Journal of pain and symptom management最新文献

{"title":"Corrigendum to 'Rapid Relief of Breathlessness with Fast-Acting Opioids and Benzodiazepines: A Systematic Review' [Journal of Pain and Symptom Management 72 (2026) e169-e195].","authors":"André Haubner, Adejoke O Oluyase, Irene J Higginson","doi":"10.1016/j.jpainsymman.2026.09.012","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2026.09.012","url":null,"abstract":"","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111019","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":"Expert Agreement on Palliative Reasoning and Monitoring in Heart Failure: International Delphi Study.","authors":"Jeanine C B De Leeuw, Yvonne M J Goërtz, Roman Rolke, Cosimo Chelazzi, Sigita Glaveckaite, Donata Kurpas, Dorota Stefanicka-Wojtas, Cristina Monforte-Royo, Pier Jaarsma, Catarina Letras, Amitava Banerjee, Carlo Leget, Geert-Jan Geersing, Everlien de Graaf, Hans-Peter Brunner-La Rocca, Daisy J A Janssen","doi":"10.1016/j.jpainsymman.2026.09.034","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2026.09.034","url":null,"abstract":"<p><strong>Context: </strong>Palliative reasoning aims to support the integration of palliative care (PC) into heart failure (HF) management and includes multidimensional monitoring of symptoms, wishes, and needs.</p><p><strong>Objectives: </strong>This study aimed to establish expert agreement on palliative reasoning and the content of a PC monitoring instrument within the European context.</p><p><strong>Methods: </strong>A two-round modified Delphi study complemented by expert panel meetings after each round. Experts in HF and PC from nine European countries rated the relevance and wording of 57 items. Agreement was pre-defined as Individual item Content Validity Index (I-CVI) ≥0.80 on a 5-point Likert scale (score ≥4), with items between I-CVI 0.75-0.80 agreement reformulated by the panel and re-assessed in round two. Items with I-CVI<0.75 on relevance were removed.</p><p><strong>Results: </strong>Round one included 155 participants and round two 121 participants (78.1% retention). Agreement was reached in the first Delphi round on all steps of palliative reasoning (I-CVI range across steps: 0.82-0.95). Across the two Delphi rounds, 25 of the 33 symptoms (76%) achieved agreement on both relevance and formulation (I-CVI range for relevance: 0.81-0.99). Nineteen of the 20 items (95%) addressing wishes and needs reached agreement on both relevance and formulation (I-CVI range for relevance: 0.84-0.97).</p><p><strong>Conclusion: </strong>This Delphi study established expert agreement on the steps of palliative reasoning and the content of a multidimensional monitoring instrument. These findings provide a shared foundation for earlier, more person-centred and coordinated PC, while allowing national adaptations.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111074","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":"Deprescribing Olanzapine After Cancer-Related Symptoms Resolve: Insights From A Two-Case Series.","authors":"Magdelene Doris Amoateng, Eduardo Bruera, Akhila Reddy","doi":"10.1016/j.jpainsymman.2026.09.035","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2026.09.035","url":null,"abstract":"<p><strong>Introduction: </strong>Olanzapine is commonly used in oncology and palliative care to manage chemotherapyinduced nausea and vomiting (CINV), cancer-related anorexia, insomnia, and anxiety. As more patients transition into long-term survivorship, medications started during active treatment may continue well beyond their original purpose. With olanzapine, prolonged exposure can increase the risk of weight gain, dyslipidemia, insulin resistance, and other metabolic complications. Despite its frequent use, clinicians have limited guidance on when and how to deprescribe olanzapine in cancer survivors.</p><p><strong>Case presentation: </strong>We describe two cancer survivors who received long-term olanzapine in a supportive care clinic. The first patient, a woman in her 30s with metastatic neuroendocrine carcinoma of the cervix, had taken olanzapine for nearly two years for insomnia and anxiety. Concerns about obesity, prediabetes, and dyslipidemia led to discontinuation and trials of alternative therapies, along with substantial intentional weight loss. However, persistent insomnia despite multiple alternatives ultimately led to re-initiation of olanzapine after a shared discussion of risks and benefits. The second patient, a woman in her 20's with Hodgkin lymphoma in remission, remained on olanzapine after treatment-related anorexia and insomnia had resolved. She completed a gradual taper without recurrence of symptoms and later showed improvement in her weight trajectory.