Palliative Care Commons^™

Improving Palliative Care Knowledge And Intentions Among Great Plains American Indians: Efficacy Results From A Randomized Clinical Trial Testing A Culture-Centric Palliative Care Message, Mary J. Isaacson, Kah Meng (Charlie) Soh, Christopher S. Wichman, Gina Johnson, Kelly Le Beaux, Semhar Michael, Lisa Sparks, Karla M. Hunter

Communication Faculty Articles and Research

Background

Methods

Results

Determining Timeframes To Death For Imminently Dying Patients: A Retrospective Cohort Study, Tricia O’Connor, Wai Man Liu, Juliane Samara, Joanne Lewis, Karen Strickland, Catherine Paterson

Research outputs 2022 to 2026

Background: Clinicians are frequently asked ‘how long’ questions at end-of-life by patients and those important to them, yet predicting timeframes to death remains uncertain, even in the last weeks and days of life. Patients and families wish to know so they can ask questions, plan, make decisions, have time to visit and say their goodbyes, and have holistic care needs met. Consequently, this necessitates a more accurate assessment of empirical data to better inform prognostication and reduce uncertainty around time until death. The aims of this study were to determine the timeframes for palliative care patients (a) between becoming comatose …

Capacity Over Cognition: A Case Of High-Risk Disease And Homelessness, Mikalah E. Maury, Avery M. Duncan, Rebecca A. Taylor, Mary Ann Beil, Maulikkumar A. Patel

HCA Healthcare Journal of Medicine

Background

Medical decision-making in indigent patients with baseline cognitive deficits and lack of supportive resources is a difficult problem that reveals many ethical issues. Performing high-level medical procedures (eg, invasive surgery, chemotherapy, radiation therapy) on these patients without supportive resources brings into question the efficacy and necessity of treatment if it places the patient at higher risk of additional complications and mortality.

Case Presentation

In this article, we present a case of a 62-year-old indigent man with a long history of encephalopathy secondary to alcohol abuse, presenting with an aggressive head and neck cancer impacting his quality of life.

Conclusion …

Hospital And Temporal Variations In Limitations Of Care Among Hospitalized Patients With Covid-19: A Virus Registry Retrospective Cohort Study, Nathan Mesfin, Nitesh Kumar Jain, Anwar Khedr, Hisham Mushtaq, Abbas B. Jama, Noura Attallah, Esraa Hassan, Benjamin Langworthy, Nicholas Ingraham, Juan Pablo Domecq Garces, Thoyaja Koritala, Donna Lee Armaignac, Nicholas Eugene Perkins, Katherine Belden, Vishakha Kumar, Karen Boman, Devang K. Sanghavi, Vikas Bansal, Rahul Kashyap, Rodrigo Cartin-Ceba, Abigail La Nou, Allan J. Walkey, R. Adams Dudley, Syed Anjum Khan

Division of Infectious Diseases and Environmental Medicine Faculty Papers

INTRODUCTION: Life-support limits (i.e., code status), the first step in the continuum of palliation and end-of-life (EoL) care, stem from decisions made by patients and their providers to align care near the EoL with patients' wishes. The pandemic created health care strain that may have influenced life-support limitation practices among patients with serious COVID-19. In this study, we examine variations in life-support limitations (do-not-resuscitate, DNR; do-not-intubate, DNI) depending on the hospital and period of hospitalization.

METHODS: We included all adults admitted to a hospital in the United States with COVID-19 from January 2020 to December 2021 using the VIRUS registry. …

A Puzzling Case Of Visual Disturbances Leads To A Fatal Neurodegenerative Diagnosis, Courtney J. Austin, Aaron Carrillo, Jennifer Rojas Huen, Victoria Parada

