Journal of pain and symptom management最新文献

{"title":"Home Hospitalization in Palliative Care for Advanced Cancer and Dementia: A Systematic Review","authors":"Beatriz Farinha-Costa MD, MSc ,&nbsp;Paulo Reis-Pina MD, MSc, PhD","doi":"10.1016/j.jpainsymman.2024.11.013","DOIUrl":"10.1016/j.jpainsymman.2024.11.013","url":null,"abstract":"<div><h3>Context</h3><div>Home hospitalization (HHOSP) is an alternative care model aimed at alleviating pressure on healthcare systems and catering to the increasing patient population. It aligns with the preference for home-based palliative care (PALC) and end-of-life care.</div></div><div><h3>Objectives</h3><div>This study systematically reviewed the literature to evaluate HHOSP's role in PALC, focusing on hospital readmissions, length of stay, patient and caregiver safety and satisfaction, place of death, and overall survival.</div></div><div><h3>Methods</h3><div>A systematic search was conducted in PubMed, Scopus, and Web of Science databases from 2013 to 2023. Participants: patients of any age or gender diagnosed with advanced, metastatic, or incurable cancer or advanced dementia. Intervention: HHOSP. Comparator: usual care. Outcomes: hospital readmissions, length of stay, patient and caregiver safety and satisfaction, place of death, and overall survival. The risk of bias was assessed using Cochrane tools.</div></div><div><h3>Results</h3><div>Six studies with 843 participants from Denmark, France, Spain, and Israel were included. The overall risk of bias was moderate to high. HHOSP reduced hospital readmissions, with 42.2%–91% of patients avoiding further hospitalizations. Caregivers reported feeling safe and satisfied with HHOSP, experiencing reduced burden. Most patients died at home (52.2%–75%). Median overall survival ranged from 28 days–11.2 months.</div></div><div><h3>Conclusion</h3><div>The findings highlight HHOSP's potential as an alternative for delivering PALC, reducing hospital readmissions, and improving patient and caregiver satisfaction. Despite heterogeneity in study designs and outcomes, HHOSP aligns with patient and caregiver preferences, enhancing the quality of end-of-life care. Further standardized research is needed to optimize HHOSP implementation.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 3","pages":"Pages 289-303"},"PeriodicalIF":3.2,"publicationDate":"2024-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716384","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":"Impact of a Criteria-Based Inpatient Palliative Oncology Consultation Model on End-of-Life Outcomes","authors":"Kathryn E. Norman MD ,&nbsp;Mary K. Buss MD MPH ,&nbsp;Kathleen A. Lee MD ,&nbsp;Abigail Escobar BS ,&nbsp;Jonathan Thomas MD ,&nbsp;Julia Berg MD ,&nbsp;Nsabimana Uwumugambi MD ,&nbsp;Laura E. Dodge ScD MPH ,&nbsp;Harry J. Han MD ,&nbsp;Carol Pilgrim FNP-BC ,&nbsp;Jonathan C. Yeh MD","doi":"10.1016/j.jpainsymman.2024.11.011","DOIUrl":"10.1016/j.jpainsymman.2024.11.011","url":null,"abstract":"<div><h3>Context</h3><div>Early, integrated palliative care (PC) improves outcomes in advanced cancer; however, inpatient PC referrals still exceed outpatient referrals nationwide. Recognizing need for enhanced integration, our cancer center implemented a criteria-based PC consultation model in inpatient oncology.</div></div><div><h3>Objectives</h3><div>To compare decedent outcomes pre- and postimplementation of a new criteria-based PC consultation model in inpatient oncology.</div></div><div><h3>Methods</h3><div>We implemented an embedded, interdisciplinary “Palliative Oncology” consult team on the oncology floor. Admitted patients were screened for advanced/metastatic solid cancer or moderate/severe symptoms. The oncology team received prompting regarding eligible patients; PC referral remained at their discretion. We compared outcomes between patients who died pre- (10/1/2019-6/30/2020) and postimplementation (7/1/2020–6/30/2022) by t-test (continuous variables) and chi-square test (categorical variables).