Journal of pain and symptom management最新文献

In the Field: Visiting Peer Institutions to Inform Pediatric Palliative Care Program Re-Development. 实地考察：访问同行机构为儿科姑息治疗项目的再开发提供信息。

IF 3.5 2区医学

Journal of pain and symptom management Pub Date : 2025-10-01 DOI: 10.1016/j.jpainsymman.2025.09.012

Ross W Cleveland, Chelsea Heneghan, Suzanne Gouda, Shih-Ning Liaw, Terrance Murphy, Vanessa Battista, Eleanor Frechette, Carlie Larocque, Abby R Rosenberg

{"title":"In the Field: Visiting Peer Institutions to Inform Pediatric Palliative Care Program Re-Development.","authors":"Ross W Cleveland, Chelsea Heneghan, Suzanne Gouda, Shih-Ning Liaw, Terrance Murphy, Vanessa Battista, Eleanor Frechette, Carlie Larocque, Abby R Rosenberg","doi":"10.1016/j.jpainsymman.2025.09.012","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2025.09.012","url":null,"abstract":"Context: The heterogeneity of Pediatric Palliative Care (PPC) programs presents challenges in forming a generalized model for growth. We developed and implemented a system to visit and learn from peer institutions to inform our own program's revision and expansion.Objectives: To describe the use of structured field trips to peer programs in North America to inform program development.Methods: OUR PROCEDURE INVOLVED THREE STEPS: First, \"organization\" included choosing visit sites, outreach and collaboration to plan logistics, development of a standardized approach, and creating inter-disciplinary field trip teams to ensure diverse PPC perspectives during each visit. Second, \"conduction\" included the field trips, creating a semi-structured debriefing interview guide aimed at uncovering common tensions, and performing interviews with those who went on each trip. Third, \"application\" involved analyzing interview data to identify and name key tensions, sharing those tension points with the team, and centering those points in a clinical model re-design.Results: We completed 7 field trips, including 16 interdisciplinary members of our team. Analysis of our debriefing interviews yielded 2 primary and 5 sub-themes/tension points. Focusing on recognizing, accepting, mitigating, or eliminating those tension points during a clinical model re-design led to the creation of several formative changes to our team structure. The field trips took 8 months from beginning to delivery of a new clinical model.Conclusions: Field trips to peer PPC teams highlight both shared and unique strengths and challenges PPC teams experience. Knowledge gained from trips may enable creative and informed guidance of PPC programmatic growth and evolution.","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

End-of-Life symptoms after Stroke: A Mixed Methods Study. 中风后的临终症状：一项混合方法研究

IF 3.5 2区医学

Journal of pain and symptom management Pub Date : 2025-09-29 DOI: 10.1016/j.jpainsymman.2025.09.023

Anna-Christin Willert, Meghan Romba, Sumayyah M Khan, William T Longstreth, Claire J Creutzfeldt

{"title":"End-of-Life symptoms after Stroke: A Mixed Methods Study.","authors":"Anna-Christin Willert, Meghan Romba, Sumayyah M Khan, William T Longstreth, Claire J Creutzfeldt","doi":"10.1016/j.jpainsymman.2025.09.023","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2025.09.023","url":null,"abstract":"Background: Stroke kills 160,000 patients annually in the US, with most deaths occurring in the hospital after a decision to withhold or withdraw life-sustaining treatment (WLST). Little is known about the experience at the end-of-life of patients with stroke, some of whom are awake, and of their families.Methods: In this single-center, mixed-methods retrospective quality improvement study, we included all patients hospitalized with acute stroke who died in 2022 after WLST. Basic characteristics were collected for descriptive analysis. Based on clinician progress notes, patients were considered awake with or not awake without conscious behavior at the time of WLST. Qualitative analysis of progress notes focused on symptoms documented for patients.Results: One-hundred-one patients with stroke died after WLST. Their median age was 73 years, 48 were women, and 34 were awake at the time of WLST, including 3 who participated in decision making. Median duration from WLST to death was 1 day (25th-75th percentile 0-2 days). Symptom documentation was rare and more likely to be found in patients who were awake (21/34, 62%) compared to those who were not awake (22/61, 36%). Dyspnea, pain, and restlessness were the main documented physical symptoms. Social, spiritual, and emotional needs of patients or families were less often documented.Conclusion: Symptom assessment at end-of-life after stroke was limited. Prospective, systematic symptom assessment is needed to understand signs and symptoms during the end-of-life process in stroke, particularly among awake patients, so as to learn how best to address and manage symptoms in these patients.","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

