{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T08:11:58Z","timestamp":1776240718715,"version":"3.50.1"},"reference-count":25,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T00:00:00Z","timestamp":1776211200000},"content-version":"unspecified","delay-in-days":104,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Pall Supp Care"],"published-print":{"date-parts":[[2026]]},"abstract":"Abstract<\/jats:title>\n \n Objectives<\/jats:title>\n Early engagement in palliative and supportive care is widely promoted as a marker of insight, acceptance, and readiness for shared decision-making. Clinicians, however, frequently observe a paradoxical longitudinal pattern in which patients who initially demonstrate high emotional, cognitive, and decisional engagement later become withdrawn or fatigued despite preserved insight. This case report illustrates such a pattern and interprets it using the concept of capacity debt.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A longitudinal case description is presented, integrating clinical observation with interpretive analysis informed by literature on patient capacity, emotional labor, cumulative complexity, and serious illness communication.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The patient demonstrated high early engagement in goals-of-care discussions, advance care planning, and emotionally demanding conversations. Over time, she developed marked conversational fatigue and withdrawal without evidence of depression, demoralization, denial, or cognitive impairment. Disengagement appeared temporally related to cumulative engagement demands rather than disease progression alone.<\/jats:p>\n <\/jats:sec>\n \n Significance of results<\/jats:title>\n This case illustrates how early intensive engagement may contribute to later disengagement through cumulative depletion of patient capacity. Interpreting this pattern as capacity debt provides a non-pathologizing and ethically grounded explanation, highlighting pacing as a core clinical skill in palliative care.<\/jats:p>\n <\/jats:sec>","DOI":"10.1017\/s1478951526102272","type":"journal-article","created":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T07:35:40Z","timestamp":1776238540000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":0,"title":["Capacity debt in palliative care: A case report illustrating longitudinal exhaustion following early engagement"],"prefix":"10.1017","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-6411-2726","authenticated-orcid":false,"given":"Richa","family":"Randhawa","sequence":"first","affiliation":[{"name":"Palliative Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2026,4,15]]},"reference":[{"key":"S1478951526102272_ref12","volume-title":"The Managed 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Published by Cambridge University Press.","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http:\/\/creativecommons.org\/licenses\/by\/4.0), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}],"article-number":"e109"}}