Journal of pain and symptom management最新文献

{"title":"Advance Care Planning and Long-Term Bereavement in Caregivers of Patients With Metastatic Cancer.","authors":"Shravya Murali, Chetna Malhotra","doi":"10.1016/j.jpainsymman.2026.02.011","DOIUrl":"10.1016/j.jpainsymman.2026.02.011","url":null,"abstract":"<p><strong>Context: </strong>Advance care planning (ACP) may reduce bereaved caregivers' risk of complicated grief and anxiety, but evidence remains limited.</p><p><strong>Objectives: </strong>To examine associations between ACP engagement and caregivers' risk of complicated grief and anxiety six months after the patient's death, moderated by patient age and patient-caregiver relationship, and mediated by patient's emotional distress and caregiver preparedness for patient's death.</p><p><strong>Methods: </strong>We used data from a prospective cohort of patients with Stage IV cancer and their primary caregivers, restricting analyses to 179 patients who died during follow-up. We assessed caregivers' risk of complicated grief using the Brief Grief Questionnaire, and anxiety with the anxiety subscale of the Hospital Anxiety and Depression Scale. Multivariable logistic and linear regression models were used, with interaction terms testing moderation by patient age and spousal relationship. Path analyses assessed indirect effects through caregiver perception of patients in the last week of life and preparedness for death.</p><p><strong>Results: </strong>ACP engagement was associated with lower odds of complicated grief risk (odds ratio [OR] = 0.36, 95% confidence interval [95% CI = [0.18, 0.72]), and lower anxiety symptoms (β = -1.18, 95% CI = [-2.28, -0.07]). These associations did not vary by patient age or patient-caregiver relationship. The combined indirect effect of ACP engagement on complicated grief through perceived patients' emotional distress and preparedness for death approached significance (β = -0.18 [95% CI, -0.39 to 0.03], P = 0.09).</p><p><strong>Conclusions: </strong>ACP may benefit diverse groups of bereaved caregivers of patients with cancer. Larger studies should examine the mechanisms underlying ACP's influence on long-term bereavement.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147321820","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":"Guided Goals of Care Conversations Reveal Evolving, Personalized Priorities.","authors":"Katherine Doyon, Amanda Glickman, Lubin Deng, Jessica Ma, Sharon E Bigger, David B Bekelman","doi":"10.1016/j.jpainsymman.2026.01.021","DOIUrl":"10.1016/j.jpainsymman.2026.01.021","url":null,"abstract":"<p><strong>Context: </strong>Understanding the dynamics of goals of care conversations between patients, nurses, and social workers in an outpatient setting may reveal benefits and opportunities for improvement.</p><p><strong>Objectives: </strong>Assess goals of care conversations between the healthcare team and Veterans with chronic heart and lung diseases to better understand patient's perspectives on care goals.</p><p><strong>Methods: </strong>In the intervention arm of a clinical trial, a nurse or social worker conducted telephone-based outpatient goals of care conversations using a semi-structured, seven-question communications guides. Inductive thematic qualitative analysis was applied to audio recordings of 27 conversations. Three independent coders iteratively developed emerging themes, which were further refined through team consensus.</p><p><strong>Results: </strong>Participants mean age was 66 years (SD 6), 93% male, and 70% self-identified non-Hispanic white. The mean length of conversation was 51 minutes (SD 14). Four themes emerged: (1) participants appreciated the discussions and found them meaningful; (2) participant readiness to engage varied and often evolved; (3) goals were highly individualized and ranged from health care to personal; and (4) participants confused medical and legal terminology.</p><p><strong>Conclusion: </strong>In goals of care conversations with Veterans with cardiopulmonary disease, goals evolved, revealing personalized insights that could shape their treatment plans. Variations in participant readiness and challenges in terminology emerged and progressed within single encounters.