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Buehler NJ, Frydman JL, Morrison RS, Gelfman LP. An Update: National Institutes of Health Research Funding for Palliative Medicine 2016-2020. J Palliat Med 2023; 26:509-516. [PMID: 36306522 PMCID: PMC10066773 DOI: 10.1089/jpm.2022.0316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2022] [Indexed: 01/27/2023] Open
Abstract
Background: The evidence base to support palliative care clinical practice is inadequate and opportunities to improve the evidence base remain despite the field's rapid growth. Objective: The aim of this study was to examine current National Institutes of Health (NIH) funding of palliative medicine research and trends over time. Design: We sought to identify NIH funding of palliative medicine (2016-2020) in two stages: (1) we searched the NIH grant database, RePORTER, for grants with the keywords, "palliative care," "end-of-life care," "hospice," and "end of life," and (2) identified palliative care researchers likely to have secured NIH funding using three strategies. Methods: We abstracted (1) the first and last authors' names from original investigations published in major palliative medicine journals from 2016 to 2018; (2) names from a PubMed-generated list of original articles published in major medicine, nursing, and subspecialty journals using the above keywords; and (3) palliative medicine journal editorial board members and members of key palliative medicine initiatives. We cross-matched the pooled names against NIH grants funded from 2016 to 2021. Results: A crosswalk analysis of the author search and NIH RePORTER search identified 1658 grants. Of those, 541 were categorized as relevant to palliative medicine, which represented 419 unique principal investigators (mean of 1.34 grants per investigator). Compared with 2011-2015, the number of NIH-funded grants increased by 25%, NIH dollars increased by 35%, and the distribution of grant types remained stable. Conclusions: Despite the challenging NIH funding climate, the number of NIH grants and funding to palliative care have increased. Given the increased funding allocation toward Alzheimer's dementia and related dementia research at the congressional level, this increase in funding reflects this funding allocation and does not represent overall growth. Dedicated federal funding for palliative care research remains critical to grow the evidence base for persons living with serious illnesses and their families.
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Affiliation(s)
| | - Julia L. Frydman
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - R. Sean Morrison
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- The National Palliative Care Research Center, New York, New York, USA
- Geriatric Research Education and Clinical Center, James J. Peters VA Medical Center, Bronx, New York, USA
| | - Laura P. Gelfman
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Geriatric Research Education and Clinical Center, James J. Peters VA Medical Center, Bronx, New York, USA
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2
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Rosenberg AR, Barton K, Junkins C, Scott S, Bradford MC, Steineck A, Lau N, Comiskey L, Yi-Frazier JP. Creating a Resilient Research Program-Lessons Learned From a Palliative Care Research Laboratory. J Pain Symptom Manage 2020; 60:857-865. [PMID: 32621950 PMCID: PMC7328580 DOI: 10.1016/j.jpainsymman.2020.06.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/22/2020] [Accepted: 06/24/2020] [Indexed: 12/03/2022]
Abstract
Conducting palliative care research can be personally and professionally challenging. Although limitations in funding and training opportunities are well described, a less recognized barrier to successful palliative care research is creating a sustainable and resilient team. In this special report, we describe the experience and lessons learned in a single palliative care research laboratory. In the first few years of the program, 75% of staff quit, citing burnout and the emotional tolls of their work. To address our sustainability, we translated resilience theory to practice. First, we identified and operationalized shared mission and values. Next, we conducted a resilience resource needs assessment for both individual team members and the larger team as a whole and created a workshop-based curriculum to address unmet personal and professional support needs. Finally, we changed our leadership approach to foster psychological safety and shared mission. Since then, no team member has left, and the program has thrived. As the demand for rigorous palliative care research grows, we hope this report will provide perspective and ideas to other established and emerging palliative care research programs.
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Affiliation(s)
- Abby R Rosenberg
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA; Cambia Palliative Care Center of Excellence at the University of Washington, Seattle, Washington, USA; Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA.
