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The coronavirus disease 2019 (COVID-19) crisis has amplified the importance of palliative care to countless patients suffering with and dying from this disease, as well as to their families, communities, and the worldwide cadre of overburdened health care workers. Particularly urgent is the need for spiritual care specialists and generalists to address spiritual suffering given the degree of isolation, loneliness, and vulnerability caused by this pandemic. Although spiritual care has long been recognized as one of the domains of quality palliative care, it is often not fully integrated into practice. All disciplines are ultimately responsible for ensuring that spiritual care is prioritized to improve quality of life and the experience of patients and families facing spiritual emergencies amid the complex life-and-death scenarios inherent to coronavirus disease 2019. Although the pandemic has revealed serious fault lines in many health care domains, it has also underscored the need to recommit to spiritual care as an essential component of whole-person palliative care., (Copyright © 2020 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose: Physical activity (PA) diaries reduce the recall error inherent in self-reported PA but are burdensome. The purpose of this study was to compare a cell phone-based diary with a paper diary and examine the reliability and validity of the cell phone diary., Methods: In a pilot study, 25 women and 23 men, age 45-65 yr, completed cell phone and paper PA diaries 4 d·wk(-1) for three consecutive weeks and a user satisfaction survey. In the subsequent validation study, 623 middle-age participants (52.5% women) were asked to complete the cell phone diary and wear an accelerometer for two 7-d periods, approximately 6 months apart. They also completed two PA questionnaires. Fitness, body mass index, and percent body fat were obtained as indirect validation criteria., Results: Estimates of PA from the cell phone and paper diaries were similar (mean within person difference = -43.8 MET·min·d(-1) of total PA, SD = 360, P = 0.49, 7.4 min·d(-1) of moderate-vigorous PA, SD = 66, P = 0.53). Users preferred the cell phone diary over the paper diary (59.6% vs 35.4%). In the subsequent study, intraclass correlations for the cell phone diary ranged from 0.55 for light PA to 0.63 for vigorous PA. Although PA estimates from the cell phone diary were generally significantly higher than those from the accelerometer and the questionnaires, correlations for moderate and vigorous PA were moderate (ρ = 0.25-0.59 with the questionnaires and 0.27-0.35 with the accelerometer). The correlations between the cell phone diary and the indirect validation criteria were generally in the expected direction and of moderate magnitude., Conclusions: A cell phone-based PA diary is equivalent to a paper diary, acceptable to users, and a relatively reliable and valid approach to self-reported PA.

Background: To develop and grow most effectively, palliative care programs must consider how best to align their mission with that of their institution. To do so, programs must identify their institutional mission and needs, what palliative care can do to address those needs given available resources, and how the palliative care team can measure and document its value. Such an approach encourages the palliative care team to think strategically and to see themselves and their service as a solution to issues and concerns within the institution. It also helps a palliative care team decide which, among many potential opportunities and possible initiatives, is the one most likely to be supported by the institution and have a recognized and significant impact., Subjects and Methods: We present five case studies to demonstrate how successful programs identify and address institutional needs to create opportunities for palliative care program growth. These case studies can serve as models for other programs seeking to develop or expand their palliative care services.

Purpose: To determine whether respondents share researchers' understandings of concepts and questions frequently used in the assessment of usual physical activity (PA) behavior., Methods: As part of On the Move, a study aimed at reducing measurement error in self-reported physical activity (PA), we conducted cognitive interviews with 19 men and 21 women, ages 45-65, regarding their responses to the PA questionnaires used in two large, population-based studies, Life After Cancer Epidemiology and California Men's Health study. One questionnaire asks about the frequency, the duration, and the perceived intensity of a range of specific activities in several different domains over the past 12 months. The second questionnaire asks about frequency and duration of specific, mostly recreational activities, grouped by intensity (i.e., moderate or vigorous) over the past 3 months. We used verbal probing techniques to allow respondents to describe their thought processes as they completed the questionnaires. All interviews were tape-recorded and transcribed, and the transcripts were then analyzed using standard qualitative methods., Results: Cognitive interviews demonstrated that a sizable number of respondents understood "intensity" in terms of emotional or psychological intensity rather than physical effort. As a result, the perceived intensity with which a participant reported doing a specific activity often bore little relationship to the MET value of that activity. Additionally, participants often counted the same activity more than once, overestimated work-related PA, and understood activities that were grouped together in a single category to be definitive lists rather than examples., Conclusion: Cognitive interviews revealed significant gaps between respondents' interpretations of some PA questions and researchers' assumptions about what those questions were intended to measure. Some sources of measurement error in self-reported PA may be minimized by additional research that focuses on the cognitive processes required to respond to PA questionnaires.