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13140103/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147317326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Remote Monitoring Instruments in Palliative Care for People With Heart Failure: A Scoping Review.","authors":"Jeanine C B De Leeuw, Yvonne M J Goërtz, Malin K Wallin, Tiny Jaarsma, Maria Friedrichsen, Pier Jaarsma, Anna Strömberg, Donata Kurpas, Dorota Stefanicka-Wojtas, Geert-Jan Geersing, Everlien de Graaf, Hans-Peter Brunner-La Rocca, Daisy J A Janssen, Thomas Grice-Jackson","doi":"10.1016/j.jpainsymman.2026.02.016","DOIUrl":"10.1016/j.jpainsymman.2026.02.016","url":null,"abstract":"<p><strong>Background: </strong>Remote monitoring could improve the management of symptoms, wishes, and needs of patients with heart failure receiving palliative care. However, an overview of existing instruments is lacking, and implementation challenges are poorly understood.</p><p><strong>Aim: </strong>To map and analyze existing instruments used to monitor symptoms, wishes, and needs in heart failure palliative care, and to evaluate their implementation.</p><p><strong>Design: </strong>This scoping review, conducted as part of the HORIZON Europe-funded RAPHAEL project, followed the framework developed by Arksey and O'Malley.</p><p><strong>Data sources: </strong>A systematic search was executed using seven databases (PubMed, Cinahl, Embase, Scopus, PsycINFO, Web of Science, and Medline) on December 11, 2024. Eligible publications focused on remote monitoring of symptoms, wishes, or needs of patients with heart failure in palliative care.</p><p><strong>Results: </strong>Of the 3820 identified studies, 23 met the inclusion criteria, of which 20 were conducted in Western countries. None of the included studies described a monitoring instrument that simultaneously evaluated symptoms, wishes, and needs. Most instruments (n = 22) focused primarily on monitoring physical symptoms and were not specifically designed for palliative care. Only one instrument monitored wishes and needs, but it did not assess symptoms. Details on implementation were often insufficient.</p><p><strong>Conclusions: </strong>Currently no instruments are available that monitor both symptoms as well as identify the wishes and needs of patients with heart failure who receive palliative care. The RAPHAEL project aims to fill this gap by developing an instrument for this purpose whilst assessing its implementation into practice.</p><p><strong>Registration: </strong>Open Science Framework (OSF) (DOI: https://doi.org/10.17605/OSF.IO/5GAFM).</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147306969","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":"\"Early Integration of Palliative Care in Nononcological Patients: A Systematic Review\" -Authors' Reply.","authors":"Joana Rodrigues Mós, Paulo Reis-Pina","doi":"10.1016/j.jpainsymman.2026.01.007","DOIUrl":"10.1016/j.jpainsymman.2026.01.007","url":null,"abstract":"","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147306903","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 Protector.","authors":"Christy M Lucas","doi":"10.1016/j.jpainsymman.2026.02.007","DOIUrl":"10.1016/j.jpainsymman.2026.02.007","url":null,"abstract":"","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146207108","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":"Managing Use of Propofol for Refractory Symptoms in End-of-Life Care: Creating an Institutional Guideline.","authors":"Christi Bartlett, Joanna Veazey Brooks, Ky Stoltzfus, Marilyn Parker","doi":"10.1016/j.jpainsymman.2026.01.025","DOIUrl":"10.1016/j.jpainsymman.2026.01.025","url":null,"abstract":"<p><strong>Background: </strong>End of life (EOL) care in hospitals is increasingly complex as patients are often critically ill and medically unstable. Propofol can be an important tool in treating refractory symptoms during EOL care to ensure comfort and prevent suffering during the dying process.</p><p><strong>Intervention: </strong>We aimed to define and standardize institutional practices for using propofol to manage refractory symptoms during EOL care. Using expert opinions, consensus building, and a microsystems team approach, we defined parameters for propofol use in managing refractory symptoms. We developed a flow diagram to guide decision making for propofol use during EOL care.</p><p><strong>Outcomes: </strong>We developed a flow diagram as a decision-making tool that reduced confusion and hesitancy about the appropriate use of propofol for refractory symptoms during EOL care.</p><p><strong>Conclusion/lessons learned: </strong>Using a multidisciplinary process, we standardized an institutional approach for use of propofol in managing refractory symptoms during EOL care in hospital.