Research Colloquium

Background: Creutzfeldt-Jakob disease (CJD) is a rare neurodegenerative disease in which early diagnosis is complicated by the presence of early non-specific and atypical presentations. Sporadic CJD (sCJD), the most common type of CJD, is caused by the spread of a disease-forming prion known as PrPSc. PrPSc multiplies and binds to the normal form of prion, or PrP, converting it to an abnormal, structurally altered disease form that spreads throughout the brain. sCJD can initially present with six different phenotypes: cognitive, affective, classic, visual (Heidenhain variant), atactic (Oppenheimer-Brownell variant), and indeterminate. The classic presentation of CJD includes rapidly progressive dementia with …

A Phenomenological Study Of Caregivers For Sexual Minority Hospice Patients, Catherine H. Bianchi

Electronic Theses and Dissertations

Lesbian, gay, and bisexual (LGB) individuals face disproportionate barriers in healthcare across the lifespan that persist and often intensify at the end of life. Despite hospice’s mission to provide comfort, dignity, and patient-centered support, it remains unclear whether these services equitably meet the needs of sexual minority patients. Seeking hospice care presents a unique conundrum for many LGB individuals: it necessitates inviting representatives of a historically exclusionary healthcare system into the privacy of their homes - spaces that often serve as sanctuaries of identity, safety, and autonomy. The already vulnerable experience of seeking care in one’s final days can be …

Fatal Facial Necrotizing Fasciitis: A Case Report Highlighting Diagnostic And Therapeutic Challenges, Muhammad Sheraz Hameed, Syed Rafay Hussain Zaidi, Ali Iqbal, Muhammad Ahsan, Austin Mitchell, Azka Asad Mirza, Joshiah Gordon, Rahmat Gul Omarzai

Department of Medicine Faculty Papers

BACKGROUND: Facial Necrotizing Fasciitis (FNF) is a rare but aggressive, life-threatening infection involving the face's subcutaneous tissues and underlying musculature. It can rapidly progress to septic shock and multi-organ failure if not promptly recognized and treated. The clinical course, including severe pain, disproportionate tenderness, and systemic signs, is often the most crucial factor in diagnosis. While computed tomography (CT) can aid in identifying early signs such as soft tissue swelling and gas formation, clinical suspicion remains paramount and should not be delayed by reliance on imaging alone. Without early intervention, FNF may lead to devastating outcomes, including disfigurement, blindness, or …

Case Report: Solitary Adrenal Metastasis From Esophageal Adenocarcinoma, Riddhi Machchhar, Ahmed Dawood Al Mahrizi, Fatima Mossolem, Mariam Abdeen, Ujjwala Jain, Jyotibala Jain, Prashant Desai

Rowan-Virtua School of Osteopathic Medicine Departmental Research

INTRODUCTION: Solitary adrenal metastasis from a primary esophageal malignancy is relatively rare. While there are case reports of aggressive treatment with esophagectomy and adrenalectomy providing long-term survival, the treatment paradigm is not well defined. Complications from esophageal adenocarcinoma and its treatment can significantly impact the patient's quality of life and prognosis.

CASE PRESENTATION: Our patient was treated with systemic therapy and, although he initially had a complete response, he later experienced local disease progression along with the development of additional metastatic sites. The patient began FOLFOX, a standard chemotherapy regimen for esophageal/gastric cancer. He experienced side effects such as fever, …

Assessment Of Dry Mouth In A Palliative Population: A Comparison Between Patient-Reported Symptoms And Clinical Oral Dryness Scale Measurements, Emir Murphy Dourieu, Dominika Lisiecka, William Evans, Patricia Sheahan

Publications

The severity and impact of dry mouth in patients receiving palliative care is underreported, and assessment methods for this condition are lacking consensus. This study aimed to examine the severity of dry mouth in a palliative population as rated on a visual oral dryness scale and to compare these findings with the actual symptoms experienced by patients, as reported through both a symptom scale measure and a bother questionnaire. 40 participants took part in this cross-sectional study. The results indicated that xerostomia is a significant and debilitating symptom for many patients receiving palliative care. Daily activities such as speaking and …

Education In Advance Care Planning: A Novel Equity-Based, Interprofessional Service-Learning Approach, Dorothy Yam, Sriya Kudaravalli, Elizabeth A. Mulvaney, Leslie Scheunemann, Grace W. Orsatti

Journal of Innovation in Health Sciences Education

Introduction: Despite health sciences graduate schools emphasizing service-learning and interprofessionalism, they often struggle to integrate these values into the curricula effectively. Advance care planning is inherently interdisciplinary and presents an opportunity to address equity gaps through service-learning. This report describes a novel interdisciplinary service-learning initiative for graduate student trainees, focused on advance care planning in underserved communities.

