Literature Review

All posts tagged with “Research News.”



Quality indicators and patient outcome measures for palliative care in cancer patients: A systematic review

07/19/25 at 03:15 AM

Quality indicators and patient outcome measures for palliative care in cancer patients: A systematic reviewEcancermedicalscience; Chase Peng Yun Ng, Moira Hegyi, Grant Lewison, Tania Pastrana, Eve Namisango, James Cleary, Barbara Hasties, Eric Kabisa, Helena Musau, Kathryn Spangenberg, Paola Ruiz, Zipporah Ali, Mertixell Mallafre-Larrosa, Alfredo Polo, Julie Torode, Ajay Aggarwal, Richard Sullivan, Mevhibe Hocaoglu; 6/25With the exponential rise in global cancer incidence, the surge in demand for palliative care has outstripped capacity, limiting patients' access to quality and holistic palliative care, especially in low- and middle-income countries. There is an overall lack of standardisation of QIs [quality indicators] and POMs [patient outcome measure], as well as variability in evidence of palliative care research. We recommend that stakeholders collaborate to develop a standardised repository of metrics for monitoring and evaluating palliative care services at both individual and system levels, with a particular focus on structural and process indicators. Incorporating validated, patient-centred measures and selecting key items as quality indicators will enable meaningful tracking of changes, guiding resource allocation and driving improvements in patient-centred care.

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Collective leadership in home-based palliative care: Advancing APRN roles to enhance success

07/19/25 at 03:10 AM

Collective leadership in home-based palliative care: Advancing APRN roles to enhance successHome Health Care Management & Practice; Nicole DePace, MS, APRN, GNP-BC, ACHPN; Rebecca Souza, DNP, ANP-BC, ACHPN; Therese Rochon, MA, MS, FNP-C; Paula Rego, DNP, AGPCNP-BC; Constance Dahlin, MSN, ANP-BC, ACHPN, FPCN, FAAN; 6/25Palliative advanced practice registered nurses are instrumental in responding to the opportunities and challenges in home-based palliative care through advocacy, practice, education, program development, and leading interprofessional teams. Collective leadership is proposed as a framework to address these tensions in home-based palliative care. Two cases are presented to compare and contrast collective and traditional leadership models, illustrate the role of the palliative advanced practice registered nurse leader, demonstrate how to avoid the pitfalls of a traditional leadership model, and build sustainable success through collective leadership principles. Finally, strategies to engage advanced practice registered nurses in leadership roles and address the tensions of the policy gaps in home-based palliative care are provided.

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End-of-life symptoms in persons dying with advanced dementia in the community setting: Findings from IN-PEACE

07/19/25 at 03:05 AM

End-of-life symptoms in persons dying with advanced dementia in the community setting: Findings from IN-PEACEJournal of Pain and Symptom Management; by Kurt Kroenke, Sujuan Gao, Susan E. Hickman, Alexia M. Torke, Nina M. Johnson, Amy Pemberton, Andrea Vrobel, Minmin Pan, Laura R. Holtz, Greg A. Sachs; 8/25This article characterizes symptom burden in persons with advanced dementia dying in the community who were enrolled in a 2-year trial of home-based palliative care. Symptoms did not generally worsen from enrollment to time of death and symptom severity was similar to persons with dementia dying in a nursing home.

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Utilization of antibiotics for the treatment of urinary tract infections in end-of-life patients

07/19/25 at 03:00 AM

Utilization of antibiotics for the treatment of urinary tract infections in end-of-life patientsAmerican Journal of Hospice and Palliative Medicine; by Abigail Thomas, Lacey Davis, Allie Dolan, Rebecca Prewett; 8/25The use of antibiotics for end-of-life patients is controversial; currently there is limited guidance on the use of antibiotics in hospice patients... The purpose of this project is to examine the utilization of antibiotics for urinary tract infections (UTIs) in hospice patients... The prescribing of antibiotics in end-of-life patients is not always appropriate regardless of the PPS. This may indicate that antibiotics are initiated in asymptomatic hospice patients, and the utilization of unnecessary medications presents the risk of adverse effects.

