND cancer pain; Marijuana AND cancer pain management; Cannabinoids AND cancer-related pain; Medical cannabis AND oncology pain; THC CBD AND cancer pain relief. Twenty articles were identified and three database reviewers (A.M.M., A.N., and L.R.K.) independently screened titles and abstracts for relevance. Full-text articles were then reviewed with full consensus for final inclusion. This narrative review examines the current understanding of the mechanisms of action and clinical efficacy of medical marijuana for cancer pain. We explore the pharmacological mechanisms underlying its analgesic properties, including its interaction with cannabinoid receptors and modulation of pain-related pathways. We also review and synthesize existing clinical evidence on the effectiveness of medical marijuana in reducing pain, improving quality of life, and minimizing opioid use in cancer patients. Overall, there continues to be limited evidence to support the use of medical cannabis for treatment of cancer-related pain. While significant progress has been made in this domain of pain management research, current federal regulations classifying marijuana as a Schedule I substance continue to limit large research studies. As the legal landscape evolves, an emphasis on future randomized controlled trial studies focused on the challenges related to medical marijuana dosing, side effects, and long-term safety will help advance the field and future cancer patients.
Physicians' decision-making in end-of-life care involves many challenging ethical, legal, medical and psychological aspects including the possibility of hastening death. Hastened death is a complex ethical issue as it may cover both intentional assistance in death through euthanasia or physician-assisted suicide and the possibility of unintentional hastening of death through intensive management of suffering (the doctrine of double effect). The research question in our study was: Do views on unintentional or intentional hastening of death, and the factors behind them, change during the first 6 years as a physician? The same questionnaire, including hypothetical patient scenario, was answered by 227 Finnish physicians twice: at the time of their graduation in 2015 and after 6 years as a physician in 2021. The scenario presented in this study was a cancer patient requesting to increase his morphine dose to a potentially lethal level. The responders were asked whether they accepted this increment or not. Opinions on euthanasia, assisted suicide and several other attitudes were asked separately with a visual analogue scale. General life values and background factors were queried as well. The proportion of physicians accepting the increase in morphine dosing was 25% in 2015 and 31% in 2021 (P=0.06). No significant change in the opinion about the reprehensibility of euthanasia and assisted suicide was found. However, withdrawal of life-sustaining treatments was considered less reprehensible in 2021. In regression analysis, male gender, being single, believing in God, not considering assisted suicide reprehensible, and not feeling burned out were associated with the acceptance of increased morphine dosing in 2021. Acceptance of intentional or unintentional hastening of death presented in the survey did not significantly change after the first 6 years working as a physician, although a nonsignificant trend towards more accepting views was seen. Nevertheless, physicians' attitudes on this issue seemed to remain divided. Our results highlight the need for respectful discussion and education on ethics among medical profession to help physicians struggling with this demanding topic starting from medical school.