Journal of pain and symptom management最新文献

{"title":"Progressive Responsibility Map: Effective Training in Hospice and Palliative Medicine Fellowships.","authors":"Ethan J Silverman, Rebecca Sands","doi":"10.1016/j.jpainsymman.2024.09.022","DOIUrl":"10.1016/j.jpainsymman.2024.09.022","url":null,"abstract":"","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":"e78-e81"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468137","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":"Variation in Palliative Care Program Performance for Patients With Metastatic Cancer.","authors":"May Hua, Ling Guo, Caleb Ing, Shuang Wang, R Sean Morrison","doi":"10.1016/j.jpainsymman.2024.10.021","DOIUrl":"10.1016/j.jpainsymman.2024.10.021","url":null,"abstract":"<p><strong>Context: </strong>While specialist palliative care is associated with improved end-of-life quality metrics for patients with advanced cancer, its effectiveness may differ between hospitals.</p><p><strong>Objectives: </strong>To examine variation in palliative care program performance on end-of-life care quality metrics.</p><p><strong>Methods: </strong>Retrospective cohort study of palliative care programs that participated in the National Palliative Care Registry, 2018-2019. Medicare data for patients age ≥65 who died with metastatic cancer were aggregated on a program-level. Variation in program performance on outcomes (use of hospice, hospice enrollment ≥3 days, use of intensive care in the last 30 days of life, and use of chemotherapy in the last 14 days of life) was quantified by risk-standardized outcome rates (RSOR) and adjusted median odds ratios (aMOR).</p><p><strong>Results: </strong>The cohort comprised 235 palliative care programs who delivered care to 33,015 patients. There was substantial variation in use of hospice (median RSOR 65.6%, interquartile range (IQR) 57.5%-74.3%), hospice enrollment ≥3 days (median RSOR 53.6%, IQR 48.6%-58.2%), and use of intensive care (median RSOR 14.1%, IQR 13.1%-15.3%), but not use of chemotherapy (median RSOR 1.5%, IQR 1.4%-1.5%). Variation was greatest for hospice use (aMOR 1.48 [1.39-1.57]), suggesting that patients at programs with high hospice use would be 48% more likely to use hospice than if they received care at programs with low use.</p><p><strong>Conclusion: </strong>We found variation in most end-of-life quality metrics for patients with metastatic cancer. Further work is needed to better understand why variations exist and whether such variations reflect a difference in quality of care.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":"23-33.e2"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502369","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":"Use of Essential Medicines for Pain Relief and Palliative Care: A Global Consensus Process.","authors":"Tania Pastrana, Liliana De Lima, Deborah Dudgeon, Anna Voeuk, Ebtesam Ahmed, Lukas Radbruch","doi":"10.1016/j.jpainsymman.2024.10.024","DOIUrl":"10.1016/j.jpainsymman.2024.10.024","url":null,"abstract":"<p><strong>Context: </strong>The WHO Model List of Essential Medicines includes 24 medications under the section Medicines for Pain and Palliative Care (EML). The Lancet Commission on Pain and Palliative Care developed the Lancet Essential Package (LEP), including 35 medications designed to alleviate serious health-related suffering worldwide.</p><p><strong>Objectives: </strong>This study aims to provide recommendations on the appropriate use of essential of medicines in palliative care.</p><p><strong>Methods: </strong>The global palliative care community was invited to submit guidelines, of which 19/22 were selected. Data was extracted on initial dose, frequency, and maximum daily dose for medications in the LEP and in the WHO EML. For medications where guidance was not available or information differed, a 2-round Delphi process was conducted with 70 experts across regions and income levels. Consensus was set to ≥70% agreement.</p><p><strong>Results: </strong>Consensus in the guidelines was identified for 24 medications on three parameters. Open questions (mostly on maximum daily dose) were included in the Delphi. 63 experts from 49 countries responded (RR = 90%). No consensus was achieved for the maximum daily dose for nine medications. Significant disparities in medication availability were noted between high-income and low/middle-income countries.</p><p><strong>Conclusion: </strong>We were able to partly achieve our goal, with limited evidence and a wide range of clinical practice described by the experts. This highlights an important gap in critical information which affects mostly the provision of palliative care at the primary care. Both limited availability and lack of training on the adequate use of essential medications may affect how clinicians manage symptoms, possibly relying on personal experience or trial and error, rather than evidence-based information.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":"53-64"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564455","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":"Improving Hospital Palliative Care Between COVID-19 Waves: A Retrospective Cohort Study.","authors":"Claude Chidiac, Luigi Sedda, Catherine Walshe, David Feuer, Mary Flatley, Anna Rodgerson, Nancy Preston","doi":"10.1016/j.jpainsymman.2024.09.015","DOIUrl":"10.1016/j.jpainsymman.2024.09.015","url":null,"abstract":"<p><strong>Context: </strong>A specialist palliative care service in an acute hospital characterized care patterns during the first wave of the COVID-19 pandemic. There were delayed referrals for minoritized ethnic groups. COVID-19 treatments (dexamethasone, anticoagulation, remdesivir) alongside service changes were introduced in the second wave.</p><p><strong>Objective: </strong>To examine changes in care patterns and trends in the context of COVID-19 treatments. A secondary objective is to examine differences in ethnic disparity between the first and second wave of COVID-19.