Palliative Care

Online Valued Living groups improve ACP and spiritual well-being in distressed patients with advanced cancer

Adults with advanced solid tumors and significant depression or anxiety (N = 240) were randomized to Valued Living or usual care in community oncology clinics. Valued Living consisted of five weekly videoconference groups plus self-paced modules delivered by social workers. At 3.5 months, participants completed 1.27 more ACP steps than usual care, notably more identification and documentation of health care proxies. They also had greater improvements in rigid cognitive avoidance of death and spiritual well-being, without clear changes in fear of death or anxiety. 1

Loneliness and social isolation near end of life associate with distinct symptom profiles

This nationally representative study analyzed 2,385 U.S. adults over 50 who died while enrolled in the Health and Retirement Study. Patients reported loneliness and social isolation within a year of death; proxies later reported 12 physical and psychological symptoms. Loneliness was more common in those with pain, depression, fatigue, drowsiness, and agitation, after adjustment for sociodemographic factors. Social isolation was more frequent with dyspnea, drowsiness, and persistent cough. 2

Prescription monitoring programs miss most non-medical opioid use in a safety-net cancer palliative clinic

In a four-year retrospective cohort of 906 cancer patients, 844 (93%) had at least one prescription monitoring program (PMP) review. Only 4% had documented PMP concern, while 20% were judged to have non-medical opioid use based on clinical review. History of illicit drug use, opioid use for non-malignant pain, and family illicit drug use predicted PMP irregularities. PMP identified far fewer concerning cases than structured clinical assessment, and a small proportion were missed even clinically. 3

Rural–urban setting influences place of death for dementia and cancer, with major gaps for coastal and dementia data

This PRISMA-compliant systematic review included 29 high-quality studies covering nearly 7 million cancer and over 3.5 million dementia decedents. Rural dementia decedents were more likely to die in residential care, whereas urban dementia decedents more often died in hospital. Large cancer cohorts generally showed more home deaths in rural areas and more hospital deaths in urban settings, though patterns varied internationally. Coastal contexts were rarely examined, and relatively few studies directly compared cancer with dementia. 4