IF 3.5 2区医学

Journal of pain and symptom management Pub Date : 2025-09-23 DOI: 10.1016/j.jpainsymman.2025.09.017

Gina M Piscitello, Robert M Arnold, Jane Schell

{"title":"Cost-related Outcomes Associated with Documented Goals of Care Conversations.","authors":"Gina M Piscitello, Robert M Arnold, Jane Schell","doi":"10.1016/j.jpainsymman.2025.09.017","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2025.09.017","url":null,"abstract":"Context: There is limited understanding about how documented goals of care conversations (GOCC) are associated with cost-related outcomes for hospitalized patients.Objective: To primarily assess the association of documented GOCC with specialty palliative consults (SPC) and hospital cost-related outcomes.Methods: This multihospital, cross-sectional study, which used propensity-score matching, assessed adult patients hospitalized between 2022-2024 at four hospitals. We used multivariable logistic and linear regression models to identify outcomes associated with documented GOCC.Results: Of 267,375 patients with median age 61 years, 19,186 had a documented GOCC and 12,300 had a SPC during hospital admission. In the propensity-score matched cohort (n=24,600), documented GOCC with SPC were associated with decreased odds of in-hospital death (aOR 0.15, 95% CI 0.12-0.18), thirty-day readmission (aOR 0.68, 95% CI 0.57-0.82) and lower hospital length of stay (adjusted log-linear coefficient [β] -0.07, 95% CI -0.14- -0.01). They were also associated with lower total direct hospital costs for patients surviving hospital admission (β -0.18, 95% CI -0.26- -0.11), admitted to an ICU (β -0.13, 95% CI -0.23- -0.03) or with GOCC documented within 48 hours of admission (β -0.28, 95% CI -0.37- -0.19). In contrast, documented GOCC overall with or without SPC were associated with increased odds of in-hospital death (aOR 8.77, 95% CI 7.44-10.35, p<0.0001) and higher hospital length of stay (β 0.25, 95% CI 0.19-0.31, p<0.0001) and total direct costs (β 0.18, 95% CI 0.12-0.24, p<0.0001).Conclusion: Early documented GOCC with SPC were associated with lower cost-related outcomes and may contribute to hospital cost-related savings.","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145149626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Caregiving activities and activity-limiting pain among African American caregivers. 非裔美国照护者的照护活动与活动限制性疼痛。

IF 3.5 2区医学

Journal of pain and symptom management Pub Date : 2025-09-23 DOI: 10.1016/j.jpainsymman.2025.09.022

Martha Abshire Saylor, Janiece L Taylor, Yifan Liu, Wonkyung Jung, Erin M Spaulding, Katherine A Ornstein

{"title":"Caregiving activities and activity-limiting pain among African American caregivers.","authors":"Martha Abshire Saylor, Janiece L Taylor, Yifan Liu, Wonkyung Jung, Erin M Spaulding, Katherine A Ornstein","doi":"10.1016/j.jpainsymman.2025.09.022","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2025.09.022","url":null,"abstract":"Background: African American caregivers disproportionately engage in high-intensity caregiving. Pain experiences of African Americans may interfere with caregiving and overall health, but little is known about the associations of caregiving activities and activity-limiting pain among African Americans.Objective: We aimed to (i) examine risk factors for activity-limiting pain among African American caregivers and (ii) analyze the relationships between caregiving intensity, patient care needs and activity-limiting pain.Methods: In a cross-sectional analysis, using nationally representative data from the National Study of Caregiving and linked National Health and Aging Trends Study, we analyzed caregiver and care recipient factors associated with activity-limiting pain among African American caregivers. We examined the relationship between caregiving intensity, patient care needs and activity-limiting pain using multivariable logistic regression. Sampling weights were applied to make nationally representative estimates.Results: Our sample (N=1,673) included mostly female (63.5%) African American caregivers, with a mean age of 55.8 ± 21.5 years. Nearly half experience pain and 11% report activity-limiting pain. In our fully adjusted, multivariable model, those with higher intensity caregiving (i.e., longer duration of caregiving) [aOR: 2.09, CI: 1.29-3.39] and higher patient care needs (i.e., supporting care recipients requiring assistance for more activities of daily living (ADLs)) [aOR: 1.15, CI: 1.02-1.29] had higher odds of activity-limiting pain compared to those with lower intensity caregiving and lower care needs.Conclusion: These findings underscore the importance of the intersection of race, caregiving, and pain. Future work should explore how African American caregivers cope with pain and how best to support them.","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145149603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Effectiveness and Safety of Home-Based RBC Transfusions in Advanced Hematologic and Solid Tumors. 家庭输血治疗晚期血液病和实体瘤的有效性和安全性。

