Journal of pain and symptom management最新文献

{"title":"Palliative Care for Severe Cutaneous Adverse Reactions: Gaps, Challenges, and the Way Forward.","authors":"Jonathan Bayuo","doi":"10.1016/j.jpainsymman.2025.01.007","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2025.01.007","url":null,"abstract":"","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007054","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":"Symptom Documentation in Unstructured Palliative Care Notes of Children and Adolescents With Cancer.","authors":"Katherine Bernier Carney, Jacob Wilkes, Tumilara Aderibigbe, Kristin Stegenga, Holly Spraker-Perlman, Lauri A Linder","doi":"10.1016/j.jpainsymman.2025.01.004","DOIUrl":"10.1016/j.jpainsymman.2025.01.004","url":null,"abstract":"<p><strong>Context: </strong>Children and adolescents with cancer experiencing complex symptoms can benefit from subspeciality palliative care. However, standardized methods of symptom documentation by pediatric palliative care teams are lacking. Understanding current approaches to symptom documentation will inform next steps to optimize symptom support.</p><p><strong>Objective: </strong>To explore the documentation of symptom prevalence and characteristics in unstructured clinical notes by pediatric palliative care clinicians caring for children and adolescents with cancer.</p><p><strong>Methods: </strong>We reviewed unstructured clinical notes documented by the pediatric palliative care team for 115 children and adolescents with cancer. Symptom-related data were abstracted and evaluated using content analysis based on the Memorial Symptom Assessment Scale 10-18 instrument items. We also evaluated documentation of severity and distress for six commonly experienced symptoms in pediatric cancer: difficulty sleeping; feelings of sadness; lack of energy; nausea/vomiting; pain; and worry.</p><p><strong>Results: </strong>We identified 1420 symptoms in 662 clinical notes for 106 patients. We identified a median of 5 individual symptoms (IQR = 3-8.5) per patient. Pain was the most frequently documented symptom (n = 79 patients, 74.5%). We identified at least one of the six commonly experienced symptoms in 88 patients (83%). Documentation of the associated severity and distress of these symptoms was inconsistent.</p><p><strong>Conclusion: </strong>Palliative care clinicians routinely documented the co-occurrence of multiple complex symptoms experienced by children and adolescents with cancer. Unstructured progress notes captured evidence of symptom impact on daily life. Clinicians may benefit from a systematic approach to document symptoms in the clinical record which supports symptom identification and communication across clinical teams.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007055","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 Traditional, Complementary, and Integrative Medicine in Pain and Psychological Distress Management for Pediatric Palliative Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"Xingyue Wu, Chun Sing Lam, Yau Shing Chu, Weishang Deng, Carmen Wing Han Chan, Kwok Yin Au, Sze Shun Man, Chi Kong Li, Chenwen Zhong, Leonard Ho, Yin Ting Cheung","doi":"10.1016/j.jpainsymman.2025.01.002","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2025.01.002","url":null,"abstract":"<p><strong>Context: </strong>Traditional, complementary, and integrative medicine (TCIM) is being increasingly used to manage symptoms in patients with palliative needs. However, there is a lack of evidence to guide its use in the pediatric palliative care (PPC) setting.</p><p><strong>Objectives: </strong>This study aimed to synthesize and evaluate the current evidence on the effectiveness of TCIM in reducing pain and psychological distress in PPC.</p><p><strong>Methods: </strong>Four English electronic databases were searched for randomized controlled trials (RCTs) published between January 2000 and August 2023. The standardized mean difference (SMD) was used to report the pooled magnitude of the treatment effect. The Grading of Recommendations Assessment, Development, and Evaluation system was used to assess the quality of the evidence for each treatment outcome.</p><p><strong>Results: </strong>Thirty RCTs were included. The interventions were massage (n = 9), music therapy (n = 6), hypnosis (n = 3), acupuncture, aromatherapy, and other TCIM modalities. Compared with the control interventions, music therapy significantly decreased pain (SMD: -1.07; 95% CI: -1.64 to -0.50; P < 0.05; I² = 72%) and relieved anxiety (SMD: -0.75; 95% CI: -1.35 to -0.15; P < 0.05; I² = 74%); massage significantly decreased pain (SMD: -0.74; 95% CI: -1.46 to -0.02; P < 0.05; I² = 83%) and relieved anxiety (SMD: -0.61; 95% CI: -1.21 to -0.01; P < 0.05; I² = 71%). Hypnosis had significant effects on procedure-related anxiety, pain, and behavioral distress management (P < 0.05). The quality of evidence was rated as \"moderate\" for the efficacy of music therapy in alleviating pain and anxiety and \"low\" for the efficacy of all of the other interventions.