Journal of pain and symptom management最新文献

{"title":"PC-FACS November 3, 2026.","authors":"","doi":"10.1016/j.jpainsymman.2026.11.001","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2026.11.001","url":null,"abstract":"","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149357541","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":"\"Google docs\" and the future of palliative care.","authors":"David Casarett","doi":"10.1016/j.jpainsymman.2026.11.002","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2026.11.002","url":null,"abstract":"","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149342505","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":"Humanizing Clinical Documentation Through Musical Principles, Supported by a TikTok Reflection.","authors":"Sydelle Ross","doi":"10.1016/j.jpainsymman.2026.10.026","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2026.10.026","url":null,"abstract":"","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149322291","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 Understanding Among U.S. Adults: Findings from HINTS 7.","authors":"Lauren A Cafferty, Dale E Lupu, Jeffrey B Bingenheimer, Melissa A Napolitano","doi":"10.1016/j.jpainsymman.2026.10.031","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2026.10.031","url":null,"abstract":"<p><strong>Context: </strong>Limited public understanding remains a barrier to greater use of palliative care. Personal experiences with serious illness and caregiving may provide opportunities to learn about palliative care through healthcare encounters, conversations with healthcare providers, and participation in treatment decisions.</p><p><strong>Objectives: </strong>This study examined whether a self-reported history of serious health condition, caregiving experience, and their interaction were associated with palliative care understanding.</p><p><strong>Methods: </strong>This cross-sectional study used nationally representative data from the 2024 Health Information National Trends Survey (HINTS) 7, Cycle 1. Palliative care understanding was assessed using a composite measure of awareness and knowledge. Survey-weighted logistic regression examined its associations with caregiving experience, serious health conditions, and their interaction, adjusting for sociodemographic characteristics.</p><p><strong>Results: </strong>The survey included 7,278 respondents, and the adjusted model included 6,128 complete cases. Caregivers had nearly twice the odds of adequate understanding compared with non-caregivers. Serious health condition was not associated with adequate understanding of palliative care. The interaction between serious health condition and caregiving experience was not significant. In exploratory analyses, awareness did not differ by history of cancer, heart disease, or lung disease.</p><p><strong>Conclusions: </strong>Caregiving experience was associated with greater palliative care understanding, whereas self-reported history of cancer, heart disease, or lung disease was not significantly associated with greater palliative care understanding, whereas caregiving experience was associated with greater understanding. These findings raise questions about whether opportunities to introduce and explain palliative care during healthcare encounters are being fully used. More direct and consistent communication about palliative care may be needed throughout the course of serious illness.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149322294","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":"Cancer versus Non-Cancer Patients Admitted to Hospice: a comparison study.","authors":"Sebastiano Mercadante, Marco Travia, Pierangela Scimone, Marcella Dabbene, Alessio Lo Cascio","doi":"10.1016/j.jpainsymman.2026.10.030","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2026.10.030","url":null,"abstract":"<p><strong>Context: </strong>Malignant disease remains the leading reason for hospice admission, and direct, patient-level comparisons of cancer and non-cancer patients within the same residential hospice are scarce.</p><p><strong>Objectives: </strong>To compare sociodemographic and clinical characteristics, symptom burden, nutritional support, length of stay and outcome between oncological and non-oncological patients admitted to a single hospice.</p><p><strong>Methods: </strong>Prospective observational cohort study of 175 consecutive admissions over one year, after removal of duplicate records. Patients were classified as oncological (n=151, 86.3%) or non-oncological (n=24, 13.7%) based on structured case report form fields. Sociodemographic, functional (Karnofsky Performance Status, KPS), nutritional, symptom (Edmonton Symptom Assessment System, ESAS) and cognitive (Memorial Delirium Assessment Scale, MDAS) data were collected at admission (T0); ESAS completion was also examined at 1 week (T7). Categorical variables were compared with the chi-square or Fisher's exact test, continuous variables (reported as median and interquartile range, including ESAS and MDAS scores) with the Mann-Whitney U test; p-values were adjusted for multiple comparisons with the Benjamini-Hochberg procedure (q).