Journal of pain and symptom management最新文献

{"title":"Evolving Models of Community-Based Pediatric Palliative Care in Eight Countries across Latin America.","authors":"Zulema Garcia Ulloa, Ximena García-Quintero, Yuriko Nakashima-Paniagua, Silvia Rivas, Monica A Gana, Antonella E Torelli, Hazel M Gutiérrez, Juliana Lopera, Wendy Cristhyna Gómez García, Sandra Chacón, Mercedes Bernadá, Michael J McNeil","doi":"10.1016/j.jpainsymman.2025.02.474","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2025.02.474","url":null,"abstract":"<p><strong>Context: </strong>High-quality pediatric palliative care is best achieved through a comprehensive interdisciplinary effort that actively involves the family and engages resources within the community. Community-based palliative care specifically strives to incorporate palliative care into local healthcare systems, adapting the most suitable model of care to each unique context.</p><p><strong>Objectives: </strong>In Latin America (LATAM), there is a paucity of palliative care teams, especially pediatric palliative care teams, working outside the hospital setting and immersed in the community. Thus, it is essential to learn more about the different community-based pediatric palliative care programs in Latin America and understand their successes in providing high quality community palliative care for children in resource-constrained settings METHODS: Eight LATAM leaders from outpatient Pediatric Palliative Care (PPC) programs, invited by St. Jude Global PPC network, participated in the study based on program alignment, operational status, and willingness. While not a systematic assessment, this sample includes benchmark Community-Based Pediatric Palliative Care (CBPPC) programs. Participants completed an online survey covering program characteristics, services, team composition, funding, implementation strategies, barriers and facilitators for success. A descriptive analysis summarized the findings, highlighting the diversity of these programs.</p><p><strong>Results: </strong>We found that the programs offer a range of services provided by an interdisciplinary team, including home-based care, telemedicine, and outpatient care. Additionally, we highlight two hospice facilities dedicated to providing pediatric palliative care. Community-based palliative care programs in Latin America are advancing patient care through community networks and alliances and are offering individualized, high-quality care tailored to the needs of patients and their families.</p><p><strong>Conclusion: </strong>This information is essential to understand how to develop successful community-based palliative care programs for children in other resource-constrained settings around the globe.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586002","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":"Longitudinal Urine Drug Testing Among Patients Receiving Opioids for Cancer Pain.","authors":"Amanda V Gusovsky Chevalier, Julia L Agne, Laura J Rush, Justin Kullgren, Adria Lam, Maureen Saphire, Darian C Rostam, Gennaro Di Tosto, Ann Scheck McAlearney, Sachin S Kale","doi":"10.1016/j.jpainsymman.2025.02.473","DOIUrl":"10.1016/j.jpainsymman.2025.02.473","url":null,"abstract":"<p><strong>Context: </strong>To assess for nonprescribed substance use and adherence to controlled medication treatment, urine drug tests (UDT) are recommended for patients receiving opioids for cancer-related pain management. However, the optimal frequency of UDTs during opioid treatment is unclear.</p><p><strong>Objectives: </strong>To describe initial and subsequent UDT results among patients diagnosed with cancer receiving outpatient palliative care (PC) at a tertiary cancer center.</p><p><strong>Methods: </strong>A single center retrospective study including adult (≥18 years old) patients who established with an outpatient PC clinic at The Ohio State University (OSU) James Cancer Hospital from July 1, 2017 to June 30, 2019. Outcomes examined were two types of unexplained UDT results: 1) time to first presence of nonprescribed substance; and 2) time to first absence of prescribed substance. Both outcomes were plotted as a reverse Kaplan-Meier survival curve. Substances implicated in unexplained UDT results were summarized.</p><p><strong>Results: </strong>A total of 1,141 patients and 2,459 UDTs were included. Mean patient age was 57 years, and the sample was 51% female and 83% White. Mean UDT per patient was 2.4 (SD = 2.1). 