Journal of pain and symptom management最新文献

{"title":"Information meetings stimulate older people to talk about their wishes at the end of life.","authors":"MSc Tessa D Bergman, Dr Annicka G M van der Plas, Dr H Roeline W Pasman, Prof Dr Bregje D Onwuteaka-Philipsen","doi":"10.1016/j.jpainsymman.2025.10.005","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2025.10.005","url":null,"abstract":"<p><strong>Context: </strong>Information meetings aim to inform older people about end-of-life care, and prepare for advance care planning (ACP). Meetings are organized by general practitioners (GPs) inviting their patients or by other organizations targeting older people in general.</p><p><strong>Objectives: </strong>To assess whether information meetings stimulate ACP (conversations with relatives, healthcare professionals, and documentation), and whether the type of meeting (GP versus other) and attendees' characteristics were associated with having ACP conversations with the GP in response to the meeting.</p><p><strong>Methods: </strong>A pre-post interventional study with questionnaires immediately before (T0) and six months after (T2) the information meeting. 98 information meetings were organized (53 by GPs; 45 by other organizations). Older people attended a meeting and filled out questionnaires at T0 (N=1,917) and T2 (N=1,088). Descriptive statistics and logistic regression analyses were done.</p><p><strong>Results: </strong>At T2, 26.4% of attendees had had an ACP conversation with their GP in response to the information meeting. Further, more older people had documented (T0: 39%; T2: 53%) and discussed their wishes with relatives (T0: 61%; T2: 84%) at T2. ACP engagement with GPs did not differ between GP or other meetings. Age (OR 1.05), non-Dutch background (OR 2.41), religiosity (OR 0.68) and previously having discussed end-of-life topics with a physician (OR 2.38) were associated with having ACP conversations with GPs.</p><p><strong>Conclusions: </strong>Information meetings about end-of-life care stimulate older people to have ACP conversations with GPs and relatives and document wishes. The type of meeting, by GPs or others, does not affect ACP conversations with their GP.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145368203","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}

{"title":"Adaptation of a serious illness communication training intervention for the Rwandan context.","authors":"Rebecca J DeBoer, Pacifique Uwamahoro, Diane Andrea Ndoli, Eulade Rugengamanzi, Augustin Mulindabigwi, Jean Bosco Bigirimana, Tumusime Musafiri, Sarah E Slater, Katherine Van Loon, Rebecca L Sudore, Wendy G Anderson, Justin J Sanders, Vincent K Cubaka","doi":"10.1016/j.jpainsymman.2025.10.010","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2025.10.010","url":null,"abstract":"<p><strong>Context: </strong>Communication skills are essential in cancer care, and international guidelines recommend communication training for all cancer care providers. Both clinical communication and training methods are influenced by culture. As oncology and palliative care expand globally, procedures are needed to adapt evidence-based communication training for diverse contexts.</p><p><strong>Objective: </strong>To adapt a serious illness communication training intervention in Rwanda.</p><p><strong>Methods: </strong>Guided by the Cultural Adaptation Process model, we conducted focus groups to understand communication training needs and gather feedback on a U.S. tool, the Serious Illness Conversation Guide (SICG). Based on identified needs, we made initial adaptations to an SICG-based training, incorporating tools from another U.S. program (VitalTalk). We piloted this training with 14 clinical psychologists, using lecture, demonstration, scripted roleplay, and small group discussion. Effectiveness was assessed through 5-point scales and qualitative feedback.</p><p><strong>Results: </strong>Seventeen interdisciplinary oncology providers participated in three focus groups. While some had received lectures on communication, all believed additional training is needed. They endorsed the approach of adapting an international program rather than creating a Rwandan training de novo. Based on their input, we adapted and piloted a training that focused on three skills: 1) Set up the conversation and assess understanding; 2) Share information via a succinct \"headline;\" 3) Respond to emotion. Training methods received mean scores of 4.0 to 4.33 (5=most effective). Further modifications were suggested to improve cultural concordance.</p><p><strong>Conclusion: </strong>Despite vast cultural differences, communication training interventions developed in the U.S. can be effectively adapted in African contexts through co-creation with local providers.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145368211","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}