| | - Krysta Barton
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Courtney Junkins
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Samantha Scott
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA; Department of Psychology, University of Denver, Denver, Colorado, USA
| | - Miranda C Bradford
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA; Children's Core for Biomedical Statistics, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Angela Steineck
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA; Cambia Palliative Care Center of Excellence at the University of Washington, Seattle, Washington, USA; Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Nancy Lau
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA; Cambia Palliative Care Center of Excellence at the University of Washington, Seattle, Washington, USA; Department of Psychiatry and Behavioral Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Liam Comiskey
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Joyce P Yi-Frazier
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA
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3
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Mehta AK, Patel R, Patel D, Davis MP. Trends in Published Palliative Care Research: A 15-Year Review. Am J Hosp Palliat Care 2020; 38:489-493. [PMID: 32705878 DOI: 10.1177/1049909120944863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND There has been a call for palliative care (PC) published research to support the impact and need for more specialty PC services. OBJECTIVE The purpose of this study was to characterize research in PC over a 15-year period in 3 PC journals published in the United States. DESIGN The authors reviewed every issue of the Journal of Pain and Symptom Management, Journal of Palliative Medicine, and American Journal of Hospice and Palliative Medicine from 2004 through 2018. Studies included were original articles and brief reports. Study type (qualitative, quantitative), author (first and last), gender, and professional degree of the author (first and last) were recorded. RESULTS A total of 4881 articles were included in this study. The proportion of quantitative papers significantly increased across 3 time points from 63% to 67% to 78%. The proportion of women first authors increased across all 3 time points (54%, 2004-2008; 57%, 2009-2013; 60%, 2014-2018), and the proportion of women last authors increased across all time points (38%, 2004-2008; 44%, 2009-2013; 46%, 2014-2018). More than 40% of authors were physicians. CONCLUSIONS Published PC studies are increasingly quantitative in design. Gender authorship is female dominant for the first authors and increasingly equal across genders for the last authors.
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Affiliation(s)
- Ambereen K Mehta
- Palliative Care Program, 8783 University of California, Los Angeles Medical Center, CA, USA
| | - Rishi Patel
- Palliative Care Program, 8783 University of California, Los Angeles Medical Center, CA, USA.,Comprehensive Blood & Cancer Center, Bakersfield, CA, USA
| | - Dheer Patel
- 1259University of Michigan, Ann Arbor, MI, USA
| | - Mellar P Davis
- Department of Palliative Care, Geisinger Medical Center, Danville, PA, USA
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4
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Kross EK, Rosenberg AR, Engelberg RA, Curtis JR. Postdoctoral Research Training in Palliative Care: Lessons Learned From a T32 Program. J Pain Symptom Manage 2020; 59:750-760.e8. [PMID: 31775020 PMCID: PMC7029795 DOI: 10.1016/j.jpainsymman.2019.11.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 11/08/2019] [Accepted: 11/11/2019] [Indexed: 12/20/2022]
Abstract
Our aging population and advances in chronic disease management that prolong the time that patients live with a chronic illness have combined to create an enormous need for improved palliative care research across diverse diseases. In this article, we describe the structure and processes of a National Institutes of Health-funded T32 postdoctoral research fellowship at the University of Washington and our experiences in developing and implementing the program. We recognize a broad definition of palliative care research, including research focused on improving quality of life, minimizing symptoms, providing psychological and spiritual support, and improving communication about patients' values and goals of care, all in the context of a serious illness. We describe our four core principles for postdoctoral training in palliative care research, each with a number of specific approaches: 1) mastering a set of essential content and research skills; 2) structured mentoring and academic career development; 3) creating and supporting early success; and 4) interdisciplinary training and team science. In addition, we also describe our framework for the essential competencies necessary for a palliative care research training program, our methods for identification and selection of applicants, our outcomes to date, and our processes of continuous quality assessment and improvement. Our goal is to describe our successful postdoctoral research training program in palliative care to promote development of new programs and share information between programs to continue to build the field of collaborative and interdisciplinary palliative care research.
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Affiliation(s)
- Erin K Kross
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Abby R Rosenberg
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA; Division of Hematology/Oncology, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Ruth A Engelberg
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - J Randall Curtis
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA.
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5
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Lanzel AF, Lavery JV. Unintended Consequences of the Right to Try Act for Palliative Care in Pediatric Oncology. JAMA Oncol 2020; 5:603-604. [PMID: 30844025 DOI: 10.1001/jamaoncol.2018.7201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Ashley F Lanzel
- Center for Ethics, The Aflac Cancer and Blood Disorders Center, Emory School of Medicine, Emory University, Atlanta, Georgia
| | - James V Lavery
- Hubert Department of Global Health, Rollins School of Public Health, and Center for Ethics, Emory University, Atlanta, Georgia
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6
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Disproportionally low funding for trauma research by the National Institutes of Health: A call for a National Institute of Trauma. J Trauma Acute Care Surg 2019; 88:25-32. [DOI: 10.1097/ta.0000000000002461] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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7
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Cross SH, Kamal AH, Taylor DH, Warraich HJ. Hospice Use Among Patients with Heart Failure. Card Fail Rev 2019; 5:93-98. [PMID: 31179019 PMCID: PMC6545999 DOI: 10.15420/cfr.2019.2.2] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 03/26/2019] [Indexed: 12/11/2022] Open
Abstract
Despite its many benefits, hospice care is underused for patients with heart failure. This paper discusses the factors contributing to this underuse and offers recommendations to optimise use for patients with heart failure and proposes metrics to optimise quality of hospice care for this patient group.
