Journal of pain and symptom management最新文献

{"title":"Development and Execution of the First Pediatric Palliative Fellowship in Latin America","authors":"Silvia Rivas MD MS, Jaime Guarda First International Pediatric Palliative Care Fellow Guatemala (UNOP Universidad Francisco Marroquin)/USA(St Jude University of Utah), Ximena García-Quintero MD MSc, Leeanna Fox-Irwin MAED, Shirley Montufar BS, Federico Antillón MD PhD, Daniel Moreira MD MEd, Claudia Delgado-Corcoran MD MPH, Courtney Perkins MHA, Julia Evans MOT MBA, Michael McNeil MD MPH, Kathryn Gradick MD MHS","doi":"10.1016/j.jpainsymman.2025.02.049","DOIUrl":"10.1016/j.jpainsymman.2025.02.049","url":null,"abstract":"<div><h3>Outcomes</h3><div>1. Evaluate implications of limited access to pediatric palliative care in low- and middle-income countries.</div><div>2. Apply lessons learned from a novel trilateral partnership to the design and execution of similar global capacity-building training opportunities in other settings.</div></div><div><h3>Key Message</h3><div>Access to specialized training in pediatric palliative care (PPC) is needed in low- and middle-income countries. Leveraging resources from a trilateral international partnership led to the development of a successful, novel PPC fellowship in Latin America.</div></div><div><h3>Abstract</h3><div>Nearly two-thirds of countries lack access to pediatric palliative care (PPC) (1), even though children in low- and middle-income countries experience higher illness-related morbidity and mortality (2). Access to specialized training in PPC is poor in these countries (3), despite accounting for 98% of the global need for PPC (4). No PPC fellowships exist in Latin America, and in one survey nearly all Latin American physicians requested additional training in PPC (5).</div></div><div><h3>Objectives</h3><div>Describe the development and execution of the first ever American Committee on Graduate Medical Education-International (ACGME-I) PPC fellowship in Latin America.</div></div><div><h3>Methods</h3><div>We leveraged resources from a trilateral partnership between Unidad Nacional de Oncología Pediátrica in Guatemala City, Guatemala, St. Jude's Children's Research Hospital in Memphis, Tennessee, and University of Utah in Salt Lake City, Utah, to create a one-year PPC fellowship with rotations at all three sites. Benefits of the multi-site approach included exposure to a spectrum of diagnoses within PPC, including oncologic, cardiac, neurologic, and genetic conditions, across prenatal, outpatient, and inpatient settings, and at various points in the course of illness, including advanced disease presentation in Guatemala. We developed a curriculum based on ACGME-I competencies, including patient care, communication, and research. Recruitment consisted of advertising through Latin American list-servs, global training opportunities, and international conferences.</div></div><div><h3>Results</h3><div>Thirteen applicants were interviewed virtually by representatives from all three sites, with one applicant selected from Hospital Luis Calvo Mackenna (HLCM) in Chile. Our first fellow successfully completed the fellowship from June 2023-June 2024, and has since submitted an original manuscript, broadened access to PPC and expanded symptom management expertise at HLCM. Recruitment for the coming year is ongoing, with plans to ultimately support two fellows annually.</div></div><div><h3>Conclusion</h3><div>Leveraging resources from a trilateral international partnership facilitates the development of a novel PPC fellowship and supports global capacity-building.</div></div><div><h3>References</h3><div>1. Knapp C, Woodworth L","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 5","pages":"Pages e438-e439"},"PeriodicalIF":3.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143807469","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":"What Happens When They Don't Die? A Pediatric IDT Case Series","authors":"Jaime Jump DO, Faith Kinnear APRN CPNP-AC, Rachel Kentor PhD, Virginia Mendoza BSN RN, Jill Ann Jarrell MD MPH FAAP FAAHPM","doi":"10.1016/j.jpainsymman.2025.02.096","DOIUrl":"10.1016/j.jpainsymman.2025.02.096","url":null,"abstract":"<div><h3>Outcomes</h3><div>1. The learners should be able to acknowledge prognostic uncertainty in pediatrics even at end-of-life across the care continuum (outpatient, inpatient and hospice) and employ tools to support patients, families and other members of the care team.</div><div>2. The learner should be able to acknowledge the importance of psychotherapeutic interventions and how to adapt evidence-based interventions based on an evolving clinical picture. It is also important that the learner understands how to support changes across the spectrums of age and neurocognitive and socioemotional development.