</div></div><div><h3>Results</h3><div>Of 820 decedents, 186 died preintervention and 634 died postintervention. Postintervention, more decedents saw inpatient PC (59%–72%, <em>P</em> &lt; 0.001) and outpatient PC (23%–34%, <em>P</em> &lt; 0.01), and had earlier first PC visit before death (76–159 days, <em>P</em> &lt; 0.001). Postintervention, fewer decedents had hospitalizations (71%–57%, <em>P</em> &lt; 0.001) and intensive care encounters (25%–17%, <em>P</em> &lt; 0.01) within last 30 days of life. Hospice length-of-stay increased (22–36 days, <em>P</em> &lt; 0.01). There were trends toward fewer emergency room visits within last 30 days of life (51%–42%, <em>P</em> = 0.02), less systemic cancer therapy within last 14 days of life (9%–5%, <em>P</em> = 0.03), and more deaths at home (41%–50%, <em>P</em> = 0.03).</div></div><div><h3>Conclusion</h3><div>Embedded, criteria-based PC consultation in inpatient oncology was associated with earlier PC involvement, longer hospice LOS, and reduced EOL care intensity.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 3","pages":"Pages 229-235.e1"},"PeriodicalIF":3.2,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142682169","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":"Symptoms of Hematologic Tumors Patients after CAR-T Therapy: A Systematic Review and Meta-Analysis","authors":"Wan Sun MD ,&nbsp;Shuo Wang PhD ,&nbsp;Jiachen Han MD ,&nbsp;Lang Zhuo PhD ,&nbsp;Jiang Cao PhD ,&nbsp;Fang Zhou PhD","doi":"10.1016/j.jpainsymman.2024.11.002","DOIUrl":"10.1016/j.jpainsymman.2024.11.002","url":null,"abstract":"<div><h3>Context</h3><div>Patients with hematologic neoplasms after Chimeric antigen receptor T-cell (CAR-T) therapy have multiple syndromes, with corresponding symptoms.</div></div><div><h3>Objectives</h3><div>The review aimed to integrate the severity and incidences of symptoms in these patients, and to investigate the difference of the symptoms among different geographic locations, types of hematological tumors, evaluating instruments, and evaluating time, to provide a theoretical basis for symptom management.</div></div><div><h3>Methods</h3><div>A literature search of PubMed, Web of Science, Embase, the Cochrane Library, China National Knowledge Internet, SinoMed, VIP, and WANFANG DATA was performed for studies reporting symptom scores or symptom incidences of these patients published before November 9, 2023. Heterogeneity between studies was assessed by Higgins’ I². A random effects model was used for studies with I² &gt; 50%. Methodological quality of included studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist.</div></div><div><h3>Results</h3><div>Eight studies were included. Among the reported symptoms, sleep disturbance, fatigue and depression were of higher severity, with the standardized scores exceeding 50. Sadness, problem with concentration, problem with memory, cough and nausea were the top five symptoms in incidence, which exceeded 50%. The symptom scores and incidences assessed by the patient-reported outcomes were higher. Within 90 days of CAR-T infusion, these patients reported a significantly higher severity and incidence of multiple symptoms.</div></div><div><h3>Conclusion</h3><div>Patients with hematologic neoplasms treated by CAR-T suffer from multiple symptoms, including depression, fatigue, and so on. Instruments used to evaluate symptoms and the evaluating time may influence the outcome of symptom assessment.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 3","pages":"Pages 304-317"},"PeriodicalIF":3.2,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142639210","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":"Shades of Loneliness.","authors":"Danielle Chammas","doi":"10.1016/j.jpainsymman.2024.10.025","DOIUrl":"10.1016/j.jpainsymman.2024.10.025","url":null,"abstract":"","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568474","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":"PC-FACS October 11, 2024","authors":"","doi":"10.1016/j.jpainsymman.2024.10.013","DOIUrl":"10.1016/j.jpainsymman.2024.10.013","url":null,"abstract":"","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"68 6","pages":"Pages 647-651"},"PeriodicalIF":3.2,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468135","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":"Towards