Journal of pain and symptom management最新文献

{"title":"Pharmacist-led Opioid Deprescribing Pilot Clinic within Outpatient Palliative Care","authors":"Maria Felton Lowry PharmD, BCPS, BCGP ,&nbsp;Sydney Lee PharmD ,&nbsp;Makayla F. Hoke PharmD ,&nbsp;Emily R. Leung PharmD ,&nbsp;Hailey Roup PharmD ,&nbsp;Hope E. Linge ,&nbsp;Linda King MD ,&nbsp;Yael Schenker MD, MAS, FAAHPM","doi":"10.1016/j.jpainsymman.2025.07.020","DOIUrl":"10.1016/j.jpainsymman.2025.07.020","url":null,"abstract":"<div><h3>Background</h3><div>Patients with cancer receiving opioid therapy often follow with specialty palliative care after achieving remission. Strategies to reduce risks associated with ongoing opioid therapy in survivorship are needed.</div></div><div><h3>Measures</h3><div>Feasibility, safety, and impact.</div></div><div><h3>Intervention</h3><div>A pharmacist-led opioid deprescribing program, embedded within a specialty palliative care clinic, was designed for patients on long-term opioid therapy who have reached cancer remission.</div></div><div><h3>Outcomes</h3><div>In the nine-month pilot phase, 80% of referred patients established care with the pharmacist. One hundred seventeen pharmacist visits occurred: 20 in person, 52 telemedicine, and 45 telephone. The pharmacist spent an average of 72 minutes for initial and 45 minutes for follow-up visits. Oral morphine equivalents (OMEs) were reduced for 75% of referred patients, with an average of 22% reduction. No patients were hospitalized for uncontrolled pain or withdrawal.</div></div><div><h3>Conclusion/Lessons learned</h3><div>Opioid deprescribing clinic was time-intensive and patients required close monitoring for implementation of patient-specific opioid deprescribing plans.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"70 5","pages":"Pages e305-e310"},"PeriodicalIF":3.5,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765012","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":"Reflections on Cultural Humility in the End-Stages of Parkinson's: The Journey of a Mandarin-speaking Patient.","authors":"Nithya Krishnamurthy, Brendan Ross, Teresa Wang, Shruti Mutalik","doi":"10.1016/j.jpainsymman.2025.07.016","DOIUrl":"10.1016/j.jpainsymman.2025.07.016","url":null,"abstract":"","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144760377","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 Italian Version of the FAMCARE-P13 Questionnaire: A Validation Study","authors":"Giacomo Massa MD ,&nbsp;Gabriele Tinè MSc ,&nbsp;Ernesto Zecca MD ,&nbsp;Rosalba Miceli PhD ,&nbsp;Alessandra Pigni MD ,&nbsp;Viviana Fusetti PhD ,&nbsp;Antonino Tallarita BSc ,&nbsp;Sara Alfieri PhD ,&nbsp;Chiara Vela MScN ,&nbsp;Cinzia Brunelli PhD ,&nbsp;Augusto Caraceni Prof.","doi":"10.1016/j.jpainsymman.2025.07.017","DOIUrl":"10.1016/j.jpainsymman.2025.07.017","url":null,"abstract":"<div><h3>Purpose</h3><div>The FAMCARE-P13 is a tool designed to evaluate patients' satisfaction with received healthcare. This self-reported questionnaire has already been adapted and validated in different languages but not Italian. The study aims to examine the cultural adaptation of the Italian version of the FAMCARE-P13 questionnaire and evaluate its psychometric properties in outpatients with advanced cancer.</div></div><div><h3>Methods</h3><div>The FAMCARE-P13, a questionnaire of 13 items scored on a 5-point Likert scale (from 1 = “very dissatisfied” to 5 = “very satisfied”), was culturally adapted into Italian through forward-back translation by native Italian and English speakers. The questionnaire was then administered to a balanced sample of outpatients with five advanced cancer histologies. The following psychometric analyses were performed: Confirmatory Factor Analysis to test the presence of a single latent factor, Cronbach's α to test internal consistency, intraclass correlation coefficient to evaluate test-retest reliability after 3 days, and a known-group validity analysis.</div></div><div><h3>Results</h3><div>A total of 300 patients completed the questionnaire. Confirmatory factor analysis fully supported a one-factor structure of the tool, with the model exhibiting robust fit indices, specifically a comparative fit index of 0.96 and a Tucker-Lewis Index of 0.95. The satisfaction was closely related to doctors' availability and availability to communicate. Cronbach's α was 0.95 (95% CI: 0.94–0.95), showing satisfactory internal consistency. Test-retest analysis showed stability over time, with a global intraclass correlation coefficient of 0.91 (<em>P</em>-value &lt; 0.0001).</div></div><div><h3>Conclusion</h3><div>The Italian version of the FAMCARE-P13 questionnaire appears valid for assessing the satisfaction with the care received by patients with advanced cancer.