</p><p><strong>Discussion: </strong>These cases show how nuanced decisions about symptom-directed medications can become during survivorship. Olanzapine may provide meaningful relief during active cancer treatment, but prolonged use can contribute to obesity, dyslipidemia, insulin resistance, and metabolic syndrome. For some patients, deprescribing may reduce long-term metabolic risk without compromising symptom control. For others, ongoing benefit may justify continued or renewed treatment when symptoms remain clinically significant.</p><p><strong>Conclusion: </strong>Olanzapine therapy should be reviewed regularly as patients move beyond active cancer treatment. Decisions to continue, taper, discontinue, or restart therapy should be individualized and should balance current symptom burden, patient priorities, and the potential for long-term metabolic harm.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111103","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":"Pharmacist-Led Telemedicine Follow-Up to Preserve Outpatient Palliative Care Access During a Regional Cancer Center Staffing Shortage: A Brief Quality Improvement Report.","authors":"Caroline Cubbison, Benjamin Kematick, Molly Bacon, Bridget Scullion, Kate Lally","doi":"10.1016/j.jpainsymman.2026.09.028","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2026.09.028","url":null,"abstract":"<p><strong>Background: </strong>Outpatient palliative care availability may decline during staffing disruptions. At our regional cancer center, on-site palliative care availability fell from three clinic days weekly to one during a family leave. We piloted independent follow-up visits by specialty-trained palliative care pharmacists for patients.</p><p><strong>Measures: </strong>Patient and encounter volume, oncologist participation, referral-to-visit time, visit completion, recommendation type, and oncologist acceptance.</p><p><strong>Intervention: </strong>From November 2025 to February 2026, we adapted an existing pharmacist-led palliative telemedicine clinic to another site. Pharmacists performed symptom assessments and titration recommendations, which oncology teams could implement.</p><p><strong>Outcomes: </strong>Mean monthly encounters increased 28% from 29 to 37. Four of six oncologists participated. Twenty-seven of 41 pharmacist visits were completed; median referral-to-visit time was 8.5 days. Opioid titration occurred in 52% of visits, and oncologists accepted 100% of recommendations.</p><p><strong>Conclusions/lessons learned: </strong>Pharmacist-led telemedicine follow-up was feasible, acceptable, and helped preserve palliative care availability during temporary staffing disruption.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111068","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 story of gabapentin and the Taser phenomenon in medicine.","authors":"David Casarett","doi":"10.1016/j.jpainsymman.2026.09.030","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2026.09.030","url":null,"abstract":"","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081076","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 people in serious health-related suffering estimates: Moving beyond multimorbidity toward a comprehensive framework.","authors":"Afsan Bhadelia, Xiaoxiao Jiang Kwete, Tania Pastrana, Héctor Arreola-Ornelas, Jinfeng Ding, Oscar Méndez-Carniado, Lukas Radbruch, William E Rosa, Hongliang Tao, Valentina Vargas Enciso, Felicia Marie Knaul","doi":"10.1016/j.jpainsymman.2026.09.022","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2026.09.022","url":null,"abstract":"","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081036","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":"Impact of a Comprehensive End of Life Admission Order Set On Clinician Self-Rated Care Proficiency.","authors":"Rachel Jalfon, Arshia Madni, Meghan Meadows, Griffin S Collins, Michelle Clayton, Ying Zheng, Yiwang Zhou, Meaghann S Weaver, Jonathan D Burlison, Rebecca Quillivan, Deena R Levine","doi":"10.1016/j.jpainsymman.2026.09.027","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2026.09.027","url":null,"abstract":"<p><strong>Context: </strong>High-quality end-of-life (EOL) care is essential to ensure comfort, dignity, and goal-concordant care. Despite its importance, variability in practice and clinician-reported challenges with preparedness and guidance persist. Electronic health record (EHR) based order sets may standardize EOL care, but their impact across settings is not well defined.</p><p><strong>Objectives: </strong>Assess the impact of a comprehensive order-set on provider proficiency with EOL care.