</div></div><div><h3>Key Message</h3><div>Pediatrics is fraught with prognostic uncertainty not only during the continuum of disease, but also for patients more imminently moving toward end-of life. In a case series approach, we hope to highlight the re-framing of goals of care across the care continuum while introducing a framework for a psychotherapeutic approach to supporting patients, families and other care team members.</div></div><div><h3>Abstract</h3><div>“It's a blessing and it's a curse,” M's mom said. We planned for his death, we checked experiences off the bucket list, but he's still here and we don't know how to live like this, constantly waiting. Pediatrics is a field of prognostic uncertainty and best guesses. As clinicians, we often turn to protocols, projected timelines, and past experiences to guide our best, evidence-based medical management. But as pediatric palliative care (PPC) clinicians, how do we support patients, families, and other team members when a patient's death doesn't follow the timeline we expected? How do we reframe success and failure in terms of advanced care planning techniques and tangible goals, even for ourselves? In this case series, presented by an interdisciplinary team and including parent reflections, we will highlight the role of outpatient and inpatient PPC providers in supporting patients, families, hospices, primary teams, and home nursing in times of uncertain prognosis, uniting competing interests and navigating variable understanding while implementing policies such as concurrent care hospice. We will propose a framework for discussing goals of care and parallel planning when patients don't die, while preserving trust and therapeutic alliance when something as momentous as death was predicted and meticulously prepared for but does not happen. A PPC psychologist will highlight how to support patients across spectrums of neurocognitive and socioemotional development, describing when and how to pivot and adapt evidence-based psychotherapeutic interventions based on an uncertain, evolving clinical picture. Parental challenges with coping and resilience, as related to persistently anticipating their child's death, will also be explored. Ultimately, it is the interdisciplinary approach across the care continuum that can support patients, families, and multi-disciplinary teams to ensure patients ","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 5","pages":"Page e468"},"PeriodicalIF":3.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143807038","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":"Medicare Advantage Contributes to Racial Disparities in Home Health Use Near End-of-life","authors":"Tessa Jones PhD LMSW, Carmen Vargas-Torres MA Economics, R. Sean Morrison MD, Claire Ankuda MD MPH MSc","doi":"10.1016/j.jpainsymman.2025.02.097","DOIUrl":"10.1016/j.jpainsymman.2025.02.097","url":null,"abstract":"<div><h3>Outcomes</h3><div>1. Participants will be able to understand the basic differences between Traditional Medicare and Medicare Advantage.</div><div>2. Participants will be able to describe how MA enrollment impacts home health utilization across racial groups</div></div><div><h3>Key Message</h3><div>Medicare Advantage (MA) enrollment is growing among Black and Hispanic populations however little is known about how MA enrollment impacts HH utilization across racial groups. This study shows that MA creates new disparities in HH utilization with Hispanic older adults disproportionately impacted. Future research must explain the mechanisms of the unexplained differences in HH utilization at the end of life.</div></div><div><h3>Abstract</h3><div>Medicare Advantage (MA) enrollment is growing, particularly among Black and Hispanic populations(1). While racial and ethnic disparities in Home Health (HH) access and outcomes have been documented (2,3), little is known about the impact of MA enrollment on HH utilization across racial groups. This is particularly important given the integral role that HH plays in the care of older adults in the last year of life (4).</div></div><div><h3>Objective</h3><div>To assess the differences in end-of-life HH use and length of stay in TM versus MA across racial and ethnic groups.</div></div><div><h3>Methods</h3><div>Using a 100% Medicare cohort of 2,153,793 2019 decedents (785,585 in MA), we fit a linear probability model predicting HH use and, among HH users, HH length of stay in the last year of life. We measured the average number of days in HH per 100 eligible days (i.e., at home, not in hospice) in the last year of life. We then compared HH use by racial groups in TM vs. MA. All models included county-level fixed-effects and adjusted for individual characteristics and neighborhood-level deprivation.