Journal of pain and symptom management最新文献

{"title":"Specialty Roles of the Palliative Care Chaplain and Social Worker: Differentiation and Overlap.","authors":"Naomi Tzril Saks, Chelsea K Brown, Natalya Johnson, Katie Rimer, Elizabeth Julian, Cara L Wallace","doi":"10.1016/j.jpainsymman.2026.04.615","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2026.04.615","url":null,"abstract":"<p><strong>Background: </strong>Specialty palliative care teams require interprofessional collaboration to address multidimensional patient and family needs. However, the operational integration of advanced practice chaplains and social workers-specialists in spiritual and psychosocial domains-remains poorly defined, limiting optimal teamwork.</p><p><strong>Objective: </strong>To develop a practical tool clarifying role differentiation and overlap between advanced practice chaplains and social workers on specialty palliative care teams.</p><p><strong>Methods: </strong>A national working group of palliative care chaplains and social workers from diverse clinical settings conducted an 18-month iterative process combining literature review, analysis of certification competencies, and synthesis of collective clinical expertise. The resulting tool, presented as a Venn diagram, is grounded in transdisciplinary practice theory and the Generalist-Specialist Model.</p><p><strong>Results: </strong>The Venn diagram delineates three domains-assessment, intervention, and professionalism-across social work-specific, chaplain-specific, and shared competencies. Social work assessment focuses on psychological and social needs, social determinants of health, and systems-level factors, while chaplain assessment targets spiritual, religious, and existential concerns. Both professions provide psychosocial and spiritual support, facilitate meaning-making and legacy work, conduct grief counseling, contribute to symptom management and advance care planning, and support team wellness. The tool operationalizes cross-domain screening where all team members screen across physical, psychosocial, and spiritual-existential domains, with specialists conducting in-depth assessments.</p><p><strong>Conclusion: </strong>This tool provides a springboard for discussion and one possible framework for optimizing interprofessional teamwork between chaplains, social workers, and all team members. Implementation requires organizational commitment to transdisciplinary practice, adequate staffing, and systemic recognition of both professions' essential contributions to comprehensive palliative care delivery.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816485","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":"Effect of specialist palliative care on acute healthcare in Stage IV cancer: prior event rate ratio.","authors":"Grace M Yang, Xiangmei, David Hui, Yu Ke, Qingyuan Zhuang, Yin Bun Cheung","doi":"10.1016/j.jpainsymman.2026.04.612","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2026.04.612","url":null,"abstract":"<p><strong>Context: </strong>The evidence for effect of specialist palliative care (SPC) on acute healthcare utilization is limited and inconclusive. Furthermore, randomized controlled trials may not reflect real-world clinical settings.</p><p><strong>Objectives: </strong>Effect of SPC on subsequent emergency department (ED) visits and inpatient hospitalizations among patients with stage IV cancer using real-world data and a novel prior event rate ratio (PERR) approach with bias-correction.</p><p><strong>Methods: </strong>Retrospective observational cohort study using the PERR method to compare ED visits and inpatient hospitalizations among patients with stage IV cancer who did versus did not receive SPC. We included patients diagnosed with stage IV cancer at National Cancer Centre Singapore between January 2019 and December 2022 and followed them up to July 2023. Each patient who received SPC was then matched with replacement to up to three patients who did not receive SPC during the study duration.</p><p><strong>Results: </strong>Among 7,144 patients with stage IV cancer, 1,499 (21.0%) received SPC by July 2023. After 1:3 matching with replacement, there were 5,948 patients in the matched cohort. Compared to those who never received SPC, those who received SPC had a PERR hazard ratio estimate of 0.644 (95% CI 0.524 to 0.792; P<0.001) for ED visits and 0.633 (95% CI 0.539 to 0.743; P<0.001) for hospitalizations. Although reduction was greater with earlier initiation of SPC (test of interaction, P<0.001), the reduction remained significant even if SPC was initiated about one year after stage IV cancer diagnosis.</p><p><strong>Conclusion: </strong>SPC was associated with lower rates of ED visits and hospitalizations.