{"title":"Unused opioids following palliative care for children at home: A missed opportunity for opioid stewardship?","authors":"Adam Rapoport, Lara Navarro, Wendy Bordman, Julia Mallen, Katherine E Nelson, Kimberley Widger, Rebecca Williams, Conor Mc Donnell","doi":"10.1016/j.jpainsymman.2025.10.011","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2025.10.011","url":null,"abstract":"<p><strong>Context: </strong>Opioids are often a key component of compassionate end-of-life care for children at home. However, after a child dies, unused opioids pose a risk for misuse or diversion, thereby contributing to the ongoing opioid crisis.</p><p><strong>Objectives: </strong>This exploratory study aimed to identify the prevalence and context of unused opioids in bereaved families' homes to inform interventions to remove medications in a compassionate and timely manner.</p><p><strong>Methods: </strong>Bereaved families whose child received palliative care from a tertiary hospital in Ontario, Canada, were invited to participate in an online survey if: (1) their child died at home between January 2020 and July 2024 (no less than 3 months prior to study commencement), (2) they had an email address on file, and (3) they did not require an English interpreter.</p><p><strong>Results: </strong>Of 121 eligible families, 45 (37.2%) completed the survey. Thirty-four respondents (75.6%) reported having unused opioids in their home at the time of their child's death, with 5 (14.7%) still in possession of opioids at the time of survey completion. Twenty-nine of 34 families (85.3%) disposed of all unused opioids, with 10 (34.4%) taking longer than a month to do so. Eighteen (62.1%) used a pharmacy 'take-back' program, the recommended disposal method.</p><p><strong>Conclusion: </strong>At the time of their child's death, most families who responded to an online survey had unused opioids in their home, some of which remained in the home for an extended period, posing a risk for misuse. Disposal methods varied, revealing the need for a clear, streamlined process for safe disposal.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145367754","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}

{"title":"A Kid at Heart: Applying Pediatric Skills to Caring for Adults.","authors":"Annie Laurie Gula, Rebecca E MacDonell-Yilmaz, Dana Guyer","doi":"10.1016/j.jpainsymman.2025.10.008","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2025.10.008","url":null,"abstract":"","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145355087","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}

{"title":"Spiritual Status and Quality of Life in Hospice Family Caregivers: A cross-sectional study.","authors":"Dong Wook Chun, Youngmin Park, In Cheol Hwang, Hong Yup Ahn","doi":"10.1016/j.jpainsymman.2025.10.012","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2025.10.012","url":null,"abstract":"<p><strong>Objectives: </strong>This study examines the association between spiritual status and quality of life (QoL) among family caregivers (FCs) of terminally ill cancer patients.</p><p><strong>Materials and methods: </strong>A cross-sectional survey was conducted at nine hospice care units in South Korea (n=170 FCs). Spiritual status was addressed using the Functional Assessment of Chronic Illness Therapy-Spiritual Well-being questionnaire (FACIT-Sp-12) and three self-rated questions that addressed spirituality, religiosity, and spiritual pain. QoL was measured using the Korean version of the Caregiver Quality of Life Index-Cancer(CQOLC-K) questionnaire. Multivariate regression analysis, adjusted for covariates via stepwise selection, was used to examine the associations between spiritual variables and CQOLC-K total and each subscale.</p><p><strong>Results: </strong>In adjusted analyses, Positive Adaptation was the only CQOLC-K subscale associated with all spiritual measures, including Meaning/peace, Faith of FACIT-Sp-12, self-rated spirituality, religiosity, and spiritual pain. No consistent independent association was observed with the CQOLC-K total. In stratified models, these associations were confined to caregivers with a religious affiliation. Spiritual pain showed subgroup-specific patterns: among religious caregivers it coexisted with higher positive adaptation and greater burden, while among non-religious caregivers it was related to worse financial concerns.</p><p><strong>Conclusion: </strong>In this cohort, spirituality aligned with domain-specific adaptation, and this linkage was limited to caregivers with a religious affiliation. Brief screening that records a single item for spiritual pain and the presence of religious affiliation may help identify caregivers with a religious affiliation who will benefit from meaning-focused spiritual support, while caregivers without a religious affiliation may benefit more from practical and financial assistance.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145337202","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}

{"title":"\"Between Universes:\" Moral Distress in Delivering Culturally Attuned Care to South Asian Breast Cancer Survivors.","authors":"Ranak Trivedi, Nathan Tran, Veena Manja, Nainwant Singh, Shreya Desai, Lidia Schapira, Dolores Gallagher-Thompson, Steven M Asch, Karl Lorenz","doi":"10.1016/j.jpainsymman.2025.09.013","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2025.09.013","url":null,"abstract":"<p><strong>Context: </strong>Even as health care institutions seek to promote culturally attuned care, clinicians may struggle when cultural norms and practices contradict established clinical practices.</p><p><strong>Objectives: </strong>To explore sources of moral distress among clinicians treating the growing population of South Asian breast cancer survivors.</p><p><strong>Methods: </strong>We report secondary analyses from a mixed methods study that aimed to understand the barriers and facilitators to providing culturally attuned care to South Asian breast cancer survivors. We conducted 30-minute virtual semi-structured interviews with multidisciplinary clinicians involved in cancer care. Interviews were guided by the Consolidated Framework of Implementation Research (CFIR). For this study, we used a thematic analysis approach to examine the sources of moral distress, and potential solutions to address it.</p><p><strong>Results: </strong>14 clinicians (8 physicians; 41.6±9.8 years; 9 women; 4 South Asian) were interviewed. We identified the following themes: 1) Clinicians experienced moral distress when South Asian cultural norms conflicted with pillars of biomedical ethics; 2) Moral distress was exacerbated by individual and system-level barriers; and, 3) Solutions may necessitate change across individual, inner setting (e.g., clinics), and outer setting (e.g., health care systems) domains of CFIR.</p><p><strong>Conclusions: </strong>Clinicians may experience moral distress when their evidence-based and ethical care approaches conflict with cultural norms. Health care systems should provide programs that support clinicians who encounter these dilemmas to ensure high quality clinical care that respects the cultural norms of South Asian breast cancer survivors.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145308280","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}