Methods: After targeted training, teams of medical, law, and social work students, and professionals from their respective fields, took part in two Life Planning Fairs in historically underserved neighborhoods in Pittsburgh, Pennsylvania. Using a form developed by the Allegheny County Bar Association …

The Impact Of Nicu Death On Bereaved Mothers, Jennie Terranova

University Honors Theses

Infant loss in the United States occurs 5.6 per 1,000 live births. This paper examines risk factors that contribute to neonatal death. Prematurity is a risk factor for NICU admission. A portion of premature babies receiving care in the NICU will die. The stressful nature of the NICU has been studied widely in journals. The impact of NICU death on hospital staff and bereaved parents has been studied less. Mortality studies suggest that bereaved mothers are at a high risk of dying within the first 5 years after their child has died. Despite the frequency of maternal death post-child loss, …

Opportunities For Solid Organ Donation In The Neonatal Intensive Care Unit, Sarah Pippin, Jotishna Sharma, Ashley Sherman, Julie Weiner

Research Days

This study aims to characterize the theoretical eligibility of neonates undergoing withdrawal of care in the NICU for donation after circulatory determination of death (DCDD), with a focus on warm ischemic time (WIT) ≤ 90 minutes.

Interpreting Difficult Conversations In The Virtual World - Interpreter’S Perspective, Joyce Zhang, Bs, Kaitlyn Williams, Ms, Kathleen Mechler, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

• Medical Interpreters are essential in language discordant patient-family-team interactions
  • Facilitate clear communication
  • Aid in understanding diagnosis, prognosis, and treatment options
• Prior studies highlight range in interpreter comfort with serious illness conversations (SIC) though limited to in-person interpreter experience
• Rise of quick-access virtual interpreter services across the nation in many healthcare setting

Medical Assistance In Dying In A Profit-Driven Health System: Ethical And Equity Challenges In The U.S. Vs. Canada, Joseph A. Zwillenberg, Eric M. Teichner, Jacob Schwell, Cameron Haghshenas, Joseph F. Majdan, Md, Facp, Fcpp

Health Equity and Quality Improvement (HEQI) Summit

Introduction

Medical Assistance in Dying (MAID), legalized in Canada in 2016, now accounts for 4.1% of all deaths nationwide and 6.6% in Quebec as of 2022(1). In Canada’s single-payer system, MAID is integrated as a publicly funded medical service. In contrast, the U.S.’s fragmented, market-driven system is defined by profit maximization, inequitable access, and insurer- driven decision-making. While MAID aims to promote autonomy and compassion, introducing it into the American context raises profound ethical concerns, particularly regarding nonmaleficence and systemic coercion. This poster evaluates the unique risks MAID poses within the U.S. healthcare system, particularly for vulnerable populations.

Preferred And Actual Place Of Death To Assess Goal Concordant End Of Life Care For Children With Cancer, Amy Johnson Md, Mba, Lisa Tarbell Msn, Rn, Fnp-C, Brooke Fridley Phd, Terrie Flatt Do

Research Days

This study examines disparities in pediatric end-of-life (EOL) cancer care, highlighting socioeconomic and racial inequities in concordance between preferred and actual death locations, ICU deaths, and intensive interventions, with findings emphasizing the need for earlier palliative care integration, proactive preference documentation, and tailored approaches to improve equity and family-centered care.

