CONTEXT:The evidence for effect of specialist palliative care (SPC) on acute healthcare utilization is limited and inconclusive. Furthermore, randomized controlled trials may not reflect real-world clinical settings. OBJECTIVES:Effect of SPC on subsequent emergency department (ED) visits and inpatient hospitalizations among patients with stage IV cancer using real-world data and a novel prior event rate ratio (PERR) approach with bias-correction. METHODS:Retrospective observational cohort study using the PERR method to compare ED visits and inpatient hospitalizations among patients with stage IV cancer who did vs did not receive SPC. We included patients diagnosed with stage IV cancer at National Cancer Centre Singapore between January 2019 and December 2022 and followed them up to July 2023. Each patient who received SPC was then matched with replacement to up to three patients who did not receive SPC during the study duration. RESULTS:Among 7144 patients with stage IV cancer, 1499 (21.0%) received SPC by July 2023. After 1:3 matching with replacement, there were 5948 patients in the matched cohort. Compared to those who never received SPC, those who received SPC had a PERR hazard ratio estimate of 0.644 (95% confidence interval 0.524-0.792; P < 0.001) for ED visits and 0.633 (95% confidence interval 0.539-0.743; P < 0.001) for hospitalizations. Although reduction was greater with earlier initiation of SPC (test of interaction, P < 0.001), the reduction remained significant even if SPC was initiated about one year after stage IV cancer diagnosis. CONCLUSION:SPC was associated with lower rates of ED visits and hospitalizations.

CONTEXT:Video recording facilitates continuous monitoring of patients with agitated delirium, but its role in inpatient palliative care remains unexplored. OBJECTIVE:This study examined the benefit of video monitoring for assessing persistent agitated delirium in an inpatient palliative supportive care unit (PSCU). METHODS:This was a prospective observational study as a part of secondary analysis of a multicenter, double-blind, randomized clinical trial examining the proportional sedation for palliative supportive care unit (PSCU) patients with persistent agitated delirium (RECORD trial). The presence or absence of agitation (modified Richmond Agitation-Sedation Scale [RASS] score, ≥+1 vs. ≤0) was documented over 24 hour using various methods (in-person vs. video), observer occupations (registered nurse [RN] vs. physician [MD]), and frequencies (intermittent [every two hours] vs. continuous [every five minute]). RESULTS:Fourteen patients underwent 227.2 hours of video monitoring (median: 16.2 hour/patient; IQR, 12.4-22.2 hours), including 170 in-person intermittent RN, 109 video intermittent RN, 109 video intermittent MD, and 2445 video continuous MD RASS assessments. Agreement (generalized estimating equations) was 75% between in-person and video intermittent RN RASS assessments, 95% between video intermittent RN and MD RASS assessments, and 73% between video intermittent and continuous MD RASS assessments. Video intermittent RN RASS assessment documented 17 (16%) agitation episodes, whereas in-person RN RASS assessment did not. Also, in-person RN RASS assessment documented 10 (9%) agitation episodes, whereas video intermittent RN RASS assessment did not. Video continuous MD RASS assessment identified 28% more agitation episodes than video intermittent MD RASS assessment and revealed three patterns of agitation (persistent, interval, and intermittent). CONCLUSION:Our preliminary findings highlight the level of interrater agreement of video monitoring with in-person assessments and its potential advantage to provide higher resolution data and patterns of agitation.