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774354","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":"Intranasal Ketamine for Existential Distress in Advanced Cancer.","authors":"Stefan Aguiar, Mary Makarious, Orly Lipsitz, Froukje E deVries, Zoe Doyle, Roger S McIntyre, Gary Rodin, Camilla Zimmermann, Ernie Mak, Breffni Hannon, Christian Schulz-Quach, Aida Al Kindy, Zeal Patel, Joshua D Rosenblat, Madeline Li","doi":"10.1016/j.jpainsymman.2026.04.611","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2026.04.611","url":null,"abstract":"<p><strong>Context: </strong>Depression and existential distress are highly prevalent among patients with advanced cancer, and there is growing evidence for ketamine as a rapidly acting antidepressant in the population, but few studies have examined existential distress outcomes with ketamine treatment. The INKeD-PC trial demonstrated efficacy of intranasal racemic ketamine for depression in patients with cancer receiving palliative care.</p><p><strong>Objectives: </strong>We now report on secondary trial outcomes, including those related to existential distress.</p><p><strong>Methods: </strong>This analysis is based on 15 trial participants who received 3 doses of ketamine and completed the primary endpoint measures including Montgomery-Åsberg Depression Rating Scale (MADRS) as primary outcome, as well as the Patient Health Questionnaire-9 (PHQ-9) for depression, Generalized Anxiety Disorders-7 (GAD-7), Edmonton Symptom Assessment System-revised (ESAS-r), McGill Quality of Life Questionnaire (MQOL), and the Death and Dying Distress Scale (DADDS). Qualitative comments from participants were used to support quantitative findings.</p><p><strong>Results: </strong>Improvements were observed across all secondary outcome measures, exceeding established minimal clinically important differences (MCIDs). GAD-7 (d = 1.22, p = 0.004), DADDS (d = 0.91, p = 0.003), ESAS-r (d = 1.21, p = 0.003) and MQOL (d = 1.53, p = 0.004). Correlations between changes in MADRS and secondary outcomes were not significant, and subscales related to psychological symptoms improved more than physical symptoms, including the MQOL Existential Well-Being factor (d=1.02, p=0.015).</p><p><strong>Conclusion: </strong>Intranasal ketamine was associated with clinically meaningful improvements in existential distress in individuals with advanced cancer being treated for depression. Ketamine may have relevance as a single agent for multidimensional distress in palliative care.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774451","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":"A systematic review of United States-based interventions to explain community-based palliative care.","authors":"Danielle H Llaneza, Kira G Sheldon, Julianne J Marsh, Samantha Burke, Elissa Kozlov, Bhoomika Kamath, Elizabeth Luth","doi":"10.1016/j.jpainsymman.2026.04.613","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2026.04.613","url":null,"abstract":"<p><strong>Context: </strong>The prevalence of serious illness has increased significantly, yet palliative care uptake remains limited, particularly in community settings. In the United States, misconceptions equating palliative care with hospice or limiting it to end-of-life care create barriers to uptake.</p><p><strong>Objective: </strong>This systematic review examines interventions focused on how community-based palliative care is explained to seriously ill individuals and caregivers.</p><p><strong>Methods: </strong>A systematic review was conducted between March 4 and August 20, 2025, for articles published after January 1, 2006, across seven databases, and supplemented by hand searches. Included studies were peer-reviewed, in English, and described interventions that explained community-based palliative care to seriously ill adults or caregivers directly or by training clinicians and other providers to do so. Data extraction followed predefined criteria and the Cochrane Checklist, with study quality assessed using the 26-item CONSORT checklist.</p><p><strong>Results: </strong>Of 4,328 unique studies identified, twelve met the inclusion criteria. Included studies targeted (1) seriously ill adults or their caregivers, (2) healthcare professionals responsible for explaining palliative care, or (3) a combination thereof. Interventions were delivered by analog, virtual, in-person, or combined methods. Ten studies assessed knowledge, and three assessed attitudes toward palliative care. Five evaluated intervention acceptability and usability, and one addressed communication outcomes. Overall, study quality reflected early-phase intervention development.