</div></div><div><h3>Results</h3><div>In the last year of life, the use of HH was substantially lower in MA vs. TM for Hispanic decedents (32.8 vs. 41.6%, <em>P</em> < 0.001), as well as Asian/Pacific Islander decedents (31.4 vs. 39.9%, <em>p</em> < 0.001). Among HH users, Hispanic decedents received 30.2 fewer days (<em>p</em> < 0.001), Black decedents 19.9 fewer days (<em>p</em> < 0.001) and Asian/Pacific Islanders 16.2 fewer days (<em>p</em> < 0.05) of HH in MA vs. TM at the EOL. Differences of this magnitude were not seen across other racial/ ethnic groups.</div></div><div><h3>Conclusion</h3><div>Enrollment in MA appears to be widening racial and ethnic disparities in HH utilization at the EOL, particularly for Hispanic older adults. Future research must strive to understand the causes and consequences of these disparities in HH utilization in the MA program.</div></div><div><h3>References</h3><div>(1) Meyers, D. J., Mor, V., Rahman, M., & Trivedi, A. N. (2021). Growth In Medicare Advantage Greatest Among Black And Hispanic Enrollees: Study examines the extent to which growth in Medicare Adv","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 5","pages":"Pages e468-e469"},"PeriodicalIF":3.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143807039","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 Care: Clinical and Program Management","authors":"Christian Sinclair MD, Eric Goodlev MD, Kira Skavinski DO, Esme Finlay MD","doi":"10.1016/j.jpainsymman.2025.02.074","DOIUrl":"10.1016/j.jpainsymman.2025.02.074","url":null,"abstract":"<div><h3>Outcomes</h3><div>1. By participating in workshop didactics and networking, participants will analyze outpatient operational, clinical, leadership and educational strengths and limitations. Participants will be successful by defining 1-2 opportunities for growth/change.</div><div>2. By participating in workshop didactics and networking, participants will develop 2-4 specific action items to enhance clinic operational, clinical, leadership and/or educational growth in the following year.</div></div><div><h3>Abstract</h3><div>This session focuses on starting, sustaining and growing clinic-based outpatient palliative care programs as well as clinical outpatient direct patient care management. Our target audience includes program leaders, physicians, fellows, nurses, nurse practitioners, PAs, social workers, pharmacists, and researchers. Major topics covered: Leadership (starting clinics, growing clinics, partnerships, stakeholders, finding space, managing the clinic team) Education (incorporating fellows, fellow curriculum, non-fellow learners) Clinical (insurance, opioid prescribing, OUD, survivorship, non-cancer populations) Operations (metrics, onboarding, billing, patient panel, clinic structure, interdisciplinary team practice)</div></div><div><h3>References</h3><div>1: Zimmermann C, Buss MK, Rabow MW, Hannon B, Hui D. Should Outpatient Palliative Care Clinics in Cancer Centers be Stand Alone or Embedded? J Pain Symptom Manage. 2023 Feb;65(2):e165-e170. doi: 10.1016/j.jpainsymman.2022.11.008. Epub 2022 Nov 25. PMID: 36437178. 2: DiScala S, Uritsky TJ, Brown ME, Abel SM, Humbert NT, Naidu D. Society of Pain and Palliative Care Pharmacists White Paper on the Role of Opioid Stewardship Pharmacists. J Pain Palliat Care Pharmacother. 2023 Mar;37(1):3-15. doi: 10.1080/15360288.2022.2149670. Epub 2022 Dec 15. PMID: 36519288. 3: Kollas CD, Ruiz K, Laughlin A. Effectiveness of Long-Term Opioid Therapy for Chronic Pain in an Outpatient Palliative Medicine Clinic. J Palliat Med. 2024 Jan;27(1):31-38. doi: 10.1089/jpm.2023.0251. Epub 2023 Aug 8. PMID: 37552851; PMCID: PMC10790545. 4: Shah R, Georgousopoulou EN, Al-Rubaie Z, Sulistio M, Tee H, Melia A, Michael N. Impact of ambulatory palliative care on symptoms and service outcomes in cancer patients: a retrospective cohort study. BMC Palliat Care. 2022 Mar 4;21(1):28. doi: 10.1186/s12904-022-00924-5. PMID: 35241067; PMCID: PMC8896341. 5: Bristol AA, Chaudhry S, Assis D, Wright R, Moriyama D, Harwood K, Brody AA, Charytan DM, Chodosh J, Scherer JS. An Exploratory Qualitative Study of Patient and Caregiver Perspectives of Ambulatory Kidney Palliative Care. Am J Hosp Palliat Care. 2021 Oct;38(10):1242-1249. doi: 10.1177/1049909120986121. Epub 2021 Jan 13. PMID: 33438435; PMCID: PMC8275690. 6: Finlay EE, Goodlev ER, Biewald MA, Skavinski KA, Sinclair CT. An Educational Needs Assessment for Outpatient Palliative Care Clinicians. J Palliat Med. 2023 Apr;26(4):464-471. doi: 10.1089/jpm.2022.0059. Epub 20","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 5","pages":"Pages e456-e457"},"PeriodicalIF":3.