Journal of pain and symptom management最新文献

{"title":"Nurses' Experiences of Serious Illness Conversations with Marginalized Patients in COVID-19.","authors":"Masami Tabata-Kelly, Amy L Bulger, Amanda J Reich, Priscilla K Gazarian, Shigeko Izumi, Tamryn F Gray, Lisa Wichmann, Simone Rinaldi, Rachelle E Bernacki","doi":"10.1016/j.jpainsymman.2025.09.001","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2025.09.001","url":null,"abstract":"<p><strong>Context: </strong>Nurses' professional training and experiences uniquely equip them to engage in serious illness conversations (SICs), however, their experiences conducting SICs with patients from historically marginalized groups during the COIVD-pandemic remain understudied.</p><p><strong>Objectives: </strong>To understand nurses' experiences in conducting SICs during the COVID-19 pandemic with patients and family members from marginalized groups.</p><p><strong>Methods: </strong>We conducted a mixed-methods study at two academic medical centers from April 2022 to June 2022. Participants included 20 registered nurses or nurse practitioners who received training using the Serious Illness Conversation Guide and conducted SICs during the pandemic. Surveys completed included demographics, Advance Care Planning Self-Efficacy Scale, and Moral Distress Thermometer. Virtual focus groups were conducted by a trained researcher using a guide. Survey and qualitative data were integrated to derive themes that captured nurses' experiences conducting SICs during the pandemic.</p><p><strong>Results: </strong>Nurses reported high self-efficacy and moderate levels of moral distress. We identified five key themes influencing nurses' experiences in engaging with marginalized patients in SICs: relational skills, pandemic-related challenges, exacerbation of moral distress and burnout, patients' unmet health-related social needs, and strategies to mitigate these challenges. Integration of survey and focus group data elucidated how highly trained nurses encountered challenges in conducting SICs despite high self-efficacy and how they experienced moral distress due to the uniquely challenging context of the pandemic and the structural barriers faced by marginalized patients.</p><p><strong>Conclusions: </strong>These findings highlight the need to address patient health-related social needs, support nurses to conduct conversations, and promote an environment that supports nurses' well-being.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040379","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":"Impacts On Everyday Activities Change With Breathlessness Duration: Exploratory Population Data.","authors":"Slavica Kochovska, Sungwon Chang, Max Olsson, Tim Luckett, David C Currow","doi":"10.1016/j.jpainsymman.2025.08.045","DOIUrl":"10.1016/j.jpainsymman.2025.08.045","url":null,"abstract":"","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040355","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":"Goal-Concordant Care in People With Amyotrophic Lateral Sclerosis Receiving Palliative Care.","authors":"Michael J Bonares, Jennifer Shapiro, Vishniha Vijayanathan, Agessandro Abrahao, Lorne Zinman, Christine Lau","doi":"10.1016/j.jpainsymman.2025.08.046","DOIUrl":"10.1016/j.jpainsymman.2025.08.046","url":null,"abstract":"<p><strong>Context: </strong>Although it is known where people with amyotrophic lateral sclerosis (ALS) are dying, less is known about whether they are dying where they want to.</p><p><strong>Objectives: </strong>To determine the rate of dying in a preferred place and factors associated with doing so in people with ALS receiving clinic-based specialist palliative care.</p><p><strong>Methods: </strong>Retrospective cohort study of people with ALS receiving clinic-based specialist palliative care in Toronto, Canada between July 2022 and February 2024. Association between preferred and actual place of death was determined using a χ² test. Factors associated with dying in a preferred place were determined using a multivariable binary logistic regression analysis.</p><p><strong>Results: </strong>In 367 individuals, at time of consultation, median age was 67 years; 60.8% had a Palliative Performance Scale score between 50% and 60%, and 43.3% had noninvasive ventilation. Mortality rate up to February 2024 was 41.7%. About 85.4% stated a preference to die at home, 8.7% in hospital, and 5.9% in a hospice facility, whereas 54.9% died at home, 34% in hospital, and 11.1% in a hospice facility. Of those with known preferred and actual place of death, 70.1% died in a preferred place (χ² = 36.2; P < 0.001). Dying in a preferred place was associated with increasing age (odds ratio [OR] = 1.1; 95% confidence interval [CI] = 1.0-1.1) and having noninvasive ventilation (OR = 2.5; 95% CI = 1.0-6.2).</p><p><strong>Conclusion: </strong>Younger age and not having noninvasive ventilation at the time of consultation may suggest a higher risk of goal-discordant end-of-life care and the need to engage in early future planning when these factors are identified.