a Crisis Management Playbook: Hospice and Palliative Team Members’ Views Amid COVID-19","authors":"Dena Schulman-Green PhD, FAAHPM ,&nbsp;Daniel David PhD, MS, RN ,&nbsp;Laura T. Moreines FNP-BC, ACHPN ,&nbsp;Jonelle Boafo MPH ,&nbsp;Emily Franzosa DRPH, MA ,&nbsp;Patricia Kim MS ,&nbsp;Margaret V. McDonald MSW ,&nbsp;Abraham A. Brody PhD, RN, FAAN ,&nbsp;Melissa D. Aldridge PhD, MBA","doi":"10.1016/j.jpainsymman.2024.09.012","DOIUrl":"10.1016/j.jpainsymman.2024.09.012","url":null,"abstract":"<div><h3>Context</h3><div>The critical role of hospice and palliative care in response to the COVID-19 pandemic is well recognized, but there is limited evidence to guide healthcare leadership through future crises.</div></div><div><h3>Objectives</h3><div>Our goal was to support future organizational resilience by exploring hospice and palliative team members’ perspectives on crisis leadership during the COVID-19 pandemic in New York City (NYC).</div></div><div><h3>Methods</h3><div>This qualitative descriptive study used individual, semi-structured interviews of purposively sampled interdisciplinary team members. Enrollment sites were two large NYC metro hospice care organizations and one outpatient palliative care practice. We asked participants to complete a demographic form and a 45–60 minute interview. We used descriptive statistics and thematic analysis, respectively, for data analysis. We triangulated the data by presenting preliminary study findings to a group of clinicians (n=21) from one of the referring organizations.</div></div><div><h3>Results</h3><div>Participants (n=30) were professionally diverse (e.g., nurses, physicians, social workers, chaplains, administrators), experienced (mean=17 years; 10 years in hospice), and highly educated (83% ≥ master's degree). About half (n=15) self-identified as white, non-Hispanic, and nearly half (n=13) self-identified as being from a racial/ethnic minoritized group. Two (n=2) did not wish to self-identify. We identified four themes that reflected challenges and adaptive responses to providing care during a crisis: Stay Open and Stay Safe; Act Flexibly; Lead Adaptively; and Create a Culture of Solidarity.</div></div><div><h3>Conclusion</h3><div>While additional work is indicated, findings offer direction for a crisis management playbook to guide leadership in hospice, palliative care, and other healthcare settings in future crises.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"68 6","pages":"Pages 573-582.e1"},"PeriodicalIF":3.2,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289580","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":"Predictive Biomarkers of Dyspnea Response to Dexamethasone and Placebo in Cancer Patients","authors":"David Hui MD, MSc ,&nbsp;Sandra K. Hanneman PhD ,&nbsp;Kristofer Jennings PhD ,&nbsp;Amy Ontai PhD ,&nbsp;Stanley Cron MSPH ,&nbsp;Eduardo Bruera MD","doi":"10.1016/j.jpainsymman.2024.07.003","DOIUrl":"10.1016/j.jpainsymman.2024.07.003","url":null,"abstract":"<div><h3>Context</h3><div>In the Alleviating Breathlessness in Cancer Patients with Dexamethasone (ABCD) trial, dexamethasone did not improve dyspnea more than placebo in unselected cancer patients. However, it is unclear if patients with greater inflammation would be more likely to derive a treatment response.</div></div><div><h3>Objectives</h3><div>To examine the predictive utility of cytokines for dyspnea response.</div></div><div><h3>Methods</h3><div>We performed a secondary analysis of the ABCD double-blind, randomized clinical trial comparing high-dose dexamethasone to placebo (NCT03367156). The primary outcome was dyspnea intensity over 14 days. Blood cytokine levels (TNF, IL-6, IL-8, and IL-10) were measured at baseline, day seven, and day 14. We used a generalized additive model to examine the association between baseline cytokine level and change in dyspnea from baseline to day seven and baseline to day 14 in dexamethasone and placebo groups.