Early-phase trials, particularly phase I studies, occupy a distinctive position in oncology. They are designed primarily to evaluate the safety, dosing, and preliminary activity of investigational agents rather than to establish definitive efficacy, and the patients who enroll in them typically have advanced disease that has progressed through standard therapies. Historically, some clinicians worried that frank discussions about goals of care and end-of-life preferences might undermine patients’ hope or their willingness to participate in research. That assumption has been increasingly challenged. Guidelines from the American Society of Clinical Oncology, updated in 2024, recommend that palliative care be integrated alongside active cancer treatment for patients with advanced cancer, and the European Society for Medical Oncology has similarly emphasized advance care planning as a core component of palliative care practice since its 2014 clinical practice guidelines on the subject.

Advance care planning encompasses a spectrum of activities: conversations in which patients articulate their values and preferences for future care, the designation of a healthcare proxy or surrogate decision-maker, and the formal documentation of those preferences in advance directives or medical orders. In the context of early-phase trials, planning takes on particular significance. Patients in these studies face inherent uncertainty about whether an experimental agent will benefit them, and trial protocols can impose demanding schedules of visits, imaging, and laboratory monitoring. When serious adverse events or disease progression occur, patients and families who have already discussed their priorities may find it easier to make consequential decisions about whether to continue on protocol therapy, transition to hospice, or pursue other options.

The original study that prompted the correspondence, conducted by a team including researchers at a major oncology center and published in Supportive Care in Cancer in January 2026, investigated the use of supportive care services and advance care planning among early-phase oncology clinical trial participants. Supportive care in this setting spans a wide range of services: palliative care consultations, pain management, psychological and psychiatric support, social work services, nutrition support, and symptom-directed interventions that run alongside the experimental treatment. The study’s central finding, as characterized in the correspondence, is an association between the use of these services and advance care planning, raising the question of what that association actually means and how it should be interpreted.

Xue and Yan’s commentary focuses precisely on this interpretive challenge. An observed association between two clinical behaviors does not by itself reveal the direction of causation, and the authors underscore that several explanations are plausible. One possibility is that engagement with supportive care services creates natural opportunities for advance care planning discussions. Palliative care clinicians, social workers, and other supportive care professionals are trained to elicit patient values and to facilitate conversations about future care, so patients who connect with these services may simply have more structured occasions to formalize their preferences. In this framing, supportive care acts as a gateway that normalizes and operationalizes planning conversations that might otherwise never occur in the busy environment of a phase I clinic.

An alternative interpretation runs in the opposite direction: patients who have already engaged in advance care planning may be more receptive to supportive care services, or their clinicians may be more likely to refer them. A patient who has documented preferences and articulated goals may signal to the care team that supportive care involvement would be aligned with their wishes. Selection effects may also be at work, since patients who are more engaged, more health-literate, or more trusting of the medical system may be more likely both to accept supportive care referrals and to complete planning documentation. The correspondence emphasizes that disentangling these possibilities matters, because the practical implications differ depending on which mechanism predominates.

The clinical stakes of this interpretive question are considerable. If supportive care use genuinely promotes advance care planning, then interventions that expand access to palliative and supportive services in early-phase trial populations could yield benefits that extend beyond symptom control, improving the alignment of care with patient values at the end of life. Prior research summarized in the surrounding literature supports this possibility. A 2024 review in Cancer Treatment Reviews examined the role of palliative care in optimizing early-phase cancer trials, and work published in Current Problems in Cancer in 2023 addressed the integration of palliative care for patients on phase I trials. An Australian single-center study published in Cancers in 2025 documented advance care planning practices specifically in early-phase trial participants, adding international perspective to a conversation that has been dominated by United States-based cohorts.

The correspondence also speaks to a persistent documentation gap. Advance care planning that occurs in conversation but is never recorded in the medical record has limited utility when patients deteriorate acutely, because clinicians who are unfamiliar with the patient cannot act on undocumented preferences. Studies across oncology settings have repeatedly found that documentation rates lag well behind the frequency of discussions, and early-phase trial populations are no exception. Xue and Yan’s commentary implicitly argues that researchers and clinicians should attend not only to whether planning occurs but to how it is captured, communicated, and honored across the multiple teams involved in trial care, including research coordinators, treating oncologists, hospitalists, and emergency personnel who may encounter these patients during acute events.

For trial design and clinical operations, the message is that supportive care and research participation should be viewed as complementary rather than competing. The traditional concern that palliative care involvement might depress trial enrollment or blur the assessment of investigational agents has not been borne out in the literature; instead, integrated models appear to support patients through the demands of protocol participation while safeguarding their broader goals. The correspondence’s authors, writing from a radiotherapy department in a Chinese provincial hospital, bring a perspective that highlights the global relevance of these questions, since norms around end-of-life communication vary across health systems and cultures, and the infrastructure for supportive care differs markedly between high-resource trial centers and other settings.

