Publications

• Conservative Management is customized CKD care, symptom management, and support to navigate care across the CKD trajectory through end of life.
• Conservative management is defined by shared decision-making and interdisciplinary teamwork in alliance with patients and care partners.
• Implementation of conservative management hinges on each practice's logistical considerations and resource availability.

Conservative management is holistic and whole-person care for people with kidney failure. This care pathway is often a good choice for patients who prioritize independence, quality of life, and avoidance of burdens associated with life prolonging therapies such as dialysis. This Kidney Health Guidance document aims to provide evidence-based clinical guidance for best practices in conservative management care delivery. Conservative management comprises three components including customized CKD care, symptom management, and smooth navigation of care transitions. This Kidney Health Guidance describes the application of these three components across the illness trajectory, including the role of shared decision-making, care partner engagement, and interdisciplinary collaboration. Practical strategies are outlined for health care professionals to integrate conservative management care delivery into practice.

Early life adversity confers lifelong health risk, and mindfulness-based interventions (MBIs) show promise for mitigating risk. This trial evaluated feasibility and acceptability of remote mindfulness and coping interventions among emerging adults who recalled childhood trauma with the goal to inform an efficacy trial examining stress-related health outcomes. Eighty-one healthy adults (ages 18–29) who recalled physical, emotional, or sexual abuse during childhood were enrolled. Participants were randomly assigned to 2-week mindfulness or coping comparison interventions and completed lab-based and ambulatory assessments at preintervention, postintervention, and one-month follow-up. Primary outcomes included measures of feasibility and acceptability. Global psychosocial outcomes were secondary. Enrollment and retention targets were reached; of 891 people recruited, 81 were eligible and enrolled, and 88% completed the trial. The intervention programs met benchmarks for feasibility, acceptability, and safe implementation. Participants completed 95% of intervention lessons and 59% of daily life practice prompts, and 93% reported positive treatment expectancies. Three mindfulness participants (8%) showed substantial increases in mental health symptoms. No serious adverse events were reported, but 53% of participants had challenging emotional experiences during the training. The assessment protocol was feasible, with 87% of ambulatory assessments and 99% of blood samples collected. There were no group differences on feasibility/acceptability outcomes. Participants in both groups showed medium-sized improvements on global mental health and mindfulness measures. Two-week remote mindfulness and control interventions were feasible and acceptable among adults exposed to childhood trauma. Further work is warranted to evaluate whether MBIs can offset health risk.

Despite numerous calls to action, palliative care remains inadequately integrated into pulmonary–critical care medicine (PCCM) practice and is de-emphasized in PCCM education. Barriers to specialty palliative care demonstrate a clear need for efficient and effective primary palliative care delivered by PCCM clinicians with advanced training. This American Thoracic Society Workshop Report builds on our policy statement on the proactive integration of palliative care in serious respiratory illness with 2 goals: (1) Develop a scalable “PalliPulm” framework to improve palliative care education and practice in PCCM and (2) inform palliative care–focused education and training programs in PCCM to guide future initiatives. We convened an interdisciplinary and interprofessional group of experts between May 2024 and February 2025 over 4 phases: (1) hybrid workshop; (2) virtual breakout groups; (3) nominal group technique and rapid qualitative analysis; and (4) workshop report development. We identified core primary palliative care skills that PCCM trainees and clinicians should obtain and prioritized the most essential skills—that is, symptom management, serious illness communication, and caregiver support in ambulatory settings and serious illness communication, symptom management, palliative care fundamentals, and end of life care in inpatient settings. We describe pragmatic ways to integrate palliative care into PCCM education and offer advanced educational resources. We provide recommendations for framing palliative care to patients and caregivers, illustrate ways to deliver culturally appropriate palliative care, and offer a path for the future of PalliPulm. This report guides PCCM leaders, trainees, and clinicians to establish scalable PalliPulm educational and practice initiatives and improve its integration into practice.