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143807050","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":"Pharmacotherapy Considerations for Challenging Symptoms in Serious Illness: The Goldilocks Guide","authors":"Mary Lynn McPherson PharmD PhD FAAHPM,&nbsp;Alexandra L. McPherson PharmD MPH,&nbsp;Eric Widera MD,&nbsp;Jeremy Hirst MD,&nbsp;Maximillian Stevenson PharmD MA BCPS","doi":"10.1016/j.jpainsymman.2025.02.084","DOIUrl":"10.1016/j.jpainsymman.2025.02.084","url":null,"abstract":"<div><h3>Outcomes</h3><div>1. At the conclusion of this presentation the participant will be able to: 1. Describe best practices for symptom management in patients with end-stage renal disease and end-stage liver disease.</div><div>2. Describe best practices for managing symptoms such as malignant bowel obstruction, and terminal secretions. 3. Describe pharmacotherapy strategies to control symptoms. 4. Describe best practices in dosing buprenorphine.</div><div>Patients living with a serious illness frequently rely on medications to palliate their symptoms (pain and non-pain). Drug therapy at this stage of a patient's life is a balancing act – clinicians need to be knowledgeable about when, what, and how to deprescribe, and how to critically select new medications to add to the mix. This pre-conference will cover a variety of topics that will illustrate precision pharmacotherapy – referred to as “The Goldilocks Guide.”</div><div>Topics will include management of challenging non-pain symptoms such as malignant bowel obstruction, nausea/vomiting, terminal secretions, fatigue and more. We will also address symptom management in end-stage renal disease and end-stage liver disease. We will discuss essential techniques of kidney supportive care focusing on several key areas. We will explore various approaches to treating fatigue, constipation, itching/pruritus in renal disease, and nausea, confusion, and ascites in liver disease. We will emphasize the importance of proper selection and dosing for medications such as opioids, gabapentin, and, dare we say, maybe even NSAIDs (in renal disease)! As a special treat, we will discuss a practical real-world approach to managing agitation in the hospice and palliative care patient. This content will focus on the thoughtful use of pharmacology to relieve the highly distressing symptoms of delirium our patients often experience. As if that weren't enough, this presentation will cover the use of buprenorphine for patients receiving palliative or hospice care. This will include candidate selection, and dosing considerations. And as a special treat, each speaker will review two recent and impactful studies on the appropriate use of pharmacotherapy in serious illness.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 5","pages":"Pages e460-e461"},"PeriodicalIF":3.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143807057","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":"Measuring a Patient Reported Outcome: A Pediatric Palliative Care Nationwide QI Collaborative","authors":"Ashley Autrey MD FAAP,&nbsp;Rachel Thienprayoon MD MS,&nbsp;Emma Jones MD","doi":"10.1016/j.jpainsymman.2025.02.090","DOIUrl":"10.1016/j.jpainsymman.2025.02.090","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;1. Describe the importance of patient or patient proxy reported outcomes in palliative care.&lt;/div&gt;&lt;div&gt;2. Articulate methods for collaborative use of a survey tool to standardly assess patient and/or family experience with palliative care services.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Key Message&lt;/h3&gt;&lt;div&gt;Patient reported outcomes are crucial in the field of palliative care. This nationwide quality improvement collaborative project demonstrates the feasibility of standard implementation of assessment and measurement of a patient/patient proxy reported outcome across 15 pediatric palliative care programs.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Abstract&lt;/h3&gt;&lt;div&gt;Introduction: Pediatric palliative care (PPC) aims to enhance the quality of life of children and families facing serious illness. Subsequently, patient reported outcomes (PRO) are crucial; however, development of valid, useful tools for our field has faced several population-specific challenges (1,2). In 2022, the Pediatric Palliative Improvement Network (PPIN) developed a collaborative project to increase the assessment of patient and family experiences with PPC services, including one of the two patient reported palliative care quality measures identified by AAHPM in 2021 (3,4). Objective: By December 31, 2022, our collaborative aimed for: 10 sites contributing data, 50% of eligible PPC patients’ experiences being assessed, and 25% response rate.