Background Prognostic awareness is foundational to informed medical decision making in the cancer setting.(1) Patients with optimistic perceptions are more likely to choose disease-directed treatments than those who acknowledge limited survival, with negative implications for quality of life(QOL) and goal concordant care(GCC).(2,3) We systematically examined perception of curability and primary treatment intent(TI) in diverse outpatients with advanced cancer, a largely incurable population. To our knowledge, at study onset, our group is unique in examining systematic screening of illness understanding. Objectives Primary objective was to evaluate perception of curability. Secondary objectives included perception of TI, and association of prognostic understanding with patient characteristics and overall survival. Methods We conducted a retrospective chart review of consecutive eligible outpatients with any advanced cancer at virtual palliative care consultation (0/1/2022-2/28/2023). Patients were systematically screened utilizing two questions from the Prognosis and Treatment Perception Questionnaire(2,4) regarding perceived curability (>25% chance of cure) and primary TI. Demographics, clinical information, and Edmonton Symptom Assessment Scale(ESAS) responses were extracted from the electronic health record. Analysis was descriptive. Results Of 198 patients, median age (range) was 61 (22-85), 44% male, 71% White, 19% Hispanic. 65% reported curable disease and 40%, curative TI. Whites were more likely to report incurable disease (42.7 vs 17.9% for non-whites, P=0.01). Patients reporting non-curative TI had higher symptom burden [total ESAS 37.0(3.0-78.0) vs 31.0(2.0- 84.0),P=0.031], more emotional distress [5.0(0.0-18.0) vs. 2.0(0.0 - 18.0),P=0.001], more depression [2.0(0.0-10.0). vs 1.0 (0.0 - 9.0), P=0.009], worse wellbeing [5.0(0.0 10.0) vs 3.0 (0.0-10.0), P=0.003] and shorter survival [11.4 (0.4-20.7) vs 17.0 months (0.9 - 20.6), P=0.03] than those who reported curative TI (all values are median [range]). Conclusions Our results highlight the importance of systematic screening of prognostic perception to develop a more nuanced understanding and interventions to optimize QOL and GCC.

Context Discussing end-of-life (EoL) values and priorities remains challenging in oncology, despite its relevance for person-centered and dignified care. Objective To explore clinical oncologists’ and oncology residents’ perceptions of personal EoL values and priorities through their experience with the Go Wish Cards Game (GWCG), and to understand their reflections on the role and applicability of this tool in oncologic practice. Methods This qualitative study included 49 participants (31 clinical oncologists and 18 oncology residents) from two Brazilian cancer centers. In individual sessions, participants selected and discussed the most meaningful GWCG cards, completing the exercise from the perspective of their own EoL values and priorities. Transcripts were analyzed using Bardin’s content analysis method to identify emerging themes. Results The most frequently chosen cards differed between groups: clinical oncologists prioritized “Having family and friends nearby,” while oncology residents emphasized “Relief from pain and shortness of breath.” Five thematic categories emerged: symptom control and physical comfort; dignity and autonomy; relationships and social/family support; spirituality and existential issues; and communication, legacy, and reflexivity. The GWCG fostered ethical and existential reflection, enhanced awareness of personal values, and demonstrated its potential as an educational and sensitizing tool in oncologic care. Conclusion The use of the GWCG promoted reflection on participants’ own EoL values and priorities, facilitating dialogue on sensitive topics. This self-reflective process can enhance participants’ sensitivity to understanding what is essential to patients. Thus, the GWCG may contribute to more humanized, reflective, and values-aligned clinical practices in oncology.

Neuroleptic and benzodiazepine medications are often considered for patients with persistent agitated delirium in the last days of life; however, the risk-to-benefit ratio of these medications is ill-defined and benzodiazepine medications have not been compared to placebo. To compare the effect of scheduled haloperidol, lorazepam, haloperidol plus lorazepam, and placebo on patients with advanced cancer and delirium and experiencing restlessness and/or agitation in the palliative care setting. This multicenter randomized clinical trial was conducted at 3 acute palliative care units in Taiwan and the US with patients with advanced cancer experiencing persistent restlessness and/or agitation despite nonpharmacologic therapies and standard-dose haloperidol. Among 245 eligible patients, 111 were enrolled, and 75 received blinded treatments. Participants were randomized in a 1:1:1:1 ratio (stratified by site and Richmond Agitation-Sedation Scale [RASS] score). The study period was from July 16, 2019, to June 8, 2023, with a 30-day follow-up after medication administration. Data analysis was performed from October 10, 2023, to April 11, 2025. Scheduled intravenous haloperidol, lorazepam, haloperidol plus lorazepam, or placebo every 4 hours until discharge, death, or withdrawal from study. Medications in all 4 groups had identical volume and appearance. Change in RASS scores during the first 24 hours. Secondary outcomes included the use of rescue neuroleptics or benzodiazepines for breakthrough restlessness or agitation during the first 24 hours, delirium severity, perceived patient comfort, and adverse events. The primary outcome was assessed in 72 patients (mean [SD] age, 64 [12] years, 42 male [58%]) with a median (IQR) MDAS score of 24 (18-29). The lorazepam group had significantly lower RASS scores than the haloperidol group (mean difference, −2.1; 95% CI, −3.4 to −0.9; P < .001) and the combination group had significantly lower RASS scores than the haloperidol group (−2.0; 95% CI, −3.2 to −0.8; P = .002); however, there was no difference observed between haloperidol and placebo groups (−0.5; 95% CI, −1.7 to 0.7; P = .42) nor between the combination and lorazepam groups (0.2; 95% CI, −1.1 to 1.4; P = .79). The combination and lorazepam groups required fewer rescue medications for breakthrough restlessness or agitation compared to the haloperidol and placebo groups (32%, 37%, 56%, 83%, respectively; P = .006). Adverse events or survival did not differ between groups. The results of this randomized clinical trial indicate that proactive use of scheduled sedatives, particularly lorazepam-based regimens, may reduce persistent restlessness and/or agitation in patients with advanced cancer and delirium in the palliative care setting. Clinicaltrials.gov Identifier: NCT03743649

