Journal of pain and symptom management最新文献

{"title":"Primary Mental Health Competencies for Hospice and Palliative Medicine Physicians: A Delphi Study.","authors":"Lisa Podgurski, Danielle Chammas, Keri O Brenner, Leah B Rosenberg, Neha G Goyal, Maria I Lapid, Sue E Morris, William F Pirl, Bridget Sumser, Benjamin W Thompson, Lindsey Wright, Daniel Shalev","doi":"10.1016/j.jpainsymman.2025.05.009","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2025.05.009","url":null,"abstract":"<p><strong>Context: </strong>Psychiatric and psychological care in serious illness is a core domain of hospice and palliative medicine (HPM), encompassing both normative psychosocial responses and mental health comorbidities. While social workers serve as psychosocial leaders on HPM interdisciplinary teams, commitment to supporting whole-person care remains the responsibility of the entire team. However, training and scope of practice for HPM physicians in the mental health domain are poorly standardized.</p><p><strong>Objectives: </strong>To establish and prioritize 'primary mental health competencies' for specialist hospice and palliative medicine physicians using expert consensus methods.</p><p><strong>Methods: </strong>We convened a panel of 8 physicians, 1 social worker, 2 psychologists, and 1 nurse practitioner with expertise at the intersection of palliative care and mental health. Using group meetings and 1:1 interviews with the project leads, the expert panel generated initial competencies. A purposive voting panel of 36 palliative care physicians representing a range of practice settings and areas of career focus finalized high-priority competencies using a two-phase modified Delphi approach.</p><p><strong>Results: </strong>The expert panel proposed 68 competencies divided into: (A) psychological foundations of serious illness care, (B) diagnosis and management of mental health disorders in serious illness, and (C) systems-based practice. After first-round voting, 23 competencies were recirculated for a second vote. Following second-round voting, 32 competencies were included in the final list: 7 from part A, 20 from part B, and 5 from part C.</p><p><strong>Conclusions: </strong>This consensus-based, expert-led process successfully generated and prioritized essential competencies in the psychological and psychiatric aspects of palliative care for specialist physicians.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127655","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":"Temporal Trends in Opioid Use and Associated Outcomes for Patients Living with Advanced Cancer.","authors":"Vikram Jairam, Meghan E Lindsay, Pamela R Soulos, Cary P Gross, Elizabeth H Prsic, Laura V M Baum, Henry S Park","doi":"10.1016/j.jpainsymman.2025.05.007","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2025.05.007","url":null,"abstract":"<p><strong>Background: </strong>Regulatory efforts in response to the opioid epidemic have resulted in a decrease in opioid prescribing, but their impact on utilization of non-opioid pain medications, pain control, and high-risk opioid use is unknown in patients with and without advanced cancer.</p><p><strong>Methods: </strong>We queried the Surveillance, Epidemiology, and End Results (SEER)-Medicare database from 1/1/2012 to 12/31/2017 to identify patients aged 66 years or older diagnosed with or without advanced solid tumor cancer. The four dependent outcomes assessed were opioid use, gabapentinoid use, pain-related ED visits, and opioid-related encounters within 12 months after the patient's diagnosis or index date. We used multivariable logistic regression models to calculate the predicted probability and temporal change of each outcome for patients with and without cancer.</p><p><strong>Results: </strong>A total of 294,113 patients were included in the cohort; 45,899 (15.6%) with advanced cancer and 248,214 (84.4%) without cancer. Over the study period, the predicted probability of opioid use declined from 66.0% to 63.5% in the cancer cohort, and from 33.2% to 29.4% in the non-cancer cohort, while gabapentinoid use increased in the cancer [9.6% to 15.0%] and non-cancer [9.0% to 13.5%] cohorts (p<0.01). There was a greater increase in pain-related ED visits [22.3% to 29.2%] and opioid-related encounters [0.7% to 4.2%] in patients with cancer than among non-cancer patients (p<0.001).</p><p><strong>Conclusions: </strong>Our findings showed a greater increase in pain-related ED visits and opioid -related encounters among patients with advanced cancer, potentially related to decreases in opioid prescribing, despite a compensatory increase in gabapentinoid use.