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"70 4","pages":"Pages 392-399.e2"},"PeriodicalIF":3.5,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144753609","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":"Estimating the Number of Services & Patients Receiving Specialized Palliative Care Globally in 2025","authors":"Stephen R. Connor PhD ,&nbsp;Eduardo Garralda MA ,&nbsp;Vilma A. Tripodoro MD, PhD ,&nbsp;Carlos Centeno MD, PhD","doi":"10.1016/j.jpainsymman.2025.07.018","DOIUrl":"10.1016/j.jpainsymman.2025.07.018","url":null,"abstract":"<div><h3>Context</h3><div>Palliative care is an essential component of every health-care system. Information on the status of palliative care service delivery is necessary to understand the gap between current capacity and population-level need.</div></div><div><h3>Objectives</h3><div>To estimate the number of specialized palliative care providers worldwide and the number of patients they served in 2025, in comparison to 2017.</div></div><div><h3>Methods</h3><div>Previous estimates from a sample of countries representing each World Bank income group in 2017, using typical case purposive sampling, were used to project numbers of patients served based on reported numbers of services, as collected through the most recent Global Palliative Care Mapping Study covering 201 countries.</div></div><div><h3>Results</h3><div>In 2025, the estimated number of specialized palliative care service delivery teams worldwide reached approximately 33,700 - representing a 35.6% increase from the 25,000 identified in 2017. Service delivery expanded across all WHO regions. The estimated number of patients served rose from almost 7 million in 2017 to approximately 10.4 million in 2025. This figure represents roughly 14% of the total global need for palliative care. However, this estimate includes both primary and specialist care needs, while this study focuses exclusively on specialist services. A substantial portion of the remaining need may be addressed through the development and integration of primary-level palliative care.</div></div><div><h3>Conclusion</h3><div>Despite notable growth in service availability, significant disparities persist, particularly in low- and middle-income countries. While over half of the need appears to be met in high-income countries, only 4.4% is addressed by specialist provision in low and middle-income countries. The contribution of primary-level care remains unknown.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"70 5","pages":"Pages 422-426"},"PeriodicalIF":3.5,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144753608","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":"Timely Documentation of CPR Codes and Medical Treatment Preferences in the EHRs of Nursing Homes","authors":"Gary Y.C. Yeung MD ,&nbsp;Martin Smalbrugge MD, PhD ,&nbsp;Martine C. de Bruijne MD, PhD ,&nbsp;Mariska Bot PhD ,&nbsp;Hylco Bouwstra MD, PhD ,&nbsp;Nienke Fleuren MD ,&nbsp;Karlijn J. Joling PhD","doi":"10.1016/j.jpainsymman.2025.07.022","DOIUrl":"10.1016/j.jpainsymman.2025.07.022","url":null,"abstract":"<div><h3>Context</h3><div>Timely documentation of cardiopulmonary resuscitation (CPR) code and medical treatment preferences in electronic health records (EHR) is important for translating advance care planning conversations into actionable medical orders.</div></div><div><h3>Objectives</h3><div>To examine documentation rates of CPR code and medical treatment preferences within the recommended first six weeks of admission in Dutch nursing homes (NHs) from 2017 to 2022.</div></div><div><h3>Methods</h3><div>This retrospective cohort used EHR from 74 Dutch NHs. We assessed the prevalence of documented CPR codes and medical treatment preferences within six weeks of admission, and the median days until first documentation. To examine whether timely documentation odds improved annually, logit generalized estimating equation models -accounting for clustering of residents within NHs– were used, stratified by NH care type, and adjusted for resident factors.</div></div><div><h3>Results</h3><div>We included 163,180 residents. CPR code and medical treatment preferences was documented within 6 weeks of admission for 88% and 64% of the residents, respectively. The median time to first documentation were 0.5-2 days across care types. Overall, between 2017 and 2022, timely documentation of CPR code increased from 82% to 92% and for medical treatment preferences from 56% to 70%. Recent admission year was associated with higher odds of timely documentation for both type of orders in psychogeriatric and somatic care, and for CPR in rehabilitation care.</div></div><div><h3>Conclusion</h3><div>Most residents had documented CPR code and medical treatment preference within the recommended six weeks of admission, with rates improving from 2017 to 2022. The improvement coincided with a national quality indicator introduced in 2018 and the COVID-19 pandemic.