Ultimately, the correspondence by Xue and Yan serves as a reminder that the statistical association between supportive care use and advance care planning in early-phase trial participants is a starting point for inquiry rather than a conclusion. Understanding whether supportive services catalyze planning, whether planning opens the door to supportive care, or whether both reflect an underlying orientation toward proactive, values-concordant care will require longitudinal designs, careful measurement of the timing of each behavior, and attention to the conversations that connect them. What is already clear is that patients who volunteer for early-phase trials are not exempt from the need for thoughtful planning about their future care, and that the clinical teams who run these trials are well positioned to ensure that supportive care and advance care planning travel together as standard practice rather than as afterthoughts.

Subject of Research: The association between supportive care service use and advance care planning among early-phase oncology clinical trial participants

Article Title: Interpreting the association between supportive care use and advance care planning in early-phase trial participants

Article References: Interpreting the association between supportive care use and advance care planning in early-phase trial participants. (n.d.). https://doi.org/10.1007/s00520-026-11295-5

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11295-5

Keywords: advance care planning, supportive care, palliative care, early-phase clinical trials, phase I oncology, cancer patients, end-of-life care, clinical trial participants, patient preferences, oncology guidelines, documentation, correspondence

Inhalation injury is one of the most feared complications of major burns. Hot gases and toxic smoke damage the delicate lining of the airway, causing swelling, secretions, and progressive respiratory failure that can develop over hours. For these patients, an artificial airway, typically a tube placed through the mouth or nose into the trachea, or a surgical opening in the neck, is often a life-saving necessity. But the tube itself introduces new risks: it can become blocked by thick secretions, dislodged, or colonized by bacteria leading to ventilator-associated pneumonia. The quality of day-to-day airway management, from humidification and suctioning to cuff pressure monitoring and secure fixation, therefore has a direct bearing on survival and recovery.

The research team, led by Fangfang Xia and colleagues in the hospital’s Department of Burns and Plastic Surgery, set out to measure how well artificial airway management was actually being delivered in their burn intensive care unit, and to identify which patient characteristics and staff-related factors predicted lapses in quality. They combined two complementary data streams. First, they performed a retrospective analysis of clinical records from all 223 patients admitted to the burn ICU between January and December 2025 who had burn injuries combined with inhalation injuries. The variables they extracted included sex, age, the total body surface area burned (TBSA), whether the patient developed acute respiratory distress syndrome (ARDS), the timing of artificial airway establishment, and any airway-related complications that occurred during the stay.

Second, recognizing that airway management is fundamentally a nursing-delivered intervention, the team surveyed 49 nursing staff members about their clinical experience, whether they had received formal airway management training, how often they attended training sessions each year, and how they documented their care. This dual approach, pairing patient outcomes with staff characteristics, allowed the investigators to look beyond the bedside and ask whether the structure of the care team itself shaped the quality of what patients received. The study was approved by the hospital’s institutional ethics committee and adhered to the principles of the Declaration of Helsinki, with all participants providing informed consent.

The headline numbers reveal a system that performs reasonably well but leaves meaningful room for improvement. The timely airway establishment rate, meaning the proportion of patients who received an artificial airway within the clinically appropriate window, stood at 82.1 percent. Overall quality compliance, a measure of how consistently management met established standards, reached 73.5 percent. In other words, roughly one in four patients did not receive airway care that fully met quality benchmarks, and nearly one in five did not have their airway established in a timely fashion. For a population in which respiratory compromise can escalate within hours, those gaps are clinically significant.

To move from description to explanation, the researchers performed multivariable logistic regression, a statistical technique that estimates the independent effect of each factor while holding the others constant. Five factors emerged as significant independent predictors of suboptimal airway management quality, all with P values below 0.05. Three were patient-related: a total body surface area burned of 60 percent or more, the concurrent development of ARDS, and delayed establishment of the artificial airway. Two were staff-related and, crucially, modifiable: nursing experience of less than three years, and an annual training frequency of fewer than two sessions.

The patient-related predictors make physiological sense. Patients with burns covering 60 percent or more of their body surface face massive fluid shifts, profound inflammatory responses, and prolonged immobility, all of which complicate airway care and increase the burden of secretions and edema. Those who develop ARDS require prolonged mechanical ventilation with high pressures and oxygen concentrations, which stresses every component of airway maintenance. And delayed airway establishment is both a marker of deteriorating physiology and a contributor to it: a patient whose swollen airway is intubated late may be harder to intubate safely, may accumulate aspirated secretions, and may start the course of artificial airway care from a worse baseline.