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Palliative care education in pediatric cardiology fellowships: A survey of program directors

07/12/25 at 03:40 AM

Palliative care education in pediatric cardiology fellowships: A survey of program directorsPediatric Cardiology; Lesje DeRose, Sarah Godfrey, Shabnam Peyvandi, Nicole M. Cresalia, Jill M. Steiner, Emily Morell; 6/25 Our survey demonstrated a wide range of PC [palliative care] educational practices among categorical pediatric cardiology fellowship programs. While most programs provided some form of PC education to their fellows, the amount and modality varied widely between programs, from very minimal PC exposure to required core PC rotations. Almost half of the participating PDs [program directors] reported dissatisfaction with the current amount of PC education in their fellowship programs. Programs such as VitalTalk (www.vitaltalk.org) and other (both in-person or virtual) modules have been utilized in other training environments with improvement in trainee comfort in PC topics, including CardioTalk for adult cardiology trainees. Didactic-based curricula in PC topics, such as mental health and ethics, have also been shown to help providers gain confidence in PC domains.

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Mapping the final journey: End-of-life frailty trajectories and cause of death

07/12/25 at 03:35 AM

Mapping the final journey: End-of-life frailty trajectories and cause of deathJournal of the American Geriatrics Society; Jianhong Xu, Jonathan Ka-Long Mak, Qian-Li Xue, Chenkai Wu; 6/25Frailty trajectories at the end of life varied by cause of death, with neurodegenerative disease decedents exhibiting more severe frailty. Among 37,465 decedents, 2,895 (7.7%) died from neurodegenerative diseases [and] three distinct frailty trajectories were identified among these decedents: rapidly progressive frailty (6.9%), moderate progression of frailty (21.1%), and advanced and stable frailty (72.0%). These patterns differed significantly from those observed in decedents with other causes of death, who exhibited persistently low frailty (24.7%), intermediate and progressive frailty (46.5%), and advanced and progressive frailty (28.8%). Compared to cancer decedents, individuals with neurodegenerative diseases had higher baseline frailty and a dominant trajectory of advanced and stable frailty. Older age, lower education, and greater chronic disease burden were associated with the advanced and progressive frailty trajectory.

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Health economic analysis of an all-virtual, at-home acute care model

07/12/25 at 03:30 AM

Health economic analysis of an all-virtual, at-home acute care modelJAMA Network Open; Brad Spellberg, MD; Christopher Lynch, MD; Hal F. Yee, MD, PhD; Josh Banerjee, MD; 6/25Hospital-at-home care models send staff, durable medical equipment (DME), and therapeutics (eg, intravenous infusions) to patients’ homes to provide care. In the US, Medicare requires in-person evaluations at least twice daily to receive payment for hospital-at-home services. In the UK National Health Service, virtual wards at home are increasingly being used in lieu of inpatient care. This economic evaluation of ... patients receiving all-virtual, at-home acute care ... found that the virtual program was cost-saving (due to avoided variable hospital costs) only for unfunded patients or patients with Medicaid, but was cost-losing for Medicare and commercially insured patients due to substantial lost inpatient revenue. These findings suggest that current payer rates for inpatient care financially disincentivize development and implementation of novel acute, at-home care models, but a simple reimbursement schema could enable net savings to both hospitals and payers.

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Facilitating advance care planning conversations among patients with cancer and their care partners utilizing a conversation game: A pilot study

07/12/25 at 03:25 AM

Facilitating advance care planning conversations among patients with cancer and their care partners utilizing a conversation game: A pilot studyCancer Reports; Kylee Kimbel, Michael Hayes, Morgan Bucher, William A Calo, Tullika Garg, Monika Joshi, Hannah Kuntz, Terrence E Murphy, Erika VanDyke, Emily Wasserman, Lauren J Van Scoy; 6/25Current guidelines [for patients with cancer] recommend early, frequent advance care planning (ACP) conversations among clinicians, patients, and care partners (CPs) and advance directive (AD) completion. However, only 55% of patients with cancer have completed such directives, suggesting the need for interventions to increase rates of ACP. The Hello game has been shown to be effective in promoting ACP in several populations but has not been tested in patients with cancer or their CP. Three themes emerged from both patient and CP focus groups ...: (1) Participants enjoyed the group dynamics and relating to peers when playing Hello; (2) Hello serves as a helpful conversation starter; (3) modifications could help tailor Hello for use in cancer context-particularly adding more questions about quality of life and mental health. Hello was well-received by dyads, and their feedback was used to tailor Hello for patients with cancer and their CPs.