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Affiliation(s)
- Sarah H Cross
- Sanford School of Public Policy, Duke University Durham, NC, US
| | - Arif H Kamal
- Duke Cancer Institute Durham, NC, US.,Duke Fuqua School of Business, Duke University Durham, NC, US
| | - Donald H Taylor
- Sanford School of Public Policy, Duke University Durham, NC, US.,Margolis Center for Health Policy, Duke University Durham, NC, US.,Duke Clinical Research Institute Durham, NC, US
| | - Haider J Warraich
- Department of Medicine, Division of Cardiology, Duke University Medical Center Durham, NC, US
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Lyons KD, Padgett LS, Marshall TF, Greer JA, Silver JK, Raj VS, Zucker DS, Fu JB, Pergolotti M, Sleight AG, Alfano CM. Follow the trail: Using insights from the growth of palliative care to propose a roadmap for cancer rehabilitation. CA Cancer J Clin 2019; 69:113-126. [PMID: 30457670 DOI: 10.3322/caac.21549] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Despite research explicating the benefits of cancer rehabilitation interventions to optimize physical, social, emotional, and vocational functioning, many reports document low rates of referral to and uptake of rehabilitation in oncology. Cancer rehabilitation clinicians, researchers, and policy makers could learn from the multidisciplinary specialty of palliative care, which has benefited from a growth strategy and has garnered national recognition as an important and necessary aspect of oncology care. The purpose of this article is to explore the actions that have increased the uptake and integration of palliative care to yield insights and multimodal strategies for the development and growth of cancer rehabilitation. After examining the history of palliative care and its growth, the authors highlight 5 key strategies that may benefit the field of cancer rehabilitation: 1) stimulating the science in specific gap areas; 2) creating clinical practice guidelines; 3) building clinical capacity; 4) ascertaining and responding to public opinion; and 5) advocating for public policy change. Coordinated and simultaneous advances on these 5 strategies may catalyze the growth, utilization, and effectiveness of patient screening, timely referrals, and delivery of appropriate cancer rehabilitation care that reduces disability and improves quality of life for cancer survivors who need these services.
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Affiliation(s)
- Kathleen D Lyons
- Scientist, Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH
- Assistant Professor of Psychiatry, Department of Psychiatry, Dartmouth College, Hanover, NH
| | - Lynne S Padgett
- Health Psychologist, Washington DC Veterans Affairs Medical Center, Washington, DC
| | - Timothy F Marshall
- Assistant Professor, School of Physical Therapy, Kean University, Union, NJ
| | - Joseph A Greer
- Program Director, Center for Psychiatric Oncology & Behavioral Sciences, Massachusetts General Hospital, Boston, MA
- Assistant Professor of Psychology, Harvard Medical School, Boston, MA
| | - Julie K Silver
- Associate Professor, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA
- Associate in Physiatry, Massachusetts General Hospital and Brigham and Women's Hospital, Boston, MA
| | - Vishwa S Raj
- Associate Professor, Director of Oncology Rehabilitation, Department of Physical Medicine and Rehabilitation, Carolinas Rehabilitation, Department of Supportive Care, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - David S Zucker
- Medical Director & Program Leader, Cancer Rehabilitation Services, Swedish Cancer Institute, Swedish Medical Center, Seattle, WA
| | - Jack B Fu
- Associate Professor, Division of Cancer Medicine, Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mackenzi Pergolotti
- Director of Research, ReVital Cancer Rehabilitation, Select Medical, Mechanicsburg, PA
| | - Alix G Sleight
- Postdoctoral Fellow, Keck School of Medicine, Department of Preventive Medicine, University of Southern California, Los Angeles, CA
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9
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Morrison RS, Aldridge MD, Block J, Chiu L, Maroney C, Morrison CA, Meier DE. The National Palliative Care Research Center: Ten Years of Promoting and Developing Research in Palliative Care. J Palliat Med 2018; 21:1548-1557. [PMID: 30136886 DOI: 10.1089/jpm.2018.0204] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The evidence base to support high-quality clinical care and number of scientists available to develop this evidence base are inadequate. OBJECTIVE To describe the first 10 years of the National Palliative Care Research Center's (NPCRC) programs and their outcomes. DESIGN Established in 2005, NPCRC was created in direct response to the recommendations of the