A Virtual Wellness Program To Enhance Well-Being For Pediatric Oncology Staff During The Covid-19 Pandemic, Karen Moody, Maria Swartz, Zachary Gresham, Martha Askins, Laura Cahalan, Pavilia Francis, Christine Geistkemper, Amy Heaton, Ruitao Lin, Melissa Melo, Alakh Rajan, Madeline Smith, Priti Tewari, Keyana R. Williams, Cheng-Han Yang, Rhonda Robert

Advances in Cancer Education and Quality Improvement

In response to the COVID-19 global health crisis and mandated social isolation, Pediatric leadership at MD Anderson Children’s Cancer Hospital was concerned for the psychological impact on its workforce and encouraged wellness programming. A grassroots wellness taskforce was assembled for the Division of Pediatrics. The task force’s primary mission was to promote the well-being of clinicians and non-clinical staff members through a broadly accessible, sustainable, and effective virtual wellness program. Guided by the Stanford Model for Professional Fulfillment, a virtual program entitled, “Weekly Wellness Webex” for Pediatrics staff was launched. Weekly Wellness Webex is a 1-hour live-streamed program with varied …

Integrating Positive Psychology And Spirituality To Foster Meaning And Well-Being In Older Adults, Crystal Morris

Adultspan Journal

This perspective article explores the integration of positive psychology interventions (PPIs) and spirituality in therapy to foster meaning and well-being in older adults. It highlights exercises such as the positive introduction, positive legacy, character strengths, mindfulness, mindful-based yoga, and a manifestation prayer journaling. The interventions presented are tools to support older adults that may experience depression, difficult life transitions, and the search for renewed meaning. Therapists who integrate PPIs and spirituality into therapy can promote a holistic, non-pathological approach to treatment.

Long-Term Care Services And Support In The Mountain West, 2023, Taylor Volk, Ivan Sun, Miguel Soriano Ralston, Kristian Thymianos, Caitlin J. Saladino, William E. Brown Jr.

Health

This fact sheet presents data from the American Association of Retired Persons (AARP) report, “Long-Term Services and Supports 2023 State Scorecard Report,” comparing Long-Term Services and Supports (LTSS) systems across multiple dimensions of performance for older adults, people with physical disabilities, and family caregivers for all 50 states. This fact sheet focuses on state-level LTSS system data for the Mountain West states of Arizona, Colorado, Nevada, New Mexico, and Utah.

In-Person And Virtual Adaptation Of An Interprofessional Palliative Care Communications Skills Training Course For Pediatric Oncology Clinicians, Karen Moody, Clark R. Andersen, Robert M. Arnold, Julie Bradley, Allie Carter, Lauren Draper, Timothy Garrington, Jonathan B. Gill, Douglas J. Harrison, Masanori Hayashi, Amy Heaton, Cynthia Holladay, Alex Lion, Alakh Rajan, Beatriz N. Rozo, Daniel V. Runco, Shermini Saini, Laura K. Salvador, Kathryn Sutton, Verna Ferguson

Advances in Cancer Education and Quality Improvement

Introduction

Empathic communication is crucial for clinicians when discussing palliative and end-of-life (PC/EOL) care with parents of children with cancer. Unfortunately, many parents report inadequate communication at these distressing times. This study evaluates the communication skills training (CST) clinicians received to deliver a PC/EOL communication intervention as part of a multi-site randomized-controlled trial (RCT). Training was provided using an in-person format and then adapted to a virtual platform to accommodate remote learners.

Methods

Clinicians were trained in dyads (one physician and one nurse [RN] or advanced practice provider [APP]) over 3 days (in-person or virtually). Four pediatric oncology cases were …

Early Celiac Plexus Block In Metastatic Pancreatic Cancer, Brian Fardman, Christina Sheedy, Joshua Raymond

Rowan-Virtua Research Day

Both Early and Delayed Celiac Plexus Blocks (CPBs) have been used in pancreatic cancer. Early CPB is completed when criteria for CPB is initially met, whereas Delayed CPB is implemented only after recalcitrant pain persists. We describe the benefit of early CPB in pancreatic cancer management.