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Impact of spirituality in Christians with serious illness - A phenomenological study

07/12/25 at 03:20 AM

Impact of spirituality in Christians with serious illness - A phenomenological studyAmerican Journal of Hospice and Pallaitive Care; Judy Lentz; 6/25Seeking support within the faith community is frequently noted in Christians with serious illness. Research interviews captured four major structures with accompanying constituent parts [including] ... sovereignty of God with unpredictability, relationship with God especially through prayer, illness-related loss with accompanying guilt for the subsequent burden created for the caregivers, and gratitude for the love and support shown to the participant by loved ones and others. The impact of the structures and constituent parts of spirituality identified by the Christians who participated in this study demonstrates the value and significance of the faith-based spiritual support received during their illness.

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Addressing the underutilization of hospice care in Asian American communities: A scoping review

07/12/25 at 03:15 AM

Addressing the underutilization of hospice care in Asian American communities: A scoping reviewAmerican Journal of Hospice and Palliative Medicine; Tuzhen Xu, PhD, APRN, FNP-C; Dan Song, PhD, RN; Gloria M. Rose, PhD, NP-C; 6/25Despite national improvements in hospice care, utilization remains low among Asian American (AA) communities. Identified barriers to hospice utilization included language and communication challenges; cultural values and beliefs surrounding death; family-centered decision-making and filial piety; religious influences such as beliefs in karma and suffering; and broader issues like low acculturation and mistrust of the healthcare system. Comprehensive cultural competence training is needed for healthcare providers, especially physicians, nurse practitioners, registered nurses, and social workers involved in hospice and palliative care.

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Hospice and palliative care experiences as expressed on the r/hospice and r/palliative subreddits

07/12/25 at 03:10 AM

Hospice and palliative care experiences as expressed on the r/hospice and r/palliative subredditsAmerican Journal of Hospice & Palliative Medicine; Riley Shin, BSA; Ashley Shin, MD; Elizabeth K. Nugent, MD, MS; 6/25 Reddit, an anonymous online community forum, provides space for sharing medical information, seeking emotional support, and facilitating open communication. This qualitative study examined the most popular questions on the r/hospice and r/palliative communities on Reddit. Seven primary themes emerged from question and advice-seeking r/hospice comments: (1) the dying process (24%), (2) coping and emotional support for patients and caregivers (22%), (3) logistics of hospice and palliative care (22%), (4) medication treatments and side effects (13%), (5) negative hospice experiences (10%), (6) support for hospice providers (7%), and (7) other less related material (2%). Assessment of posts on the r/hospice and r/palliative subreddits revealed gaps in communication between patients, caregivers, and healthcare providers in several important areas, most importantly in demystifying the dying process and providing patient and caregiver support.

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Measuring goal-concordant care using electronic clinical notes

07/12/25 at 03:05 AM

Measuring goal-concordant care using electronic clinical notesJAMA Network; by Catherine L. Auriemma, Anne Song, Lake Walsh, Jason Han, Sophia Yapalater, Alexander Bain, Lindsay Haines, Stefania Scott, Casey Whitman, Stephanie Parks Taylor, Gary E. Weissman, Matthew J. Gonzales, Roshanthi Weerasinghe, Staci J. Wendt, Katherine R. Courtright; 7/3/25In this longitudinal cohort study among 109 patients with serious illness and limited prognoses, clinicians reviewed and classified 398 epochs of care as goal concordant (50%), goal discordant (19%), or of uncertain concordance (32%) with nearly perfect interrater agreement for categorizing the type of care received. These findings suggest that using electronic clinical notes to measure goal-concordant care is feasible, laying the groundwork for future automated text-based classification methods to improve reliability and pragmatism of measuring goal-concordant care for clinical and research use at scale.