IF 3.5 2区医学

Journal of pain and symptom management Pub Date : 2025-09-23 DOI: 10.1016/j.jpainsymman.2025.09.021

Naohiro Miyashita, Kota Ohashi, Masahiro Onozawa

{"title":"Effectiveness and Safety of Home-Based RBC Transfusions in Advanced Hematologic and Solid Tumors.","authors":"Naohiro Miyashita, Kota Ohashi, Masahiro Onozawa","doi":"10.1016/j.jpainsymman.2025.09.021","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2025.09.021","url":null,"abstract":"Context: Home-based red blood cell transfusion (RBC-TF) offers a potential treatment for terminally ill patients who suffer from anemia-related symptoms but face difficulties visiting medical facilities. However, its clinical utility and safety remain underexplored.Objectives: To evaluate the effectiveness, safety, and procedural characteristics of home-based RBC-TF in terminally ill patients with hematological malignancies (HM) and solid tumors (ST).Methods: This retrospective study included patients with terminal-stage HM or ST who received home-based RBC-TF between July 2020 and February 2025. Symptom relief was used to assess effectiveness, and adverse events (AEs) were documented to evaluate safety. Biomarkers related to cancer cachexia were also analyzed. All transfusions followed standardized protocols, including premedication and the use of leukoreduced and irradiated RBCs.Results: Seventy-seven patients (58 HM, 19 ST) received 1,664 units of RBCs. Symptom improvement was significantly greater in HM patients compared to ST patients for fatigue (94.1% vs. 53.8%, P = 0.003) and appetite loss (55.0% vs. 6.7%, P = 0.004). No severe AEs were observed; two mild allergic reactions occurred (0.29%). ST patients exhibited more severe cachexia-related markers, including lower albumin and higher CRP levels.Conclusion: Home-based RBC-TF is a feasible and safe palliative intervention for carefully selected patients, especially those with HM. Standardized transfusion protocols may contribute to improved safety. Patient selection is essential, particularly in those with advanced cachexia who may experience limited benefit.","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145149536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Differences in pain episodes among children with complex chronic conditions at end of life. 患有复杂慢性疾病的儿童临终时疼痛发作的差异。

IF 3.5 2区医学

Journal of pain and symptom management Pub Date : 2025-09-23 DOI: 10.1016/j.jpainsymman.2025.09.015

Jori F Bogetz, Megan Phan, Elsa Ayala, Yasmeen Alayli, Emily E Johnston, Prasanna Ananth, Julie McGalliard, Bryan Strub, Miranda C Bradford, Abby R Rosenberg

{"title":"Differences in pain episodes among children with complex chronic conditions at end of life.","authors":"Jori F Bogetz, Megan Phan, Elsa Ayala, Yasmeen Alayli, Emily E Johnston, Prasanna Ananth, Julie McGalliard, Bryan Strub, Miranda C Bradford, Abby R Rosenberg","doi":"10.1016/j.jpainsymman.2025.09.015","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2025.09.015","url":null,"abstract":"Objective: This study examined disparities in pain episodes at end-of-life (EOL) among children with complex chronic conditions (CCCs).Methods: This was a retrospective study of children and young adults ages 0-25 years who died in-hospital at a U.S. academic institution between January 2021-December 2024. Demographic data and pain scores (0=no pain to 10=worst pain) from the electronic health record were automatically abstracted. Exploratory analyses included descriptive statistics and Pearson's chi square tests.Results: Among 482 children, 50% (n=243) were infants, 31% (n=148) were children 1-12 years, 13% (n=62) were adolescents 13-17 years, and 6% (n=29) were young adults ≥18 years. 55% (n=264) were male, 47% (n=202) were white, 18% (n=88) were Hispanic, and 18% (n=81) preferred a language other than English. 70% (n=339) had congenital/genetic, neurologic/neuromuscular, and/or metabolic CCCs; 22% (n=104) had malignancy; 22% (n=107) had hematologic/immunologic CCCs; and 16% (n=78) had respiratory CCCs. 87% (n=420) died in the intensive care unit (ICU). In the last 3 days of life, 60% (n=276) had at least one moderate-to-severe pain score ≥4 and, of those, 32% (n=148) had at least one severe pain score ≥7. We observed a higher proportion of children with severe pain episodes among adolescents/young adults, Hispanics, those who preferred a language other than English, those with malignancy, hematologic/immunologic, and respiratory CCCs, and those who died in the ICU.Conclusion: Moderate-to-severe pain episodes were present in >50% of children with CCCs in the last 3 days of life. The proportion differed based on demographic factors reflecting known health disparities.","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145149558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Not Against Death, But for the Dying: A Different Kind of Resistance. 不是反对死亡，而是为了死亡：一种不同的抵抗。

