Journal of pain and symptom management最新文献_第2页

When Hospice Referrals are Placed to Improve Acute Care Hospital Mortality Metrics. 当安宁疗护转介被放置以改善急症护理医院死亡率指标。

IF 3.5 2区医学

Journal of pain and symptom management Pub Date : 2025-10-08 DOI: 10.1016/j.jpainsymman.2025.10.002

Gina M Piscitello, Emily Martin, Gregg A Robbins-Welty, Ryan Baldeo, Joseph Shega, Michael T Huber

引用次数: 0

Hospice Use and Aggressive End-of-Life Care Among Cancer and Non-Cancer Decedents in Taiwan. 台湾癌症与非癌症病患临终关怀之使用与积极临终关怀。

IF 3.5 2区医学

Journal of pain and symptom management Pub Date : 2025-10-07 DOI: 10.1016/j.jpainsymman.2025.09.026

Chun-Li Wang, Chiann-Yi Hsu, Chia-Yen Lin

{"title":"Hospice Use and Aggressive End-of-Life Care Among Cancer and Non-Cancer Decedents in Taiwan.","authors":"Chun-Li Wang, Chiann-Yi Hsu, Chia-Yen Lin","doi":"10.1016/j.jpainsymman.2025.09.026","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2025.09.026","url":null,"abstract":"Context: Palliative care has expanded to include non-cancer populations, yet disparities in hospice access and end-of-life (EOL) care quality between cancer and non-cancer patients remain.Objectives: To examine 10-year trends and determinants of hospice use and aggressive EOL care among cancer and hospice-eligible non-cancer decedents in Taiwan.Methods: This retrospective study included 15,546 adult inpatients who died or were terminally discharged from a tertiary center between 2010 and 2019. Patients were classified as cancer or hospice-eligible non-cancer based on Taiwan's National Health Insurance criteria. Hospice enrollment and 15 indicators of aggressive EOL care were assessed within the last 28 days of life. Linear and logistic regression identified trends and predictors.Results: Hospice utilization increased significantly over time in both cancer and non-cancer groups. For cancer decedents, hospice enrollment rose from 6.2% in 2010 to 52.3% in 2019 (β = 0.94, p<0.001) while non-cancer patients showed a more modest increase from 0.6% to 16.2% (β = 0.81, p<0.001). Non-cancer patients consistently exhibited higher aggressive-care scores (mean 5.2 vs. 3.6, p<0.001), particularly in ICU admission, mechanical ventilation, vasopressor use, and CPR. Cancer diagnosis (aOR = 0.33), receipt of hospice care (aOR = 0.46), and self-signed DNR (aOR = 0.41) were independently associated with lower odds of receiving high-intensity EOL care.Conclusions: Despite improvement, non-cancer patients remain less likely to access hospice and more likely to receive aggressive treatments. Enhanced prognostic recognition and equitable palliative integration are needed.","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145258315","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}

引用次数: 0

Author Response to Comment on: "Deep Continuous Sedation Until Death and Experience of Relatives and Healthcare Providers: A Systematic Review". 作者对以下评论的回应：“深度持续镇静直到死亡和亲属和医疗保健提供者的经验：系统回顾”。

IF 3.5 2区医学

Journal of pain and symptom management Pub Date : 2025-10-06 DOI: 10.1016/j.jpainsymman.2025.09.024

Marie Locatelli, Cécile Flahault, Léonor Fasse

引用次数: 0

Assessment of a zero-shot large language model in measuring documented goals-of-care discussions. 在测量记录的护理目标讨论中的零射击大语言模型的评估。

IF 3.5 2区医学

Journal of pain and symptom management Pub Date : 2025-10-06 DOI: 10.1016/j.jpainsymman.2025.09.025

Robert Y Lee, Kevin S Li, James Sibley, Trevor Cohen, William B Lober, Danae G Dotolo, Erin K Kross