12088 Background: Despite ASCO supporting the benefits of early supportive/palliative care (SPC) integration, many patients with advanced cancer were referred < 6 months before death or not at all. Our comprehensive cancer center has an active SPC program to promote early access. This study evaluated how the timing of SPC referral changed over the past seven years and identified predictors of early SPC referral. Methods: This study included a random sample of 100 patients seen for consultation at the SPC clinic per year from 2017 to 2023. Data included demographics, cancer type, disease stage, symptom burden, performance status, date of SPC referral, and date of death or last follow-up. The primary outcome was overall survival (OS) from SPC consultation. Timing of referral and number of visits were examined using time-to-event analysis. Early SPC referral was defined as occurring ≥ 6 months before death among decedents. Univariable and multivariable logistic regression models were used to identify predictors of early SPC referral. Results: Among 700 patients (median age 62, 54% female, 92% with advanced cancer), OS from SPC referral increased significantly over the years (Median OS: 9.3 months in 2017, 31.7 months in 2021, and not reached in 2023) (Table). The median follow-up for alive individuals was 19.1 months. The median number of follow-up SPC visits increased from 3 in 2017 to 7 in 2023 (P < 0.001). Early SPC referral occurred in 72% (n = 449) of decedents. In multivariable analysis, male sex (OR: 1.85, P = 0.014), head and neck cancer (OR: 4.64, P < 0.001), hematologic malignancies (OR: 3.31, P = 0.013), less pain (OR: 0.9, P = 0.008) and less anorexia (OR: 0.88, P = 0.001) were associated with early SPC referral. Conclusions: Patients at our center were referred to SPC earlier and earlier over the past 7 years, achieving a median OS of 32 months. This trend highlights that early SPC is not only possible but potentially self-reinforcing, facilitating timely, longitudinal care along the cancer journey, particularly as patients are living longer with advanced cancer. Outpatient supportive/palliative care referral between 2017 and 2023. Year 2017 2018 2019 2020 2021 2022 2023 P-Value Number of SPC Consults* 1,844 1,766 1,863 1,804 2,055 2,221 2,178 0.011 All Patients Median OS, Months 9.3(6.9 – 14.2) 9.1(6.4 – 19.5) 18.9(10.7 – 30.7) 31.8(14 – NR) 31.7(13.3 – NR) NR NR 0.0001 6-months OS % 63 61 70 75 75 83 79 Advanced Cancer Only Median OS, Months 9.3(6.9 – 14.2) 7.1(5.7 – 18.9) 15.9(9.5 – 25.8) 24.2(13.4 – NR) 25.8(12.7 – NR) 24.7(16.4 – NR) NR 0.0014 6-month OS % 63 59 68 73 73 79 78 Total SPC Visits, Median 3(3 – 4) 4 (3– 5) 3 (2– 4) 5 (3 – 7) 4 (4 – 9) 7(5 – 15 7 (6 – NR) < 0.001 Abbreviations: SPC, Supportive/Palliative Care; NR, not reached; OS, overall survival. * 100 patients were randomly selected per year for analysis. Ranges in parentheses represent 95% CI (confidence interval).

