Journal of pain and symptom management最新文献

{"title":"Underuse of Palliative Medications and Services in Children with Life-Limiting Conditions.","authors":"Hagit Levine, Tamar Freud, Yotam David Ginati, Yuval Landau, Yochai Schonmann, Yahav Shvartzman, Pesach Shvartzman, Roni Peleg","doi":"10.1016/j.jpainsymman.2026.10.004","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2026.10.004","url":null,"abstract":"<p><strong>Context: </strong>Children with life-limiting conditions experience substantial pain, depression, and anxiety, yet the real-world use of symptom-directed medications and palliative services in this population is largely uncharacterized.</p><p><strong>Objectives: </strong>To examine the use, and potential underuse, of antidepressant and other symptom-directed psychotropic medications, psychological services, and dedicated palliative care services (palliative consultation, hospice referral, and pain consultation) among children with life-limiting conditions.</p><p><strong>Methods: </strong>Retrospective population-based cohort study using the electronic medical records of Clalit Health Services, Israel's largest health care organization. Children aged 0-18 years with chronic life-limiting or life-threatening conditions diagnosed between 2000 and 2025 were followed until death or end of follow-up. Medication dispensing, psychiatric and psychological consultations, and palliative care services were compared across age groups and regions.</p><p><strong>Results: </strong>The cohort included 83,419 children, of whom 3,267 died. In the final year of life, only 18.2% of children who died received benzodiazepines and fewer than 3% received selective serotonin reuptake inhibitors (SSRIs). Psychiatric and psychological consultations reached only 1.8% and 0.6%, respectively; 95.7% received no palliative consultation, and hospice referrals and pain consultations were each provided to 0.2%. SSRI, SNRI, and methylphenidate use rose steeply with age (SSRIs: 0.5% of infants vs. 13.1% of adolescents; p<0.001). Benzodiazepine use was higher in the center and north, whereas palliative consultations were more common in the south and center (p<0.001). Among living children, palliative service use was virtually absent.</p><p><strong>Conclusion: </strong>Children with life-limiting conditions in Israel experience profound, systematic underuse of symptom-directed medications, psychological services, and dedicated palliative care across the entire disease trajectory, demanding urgent policy action.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169636","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 Fifth Thing To Say.","authors":"Perryn Ng","doi":"10.1016/j.jpainsymman.2026.10.002","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2026.10.002","url":null,"abstract":"","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164499","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":"What Does Palliative Care Delivery Look Like?: A Retrospective Claims-Based Analysis.","authors":"John J Shin, Aidan M Campbell, Ravi Chandra Thota, Amber E Barnato, Gabriel A Brooks, Amro M Farid, Inas S Khayal","doi":"10.1016/j.jpainsymman.2026.09.039","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2026.09.039","url":null,"abstract":"<p><strong>Context: </strong>Timely palliative care (PC) is a marker of high-quality care for patients with poor-prognosis cancer, yet real-world delivery falls short of guideline-concordant care. Clinician type is an underexplored factor.</p><p><strong>Objectives: </strong>This study characterizes PC delivery by clinician type among decedents with poor-prognosis cancer at hospitals with PC programs.</p><p><strong>Methods: </strong>Using Medicare claims linked to the National Palliative Care Registry, we identified PC encounters in the last six months of life among decedents with poor-prognosis cancer. Billing clinicians were classified into team-based physician, independent physician, team-based advanced practice provider (APP), and independent APP. We performed analyses of clinician type distribution, timing, and encounter frequency, and examined whether clinician type at first visit and encounter frequency varied by staffing capacity.</p><p><strong>Results: </strong>We identified 33,677 poor-prognosis cancer decedents attributed to 276 hospitals; 72.8% had at least one PC encounter. The most common clinician type was team-based physician (37%). 69% of patients whose first encounter was with an independent physician had it within 30 days of death, compared to 48% of patients with an independent APP, but were more often limited to only one encounter (61% vs. 30%). After adjusting for staffing capacity, team-based physician first encounters were associated with higher odds of 3+ encounters (Odds Ratio [OR]=2.88, 95% Confidence Interval [CI]=2.70-3.08) vs. independent physician encounters. Team-based APP first encounters were associated with lower odds of 3+ encounters (OR=0.88, 95% CI=0.79-0.97).