15.1% of patients had an unexplained UDT. Among patients with an unexplained UDT, 45% were detected at baseline UDT. At 24 months, probability of: nonprescribed substance was 19.7% (95% CI [15.4, 24.9]); absence of prescribed substance was 18.6% (95% CI [14.1%, 24.4%]). Cocaine was the most common (18.1%) nonprescribed substance, and oxycodone (52.7%) was the most common absent substance.</p><p><strong>Conclusion: </strong>Unexplained UDT results were captured at varying timepoints throughout PC engagement, supporting the use of baseline and subsequent UDTs to optimize patient safety in cancer symptom management. PC providers should consider continuing to use UDTs as a way to monitor medication adherence throughout PC engagement.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586029","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":"Practice of Palliative Sedation in Patients Followed by a Palliative Home Care Team.","authors":"Sebastiano Mercadante, Laura Tartaglia, Alessio Lo Cascio, Alessandra Casuccio","doi":"10.1016/j.jpainsymman.2025.02.469","DOIUrl":"10.1016/j.jpainsymman.2025.02.469","url":null,"abstract":"<p><strong>Context: </strong>Information about the use of palliative sedation (PS) at home is limited.</p><p><strong>Objectives: </strong>The aim of this study was to assess the frequency, indications, and modalities of PS in patients with incurable disease, including cancer and non cancer patients, followed at home.</p><p><strong>Methods: </strong>A consecutive sample of patients who were admitted to home palliative care was prospectively assessed. From the entire sample, patients who underwent PS were selected. Data regarding indications for PS, drugs and their maximum doses, intent (proportional and deep PS), and duration of PS were collected. The level of satisfaction of doctors and caregivers, evaluated one week after death, was classified in four catagories: satisfied, satisfied, not very satisfied, unsatisfied.</p><p><strong>Results: </strong>Fifty-seven of patients of 176 patients (32%) received PS in the last days of life. The mean duration of PS was 34 h (SD 32). Indications for PS were in a rank order: agitated delirium (n.43, 75.4%), dyspnea (n.9, 15.8%), psychoexistential distress (n.4, 7%), pain (n.1, 1.8%). Proportional and deep sedation were used in 38 (66.6%) and 19 (33,4%) cases, respectively. The most frequent drug used for PS was chlorpromazine at mean doses of 128 mg/day. The mean interval between proposal of PS and effective start of PS was 31(SD 84) hours. In six cases there there was a delay in starting PS, due to resistance on behalf of caregivers. Patients with a cancer diagnosis and a lower Karnofsky status at home care admission were more likely to be sedated (P = 0.009 and P = 0.002, respectively). Physicians were highly satisfied, satisfied, and not very satisfied in 38 (66.7%), 16 (28.1%), and 3 (5.3%) cases, respectively. Similar figures were provided by caregivers, who were highly satisfied, satisfied, and not very satisfied in 36 (63.2%), 14 (24.6%) and 7 (12.3%) of cases, respectively.</p><p><strong>Conclusion: </strong>PS was feasible at home by using an individual treatment. Timing may depend on various factors, including agreement with caregivers, logistics or drug supply. Further research is necessary to compare attitudes regarding PS in countries with different sociocultural profiles and organization models.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542378","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":"Nasogastric Tube Syndrome: A Case Report of otalgia and hoarseness in a Palliative Care Setting.","authors":"Naoki Suzuki","doi":"10.1016/j.jpainsymman.2025.02.470","DOIUrl":"10.1016/j.jpainsymman.2025.02.470","url":null,"abstract":"<p><strong>Background: </strong>Nasogastric tube syndrome (NGTS) is a rare but potentially life-threatening complication of nasogastric tube (NGT) placement. It is characterized by throat pain, hoarseness, and vocal cord paralysis. Awareness is essential for preventing severe airway compromise.</p><p><strong>Case presentation: </strong>A 57-year-old woman with pseudomyxoma peritonei developed NGTS while admitted to a palliative care unit with a prolonged NGT placement for intestinal obstruction. The patient presented with symptoms including throat pain, otalgia, and subsequent hoarseness. Fiberoptic laryngoscopy revealed restricted vocal cord abduction and posterior pharyngeal erythema. Despite the option of removing the NGT, it was retained due to ongoing drainage needs and the absence of respiratory distress. Conservative management, including corticosteroids, antibiotics, and proton pump inhibitors, led to symptom resolution.