Journal of pain and symptom management最新文献

{"title":"Quality Matters: Effect of High-Quality Early Palliative Care in Advanced Cancer.","authors":"EunKyo Kang, Su-Jin Koh, Jung Hun Kang, Yu Jung Kim, Seyoung Seo, Jung Hoon Kim, Jaekyung Cheon, Eun Joo Kang, Eun-Kee Song, Eun Mi Nam, Ho-Suk Oh, Hye Jin Choi, Jung Hye Kwon, Woo Kyun Bae, Jeong Eun Lee, Kyung Hae Jung, Young Ho Yun","doi":"10.1016/j.jpainsymman.2025.08.031","DOIUrl":"10.1016/j.jpainsymman.2025.08.031","url":null,"abstract":"<p><strong>Context: </strong>Early palliative care (EPC) is an integral treatment for advanced cancer patients, improving quality of life and symptom management, but the impact of its quality on outcomes is less understood.</p><p><strong>Objectives: </strong>This study aimed to quantify the quality of EPC and analyze its longitudinal association with depression levels, quality of life (QoL), patient survival, and self-management strategies in patients with advanced cancer.</p><p><strong>Methods: </strong>This secondary analysis included 144 advanced cancer patients from a randomized controlled trial in South Korea. Participants were stratified into high-quality (N = 76) and low-quality (N = 68) EPC groups based on Quality Care Questionnaire-Palliative Care scores. Outcomes including QoL (McGill Quality of Life Questionnaire, EORTC QLQ-C15-PAL), depression (PHQ-9), and self-management strategies (SMASH Assessment Tool Short Form) were assessed at baseline, 12, 18, and 24 weeks. Two-year overall survival was analyzed using Kaplan-Meier curves and log-rank tests, while repeated measures used generalized estimating equations and linear mixed-effects models.</p><p><strong>Results: </strong>The high-quality EPC group demonstrated a significantly lower prevalence of depression at 24 weeks (14.7% vs. 39.1%, P = 0.036) and a higher 2-year survival rate (P = 0.006) compared to the low-quality group. Significant improvements were observed in existential and social burden (MQOL) and self-management preparation and implementation strategies (SAT-SF) at 18 and 24 weeks in the high-quality EPC group. Overall QoL measured by EORTC QLQ-C15-PAL showed minimal group differences.</p><p><strong>Conclusion: </strong>The quality of EPC services significantly impacts depression, patient survival, aspects of QoL, and self-management capabilities. These findings emphasize the importance of high-quality EPC beyond mere provision.</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":"145000710","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":"A Decade of Interactive Educational Exchange: Impacting Interprofessional Palliative Care Education.","authors":"Laura J Morrison, Shirley Otis-Green, Julie Bruno, Pamela N Fordham, Elise C Carey","doi":"10.1016/j.jpainsymman.2025.08.001","DOIUrl":"10.1016/j.jpainsymman.2025.08.001","url":null,"abstract":"<p><p>The interprofessional clinical practice model is arguably the most impactful and generative aspect of hospice and palliative care (HPC) clinical practice. This article describes the innovative, shared interprofessional leadership model, andragogical infrastructure, program development, educational impact, and critical lessons from the Interactive Educational Exchange (IEE). In response to a deficit in interprofessional HPC educational opportunities for rapid scholarship dissemination and mentorship, interprofessional leaders from medicine, social work and nursing proposed and implemented the IEE at the Annual Assembly of Hospice and Palliative Care presented by the American Academy of Hospice and Palliative Medicine and Hospice and Palliative Nurses Association from 2010 to 2020. The reported outcome measures for interprofessional scholarship and engagement, session evaluations, and attendance demonstrate why this successful innovation was repeated annually for over a decade pre-COVID. Scholarship dissemination was rapid, with robust community engagement, inclusive of multiple professional disciplines over time. Indeed, the IEE became a step in the career trajectory of many interprofessional HPC clinician-educators during that decade. The highlighted lessons around vision, structure, and community leave us with an IEE model that can be flexibly adapted to other settings. In championing the interprofessional HPC clinical model forward to achieve the highest quality of care for our patients, we recommend prioritizing intentional models to promote and support interprofessional HPC educators in dissemination of scholarship, collaborative mentorship, and community building so all can thrive.</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":"145000761","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":"Health System Intervention to Innovate and Improve Advance Care Planning for Older Adults.","authors":"Katherine Aragon, Brian S Wood, Karen Halpert, Aaron J Miller, Stephanie Turner, Kinsey Brady, Laura C Hanson","doi":"10.1016/j.jpainsymman.2025.08.029","DOIUrl":"10.1016/j.jpainsymman.2025.08.029","url":null,"abstract":"<p><strong>Background: </strong>Advance care planning (ACP) conversations happen infrequently even for patients with serious illness. Because patients are seen across settings, a unified approach to ACP is important in large integrated health systems.</p><p><strong>Measures: </strong>To describe the structural and clinical process changes implemented by a large health system to improve and expand ACP for older adults.