Eating disorders (ED), particularly anorexia nervosa (AN), represent high-morbidity, high-mortality psychiatric illnesses with multisystem medical complications, frequent relapse, and substantial caregiver burden. As palliative care (PC) clinicians increasingly encounter patients with severe and enduring ED, they may be asked to help manage complex symptom distress, navigate treatment refusals, support families, and participate in values-based goals of care discussions amid prognostic uncertainty. At the same time, the emerging and contested discourse around "terminal anorexia nervosa" underscores the need for careful clinical reasoning, nuanced capacity assessment, and ethically rigorous, interdisciplinary deliberation. In this article, an interdisciplinary group of PC, psychiatry, psychology, and eating-disorder specialist clinicians presents a practical "Top Ten Tips" framework to support real-world care. Tips emphasize early recognition of countertransference and moral distress, medical severity assessment and refeeding risk, trauma-informed and harm-reduction approaches, task-specific decision-making capacity evaluations, communication strategies that prioritize values and meaning over labels, and collaboration with eating-disorder specialty teams, ethics consultation, and community resources. We aim to provide actionable guidance that strengthens PC clinicians' confidence and consistency when caring for patients with severe EDs.

BACKGROUND: Cancer care increasingly emphasizes holistic, patient-centered support across the disease trajectory; however, many health systems lack sufficient resources to address patients' physical, psychosocial, and logistical care needs, particularly in under-resourced settings. Patient navigation, delivered by trained non-clinician, peer, or community-based navigators, has demonstrated effectiveness in improving cancer screening and treatment initiation, yet its role in addressing the ongoing health and related care needs of people living with cancer remains less well characterized.

METHODS: This scoping review aimed to synthesize peer-reviewed and gray literature evaluating patient navigation interventions focused on the care needs of people living with cancer to summarize program characteristics, facilitators, and barriers. A search of Ovid MEDLINE (1990-June 2024) identified 4300 records.

RESULTS: Following rigorous screening and data extraction, 17 studies met the inclusion criteria. Most studies were conducted in the United States (88%), and over half employed randomized or cohort designs. Navigation programs varied widely in patient populations, cancer types, intervention duration, delivery modality, and navigator training and roles. Nearly half of the studies targeted under-resourced or marginalized populations. Interventions commonly addressed unmet needs, symptom management, care coordination, survivorship, palliative and end-of-life care, insurance, or psychosocial support. Across heterogeneous outcomes, most studies reported statistically significant improvements in patient-reported outcomes (e.g., quality of life, self-efficacy, psychosocial well-being), navigation process outcomes (e.g., satisfaction, feasibility, navigator-patient relationships), and, less frequently, health-related outcomes such as health care access and utilization. Key facilitators included strong institutional infrastructure, integration within oncology teams, flexible and accessible delivery, cultural responsiveness, and robust navigator training and supervision. Barriers included limited perceived need among lower-acuity patients, role ambiguity, technological challenges, insufficient follow-up, reimbursement constraints, and mismatches between program intensity and patient or caregiver needs.

CONCLUSIONS: Findings highlight the importance of flexible, relationship-centered, and well-integrated patient navigation models and underscore the need for standardized training, sustainable reimbursement, and patient-driven programs designed to optimize impact and equity.

Oncology Advanced Practice Providers (APPs) including Advanced Practice Registered Nurses, Physician Assistants, and Clinical Pharmacists (CPs), play a vital role in delivering high-quality, patient-centered cancer care across the United States. Despite their widespread presence in oncology practices, APPs remain underutilized in cancer clinical research, representing a missed opportunity to expand trial access and improve patient outcomes. Clinical trials are essential to advancing oncology care, yet participation remains critically low among adult patients. Given Oncology APPs' and CPs' central role in cancer care delivery, their meaningful engagement in oncology clinical trial research is imperative as the standard of oncology care. This position paper, with contributions from five professional societies, presents solutions and resources to barriers limiting APPs' and CPs' involvement in cancer clinical research, including gaps in education, role expectations, limited protected time, restrictive policies, insufficient financial support, and under-recognition of contributions. Integrating APPs and CPs more fully into the clinical research enterprise is essential to improving trial access, patient outcomes, closing equity gaps, and accelerating innovation in oncology care.