Institute of Medicine. Specifically, NPCRC was created to expand the palliative care evidence-based needed for both health policy and clinical practice by supporting research scientists, stimulating research and innovation, and creating a community of researchers focused on the needs of persons with serious illness and their families. MEASUREMENTS Subsequent grant funding following NPCRC investment (web searches of NIH Research Portfolio Online Reporting Tools [RePORT], Veterans Administration and Patient Centered Outcomes Research Institute [PCORI] grant databases, grantee on-line surveys, and grantee annual reports) promotions (grantee on-line surveys and annual reports), publications (PubMed searches), and NPCRC participant satisfaction (grantee questionnaires). RESULTS As of July 2017, NPCRC has funded 47 junior investigators representing over 10 disciplines. These investigators have leveraged NPCRC's $7.8 million investment into 52 federal grants totaling $74.8 million dollars and 69 foundation grants totaling $16 million. Thirty-five grants ($5.8 million) have been awarded to experienced investigators, resulting in additional grant funding of $104.5 million dollars ($78.5 million federal, $26 million nonfederal). Satisfaction with NPCRC's program has been uniformly high and policy efforts have resulted in enhanced federal funding opportunities in palliative care research. CONCLUSIONS NPCRC's focus on people and infrastructure in conjunction with a top-down bottom-up strategy has been critical in improving the palliative care evidence base.
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Affiliation(s)
- R Sean Morrison
- 1 National Palliative Care Research Center of the Brookdale Department of Geriatrics and Palliative Medicine , Icahn School of Medicine at Mount Sinai, New York, New York
| | - Melissa D Aldridge
- 1 National Palliative Care Research Center of the Brookdale Department of Geriatrics and Palliative Medicine , Icahn School of Medicine at Mount Sinai, New York, New York
| | - James Block
- 1 National Palliative Care Research Center of the Brookdale Department of Geriatrics and Palliative Medicine , Icahn School of Medicine at Mount Sinai, New York, New York.,2 Center to Advance Palliative Care of the Brookdale Department of Geriatrics and Palliative Medicine , Icahn School of Medicine at Mount Sinai, New York, New York
| | - Lily Chiu
- 1 National Palliative Care Research Center of the Brookdale Department of Geriatrics and Palliative Medicine , Icahn School of Medicine at Mount Sinai, New York, New York
| | - Catherine Maroney
- 1 National Palliative Care Research Center of the Brookdale Department of Geriatrics and Palliative Medicine , Icahn School of Medicine at Mount Sinai, New York, New York
| | - Corey A Morrison
- 1 National Palliative Care Research Center of the Brookdale Department of Geriatrics and Palliative Medicine , Icahn School of Medicine at Mount Sinai, New York, New York.,3 Brown University School of Public Health , Providence, Rhode Island
| | - Diane E Meier
- 2 Center to Advance Palliative Care of the Brookdale Department of Geriatrics and Palliative Medicine , Icahn School of Medicine at Mount Sinai, New York, New York
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10
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Meier DE, Back AL, Berman A, Block SD, Corrigan JM, Morrison RS. A National Strategy For Palliative Care. Health Aff (Millwood) 2018; 36:1265-1273. [PMID: 28679814 DOI: 10.1377/hlthaff.2017.0164] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
In 2014 the World Health Organization called for palliative care to be integrated as an essential element of the health care continuum. Yet in 2017 US palliative care services are found largely in hospitals, and hospice care, which is delivered primarily in the home, is limited to people who are dying soon. The majority of Americans with a serious illness are not dying; are living at home, in assisted living facilities, or in nursing homes; and have limited access to palliative care. Most health care providers lack knowledge about and skills in pain and symptom management, communication, and care coordination, and both the public and health professionals are only vaguely aware of the benefits of palliative care and how and when to access it. The lack of policy supports for palliative care contributes to preventable suffering and low-value care. In this article we outline the need for a national palliative care strategy to ensure reliable access to high-quality palliative care for Americans with serious medical illnesses. We review approaches employed by other countries, list the participants needed to develop and implement an actionable strategy, and identify analogous US national health initiatives to inform a process for implementing the strategy.