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Home-based palliative care for cancer patients: Evaluating a decade of nursing-led interventions

07/12/25 at 03:00 AM

Home-based palliative care for cancer patients: Evaluating a decade of nursing-led interventionsAmerican Journal of Hospice and Palliative Medicine; Júnia de Oliveira Alves, RN; Eduardo Bruera, MD; Mônica Isaura Corrêa, MD; Sonia Souza, PhD; Marília Ávila de Freitas Aguiar, PhD; Ana Paula Drummond-Lage, PhD; 6/25Home-based palliative care is an effective approach for managing advanced-stage cancer patients, particularly in regions with limited healthcare infrastructure. In Brazil, the “Better at Home” Program enables interdisciplinary teams to deliver palliative care in patients’ homes, with nurses playing a central role in providing clinical and supportive interventions. Registered nurses (RNs) were responsible for complex procedures, supervision of nursing technicians (NTs), and caregiver training, while NTs performed routine clinical tasks and assisted with daily care. Notably, 99.4% of patients died at home, suggesting alignment with palliative goals of care. These findings underscore the central role of RNs in coordinating and delivering home-based palliative oncology care within a multidisciplinary framework.

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Grief and bereavement in pediatric palliative care #502

07/05/25 at 03:45 AM

Grief and bereavement in pediatric palliative care #502Journal of Palliative Medicine; by Lori Wiener, Meaghann S. Weaver; 6/25Grief is the natural emotional response to loss. In pediatric illnesses, grief may be a response to physical loss (a patient missing her own bedroom while admitted to the hospital), a relational loss (separation from peer friendships due to extended hospitalizations), and loss of meaning (ambitions, dreams, or hopes for the future are compromised by a life-limiting illness). For children and families, grief often begins at the time of diagnosis and fluctuates through the disease trajectory.

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Disparities in receipt of palliative-intent treatment among disaggregated Hispanic populations with breast, lung, and prostate cancer in the United States

07/05/25 at 03:40 AM

Disparities in receipt of palliative-intent treatment among disaggregated Hispanic populations with breast, lung, and prostate cancer in the United StatesCancer; Shriya K. Garg BS; Khushi Kohli BA; Isha K. Garg BS; Yash K. Garg BS; Lilac G. Nguyen BS; Isabella S. Nguyen BS; Erin Jay G. Feliciano MD, MBA; Yefri A. Baez MD; Brandon A. Mahal MD; Puneeth Iyengar MD, PhD; Daniel R. Gomez MD, MBA; Kaitlyn Lapen MD; Edward Christopher Dee MD; 5/25 This study examines disparities in the receipt of palliative-intent interventions among Hispanic subgroups with advanced lung, breast, and prostate cancer. Among 945,894 total patients, disaggregated analyses revealed reduced receipt of palliative-intent interventions for patients with lung, breast, and prostate cancer of Mexican descent ... compared to non-Hispanic White patients. Receipt for patients of South or Central American descent was reduced in comparison to non-Hispanic White patients for lung and breast cancer ... Uptake of palliative interventions for metastatic lung and breast cancer was reduced for patients of Cuban descent ..., and was lower for patients of Dominican descent with breast cancer, compared to non-Hispanic White patients ... These findings demonstrate disparities in the receipt of palliative-intent interventions among disaggregated Hispanic subgroups. This study highlights the need for disaggregated research to further characterize these disparities and their drivers.

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A life-affirming palliative care model for severe and enduring anorexia nervosa

07/05/25 at 03:35 AM

A life-affirming palliative care model for severe and enduring anorexia nervosaAMA Journal of Ethics; by Jonathan Treem, Joel Yager, Jennifer L. Gaudiani; 9/23Some individuals with severe and enduring anorexia nervosa experience dramatically degraded quality of life in the face of refractory illness and compulsory treatment. We propose a palliative care (PC) model for this group of patients that aims to support their unique goals of care, improve social-professional function, reduce physical suffering, and honor the whole person. Far from representing a pre-hospice model, a PC model for those with severe and enduring anorexia nervosa instead provides an alternative to current practices in hopes of meaningfully improving quality of life and outcomes.Publisher's note: While slightly dated, this article recently came across my desk and was a reminder of ethical issues in serious illness care for people with anorexia nervosa.

