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OBJECTIVE: Characterize key factors and training needs of U.S. cancer centers in implementing family caregiver support services. METHODS: Sequential explanatory mixed methods design consisting of: (1) a national survey of clinicians and administrators from Commission-on-Cancer-accredited cancer centers (N = 238) on factors and training needed for establishing new caregiver programs and (2) qualitative interviews with a subsample of survey respondents (N = 30) to elicit feedback on survey findings and the outline of an implementation strategy to facilitate implementation of evidence-based family caregiver support (the Caregiver Support Accelerator). Survey data was tabulated using descriptive statistics and transcribed interviews were analyzed using thematic analysis. RESULTS: Top factors for developing new caregiver programs were that the program be: consistent with the cancer centers mission and strategic plan (87%), supported by clinic leadership (86.5%) and providers and staff (85.7%), and low cost or cost effective (84.9%). Top training needs were how to: train staff to implement programs (72.3%), obtain program materials (63.0%), and evaluate program outcomes (62.6%). Only 3.8% reported that no training was needed. Qualitative interviews yielded four main themes: (1) gaining leadership, clinician, and staff buy-in and support is essential; (2) cost and clinician burden are major factors to program implementation; (3) training should help with adapting and marketing programs to local context and culture; and (4) the Accelerator strategy is comprehensive and would benefit from key organizational partnerships and policy standards. CONCLUSION: Findings will be used to inform and refine the Accelerator implementation strategy to facilitate the adoption and growth of evidence-based cancer caregiver support in U.S. cancer centers.

Objective: Characterize key factors and training needs of U.S. cancer centers in implementing family caregiver support services. Methods: Sequential explanatory mixed methods design consisting of: (1) a national survey of clinicians and administrators from Commission‐on‐Cancer‐accredited cancer centers (N = 238) on factors and training needed for establishing new caregiver programs and (2) qualitative interviews with a subsample of survey respondents (N = 30) to elicit feedback on survey findings and the outline of an implementation strategy to facilitate implementation of evidence‐based family caregiver support (the Caregiver Support Accelerator). Survey data was tabulated using descriptive statistics and transcribed interviews were analyzed using thematic analysis. Results: Top factors for developing new caregiver programs were that the program be: consistent with the cancer center's mission and strategic plan (87%), supported by clinic leadership (86.5%) and providers and staff (85.7%), and low cost or cost effective (84.9%). Top training needs were how to: train staff to implement programs (72.3%), obtain program materials (63.0%), and evaluate program outcomes (62.6%). Only 3.8% reported that no training was needed. Qualitative interviews yielded four main themes: (1) gaining leadership, clinician, and staff buy‐in and support is essential; (2) cost and clinician burden are major factors to program implementation; (3) training should help with adapting and marketing programs to local context and culture; and (4) the Accelerator strategy is comprehensive and would benefit from key organizational partnerships and policy standards. Conclusion: Findings will be used to inform and refine the Accelerator implementation strategy to facilitate the adoption and growth of evidence‐based cancer caregiver support in U.S. cancer centers. [ABSTRACT FROM AUTHOR]

Patients with cancer and their families comprise a significant population served by palliative care. Close collaboration between oncology clinicians and palliative care teams has demonstrated improved patient-centered care, especially when this care is integrated early in the course of the disease. The American Society of Clinical Oncology recently released their updated clinical practice guidelines for palliative care in oncology, which provide new opportunities for collaboration to expand the scope of care. [ABSTRACT FROM AUTHOR]

1. Utilizing the ISPEC curriculum and case-based demonstration, participants will self-report the ability to define spiritual distress and recognize components of spiritual assessment. 2. Utilizing an established experiential exercise, participants will self-report the ability to reflect on their own spirituality as part of their clinical practice, and their own well-being and call to serve. Spiritual care, an essential domain of Palliative Care, is increasingly recognized as an equal aspect of patient-centered, whole person care. The ISPEC curriculum is a resource for spiritual care training and clinician self-care. The Interprofessional Spiritual Care Curriculum (ISPEC), offered since 2018, is an evidence-informed curriculum to train interdisciplinary health teams to recognize and attend to the spiritual needs of seriously or chronically ill patients. Addressing spiritual and religious issues is essential to DEI and fundamental to respectful care. Based on the generalist-specialist spiritual care model, clinician-chaplain pairs attend ISPEC to learn content, teaching, and leadership skills. To date, over 500 attendees from 29 countries have participated in ISPEC. With increasing physician suicides and nurse burnout, attendees note how ISPEC reconnects them to their sense of meaning and purpose. Participants have the opportunity, through reflection on their patient encounters, to develop their inner resources. In this session, we will teach key concepts from the six-module ISPEC curriculum, with particular focus on spiritual distress, spiritual assessment, and clinician well-being. ISPEC is designed to meet the critical need to educate clinicians to provide spiritual care in clinical settings. Teaching methods include content from the ISPEC curriculum, case presentations, discussion, and experiential exercises. Attendance at three recent courses included 53% clinicians and 45% chaplains. Course participants' (N=113) overall course ratings were 27% as very good and 69% as excellent. Individual module ratings were 32% rated as very good and 55% as excellent. Along with reporting an increase in skill and confidence in providing spiritual care, ISPEC participants report the course also impacts them on a personal level. ISPEC can serve as a model for organizations as they strive to improve spiritual care, practiced by clinicians and chaplains, as essential to an overall QI effort in palliative care. Managing Suffering and Distress / Existential / Humanities / Spirituality / Religion [ABSTRACT FROM AUTHOR]