</p><p><strong>Conclusion: </strong>This case emphasizes the importance of recognizing NGTS, particularly in palliative care settings, and highlights the need for vigilance for atypical symptoms like otalgia. Conservative management may be effective in selected cases, underscoring the importance of individualized care and increased awareness among clinicians.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542416","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":"Optimizing Advance Care Planning in Dementia: Recommendations From a 33-Country Delphi Study.","authors":"Jenny T van der Steen, Lieve Van den Block, Miharu Nakanishi, Karen Harrison Dening, Deborah Parker, Philip Larkin, Paola Di Giulio, Jürgen In der Schmitten, Rebecca L Sudore, Ninoslav Mimica, Iva Holmerova, Sandra Martins Pereira, Ida J Korfage","doi":"10.1016/j.jpainsymman.2025.02.471","DOIUrl":"10.1016/j.jpainsymman.2025.02.471","url":null,"abstract":"<p><strong>Context: </strong>Advance care planning (ACP) is relevant yet challenging with cognitive decline.</p><p><strong>Objective: </strong>To provide evidence and consensus-based clinical recommendations for how to conduct ACP in dementia.</p><p><strong>Methods: </strong>International Delphi study conducted by the European Association for Palliative Care 'ACP in dementia' taskforce with four online surveys (September 2021-June 2022). A panel of 107 experts from 33 countries and seven individuals with dementia contributed. The recommendations specific for dementia were initially based on two earlier Delphi studies and literature searches addressing guidance including the right timing and how to personalize ACP. We used conservative preregistered criteria for consensus.</p><p><strong>Results: </strong>Thirty constitutive elements of ACP were identified (e.g., 'assess understanding of ACP'). Only five were deemed 'optional.' The panel estimated a median of four conversations could address elements to be addressed at least once. Recommendations included to assume capacity as a principle, conscious of the need to explore its fluctuation, to encourage engaging and playing active roles, and to establish connection and inform and prepare family. There was a consensus to offer ACP around dementia diagnosis, to raise end-of-life issues later, and to personalize ACP with flexibility, providing of information and exploring understanding. The advice of the persons with dementia pointed to a wish for a well-coordinated holistic approach.</p><p><strong>Conclusion: </strong>Consensus was reached, including in areas of ambiguity, to guide ACP in dementia. ACP should be embedded in a nonprescriptive, individualized approach that involves both the person with dementia and their families. Future studies may evaluate trade-offs between optimal ACP and feasible implementation.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542377","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":"Attention to Distress Goes With the Territory Response to “Palliative Care Consults for Clinician Distress: Part of the Job?” Schenker, Yael et al. Journal of Pain and Symptom Management, Volume 68, Issue 6, 641 - 646","authors":"Abigail Latimer PhD, MSW, LCSW, APHSW-C ,&nbsp;Vickie Leff LCSW, APHSW-C ,&nbsp;Terry Altilio LCSW, APHSW-C","doi":"10.1016/j.jpainsymman.2025.01.010","DOIUrl":"10.1016/j.jpainsymman.2025.01.010","url":null,"abstract":"","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 4","pages":"Pages e320-e321"},"PeriodicalIF":3.2,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143488181","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":"Harms of Morphine for Chronic Breathlessness in Relation to Dose, Duration and Titration Phase.","authors":"Magnus Ekström, Fatima Alameri, Sungwon Chang, Diana Ferreira, Miriam J Johnson, David C Currow","doi":"10.1016/j.jpainsymman.2025.02.020","DOIUrl":"10.1016/j.jpainsymman.2025.02.020","url":null,"abstract":"<p><strong>Context: </strong>Morphine to treat severe chronic breathlessness might increase adverse events (AEs).</p><p><strong>Objectives: </strong>We aimed to evaluate the risk of AEs in relation to dose, duration and titration phase of regular, low-dose sustained-release (SR) oral morphine for chronic breathlessness in people with chronic obstructive pulmonary disease (COPD).