</p><p><strong>Methods: </strong>Retrospective cohort study comparing patients referred to an acute hospital palliative care service with confirmed COVID-19 infection either at the peak of the first (Mar-Apr 2020, W1), or second (Dec 2020-Feb 2021, W2) wave of the pandemic. Demographic, clinical characteristics, and outcomes data were compared using statistical tests; generalized linear mixed models for modelling of elapsed time from admission to referral; and survival analysis.</p><p><strong>Results: </strong>Data from 165 patients (W1 = 60, W2 = 105) were included. Patients in W1 were referred earlier to palliative care than in W2, particularly in the first 10 days from admission. Receiving dexamethasone or anticoagulants, and absence of dementia, hypertension, and fever were associated with longer time to referral to palliative care. Delays in referrals of Black and Asian patients during W1 was no longer observable in W2. There was no association between socioeconomic status and care patterns and trends. The Australian-modified Karnofsky Performance Status (HR < 0.92, 95% CI: 0.88-0.95) and phase of illness (HR > 3, 95% CI: 2-5) were good predictors of survival.</p><p><strong>Conclusion: </strong>Our findings have the potential to inform strategies that improve palliative care response and equity beyond COVID-19, and in future pandemics or crises.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":"e37-e45"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289575","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":"Discussion of Spirituality in Family Conferences of Infants With Neurologic Conditions.","authors":"Dana Peralta, Nikhita Nanduri, Simran Bansal, Sharla Rent, Debra H Brandon, Kathryn I Pollak, Monica E Lemmon","doi":"10.1016/j.jpainsymman.2024.09.020","DOIUrl":"10.1016/j.jpainsymman.2024.09.020","url":null,"abstract":"<p><strong>Introduction: </strong>Spirituality serves as a mechanism to understand and cope with serious illness, yet little is known about how families and clinicians incorporate spirituality in pediatric family conferences.</p><p><strong>Objectives: </strong>We sought to characterize the frequency and nature of spiritual statements in conferences between families and clinicians caring for infants with neurologic conditions.</p><p><strong>Methods: </strong>In this descriptive qualitative study, we used an existing dataset of audio-recorded, de-identified, transcribed family conferences of infants with neurologic conditions. Inclusion criteria for infants were 1) age < 1 year, 2) presence of a neurologic condition, and 3) planned conversation about neurologic prognosis or goals of care. We used a content analysis approach to code the data.</p><p><strong>Results: </strong>68 family conferences were held for 24 infants and 36 parents. Most parents (n = 32/36, 89%) self-identified as spiritual. References to spirituality occurred in the 32% of conferences (n = 22/68). Spiritual discussion included three domains: 1) Spiritual beliefs and practices, 2) Spiritual support, and 3) Parent-child connection as sacred. Clinicians' responses to family member spiritual statements were inconsistent and included providing affirmation, exploring goals of care, and continuing discussion of clinical information.</p><p><strong>Conclusions: </strong>Spirituality was discussed in approximately one-third of family conferences. Clinician engagement with spirituality discussion was variable. These findings highlight a need for training on when and how to discuss spirituality in conversations with families of seriously ill infants.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":"34-43.e1"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348665","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":"Who Better Than Palliative Care? Supporting Clinicians in the Face of Serious Illness.","authors":"Jennifer Snaman, Abby Rosenberg","doi":"10.1016/j.jpainsymman.2024.10.003","DOIUrl":"10.1016/j.jpainsymman.2024.10.003","url":null,"abstract":"","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":"e95-e96"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468140","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":"Effects of Exercise in Adults With Cancer Pain: A Systematic Review and Network Meta-Analysis.","authors":"Jie Wang, Meiling Lv, Hongpeng Li, Dongqing Guo, Xin Chu","doi":"10.1016/j.jpainsymman.2024.08.033","DOIUrl":"10.1016/j.jpainsymman.2024.08.033","url":null,"abstract":"<p><strong>Context: </strong>Pain is one of the most common symptoms of cancer patients, affecting the patient's physical, psychological, behavioral, social relations and other aspects. Previous studies have demonstrated that exercise is effective for cancer pain, and the optimal exercise is still unknown.</p><p><strong>Objectives: </strong>This study aimed to compare the effects of different exercise interventions on cancer pain in adults.</p><p><strong>Methods: </strong>Randomized control trials identified from medical literature databases that reported effects of exercise in adults with cancer pain were included in this study. Literature screening and data extraction were conducted independently by 2 researchers. Cochrane Bias Assessment 2.0 was used to assess the quality of the literature, and Stata 15.0 software was used for Network meta-analysis.</p><p><strong>Results: </strong>Forty-one studies were included, involving 3537 patients with cancer pain. The types of exercise involved included aerobic exercise, medium intensity continuous training, high-intensity interval training, resistance exercise, mind-body exercise and comprehensive exercise program (CEP). The results suggested that CEP was more effective than the usual care in relieving pain intensity in cancer patients [SMD = -1.96,95% CI (-3.47, -0.44)] (SUCRA = 97.9%). Mind-body exercise outperformed usual care in reducing pain interference in cancer patients [SMD = -0.65, 95% CI (-1.21, -0.09)] (SUCRA = 83.8%).