Accurate prognostic information is crucial for guiding end-of-life (EOL) decision-making in advanced cancer care. Although the European Society for Medical Oncology (ESMO) recommends using clinicians' prediction of survival (CPS) as an initial reference, CPS alone often lacks precision. This review synthesizes current prognostic models and the dialog surrounding EOL survival prediction. For patients with an expected survival of months, several validated prognostic tools are available, including measures such as the Eastern Cooperative Oncology Group Performance Status, the modified Glasgow Prognostic Scale, and comprehensive models such as the Supportive and Palliative Care Indicator Tool and the adaptable prognosis prediction model. When survival is expected to be weeks, the Palliative Performance Scale serves as a key assessment tool, while models such as the Palliative Prognostic Index and Prognosis in Palliative Care Study models are helpful. In the final days of life, clinicians primarily rely on observable physical indicators, including decreased consciousness and specific breathing patterns, whereas the surprise question has demonstrated limited predictive utility in this context. While most patients with advanced cancer express a desire for prognostic information, cultural considerations-particularly in Asia-necessitate nuanced communication approaches. Serious illness conversations have been shown to improve patient well-being; however, further research is needed to optimize these discussions, address unfinished business, and promote equitable access to prognostic dialog, particularly for vulnerable populations. Enhancing prognostic communication is critical for facilitating shared decision-making and improving the quality of EOL care.

BACKGROUND:Terminal dyspnea is a distressing symptom in advanced cancer patients. Although opioids are standard treatment, their effectiveness may differ between opioid-naïve and -tolerant patients. OBJECTIVES:To evaluate responses to opioid titration for terminal dyspnea and assess differences in palliative care physicians' perceptions of opioid effectiveness between opioid-naïve and -tolerant patients. DESIGN:A pre-planned secondary analysis of a multicenter prospective cohort study. SETTING/SUBJECTS:Advanced cancer patients (n = 108) with moderate to severe terminal dyspnea and an Eastern Cooperative Oncology Group performance status of 3-4, receiving continuous parenteral opioid infusions, were included and categorized as opioid-naïve (n = 48) or opioid-tolerant (n = 60). MEASUREMENTS:Opioid doses were titrated in four predefined levels within 48 hours, with effectiveness assessed 6 hours post-titration using the Clinician Global Impression-Improvement scale. Opioid ineffectiveness was defined as the need for continuous sedatives or death without dyspnea relief, with doses recorded as the parenteral morphine-equivalent daily dose. RESULTS:The mean age was 72 years, and lung cancer was present in 43 patients (40%). Opioid-naïve patients showed a 100% response after 12 titrations, while opioid-tolerant patients exhibited a 68% response after 34 titrations. At death or one month after treatment, opioids were determined to be ineffective in 8.3% of opioid-naïve and 38% of opioid-tolerant patients (p < 0.001). Median doses at ineffectiveness were 15 mg (IQR = 7.5-23) and 36 mg (IQR = 14-200), respectively. CONCLUSIONS:Opioid-tolerant patients showed a lower-level response and were more likely to experience ineffectiveness than opioid-naïve patients. Larger studies are needed to confirm these findings and improve terminal dyspnea management.

The best tools to assess patient illness understanding are unclear. Here, we examined the assessment tools for illness understanding administered in randomized clinical trials (RCTs) involving patients with advanced cancer, how accuracy of illness understanding was assessed, and each tool’s level of accuracy. We conducted a systematic review of Ovid MEDLINE, Ovid EMBASE, and Web of Science from database inception to 28 February 2024. We included all RCTs that reported on illness understanding assessments in cancer patients. The assessment measures were classified into five categories: prognostic awareness, health status, curability, treatment intent, and treatment risks/benefits. We extracted the questions, answers, definitions of accuracy, and accuracy rates of each category. The final sample included 27 articles based on 16 RCTs; five articles (19%) had a Jadad score of ≥3. Among these articles, 10 (37%) assessed prognostic awareness, 4 (15%) assessed health status, 9 (33%) assessed curability, 11 (41%) assessed treatment intent, and 3 (11%) assessed treatment risks/benefits. Only four RCTs examined illness understanding as a primary outcome or communication intervention. We observed significant heterogeneity in the questions, answers, definition of accuracy, and accuracy rate of patients’ responses for all themes except for health status. The accuracy rate ranged from 6% to 33% for prognostic awareness, 45% to 59% for health status, 35% to 84% for curability, 26% to 88% for treatment intent, and 17% to 75% for treatment risks/benefits. This study highlights significant variation in current illness understanding assessments and opportunities for standardization to support clinical practice and research.