</p><p><strong>Conclusions: </strong>Existing evidence supports the therapeutic benefits of music therapy, massage, and hypnosis on relieving pain and anxiety symptoms in the PPC setting, though the evidence is of low-to-moderate quality.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971270","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":"Association of Palliative Care Timing With End-of-Life Quality in Children With Heart Disease.","authors":"Kathryn L Songer, Sarah E Wawrzynski, Lenora M Olson, Mark E Harousseau, Huong D Meeks, Benjamin L Moresco, Claudia Delgado-Corcoran","doi":"10.1016/j.jpainsymman.2025.01.003","DOIUrl":"10.1016/j.jpainsymman.2025.01.003","url":null,"abstract":"<p><strong>Context: </strong>Children with heart disease are at risk for early mortality and parents often perceive suffering at end-of-life (EOL). Involvement of pediatric palliative care (PPC) is a proposed quality measure at the EOL in children with cancer, and early PPC involvement is associated with other quality measures. The impact of early PPC involvement on EOL quality is unknown in children with heart disease.</p><p><strong>Objectives: </strong>Evaluate the association of early PPC on potential EOL quality indicators for children with heart disease.</p><p><strong>Methods: </strong>Children (0-21 years) treated in a cardiac ICU and who died between January 2014 to December 2022 were identified. Details about EOL, including location and mode of death, and EOL quality indicators were extracted manually from the electronic medical record. We compared demographics, EOL characteristics, and EOL quality indicators by receipt and timing of PPC (i.e. ≥30 days from (early) or <30 days of death (late).</p><p><strong>Results: </strong>Of 140 children, 75 (54%) received early PPC and 65 (46%) received late PPC. EOL quality indicators did not vary significantly between groups, with the exception of children with early PPC were less likely to have been intubated in the last 14 days of life compared to those with late PPC (40% vs 63%, P = 0.006).</p><p><strong>Conclusion: </strong>Our findings may indicate that quality indicators extrapolated from pediatric oncology do not apply to children with heart disease, as they have notably different disease trajectories and intervention options. We recommend defining high-quality EOL care indicators for children with heart disease as a priority.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971269","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 Pill in the Diaper\" - Management of Malignant Bowel Obstruction in a Girl at Home.","authors":"Hans-Ulrich Bender, Marije Stewart, Maria Flury, Karin Meier, Eveline Stutz-Grunder, Eva Bergstraesser","doi":"10.1016/j.jpainsymman.2025.01.001","DOIUrl":"10.1016/j.jpainsymman.2025.01.001","url":null,"abstract":"","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971267","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":"Implementation of Ambulatory Kidney Supportive Care in a Safety Net Hospital.","authors":"Jennifer S Scherer, Radhika J Gore, Annette Georgia, Susan E Cohen, Nina Caplin, Olga Zhadanova, Joshua Chodosh, David Charytan, Abraham A Brody","doi":"10.1016/j.jpainsymman.2024.12.025","DOIUrl":"10.1016/j.jpainsymman.2024.12.025","url":null,"abstract":"<p><strong>Context: </strong>Chronic kidney disease (CKD) disproportionately impacts lower socioeconomic groups and is associated with many symptoms and complex decisions. Integration of Kidney Supportive Care (KSC) with CKD care can address these needs. To our knowledge, this approach has not been described in an underserved population.</p><p><strong>Objectives: </strong>We describe our adaptation of an ambulatory integrated KSC and CKD clinic for implementation in a safety net hospital. We report our utilization metrics; characteristics of the population served; and visit activities.</p><p><strong>Methods: </strong>We considered modifications from the perspectives of people with CKD, their providers, and the health system. Modifications were informed by meeting notes with key participants (hospital administrators [n = 5], funders [n = 1], and content experts [n = 2]), as well as literature on palliative care program building, safety net hospitals, and KSC. We extracted utilization data for the first 15 months of the clinic's operations, demographics, clinical characteristics, unmet health related social needs, and symptom burden, measured by the Integrated Palliative Outcome Scale-Renal (total Score, and sub-scores of physical, psychological, and practical impact of CKD) from the electronic health record. Results are reported using descriptive statistics.