</p><p><strong>Conclusion: </strong>Interventions focused on how community-based palliative care is explained to patients and caregivers are in the early stages of development. Future research should prioritize rigorous designs, larger samples, and outcomes that evaluate receptivity towards palliative care to increase eventual uptake.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774344","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":"Assessing Knowledge and Attitudes of Palliative Care: Insights from a Cross-Sectional Survey.","authors":"Mindy Kim, Jessica E Ma, Kiira Lyons, Sam Klotman, David J Casarett","doi":"10.1016/j.jpainsymman.2026.04.616","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2026.04.616","url":null,"abstract":"","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774410","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":"Patterns of referral to embedded palliative care and impact of timing on end-of-life outcomes.","authors":"Fionnuala Crowley, Tianxiang Sheng, Li Zeng, Mollie Hobensack, Nadeem Bilani, Kari Brown, Beth Popp, Debora Afezolli, Lauren Kelly, Winston Wey, Joanna Chen, Robert Arnold, Vanessa Austin, Aleena Bajwa, Eve Easton, Arlyn Pagala, Marcio Diniz, Cardinale B Smith, Laura Gelfman","doi":"10.1016/j.jpainsymman.2026.04.608","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2026.04.608","url":null,"abstract":"<p><strong>Background: </strong>Early palliative care referral has demonstrated benefits in quality of life and end-of-life outcomes, yet results have been inconsistent across cancer types. Previous guidelines recommended time-based referrals but optimal timing may vary by individual patient factors.</p><p><strong>Aim: </strong>Investigate factors associated with the timing of referral to palliative care and the impact of timing of referral and the number of appointments on end-of-life outcomes.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of 779 patients with metastatic solid tumors referred to outpatient palliative care at two cancer center sites(2021-2023). We examined referral patterns and analyzed associations between timing, patient characteristics, and end-of-life outcomes. For bivariate analysis, \"early\" was defined as referral within 3 months of diagnosis.</p><p><strong>Results: </strong>Overall, 38.9% of patients received early referral, with significant variation by cancer type (p<0.001): patients with head and neck cancer had the highest early referral rate (53.3%) while those with breast cancer had the lowest (9.6%). Patients with Medicaid insurance were more likely to receive early referral (42.8% vs 35.2%, p=0.04). Among 321 patients who died during follow-up, earlier referral relative to death was associated with increased hospice enrollment (OR 1.016 per month, p=0.01), reduced end-of-life chemotherapy (OR 0.964 per month, p=0.002), lower hospital death rates (OR 0.988 per month, p=0.04), and decreased ICU utilization (IRR 0.962, p=0.02). The timing of referral proved more influential than visit intensity across all end-of-life outcomes.</p><p><strong>Conclusions: </strong>Palliative care referral timing varies significantly by cancer type and insurance status. Earlier referral relative to death influenced end-of-life outcomes more than visit intensity, supporting stepped models, which have found non-inferior outcomes to early palliative care despite fewer visits.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774409","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 do medical oncologists want for themselves at the end-of-life? Analysis of Go Wish Cards Game.","authors":"Vitória Aparecida Betussi, Livia Costa de Oliveira, Karla Santos da Costa Rosa, Izabella da Silva Oliveira, Larissa Pereira Santos, Fulvio Bergamo Trevizan, Carlos Eduardo Paiva, Eduardo Bruera, David Hui, Bianca Sakamoto Ribeiro Paiva","doi":"10.1016/j.jpainsymman.2026.04.005","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2026.04.005","url":null,"abstract":"<p><strong>Context: </strong>Discussing end-of-life (EoL) values and priorities remains challenging in oncology, despite its relevance for person-centered and dignified care.</p><p><strong>Objective: </strong>To explore clinical oncologists' and oncology residents' perceptions of personal EoL values and priorities through their experience with the Go Wish Cards Game (GWCG), and to understand their reflections on the role and applicability of this tool in oncologic practice.</p><p><strong>Methods: </strong>This qualitative study included 49 participants (31 clinical oncologists and 18 oncology residents) from two Brazilian cancer centers. In individual sessions, participants selected and discussed the most meaningful GWCG cards, completing the exercise from the perspective of their own EoL values and priorities. Transcripts were analyzed using Bardin's content analysis method to identify emerging themes.