BackgroundThere is much concern that opioids administered as intravenous (iv) bolus for pain relief may inadvertently increase their risk for abuse. However, there is insufficient data to support this. The authors compared the abuse liability potential, analgesic efficacy, and adverse effect profile of fast (iv push) versus slow (iv piggyback) administration of iv hydromorphone among hospitalized patients requiring iv opioids for pain.MethodsIn this double-blind, double dummy, randomized, 2 x 2 crossover trial, patients with >= 4 cancer-related pain were randomly assigned to receive either iv hydromorphone 1 mg administered over 2 minutes (fast iv push) or 15 minutes (slow iv piggyback) during the first treatment period. Participants crossed over to receive the alternate treatments during the second period after a 6-hour washout period.ResultsEighty-three eligible patients were allocated to slow-fast (42, 51%) or fast-slow (41, 49%). Both treatments produced low abuse potential scores with no difference between them (mean peak Drug Effect Questionnaire "drug liking" subscale of fast [24.00] vs. slow [24.34], p = .82). A total of 92% and 94% of slow and fast iv hydromorphone recipients, respectively, had similar improvements in pain scores over 120 minutes (odds ratio, 0.67; 95% confidence interval, 0.06-5.82, p = .65). Drowsiness was more frequent with the fast than the slow rate (50% vs. 29% at 15 minutes [p = .03] and 52% vs. 31% at 60 minutes [p = .03]).ConclusionsSlow iv hydromorphone infusion resulted in similar abuse liability potential and pain improvement but less sedation than fast injection. These findings, taken together, suggest that the slow infusion may be considered as a first-line modality for iv opioid administration in hospitalized patients requiring intermittent opioids for pain.

Importance:Patients with dementia have considerable supportive care needs. Specialist palliative care may be beneficial, but it is unclear which patients are most appropriate for referral and when they should be referred. Objective:To identify a set of consensus referral criteria for specialist palliative care for patients with dementia. Design, Setting, and Participants:In this survey study using 3 rounds of Delphi surveys, an international, multidisciplinary panel of clinicians from 5 continents with expertise in the integration of dementia and palliative care were asked to rate 83 putative referral criteria (generated from a previous systematic review and steering committee discussion). Specialist palliative care was defined as an interdisciplinary team consisting of practitioners with advanced knowledge and skills in palliative medicine offering consultative services for specialist-level palliative care in (nonhospice) inpatient, outpatient, community, and home-based settings. Main Outcomes and Measures:Consensus was defined a priori as at least 70% agreement among experts. A criterion was coded as major if the experts advocated that meeting 1 criterion alone was satisfactory to justify a referral. Data were summarized using descriptive statistics. Results:Of the 63 invited and eligible panelists, the response rate was 58 (92.1%) in round 1, 58 (92.1%) in round 2, and 60 (95.2%) in round 3. Of the 58 panelists who provided demographic data in round 1, most were aged 40 to 49 years (28 of 58 [48.3%]), and 29 panelists (50%) each were men and women. Panelists achieved consensus on 15 major and 42 minor criteria for specialist palliative care referral. The 15 major criteria were grouped under 5 categories, including dementia type (eg, rapidly progressive dementia), symptom distress (eg, severe physical symptoms), psychosocial factors or decision-making (eg, request for hastened death, assisted suicide, or euthanasia), comorbidities or complications (eg, ≥2 episodes of aspiration pneumonia in the past 12 months); and hospital use (eg, ≥2 hospitalizations within the past 3 months). Conclusions and Relevance:In this Delphi survey study, international experts reached consensus on a range of criteria for referral to specialist palliative care. With testing and validation, these criteria may be used to standardize specialist palliative care access for patients with dementia across various care settings.