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Antibiotics at end of life: Where are we now and where are we going? A narrative review

07/05/25 at 03:30 AM

Antibiotics at end of life: Where are we now and where are we going? A narrative reviewAmerican Journal of Hospice and Palliative Medicine; by Patrick D Crowley, Francis X Whalen, Leslie R Siegel, Douglas W Challener; 8/25Antibiotics are frequently prescribed at the end of life, though the benefits and harms are not well understood. Prescribing practices vary based on individual situation and geographic location. Patients with cancer and those hospitalized receive more antibiotics than those enrolled in outpatient hospice. Urinary tract infections and pulmonary infections are the most common conditions treated with antibiotics at the end of life -most often with penicillin derivatives and vancomycin in the hospital, fluoroquinolones in outpatient, and cephalosporins in both settings. When asked, patients most often prefer limiting antibiotics to symptom management at the end of life. Physicians’ over-estimation of patient preference for antibiotics and the increased probability of misdiagnosis increases antibiotic prescription rates. Antibiotics can improve symptoms when used for specific diseases at the cost of drug reactions, resistant organisms, and delayed discharge. Antibiotic use has variable results on survival duration.

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Clinicians’ perceptions about institutional factors in moral distress related to potentially nonbeneficial treatments

07/05/25 at 03:25 AM

Clinicians’ perceptions about institutional factors in moral distress related to potentially nonbeneficial treatmentsJAMA Network Open; Teva D. Brender, MD; Julia K. Axelrod, BA; Sofia Weiss Goitiandia, MA, MSc; Jason N. Batten, MD, MA; Elizabeth W. Dzeng, MD, PhD, MPH; 6/25In this qualitative study, we described institutional factors that may exacerbate, prevent, or mitigate the influence of societal factors contributing to moral distress related to potentially nonbeneficial LST [life-sustaining treatments]. Health systems should consider how health care consumerism influences patients’, families’, and clinicians’ expectations regarding potentially nonbeneficial LST, particularly at hospitals with advanced technological interventions (eg, organ transplantation, extracorporeal membrane oxygenation, salvage chemotherapies). Future studies should explore the societal and institutional factors contributing to moral distress for clinicians at lower-resourced hospitals, such as inaccessible advanced treatments and barriers to transferring patients for higher levels of care. While some institutions lacked sufficient structures to support clinicians’ efforts to de-escalate potentially nonbeneficial treatments, policies empowering clinicians across the medical hierarchy, as well as conflict resolution and emotional support resources (eg, palliative care) might prevent or mitigate moral distress.

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Palliative care knowledge, attitudes, and self-competence of nurses working in hospital settings

07/05/25 at 03:20 AM

Palliative care knowledge, attitudes, and self-competence of nurses working in hospital settingsJournal of Palliative Care; Mona Ibrahim Hebeshy, PhD, RN; Darcy Copeland, PhD, RN; 6/25With the growing need to integrate palliative care into healthcare systems, nurses in hospital settings often provide care for patients with life-limiting conditions, many of whom lack formal education in palliative care. [Conclusions:] Nurses generally feel competent; however, they often lack confidence in addressing patients’ social and spiritual needs. They experienced unease when discussing death and exhibited paternalistic attitudes. Significant differences were found in educational background, nursing experience, personal caregiving experience, and practice setting. Positive correlations exist between attitudes, knowledge, and self-competence, indicating that greater knowledge and competence were associated with better attitudes toward end-of-life care.

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Top ten tips palliative care clinicians should know about managing diabetes at end-of-life

07/05/25 at 03:15 AM

Top ten tips palliative care clinicians should know about managing diabetes at end-of-lifeJournal of Palliative Medicine; by Rebekka DePew, Tonya Hershman, Monica Giles, William E Rosa, Kimberly Curseen; 6/25Palliative care clinicians will regularly take care of patients with diabetes and play numerous roles in educating not only patients but also families and care partners regarding the changing balance of harms and benefits of blood glucose control as patients near end of life (EOL). There is limited evidence regarding the optimal timing and process for de-escalation of blood sugar monitoring and diabetes medications (including insulin) in the hospice and EOL setting.

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Fireproofing the soul: Navigating fear of the afterlife among palliative care patients

07/05/25 at 03:10 AM

Fireproofing the soul: Navigating fear of the afterlife among palliative care patientsJournal of Palliative Medicine; Ptr Shannon Blower, Jonathan Walker, Lucius Walker, Steven Radwany; 6/25Among palliative care patients, spiritual uncertainty about what may await them after death is a fairly common but often overlooked source of anxiety. Specifically, patients (especially those from orthodox Christian backgrounds that propound the concept of hell as a literal place) may harbor unexpressed fears about being consigned to hell due to the perceived sins they have committed in life. Such fears can be genuinely debilitating and may result in non-responsiveness to traditional palliative therapy. Here, we discuss our experiences with this phenomenon and propose some possible solutions. We offer readers suggestions for how to best identify potential sufferers, broach the subject with such patients, and reassure them.