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146197851","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":"Patient Perspectives on Preoperative Code Status Discussions: A Qualitative Analysis.","authors":"Shanze Tahir, Jocelyn Streid, Matthew B Allen, Angela M Bader, David L Hepner","doi":"10.1016/j.jpainsymman.2026.02.002","DOIUrl":"10.1016/j.jpainsymman.2026.02.002","url":null,"abstract":"<p><strong>Context: </strong>Professional guidelines from the American Society of Anesthesiologists (ASA) and American College of Surgeons (ACS) emphasize the importance of preoperative communication regarding code status, particularly for patients with limitations on resuscitation. However, little is known about how surgical patients with DNR/DNI or MOLST orders perceive these conversations.</p><p><strong>Objectives: </strong>To understand patient perspectives to improving perioperative communication and aligning care with patient values.</p><p><strong>Participants and setting: </strong>This study included 12 adult surgical patients aged 65 and older with documented treatment-limiting directives in the electronic medical record, recruited from a tertiary academic medical center between September 2024 and March 2025.</p><p><strong>Methods: </strong>We conducted semi-structured interviews with eligible patients before their scheduled operations. Interview content focused on patient understanding of code status documentation, experiences with prior discussions, expectations for perioperative management, and preferences for future conversations. Transcripts were analyzed using a hybrid deductive-inductive qualitative content approach.</p><p><strong>Results: </strong>Seventy-five percent of participants were aware of their documented resuscitation preferences, but fewer than half recalled having a preoperative discussion. Three-quarters experienced discordance between their EMR documentation and personal understanding of code status. Thematic analysis revealed four major findings: (1) conflict and stress related to surgical \"buy-in,\" (2) disappointment with system-level factors, (3) limited patient understanding, and (4) trust arising from shared decision-making. Participants described time pressure, fragmented care, and unclear documentation as barriers to meaningful conversations.</p><p><strong>Conclusion: </strong>This study offers novel insight into how older surgical patients with treatment-limiting directives experience perioperative code status discussions. Findings highlight gaps in communication, systemic barriers, and patient-identified needs for trust, continuity, and time to reflect. These insights may inform efforts to improve serious illness communication and support patient-centered perioperative care.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146180757","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":"Elastomeric Pumps for Continuous Subcutaneous Infusion of Symptom Control Medication on Discharge","authors":"Stephanie Gover MBiochem, MB, BChir ,&nbsp;Chiara Creed MPharm, IPresc ,&nbsp;Shumi Tattersfield MPharm, IPresc ,&nbsp;Daniel Harper DipHE ,&nbsp;Jane Neerkin MBBs, BSc(Hons)","doi":"10.1016/j.jpainsymman.2025.10.031","DOIUrl":"10.1016/j.jpainsymman.2025.10.031","url":null,"abstract":"<div><h3>Background</h3><div>Maintaining continuous subcutaneous infusion (CSCI) of symptom control medication is difficult when discharging palliative and end of life (EoL) patients.</div></div><div><h3>Objectives</h3><div>To determine the feasibility of using a single use elastomeric pump (EP) to deliver CSCI medication for 24 hours, as an alternative to syringe drivers (SDs) at discharge.</div></div><div><h3>Methods</h3><div>Palliative care inpatients on CSCIs leaving a tertiary hospital were prescribed an EP for day leave or discharge. We collected retrospective data over 12 months on the number of EPs administered, drug prescription, and adverse events. Hospital savings in terms of bed-days and loss of hospital pumps were extrapolated from this.</div></div><div><h3>Results</h3><div>A total of 107 EPs were administered to patients leaving hospital without issue. 16 patients were given 2 EPs to facilitate administration of incompatible drugs. Extrapolated costs indicate £59,060 was saved over 12-months.</div></div><div><h3>Conclusions</h3><div>EPs are a safe, effective, and cost-saving method to deliver CSCI medication for palliative care and EoL patients leaving hospital.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"71 2","pages":"Pages e162-e166"},"PeriodicalIF":3.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145459065","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 Development Status and Five-Year Evolution of Pediatric Palliative Care in Mainland China","authors":"Siyu Cai MD ,&nbsp;Xiaoxia Peng PhD ,&nbsp;Qiaohong Guo PhD ,&nbsp;Zishen Wang BS ,&nbsp;Ruixin Wang MD ,&nbsp;Xuan Zhou MD","doi":"10.1016/j.jpainsymman.2025.10.030","DOIUrl":"10.1016/j.jpainsymman.2025.10.030","url":null,"abstract":"<div><h3>Background</h3><div>Pediatric palliative care (PPC) should be integrated throughout the disease trajectory and recognized as a fundamental component of pediatric healthcare systems.