{"title":"Improving Compassionate Extubation Practices in the Pediatric Intensive Care Unit.","authors":"Elizabeth Rinaldi, Debbie Brostoff, Robin V Klein, Meredith C Winter","doi":"10.1016/j.jpainsymman.2025.09.029","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2025.09.029","url":null,"abstract":"<p><strong>Background: </strong>This study was conducted in a free-standing pediatric academic institution in the pediatric intensive care unit (PICU) and cardiothoracic intensive care unit (CTICU), focusing on children with planned compassionate extubation (CE). Prior to the study, variability in CE practices led to inconsistencies in care and communication.</p><p><strong>Objectives: </strong>Implement and assess the efficacy of a protocol to ensure consistent symptom management, enhance documentation, and promote communication among providers during CE events.</p><p><strong>Methods: </strong>Pre and post quality improvement project with implementation of a CE protocol in February 2022, including (1) a checklist to standardize orders, documentation, medical management, and provider availability around the time of CE and (2) a post-extubation staff debriefing tool. The study was carried out by a multidisciplinary team composed of providers, nurses, respiratory therapists, palliative care specialists, and a child life specialist. The improvement team evaluated CE events for a 12 month period before (January-December 2020) and for 12 months after (February 2022-January 2023) the intervention roll-out date via manual chart review and Research Electronic Data Capture surveys of staff members who participated in the CE. The primary outcome was the compliance with best practices surrounding documentation and clinical interventions at the time of CE. Secondary outcomes included staff satisfaction with the CE process and rate of debriefings.</p><p><strong>Results: </strong>There were 18 pre-intervention events and 26 post-intervention CE events that underwent chart review. 53 surveys were reviewed, 20 pre-intervention and 33 post-intervention. There was a significant increase in the appropriate placement of extubation orders (6% prior to protocol, 69% at study conclusion), improvement in timely advance care plan documentation (89% prior to protocol, 100% at study conclusion), and increase in cessation of vasoactive infusions at the time of extubation (78% prior to protocol, 100% at study conclusion). The rates of debriefs remained similar before and after protocol implementation (65% and 67% respectively). Overall, the protocol was well received by ICU staff, over 90% of staff surveys showed positive feedback on patient and provider comfort during CE.</p><p><strong>Conclusions: </strong>A CE protocol improved documentation and communication around pediatric end-of-life care. Future improvements should focus on exploring the barriers to post-extubation debriefings.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145280510","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}

{"title":"IMPACT OF A CURRICULUM REFORM IN GRADUATE STUDENTS SELF-REPORTED PALLIATIVE CARE COMPETENCIES.","authors":"Mónica Grez A, Alfredo Rodríguez-Nunez, Armando Maldonado-Morgado, Felipe Castro, Nicolás Orozco, Luciana Crispino, Francisca Villouta, Carolina Jaña, Ofelia Leiva-Vásquez, Pedro E Pérez-Cruz","doi":"10.1016/j.jpainsymman.2025.10.003","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2025.10.003","url":null,"abstract":"<p><strong>Introduction: </strong>Expanding quality basic palliative care (PC) training for undergraduate health professionals is a key strategy to secure timely access to PC for the large population in need. However, evidence on the impact of changes in undergraduate medical curriculum in PC remains limited. This study aimed to assess the impact of expanded undergraduate PC training on students' self-perceived competencies, knowledge, and training adequacy, comparing cohorts before and after a curricular reform.</p><p><strong>Methods: </strong>In this cross-sectional study, recently graduated medical students from two cohorts at the same university-one with limited exposure and the other with extended exposure to a PC curriculum-were invited to complete an electronic survey. The aim was to assess their perception of the PC training received during medical school, their self-assessed core competencies, and their knowledge in the field.</p><p><strong>Results: </strong>157 (64%) out of 244 graduates answered the survey. Students exposed to the extended PC curriculum, more frequently reported that the theoretical and practical contents received were sufficient (p<0.001), had higher scores in PC knowledge assessment and, reported having significantly more skills to deliver bad news (p=0.01), to evaluate physical symptoms (p=0.04), spiritual symptoms (p 0.01), to explain what the PC consist of (p=0.028) and to evaluate symptoms emotional (p=0.003).</p><p><strong>Conclusions: </strong>Integrating and increasing exposure to PC training throughout the entire medical school curriculum enhances recently graduated medical students' perception of the adequacy of their training, strengthens their self-perceived competencies, and improves their knowledge in PC.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274819","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}