{"title":"Assessment of a zero-shot large language model in measuring documented goals-of-care discussions.","authors":"Robert Y Lee, Kevin S Li, James Sibley, Trevor Cohen, William B Lober, Danae G Dotolo, Erin K Kross","doi":"10.1016/j.jpainsymman.2025.09.025","DOIUrl":"10.1016/j.jpainsymman.2025.09.025","url":null,"abstract":"Context: Goals-of-care (GOC) discussions and their documentation are important process measures in palliative care. However, existing natural language processing (NLP) models for identifying such documentation require costly task-specific training data. Large language models (LLMs) hold promise for measuring such constructs with fewer or no task-specific training data.Objective: To evaluate the performance of a publicly available LLM with no task-specific training data (zero-shot prompting) for identifying documented GOC discussions.Methods: We compared performance of two NLP models in identifying documented GOC discussions: Llama 3.3 using zero-shot prompting; and, a task-specific BERT (Bidirectional Encoder Representations from Transformers)-based model trained on 4,642 manually annotated notes. We tested both models on records from a series of clinical trials enrolling adult patients with chronic life-limiting illness hospitalized over 2018-2023. We evaluated the area under the receiver operating characteristic curve (AUC), area under the precision-recall curve (AUPRC), and maximal F1 score, for both note-level and patient-level classification over a 30-day period.Results: In our text corpora, GOC documentation represented <1% of text and was found in 7.3-9.9% of notes for 23-37% of patients. In a 617-patient held-out test set, Llama 3.3 (zero-shot) and BERT (task-specific, trained) exhibited comparable performance in identifying GOC documentation (Llama 3.3: AUC 0.979, AUPRC 0.873, and F1 0.83; BERT: AUC 0.981, AUPRC 0.874, and F1 0.83).Conclusion: A zero-shot large language model with no task-specific training performed similarly to a task-specific trained BERT model in identifying documented goals-of-care discussions. This demonstrates the promise of LLMs in measuring novel clinical research outcomes.","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251486","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}

引用次数: 0

Addressing Palliative Care Gaps for Rare Congenital Disease in Adults: CM-AVM2 as an Example. 解决成人罕见先天性疾病的姑息治疗差距：CM-AVM2为例。

IF 3.5 2区医学

Journal of pain and symptom management Pub Date : 2025-10-04 DOI: 10.1016/j.jpainsymman.2025.09.027

Matthew W Kenaston, Ryan Baldeo, Tyler K Murphy

{"title":"Addressing Palliative Care Gaps for Rare Congenital Disease in Adults: CM-AVM2 as an Example.","authors":"Matthew W Kenaston, Ryan Baldeo, Tyler K Murphy","doi":"10.1016/j.jpainsymman.2025.09.027","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2025.09.027","url":null,"abstract":"Capillary malformation-arteriovenous malformation type 2 (CM-AVM2) is a rare vascular disorder marked by complex, progressive symptoms and limited treatment options. As more individuals with rare diseases reach adulthood, palliative care plays an essential role in supporting quality of life when disease-directed therapies begin to fail. We present a young adult male with EPHB4-positive CM-AVM2, transferred to our tertiary care center for progressive malnutrition, refractory diarrhea, and worsening abdominal pain despite extensive subspecialty care. His hospitalization was marked by escalating symptom burden, limited response to medical therapies, and increasing emotional distress for both patient and family. Palliative care was consulted to assist with pain control and symptom management, with initial reluctance for discussing goals of care (GOC). Through medication optimization, dynamic communication, and consistent interdisciplinary collaboration, the team helped stabilize aspects of his comfort and gradually facilitated GOC discussions. Our case emphasizes the value of integrating palliative care in rare disease management, particularly when longstanding treatments are refractory. We further discuss how palliative care in this setting differs from standard frameworks, requiring proactive use of disease-specific resources and protracted, anticipatory care planning to optimize quality of life.","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238900","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}

引用次数: 0

In the Field: Visiting Peer Institutions to Inform Pediatric Palliative Care Program Re-Development. 实地考察：访问同行机构为儿科姑息治疗项目的再开发提供信息。

IF 3.5 2区医学

Journal of pain and symptom management Pub Date : 2025-10-01 DOI: 10.1016/j.jpainsymman.2025.09.012

Ross W Cleveland, Chelsea Heneghan, Suzanne Gouda, Shih-Ning Liaw, Terrance Murphy, Vanessa Battista, Eleanor Frechette, Carlie Larocque, Abby R Rosenberg

{"title":"In the Field: Visiting Peer Institutions to Inform Pediatric Palliative Care Program Re-Development.","authors":"Ross W Cleveland, Chelsea Heneghan, Suzanne Gouda, Shih-Ning Liaw, Terrance Murphy, Vanessa Battista, Eleanor Frechette, Carlie Larocque, Abby R Rosenberg","doi":"10.1016/j.jpainsymman.2025.09.012","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2025.09.012","url":null,"abstract":"Context: The heterogeneity of Pediatric Palliative Care (PPC) programs presents challenges in forming a generalized model for growth. We developed and implemented a system to visit and learn from peer institutions to inform our own program's revision and expansion.Objectives: To describe the use of structured field trips to peer programs in North America to inform program development.Methods: OUR PROCEDURE INVOLVED THREE STEPS: First, \"organization\" included choosing visit sites, outreach and collaboration to plan logistics, development of a standardized approach, and creating inter-disciplinary field trip teams to ensure diverse PPC perspectives during each visit. Second, \"conduction\" included the field trips, creating a semi-structured debriefing interview guide aimed at uncovering common tensions, and performing interviews with those who went on each trip. Third, \"application\" involved analyzing interview data to identify and name key tensions, sharing those tension points with the team, and centering those points in a clinical model re-design.Results: We completed 7 field trips, including 16 interdisciplinary members of our team. Analysis of our debriefing interviews yielded 2 primary and 5 sub-themes/tension points. Focusing on recognizing, accepting, mitigating, or eliminating those tension points during a clinical model re-design led to the creation of several formative changes to our team structure. The field trips took 8 months from beginning to delivery of a new clinical model.Conclusions: Field trips to peer PPC teams highlight both shared and unique strengths and challenges PPC teams experience. Knowledge gained from trips may enable creative and informed guidance of PPC programmatic growth and evolution.","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225801","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}