</p><p><strong>Results: </strong>Adaptions were proactive and done by clinical and administrative leaders. Meetings identified challenges of the safety net setting including people presenting with advanced disease and having several social needs. Modifications to our base model were made in staffing, data collection, and work flow. Show rate was approximately 68%, with a majority of people identifying as Black or Hispanic, and uninsured or on Medicaid. Symptom burden was lower than previous reports, driven by a better psychological sub-score.</p><p><strong>Conclusions: </strong>We describe a feasible ambulatory care model of KSC in a safety net setting that can serve as a framework for the development of other noncancer palliative care ambulatory clinics. Future work will optimize our model.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950492","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":"Preparing Surrogates for Decision-Making: Development and Pilot Testing of Prepare for Their Care.","authors":"Lingsheng Li, Brookelle H Li, Clarissa Ferguson, Jana Powell, Aiesha M Volow, Jasmine Santoyo-Olsson, Heather A Harris, Anne Kinderman, Patricia Levenberg, Judy Long, Alexander Smith, Alexia M Torke, Deborah E Barnes, Rebecca L Sudore","doi":"10.1016/j.jpainsymman.2024.12.026","DOIUrl":"10.1016/j.jpainsymman.2024.12.026","url":null,"abstract":"<p><strong>Context: </strong>Surrogate decision-makers have expressed the need for better preparation around communication and medical decision-making.</p><p><strong>Objectives: </strong>This mixed-methods feasibility study aimed to assess the feasibility and usability of an online program to prepare surrogates for their role.</p><p><strong>Methods: </strong>We developed a 2-part program for surrogates called PREPARE For THEIR Care with a diverse group of Community Advisory Board members and caregivers recruited from the National Patient Advocacy Foundation. We conducted pilot testing of the program with caregivers. Using validated surveys, we assessed the feasibility and usability of the program and measured pre-to-post Advance Care Planning (ACP) Engagement among caregiver participants.</p><p><strong>Results: </strong>Of the 26 pilot participants, mean age was 52 ± 12.7 years; 27% were men, 4% were nonbinary, 27% identified as Asian, 27% Black, 11% Multi-Racial, and 35% White. Participants found the program to be informative, comprehensive, and easy to use. Ease-of-use was rated 9.6 ± 0.92 on a 10-point scale; and, on 5-point scales, comfort using the program was rated 4.8 ± 0.51, helpfulness 4.6 ± 0.65, and likelihood to recommend to others 4.7 ± 0.53. There was improvement comparing pre- and postsurveys in readiness to engage in ACP for others (4.23 ± 0.67) to 4.47 ± 0.73), P = 0.04) and for self (3.55 ± 1.36) to (3.89 ± 1.06), P = 0.02).</p><p><strong>Conclusion: </strong>In this pilot study, the prepare for their care program resulted in high user satisfaction and improved pre-to-post surrogate readiness to engage in ACP. Larger trials are needed to evaluate the impact of the program on surrogate readiness and confidence.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950493","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":"Early Integration of Palliative Care in Non-Oncological Patients: A Systematic Review.","authors":"Joana Rodrigues Mós, Paulo Reis-Pina","doi":"10.1016/j.jpainsymman.2024.12.023","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2024.12.023","url":null,"abstract":"<p><strong>Introduction: </strong>Palliative care (PALC) is traditionally linked to end-of-life cancer care but also benefits advanced non-oncological diseases.</p><p><strong>Objectives: </strong>This systematic review evaluated the impact of early PALC on quality of life (QOL), symptom management, advance care planning (ACP), and healthcare resource utilization (HRU) among non-oncological patients.</p><p><strong>Methods: </strong>PubMed, Web of Science, and Scopus databases were searched for randomized controlled trials and clinical studies published between January 2018 and April 2023. Participants were adult patients with non-oncological diseases exposed to PALC interventions compared to usual care. Outcomes included QOL, symptom management, ACP, and HRU. The risk of bias was assessed using Cochrane tools.</p><p><strong>Results: </strong>Seven studies were included involving 1118 patients. Early PALC positively affects pain interference and fatigue in heart failure (HF) patients and time until first readmission and days alive outside the hospital in end-stage liver disease (ESLD) patients. Benefits were noted in symptom burden for patients with Human Immunodeficiency Virus (HIV), anxiety and depression in stroke patients, and ACP in chronic obstructive pulmonary disease (COPD) and idiopathic pulmonary fibrosis (IPF) patients. However, results for anxiety and depression in HF patients are inconsistent, and no significant differences in QOL were observed in HF, ESLD, IPF, and COPD. The intervention did not improve overall QOL in HIV.