</p><p><strong>Intervention: </strong>UNC Health, a large academic public health system, created the ACP Taskforce to develop and implement a plan to document, facilitate, and educate to expand ACP across entities for patients 65 years and older.</p><p><strong>Outcomes: </strong>Between July 2019 to June 2022, the percentage of patients 65 years and older with any ACP documentation increased from 63% to 72.2%. ACP documentation shifted over that time to documenting health care decision makers and completing ACP notes.</p><p><strong>Conclusion/lessons learned: </strong>Aligning ACP across a large health system was facilitated by representation across entities and resulted in improved ACP practices.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144992794","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":"Icarus Along the Exit.","authors":"Christy M Lucas","doi":"10.1016/j.jpainsymman.2025.08.034","DOIUrl":"10.1016/j.jpainsymman.2025.08.034","url":null,"abstract":"","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144992797","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":"Emergency Physicians and Hospice and Palliative Medicine: A Growing Trend in Fellowship Training.","authors":"Alexander Zirulnik, Caroline Meehan, Daniel Markwalter, Jennifer Gabbard, Alyssa Tilly, Paul Zimmerman, Jensy Stafford, Justin Brooten","doi":"10.1016/j.jpainsymman.2025.08.036","DOIUrl":"10.1016/j.jpainsymman.2025.08.036","url":null,"abstract":"<p><strong>Context: </strong>Emergency Medicine (EM) has played a foundational role in Hospice and Palliative Medicine (HPM) since the subspecialty's formal recognition. Yet, little is known about the growth of EM-trained physicians pursuing HPM fellowship.</p><p><strong>Objectives: </strong>To quantify trends in EM applicants and successful fellowship match outcomes to HPM fellowships from 2016 to 2023 and compare them with other primary specialties.</p><p><strong>Methods: </strong>A retrospective analysis of National Resident Matching Program (NRMP) data was conducted for all HPM fellowship applicants from 2016 to 2023. Trends in active applicants, successful match rates, and year-over-year growth were evaluated by specialty.</p><p><strong>Results: </strong>From 2016 to 2023, EM applicants to HPM fellowships increased by 400%, from 11 to 55 applicants, far outpacing overall growth across specialties (89%). Successful EM match rates remained high (average 85.4%), peaking at 92.9% in 2022. EM also showed the fastest growth in matched applicants, with an average annual increase of 27.2%.</p><p><strong>Conclusion: </strong>EM is one of the fastest-growing sources of applicants to HPM fellowships, reflecting rising recognition of palliative care's value in acute care. This trend has important implications for workforce planning, specialty integration, and the future of dual-trained EM-HPM clinicians.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144992752","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":"Research Burden in Pediatric Cancer: A Mixed Methods Study From the PediQUEST Response Trial.","authors":"Erika Tsuchiyose, Deborah Feifer, Alexandra F Merz, Madeline Avery, Ijeoma J Eche-Ugwu, Opeyemi Awofeso, Liliana Orellana, Denise Becker, Chris Feudtner, Jason L Freedman, Tammy I Kang, Abby R Rosenberg, Elisha D Waldman, Christina K Ullrich, Joanne Wolfe, María L Requena, Veronica Dussel","doi":"10.1016/j.jpainsymman.2025.08.032","DOIUrl":"10.1016/j.jpainsymman.2025.08.032","url":null,"abstract":"<p><strong>Context: </strong>Research burden in pediatric advanced cancer is understudied.</p><p><strong>Objectives: </strong>To analyze study burden among parents and children participating in the PediQUEST Response Trial, and explore associated factors, including belonging to historically marginalized (HM) backgrounds or facing economic hardship (EH).</p><p><strong>Methods: </strong>Mixed-methods secondary analysis of data collected for an RCT. Children ≥2 years old with advanced cancer and a parent were enrolled for 18-weeks across five US pediatric cancer centers. Trough thematic analysis, we examined all parents and child (≥8yo) interviews to identify burden sources. We created a six-level \"degree of burden\" variable that integrated qualitative data (burden sources, levels 0-3) and quantitative data (dropout status, levels 4-5). Social disparity was grouped as: neither HM nor EH, either HM or EH, and both. We used ordinal logistic regression to explore burden-disparity associations.</p><p><strong>Results: </strong>Among 154 randomized dyads, 149 had HM/EH data; 102 families completed interviews (102 parents, 44 children). Two burden themes were identified: study-related and daily life stressors. Most parents (62.4%) and children (48.8%) had burden levels 0-3; high levels (4-5) affected about 20% of families. Social disparity levels were 47.7% HM-/EH-, 30.9% HM+ or EH+, and 21.5% HM+/EH+. Parent burden increased with social disparity (HM+ or EH+ vs. HM-/EH-: cumulative OR 2.3, 95%CI 1.1, 5.1; HM+/EH+ vs. HM-/EH- OR 4.9, 95% CI 1.9, 12.2); no associations found for child's burden.</p><p><strong>Conclusion: </strong>Study burden was mostly low to moderate but higher in families endorsing social disparities. Enhanced support strategies may promote diversity in pediatric advanced cancer research.