Aim Design Methods Results Conclusion Impact and Implications for the Profession Reporting Method Patient/Public Contribution To explore (1) perspectives and attitudes of Native Americans regarding transitions from serious illness to death, and (2) awareness about hospice and palliative care service models in a Great Plains reservation‐based community.Qualitative descriptive study.Community members and clinicians were invited to participate in a semi‐structured focus group or interview by Tribal Advisory Board members. Analysis involved three phases: (1) qualitative descriptive analysis of preliminary themes using the Addressing Palliative Care Disparities conceptual model; (2) a cultural review of the data; and (3) reflexive thematic analysis to synthesize findings.Twenty‐six participants engaged in two focus groups (n = 5–6 participants in each) and interviews (n = 15). Four themes were derived from their stories: (1) family connectedness is always priority; (2) end‐of‐life support is a community‐wide effort; (3) everyone must grieve in their own way to heal; and (4) support needs from outside the community.Findings highlight cultural considerations spanning the life course. Clinicians, researchers and traditional wisdom keepers and practitioners, particularly those working in rural and/or reservation‐based settings, must provide culturally safe care. This must include acknowledging and prioritizing the needs and preferences of Native American patients and the impact on their families and communities.Leveraging community assets, such as family and social networks, is key for supporting Native American patients with serious illnesses. Additionally, facilitating greater family and caregiver involvement along a patient's care trajectory may be a pathway for easing health care workers' caseloads in reservation‐based areas, where resources are limited.The Consolidated Criteria for Reporting Qualitative Research (COREQ) guideline was used.The study was ideated based on community insight. Tribal Advisory Board members oversaw all aspects including recruitment, data acquisition, interpretation of findings and tribal data dissemination. [ABSTRACT FROM AUTHOR]

Background: Spiritual care is a core component of high-quality palliative care, yet gaps exist in spiritual care provision. Understanding clinicians' levels of confidence around spiritual care and their perceptions of necessary knowledge/skills to enhance their ability to provide spiritual care is foundational for improving delivery of spiritual care in practice., Objectives: To understand confidence levels with providing spiritual care and perceived needs in relation to the provision of spiritual care among palliative clinicians (nurses, social workers, chaplains)., Design: N = 260 clinicians participating in interprofessional communication and end-of-life care training programs completed a structured survey., Measurements: Clinicians responded to 42 closed-ended questions assessing their confidence in engaging in spiritual care across 6 dimensions, and one open-ended question: "What areas of knowledge or skill would best help to improve your ability to provide spiritual care across diverse populations?", Results: Findings reveal varied levels of confidence with spiritual care across dimensions. Chaplains reported the highest levels of confidence compared with nurses and social workers. Key areas of knowledge/skills to improve spiritual care provision were: (1) Training and support for clinicians in spiritual care; (2) Strategies for providing spiritual care to patients from diverse cultural and/or religious backgrounds; (3) Better understanding of specific populations and contexts that may affect spiritual care provision; and (4) Clinicians' personal growth & practices to improve spiritual care., Conclusions: Additional support with spiritual care provision is needed, especially among spiritual care generalists. A focus on culturally attuned care is needed, honoring unique patient contexts and centering patient and family priorities., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Patients with secondary metastatic involvement of the musculoskeletal system due to primary cancers are a rapidly growing population with significant risks for health-related end-of-life morbidities. In particular, bone metastases or metastatic bone disease (MBD) imparts significant adversity to remaining quality of life. No rigorous review of clinical trials on the use of supportive care interventions for MBD has been conducted. The objective of this review was to examine the characteristics of supportive care interventions for MBD and critically appraise study designs, key findings, and quality of evidence of the research., Methods: We searched for published clinical trials, systematic reviews and meta-analyses in PubMED, CINAHL and Google Scholar for articles published between September 2017 and September 2022. Some examples of Medical Subject Headings terms were: 'secondary neoplasm', 'metastatic bone disease', 'palliative care' and 'supportive care intervention'. Quality of published evidence was evaluated based on treatment types and study design., Results: After reviewing 572 publications, 13 articles were included in the final review and evaluation including seven clinical trials, two trial protocols and four systematic reviews. Feasible interventions included enhanced palliative care consultation, palliative radiotherapy and alternative medicines. Interventions addressed primary endpoints of fatigue (N=4, 31%), pain (N=3, 23%) or cancer-related symptoms (N=3, 23%) with patient-reported outcome instruments. No interventions reported on fracture complications or endpoints, specifically. The quality of most studies was moderate to strong., Conclusion: Supportive care interventions for MBD are feasible and the impact is measurable via patient-reported outcome measures. While the evidence for interventions was moderate to strong, there are very few specific controlled trials for skeletal-related events and impacts of social determinants of health. Further clinical trials are needed to define supportive care interventions for MBD that demonstrate reduced risk of fracture and that mitigate the reduced quality of life when negative musculoskeletal outcomes arise., Competing Interests: Competing interests: AF is supported in part by the UC Davis Paul Calabresi Career Development Program for Clinical Oncology funded by the National Cancer Institute/National Institutes of Health (5K12-CA138464)., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)