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;As a PPIN multi-site collaborative, project leaders provided standardized guidance for study processes, accurate timely data gathering, and collaborative learning. Data was collected from January-December 2022. The standardized PPIN family satisfaction survey tool was used as a guide for survey development. All sites included two standardized key indicator questions: 1. “Did you feel heard and understood by the palliative care team?”, a PRO measure identified by AAHPM and 2. “Would you recommend palliative care to another patient/ family?”, inspired by a question in children's hospital surveys (3,5).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Fifteen of 32 enrolled sites (47%) provided at least one cycle of data, averaging 6.5 cycles per site. A total of 2496 eligible patients were identified with 1657 patients and/or families (66%) surveyed about their experiences. 328 participants (20%) responded with a monthly response rate ranging from 9% to 35% collectively across all sites. Most patients and families felt heard and understood (96%) and would recommend palliative care (93%).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;Assessments of patient and family experiences with PPC are feasible and informative. PRO data can help ensure that PPC services are meeting their patients and families’ needs, identifying opportunities for improvement, and demonstrating value to advocate for program growth.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;References&lt;/h3&gt;&lt;div&gt;1. Currow DC, Davidson PM, Higginson IJ. “Outcomes” is not an oxymoron in hospice/palliative care","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 5","pages":"Pages e463-e464"},"PeriodicalIF":3.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143807063","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":"Epic-Fail: ICD Education Through a Patient Portal in Highly Diverse, Safety-net Population","authors":"Jingwen Zhang MD,&nbsp;Melanie Sulistio MD FACC FAHA,&nbsp;Kristin Alvarez PharmD,&nbsp;Sarah Godfrey MD MPH,&nbsp;Nakul Patel BS,&nbsp;Carla Khalaf McStay MD MS","doi":"10.1016/j.jpainsymman.2025.02.030","DOIUrl":"10.1016/j.jpainsymman.2025.02.030","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;1. Participants will be able to evaluate how improving patient knowledge regarding their implantable cardioverter-defibrillator (ICD) impacts their ability to engage with discussions regarding end-of-life preferences and shock status.&lt;/div&gt;&lt;div&gt;2. Participants will be able to analyze common barriers to engaging with portal-based education for diverse populations and outline strategies to overcome and engage despite those barriers.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Key Message&lt;/h3&gt;&lt;div&gt;In a racially and socioeconomically diverse population of outpatients with ICDs that were sent patient-portal based education, few patients independently engaged with the education. However, individualized interventions led to greater rates of engagement in those with barriers to care. Of the patients who completed this education, most reported gaining new insight into ICD function or end-of-life choices.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Abstract&lt;/h3&gt;&lt;div&gt;In patients with implantable cardioverter-defibrillators (ICDs), knowledge deficiencies regarding ICDs reduce their willingness to discuss end-of-life preferences and include racial/gender disparities.(1-3) Patient portals present opportunities for large-scale education, advanced care planning (ACP) and improving health outcomes, but utilization disparities are poorly understood.(4-6)&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;div&gt;We evaluated perceptions of ICDs and end-of-life preferences among a diverse outpatient population after completing video-based education disseminated via patient portal. We evaluated how this group utilized the portal for education.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;An ICD educational video and online survey (English and Spanish) were sent via patient portal to outpatients with both ICDs and activated patient portals at a large, diverse, safety-net system. The study was piloted in 25 patients, with initial instructional phone calls, and later released to the remaining 1,133 patients without instructional calls. Phone surveys about ICD knowledge, attitudes and end-of-life preferences were conducted for those who watched the video.(7) Results The video was distributed to 1,158 patients (45.5% Black, 26.5% Hispanic White, 24.0% non-Hispanic White). Only 22 (2%) completed the online survey (40.9% non-Hispanic White, 36.4% Black, 22.7% Hispanic White). Only 4 (out of 207) Spanish-speakers engaged and required instructional calls. Nineteen (86.4%) patients had never been asked about end-of-life preferences before and 9 (40.9%) were first-time learners that they could deactivate their ICD.