</p><p><strong>Methods: </strong>Clinician perceptions of satisfaction with EOL guidance, preparedness for care delivery, and ease of order process were assessed pre-and post-implementation of an electronic EOL admission order set at St. Jude Children's Research Hospital. Comparison between baseline (T1) and post-implementation (T2) responses used chi-square or Fisher's exact tests and ordinal logistic regression. McNemar's test, Stuart-Maxwell test, and mixed‑effects ordinal logistic regression were utilized for retrospective response analysis.</p><p><strong>Results: </strong>A total of 340 survey responses were analyzed (T1:n=197; T2:n=143). Implementation was associated with significant improvements in satisfaction with EOL guidance among prescribers (including physicians and advanced practice providers) (very satisfied:10.9% → 33.9%, p=0.004) and nurses (7.1% → 19.7%, p=0.028). Nurses reported substantial increases in preparedness (very prepared:14.2% → 53.0%, p<0.001). Prescribers reported greater ease in placing and following EOL orders (OR=2.81; 95% CI:1.82-4.37; p<0.001). Retrospective assessment at T2 demonstrated higher satisfaction after implementation than before (OR=2.39; 95% CI:1.44-3.97; p=0.001). Improvements were consistent across roles and experience levels.</p><p><strong>Conclusions: </strong>Implementation of a standardized EOL admission order set can improve clinician reported satisfaction, perceived preparedness, and workflow efficiency in EOL care processes, which may result in enhanced EOL care delivery.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149061952","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":"GOC Conversations About LVAD Deactivation in Destination Therapy and Bridge-to-Candidacy Decedents.","authors":"Eilann C Santo, Hanna-Riikka Lehto, Yilong Peng, Lauren K O'Shea, Lara Coakley, Anju Nohria, Amanda J Reich, Rachelle E Bernacki","doi":"10.1016/j.jpainsymman.2026.09.024","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2026.09.024","url":null,"abstract":"<p><strong>Context: </strong>Patients implanted with a left ventricular assist device (LVAD) as destination therapy (DT) or bridge-to-candidacy (BTC) have no established path off the device, making eventual deactivation likely. Documentation of goals-of-care (GOC) conversations addressing potential LVAD deactivation remains poorly described.</p><p><strong>Objective: </strong>To characterize the prevalence, timing, and clinical setting of documented GOC conversations addressing potential LVAD deactivation among DT and BTC decedents.</p><p><strong>Methods: </strong>Single-center, retrospective cohort study of DT and BTC LVAD patients who died between July 1, 2015-July 1, 2024 at a tertiary academic center with embedded palliative care. Clinical and death-related variables came from the Interagency Registry for Mechanically Assisted Circulatory Support. GOC conversations addressing potential deactivation were identified through structured electronic health record review using a keyword library.</p><p><strong>Results: </strong>Among 45 decedents, 35 (77.8%) had at least one documented deactivation conversation (79 total). Median time from first conversation to death was 20 days. Median time from implantation to first conversation was 566 days (IQR 52-1,659). Among first conversations, 40% occurred within 7 days of death; only 2 preceded implantation. Most were inpatient (87.3%) and authored by palliative care clinicians (78.5%). Palliative care was involved with 82.2% of patients, yet 10.8% had no documented deactivation conversation and 13.3% died in hospice.</p><p><strong>Conclusions: </strong>Documented GOC conversations addressing potential LVAD deactivation were not universal and typically first occurred near death, despite broad palliative care availability and a median of 566 days on device. Conversations occurred primarily during acute decline, leaving limited opportunity for preparation earlier in the course of support.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149061954","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":"Morphine for End-of-Life Dyspnea: Underuse in the Emergency Department Versus Inpatient Care.","authors":"Asher Taragin, Avigail Bar Tikvah, Meir Frankel","doi":"10.1016/j.jpainsymman.2026.09.026","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2026.09.026","url":null,"abstract":"<p><strong>Background: </strong>Dyspnea is a common and distressing symptom at the end of life, particularly among patients with advanced cancer, heart failure, or chronic lung disease. Although morphine is well established for relieving dyspnea and supported by clinical guidelines, it remains underutilized in the Emergency Department (ED). This study compared morphine administration for dyspnea at the end of life within the same cohort of patients across two settings, the ED and subsequent inpatient care, and examined the clinical determinants of administration in the ED.