</p><p><strong>Clinicaltrials: </strong>gov NCT03408314.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12439119/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144992783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Case for Collaboration to Optimize Quality.","authors":"Steven Z Pantilat, Arif H Kamal, David C Currow","doi":"10.1016/j.jpainsymman.2025.08.040","DOIUrl":"10.1016/j.jpainsymman.2025.08.040","url":null,"abstract":"","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144992861","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":"Passing By.","authors":"Diana Halloran","doi":"10.1016/j.jpainsymman.2025.08.035","DOIUrl":"10.1016/j.jpainsymman.2025.08.035","url":null,"abstract":"","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144992830","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 Prognostic Notifications on Inpatient Advance Care Planning: A Cluster Randomized Trial.","authors":"Jessica E Ma, Kayla W Kilpatrick, Clemontina A Davenport, Jonathan Walter, Yvonne Acker, Noppon Setji, Maren K Olsen, Mihir Patel, Michael Gao, Matthew Gardner, Jamie Gollon, Mark Sendak, Suresh Balu, David Casarett","doi":"10.1016/j.jpainsymman.2025.08.013","DOIUrl":"10.1016/j.jpainsymman.2025.08.013","url":null,"abstract":"<p><strong>Background: </strong>A poor prognosis is an important trigger for advance care planning (ACP) conversations, but clinicians often overestimate prognosis.</p><p><strong>Objective: </strong>To determine whether ACP note documentation increases by notifying inpatient physicians that a patient is at high risk of mortality.</p><p><strong>Methods: </strong>A pragmatic cluster randomized trial at an academic medical center from September 2021 to December 2022 randomized attending physicians on the inpatient medicine team. An email and page notification was sent to physicians randomized to intervention group for admitted patients at high risk of 30-day and 6-month death based on a machine learning model. The notification recommended to have and document an ACP conversation in the electronic health record (EHR). The primary outcome was documentation of an ACP conversation during hospital admission by the randomized physician. The secondary outcome was ACP note documented by any clinician during the hospital admission. Healthcare utilization outcomes included length of stay and discharge to hospice.</p><p><strong>Results: </strong>Seventy randomized physicians (35 in each group) cared for 314 unique patients (138 control and 176 intervention) at high risk of mortality. Patients of physicians randomized to the intervention group were more likely to have a documented ACP conversation by the randomized physician compared to the control group (34.7% vs. 19.6%; OR 2.04; 95% CI 1.16-3.59). There was no significant change in ACP documentation by any clinician (52.8% intervention vs. 42.8% control group, OR 1.31; 95% CI 0.81-2.13).</p><p><strong>Conclusions: </strong>Machine learning mortality model notifications can motivate physicians to document ACP conversations during a hospitalization.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957801","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":"Global Consensus-Based Essential and Expanded Packages for Palliative Care and Pain Relief for Adults and Children: A Delphi Study.","authors":"Tania Pastrana, Liliana De Lima, Veronica Dussel, Xiaoxiao Jiang Kwete, Julia Downing, Marie Fallon, Liz Grant, Afsan Bhadelia, Lukas Radbruch","doi":"10.1016/j.jpainsymman.2025.08.027","DOIUrl":"10.1016/j.jpainsymman.2025.08.027","url":null,"abstract":"<p><strong>Background: </strong>In 2018, the Lancet Commission on Global Access to Palliative Care and Pain Relief introduced the concept of serious health-related suffering (SHS) to quantify the need for palliative care and proposed an essential package of palliative care and pain relief (PCPR) to address it. However, this package did not account for complex and specialized needs, and its global implementation has been limited.</p><p><strong>Objectives: </strong>We conducted a multistage, modified Delphi study to update and expand the initial Essential Package for children and adults METHODS: Two international panels -adult and pediatric- representing diverse geographical regions and income levels participated in two Delphi rounds. External validation was conducted by global experts in palliative care.</p><p><strong>Results: </strong>Retention rates for the Delphi rounds were 79.5% for adults and 64.0% for children. Consensus was achieved on the updated Essential Packages for both adults and children, with minor modifications. Expanded Packages were developed, including additional medications, equipment, and human resources to address broader needs. The study also revealed persistent inequities in medicine availability, particularly in low- and middle-income countries, and limited awareness of the Lancet Commission's Essential Package among health professionals.</p><p><strong>Conclusion: </strong>These globally validated Essential and Expanded Packages for adults and children offer a practical adaptable framework to guide national health strategies, strengthen palliative care services, and reduce SHS. Their adoption can meaningfully contribute to achieving Universal Health Coverage.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957689","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}