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"70 5","pages":"Pages 427-436.e1"},"PeriodicalIF":3.5,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731871","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 Association of Filial Piety and Financial Toxicity With Surrogate Decisional Conflict Among Adult Children of ICU Patients With Cancer","authors":"Xiaochun Wu MSN, RN ,&nbsp;Yali Tang BSc ,&nbsp;Jieling Chen PhD","doi":"10.1016/j.jpainsymman.2025.07.023","DOIUrl":"10.1016/j.jpainsymman.2025.07.023","url":null,"abstract":"<div><h3>Context</h3><div>Filial piety, a Confucian cultural value, is deeply rooted in the parent-child relationship in Chinese and many other Asian cultures. Adult children often experience decisional conflict when making decisions for their critically ill parents. However, the quantitative relationship between filial piety and surrogate decisional conflict has yet to be explored.</div></div><div><h3>Objective</h3><div>To examine the associations of both financial toxicity and filial piety with surrogate decisional conflict among adult children of intensive care unit (ICU) patients with cancer.</div></div><div><h3>Methods</h3><div>A cross-sectional survey was conducted in an ICU of a tertiary hospital in Guangzhou, China. A sample of 180 adult children serving as surrogates for patients with cancer completed the survey after the patients had been admitted to the ICU for at least 4 days. The measures included the family version of the Decision Conflict Scale, the Filial Piety Values Scale for Children of Patients with Advanced Cancer, and the Comprehensive Scores for Financial Toxicity. Multiple regression analysis was conducted to examine factors associated with surrogate decisional conflict.</div></div><div><h3>Results</h3><div>The adult children of ICU patients with cancer experienced a high level of surrogate decisional conflict. Surrogate decisional conflict was associated with more siblings (<span><math><mrow><mi>β</mi><mo>=</mo><mn>0.183</mn><mo>,</mo><mspace></mspace><mi>p</mi><mo>=</mo><mn>0.017</mn></mrow></math></span>), lower levels of filial piety (<span><math><mrow><mi>β</mi><mo>=</mo><mo>−</mo><mn>0.177</mn><mo>,</mo><mspace></mspace><mi>p</mi><mo>=</mo><mn>0.018</mn></mrow></math></span>) and severe financial toxicity (<span><math><mrow><mi>β</mi><mo>=</mo><mo>−</mo><mn>0.159</mn><mo>,</mo><mspace></mspace><mi>p</mi><mo>=</mo><mn>0.045</mn></mrow></math></span>).</div></div><div><h3>Conclusion</h3><div>Healthcare providers are recommended to provide culturally sensitive support for Chinese adult children making decisions for their parents with cancer in the ICU, such as offering strategies to mitigate the negative impact of financial toxicity and helping surrogates clarify their filial piety values to relieve decisional conflict.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"70 5","pages":"Pages 437-446"},"PeriodicalIF":3.5,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731869","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 Paradox of Palliphobia.","authors":"Juan Luis Torres-Tenor","doi":"10.1016/j.jpainsymman.2025.07.019","DOIUrl":"10.1016/j.jpainsymman.2025.07.019","url":null,"abstract":"","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731870","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":"Clinician Perspectives on Open Notes in Oncology Palliative Care: A Mixed-Methods Study","authors":"Joanna Veazey Brooks PhD, MBE ,&nbsp;Delisia Chapman-Brown MPH ,&nbsp;Amanda Thimmesch BA ,&nbsp;Elizabeth Wulff-Burchfield MD ,&nbsp;Christian Sinclair MD ,&nbsp;Daniel English MSGH ,&nbsp;Heather Nelson-Brantley PhD, RN, NEA-BC, CNE","doi":"10.1016/j.jpainsymman.2025.07.014","DOIUrl":"10.1016/j.jpainsymman.2025.07.014","url":null,"abstract":"<div><h3>Context</h3><div>The 21st Century Cures Act Interoperability and Information Blocking Rule (IBR) has the laudable goal of increased transparency in sharing health information with patients and informed decision-making by patients, yet strategies to support IBR implementation are sparse. Without evidence-based guidelines, health systems and palliative care clinicians have been left to navigate implementation of the IBR on their own.</div></div><div><h3>Objectives</h3><div>We sought to understand clinician perspectives and experiences with the IBR in oncology and palliative care.</div></div><div><h3>Methods</h3><div>We used a convergent parallel mixed method design with clinician surveys and interviews.</div></div><div><h3>Results</h3><div>29 clinicians from one institution participated in the study. Three themes emerged from the data: 1) specialty-specific worry about harm; 2) documentation changes in response to the IBR; and 3) sharing notes as a helpful tool. We found that clinicians see benefits and concerns around the IBR. Oncology clinicians worried more about the sensitivity of test results while palliative care clinicians worried more about the sensitivity of information included in documentation of family meetings and of prognostic information.