It is the two staff-related findings, however, that carry the clearest practical message, because they are the ones an institution can change. Nurses with less than three years of experience were significantly more likely to be involved in suboptimal airway management, suggesting that the skills required, precise suctioning technique, correct cuff pressure management, early recognition of tube obstruction or displacement, and sound clinical judgment about secretion load, are accumulated through years of bedside practice. Equally telling, nurses who attended fewer than two training sessions per year were at higher risk of suboptimal care. The message is that competency in artificial airway management is not a one-time credential but a perishable skill that decays without regular reinforcement.

The authors also observed that where quality fell short, it tended to manifest as inconsistent protocol adherence and incomplete documentation, rather than as dramatic single-point failures. This pattern is common in intensive care: the difference between adequate and excellent care often lies in the accumulation of small, unglamorous tasks performed correctly and recorded properly, shift after shift. Documentation matters not only for continuity between clinicians but also as a quality-control signal, since gaps in the record make it harder for teams to detect drifting practice standards before they produce complications.

Based on their findings, the researchers recommend a package of institutional reforms: risk stratification frameworks that flag patients with extensive burns or evolving ARDS for intensified airway surveillance; standardized assessment tools that make protocol adherence measurable rather than assumed; tiered, competency-based training programs that ensure less experienced nurses receive structured skill-building and that all staff receive training at least twice a year; and strengthened multidisciplinary collaboration between burn surgeons, intensivists, and nursing teams. The study, funded by Ningxia Medical University, is retrospective and conducted at a single center, so the authors’ results describe one institution’s experience rather than a universal benchmark. But the structure of the findings, that injury severity sets the stage while training and timing determine execution, offers a concrete, testable template for other burn units. In a field where the airway is quite literally the difference between breathing and not, the suggestion that two of the five decisive factors are as simple as experience and regular training is a conclusion worth acting on.

Subject of Research: Quality of artificial airway management and its modifiable predictors in burn patients with inhalation injury

Article Title: Quality of artificial airway management and its modifiable predictors in burn patients with inhalation injury: a retrospective cohort study

Article References: Xia, F., You, X., Zhou, X., Yao, M., & Yan, R. (2026). Quality of artificial airway management and its modifiable predictors in burn patients with inhalation injury: a retrospective cohort study. BMC Nursing. https://doi.org/10.1186/s12912-026-05433-x

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05433-x

Keywords: burn injury, inhalation injury, artificial airway management, nursing quality, ARDS, TBSA, nurse training, retrospective cohort study, burn intensive care, airway complications, protocol adherence, documentation

The research team, led by Roseane Christhina da Nova Sá-Serafim, Gabriella Tambara Nunes de Souza, and Emerson Do Bú, designed the study around a deceptively simple question: if national and state-level documents recommend specific practices for hospital psychologists, are those recommendations actually being followed? The answer, in many cases, is no. Using an online questionnaire that presented 30 statements derived from the main guideline documents governing Brazilian hospital psychology, participants rated how closely each statement reflected their daily practice and how strongly they believed it should be implemented as a guideline. The statements spanned two domains distilled from existing professional references: the management of hospital psychology services, covering team organization, supervision, protocol development, and working conditions, and the professional performance of hospital psychologists, covering direct patient and caregiver care, interprofessional collaboration, documentation, emergency response, and bereavement support.

The technical core of the analysis was a comparison between current practice and intention to implement. For each statement, the researchers used one-sample t-tests to determine whether a practice was performed systematically, benchmarking mean ratings against the scale midpoint of 3.5 on a six-point agreement scale. Paired-sample t-tests then compared each current-practice rating with its corresponding intention-to-implement rating, revealing where professionals see room for standardization. The results showed that several recommended practices are not consistently institutionalized. In the management domain, only the systematization of psychological assessment and performance protocols failed to differ significantly from the midpoint, suggesting these activities lack routinized, standardized execution. In the performance domain, two gaps stood out: psychologists do not uniformly cap their caseloads at 12 patients per 12-hour shift, and 24-hour availability of psychological services is not systematically guaranteed across hospitals.

These two practical gaps carry significant clinical weight. The absence of round-the-clock psychological support is especially consequential in emergency departments, intensive care units, and palliative care settings, where emotional crises do not respect office hours. Meanwhile, the inconsistency around patient-per-shift limits points to a workload problem that extends beyond convenience. Unregulated caseloads can produce work overload, elevating the risk of burnout syndrome among psychologists and, by extension, threatening the quality and equity of care delivered to patients and families. The study’s authors note that clear workload standards, combined with adequate staffing, leadership support, and documentation infrastructure, are precisely the organizational conditions that implementation science identifies as decisive for translating professional consensus into routine practice.