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040343","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":"Subcutaneous Opioids: Under the Skin Irritation or New Standard of Care?","authors":"Alexis Beachy, Lynn Aung, Natalie Malone, Amy Durell, Zak Tressel, Tommy Petros, Kerry Bertke","doi":"10.1016/j.jpainsymman.2025.08.047","DOIUrl":"10.1016/j.jpainsymman.2025.08.047","url":null,"abstract":"<p><strong>Background: </strong>Opioids are widely used for pain management in hospitalized adults and can be administered through various routes. While oral (PO) and intravenous (IV) routes remain most common, the subcutaneous (SUB-Q) route is underutilized despite historical safety and supporting literature.</p><p><strong>Objective: </strong>This quality improvement study implemented a revised standard of practice (SOP) for opioid administration, promoting the PO route when feasible and SUB-Q as the preferred parenteral route. IV remained available when clinically appropriate.</p><p><strong>Methods: </strong>This pilot study was conducted on a 24-bed adult general medicine unit at a large community teaching hospital. Extensive interdisciplinary education was provided prior to SOP implementation. Primary outcomes evaluated IV and SUB-Q opioid administrations. Secondary outcomes analyzed total opioid administrations (all routes), mean oral morphine equivalents (OMEs), and mean patient-reported pain scores (0-10 scale). All outcomes were measured per patient day (PPD) during the first five days of admission.</p><p><strong>Results: </strong>IV opioid administration decreased by 33% while overall opioid consumption (OMEs) was modestly reduced. Statistically significant reductions in average pain scores were observed postintervention on days one and five.</p><p><strong>Conclusions: </strong>Implementation of a new opioid SOP was associated with reduced IV opioid use while maintaining effective pain control across both groups.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033551","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 of Virtual Reality in Managing Pain for Patients in Palliative Care: A Systematic Review and Meta-Analysis.","authors":"Nezar Ahmed Salim, Janiece Taylor","doi":"10.1016/j.jpainsymman.2025.08.030","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2025.08.030","url":null,"abstract":"<p><strong>Background: </strong>Pain management in palliative care, especially among cancer patients, remains a critical challenge that significantly affects patient quality of life. Virtual Reality (VR) has emerged as a promising non-pharmacological intervention that could revolutionize pain management strategies in this vulnerable population. This systematic review and meta-analysis evaluate the effectiveness of VR interventions, focusing exclusively on randomized controlled trials to provide a comprehensive assessment of VR as a therapeutic tool.</p><p><strong>Methods: </strong>This systematic review and meta-analysis followed the JBI methodology for RCTs. We included English-language randomized controlled trials that evaluated virtual reality (VR) for pain management in adult palliative care cancer patients. Due to COVID-19-related publication delays, our search extended beyond the standard five-year scope. Keywords used included \"Virtual Reality,\" \"Pain Management,\" \"Palliative Care,\" and \"Cancer Patients,\" across databases such as PubMed, Scopus, Web of Science, and PsycINFO. Exclusions covered non-randomized studies and those with methodological flaws. Study selection was conducted using Covidence. Data analysis was performed using STATA V. 17, calculating standardized mean differences (SMDs) for pain measurement scales.</p><p><strong>Results: </strong>The analysis of ten trials demonstrated VR's capability to significantly reduce pain intensity in palliative care. The pooled effect size showed a moderate to large reduction in pain, with enhanced effectiveness observed in longer VR sessions and with interactive content. Despite variability, the consistent findings support VR's potential as a flexible and adaptable approach to pain management.</p><p><strong>Conclusions: </strong>Virtual reality offers a promising alternative for pain management in palliative care, highlighting the necessity for standardized protocols and further research into its long-term effects and economic viability. To gain a deeper understanding of how VR affects patient experiences and outcomes, future research should implement mixed-methods studies that combine quantitative data with qualitative insights. This approach will allow for a more comprehensive evaluation of VR's impact on the quality of life and pain management strategies, ensuring that interventions are tailored to meet the complex needs of palliative care patients STUDY REGISTRATION: The current study registered with the International Prospective Register of Systematic Reviews (PROSPERO) under the registration number [CRD42024512961].