</p><p><strong>Results: </strong>The most frequently chosen cards differed between groups: clinical oncologists prioritized \"Having family and friends nearby,\" while oncology residents emphasized \"Relief from pain and shortness of breath.\" Five thematic categories emerged: symptom control and physical comfort; dignity and autonomy; relationships and social/family support; spirituality and existential issues; and communication, legacy, and reflexivity. The GWCG fostered ethical and existential reflection, enhanced awareness of personal values, and demonstrated its potential as an educational and sensitizing tool in oncologic care.</p><p><strong>Conclusion: </strong>The use of the GWCG promoted reflection on participants' own EoL values and priorities, facilitating dialogue on sensitive topics. This self-reflective process can enhance participants' sensitivity to understanding what is essential to patients. Thus, the GWCG may contribute to more humanized, reflective, and values-aligned clinical practices in oncology.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774424","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":"Corrigendum to 'Intensity of Cancer Care Near the End-of-Life at a Tertiary Care Cancer Center in Jordan' [Journal of Pain and Symptom Management 57 (2019) 1106-1113].","authors":"Hikmat Abdel-Razeq, Omar Shamieh, Mahmoud Abu-Nasser, Moath Nassar, Yazan Samhouri, Bashar Abuqayas, Joud Asfour, Joud Jarrah, Zaid Abdelrahman, Zaid Ameen, AbdelRahman Al-Hawamdeh, Mohammad Alomari, Amal Al-Tabba', Dalia Al-Rimawi, David Hui","doi":"10.1016/j.jpainsymman.2026.03.011","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2026.03.011","url":null,"abstract":"","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147717168","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":"Real-World Experience with Initiating Buprenorphine in Opioid Tolerant Patients with Cancer Pain.","authors":"Olivia Idom, Marshall Winget, Amanda Toye, Karen Hande, Stephanie Mazzara, Heather Jackson, Lindsay Mundy, Jody B Smith, Maie El-Sourady, Sara F Martin, Rajiv Agarwal, Taylor Butler","doi":"10.1016/j.jpainsymman.2026.04.605","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2026.04.605","url":null,"abstract":"<p><strong>Purpose: </strong>Full-opioid agonists are commonly used for cancer-related pain but include risks such as constipation and respiratory depression. Buprenorphine, a partial opioid agonist, may offer a safer alternative, though concerns regarding withdrawal symptoms and efficacy remain. This study evaluates the real-world success of initiating buprenorphine in opioid tolerant patients for cancer-related pain management.</p><p><strong>Objectives: </strong>Assess the success rate of initiating buprenorphine products in opioid tolerant patients with cancer-related pain and chronic pain with a history of cancer and evaluate associated clinical outcomes including pain control, withdrawal symptoms, and buprenorphine discontinuation.</p><p><strong>Methods: </strong>This retrospective, single-center study included adult patients with active or historical malignancy who initiated transdermal or buccal buprenorphine between January 2023 and June 2024. The primary outcome was a successful initiation at 30 days, defined as continued buprenorphine use, absence of withdrawal symptoms, and stable or improved pain scores.</p><p><strong>Results: </strong>A total of 77 patients were screened with 48 meeting inclusion criteria. Successful initiations occurred in 34 patients (71%). For the entire cohort, mean pain scores decreased from 6.3 at baseline to 4.9 at day 30. Withdrawal symptoms were reported in 8% of patients. On day 30, 77% remained on buprenorphine, and two patients resumed full-opioid agonists. Most patients who continued buprenorphine (65%) remained on their initial dose.</p><p><strong>Conclusion: </strong>Buprenorphine appears to be a safe and effective alternative for managing cancer-related pain, with minimal withdrawal symptoms and stable or improved pain control. These findings support broader use of buprenorphine products in cancer-related pain management, though further prospective studies are needed.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147729039","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":"Perception Towards Take Home Naloxone Among Patients with Cancer on Opioids Who Live Alone.","authors":"Jaya Amaram-Davila, Diana Urbauer, Glorymar Lopez Garayua, Rony Dev, Eduardo Bruera, Akhila Reddy","doi":"10.1016/j.jpainsymman.2026.04.607","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2026.04.607","url":null,"abstract":"","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147729021","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}