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Palliative care in the ICU: From oxymoron to standard of care

07/05/25 at 03:05 AM

Palliative care in the ICU: From oxymoron to standard of careIntensive Care Medicine; Nancy Kentish-Barnes, Judith E. Nelson; 6/25 Palliative care can be integrated into intensive care through ICU clinicians and palliative care specialists, and these approaches are complementary and synergistic. One study found that proactive specialist involvement in ICU rounds for high-risk patients led to more and earlier family meetings and shorter hospital stays. However, collaboration challenges, such as continuity of communication, highlight the need for close team cooperation. The integrative model trains intensivists and ICU nurses to embed palliative care into routine practice, ideally starting in medical and nursing education. Research has shown that improved communication and support from intensivists and ICU nurses are associated with better bereavement outcomes for families, including reduced post-traumatic stress, anxiety, depression, and prolonged grief.

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Medicare Advantage plan disenrollment: Beneficiaries cite access, cost, and quality among reasons for leaving

07/05/25 at 03:00 AM

Medicare Advantage plan disenrollment: Beneficiaries cite access, cost, and quality among reasons for leavingHealth Affairs; by Geoffrey J. Hoffman, Lianlian Lei, Ishrat Alam, Myra Kim, Lillian Min, Zhaohui Fan, Deborah Levine; 6/25Medicare Advantage (MA) is growing in popularity, but it is seeing substantial plan disenrollments among high-risk Medicare beneficiaries. Understanding and addressing factors associated with disenrollment are crucial for improving MA access and quality but are complicated by data issues, including the inability to adequately assess beneficiaries’ perceptions of access and quality in MA... Difficulty accessing needed medical care was more strongly associated with MA-to–traditional Medicare exits than MA-to-MA plan switching. Dissatisfaction with access, cost, and quality was much more common for enrollees in poor health. These findings renew concerns about access to high-quality care for high-risk and other MA enrollees.

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Artificial intelligence and health care waste—Promise or peril?

06/28/25 at 03:45 AM

Artificial intelligence and health care waste—Promise or peril?JAMA Health Forum; William H. Shrank, MD, MSHS; Suhas Gondi, MD, MBA; David J. Brailer, MD, PhD; 6/25One obvious target of AI [artificial intelligence] tools in health care is the reduction of waste. While LLM [large language model] applications to health care are still nascent—many still make errors, and more rigorous evaluations are needed—most agree that the long-term opportunity for AI in health care is tremendous. A recent study estimated that widespread adoption of AI could lead to savings of 5% to 10% of total US health care spending. Realizing even a fraction of this potential would increase the affordability of care for people in the US and free substantial societal resources to make other valuable investments. But getting there will require deliberate choices from leaders and policymakers and careful attention to risks that could set back progress.

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Strengths and opportunities: Clinicians' perspectives on palliative care for Amyotrophic Lateral Sclerosis (ALS) in the United States

06/28/25 at 03:35 AM

Strengths and opportunities: Clinicians' perspectives on palliative care for Amyotrophic Lateral Sclerosis (ALS) in the United StatesMuscle & Nerve; Kara E Bischoff, Gayle Kojimoto, David L O'Riordan, Yaowaree L Leavell, Samuel Maiser, Astrid Grouls, Alexander K Smith, Steven Z Pantilat, Benzi M Kluger, Ambereen K Mehta; 6/25Half of ALS clinicians [surveyed] reported they are able to manage patients' pain (55%) and mood symptoms (52%) "very well." Fewer reported managing care partner needs (43%) and spiritual/existential distress (29%) "very well." Fifty-eight percent of pALS [people with ALS] are referred to outpatient PC and 69% to hospice at some point in the illness. ALS clinicians generally felt satisfied with PC teams' care, but PC clinicians were less confident managing motor symptoms (51% confident) and helping care partners understand how to provide care (51%) and use equipment (25%). Most clinicians felt the quality of PC provided by ALS (77%) and PC (90%) teams is good/excellent. However, qualitative comments highlighted that both ALS and PC clinicians have knowledge gaps, and collaboration between ALS and PC clinicians should increase.

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