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.

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.

BACKGROUND: Although mobile health (mHealth) apps for tobacco cessation augment traditional cessation methods and have contributed to increases in cessation rates, Black adults are underrepresented in mHealth app studies for tobacco cessation. As a result, their mHealth app preferences are not well-known.

OBJECTIVE: Our goal was to identify features of mHealth apps for cessation that are important to Black adults who use tobacco products.

METHODS: We developed an online discrete choice experiment with 12 pairs of hypothetical mHealth apps for tobacco cessation. Inclusion criteria included being 21 years or older, current use of any tobacco product, and identifying as Black or African American. Participants had to be interested in tobacco cessation and have a history of mHealth app use or be willing to use one in the future. From each pair of hypothetical apps within the survey, participants had to choose the app they preferred. Each hypothetical app was made up of 7 features developed from existing mHealth literature and prior qualitative work: graphics, marketing, strategies for quitting, connection with others, personalization, benefits of quitting, and health information. Each feature had up to 4-5 levels (ie, variations of that attribute), and each hypothetical mHealth app was comprised of a random assortment of levels of features. Hierarchical Bayes estimation was used to determine the part-worth utility for each level within each feature for each participant, which was then used to calculate the importance score. Average importance scores across respondents were used to determine overall importance scores for each feature.

RESULTS: We had 901 adult participants. The mean age was 41 (SD 14.02) years, and about a third of participants (377/901, 42%) were female. Two-thirds of participants (549/901, 61%) had used an mHealth app in the past, and the great majority (786/901, 87%) indicated a willingness to use an app for health purposes in the future. The features had the following importance: graphics (16%), marketing (15%), strategies for quitting (15%), connection with others (14%), personalization (13%), benefits of quitting (13%), and health information (13%). Within features, strategies for quitting had the highest and third-highest levels of "making a step-by-step quit plan" and "recommendations to manage relapse or withdrawal," respectively. Marketing had the second-highest level of "Historically Black Colleges and Universities-endorsed app." Graphics had the fourth-highest level of "short video testimonials from people who successfully quit," while connection with others had the fifth-highest level of "quit buddy program for support and accountability."

CONCLUSIONS: This study identified features of mHealth apps important to Black adult tobacco users. To enhance the appeal of mHealth apps to such adults, prioritizing inclusion of highly preferred levels in apps may lead to higher use and improved cessation.

PURPOSE: To explore patterned processes of identity transformation among Chinese women living with breast cancer.

METHOD: An interpretive description qualitative study was conducted using in-depth narrative interviews with 18 Chinese women. Participants were recruited from multiple provinces across China through a tertiary oncology department and a survivor-led non-profit organization. Purposive and snowball sampling were used. Data were collected between June 2024 and March 2025 and analyzed using Braun and Clarke's reflexive thematic analysis (RTA).

RESULTS: Four themes and twelve subthemes were identified, capturing women's experiences of identity transformation following breast cancer: Identity Fracture at Diagnosis, Awakening of the Inner Self, Active Reconstruction of Self, and Identity Integrating and Expanding. This process was characterized by a dynamic pattern of attention reorientation, shifting from habitual other-focused absorption shaped by caregiving expectations, to forced and intentional self-focused attention, and in some narratives, to a meaning-driven re-engagement with others.

CONCLUSIONS: Breast cancer survivorship among Chinese women involves more than physical recovery. Women described ongoing processes of meaning reconstruction and identity realignment. Attention reorientation provides a culturally grounded explanation mechanism for understanding how women navigate identity reconstruction. These findings underscore the importance of attention-informed and culturally responsive nursing care that supports identity reconstruction and psychosocial adaptation across the survivorship continuum.

BACKGROUND: Utilization of targeted agents and immunotherapy led to improved survival in women with metastatic breast cancer (MBC). However, a knowledge gap remains about the side effects and symptom burden associated with these therapies that are not fully described for people living with MBC. We examined patient-reported symptom severity, interference, and symptom burden related to MBC cancer treatments and identified correlated sociodemographic and clinical factors.