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127706","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":"End-of-Life Symptoms in Persons Dying with Advanced Dementia in the Community Setting: Findings from IN-PEACE.","authors":"Kurt Kroenke, Sujuan Gao, Susan E Hickman, Alexia M Torke, Nina M Johnson, Amy Pemberton, Andrea Vrobel, Minmin Pan, Laura R Holtz, Greg A Sachs","doi":"10.1016/j.jpainsymman.2025.05.004","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2025.05.004","url":null,"abstract":"<p><strong>Context: </strong>The symptom burden in persons dying with advanced dementia outside long-term care facilities has not been well studied.</p><p><strong>Objectives: </strong>To determine the symptom burden in persons dying with advanced dementia in the community setting.</p><p><strong>Methods: </strong>The sample consisted of patient-caregiver dyads enrolled in the 24-month IN-PEACE trial of home-based care management for advanced dementia. Postmortem interviews were administered to caregivers of persons with advanced dementia who had recently died. The primary outcome was the Comfort Assessment in Dying-End of Life in Dementia (CAD-EOLD) scale. A secondary symptom measure was the Symptom Management in End of Life Dementia (SM-EOLD). Results were analyzed and compared to previous studies using the CAD-EOLD.</p><p><strong>Results: </strong>Of the 83 persons with dementia who died during 24 months of follow-up, postmortem caregiver interviews were completed in 80 cases of which 79 completed the CAD-EOLD. Patients' mean age was 83.1; 68% were women, 57% white, and 37% African American. Most patients (62%) died at home and only 32% died in a hospital or nursing home. Hospice enrollment occurred in 75% of participants. Symptom management as reflected in CAD-EOLD scores was comparable to previous studies of persons with dementia dying in nursing homes. Compared to baseline SM-EOLD scores, end-of-life symptom scores were 4 points better. Intervention and control group outcomes were similar.</p><p><strong>Conclusions: </strong>Some community-dwelling persons with advanced dementia can die at home with symptom management comparable to that received in nursing homes.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127565","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":"Validity, Reliability, and Clinical Usefulness of the PC-6 Model for Spiritual Assessment in Palliative Care.","authors":"Dirk Labuschagne, Patricia K Palmer, Burl Cole, Steven B Drennan, Melissa L Harry, Edward Peñate, Kathryn A Ulrich, George Fitchett","doi":"10.1016/j.jpainsymman.2025.05.010","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2025.05.010","url":null,"abstract":"<p><strong>Context: </strong>Spiritual care is a core component of quality palliative care (PC), yet a validated tool for spiritual assessment in PC has been lacking. The PC-6, a six-theme model for assessing and quantifying spiritual concerns in PC patients, aims to fill this gap.</p><p><strong>Objectives: </strong>This study tested the validity, reliability, and clinical usefulness of the PC-6.</p><p><strong>Methods: </strong>End-of-life patients (≥ 18 years) in inpatient, outpatient, or home care settings of three Midwest medical centers were interviewed by a chaplain trained in using the PC-6. Patients completed pre- and post-interview self-report measures. For validity, PC-6 scores were compared (Spearman correlation) with Spiritual Pain, Religious/Spiritual Struggles Scale (RSS), and QUAL-E (Preparation and Completion subscales). Inter-rater and intra-rater reliability were tested using the iccCount coefficient.</p><p><strong>Results: </strong>The study enrolled 110 patients (mean age 64.95, SD 15.01) who were majority female (60.9%) and White (80%), with 56.4% having a primary cancer diagnosis. Overall, 43% had moderate or severe spiritual concerns, 15% in two or more themes. PC-6 scores correlated significantly with Spiritual Pain (.217, p<.05), RSS (.394, p<.001), and QUAL-E Preparation and Completion subscales (-.249 and -.288, respectively, both p<.01). Reliability testing found inter-rater reliability (n=57) of 0.402 (95% CI 0.111, 0.629) and intra-rater reliability (n=54) of 0.593 (95% CI 0.019, 0.873). Most patients found the interview helpful (90%) and the duration appropriate (91%).</p><p><strong>Conclusion: </strong>The PC-6 is a valid, reliable, and patient-valued tool for spiritual assessment in PC. Further research is needed to explore its interdisciplinary use and validity across diverse subgroups.