</p><p><strong>Conclusions: </strong>The impact of early PALC on health outcomes in non-oncological diseases is inconsistent. Addressing barriers to early PALC integration and conducting further high-quality research are essential for optimizing care pathways and enhancing patient outcomes.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950470","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":"Correlates of Perceived Illness Severity and Terminality in Advanced Lung and Prostate Cancer.","authors":"Michaela Di Palmo, Ekin Secinti, Ellen Krueger, Nasser H Hanna, Nabil Adra, Gregory A Durm, Lawrence Einhorn, Roberto Pili, Shadia I Jalal, Catherine E Mosher","doi":"10.1016/j.jpainsymman.2024.12.024","DOIUrl":"10.1016/j.jpainsymman.2024.12.024","url":null,"abstract":"<p><strong>Context: </strong>While prognostic awareness has been commonly assessed as perceived illness terminality in patients with advanced cancer, both perceptions of illness severity and terminality may be correlated with symptom burden and quality of life.</p><p><strong>Objectives: </strong>The present study examined physical and psychological symptoms, quality of life, and smoking status in relation to perceived illness severity and terminality in patients with advanced, inoperable lung and prostate cancer.</p><p><strong>Methods: </strong>Patients (N=198) were recruited from hospitals in the midwestern U.S. to complete a one-time survey. Prognostic awareness was assessed in the following categories: \"relatively healthy,\" \"seriously ill but not terminally ill,\" or \"seriously and terminally ill.\"</p><p><strong>Results: </strong>Only 12% reported an accurate prognostic awareness (\"seriously and terminally ill\") and 66% perceived themselves as \"relatively healthy.\" Higher levels of anxiety, depressive symptoms, fatigue, and pain and worse quality of life were associated with a higher likelihood of reporting serious illness, irrespective of perceived illness terminality. Smoking status was unrelated to prognostic awareness. For patients with advanced lung cancer, greater breathlessness was associated with a higher likelihood of reporting serious or terminal illness.</p><p><strong>Conclusion: </strong>Our findings suggest that perceiving cancer as serious, not just terminal, is related to symptom burden and quality of life. Results point to the need for interventions to improve prognostic understanding and coping with the disease.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950417","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":"Quality of Virtual vs. In-Person Outpatient Palliative Care: Disparities by Language and Race.","authors":"Sarah Nouri, Steven Z Pantilat, Christine S Ritchie, Courtney R Lyles, Ying Shi, David O'Riordan, John Boscardin, Rebecca L Sudore","doi":"10.1016/j.jpainsymman.2024.12.016","DOIUrl":"10.1016/j.jpainsymman.2024.12.016","url":null,"abstract":"<p><strong>Context: </strong>Virtual visits have increased in outpatient, clinic-based palliative care (OPC). The association between virtual visits and OPC outcomes is largely unknown.</p><p><strong>Objectives: </strong>(1) Examine the association between visit type (virtual vs. in-person) and screening (yes/no) for psychosocial, spiritual, and goals of care needs. (2) Assess effect modification by language.</p><p><strong>Methods: </strong>We used data from the Palliative Care Quality Network (01/2017-03/2021). We conducted multivariable analyses adjusting for age, sex, diagnosis, self-reported race-ethnicity, and language, clustered by site, and included an interaction term to assess effect modification by language.</p><p><strong>Results: </strong>Among 2684 patients, 29% had a virtual visit; 50% were ≥65 years old, 24% non-English preferred languages; 18% identified as Hispanic, 9% Black, 17% Asian, 6% Native Hawaiian/Pacific Islander. There were no differences by visit type in screening for psychosocial (aOR 0.87 vs. in-person visits, 95% CI 0.60-1.25), spiritual (aOR 0.81, 95% CI 0.57-1.15), or goals of care needs (aOR 1.05, 95% CI 0.85-1.31). Patients with non-English preferred languages (vs. English-speaking) had significantly lower odds of screening regardless of visit type. Patients identifying as Black (vs. White) also had significantly lower odds of screening.</p><p><strong>Conclusions: </strong>There were no differences by visit type in screening for psychosocial, spiritual, and goals of care needs. Patients with preferred languages other than English were significantly less likely to be screened than English speakers, though there was no further difference by visit type. Patients identifying as Black were also significantly less likely to be screened. Addressing these disparities in core OPC elements is essential in providing equitable, high-quality OPC.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932180","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}