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Affiliation(s)
- Diane E Meier
- Diane E. Meier is director of the Center to Advance Palliative Care and a professor in the Department of Geriatrics and Palliative Medicine, both at the Icahn School of Medicine at Mount Sinai, in New York City
| | - Anthony L Back
- Anthony L. Back is a professor in the Department of Medicine and codirector of the Cambia Palliative Care Center of Excellence at the University of Washington, cofounder of Vitaltalk (a nonprofit communication skills training organization), and an affiliate member of the Fred Hutchinson Cancer Research Center, all in Seattle
| | - Amy Berman
- Amy Berman is a senior program officer at the John A. Hartford Foundation, in New York City
| | - Susan D Block
- Susan D. Block is director of the Serious Illness Care Program at Ariadne Labs and a professor of psychiatry and medicine at Harvard Medical School, both in Boston, Massachusetts
| | - Janet M Corrigan
- Janet M. Corrigan is chief program officer for patient care at the Gordon and Betty Moore Foundation, in Palo Alto, California
| | - R Sean Morrison
- R. Sean Morrison is director of the National Palliative Care Research Center and a professor in the Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai, in New York City
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11
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Brown E, Morrison RS, Gelfman LP. An Update: NIH Research Funding for Palliative Medicine, 2011-2015. J Palliat Med 2018; 21:182-187. [PMID: 28792780 PMCID: PMC5797329 DOI: 10.1089/jpm.2017.0287] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2017] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The evidence base to support palliative care clinical practice is inadequate and opportunities to improve the palliative care evidence base remain despite the field's rapid growth. OBJECTIVE To examine current NIH funding of palliative medicine research, changes since our 2013 report, and trends since our 2008 report. DESIGN We sought to identify NIH funding of palliative medicine from 2011 to 2015 in two stages: (I) we searched the NIH grants database "RePorter" for grants with key words "palliative care," "end-of-life care," "hospice," and "end of life" and (II) we identified palliative care researchers likely to have secured NIH funding using three strategies. METHODS We abstracted (1) the first and last authors' names from original investigations published in major palliative medicine journals from 2013 to 2015; (2) these names from a PubMed-generated list of original articles published in major medicine, nursing, and subspecialty journals using the above key words; and (3) palliative medicine journal editorial board members and key members of palliative medicine initiatives. We crossmatched the pooled names against NIH grants funded from 2011 to 2015. RESULTS The author and NIH RePorter search identified 854 and 419 grants, respectively. The 461 grants categorized as relevant to palliative medicine represented 334 unique PIs. Compared to 2006-2010, the number of NIH-funded junior career development awards nearly doubled (6.1%-10%), articles published in nonpalliative care specialty journals tripled (13%-37%), published palliative care researchers increased by 2.5-fold (839-2120), and NIH-funded original palliative medicine research articles doubled (21%-39%). CONCLUSIONS Despite the challenging NIH funding climate, NIH funding to palliative care remained stable. The increase in early stage career development funding, palliative care investigators, and palliative medicine research published in nonpalliative medicine journals reflects important advances to address the workforce and evidence gaps. Further support for palliative care research is still needed.
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Affiliation(s)
- Elizabeth Brown
- From the Icahn School of Medicine at Mount Sinai, New York, New York
| | - R. Sean Morrison
- The National Palliative Care Research Center, New York, New York
- The Hertzberg Palliative Care Institute of the Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
- Geriatric Research Education and Clinical Center, James J. Peters VA Medical Center, Bronx, New York
| | - Laura P. Gelfman
- The Hertzberg Palliative Care Institute of the Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
- Geriatric Research Education and Clinical Center, James J. Peters VA Medical Center, Bronx, New York
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12
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Hanchanale S, Kerr M, Ashwood P, Curran E, Ekstrom M, Allen S, Currow D, Johnson MJ. Conference presentation in palliative medicine: predictors of subsequent publication. BMJ Support Palliat Care 2017; 8:73-77. [DOI: 10.1136/bmjspcare-2017-001425] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 10/09/2017] [Accepted: 10/25/2017] [Indexed: 11/04/2022]
Abstract
ObjectivesConcerns have been raised about poor-quality palliative care research and low publication rate from conference abstracts. The study objectives: to estimate the publication rate for European Association for Palliative Care research conference abstracts (2008) and explore associated characteristics and to understand reasons for non-publication.MethodsFull published papers were searched to March 2015 (Medline; Pubmed; Google Scholar) and data extracted: country of origin, study design/population/topic. Multivariate logistic regression was used to identify predictors of publication.Members of two different palliative care associations were surveyed to understand reasons for non-publication. χ2 statistic was used to explore associations with publication.ResultsOverall publication rate of the 445 proffered abstracts was 57%. In the final model, publication was more likely for oral presentations (OR 2.13; 95% CI 1.28 to 3.55; P=0.003), those from Europe (3.24; 1.09 to 9.56; P=0.033) and much less likely for non-cancer topics (0.21; 0.07 to 0.64; P=0.006). Funding status, academic unit or study design were not associated with publication.Survey407/1546 (26.3%) physicians responded of whom 254 (62%) had submitted a conference abstract. Full publication was associated with: oral presentation (P<0.001), international conference abstracts (P=0.01) and academic clinicians versus clinicians (P<0.001). Reasons for non-publication included: low priority for workload (53%) and time constraints (43%).ConclusionsThe publication rate was similar to 2005 clinical conference. Probable quality markers were associated with publication: oral presentations selected by conference committee, international conference abstracts and abstracts from those with an academic appointment. Publication was given a low priority among clinical time pressures.