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;Despite patient portals allowing for large-scale education, we show engagement was minimal for a diverse population with active accounts. Accounts may have been activated by surrogates with minimal use. Language may be a barrier, requiring more personalized intervention. However, those who engaged demonstrated benefit. Portal-based resources may assist clinicians who face t","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 5","pages":"Pages e424-e425"},"PeriodicalIF":3.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143807143","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":"Collective Bargaining: Tour of East and South Asian Cultural Medical Decision Making","authors":"Rushil Patel MD,&nbsp;Arshia Madni MD,&nbsp;Matthew Kwong MD HMDC,&nbsp;Kim Fong DO,&nbsp;Eriko Onishi MD MCR PhD,&nbsp;Viraj Patel MDiv MPH,&nbsp;Sabina Sandhu MD,&nbsp;Cynthia Pan MD FACP AGSF","doi":"10.1016/j.jpainsymman.2025.02.065","DOIUrl":"10.1016/j.jpainsymman.2025.02.065","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;1. Participants will self-report the ability to identify considerations that shape medical decision-making preferences for East and South Asian families (e.g., roles of patients and families, attitudes towards clinicians, religious/spiritual influences, and community organizations).&lt;/div&gt;&lt;div&gt;2. Participants will apply a framework based on cultural humility while navigating shared decision making with their ESA patients and families.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Key Message&lt;/h3&gt;&lt;div&gt;As Asian American communities grow in the U.S., clinicians will increasingly care for diverse families affected by serious illness, who may not consider patient autonomy as the consummate value. This interdisciplinary panel will use clinical vignettes to model a systematic approach for identifying factors that influence decision-making preferences when caring for East and South Asian families facing serious illness.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Abstract&lt;/h3&gt;&lt;div&gt;The National Institute of Health's Minority Health and Health Disparities Research Framework highlights a key social determinant of health being medical decision-making (MDM) (1). This can be challenging when palliative care clinicians care for patients whose MDM at end-of-life is culturally discordant (2-5). One such patient population is the diverse and fast growing Asian American (AA) population (6). As clinicians support AA families, they may feel unprepared to reconcile families’ cultural preferences for collective MDM with the American healthcare system's orientation towards autonomous MDM (3).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;div&gt;Using a case-based approach, an interdisciplinary panel, consisting of clinicians and caregivers, will use the ABCDE Cultural Assessment Model (7) to equip clinicians in uncovering factors that impact MDM in East and South Asians grappling with serious illness. Factors may include roles of patients and families, attitudes towards clinicians, religious/spiritual considerations, and community resources. This session will help clinicians compare and contrast MDM nuances amongst East and South Asian cultures, ultimately improving clinician-patient interaction skills, enhancing cultural humility, and reducing healthcare disparities.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;Palliative care clinicians will apply an evidence-based model of cultural humility to real-world scenarios of collective MDM, to improve care for Asian families affected by serious illness and reduce healthcare disparities.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;References&lt;/h3&gt;&lt;div&gt;1. Alvidrez J, Castille D, Laude-Sharp M, Rosario A, Tabor D. The National Institute on Minority Health and Health Disparities Research Framework. Am J Public Health. 2019 Jan;109(S1):S16-S20. 2. Madni A. Culturally Responsive Care for Patients With a Serious Illness. Journal of Palliative Medicine 2024 27:5, 699-701 3. Jia Z, Leiter RE, Sanders JJ, et al. Asian American Medicare Beneficiaries Disproportionately Receive Invasive Mechanical Vent","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 5","pages":"Pages e450-e451"},"PeriodicalIF":3.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143807167","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":"Hospice Regulatory Update 2025","authors":"Edward Martin MD MPH","doi":"10.1016/j.jpainsymman.2025.02.071","DOIUrl":"10.1016/j.jpainsymman.2025.02.071","url":null,"abstract":"<div><h3>Outcomes</h3><div>1. Identify the changes proposed for the Hospice Medicare Benefit in pending legislation.</div><div>2. Describe the potential barriers to access to Hospice that could be an unintended consequence of this legislation.