Navigating Challenges In Palliative Care: A Survey On Asco Guideline Adherence Among Health Care Providers In Low- And Middle-Income Countries., Cristiane Decat Bergerot, Enrique Soto-Perez-De-Celis, Chadane Thompson, Rushil Patel, Jafar Al-Mondhiry, Tingting Zhang, Nathasha Dhawan, Darcy Burbage, Joseph Mccollom Do, Mazie Tsang, Ramy Sedhom, William E Rosa

PCI Publications and Projects

PURPOSE: Integrating palliative care into oncology is essential, yet disparities in access and quality persist, particularly in low- and middle-income countries (LMICs). The ASCO guidelines advocate for early, routine, interdisciplinary palliative care for patients with advanced cancer. Barriers to implementing these recommendations include resource limitations, inadequate training, and cultural perceptions. Recognizing these challenges is essential for improving equitable access to palliative care worldwide.

METHODS: This prospective survey assessed adherence to ASCO recommendations for palliative care integration among LMIC health care providers (HCPs). Participants were recruited via e-mail, social media, and a list of members involved in the ASCO Palliative Care …

Use Of Interdisciplinary Rounds For The Identification Of Hospitalized Adults In Need Of Palliative Care, Brenda A. Blunt

Evidence-Based Practice Project Reports

Palliative care (PC) is specialized care that aims to provide relief from the stress and symptoms of living with a serious illness (Center to Advance Palliative Care, 2022). PC services are often underutilized in the hospital, leaving a significant number of patients with unmet needs (Haranis et al, 2023; Kawashima & Evans, 2023; Smith et al, 2019). The purpose of this evidence-based practice project was to improve processes for identifying hospitalized patients for referral to specialty inpatient PC. The intervention involved interdisciplinary rounds (IDR) for adult inpatients on two medical-surgical (MESG) units in an 84-bed community hospital in suburban Milwaukee, …

Unmet Supportive Care Needs In Patients With Advanced Cancer And Its Impact On Distress, Kayla W Miranda, Benjamin L Musher, Hoda J Badr

Faculty, Staff and Students Publications

Purpose: Patients with advanced cancer endure considerable physical and emotional distress without sufficient supportive care. This cross-sectional study examined the relationship between cancer-related symptoms, supportive care needs, and distress levels in patients with advanced lung, head and neck, or gastrointestinal cancers.

Methods: 158 patients were assessed for symptom burden and distress levels using the M.D. Anderson Symptom Inventory (MDASI) and unmet needs using the Supportive Care Needs Survey (SCNS-34) within one month of treatment initiation. Pearson correlations and multiple regression analyses were used to explore associations between supportive care needs and distress.

Results: Distress levels were moderate across the study …

Symptom Documentation In Unstructured Palliative Care Notes Of Children And Adolescents With Cancer., Katherine Bernier Carney, Jacob Wilkes, Tumilara Aderibigbe, Kristin Stegenga, Holly Spraker-Perlman, Lauri A. Linder

Manuscripts, Articles, Book Chapters and Other Papers

CONTEXT: Children and adolescents with cancer experiencing complex symptoms can benefit from subspeciality palliative care. However, standardized methods of symptom documentation by pediatric palliative care teams are lacking. Understanding current approaches to symptom documentation will inform next steps to optimize symptom support.

OBJECTIVE: To explore the documentation of symptom prevalence and characteristics in unstructured clinical notes by pediatric palliative care clinicians caring for children and adolescents with cancer.