引用次数: 0

End-of-Life symptoms after Stroke: A Mixed Methods Study. 中风后的临终症状：一项混合方法研究

IF 3.5 2区医学

Journal of pain and symptom management Pub Date : 2025-09-29 DOI: 10.1016/j.jpainsymman.2025.09.023

Anna-Christin Willert, Meghan Romba, Sumayyah M Khan, William T Longstreth, Claire J Creutzfeldt

{"title":"End-of-Life symptoms after Stroke: A Mixed Methods Study.","authors":"Anna-Christin Willert, Meghan Romba, Sumayyah M Khan, William T Longstreth, Claire J Creutzfeldt","doi":"10.1016/j.jpainsymman.2025.09.023","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2025.09.023","url":null,"abstract":"Background: Stroke kills 160,000 patients annually in the US, with most deaths occurring in the hospital after a decision to withhold or withdraw life-sustaining treatment (WLST). Little is known about the experience at the end-of-life of patients with stroke, some of whom are awake, and of their families.Methods: In this single-center, mixed-methods retrospective quality improvement study, we included all patients hospitalized with acute stroke who died in 2022 after WLST. Basic characteristics were collected for descriptive analysis. Based on clinician progress notes, patients were considered awake with or not awake without conscious behavior at the time of WLST. Qualitative analysis of progress notes focused on symptoms documented for patients.Results: One-hundred-one patients with stroke died after WLST. Their median age was 73 years, 48 were women, and 34 were awake at the time of WLST, including 3 who participated in decision making. Median duration from WLST to death was 1 day (25th-75th percentile 0-2 days). Symptom documentation was rare and more likely to be found in patients who were awake (21/34, 62%) compared to those who were not awake (22/61, 36%). Dyspnea, pain, and restlessness were the main documented physical symptoms. Social, spiritual, and emotional needs of patients or families were less often documented.Conclusion: Symptom assessment at end-of-life after stroke was limited. Prospective, systematic symptom assessment is needed to understand signs and symptoms during the end-of-life process in stroke, particularly among awake patients, so as to learn how best to address and manage symptoms in these patients.","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206643","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}

引用次数: 0

IF 3.5 2区医学

Journal of pain and symptom management Pub Date : 2025-09-23 DOI: 10.1016/j.jpainsymman.2025.09.017

Gina M Piscitello, Robert M Arnold, Jane Schell

{"title":"Cost-related Outcomes Associated With Documented Goals of Care Conversations.","authors":"Gina M Piscitello, Robert M Arnold, Jane Schell","doi":"10.1016/j.jpainsymman.2025.09.017","DOIUrl":"10.1016/j.jpainsymman.2025.09.017","url":null,"abstract":"Context: There is limited understanding about how documented goals of care conversations (GOCC) are associated with cost-related outcomes for hospitalized patients.Objective: To primarily assess the association of documented GOCC with specialty palliative consults (SPC) and hospital cost-related outcomes.Methods: This multihospital, cross-sectional study, which used propensity-score matching, assessed adult patients hospitalized between 2022 and 2024 at four hospitals. We used multivariable logistic and linear regression models to identify outcomes associated with documented GOCC.Results: Of 267,375 patients with median age 61 years, 19,186 had a documented GOCC and 12,300 had a SPC during hospital admission. In the propensity-score matched cohort (n = 24,600), documented GOCC with SPC were associated with decreased odds of in-hospital death (aOR 0.15, 95% CI 0.12 to 0.18), thirty-day readmission (aOR 0.68, 95% CI 0.57 to 0.82) and lower hospital length of stay (adjusted log-linear coefficient [β] -0.07, 95% CI -0.14 to -0.01). They were also associated with lower total direct hospital costs for patients surviving hospital admission (β -0.18, 95% CI -0.26 to -0.11), admitted to an ICU (β -0.13, 95% CI -0.23 to -0.03) or with GOCC documented within 48 hours of admission (β -0.28, 95% CI -0.37 to -0.19). In contrast, documented GOCC overall with or without SPC were associated with increased odds of in-hospital death (aOR 8.77, 95% CI 7.44 to 10.35, P < 0.0001) and higher hospital length of stay (β 0.25, 95% CI 0.19 to 0.31, P < 0.0001) and total direct costs (β 0.18, 95% CI 0.12 to 0.24, P < 0.0001).Conclusion: Early documented GOCC with SPC were associated with lower cost-related outcomes and may contribute to hospital cost-related savings.","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145149626","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}