</p><p><strong>Conclusion: </strong>These findings establish a foundation for examining whether clinician type at first encounter relates to patient and hospital outcomes.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137085","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":"Unplanned healthcare use and self-efficacy for managing symptoms during oral anticancer therapy.","authors":"Amna Rizvi-Toner, Antoinette B Coe, Christopher R Friese, Milisa Manojlovich, Lauren P Wallner, Karen B Farris","doi":"10.1016/j.jpainsymman.2026.10.001","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2026.10.001","url":null,"abstract":"<p><strong>Context: </strong>Oral anticancer agent (OAA) use in cancer treatment necessitates patient symptom self-management, which requires self-efficacy. Appropriate management may deter costly and burdensome unplanned healthcare use.</p><p><strong>Objectives: </strong>To assess self-efficacy for managing symptoms over time in patients taking targeted OAAs, and to evaluate associations between self-efficacy, symptom severity, and unplanned healthcare use.</p><p><strong>Methods: </strong>We conducted a prospective cohort study of participants initiating OAAs, following them for approximately the first eight months of therapy. Participants completed patient reported outcome measures (PROMs) online at six timepoints. Descriptive statistics quantified demographics, cancer characteristics, symptoms, self-efficacy for managing symptoms, and unplanned healthcare use. Logistic regression models estimated whether unplanned healthcare service use was associated with self-efficacy for managing symptoms and symptom severity. Mixed effects logistic regressions were used to account for repeated measures and time effects.</p><p><strong>Results: </strong>Fifty-nine participants (95%) completed the first set of PROMs within three weeks of starting therapy; about eight months later, 29 (47%) completed the sixth and final set. Participants were mostly White (90%) and female (61%). Twenty-four unique participants (41%) used unplanned healthcare 38 times. Multivariable adjusted odds of unplanned healthcare use were lower for participants with above versus below average self-efficacy (OR 0.24; 95% CI 0.11-0.53), but higher with each one-point increase in pain severity (OR 1.29; 95% CI 1.11-1.51).</p><p><strong>Conclusion: </strong>Unplanned healthcare use was associated with lower self-efficacy for managing symptoms and greater pain severity. Clinicians should redouble efforts to assess and manage pain proactively. Assessing self-efficacy to deliver targeted support to patients may potentially reduce unplanned healthcare use.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127738","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":"Using community-engaged approach to develop culturally informed study materials in palliative care.","authors":"Jyotsana Parajuli, Zhuo Job Chen, Regine M Smith, Savannah Norris, Liliana M Hernandez, Sarah Rutledge, Grant Williams, Marie A Bakitas","doi":"10.1016/j.jpainsymman.2026.09.037","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2026.09.037","url":null,"abstract":"<p><strong>Introduction: </strong>Cultural values and beliefs of individuals may affect their healthcare decision-making including their preferences and readiness for palliative care - especially among under-represented populations. Community-engaged research approaches can help investigators to better understand older adults with cancer and their family caregivers' cultural preferences regarding their palliative care needs and readiness for palliative care services.</p><p><strong>Methods: </strong>Using a community-engaged approach, we formed and worked with a racially/ethnically diverse advisory board of older adults with cancer and their family caregivers to develop culturally informed recruitment flyers and the semi-structured interview guides for a palliative care readiness (PALCARE) tool development and validation study.</p><p><strong>Results: </strong>Our advisory group comprised five members (three patients and two caregivers). They provided two major recommendations related to cultural considerations of our study materials: 1) language sensitivity (creating positive and non-threatening questions), and 2) acknowledging the heterogeneity of experiences (consider using language that recognize the heterogeneity/diversity of experiences with palliative care and serious illness).</p><p><strong>Conclusion: </strong>Partnering with community members helped ensure that the PALCARE tool development/validation study materials were culturally responsive for the target population.