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13
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How Medicine Has Changed the End of Life for Patients With Cardiovascular Disease. J Am Coll Cardiol 2017; 70:1276-1289. [DOI: 10.1016/j.jacc.2017.07.735] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/13/2017] [Accepted: 07/19/2017] [Indexed: 12/20/2022]
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14
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State of Research on Palliative Care in Heart Failure as Evidenced by Published Literature, Conference Proceedings, and NIH Funding. J Card Fail 2016; 23:197-200. [PMID: 27989871 DOI: 10.1016/j.cardfail.2016.10.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 10/14/2016] [Accepted: 10/17/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Heart failure (HF) is the most common diagnosis in hospitalized patients older than 65 years of age. Although these patients often need specialist-directed palliative care, <10% ever receive these services. This may be due to a lack of evidence examining the benefits of palliative care for these patients. To understand the current state of research on the interface of palliative care and HF, we examined trends in publications, presentations at national meetings, and National Institutes of Health (NIH) funding. METHODS Using key terms, we identified items about palliative care and HF in the following sources: (1) the tables of contents of nine leading cardiology journals, (2) abstracts of conference proceedings from four cardiology societies, and (3) all NIH grants from 2009 to 2013. RESULTS Of the journals reviewed, fewer than 1% of their publications related to palliative care. Less than 2% of HF-related sessions in conference proceedings mentioned palliative care. Of the NIH's $45 billion directed to HF research, only $14 million (0.03%) was spent on palliative care research. CONCLUSIONS Despite calls for improving palliative care for patients with advanced HF, a lack of sufficient attention persists in research abstracts, concurrent sessions at national meetings, and NIH funding to increase the evidence base. Without these improvements, the ability to deliver high-quality specialist palliative care to patients with HF and their families will remain severely limited.
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Aldridge MD, Hasselaar J, Garralda E, van der Eerden M, Stevenson D, McKendrick K, Centeno C, Meier DE. Education, implementation, and policy barriers to greater integration of palliative care: A literature review. Palliat Med 2016; 30:224-39. [PMID: 26405109 DOI: 10.1177/0269216315606645] [Citation(s) in RCA: 214] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Early integration of palliative care into the management of patients with serious disease has the potential to both improve quality of life of patients and families and reduce healthcare costs. Despite these benefits, significant barriers exist in the United States to the early integration of palliative care in the disease trajectory of individuals with serious illness. AIM To provide an overview of the barriers to more widespread palliative care integration in the United States. DESIGN AND DATA SOURCES A literature review using PubMed from 2005 to March 2015 augmented by primary data collected from 405 hospitals included in the Center to Advance Palliative Care's National Palliative Care Registry for years 2012 and 2013. We use the World Health Organization's Public Health Strategy for Palliative Care as a framework for analyzing barriers to palliative care integration. RESULTS We identified key barriers to palliative care integration across three World Health Organization domains: (1) education domain: lack of adequate education/training and perception of palliative care as end-of-life care; (2) implementation domain: inadequate size of palliative medicine-trained workforce, challenge of identifying patients appropriate for palliative care referral, and need for culture change across settings; (3) policy domain: fragmented healthcare system, need for greater funding for research, lack of adequate reimbursement for palliative care, and regulatory barriers. CONCLUSION We describe the key policy and educational opportunities in the United States to address and potentially overcome the barriers to greater integration of palliative care into the healthcare of Americans with serious illness.