</p><p><strong>Methods: </strong>Secondary analysis of a double-blind, randomized, trial of SR morphine titrated to 0-32 mg/day over three weeks in people with COPD and chronic breathlessness. Risk of AEs by morphine or placebo dose, duration and titration phase (initiation, stable dose or up-titration) was analyzed using multivariable generalized estimating equation (GEE) models.</p><p><strong>Results: </strong>We included 156 people (49% female) of whom 100 (64%) experienced any AE during week 1: 64% of those on 8 mg/morphine/day; 78% on 16 mg/morphine/day; and 48% on placebo. In multivariable analysis, the AE risk was highest the first week of morphine treatment and decreased in week two (adjusted rate ratio [aRR] 0.71; 95% confidence interval (CI) 0.54, 0.94) and week three (aRR 0.49; 95% CI 0.37, 0.67). Over the three weeks, the AE risk was similar between titration phases, and there was no statistically significant trend with higher morphine doses (P-values>0.10). Most AEs did not require treatment discontinuation or dose reduction and resolved by the end of titration.</p><p><strong>Conclusion: </strong>In people with COPD and severe chronic breathlessness, the risk of AEs was highest during the first week of treatment in a dose-related fashion but did not differ by titration phase or by dose of once-daily SR morphine between 8 and 32 mg/day. Trial registration NCT02720822.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523757","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":"Outpatient Palliative Medicine: A Synopsis of Recent Clinically Important Publications.","authors":"Mellar P Davis, Meredith E O'Connor, Ye M Aung","doi":"10.1016/j.jpainsymman.2025.02.018","DOIUrl":"10.1016/j.jpainsymman.2025.02.018","url":null,"abstract":"","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523676","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":"Enabling Inclusive Psychosocial Research Strategies Among African American Parents of Children With Cancer.","authors":"Ijeoma Julie Eche-Ugwu, Terese Aronowitz, Gloria E White-Hammond, Alexandra Merz, Puja J Umaretiya, Karen Bullock, Kimberly S Johnson, Joanne Wolfe, Angela M Feraco","doi":"10.1016/j.jpainsymman.2025.02.015","DOIUrl":"10.1016/j.jpainsymman.2025.02.015","url":null,"abstract":"","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143492280","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":"Explaining Racial and Ethnic Disparities in Advance Care Planning: A Decomposition Analysis.","authors":"Yifan Lou, Emma Zang, Qianqian Li","doi":"10.1016/j.jpainsymman.2025.02.014","DOIUrl":"10.1016/j.jpainsymman.2025.02.014","url":null,"abstract":"<p><strong>Background: </strong>The study quantifies the relative significance of a range of demographic, socioeconomic status (SES), health care service and access, health, and psychological factors in explaining racial and ethnic disparities in advance care planning (ACP).</p><p><strong>Methods: </strong>Our sample included 8416 White, Black, or Hispanic adults aged 65 or older, using the 2020 Health and Retirement Study. We applied Gelbach's decomposition method to understand the relative contribution of 37 factors in explaining White-Black and White-Hispanic disparities in ACP discussion and advance directives (AD) completion.</p><p><strong>Results: </strong>The ACP disparities between White and Hispanic populations were nearly twice as large as the disparity between White and Black populations. Decomposition analyses reveal that the 37 factors collectively explained approximately 65% of the White-Hispanic ACP gaps and 37.5% and 57.1% of the Black-White gaps in ACP discussions and AD completion, respectively. Notably, demographic, SES, and health care service and access factors played substantial roles in these disparities, while health factors did not emerge as significant contributors. Education was the most important contributor across all four tested gaps. Perceptions on how often wishes were respected in healthcare uniquely accounted for 10% of the explained White-Black disparities in ACP discussions. Immigration status and living arrangements were significant contributors to explained White-Hispanic disparities but not to White-Black differences.</p><p><strong>Discussions: </strong>Interventions targeting less educated older Black and Hispanic individuals should be prioritized to narrow the ACP disparity. Negative healthcare experiences in previous care and household dynamics should be addressed while working with Black and Hispanic older adults, respectively.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143483467","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}