</p><p><strong>Conclusion: </strong>Current evidence shows that CEP is the best way to relieve the pain intensity of cancer patients, and mind-body exercise is the best way to reduce pain interference of cancer patients. Due to the limited number and quality of the included studies, the above conclusions need to be further verified by more high-quality studies.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":"82-101"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142108430","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 in Hematology: A Systematic Review of the Components, Effectiveness, and Implementation.","authors":"Sophie Hochrath, Naomi Dhollander, Luc Deliens, Rik Schots, Frederick Daenen, Tessa Kerre, Kim Beernaert, Koen Pardon","doi":"10.1016/j.jpainsymman.2024.08.025","DOIUrl":"10.1016/j.jpainsymman.2024.08.025","url":null,"abstract":"<p><strong>Context: </strong>While the evidence supporting the benefits of integration of palliative care into cancer care for patients and informal caregivers is growing, it poses challenges for hematological cancer patients due to rapidly changing disease trajectories, uncertain prognosis, and diverse care needs.</p><p><strong>Objectives: </strong>This systematic review aims to provide an overview of the intervention components, the targeted outcomes, the effectiveness in improving patient and informal caregiver outcomes, and the implementation into clinical practice.</p><p><strong>Methods: </strong>We systematically searched PubMed (MEDLINE), EMBASE, CENTRAL, PsycINFO, and CINAHL in March 2023. The studies included described interventions in palliative care, with multiple components, targeting patients with hematological cancer and/or their informal caregivers, and producing primary data on effectiveness or implementation. Quality was assessed using the QualSyst tool.</p><p><strong>Results: </strong>We identified 19 reports on 16 different palliative care interventions, including four quasi-randomized controlled trials. These interventions were provided by secondary and tertiary palliative care providers in a hospital setting. Tertiary interventions significantly improved the most common patient outcomes, including pain, quality of life, symptom burden, depression, and anxiety. Meanwhile, secondary interventions were feasible and well-accepted by healthcare professionals and patients. Despite limited inclusion of informal caregivers, the results indicated significant improvements in quality of life and depression.</p><p><strong>Conclusion: </strong>While palliative care interventions are found to improve patient outcomes, future research is needed on the effectiveness of secondary palliative care interventions, integrating primary palliative care, and more reliable and frequent implementation measurements. More focus on informal caregivers and resource allocation based on patient needs is warranted.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":"114-133.e2"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142036099","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":"Recommendations for Psychosocial Support for Long-Distance Caregivers of Terminally Ill Patients.","authors":"Franziska A Herbst, Nils Schneider, Stephanie Stiel","doi":"10.1016/j.jpainsymman.2024.10.020","DOIUrl":"10.1016/j.jpainsymman.2024.10.020","url":null,"abstract":"<p><strong>Context: </strong>The provision of appropriate psychosocial support has a significant impact on quality of life for informal caregivers of terminally ill patients. Long-distance caregivers have specific wishes and needs for psychosocial support.</p><p><strong>Objectives: </strong>To date, no formal support measures for long-distance caregivers of terminally ill patients have been developed in Germany. The national Delphi study aimed at systematically and empirically generating recommendations for psychosocial support measures, tailored to this population.</p><p><strong>Methods: </strong>Recommendations were formulated on the basis of qualitative interviews exploring the support experiences and unmet needs of long-distance caregivers of terminally ill patients. Experts from hospice and palliative care rated the relevance and feasibility of 10 recommendations using two 4-point Likert-type scales. Additionally, suggestions for improvement were captured via free text fields. Recommendations were deemed to have achieved consensus when ≥ 80% of participants indicated \"strongly agree\" or \"somewhat agree\" for both relevance and feasibility.</p><p><strong>Results: </strong>A total of 26 experts completed two Delphi rounds. Following the first round, eight of the 10 recommendations were revised according to participant feedback. After the second round, consensus was achieved for five of these revised recommendations. Three recommendations were rejected, as participants regarded them unfeasible due to a perceived lack of personnel resources.</p><p><strong>Conclusion: </strong>The consensus-based recommendations represent the first empirically grounded guidelines in Germany aimed at addressing the psychosocial needs of long-distance caregivers of terminally ill patients. The recommendations seek to raise awareness among both professional and voluntary workers regarding the specific support requirements of this understudied population.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":"10-22.e1"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502468","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":"Addressing Family Financial Toxicity Across Serious Illnesses.","authors":"Rod Carlo Columbres, Puneeth Iyengar, Edward Christopher Dee","doi":"10.1016/j.jpainsymman.2024.09.013","DOIUrl":"10.1016/j.jpainsymman.2024.09.013","url":null,"abstract":"","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":"e90-e92"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289571","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}