</p><p><strong>Results: </strong>Most non-oncological patients had a neurological disease (21/24), mainly neurodegenerative diseases, amyotrophic lateral sclerosis and dementia. Non-oncological patients were older (median 78.5 vs 72 years, P=0.002, q=0.012) and had worse performance status at admission (median KPS 20 vs 30, P<0.001, q=0.006). Artificial nutrition was more frequent among non-oncological patients (37.5% vs 14.9%, P=0.018), although not after correction for multiple comparisons (q=0.060). MDAS scores were higher in non-oncological patients (median 13 vs 4, P=0.021). ESAS data were missing in about half of oncological and three quarters of non-oncological patients; no ESAS item differed between groups after correction for multiple comparisons, and the non-oncological group's valid ESAS sample fell to a single patient by T7. Length of stay (11 vs 8 days, P=0.518) and in-hospice mortality (80.0% vs 70.8%, P=0.455) did not differ significantly.</p><p><strong>Conclusion: </strong>In this single-centre series, non-oncological patients, mostly affected by neurological diseases, were admitted older, more functionally compromised and with higher MDAS scores than oncological patients, despite comparable length of stay and mortality. Apparent differences in symptom burden are confounded by substantial, likely informative, missing data and should be interpreted with caution. Whether these differences reflect later referral or the age profile of the underlying diseases cannot be determined from these data.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149322289","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":"Clarifying the Definition and Analysis of Opioid Switching in Advanced Cancer.","authors":"Yohei Kishi, Yurika Saito, Anri Inumaru","doi":"10.1016/j.jpainsymman.2026.09.007","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2026.09.007","url":null,"abstract":"","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149322290","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":"Methylphenidate for cancer-related fatigue by assessment time: a systematic review and meta-analysis.","authors":"Yasmin Zani Magro, Andersom Ricardo Fréz, Verônica Silva Furlani, Isabella Cristina Chiamolera, Cristina Maria Nunes Cabral, Aline Cristiane Binda","doi":"10.1016/j.jpainsymman.2026.10.027","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2026.10.027","url":null,"abstract":"<p><strong>Background: </strong>Cancer-related fatigue is highly prevalent and significantly impairs quality of life and treatment adherence. Methylphenidate is commonly prescribed, but its efficacy remains uncertain.</p><p><strong>Objective: </strong>To evaluate the efficacy of methylphenidate for cancer-related fatigue, accounting for the timing of fatigue assessment and the certainty of the available evidence.</p><p><strong>Methods: </strong>A systematic review and meta-analysis of randomized controlled trials was conducted. PubMed, Embase, CINAHL, Cochrane CENTRAL, and SPORTDiscus were systematically searched from inception to February 2026, without language or date restrictions. Adult patients with cancer-related fatigue were included, and methylphenidate was compared with placebo. Fatigue outcomes were analyzed separately during treatment, immediately post-treatment, and at follow-up. The time-specific meta-analyses, subgroup analyses, and sensitivity analyses were conducted post hoc. The review was registered in PROSPERO (CRD42023429827).</p><p><strong>Results: </strong>Fourteen randomized controlled trials, involving 1,155 patients, were included. Methylphenidate was associated with a small but statistically significant improvement in fatigue during treatment (SMD 0.26, 95% CI 0.04 to 0.47; I²=30%). No statistically significant benefit was observed immediately post-treatment (SMD 0.27, 95% CI 0.00 to 0.53; I²=63%) or at follow-up (SMD 0.36, 95% CI -0.13 to 0.84; I²=23%). Sensitivity analyses generally supported the during-treatment finding, while subgroup analyses showed statistically significant effects in studies with treatment durations of at least two weeks, among patients with advanced cancer and/or receiving palliative care, and in studies evaluating racemic methylphenidate. No statistically significant improvement in quality of life was observed. The certainty of evidence ranged from very low to low.</p><p><strong>Conclusions: </strong>Current randomized evidence suggests a small benefit of methylphenidate for cancer-related fatigue during treatment, although its clinical relevance and persistence after treatment remain uncertain. The low to very low certainty of the evidence and exploratory nature of subgroup analyses limit conclusions regarding which patients may benefit from treatment.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149322292","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":"Opioid Switching for Cancer Pain in Non-Hospitalized Patients: The challenges. A Narrative Review.","authors":"Sebastiano Mercadante, Eduardo Bruera","doi":"10.1016/j.jpainsymman.2026.10.029","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2026.10.029","url":null,"abstract":"<p><strong>Objectives: </strong>To critically examine clinical evidence regarding opioid switching (OS) exclusively within community settings (outpatient clinics and home care programs), identify scenarios necessitating acute inpatient palliative admission, and evaluate digital health integrations to safely support community-based rotation.