ABSTRACT Background Patients with advanced cancer are at risk for malnutrition and anorexia‐cachexia syndrome. The study objective was to determine the frequency of these conditions in patients evaluated in an outpatient supportive care clinic (SCC). Methods One hundred patients with cancer were prospectively enrolled to complete a cross‐sectional one‐time survey. We collected patient demographics, cancer diagnosis, weight history and height and Zubrod performance status from electronic health records. Patients completed the Functional Assessment of Anorexia Therapy–Anorexia/Cachexia Subscale (FAACT‐A/CS) questionnaire, the Edmonton Symptom Assessment Scale (ESAS), the Patient‐Generated Subjective Global Assessment–Short Form (PG‐SGA‐SF), the Hospital Anxiety and Depression Scale (HADS) and a Body Image Scale (BIS). A PG‐SGA‐SF cut‐off of ≥ 6 indicated malnutrition risk, and loss of appetite was defined as either ESAS ≥ 3 or FAACT‐ACS ≤ 37. Results Of the 165 patients approached, 100 (61%) completed the survey. The average (SD) age was 61.6 years old (11.5). The majority were female (52%), White (75%) and married (80%). The most common cancers were gastrointestinal (22%) and genitourinary (21%). Sixty‐one per cent (61%) screened positive for risk of malnutrition (PG‐SGA‐SF ≥ 6), anorexia was noted in 60% (ESAS ≥ 3) and 53% (FAACT‐A/CS ≤ 37) of patients, 10% of patients were noted to have a body mass index < 18.5, and 28% had body image dissatisfaction (BIS ≥ 10). Documented > 5% weight loss over the past 6 months was noted in 49%; 61% noted > 10% lifetime weight loss, relative to usual adult body weight or at time of diagnosis. Patients with anorexia (FAACT‐ACS ≤ 37) compared with no anorexia reported significantly higher HADS anxiety score (4.4 vs. 3.2, p = 0.04), depression (5.9 vs. 3.5, p = 0.001), body image distress (BIS 7.2 vs. 4.9, p = 0.03) and worse appetite (ESAS 1.4 vs. 0.6, p = 0.02). Symptoms including depression, anxiety and body image distress were not significantly different between patients with either a history of > 10% lifetime weight loss or > 5% weight loss over 6 months. Conclusions Malnutrition risk was noted in roughly 60% of patients with advanced cancer. Inclusion of patients' body mass index to malnutrition or cachexia criteria resulted in underdiagnosis. Subjective symptoms of anorexia, but not objective weight loss, was significantly associated with anxiety and depression. Routine malnutrition screening with the PG‐SGA‐SF should be incorporated into all outpatient SCC visits and, comparing current weight to documented pre‐illness baseline weight, should be obtained to determine the severity of cachexia.

CONTEXT:Systematic screening of illness understanding is a novel approach that normalizes discussion of this sensitive topic and helps to identify patients with information needs. OBJECTIVES:To examine changes over time in perception of curability among patients with advanced cancer and the predictors of misperception. METHODS:We implemented universal electronic systematic screening of illness understanding for each patient in our Supportive Care Center using questions from the Prognosis and Treatment Perception Questionnaire. The current study retrospectively reviewed data from all patients with advanced solid tumors who completed screening at their consultation and at least one follow-up visit within 1 year. RESULTS:The analysis included 432 patients: mean age 58 years (SD 14), 248 (57.4%) female, 331 (76.6%) White. The mean number of visits to the supportive care center was 2.69 (SD 0.9), and the median time between the initial consultation and second visit was 85 days (IQR 68.0-113.3). At visits 1 and 2, 34.0% (147/432) and 36.8% (159/432) of patients, respectively, had an accurate perception of curability (P=0.3). In multivariable analysis, inaccurate perception of curability at both initial consultation and second visit was associated with Asian race (OR=3.08, P=0.02), greater well-being (reverse scored, OR=0.83, P<0.001) and better sleep (OR=0.89, P=0.002), and lower fatigue (OR=0.92, P=0.02), depression (OR=0.88, P=0.001), anxiety (OR=0.9, P=0.006), and financial distress (OR=0.92, P=0.015). CONCLUSION:Only one in three patients with advanced cancer had an accurate understanding of their curability, with limited improvement over time. Systematic screening may provide opportunities to improve illness understanding and coping support.

Background: Accurate prediction of next-day survival in imminently dying patients is crucial for facilitating timely end-of-life decisions. Objectives: To develop diagnostic models for predicting next-day survival in cancer patients with a Palliative Performance Scale (PPS) score of ≤20. Design: A multicenter, prospective, observational study. Setting/subjects: We enrolled advanced cancer patients at 23 palliative care units across Japan. Measurements: Clinical signs of impending death were recorded daily after patients' PPS scores decreased to ≤20, continuing until death or for up to 14 days. The developed models included the prediction of one-day survival-decision tree (P1d-Survival-DT), based on recursive partitioning analysis, the P1d-Survival-organ system score, which utilized a scoring system across four clinical systems (nervous/cardiovascular/respiratory/musculoskeletal), and the early signs model that focused on the absence of two early signs (altered consciousness and liquid dysphagia). Results: Of the 1896 patients included in the study, 1396 (74%) reached PPS ≤20. The average age was 73 ± 12 years, with 49% being female. The P1d-Survival-DT model showed next-day survival rates of 91.6% for patients with a response to verbal stimuli and no peripheral cyanosis, and 37.1% for those with no response to verbal stimuli and respiration with mandibular movement. The P1d-Survival-organ system score model revealed a 95.9% survival rate for score = 0, decreasing progressively to 46.7% for score = 4. The early signs model predicted a 95.2% survival rate in patients with normal consciousness and no liquid dysphagia. Conclusions: This study successfully developed three distinct models to predict next-day survival in cancer patients with PPS ≤20, offering vital tools for informed decision making in palliative care settings.