引用次数: 0

Caregiving Activities and Activity-Limiting Pain Among African American Caregivers. 非裔美国照护者的照护活动与活动限制性疼痛。

IF 3.5 2区医学

Journal of pain and symptom management Pub Date : 2025-09-23 DOI: 10.1016/j.jpainsymman.2025.09.022

Martha Abshire Saylor, Janiece L Taylor, Yifan Liu, Wonkyung Jung, Erin M Spaulding, Katherine A Ornstein

{"title":"Caregiving Activities and Activity-Limiting Pain Among African American Caregivers.","authors":"Martha Abshire Saylor, Janiece L Taylor, Yifan Liu, Wonkyung Jung, Erin M Spaulding, Katherine A Ornstein","doi":"10.1016/j.jpainsymman.2025.09.022","DOIUrl":"10.1016/j.jpainsymman.2025.09.022","url":null,"abstract":"Background: African American caregivers disproportionately engage in high-intensity caregiving. Pain experiences of African Americans may interfere with caregiving and overall health, but little is known about the associations of caregiving activities and activity-limiting pain among African Americans.Objective: We aimed to 1) examine risk factors for activity-limiting pain among African American caregivers and 2) analyze the relationships between caregiving intensity, patient care needs and activity-limiting pain.Methods: In a cross-sectional analysis, using nationally representative data from the National Study of Caregiving and linked National Health and Aging Trends Study, we analyzed caregiver and care recipient factors associated with activity-limiting pain among African American caregivers. We examined the relationship between caregiving intensity, patient care needs and activity-limiting pain using multivariable logistic regression. Sampling weights were applied to make nationally representative estimates.Results: Our sample (N = 1673) included mostly female (63.5%) African American caregivers, with a mean age of 55.8 ± 21.5 years. Nearly half experience pain and 11% report activity-limiting pain. In our fully adjusted, multivariable model, those with higher intensity caregiving (i.e., longer duration of caregiving) [aOR: 2.09, CI: 1.29-3.39] and higher patient care needs (i.e., supporting care recipients requiring assistance for more activities of daily living (ADLs)) [aOR: 1.15, CI: 1.02-1.29] had higher odds of activity-limiting pain compared to those with lower intensity caregiving and lower care needs.Conclusion: These findings underscore the importance of the intersection of race, caregiving, and pain. Future work should explore how African American caregivers cope with pain and how best to support them.","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145149603","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}

引用次数: 0

Effectiveness and Safety of Home-Based RBC Transfusions in Advanced Hematologic and Solid Tumors. 家庭输血治疗晚期血液病和实体瘤的有效性和安全性。

IF 3.5 2区医学

Journal of pain and symptom management Pub Date : 2025-09-23 DOI: 10.1016/j.jpainsymman.2025.09.021

Naohiro Miyashita, Kota Ohashi, Masahiro Onozawa

{"title":"Effectiveness and Safety of Home-Based RBC Transfusions in Advanced Hematologic and Solid Tumors.","authors":"Naohiro Miyashita, Kota Ohashi, Masahiro Onozawa","doi":"10.1016/j.jpainsymman.2025.09.021","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2025.09.021","url":null,"abstract":"Context: Home-based red blood cell transfusion (RBC-TF) offers a potential treatment for terminally ill patients who suffer from anemia-related symptoms but face difficulties visiting medical facilities. However, its clinical utility and safety remain underexplored.Objectives: To evaluate the effectiveness, safety, and procedural characteristics of home-based RBC-TF in terminally ill patients with hematological malignancies (HM) and solid tumors (ST).Methods: This retrospective study included patients with terminal-stage HM or ST who received home-based RBC-TF between July 2020 and February 2025. Symptom relief was used to assess effectiveness, and adverse events (AEs) were documented to evaluate safety. Biomarkers related to cancer cachexia were also analyzed. All transfusions followed standardized protocols, including premedication and the use of leukoreduced and irradiated RBCs.Results: Seventy-seven patients (58 HM, 19 ST) received 1,664 units of RBCs. Symptom improvement was significantly greater in HM patients compared to ST patients for fatigue (94.1% vs. 53.8%, P = 0.003) and appetite loss (55.0% vs. 6.7%, P = 0.004). No severe AEs were observed; two mild allergic reactions occurred (0.29%). ST patients exhibited more severe cachexia-related markers, including lower albumin and higher CRP levels.Conclusion: Home-based RBC-TF is a feasible and safe palliative intervention for carefully selected patients, especially those with HM. Standardized transfusion protocols may contribute to improved safety. Patient selection is essential, particularly in those with advanced cachexia who may experience limited benefit.","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145149536","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}

引用次数: 0