</p><p><strong>Background: </strong>Up to 40% of advanced cancer patients require an OS to optimize analgesia or mitigate adverse effects. Although over 50% of cancer deaths occur outside hospitals, most OS data derive from inpatient populations, creating a significant evidence gap for community-based protocols.</p><p><strong>Methods: </strong>A narrative review was conducted, focusing on clinical trials and observational studies-specifically referencing parameters consolidated in the working paper -that evaluated OS frequencies, indications, success rates, and equianalgesic ratios strictly in ambulatory or home palliative care.</p><p><strong>Results: </strong>Outpatient and home care OS achieves high success rates (65%-82.5%), predominantly driven by uncontrolled pain (52%-88%). Real-world data confirm the feasibility of community rotations to transdermal fentanyl, levorphanol, buprenorphine, and tiered oral methadone. Published equianalgesic ratios vary widely. In most studies, post-switch doses were not lower than pre-switch doses and in some they increased, although these data are largely retrospective and may partly reflect disease progression. Complex scenarios-such as acute pain crises, severe neurotoxicity, and high-dose methadone rotations-strictly mandate acute inpatient palliative monitoring. Digital clinical tools (e.g., SPOT, with 96.3% equianalgesic accuracy) enhance prescriber confidence, but specific telemedicine-guided OS protocols lack prospective validation.</p><p><strong>Conclusions: </strong>Opioid switching is safe and effective in the community for straightforward scenarios when managed by experienced multidisciplinary teams. Future research must urgently address the lack of prospective home care protocols and randomized trials validating dedicated telemedicine-supported switching pathways.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149322293","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":"Stories in the ER.","authors":"Rebecca Kowaloff","doi":"10.1016/j.jpainsymman.2026.10.024","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2026.10.024","url":null,"abstract":"","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149322297","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 Tracheostomy Decision-Making: A Targeted Scoping Review.","authors":"Ozan Gurcan, Alejandra Gabela, Rachel Jalfon, Abby Cohen, Meaghann Weaver","doi":"10.1016/j.jpainsymman.2026.10.025","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2026.10.025","url":null,"abstract":"<p><strong>Background: </strong>Tracheostomy is usually placed to support recovery or long-term survival, but it is also placed in patients with life-limiting illness whose goals of care are palliative. In these patients, a technology built for long-term life support is placed where the aim is not to prolong life. Little is known about how these decisions are made.</p><p><strong>Objectives: </strong>To map how decisions to place a palliative tracheostomy are made, including the populations and settings in which they arise, the factors that shape them, the stakeholders involved, and their communicative and ethical dimensions.</p><p><strong>Eligibility criteria: </strong>Eligibility turned on the documented goal of the decision to place a tracheostomy, taken from the authors' stated aim read together with the reported trajectory and care plan. Sources in which the procedure served life prolongation, recovery, rehabilitation, or weaning toward those ends were excluded, even where the patient had a life-limiting illness or was receiving palliative care. English-language sources published in peer-reviewed journals from January 2016 to February 2026 were eligible.</p><p><strong>Sources of evidence: </strong>A systematic search of PubMed/MEDLINE, developed with a biomedical research librarian and executed on February 15, 2026, yielded 183 records.</p><p><strong>Charting methods: </strong>A charting form developed a priori covered source characteristics, clinical and decisional context, ethical and communicative dimensions, quality of life, and structural constraints on care.</p><p><strong>Results: </strong>Four sources were included: two adult case reports, a pediatric case series, and an ethics analysis of one infant. None formally defined palliative tracheostomy. Each tracheostomy served a stated goal, such as communication, time with family, or going home or to hospice, judged by the patient or, for children, with the parents. In three sources, the goal depended on care the hospital does not provide, and only one reported weighing that care before the offer. Caregiver burden was weighed in the decision in one source. No source followed a patient beyond placement to a later decision about the tracheostomy or the ventilation it carried.</p><p><strong>Conclusions: </strong>In these sources, the aim of a palliative tracheostomy was set in the hospital, but going home or to hospice depended on external care that was not guaranteed. Teams should confirm that this care can be arranged in time and that the family can sustain its share, weigh the procedure against withdrawal with comfort care, and record a purpose stated by the patient or family, with agreed triggers for revisiting it. Whether the reported patterns hold more broadly remains to be tested.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149322295","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}