Training Researchers in the Field of Religion, Spirituality, and Health: Experiences from a Workshop in the United States and Recommendations for Future Workshop Curricula.

Although a substantial amount of research has been conducted in the field of religion, spirituality, and health, much still needs to be done. Training of researchers to conduct studies in the field of religion, spirituality, and health is essential for continued academic and methodological rigor. Such training should be globally oriented to ensure both representation and evidence from non-western cultures which is currently lacking. While little attention is given to this area in mainstream contemporary academic curricula, some researchers in the field have provided exceptional leadership in designing programs to train future researchers. In this commentary, the authors who participated in one such training program at Duke University, offer their insights based on a qualitative descriptive analysis of survey responses from a sample of participants. These insights relate to participants' perceptions of the most valuable experiences from a workshop on religion, spirituality, and health, and include recommendations for future content in training programs in this field. The multicultural aspect of the program with researchers, clinicians, and other professionals from 17 different countries was the most enriching aspect of the workshop. One of the key recommendations for future training efforts is to dedicate workshop time for participants to work collaboratively in the design and plan for international and interdisciplinary research projects with guidance from faculty.Please confirm if the author names are presented accurately and in the correct sequence (given name, middle name/initial, family name). Author 1 Given name: [Tobias Anker] Last name [Stripp]. Also, kindly confirm the details in the metadata are correct.They are correct.

Palliative Extubation: A Discussion of Practices and Considerations.

Palliative extubation (PE), also known as compassionate extubation, is a common event in the critical care setting and an important aspect of end-of-life care.1 In a PE, mechanical ventilation is discontinued. Its goal is to honor the patient's preferences, optimize comfort, and allow a natural death when medical interventions, including maintenance of ventilatory support, are not achieving desired outcomes. If not done effectively, PE can cause unintended physical, emotional, psychosocial, or other stress for patients, families, and healthcare staff. Studies show that PE is done with much variability across the globe, and there is limited evidence of best practice. Nevertheless, the practice of PE increased during the coronavirus disease 2019 pandemic due to the surge of dying mechanically ventilated patients. Thus, the importance of effectively conducting a PE has never been more crucial. Some studies have provided guidelines for the process of PE. However, our goal is to provide a comprehensive review of issues to consider before, during, and after a PE. This paper highlights the core palliative skills of communication, planning, symptom assessment and management, and debriefing. Our aim is to better prepare healthcare workers to provide quality palliative care during PEs, most especially when facing future pandemics.

Spiritual distress: symptoms, quality of life and hospital utilisation in home-based palliative care.

OBJECTIVES: The purpose of this study was to use a spiritual screening question to quantify the prevalence of spiritual distress (SD) in a large cohort of seriously ill patients at admission to home-based palliative care (HBPC) and to examine the associations between SD with symptom burden, quality of life and hospital-based utilisation up to 6 months after admission to HBPC. METHODS: Data for this cohort study (n=658) were drawn from a pragmatic comparative-effectiveness trial testing two models of HBPC. At admission to HBPC, SD was measured using a global question (0-10-point scale: none=0; mild=1-4; moderate-to-severe=5+); symptoms and quality of life were measured with the Edmonton Symptom Assessment Scale (ESAS) and PROMIS-10. Hospital utilisation was captured using electronic records and claims. Median regression and proportional hazard competing risk models assessed the association between SD with symptoms and quality of life, and hospital utilisation, respectively. RESULTS: Nearly half of the patients/proxies reported some level of SD. Increasing SD was significantly associated with higher symptom burden (increase of 7-14 points on ESAS) and worse mental well-being (decrease of 2.7 to 4.6 points on PROMIS-10-mental) in adjusted models. Compared with patients/proxies who reported no SD, those with at least some level of SD were not at increased risk for hospital-based utilisation over a median follow-up period of 2 months. CONCLUSION: While SD is cross-sectionally associated with worse symptoms and mental well-being, it did not predict downstream hospital-based utilisation. Our results highlight the importance of assessing for and managing SD in patients with serious illness.

A Unique Case Report on Methadone Used for Treatment of Opioid-induced Hyperalgesia in a Cancer Patient at the End of Life.

Opioids are the cornerstone of palliative pain management. Opioids work on the mu-opioid receptor as an agonist for the treatment of pain. Repeated exposure to opioids over time can lead to undesired desensitization of the antinociceptive receptor while sensitizing the N-methyl-D-aspartate (NMDA) pathway, causing a paradoxical effect where the treatment of pain creates more sensitivity to certain stimuli. This phenomenon is known as opioid-induced hyperalgesia (OIH). Methadone, a synthetic opioid, may be more effective for pain and offers advantages over other opioids in specific clinical situations due to its partial antagonistic effect on the NMDA pathway. We describe a unique case where as needed (prn) and continuous intravenous (IV) methadone was effective in relieving OIH caused by high doses of IV Dilaudid for intractable cancer pain at the end of life. Given its unique pharmacokinetics, effective pain control, and the prevention of suffering from OIH, methadone should be considered earlier on in palliative pain management, especially in those patients predicted to require high levels of opioid dosing.

Cancer-related pain management in clinical oncology.

Uncontrolled pain is one of the most feared and debilitating symptoms among cancer patients, and many suffer unnecessarily from suboptimal pain control. Cancer-related pain is often multidimensional and can affect all aspects of a patient's life. Hence, achieving adequate pain relief among cancer patients involves a proper assessment of psychosocial, spiritual, and physical pain issues, matched with an individualized treatment plan involving pharmacologic, nonpharmacologic, and procedural therapies when appropriate. Providing effective pain relief can help ease the overall burden of disease among oncology patients while helping them tolerate cancer-directed therapies and achieve the most optimal quality of life throughout all phases of the disease continuum. In this review, the authors will discuss the syndromes, assessment of, and treatment for cancer-related pain in the outpatient setting.