METHODS: We reviewed unstructured clinical notes documented by the pediatric palliative care team for 115 children and adolescents with cancer. Symptom-related data were abstracted and evaluated using content analysis based on the …

Prognostic Utility Of Palliative Prognostic Index In Advanced Cancer: A Systematic Review And Meta-Analysis, Si Qi Yoong, Hui Zhang, Dee Whitty, Wilson Wai San Tam, Wenru Wang, Davina Porock

Research outputs 2022 to 2026

OBJECTIVES: To evaluate the prognostic utility of Palliative Prognostic Index (PPI) scores in predicting the death of adults with advanced cancer. METHODS: A systematic review and meta-analysis were conducted. Six databases were searched for articles published from inception till 16 February 2024. Observational studies reporting time-to-event outcomes of PPI scores used in any setting, timing and score cutoffs were eligible. Participants were adults with advanced cancer residing in any setting. Random effects meta-analysis was used to pool hazard, risk, or odds ratios. Findings were narratively synthesized when meta-analysis was not possible. RESULTS: Twenty-three studies (n = 11,235 patients) were included. …

Ethical Considerations Of Percutaneous Endoscopic Gastrostomy Tube Placement In A Patient With Creutzfeldt-Jakob Disease And Advanced Dementia, Toni Habib, Niamh Siobhán Mulrooney, Yisroel Grabie, Mohammad Maruf, Sophia Kasapira

HCA Healthcare Journal of Medicine

Background

Creutzfeldt-Jakob disease (CJD) is a rapidly progressive neurodegenerative condition that is not easily diagnosed and has no curative treatments available, essentially requiring palliative measures, including tube feeding. Nonetheless, data shows that the endoscope used for percutaneous endoscopic gastrostomy (PEG) tube insertion can be a vector for CJD transmission.

Case Presentation

We discuss the case of an elderly patient diagnosed with CJD, requiring tube feeding. Multiple specialists were consulted, and they were unable to reach an agreement on the best approach. Eventually, the hospital ethics committee intervened, and the family agreed to comfort measures only. This case report sheds light …

Impact Of A Comprehensive Palliative Quality Improvement Initiative (Icu-Pal) In A Medical-Surgical Intensive Care Unit, Aunie M. Danyalian, Michele M. Iguina, Manjot Malhi, Umair Shaikh, Sanaz B. Kashan, Dionne Morgan, Daniel Heller, Mauricio Danckers

HCA Healthcare Journal of Medicine

Background

Early palliative care practice implementation in the intensive care unit (ICU) improves advance care planning, promotes patient and family satisfaction, and decreases health care costs. The consensus for protocolized palliative care delivery is unknown. We assessed the impact of a qualitive improvement educational intervention that promotes the identification of critically ill patients who will benefit from early expert palliative care interventions.

Methods

In this observational study, we examined the impact of an educational intervention that promoted (1) early detection of palliative care triggers (PCT) during ICU multidisciplinary rounds (MDRs), (2) admission and 48-hour pain assessment, and (3) family meetings …

Families' Experiences Of End-Of-Life Care In An Acute Private Hospital: A Qualitative Study, Rosemary Saunders, Susan Alexander, Julie Andrew, Anne Wilkinson, Karen Gullick, Ashwini Davray, Manonita Ghosh, Karla Seaman, Michelle Gay

Research outputs 2022 to 2026

Objectives This study explored bereaved relatives' experiences of end-of-life care (EoL care) in the last 3 days in an acute private hospital in Australia. Methods An interpretative qualitative study was conducted. Semi-structured interviews with 8 bereaved relatives whose family member had died at an acute private hospital shared their experiences of the EoL care during the last 3 days of life. The transcribed interviews were analyzed using inductive thematic analysis. Results Bereaved family members had mixed experiences, and their primary concerns related to the need for improvements in support for the family; communication; and clinicians partnering with families. The need …

Enhancing End Of Life Care Through Recognition & Flagging Of Imminence To Increase Visits, Ali Ahmed, Guru Chinnaraj, Ana Goncalves, Ahad Ahmed, Ezekiel Ijaopo, Joseph Shega, Diana Tren

North Florida Division GME Research Day 2025

No abstract provided.

Finding Grace With Advanced Cirrhosis: Improving Palliative Care Consult Utilization Final Results, Saud Khan, Samuel Kwiatkowski, Anjali Lukose, Amanda T. Rivera Miranda, Priscilla Phan, Ashwini Komarla, Sabiha Kazi, Diana Treu, Amar Mandalia

North Florida Division GME Research Day 2025

No abstract provided.