BACKGROUND: Breast cancer survivors (BCS) experience persistent physical and psychological effects after treatment, with racially diverse groups demonstrating lower adherence to cancer-specific resistance exercise guidelines. Online resistance exercise interventions show promise for enhancing accessibility and health outcomes among BCS. However, evidence regarding their feasibility of implementation remains limited. Yet, such information is critical for assessing scalability and implementation in non-laboratory settings.

PURPOSE: Using the RE-AIM (reach, efficacy, adoption, implementation, and maintenance) framework, this study evaluated the reach, efficacy, adoption, and implementation of a 12-week, supervised, online resistance exercise intervention for racially diverse BCS.

METHODS: A mixed methods approach with a pre-post-study design was used. Quantitative outcomes included sociodemographic representativeness (reach), physical function (efficacy), and session fidelity (implementation). Qualitative interviews examined participant experiences, barriers, and facilitators (adoption).

RESULTS: The intervention enrolled a racially diverse BCS sample (N = 47; 57.4% White, 23.4% Black, 14.8% Asian) that was mostly representative of the host institution catchment area, though participants had higher education levels. The intervention group demonstrated statistically significant improvements in upper- (P = .009) and lower-body physical function (P = .003) versus control, only. Adoption facilitators included program convenience, accessibility of online delivery, and trainer support, while barriers were equipment challenges, competing priorities, and cancer-related side effects. Program implementation fidelity was high for core components.

CONCLUSIONS: Key factors contributed to the feasibility of implementation of the intervention. Future remote exercise interventions should address equipment needs, individualized support, and tailored recruitment to enhance adoption and facilitate scalability in non-laboratory settings.

CLINICAL TRIAL INFORMATION: The Clinical Trials Registration #NCT04562233.

BACKGROUND: To investigate the cumulative impact of individual- and neighborhood-level social determinants of health (SDoH) on patient-reported outcome measures (PROMs) among head and neck cancer (HNC) survivors.

METHODS: Among 93 survivors who underwent radiotherapy, associations between SDoH (independently and in a composite score) and validated PROMs were analyzed using univariable and multivariable regression models.

RESULTS: For every 1-point increase in the composite SDoH score, indicating an increase in the number of adverse individual- and neighborhood-level factors, physical QoL decreased by 2.92 points (p = 0.010) and depression severity increased by 0.62 points (p = 0.018). Higher neighborhood deprivation and Medicaid/no insurance were associated with worse physical and social-emotional QoL, depression severity, and anxiety severity. Higher neighborhood deprivation was also associated with worse neck disability.

CONCLUSION: Accumulating adverse individual- and neighborhood-level SDoH collectively increase the risk of poorer PROMs. Multilevel SDoH interventions are needed to improve health outcomes and promote equitable care in HNC.

BACKGROUND: As syphilis cases increase across the U.S., the emergency department (ED) has emerged as a critical venue for screening. However, little is known about the current ED screening landscape. This study aims to evaluate the national landscape of ED syphilis screening, identify barriers to implementation, and characterize existing infrastructure that may support expansion of syphilis screening in the ED.

METHODS: Electronic surveys were distributed via email to 281 institutions with emergency medicine residency programs. Survey responses were also solicited from institutions both with and without residency programs utilizing relevant professional society listservs and in-person conference recruitment from October 2023 through May 2024. Responses were summarized using descriptive statistics and stratified by hospital type.

RESULTS: A total of 138 unique EDs responded (105 academic, 33 non-academic). Systematic syphilis screening was reported by only 12.6% of EDs and was more frequent in academic centers. Most screening protocols were risk-based; universal screening was rare. HIV screening programs were present in 60.0% of academic and 30.3% of non-academic EDs. Most EDs relied on designated staff for result review and patient notification, but more than one-quarter reported no defined treatment location for syphilis. Commonly cited facilitators to screening included standardized guidelines, electronic medical record integration, and additional staffing, while major barriers included time constraints, limited resources, and challenges with follow-up.

CONCLUSIONS: Despite rising syphilis rates, ED-based syphilis screening remains uncommon. Existing HIV and sexually transmitted infection screening and treatment infrastructure may provide a foundation for expanding syphilis screening through operationally feasible, guideline-supported approaches.