</div></div><div><h3>Results</h3><div>Of the 128 enrolled patients, 45 provided blood samples. TNF, IL-6, and IL-8 decreased over 14 days in the dexamethasone group but not placebo (<em>P</em>&lt;0.05). Lower baseline TNF was associated with a greater reduction in dyspnea intensity by day seven in the placebo group (<em>P</em>=0.0013); conversely, higher baseline TNF was associated with a greater reduction in dyspnea intensity by day 7 in the dexamethasone group (difference between groups <em>P</em>=0.0019). Similar patterns were observed for IL-6 (<em>P</em>=0.000051), IL-8 (<em>P</em>=0.00063), and IL-10 (<em>P</em>=0.01) on day seven, and all cytokines on day 14.</div></div><div><h3>Conclusion</h3><div>Cytokines decreased with dexamethasone, but not placebo. Higher baseline cytokine levels may identify patients likely to respond to dexamethasone and less likely to respond to placebo.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"68 4","pages":"Pages 392-401"},"PeriodicalIF":3.2,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289579","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":"PC-FACS September 6, 2024","authors":"","doi":"10.1016/j.jpainsymman.2024.09.004","DOIUrl":"10.1016/j.jpainsymman.2024.09.004","url":null,"abstract":"","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"68 5","pages":"Pages 533-538"},"PeriodicalIF":3.2,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289578","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 Without Borders.","authors":"Benjamin Fay, Balawal Qaiser, Dhrity Bhowmik, Cynthia X Pan","doi":"10.1016/j.jpainsymman.2024.08.038","DOIUrl":"10.1016/j.jpainsymman.2024.08.038","url":null,"abstract":"","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289576","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":"Identifying Palliative Care Needs in Patients With Heart Failure Using Patient Reported Outcomes","authors":"Camilla Lykke PhD ,&nbsp;Birgit Jurlander MD, PhD ,&nbsp;Ola Ekholm MSc ,&nbsp;Per Sjøgren MD, DMSci ,&nbsp;Gitte Irene Juhl MD, PhD ,&nbsp;Geana Paula Kurita PhD ,&nbsp;Sille Larsen RN ,&nbsp;Niels Tønder MD, DMSci ,&nbsp;Lene Vibe Høyer CNL ,&nbsp;Inge Eidemak MD, PhD ,&nbsp;Ann-Dorthe Zwisler MD, PhD","doi":"10.1016/j.jpainsymman.2024.09.002","DOIUrl":"10.1016/j.jpainsymman.2024.09.002","url":null,"abstract":"<div><h3>Context</h3><div>Heart failure (HF) is considered a multifaceted and life-threatening syndrome characterized by high symptom-burden and significant mortality.</div></div><div><h3>Objectives</h3><div>To describe the symptom-burden in patients with HF and identify their palliative care needs. In this respect, symptom burden related to sex, age and classification of HF using New York Heart Association Functional Classification (NYHA) were analyzed.</div></div><div><h3>Methods</h3><div>A cross-sectional questionnaire survey included adult HF patients according to NYHA II, III, and IV. Palliative care needs were assessed using validated patient reported outcomes measures; SF-36v1, HeartQoL, EORTC- QLQ-C15-PAL, MFI-20 and HADS. Patients were recruited from the Department of Cardiology, North Zealand Hospital, Denmark.</div></div><div><h3>Results</h3><div>In total, 314 patients (79%) completed the questionnaire (233 men). Mean age = 74 years (range 35–94 years). In all, 42% had NYHA III or IV and 53% self-rated their health to be fair or poor. In all, 19% NYHA II and 67% NYHA III/IV patients had ≥4 severe palliative symptoms according to EORTC-QLQ-C15-PAL. In addition, NYHA III/IV had a mean of 8.9 symptoms and a mean of 5.4 severe symptoms. Women, older patients, and those with NYHA III/IV had worse outcomes regarding health-related quality of life, functional capacity, and symptom burden.</div></div><div><h3>Conclusions</h3><div>Patients with HF have a high prevalence of symptoms and, thus, potential palliative care needs. Predominantly, women, older patients, and those with higher severity of disease have the highest symptom burden. PROMs can help cardiologists address the palliative care needs and systematic assessment may be a prerequisite to integrate symptom-modifying and palliative care interventions.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"68 6","pages":"Pages 561-572"},"PeriodicalIF":3.2,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289574","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}