{"title":"Mental Healthcare Delivery in Palliative Care: Patient and Caregiver Perspectives.","authors":"Mia Pattillo, Jeffers Guthrie, Molly Nowels, Maureen Ekwebelem, Karolina Sadowska, Milagros Silva, M Carrington Reid, Daniel Shalev","doi":"10.1016/j.jpainsymman.2025.10.001","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2025.10.001","url":null,"abstract":"<p><strong>Background: </strong>Palliative care aims to improve quality of life for individuals with serious illness, yet mental health needs in this population often remain under-addressed. Currently, little is known about how patients and caregivers perceive the role of mental health services within palliative care.</p><p><strong>Objectives: </strong>To explore patient and caregiver perspectives on (1) current delivery of mental health support in palliative care for serious medical illnesses and (2) preferences for integrated specialty mental health services.</p><p><strong>Methods: </strong>We conducted semi-structured interviews with 23 patients receiving ambulatory palliative care and 11 caregivers at an academic medical center. Interviews explored experiences with mental health care, perceived roles of palliative care, and preferences for integration. Transcripts were analyzed using thematic analysis.</p><p><strong>Results: </strong>Participants described strong therapeutic relationships with palliative care clinicians, who offered informal mental health support through conversations, medication management, and referrals. However, many were uncertain whether mental health care formally fell within providers' roles. Both patients and caregivers expressed broad support for integrated mental health services, citing benefits such as improved care coordination, streamlined logistics, and access to clinicians with knowledge about serious illness. Caregivers emphasized their own emotional burdens and advocated for inclusion as recipients of mental health support.</p><p><strong>Conclusions: </strong>Patients and caregivers view integrated mental healthcare as a valuable addition to palliative care. Integration models should include specialist mental health providers, address caregiver needs, and offer flexible delivery formats. Palliative care's transdiagnostic scope, interdisciplinary structure, and psychosocial orientation make it a strategic site for integrated care.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274941","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}

{"title":"Palliative Care for Advanced Liver Disease: Hepatology and Palliative Care Specialists Experiences.","authors":"Nicholas Hoppmann, Marie Bakitas, Macy Stockdill, Jan DeNofrio, Victor Navarro, Manisha Verma","doi":"10.1016/j.jpainsymman.2025.09.028","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2025.09.028","url":null,"abstract":"<p><strong>Context: </strong>People with advanced liver disease (ALD) face progressive symptoms and may benefit from palliative care (PC); but optimal care models remain unknown.</p><p><strong>Objectives: </strong>To describe PC-trained hepatologists and board-certified PC specialists experiences with integrating PC into ALD care.</p><p><strong>Methods: </strong>We conducted an embedded qualitative evaluation study, within the 19-site, randomized PAL-LIVER comparative effectiveness trial, to understand clinicians' perspectives on providing integrated PC in ALD. Semi-structured interviews, conducted between March 23, 2020, and July 1, 2022, were transcribed verbatim, coded, and analyzed to generate themes about their experiences.</p><p><strong>Results: </strong>Clinicians (17=hepatologists; 15=PC providers) with mean age (SD) of 47.3 (8.8) years, 65.3% women, 78.1% White, 68.4% physicians, and 25% nurse practitioners; 43.7 % had been in practice ≤10 years. Shared themes included: 1) Cross-disciplinary primary PC and ALD education is central to PC integration; and 2) Providing PC takes time. Hepatologists unique themes were: 1) Navigating the intersection of primary and specialty PC, and 2) Increased awareness of caregivers' needs. PC specialists' unique themes were: 1) Misperceptions of PC, and 2) Characteristics of hepatology-palliative collaborations.</p><p><strong>Conclusions: </strong>Future PC implementation into routine ALD care will require cross-disciplinary education, adjustments to hepatologists clinical schedules to allocate time to assess and address patient and caregiver PC needs and to discern which patients are best managed by a trained hepatologist vs a PC specialist. On-going misperceptions about the purpose of PC were addressed and facilitated by interdisciplinary collaboration. Our results will guide future efforts to scale PC integration into routine ALD management.</p><p><strong>Clinicaltrials: </strong>gov NCT03540771.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274978","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}