The Evolving Roles and Expectations of Inpatient Palliative Care Through COVID-19: a Systematic Review and Meta-synthesis.

BACKGROUND: Palliative care performed a central role in responding to the systemic suffering incurred by the COVID-19 pandemic. Yet, few studies have elucidated the inpatient palliative care specialists' experiences and perceptions. OBJECTIVE: Systematically review and synthesize the evolving roles and expectations of inpatient palliative care specialists in response to COVID-19. DESIGN: A systematic review and meta-synthesis informed by Thomas and Harden's framework and Pozzar et al.'s approach was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. DATA SOURCES: MEDLINE, EMBASE, CINAHL, and PubMed were systematically searched for articles published between December 2019 and March 2023. We included all peer-reviewed qualitative and mixed-method literature studying the roles and expectations of inpatient palliative care specialists. A mixed-method appraisal tool was used for quality assessment. RESULTS: Of 3869 unique articles, 52 were included. Studies represented North American (n = 23), European (n = 16), South American (n = 4), Oceanic (n = 2), Asian (n = 2), West African (n = 1), Middle Eastern (n = 1), and inter-continental settings (n = 3). Most were reported in English (n = 50), conducted in 2020 (n = 28), and focused on the perspectives of inpatient palliative care clinicians (n = 28). Three descriptive themes captured the roles and expectations of inpatient palliative care specialists: shifting foundations, reorienting to relationships, and evolving identity. Two analytical themes were synthesized: palliative care propagates compassion through a healing presence, and palliative care enhances the systemic response to suffering through nimble leadership. CONCLUSION: Inpatient palliative care specialists responded to the COVID-19 pandemic by establishing their healing presence and leading with their adaptability. To develop institutionally tailored and collaborative responses to future pandemics, future studies are needed to understand how inpatient palliative care clinicians are recognized and valued within their institutions.

The use of outcome feedback by emergency medicine physicians: Results of a physician survey.

BACKGROUND: Feedback on patient outcomes is invaluable to the practice of emergency medicine but examples of effective forms of feedback have not been well characterized in the literature. We describe one system of emergency department (ED) outcome feedback called the return visit report (RVR) and present the results of a survey assessing physicians' perceptions of this novel form of feedback. METHODS: An Opinio web-based survey was conducted in 81 emergency physicians (EPs) at three EDs. RESULTS: Of the 81 physicians surveyed, 40 (49%) responded. Most participants indicated that they frequently review their RVRs (83%), that RVRs are valuable to their practice of medicine (80%), and that RVRs alter their practice in future encounters (57%). Respondents reported seeking other forms of outcome feedback including speaking with other EPs (83%) and reviewing discharge summaries of admitted patients (87%). There was no correlation between demographic data and use of RVRs. CONCLUSION: EPs value RVRs as a form of feedback. RVRs could be improved by reducing the observational interval and optimizing report relevance and differential weighting.

Who takes the lead hand? Correlates of handholding position in lesbian couples.

When couples hold hands, one partner must take the lead hand and the other the following hand position. As potential correlates or predictors of handholding positions within lesbian couples, this article explored differences in height, age, income, who initiated the relationship, who usually initiates sexual intimacy, previous history of partnership with a male, and who has the most "say" in decision-making. Data revealed only 2 significant variables: The taller partner was more likely to have the lead hand, and a woman who had previously been partnered with a male was more likely to take the trailing hand position.

The influence of political jurisdiction, age, and sex on handholding in public by same-sex couples.

Three hundred-forty lesbians and 62 gay males, largely from North America and in partnered relationships, completed online surveys that explored what handholding means to same-sex couples. The data suggest that lesbians in the United States are more likely now than » century ago to hold hands in public spaces. Younger lesbians are more likely to hold hands in public than older lesbians, and Canadian lesbians hold hands more often in public than American lesbians. In response to the question, "What does handholding mean to you?," 26% of the female respondents from North America overtly referred to public handholding as either a political act or a risky behavior. The number of comments of that nature was similar, regardless of whether the lesbians resided in the United States or Canada. Data suggest that full acceptance of same-sex couples in public spaces has not yet occurred, even in jurisdictions where same-sex couples have the same legal rights as heterosexual couples. Although the sample size for males was too small to analyze the influence of age or political jurisdiction on public handholding, males, in general, were significantly less likely than females to view handholding as a means of staying "connected" with their partners.