IF 3.5 2区医学

Journal of pain and symptom management Pub Date : 2025-09-23 DOI: 10.1016/j.jpainsymman.2025.09.014

Juan Luis Torres-Tenor

引用次数: 0

Economic benefits of investment in palliative care: an appraisal of current evidence and call to action. 缓和治疗投资的经济效益：对现有证据的评估和行动呼吁。

IF 3.5 2区医学

Journal of pain and symptom management Pub Date : 2025-09-22 DOI: 10.1016/j.jpainsymman.2025.09.020

Liz Gwyther, Maya Jane Bates, Bach Tran, Liz Grant, Richard Harding, Eric L Krakauer, Peter May, Eve Namisango, M R Rajagopal, Eleanor Reid, Charles Normand

引用次数: 0

Systematic Screening of Advanced Cancer Patients' Curability Perception: A Longitudinal Analysis. 晚期癌症患者治愈认知的系统筛查：一项纵向分析。

IF 3.5 2区医学

Journal of pain and symptom management Pub Date : 2025-09-22 DOI: 10.1016/j.jpainsymman.2025.09.011

Kayley Ancy, Grecia Aldana Singleton, Yi Huang, Donna S Zhukovsky, Yvonne Heung, Eduardo Bruera, David Hui

{"title":"Systematic Screening of Advanced Cancer Patients' Curability Perception: A Longitudinal Analysis.","authors":"Kayley Ancy, Grecia Aldana Singleton, Yi Huang, Donna S Zhukovsky, Yvonne Heung, Eduardo Bruera, David Hui","doi":"10.1016/j.jpainsymman.2025.09.011","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2025.09.011","url":null,"abstract":"Context: Systematic screening of illness understanding is a novel approach that normalizes discussion of this sensitive topic and helps to identify patients with information needs.Objectives: To examine changes over time in perception of curability among patients with advanced cancer and the predictors of misperception.Methods: We implemented universal electronic systematic screening of illness understanding for each patient in our Supportive Care Center using questions from the Prognosis and Treatment Perception Questionnaire. The current study retrospectively reviewed data from all patients with advanced solid tumors who completed screening at their consultation and at least one follow-up visit within 1 year.Results: The analysis included 432 patients: mean age 58 years (SD 14), 248 (57.4%) female, 331 (76.6%) White. The mean number of visits to the Supportive Care Center was 2.69 (SD 0.9), and the median time between the initial consultation and second visit was 85 days (IQR 68.0-113.3). At visits 1 and 2, 34.0% (147/432) and 36.8% (159/432) of patients, respectively, had an accurate perception of curability (p=0.3). In multivariable analysis, inaccurate perception of curability at both initial consultation and second visit was associated with Asian race (OR=3.08, p=0.02), greater well-being (reverse scored, OR=0.83, p<0.001) and better sleep (OR=0.89, p=0.002), and lower fatigue (OR=0.92, p=0.02), depression (OR=0.88, p=0.001), anxiety (OR=0.9, p=0.006), and financial distress (OR=0.92, p=0.015).Conclusion: Only one in three patients with advanced cancer had an accurate understanding of their curability, with limited improvement over time. Systematic screening may provide opportunities to improve illness understanding and coping support.","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145137953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Cancer-Related Fatigue and Muscle Function. 癌症相关的疲劳和肌肉功能。

IF 3.5 2区医学

Journal of pain and symptom management Pub Date : 2025-09-22 DOI: 10.1016/j.jpainsymman.2025.09.019

Mellar P Davis, Armida Parala-Metz

引用次数: 0