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119878","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":"Vocational awe is (not) enough: Learnings from early adopters of serious illness communication.","authors":"Patrick Malecha, Alexis Drutchas, Jenny Klintman, Elizabeth Lindenberger, Juliet Jacobsen","doi":"10.1016/j.jpainsymman.2025.05.006","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2025.05.006","url":null,"abstract":"<p><strong>Context: </strong>As part of a broader institutional initiative, the serious illness care program was implemented in a multi-site academic primary care practice. After 2 years, a minority was observed to be documenting serious illness conversations routinely.</p><p><strong>Objectives: </strong>We aimed to learn about the motivations and actions of clinicians who routinely conducted and documented serious illness conversations.</p><p><strong>Methods: </strong>We identified primary care early adopters of serious illness communication: 17 of 228 physicians (roughly 8%) who were documenting at least 1-2 conversations every 1-2 months for a year. Fifteen physicians agreed to participated in semi-structed interviews and which were then analyzed with thematic analysis.</p><p><strong>Results: </strong>Early adopters successfully integrate serious illness conversations into clinical practice by using four strategies that amplify vocational awe: their deep sense of their professions core value. Three strategies focus on positive aspects of serious illness communication: (1) reflecting on the meaningful impact of serious illness conversations on clinical care; (2) feeling a resonance between serious illness communication and their personal identity and values; and (3) identifying with the medical community's sense that serious illness communication contributes to good clinical care. The fourth strategy is to minimize system limitations using a range of tactics that include accepting time shortages and streamlining workflow.</p><p><strong>Conclusion: </strong>Vocational awe is a powerful driver for engaging in serious illness communication; however, without system-level resource support, it does not sustainably motivate most clinicians. Serious illness communication needs to be a part of routine healthcare with appropriately allocated time, compensation, and workflow support.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119879","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":"Exploring how claims of 'suffering' are operationalized in pediatric critical care.","authors":"Karolina Grekov, Jason Batten, Tyler Tate, Kanwaljeet J S Anand, David Magnus, Meghan C Halley","doi":"10.1016/j.jpainsymman.2025.05.005","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2025.05.005","url":null,"abstract":"<p><strong>Context: </strong>Identifying when a child is suffering can be incredibly challenging. Understanding how the term 'suffering' is used in pediatric critical care - and specifically end of life care - is critical for clinical decision-making, communication, and goal-setting between healthcare providers and families. To gain insight into this complex question, we employed ethnographic methods to explore the underlying meanings and goals associated with the use of this term by clinicians, patients, and families in the Pediatric Intensive Care Unit (PICU).</p><p><strong>Objectives: </strong>To explore how the term 'suffering' is operationalized by clinicians and families in Pediatric Intensive Care Units (PICUs) and its implications for decision-making.</p><p><strong>Methods: </strong>This study was conducted in three specialized PICUs within a large tertiary children's hospital. This exploratory qualitative study used ethnographic methods, including narrative literature review, analysis of verbatim transcripts of 30 care conferences and 50 ethnographic observations involving physicians, nurses, and families. Analyses employed an iterative, interpretive approach to identify key themes across data sources.</p><p><strong>Results: </strong>This study identified three main themes: 1) 'Suffering' was rarely defined, 2) Discussions of patient 'suffering' included collateral impacts on providers and families, in addition to impacts on patient experience; and 3) Physicians used 'suffering' to pivot goals of care, while parents used it variably.</p><p><strong>Conclusion: </strong>These findings suggest that 'suffering' is often invoked in the PICU with little specificity, is used to signal provider or caregiver distress, and is used with the intention to shift goals of care in a manner not always consistent with family values or interpretations. Recognizing the implicit messages conveyed through language may support families and healthcare providers to better communicate their goals and preferences, fostering collaborative decision-making and enhancing patient outcomes in the PICU and during end-of-life care.