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127767","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":"Efficacy and safety of adjunct methadone with opioid therapy for cancer pain: a systematic review.","authors":"Philip Austin, Marco Lamonaca, Kenny Kwon Ho Lee, Jessica Lee, Aaron Wong, Hiromichi Matsuoka, Jisu Kim, Malama Tafuna'i, Tim Luckett, Wei Lee","doi":"10.1016/j.jpainsymman.2026.09.032","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2026.09.032","url":null,"abstract":"<p><strong>Context: </strong>The use of opioid analgesia for cancer-related pain is challenging. Adequate pain relief is not always achieved where prolonged prescription of opioids carry risks including adverse effects, tolerance and hyperalgesia. Recent studies suggest that methadone as an adjunct to ongoing opioid therapy is effective in reducing pain severity without increases in adverse effects.</p><p><strong>Objectives: </strong>To systematically evaluate current evidence of the efficacy, safety and tolerability of adjunct methadone in combination with ongoing opioid regimens for cancer-related pain.</p><p><strong>Methods: </strong>A systematic search of MEDLINE, EMBASE, CINAHL and CENTRAL was conducted to identify studies that evaluated the efficacy, safety and tolerability of adjunct methadone with ongoing opioid regimens for cancer-related pain.</p><p><strong>Results: </strong>Of 4680 articles located, 13 studies including 641 participants (mean age 62.8 years, 53% male) were accepted for review. Included studies comprised of one RCT, three prospective open-label studies, five retrospective observational studies and four case reports. Despite low-quality evidence, findings from all studies report that adjunct methadone offers meaningful analgesic benefit. Ten studies also report adverse effects, however, only a few cases were noted as severe.</p><p><strong>Conclusion: </strong>This is the first systematic review to synthesise evidence from current literature on the efficacy of adjunct methadone with ongoing opioid regimens for cancer-related pain. Although findings across all studies suggest analgesic benefit for cancer-related pain, high-quality, larger-scale RCTs are required to better inform clinical recommendations.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127804","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":"Short-term adverse events during corticosteroid use in advanced cancer: a retrospective pilot study.","authors":"Amandine Mathé, Anne-Lise Giffard, Véronique Avérous, Adeline Lejeune, Aude Spire, Etienne Rivière","doi":"10.1016/j.jpainsymman.2026.09.031","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2026.09.031","url":null,"abstract":"<p><strong>Context: </strong>. Systemic corticosteroids are widely used in oncology and palliative care, but short-term adverse effects in patients with advanced cancer are poorly described.</p><p><strong>Objective: </strong>. We aimed to describe the incidence, timing and clinical impact of adverse events (AEs) potentially associated with short-term corticosteroid exposure, in hospitalized patients with advanced cancer.</p><p><strong>Method: </strong>. We conducted a monocentric retrospective descriptive pilot study for hypothesis generation, based on medical chart review by a single investigator, in an oncology department of a secondary care hospital. The study period extended from 1 September 2022 to 28 February 2023. Based on a literature review, we defined 12 AEs considered potentially related to corticosteroids. For each event, we recorded the day of onset since corticosteroid initiation, the dose and cumulative dose at onset, clinical consequences and therapeutic responses, associations between AEs and patient characteristics, corticosteroid prescription patterns and interacting concomitant drugs. Adult patients (>18 years) with advanced incurable cancer, with or without ongoing disease-directed anticancer treatment, who started systemic corticosteroids during admission were included.</p><p><strong>Results: </strong>. Twenty-nine patients (mean age 68 ± 11 years) were included. Nineteen patients (65.5%) developed ≥1 AE (52 events). The most frequent AEs were hypertension (n=11 patients among 28 with monitoring), infections (12 events for 10 patients), hyperglycemia (n=7 among 14 with monitoring) and insomnia (n=6). Approximately half of all adverse events occurred within the first 10 days of treatment. Patients with recorded AEs had longer corticosteroid exposure and more frequent dose adjustments during hospitalization.</p><p><strong>Conclusion: </strong>. In hospitalized patients with advanced cancer, adverse events potentially associated with short-term systemic corticosteroid exposure were frequently recorded, often early after treatment initiation. These exploratory findings support the relevance of existing recommandations for careful monitoring and regular reassessment of corticosteroid therapy and warrant furter investigation in larger prospective studies.