Not everything, however, needs fixing. Several practices scored as well-established, with no meaningful difference between current performance and intention to implement. These include organizing the work process, attending to psychological complications, providing care to caregivers when needed, intervening with grieving family members, and refraining from communicating test results, a task typically reserved for physicians. This pattern suggests that while the structural and managerial scaffolding of hospital psychology remains uneven, the core relational and clinical work, listening to patients, supporting families, facilitating communication within the multidisciplinary team, is already deeply embedded in daily routines across the country.

To test whether the intention to adopt guidelines varied systematically across professional and institutional characteristics, the researchers turned to confirmatory factor analysis and analysis of variance. The two-factor structure of the intention measure fit the data well, with excellent fit indices including a comparative fit index of 0.984 and strong internal consistency for both dimensions. The subsequent ANOVAs, however, told a subtler story. Intentions to implement guideline-based practices were uniformly high across the sample, so high that the researchers describe a ceiling effect: with almost everyone expressing strong endorsement, restricted variance limits the ability to detect reliable differences between subgroups. Within that constraint, two institutional variables emerged with marginal, preliminary associations. Psychologists in public hospitals showed greater intention than those in private hospitals to implement management guidelines, and professionals in medium-sized hospitals expressed stronger intentions regarding practice guidelines than those in small hospitals.

Neither finding should be read as definitive. The authors are explicit that marginal effects falling between conventional significance thresholds of 0.05 and 0.10 should be treated as preliminary signals rather than confirmatory evidence, particularly given uneven subgroup sizes in this exploratory sample. More importantly, individual characteristics such as gender, academic degree, type of contract, hospital region, city type, and theoretical orientation showed no reliable association with intentions. The interpretive takeaway is not that these variables are irrelevant, but that universal endorsement of standardization flattens the differences the researchers hoped to detect. Hospital management model and size may still matter as proxies for governance arrangements, administrative oversight, documentation infrastructure, and service complexity, all of which shape how feasible and legitimate standardization feels within a given institution.

The study frames its central concept, intention to implement, through the lens of implementation science rather than assuming that agreement automatically produces action. Drawing on classic behavioral research, including the theory of planned behavior and meta-analytic evidence of a persistent intention-behavior gap, the authors distinguish endorsement from implementation. A professional can strongly agree that guidelines are valuable and appropriate while facing structural barriers, limited staffing coverage, inadequate documentation systems, or uneven institutional support, that prevent routine adoption. This distinction tempers causal interpretation of the results and clarifies what regulatory bodies can realistically do: leverage the observed professional consensus to advance guideline development, while investing in the organizational supports, training, supervision, and monitoring mechanisms that make fidelity achievable in real hospital conditions.

The urgency of standardization is underscored by recent crises. During the COVID-19 pandemic and the devastating floods that struck Rio Grande do Sul in 2024, hospital psychologists were called upon to deliver coordinated psychological support under extreme conditions, often without clear reference parameters. Well-defined guidelines, the authors argue, can reduce stress and trauma for both patients and healthcare teams during emergencies, promote evidence-based intervention, and facilitate collaboration among health professionals. Yet most Brazilian states lack the specific, objective guidelines that a handful of pioneering regional councils have already produced, such as the Siga Psi document in Paraíba and the technical note from Minas Gerais, which addresses professional qualification, team sizing, occupational health and safety, and medical record registration.

Looking forward, the researchers propose a pragmatic research agenda: translate the most strongly endorsed recommendations into a structured guideline package with clear operational definitions, examine feasibility and fidelity across public, private, and differently sized hospital contexts, and evaluate downstream outcomes ranging from service coverage and documentation quality to team communication, staff wellbeing, and patient- and caregiver-reported results. The study’s own limitations, including non-representative regional sampling and a lengthy questionnaire that may have induced cognitive fatigue, point toward larger and more balanced replications. What the current findings establish is a baseline: Brazilian hospital psychologists overwhelmingly want standardization, many recommended practices already function well, but the managerial and organizational conditions needed to institutionalize guidelines consistently remain a work in progress across the country’s hospitals.

Subject of Research: Current clinical practices of hospital psychologists in Brazil and their intentions to implement standardized guidelines in psychological care.

Article Title: Hospital Psychology in Brazil: Current Practices and Intentions to Implement Guidelines in Psychological Care

Article References: da Nova Sá-Serafim, R. C., de Souza, G. T. N., & Do Bú, E. (2026). Hospital Psychology in Brazil: Current Practices and Intentions to Implement Guidelines in Psychological Care. Trends in Psychology. https://doi.org/10.1007/s43076-026-00525-8

Image Credits: AI Generated

DOI: 10.1007/s43076-026-00525-8

Keywords: hospital psychology, Brazil, clinical guidelines, implementation science, psychological care, burnout, public hospitals, standardization, multidisciplinary teams, workload, evidence-based practice, Trends in Psychology