</div></div><div><h3>Aim</h3><div>To describe the development level of PPC in mainland China and elucidate the changing characteristics in this field over the past five years.</div></div><div><h3>Methods</h3><div>This is a cross-sectional study initiated by the PPC subspecialty group of the Pediatrics Society of the Chinese Medical Association. Study participants included all PPC teams in mainland China. The questionnaire was structured into five main sections: team characteristics, personnel composition, service quality, service types and contents, and support needs. This study compared the level of PPC development in mainland China in 2025 with that of 2019, with the 2019 data sourced from literature published by our team. Descriptive statistics were used to analyze the data.</div></div><div><h3>Results</h3><div>There were 36 PPC teams, covering 16 out of 31 (51.61%) provinces and municipalities in mainland China. The median total number of team members was 12 (9, 16). From 2019 to 2025, the number of teams decreased from 45 to 36. However, the total number of team members increased from 300 to 513, demonstrating significant structural improvements in PPC teams. With the improved team structure, the content of palliative care services has significantly expanded.</div></div><div><h3>Conclusion</h3><div>Over the past five years, the PPC system in mainland China has made improvements to its team structure and dynamics. Despite this progress, it continues to face interrelated challenges: severe resource shortages, inefficient resource utilization, and uneven geographical distribution of services.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"71 2","pages":"Pages 307-315.e1"},"PeriodicalIF":3.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145471143","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":"Safely Easing Pain in Home Hospice Patients With Opioid Infusions: A Quality Improvement Project","authors":"Linda Mae Abbott DNP, RN,&nbsp;Seungman Kim PhD,&nbsp;Alyce Ashcraft PhD, RN","doi":"10.1016/j.jpainsymman.2025.11.002","DOIUrl":"10.1016/j.jpainsymman.2025.11.002","url":null,"abstract":"<div><h3>Background</h3><div>Opioid infusions are critical for managing pain in home hospice care but carry a high risk of medication errors. This quality improvement (QI) project evaluated adherence to a standardized PCA opioid infusion procedure and examined whether a nurse education intervention improved compliance.</div></div><div><h3>Measures</h3><div>Compliance was assessed using a ten-item checklist that captured key safety and documentation behaviors, including double-check verification, verification of nurse documentation and identification, expiration-date documentation, photo verification, documentation of pump lock and unlock, near-miss event reporting, compliance with the protocol, and identification of adverse events. Weekly average compliance scores were calculated for 47 weeks (29 pre-intervention and 18 post-intervention).</div></div><div><h3>Intervention</h3><div>The intervention consisted of a nurse education program focused on the standardized PCA opioid infusion procedure. Education covered double-check processes, standardized documentation using smart phrases, photo verification, and adherence to required safety steps. No patient-identifying information was collected.</div></div><div><h3>Outcomes</h3><div>Weekly average compliance scores significantly improved after the intervention (Mann–Whitney U test). Chi-square tests showed that several checklist items were significantly associated with the intervention period. Linear regression demonstrated that the intervention remained a significant predictor of higher compliance after controlling for nurse role and travel distance. No adverse events occurred during the study period.</div></div><div><h3>Conclusions/Lessons Learned</h3><div>Standardizing PCA opioid infusion procedures through focused nurse education, supported by digital documentation tools, improved compliance and strengthened patient safety in home hospice care. QI teams should consider combining education with standardized workflows and mobile documentation supports to reduce variability and enhance adherence.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"71 2","pages":"Pages e183-e189"},"PeriodicalIF":3.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145513149","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}