Social media is widely used but few studies have examined how patients with advanced cancer want their accounts managed after death. The objective of this study was to determine the proportion of our patients with advanced cancer who have discussed the post-mortem management of their social media accounts with their family or friends. This was a cross-sectional survey in which patients with advanced cancer at an outpatient Supportive Care Clinic at a tertiary cancer center completed a novel survey on social media use that assessed patients’ social media use practices, attitudes and preferences, and reactions to the survey. Of 117 patients, 72 (61.5

This review examines the literature on palliative rehabilitation for patients with advanced cancer, focusing on definitions, structures, processes, and outcomes. Palliative cancer rehabilitation targets comfort and functional improvement for patients with limited rehabilitation potential across various settings. The palliative cancer rehabilitation team, typically led by a physician, coordinates symptom management and referrals to rehabilitation and other allied healthcare professionals as needed. The outcomes of palliative cancer rehabilitation varied widely by goals, settings, and interventions. Studies in hospice settings generally reported improved symptom control; inpatient rehabilitation had mixed functional outcomes; and outpatient palliative rehabilitation may contribute to enhanced functional and symptom outcomes, especially among patients with higher baseline function. Palliative cancer rehabilitation emphasizes a collaborative approach that integrates palliative care with rehabilitation interventions, aiming to enhance quality of life and address diverse patient needs. Further research and standardization are necessary to realize its full potential.

End-of-life delirium affects a vast majority of patients before death. It is highly distressing and often associated with restlessness or agitation. Unlike delirium in other settings, it is considered irreversible, and non-pharmacologic measures may be less feasible. The objective of this review is to provide an in-depth discussion of the clinical trials on delirium in the palliative care setting, with a particular focus on studies investigating pharmacologic interventions for end-of-life delirium. To date, only six randomized trials have examined pharmacologic options in palliative care populations, and only two have focused on end-of-life delirium. These studies suggest that neuroleptics and benzodiazepines may be beneficial for the control of the terminal restlessness or agitation associated with end-of-life delirium. However, existing studies have significant methodologic limitations. Further studies are needed to confirm these findings and examine novel therapeutic options to manage this distressing syndrome.

BackgroundFew studies have examined patient preferences for telehealth in palliative care after the availability of COVID-19 vaccines. We examined patient preferences for video versus in-person visits and factors contributing to preferences in the post-vaccine era.MethodsThis is a cross-sectional survey of patients who were seen at our palliative care clinic between April 2021 and March 2022. Patients were surveyed directly their preference for either video or in-person visits for outpatient palliative care (primary outcome). We also surveyed preferences including convenience, cost, wait time, and perceptions of COVID-19 safety regarding their palliative virtual-video visit. We examined clinical factors associated with preferences with multivariate logistic regression.Results200 patients completed the survey. 132 (67%, 95% confidence interval [CI]: 60%, 74%) preferred virtual-video, while 16 (8%) preferred in-person visits during the COVID-19 pandemic. 120 (61%, 95% CI: 54%, 68%) preferred virtual-video after the pandemic. Patients perceived virtual-video favorably regarding travel and related costs (179 [91%]), convenience (175 [88%]), and wait time (136 [69%]). Multivariable analysis showed concerns for catching COVID-19 from healthcare providers (odds ratio [OR]: 4.20; 95% CI: 1.24–14.25; P=0.02) and feeling comfortable with computers or mobile devices (OR: 4.59; 95% CI: 1.02, 20.60; P=0.047) were significantly associated with preferring virtual-video. Patients who were of Hispanic or Latino ethnicity (OR: 0.25; 95% CI: 0.09, 0.71) and had increased dypsnea (OR: 0.74; 95% CI: 0.59, 0.93) were less likely to prefer video over in-person.ConclusionPatients expressed strong preference for video over in-person visits in the outpatient palliative care setting.