</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145015637","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":"Management of dyspnea with high-flow nasal air or fan - a randomized controlled crossover trial.","authors":"Sirpa Leivo-Korpela, Heidi A Rantala, Lauri Lehtimäki, Reetta P Piili, Hannele Hasala, Tarja Korhonen, Juho T Lehto","doi":"10.1016/j.jpainsymman.2025.08.033","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2025.08.033","url":null,"abstract":"<p><strong>Context: </strong>High-flow nasal therapy (HFNT) may relieve severe dyspnea, but its role compared to other treatment options in palliative care remains unclear.</p><p><strong>Objectives: </strong>Assess the effect and feasibility of HFNT with air compared to fan therapy in relieving dyspnea among non-hypoxemic patients with incurable cancer.</p><p><strong>Methods: </strong>This prospective, randomized, controlled, crossover trial compared airflow delivered by HFNT and fan. The duration of both interventions was 30 minutes. Change in dyspnea was measured using a numeric rating scale (NRS) from 0 to 10. The overall benefits and adverse events of the interventions were assessed. (Trial identifier, NCT05257850).</p><p><strong>Results: </strong>Thirty-six patients with dyspnea on NRS ≥3, and oxygen saturation ≥88% were enrolled, and 28 patients completed the trial. The median NRS for dyspnea decreased from 5.0 (IQR 4.0-6.5) to 3.5 (IQR 2.0-5.8, P = 0.001) with HFNT with air and from 5.0 (IQR 4.0-7.0) to 2.5 (IQR 1.0-7.0, P = 0.012) with fan. The median change in dyspnea on NRS was -1.0 (IQR 0.0 - -2.8) for both HFNT with air and fan, with no significant difference between the therapies (P = 0.935). Over half of the patients reported that both therapies relieved their dyspnea and that they adapted well to them.</p><p><strong>Conclusion: </strong>The effect of airflow through HFNT or fan on dyspnea did not differ in non-hypoxemic patients with advanced cancer. Both therapies seemed to give slight relief on dyspnea without significant adverse events. Thus, the choice between HFNT with air or fan should be made according to the patient´s preferences.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008377","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 Voices: Evaluating Stakeholder Engagement in Pediatric Palliative Care Research.","authors":"Camille R Murray, Elizabeth Reisinger Walker, Maura Savage, Khaliah Johnson","doi":"10.1016/j.jpainsymman.2025.08.041","DOIUrl":"10.1016/j.jpainsymman.2025.08.041","url":null,"abstract":"<p><strong>Context: </strong>Black and Native American children in the United States experience disparities in serious illness care and outcomes which are compounded by systemic inequities. These disparities necessitate research approaches that center the voices of racially minoritized families, combat systems of oppression, and promote culturally humble care. Community-based participatory research (CBPR) emphasizes engaging affected communities throughout the research process.</p><p><strong>Objectives: </strong>In this evaluation, we assessed the engagement of a stakeholder advisory board (SAB) convened to guide a study about racism in pediatric serious illness care.</p><p><strong>Methods: </strong>We used a mixed method combined process and outcome evaluation to explore SAB members' perceptions of meaningful participation in meetings and agency in influencing the project's direction. Themes from observation data, Zoom chat logs, and post-meeting surveys were synthesized using triangulation.</p><p><strong>Results: </strong>Three themes emerged: consistent and active engagement, building connection through empathy and humor, and shared purpose and personal commitment. These findings suggest that members' relationships with each other and sense of purpose fueled sustained engagement. Real-time response to improvement suggestions by SAB members fostered trust with the research team and promoted members' understanding of their capacity within the project.</p><p><strong>Conclusion: </strong>The SAB facilitated meaningful contributions toward the larger project from members and provided an emotionally supportive environment where participants could process shared experiences of racism in healthcare. The findings demonstrate the alignment between CBPR and values of palliative care and the value of iterative evaluation in community-engaged pediatric serious illness health equity research.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006265","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":"Nonpharmacological Interventions for Sleep in People With Upper Gastrointestinal Cancer: A Systematic Review and Meta-Analysis.","authors":"Lijun Li, Shuman Wang, Qian Sun, Tracey L Sletten, Joshua F Wiley","doi":"10.1016/j.jpainsymman.2025.08.037","DOIUrl":"10.1016/j.jpainsymman.2025.08.037","url":null,"abstract":"<p><strong>Context: </strong>Sleep problems are common after an upper gastrointestinal (GI) cancer diagnosis. Identifying evidence-based interventions is critical to address sleep problems.