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127764","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":"Centering Community in End-of-Life Care: Barriers and Facilitators in Urban Black Populations.","authors":"Amisha Parekh de Campos, Christine DiLeone, Denise Morris, Ronit Elk","doi":"10.1016/j.jpainsymman.2026.09.036","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2026.09.036","url":null,"abstract":"","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111091","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":"Recognizing Quality Advance Care Planning Documentation: A Quality Improvement Initiative.","authors":"Maria Teresa Cruz Carreras, Mary Senkel, Linda Luu, Jeff Beno, Kathryn Burk, Brian Cameron, Corbin Dill, Rani Benson, Paulette Cabinte, Florence Maffeu-Tamwo, Smitha Raphel, Ryan Sudario, Rekha Thoppil, Polly Sudario, Maria Soliman, Nico Nortje","doi":"10.1016/j.jpainsymman.2026.09.038","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2026.09.038","url":null,"abstract":"<p><strong>Background: </strong>ACP documentation in oncology emergency care frequently fails to capture patient values, reasoning, and voice, limiting its clinical utility.</p><p><strong>Measures: </strong>A five-domain ACP Documentation Quality Rubric (patient/family voice, goals/values, decision clarity, shared decision-making, plan integration) classified notes as Basic, Adequate, or Exemplary; the primary outcome was the proportion rated Exemplary.</p><p><strong>Intervention: </strong>Six components launched February 2026: provider education, exemplar dissemination, reviewer calibration, a point-of-care poster, unit champions, and formal kudos recognition of exemplary documentation.</p><p><strong>Outcomes: </strong>Exemplary documentation rose from 14.98% (49/327) at baseline to 21.54% (129/599) post-intervention, a 43.7% relative increase exceeding the 15% target (p=0.016); inter-rater reliability improved (weighted kappa 0.41 to 0.53).</p><p><strong>Conclusions/lessons learned: </strong>Standardized rubrics paired with peer recognition can measurably improve ACP documentation quality in a high-acuity oncology setting; sustainability and downstream patient outcomes warrant further study.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111055","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":"When the Plan Must Change: A Qualitative Study of Communicating Opioid Deprescribing Decisions.","authors":"Julie Childers, Kelly Harris, Ethan Silverman, Rene Claxton, Lourdes Ponte Cordova, Janet Ho","doi":"10.1016/j.jpainsymman.2026.09.029","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2026.09.029","url":null,"abstract":"<p><strong>Context: </strong>With increased survival in cancer and other serious illness, palliative care clinicians are increasingly facing decisions about the benefits versus burdens of opioid therapy in individuals with longer prognoses. When a patient who is prescribed opioids develops an opioid use disorder, guidelines recommend transitioning to a medication for opioid use disorder (MOUD) such as buprenorphine. However, how best to communicate this transition is unknown.</p><p><strong>Objective: </strong>We developed a framework for these conversations based on our clinical experience, and, using directed content analysis, we sought to qualitatively evaluate the framework in clinician and non-clinician interviews.</p><p><strong>Methods: </strong>We first created a 13-minute demonstration video of a physician-patient interview in which the physician used our proposed skills, and an interview guide. Participants (10 clinicians with experience caring for patients with cancer, 11 individuals with lived experience) reviewed the video, and then were asked to comment on the skills used, and bring up additional skills. We used coding and thematic analysis to identify themes.</p><p><strong>Conclusion: </strong>We identified six themes which refined our initial communication framework: raising a concern directly, balancing boundaries with shared decision-making, expressing empathy, embedding these conversations within a long-term clinician-patient relationship, countering stigma, and preserving positive regard. When a patient prescribed opioid therapy for pain has developed an addiction, clinicians should balance setting clear limits on opioid prescribing with expression of concern. Further, clinicians should work to develop awareness around their own attitude towards the patient with chronic pain and substance use disorder, and actively repudiate stigma in these conversations.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111060","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}