</div></div><div><h3>Key Message</h3><div>The past year has seen the development of the first legislation to reform the Hospice Medicare Benefit. This creates enormous opportunity and challenges for Hospice and this presentation will review the details and outline the Academy response to the proposed legislation. The presentation will also address other regulatory developments.</div></div><div><h3>Abstract</h3><div>The past year has seen the development of the first legislation to reform the Hospice Medicare Benefit. This creates enormous opportunity and challenges for hospice. The legislation was developed in response to concerns about fraud in hospice and the goal was to improve Hospice integrity. While this is a laudable goal, as proposed, this legislation could significantly impact access to hospice. Other parts of the proposal seek to provide support for concurrent care and room and board coverage for terminally ill patients who seek to receive hospice services in a long-term care setting as opposed to having to receive skilled care to have that support. in addition to this important legislation the session will also review other developments in the ongoing regulatory burden and scrutiny that Hospices continue to face.</div></div><div><h3>References</h3><div>G:P18HCMSMEDCRWMDHOSPICE-PKGE-MAY_01.XML Draft legislation</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 5","pages":"Page e455"},"PeriodicalIF":3.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143807169","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 View from the Bridge, Determining the Next Step in Cardiac Therapy","authors":"Kehinde Idowu MD,&nbsp;Pamela Gordon MD,&nbsp;Xaviera Barnwell LMSW","doi":"10.1016/j.jpainsymman.2025.02.056","DOIUrl":"10.1016/j.jpainsymman.2025.02.056","url":null,"abstract":"<div><h3>Outcomes</h3><div>1. Participants will be able to provide support to patients in distress from loss of eligibility for advance cardiac therapy.</div><div>2. Participants will be able to collaborate with other specialties in transitioning care towards hospice, and mitigate potential symptoms.</div></div><div><h3>Key Message</h3><div>Palliative care physicians will need to revamp the approach of hospice and palliative care in cardiac failure with recent advancements. Decision to no longer pursue destination therapy while on the bridge, can be distressing for patients, their families and clinicians involved.</div></div><div><h3>Abstract</h3><div>Impella placement for management of cardiogenic shock is rapidly increasing. Impella 5.5 is approved by the FDA (I) for &lt;14 days but too often, patients are on these devices longer as a bridge to destination therapy. Changes in eligibility can lead to distress in patients, families, and caregivers with palliative teams caught in the middle. A 46-year-old male was admitted for cardiogenic shock. He required inotropic support and bridge with Impella. He was unable to wean from Impella or inotrope support. He experienced multiple setbacks that impacted his eligibility for destination therapy. Palliative care was consulted after cardiology determined he was no longer eligible for destination therapy. A family meeting was held and based on his limited options he wanted to continue with Impella and remain a full code. In attempting to fulfill his wishes, cardiology re-evaluated his candidacy again and came to the same conclusion. Palliative care continued to follow and offered support. His updated goal was to get home, 2 hours away from the hospital to see his mother. While cardiology formulated a potential plan for impella removal, palliative care discussed hospice care in multiple meetings with the patient and his family on multiple occasions. Patient and family viewed the palliative care team as “bad news team.” He asked to no longer see the physicians but continued to receive support from social worker. After 11 weeks in the hospital, he was transferred to another local hospital where he had an LAVD placed and since been discharged home. When patients are walking the thin line of eligibility for a potentially lifesaving intervention, for some the path can be challenging emotionally and mentally especially when eligibility can change from a day-to-day basis. Palliative care teams could find themselves as the face of a worst option.</div></div><div><h3>References</h3><div>(I)Improved clinical outcomes associated with the Impella 5.5 compared to the Impella 5.0 in contemporary cardiogenic shock and heart failure patients Ramzy, Danny et al. The Journal of Heart and Lung Transplantation, Volume 42, Issue 5, 553 - 557</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 5","pages":"Pages e443-e444"},"PeriodicalIF":3.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143807239","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}