</p><p><strong>Objectives: </strong>This review aimed to summarise evidence on the efficacy of nonpharmacological interventions (NPIs) for sleep in individuals with upper GI cancer and to meta-analyse randomised controlled trials (RCTs).</p><p><strong>Method: </strong>Six databases were searched from inception until July 2025. RCTs and quasi-experimental trials were included. The standardized mean difference (SMD) with random-effects model was used to report the pooled treatment effect. Cochrane risk-of-bias tool for RCTs (RoB 2) and GRADE scoring were used to assess the risk of bias and quality of the evidence overall and for each intervention type.</p><p><strong>Results: </strong>Twenty-eight studies were included involving 2693 participants with upper GI cancer. The overall effect size of NPIs was large (SMD = -1.18, 95% CI [-1.62, -0.74], I² = 94%, P < 0.001). NPIs were divided into four types. The effect size of (1) physical activity and rehabilitation interventions (SMD = -0.35, 95 % CI [-0.64, 0.00], I² = 56%, P = 0.05), and (2) nutritional support interventions (SMD = -0.35, 95 % CI [-0.71, 0.02], I² = 57%, P = 0.06) were not statistically significant. However, statistically significant results were observed for other two intervention types: (3) Psychological, information and symptom management interventions (SMD = -1.85, 95 % CI [-2.70, -0.99], I² = 94%, P < 0.001), and (4) sensory-based interventions (SMD = -1.66, 95% CI [-2.60, -0.71], I² = 94%, P < 0.001). Most studies had some concerns or high risk of bias in at least one domain, particularly due to deviations from intended interventions and in measurement of the outcome.</p><p><strong>Conclusions: </strong>Due to heterogeneity and a limited number of trials, it is not possible to make definitive recommendations for the optimal intervention for improving sleep in people with upper GI cancer. Future research should include larger sample sizes, be randomised and include standardised procedures.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145000748","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":"Experiences of Adult Informal Caregivers in Palliative Care Provision for Persons with Advanced Cancer: A Meta-synthesis.","authors":"Emmanuel Kwadwo Anago, Clare McFeely, Jonathan Bayuo, Joseph Ngmenesegre Suglo, Laura Dueck Friesen","doi":"10.1016/j.jpainsymman.2025.08.042","DOIUrl":"10.1016/j.jpainsymman.2025.08.042","url":null,"abstract":"<p><strong>Context: </strong>Cancer diagnoses are increasing in Sub-Saharan Africa. Diagnoses often occur at a late stage in the disease, hampering the timely initiation of palliative care. The lack of formalized palliative care provision in the region results in informal caregivers assuming most of the caregiving roles for patients. This has considerable implications for informal caregivers.</p><p><strong>Objectives: </strong>This meta-synthesis seeks to explore how informal caregivers of persons living with advanced cancer have experienced palliative care provision in Sub-Saharan Africa.</p><p><strong>Methods: </strong>This study was guided by Hannes' framework of meta-synthesis. A systematic search of MEDLINE, EMBASE, PsycInfo, Global Health, CINAHL, Web of Science, Scopus, and the Africa Index Medicus databases was conducted. Two authors independently performed the screening and extraction processes. Thematic synthesis guided the analysis and synthesis.</p><p><strong>Results: </strong>Fifteen studies were retained in the study. The synthesis yielded eight analytical themes: motivations for caregiving, roles of informal caregivers, challenges and barriers of informal caregiving, quality of informal caregiving, burden and price of informal caregiving, coping strategies of informal caregivers, recommendations for improving caregiving, and the paradox of end-of-life preparation and advanced planning.</p><p><strong>Conclusion: </strong>In Sub-Saharan Africa, informal caregivers provide the backbone of palliative care, often without preparation, resources, or formal support. Their roles are shaped by cultural expectations of family duty but constrained by poverty and limited health infrastructure. Strengthening caregiver training and integrating their contributions into developing formal palliative care systems are essential to improve outcomes for patients and families.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145000743","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 End of the Line: The Role of Cardiac Surgery in Palliative Care.","authors":"Hima Bindu Thota, Elizabeth Blizzard, Huzaifa Shakir","doi":"10.1016/j.jpainsymman.2025.08.039","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2025.08.039","url":null,"abstract":"","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145000873","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}