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Affiliation(s)
- Melissa D Aldridge
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Eduardo Garralda
- ATLANTES Research Programme, Institute for Culture and Society, University of Navarra, Pamplona, Spain and Palliative Medicine Group, Area of Oncology and Haematology, Navarra's Health Research Institute (IDISNA), Pamplona, Spain
| | | | - David Stevenson
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Karen McKendrick
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Carlos Centeno
- ATLANTES Research Programme, Institute for Culture and Society, University of Navarra, Pamplona, Spain and Palliative Medicine Group, Area of Oncology and Haematology, Navarra's Health Research Institute (IDISNA), Pamplona, Spain
| | - Diane E Meier
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA Center to Advance Palliative Care, New York, NY, USA
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Randomized clinical trials in US hospices: challenges and the current state of the art. ACTA ACUST UNITED AC 2015. [DOI: 10.4155/cli.15.52] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Affiliation(s)
- Yael Schenker
- Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Robert Arnold
- Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, Pittsburgh, Pennsylvania
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Knobf M, Cooley M, Duffy S, Doorenbos A, Eaton L, Given B, Mayer D, McCorkle R, Miaskowski C, Mitchell S, Sherwood P, Bender C, Cataldo J, Hershey D, Katapodi M, Menon U, Schumacher K, Sun V, Ah D, LoBiondo-Wood G, Mallory G. The 2014–2018 Oncology Nursing Society Research Agenda. Oncol Nurs Forum 2015; 42:450-65. [DOI: 10.1188/15.onf.450-465] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
Palliative care is the interdisciplinary specialty focused on improving quality of life for persons with serious illness and their families. Over the past decade,1 the field has undergone substantial growth and change, including an expanded evidence base, new care-delivery models, innovative payment mechanisms, and increasing public and professional awareness.
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Nakanishi M, Miyamoto Y, Long CO, Arcand M. A Japanese booklet about palliative care for advanced dementia in nursing homes. Int J Palliat Nurs 2015; 21:385-91. [DOI: 10.12968/ijpn.2015.21.8.385] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Miharu Nakanishi
- Chief Researcher, Tokyo Metropolitan Institute of Medical Science, Japan
| | - Yuki Miyamoto
- Lecturer, Department of Psychiatric Nursing, Graduate School of Nursing, University of Tokyo, Japan
| | - Carol O Long
- Principal, Capstone Healthcare and Palliative Care Essentials, Phoenix, Arizona, US
| | - Marcel Arcand
- Professor, Department of Family Medicine, University of Sherbrooke, Quebec, Canada
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Riffin C, Pillemer K, Chen EK, Warmington M, Adelman RD, Reid MC. Identifying Key Priorities for Future Palliative Care Research Using an Innovative Analytic Approach. Am J Public Health 2015; 105:e15-e21. [PMID: 25393169 DOI: 10.2105/ajph.2014.302282] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Using an innovative approach, we identified research priorities in palliative care to guide future research initiatives. We searched 7 databases (2005-2012) for review articles published on the topics of palliative and hospice-end-of-life care. The identified research recommendations (n = 648) fell into 2 distinct categories: (1) ways to improve methodological approaches and (2) specific topic areas in need of future study. The most commonly cited priority within the theme of methodological approaches was the need for enhanced rigor. Specific topics in need of future study included perspectives and needs of patients, relatives, and providers; underrepresented populations; decision-making; cost-effectiveness; provider education; spirituality; service use; and interdisciplinary approaches to delivering palliative care. This review underscores the need for additional research on specific topics and methodologically rigorous research to inform health policy and practice.