METHODS: This is a cross-sectional study. Women with MBC on systemic cancer treatment recruited from oncology clinics and advocacy organizations completed a survey from February to September 2024. We used the MD Anderson Symptom Inventory (MDASI) Immunotherapy module to describe symptom severity and interference of 20 symptoms and symptom burden. We conducted descriptive statistics and stepwise multiple linear regression to identify sociodemographic and clinical factors correlated with symptom severity, interference, and symptom burden.

RESULTS: In the sample of 209 participants, the mean age was 50.11 years (SD = 14.12); 76.6% were White. Most were HR+/HER2- subtype, with an average time of 4.35 years since MBC diagnosis. Fatigue, sleep disturbance, forgetfulness, drowsiness, and sadness were the most prevalent symptoms. Participants identified as non-White, have completed more lines of treatments reported higher symptom severity, interference, and total symptom burden. However, having dependent children (β = 0.32, 95% CI [0.04, 0.60], P = 0.027) was associated with more severe symptom interference.

CONCLUSION: The type and number of treatments, being non-White and caring for dependent children, were associated with a higher symptom burden. Symptom management interventions should be tailored for a specific MBC subgroup and to improve overall well-being for the MBC population.

BACKGROUND: Patients, particularly those at the end of their lives, frequently receive goal-discordant care, and their surrogate decision-makers suffer long-term psychological injury. Contributors to these issues may include infrequent communication between clinicians and surrogates, failure to discuss prognosis, values, and treatment options that include comfort-focused care, and surrogates facing high-stakes decision-making while underprepared and overwhelmed psychologically and emotionally.

DESIGN: This is a multicenter, patient-randomized efficacy trial of a multi-component intervention, versus usual care, for 370 incapacitated, critically ill adults at high risk of death or severe disability, and their surrogate decision-makers, from 7 hospitals across the United States.

INTERVENTION: The intervention combines surrogate utilization of a digital Family Support Tool (FST) in real-time during their loved one's hospitalization with proactively scheduled family meetings, for which both surrogates and clinicians receive additional preparation, at set intervals during the ICU hospitalization. Those in the control arm will receive usual ICU care.

OUTCOMES: Our primary outcome is patient-centeredness of care, measured using the modified Patient Perceived Patient-Centeredness of Care (PPPC) scale. Secondary outcomes include surrogates' psychological symptom burden, communication and decision quality, and patients' health resource utilization and clinical outcomes.

CONCLUSION: This trial will provide robust evidence about the impact of combining the FST with increased and intentional communication, on patient, family, and health system outcomes for those hospitalized in the ICU.

While primary invasive lobular carcinoma (ILC) is well characterized, metastatic ILC remains understudied. Within the post-mortem tissue donation programs, UPTIDER (Belgium) and Hope for Others (USA), we first aimed to explore intra-patient heterogeneity of key prognostic and predictive markers (stromal tumor-infiltrating lymphocytes (sTIL), estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2) and KI67). Secondly, we compared detection of the metastases by pathology on autopsy samples versus pre-mortem imaging. In total, 306 metastases from 12 patients were collected at autopsy (median: 27 per patient). Both primary tumors (n = 15) and metastases (n = 232) had low sTIL levels, with a median of 2% (range: 0.67-6.67%) and 0.67% (range: 0-13.33%), respectively. Regression models showed lower ER- and PR-expression in metastases (respectively, n = 265 and n = 64) compared to primary tumors (both p < 0.01). KI67 was significantly higher in metastases (n = 262, p = 0.02). HER2-low metastases were found in all but one patient although in varying proportion of metastases (range: 7.5-100%). Central radiology and pathology review had a median concordance of 78% at organ level (range: 33.33-100%) and 71% at patient level (range: 55.88-85.29%). Our findings suggest that a single metastatic biopsy has great limitations to guide treatment and that more adequate methods are needed to detect and monitor ILC metastases.