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Across the three cohorts, most survey respondents ranked “time burden to patients” as the primary logistical barrier to outpatient palliative care referral. Both oncology and palliative providers indicated comfort with primary palliative care skills although palliative providers were more comfortable with symptom management compared with oncology providers (93.3% vs. 32.2%). A majority of participants (94.9%) were willing to refer to a palliative care provider embedded within an oncology clinic. Conclusion Additional health care time cost to patients is a major barrier to outpatient palliative care referral. Embedding a palliative care provider in an oncology clinic may be an acceptable model to increase patient access to outpatient palliative care while supporting the oncology team.Background Adequate end-of-life (EOL) care/breaking-bad-news (BBN) discussions with patients are becoming increasingly essential to adequate patient care. Purpose Whether a half-day workshop would lead to improved confidence in EOL/BBN care discussions for internal medicine interns. read more Methods Internal medicine interns (n = 43) were assigned to participate in a half-day workshop at Thomas Jefferson University Hospital. The workshop involved two standardized patient (SP) interactions involving delivering news of a terminal illness/initiating goals of care discussion with the intervention of SP feedback, a didactic and lecture on proper EOL/BBN discussion. Voluntary anonymous surveys before and after the workshop were utilized to assess impact. Results A majority of interns felt more comfortable with leading EOL care/BBN discussions after the workshop and had a positive experience. Conclusions A half-day curriculum is efficacious in educating EOL/BBN communication to internal medicine interns, but should be further assessed in a larger more standardized study involving an objective assessment.Background Limited information is available on the relationship between C-reactive protein (CRP) levels and pain in advanced cancer. Objectives To investigate the relationship between serum levels of CRP and subtypes of pain. Design A secondary cross-sectional analysis of a prospective cohort study. Setting/Subjects Patients with advanced cancer admitted to 23 palliative care units in Japan. Measurements Patients rated the severity of pain on the numerical rating scale (NRS) and physicians evaluated pain on the integrated palliative care outcome scale (IPOS). Physicians assessed neuropathic pain and breakthrough pain based on their presence or absence. Patients were divided into four groups according to CRP levels. Comparisons were performed using the Kruskal-Wallis test or chi-squared test. To evaluate the relationship between CRP and subtypes of pain, adjusted odds ratios (ORs) and 95% confidence intervals (CIs) in logistic models were calculated. Results We divided 1513 patients into four groups low CRP (n = 234), moderate CRP (n = 513), high CRP (n = 352), and very high CRP (n = 414). Spearman’s correlation coefficient between CRP and pain NRS and that between CRP and pain IPOS were 0.15 (p  less then  0.001) and 0.16 (p  less then  0.001), respectively. In the models of pain NRS and pain IPOS, significantly higher adjusted ORs than in the low CRP group were observed in the very high CRP group (1.81 [95% CI 1.14-2.88], p = 0.01; 1.74 [95% CI 1.18-2.57], p = 0.005, respectively). Relationships were not observed between CRP, neuropathic pain, and breakthrough pain. Conclusions The results indicated direct relationships between CRP, pain NRS, and pain IPOS.Background Over the past 5 years, China has invested substantially in palliative care programs to meet the rising demand for such services. In China’s mainland, most palliative care programs are embedded within an established hospital unit, but a small subset of providers practice exclusively in a stand-alone inpatient palliative care department. Objective To explore the lived experience of professionals at an independently operating palliative care hospital department in China’s mainland. Design We used purposive sampling to select palliative care physicians and nurses. Semistructured in-depth interviews were conducted in person. Thematic analysis was used to elicit key themes that pertained to participants’ lived experience. Setting/Subjects Ten palliative care physicians and seven nurses at the palliative medicine department in the West China Fourth Hospital of Sichuan University in Chengdu, Sichuan Province, participated in the interviews. Results Three themes related to participants’ lived experience were (1) interactions with patients and families (e.g., frequent encounters with death, communication difficulties, witnessing family struggles, and developing mutually trusting relationships); (2) factors influencing their work life (e.g., supportive working environment, unmet training needs, policy restrictions, and lack of public awareness); and (3) perceived nature of work (e.g., complex and demanding, underappreciation, encroachment of work stress into personal life, deriving accomplishment from work, and personal growth). Conclusion This study helps fill the void in the palliative care literature regarding the lived experience of inpatient palliative care professionals in China’s mainland. Our findings revealed factors influencing the well-being of palliative care professionals that are meaningful to policymakers.Objective The primary objective was to evaluate the efficacy of a weekly palliative care-guided, case-based discussion of high-risk infants on Neonatal Intensive Care Unit (NICU) physician (MD) and Advanced Practice Provider (APP) perceptions of pediatric palliative care (PPC). Study Design The study setting was a level IV academic NICU in a United States midwestern children’s hospital. A pre/post design was used to evaluate the effects of a weekly palliative care-guided, case-based discussion of high-risk infants on neonatology providers’ (MD and APP) perspectives of palliative and end-of-life care in the NICU using a previously published survey instrument. Surveys were completed at baseline and after 12 months of implementation. Data was analyzed with a Wilcoxon Signed Rank test with significance set at p  less then  0.05. Results Thirty-one providers (13 APPs and 18 MDs) completed both pre- and post-intervention surveys. Post-intervention, providers were more likely to endorse that they “are comfortable with PPC”, “feel comfortable teaching PPC to trainees”, “feel confident handling end-of-life care”, “have time to discuss PPC”, and “were satisfied with the transition to end-of-life care for their most recent patient”.