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Affiliation(s)
- Catherine Riffin
- Catherine Riffin, Karl Pillemer, and Emily K. Chen are with the Department of Human Development, Cornell University, Ithaca, NY. Marcus Warmington, Ronald D. Adelman, and M. C. Reid are with the Division of Geriatrics and Palliative Medicine, Weill Medical College, New York, NY
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May P, Normand C, Morrison RS. Economic impact of hospital inpatient palliative care consultation: review of current evidence and directions for future research. J Palliat Med 2014; 17:1054-63. [PMID: 24984168 DOI: 10.1089/jpm.2013.0594] [Citation(s) in RCA: 117] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Maintaining the recent expansion of palliative care access in the United States is a recognized public health concern. Economic evaluation is essential to validate current provision and assess the case for new programs. Previous economic reviews in palliative care reported on programs across settings and systems; none has examined specifically the hospital consultative model, the dominant model of provision in the United States. OBJECTIVES To review systematically the economic evidence on specialist palliative care consultation teams in the hospital setting, to appraise this evidence critically, and to identify areas for future research in this field. DATA SOURCES A meta-review ("a review of existing reviews") was conducted of eight published systematic reviews and one relevant nonsystematic review. To identify articles published outside of the timeframe of these reviews, systematic searches were performed on the PubMed, CINAHL, and EconLit databases. STUDY SELECTION Articles were included if they compared the costs and/or cost effectiveness of a specialist hospital inpatient palliative care consultation for adult patients with those of a comparator. RESULTS Ten studies were included and these demonstrate a clear pattern of cost-saving impact from inpatient consultation programs. Nevertheless, knowledge gaps still exist regarding the economic effects of these programs. Current evidence has been generated from the hospital perspective; health system costs, patient and caregiver costs, and health outcomes are typically not included. CONCLUSIONS Inpatient palliative care consultation programs have been shown to save hospitals money and to provide improved care to patients with serious illness. With a clear pattern of cost-saving using current methodology, it is timely to begin expanding the scope of economic evaluation in this field. Future research must address the measurement of both costs and outcomes to understand more fully the role that palliative care plays in enhancing value in health care. Relevant domains for such research are identified.
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Affiliation(s)
- Peter May
- 1 Centre for Health Policy and Management, Trinity College Dublin , Ireland
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Affiliation(s)
- Mark T. Hughes
- General Internal Medicine and Berman Institute of Bioethics, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287-0941;
| | - Thomas J. Smith
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287-0005;
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Richmond NA, Lamel SA, Davidson JM, Martins-Green M, Sen CK, Tomic-Canic M, Vivas AC, Braun LR, Kirsner RS. US-National Institutes of Health-funded research for cutaneous wounds in 2012. Wound Repair Regen 2013; 21:789-92. [DOI: 10.1111/wrr.12099] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 07/10/2013] [Indexed: 01/07/2023]
Affiliation(s)
- Nicholas A. Richmond
- Department of Dermatology and Cutaneous Surgery; Miller School of Medicine; University of Miami; Miami Florida
| | - Sonia A. Lamel
- Department of Dermatology and Cutaneous Surgery; Miller School of Medicine; University of Miami; Miami Florida
| | - Jeffrey M. Davidson
- Department of Pathology, Microbiology and Immunology; Vanderbilt University School of Medicine; Nashville Tennessee
- Research Service; VA Tennessee Valley Healthcare System; Nashville Tennessee
| | - Manuela Martins-Green
- Department of Cell Biology and Neuroscience; University of California; Riverside California
| | - Chandan K. Sen
- Comprehensive Wound Center; Wexner Medical Center; The Ohio State University; Columbus Ohio
| | - Marjana Tomic-Canic
- Department of Dermatology and Cutaneous Surgery; Miller School of Medicine; University of Miami; Miami Florida
| | - Alejandra C. Vivas
- Department of Dermatology and Cutaneous Surgery; Miller School of Medicine; University of Miami; Miami Florida
| | - Liza R. Braun
- Department of Dermatology and Cutaneous Surgery; Miller School of Medicine; University of Miami; Miami Florida
| | - Robert S. Kirsner
- Department of Dermatology and Cutaneous Surgery; Miller School of Medicine; University of Miami; Miami Florida
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Kurella Tamura M, Meier DE. Five policies to promote palliative care for patients with ESRD. Clin J Am Soc Nephrol 2013; 8:1783-90. [PMID: 23744000 PMCID: PMC3789338 DOI: 10.2215/cjn.02180213] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Patients with ESRD experience complex and costly care that does not always meet their needs. Palliative care, which focuses on improving quality of life and relieving suffering for patients with serious illnesses, could address a large unmet need among patients with ESRD. Strengthening palliative care is a top policy priority for health reform efforts based on strong evidence that palliative care improves value. This commentary outlines palliative care policies for patients with ESRD and is directed at policymakers, dialysis providers, nephrology professional societies, accreditation organizations, and funding agencies who play a key role in the delivery and determination of quality of ESRD care. Herein we suggest policies to promote palliative care for patients with ESRD by addressing key barriers, including the lack of access to palliative care, lack of capacity to deliver palliative care, and a limited evidence base. We also provide examples of how these policies could be implemented within the existing ESRD care infrastructure.
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Affiliation(s)
- Manjula Kurella Tamura
- Veterans Affairs Palo Alto Health Care System Geriatrics Research Education and Clinical Center. Palo Alto, California
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California; and
| | - Diane E. Meier
- Center to Advance Palliative Care and Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
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