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144102033","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":"Challenges and Ethical Considerations of Palliative Care in Indian Prisons.","authors":"Swapnil Kumar Barasker, Pankaj Singhai, Maya Nair, Deepali Kumar","doi":"10.1016/j.jpainsymman.2025.05.003","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2025.05.003","url":null,"abstract":"<p><p>Palliative care in Indian prisons faces challenges due to overcrowding, inadequate medical infrastructure, and societal neglect of incarcerated individuals. Chronic illnesses are common, yet regular follow-ups are lacking due to limited staff and resources. Psychological issues like mistrust in medical care and fear of dying alone further complicate care. Although medical parole exists, bureaucratic inefficiencies often lead to delayed or denied release. In contrast, few developed nations with prison hospice models integrate interdisciplinary teams and inmate caregivers, offering structured approaches to compassionate care despite facing challenges of their own. Ethical principles like autonomy, beneficence, nonmaleficence and justice are often compromised in Indian prisons, demanding policy reforms. Expanding hospice facilities, training prison staff in compassionate care, and improving the use of compassionate release mechanisms can ensure humane end of life care for incarcerated individuals.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078579","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":"The Potential Role of Palliative Care and Hospice in Addressing Prolonged Grief Disorder in the United States.","authors":"Christopher Magoon, Daniel Shalev","doi":"10.1016/j.jpainsymman.2025.04.018","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2025.04.018","url":null,"abstract":"","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078583","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":"Acute Intestinal Pseudo-Obstruction in an Infant with Hypoxic Ischemic Encephalopathy: A Palliative Approach with Neostigmine.","authors":"Sonia Brar, Katherine Boone","doi":"10.1016/j.jpainsymman.2025.04.019","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2025.04.019","url":null,"abstract":"","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144000790","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":"Factors Associated with Cancer Patients' Preferences for Telemedicine or In-Person Palliative Care.","authors":"Min Ji Kim, Michael Tang, Terry Taylor, Minxing Chen, David Hui, Akhila Reddy, Santhosshi Narayanan, Eduardo Bruera","doi":"10.1016/j.jpainsymman.2025.05.002","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2025.05.002","url":null,"abstract":"<p><strong>Context: </strong>Prior studies demonstrate sociodemographic factors as barriers to telemedicine. Greater understanding of telemedicine preferences in cancer patients receiving palliative care and factors associated with their preferences could inform future care delivery in this vulnerable population.</p><p><strong>Objectives: </strong>This study aimed to identify cancer patients' preferences for in-person versus telemedicine palliative care visits in real-world clinical practice and associated patient-centric factors.</p><p><strong>Methods: </strong>This was a retrospective study involving chart review of in-person or telemedicine palliative care visits between September 2021 and October 2021, during which patients' preferences for telemedicine or in-person visits and perceived difficulty coming in-person were routinely asked. Their answers were collected from the electronic chart. Associations between visit preference and sociodemographic and clinical factors were identified.</p><p><strong>Results: </strong>Of 400 patients, mean age was 59 years. 217 (54%) were female. 285 (71%) were White. Most had advanced cancer (344; 86%). 83% (n=333) preferred telemedicine. 72% (n=288) cited difficulty coming in-person. On univariate analysis, female gender (p=0.03), college completion (p<0.01), and perceived difficulty coming in-person (p<0.01) were associated with preferring telemedicine. Positive Cut-Down, Annoyed, Guilty, Eye-Opener-Adapted to Include Drugs (CAGE-AID) score (p=0.02) was associated with in-person preference. On multivariate analyses, perceived difficulty coming in-person was associated with telemedicine preference (OR: 16.81; 95% CI: 7.91-35.28; p<0.01). A positive CAGE-AID score was associated with in-person preference (OR: 0.17; 95% CI: 0.05-0.59; p=0.01).</p><p><strong>Conclusion: </strong>Most patients having outpatient palliative care visits preferred telemedicine. Perceived difficulty coming in-person was associated with telemedicine preference. Patients with positive CAGE-AID scores were less likely to prefer telemedicine.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030838","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}