</p><p><strong>Methods: </strong>A retrospective cohort analysis was conducted on adult patients presenting with dyspnea at the end of life admitted to the ED at Shaare Zedek Medical Center, Israel, between 2023 and 2024, who died during the same hospitalization. Clinical characteristics, morphine administration, and survival outcomes were analyzed.</p><p><strong>Results: </strong>A total of 250 patients were included (mean age 83.2 ± 11.5 years; 51.2% female). Only 15.2% received morphine in the ED, whereas 68% of the same patients received morphine during subsequent hospitalization; the mean time to administration among ED recipients was 5.8 hours. Multivariate logistic regression identified lung cancer (OR = 3.41, p = 0.022), DNR status (OR = 3.17, p = 0.010), and pulse rate on arrival (OR = 1.02, p = 0.008) as significant predictors of ED administration. Morphine administration was not associated with shortened survival: no difference in time to death was observed for ED morphine use (p = 0.165). Observed survival was longer among patients who received morphine during hospitalization (282.20 vs 152.35 hours, p < 0.001); this comparison is subject to immortal time bias, as morphine could be administered at any point after admission, and is not interpreted as a treatment effect. This direction was also preserved in a multivariable Cox model adjusting for respiratory support, age, pulse rate, and blood pressure (HR = 1.51, 95% CI: 1.14-2.02), though that estimate carries the same immortal-time-bias caveat.</p><p><strong>Conclusions: </strong>The same patients who did not receive morphine in the ED frequently received it within hours of admission, indicating that underutilization reflects the setting and structure of emergency care rather than patient characteristics or symptom severity. Lung cancer and DNR status, rather than symptom burden, predicted administration. Morphine administered in the emergency department, where timing is fixed and not subject to immortal time bias, showed no association with time to death, consistent with prior observational literature.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149039533","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":"Impact of Medication-Related Problems in Hospitalized Patients Eligible for Palliative Care: A Prospective Cohort Study.","authors":"Jéssica Gonçalves Rangel, Maria Fernanda Carvalho Ribeiro, Aline Maure, Maria Rita da Silva Vieira, Marília Silveira de Almeida Campos, Rafael Araujo Silva, Ivis Vinicius de Oliveira Martins, Carlos Marcelo de Barros, Fabiana Rossi Varallo, Tiago Marques Dos Reis","doi":"10.1016/j.jpainsymman.2026.09.023","DOIUrl":"10.1016/j.jpainsymman.2026.09.023","url":null,"abstract":"<p><strong>Background: </strong>Hospitalized patients receiving palliative care frequently present multimorbidity and polypharmacy, increasing exposure to adverse drug events (ADEs). Evidence specific to this population, particularly in middle-income countries, remains scarce.</p><p><strong>Methods: </strong>Prospective observational cohort study conducted from January to December 2024 at a regional referral hospital in southern Minas Gerais, Brazil. Adult inpatients with palliative care needs hospitalized for at least 48 hours were included and followed until discharge or death. ADEs were identified through electronic medical record review and semi-structured interviews, then classified by etiology, causality (WHO-UMC), severity, and preventability. Negative binomial regression was used to identify predictors of ADE number; secondary analyses assessed quality of life and potentially inappropriate medications (PIMs).</p><p><strong>Results: </strong>Among 46 patients enrolled (63% male; mean age 70 years, SD 11.1), 47.8% died during hospitalization. The cumulative incidence of in-hospital ADEs was 73.9%. A total of 70 adverse drug reactions (ADRs) were identified, most frequently involving opioids (61.4%). ADRs predominated at admission and among patients who died; medication errors were more frequent at discharge. Severe events were more frequent among patients who died; medication errors were, by definition, classified as potentially preventable. Age (IRR 1.030; 95% CI 1.002-1.060; P = 0.036), time since diagnosis (IRR 1.0004; P = 0.004), and Palliative Prognostic Index (PPI) score (IRR 1.099; P = 0.034) were significant predictors of ADE number. A higher PIM count was associated with worse quality of life (β = 0.386; P = 0.031).</p><p><strong>Conclusions: </strong>Nearly three-quarters of hospitalized patients receiving palliative care experienced at least one ADE, and opioids accounted for the majority of identified ADRs. Structured pharmacovigilance, medication reconciliation, and systematic pharmacotherapy review are warranted to improve medication safety in this setting.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149039525","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}