</div></div><div><h3>Conclusion</h3><div>Findings from our study indicate that clinicians’ experience with the IBR is more nuanced than the initial worry expressed by clinicians in editorials. Additionally, our study shows the importance of capturing specialty-specific experiences with the IBR, as concerns can differ. Future research should continue to examine clinician and organizational practices around implementation of the IBR to identify best practices for maximizing patient and clinician benefit while minimizing unintended harm.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"70 5","pages":"Pages 410-421"},"PeriodicalIF":3.5,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731868","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":"Standardized Assessment of Patient Experience in Pediatric Palliative Care: A National Collaboration","authors":"Ashley K. Autrey MD ,&nbsp;Stacey Rifkin-Zenenberg DO ,&nbsp;Tracy Hills DO ,&nbsp;Jennifer Salant MD ,&nbsp;Rachna May MD ,&nbsp;Elliot Rabinowitz MD ,&nbsp;Chelsea Heneghan CNP ,&nbsp;Laura Drach DO, MSN ,&nbsp;Emma Jones MD, MA ,&nbsp;Rachel Thienprayoon MD","doi":"10.1016/j.jpainsymman.2025.07.011","DOIUrl":"10.1016/j.jpainsymman.2025.07.011","url":null,"abstract":"<div><h3>Background</h3><div>Use of patient reported outcome measures (PROMs) are crucial to providing patient-centered care. In 2022, the Pediatric Palliative Improvement Network developed a project to standardize the assessment of patient experiences with PPC services.</div></div><div><h3>Measures</h3><div>By December 31, 2022, we aimed for: 10 participating sites, 50% of eligible PPC patient experiences assessed, and 25% response rate.</div></div><div><h3>Intervention</h3><div>Project leaders provided guidance for study processes, accurate timely data gathering, and collaborative learning. Data was collected from January to December, 2022. Sites utilized two standardized key indicator questions, including one National Quality Forum-endorsed palliative care PROM.</div></div><div><h3>Results</h3><div>Fourteen sites participated with 69% of patients (1631/2360) surveyed and 304 responses (19% response rate) gathered. Patients/Families felt heard and understood and would recommend PPC.</div></div><div><h3>Conclusions/Lessons learned</h3><div>Standardized assessments of patient experience with PPC are feasible and informative. PROMs can ensure that PPC services meet patient needs, identify opportunities for improvement, and demonstrate value.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"70 5","pages":"Pages e299-e304"},"PeriodicalIF":3.5,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144718074","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":"Utilization of the No One Dies Alone Program to Support Dying Patients","authors":"Austin Chen MD, MS ,&nbsp;Ketki Sathe MBBS, MS ,&nbsp;Yixuan C. Zhang BA ,&nbsp;Lyndia C. Brumback PhD ,&nbsp;Addy L. Elketami MS ,&nbsp;Jamie T. Nomitch MD, MS ,&nbsp;Timothy J. Shipe MDiv ,&nbsp;Cynthia M. Thelen BA ,&nbsp;Katherine G. Hicks MD ,&nbsp;Ann L. Jennerich MD, MS","doi":"10.1016/j.jpainsymman.2025.07.013","DOIUrl":"10.1016/j.jpainsymman.2025.07.013","url":null,"abstract":"<div><h3>Context</h3><div>The No One Dies Alone (NODA) program has utilized trained volunteers to provide support to dying patients for over 20 years.</div></div><div><h3>Objectives</h3><div>Evaluating program utilization at a large, urban medical center can provide insights to guide expansion and address unmet needs.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of hospitalized patients enrolled in the NODA program at Harborview Medical Center (HMC), a level I trauma center in Seattle, WA. The NODA program has been operating at HMC since 2012, and our cohort includes data through 2020. We extracted patient demographics, admission characteristics, and program utilization metrics from the electronic health record and used descriptive statistics to summarize the data from decedents.</div></div><div><h3>Results</h3><div>During the study period, 245 patients were referred to the NODA program, and data were available for 234 hospitalized patients. The average length of time spent in the program was four days (SD 6), with 37% of patients enrolled for only a single day. Most patients received a visit from NODA volunteers, although 22% had no volunteer visits. In cases where a volunteer did not visit, the most common reason was patient death prior to volunteer arrival (92%). Many patients had family visit during the hospitalization (56%).</div></div><div><h3>Conclusion</h3><div>The NODA program was utilized for patients with and without family support. Some patients were unable to benefit from the program due to timing of referral relative to death, highlighting the importance of early consultation to maximize program benefits.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"70 5","pages":"Pages e311-e317"},"PeriodicalIF":3.5,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144718075","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}