Journal of pain and symptom management最新文献

{"title":"The Power of Preparation: A QI Initiative Implementing Structured Premeetings in a Pediatric CICU.","authors":"Chelsea Heneghan, Deborah J Baker, Chelsea Cotnoir, Christine Gallagher, Katie Moynihan, Meghan M Walsh, Jennifer M Snaman, Elliot Rabinowitz, Rita D'Aoust","doi":"10.1016/j.jpainsymman.2026.09.013","DOIUrl":"10.1016/j.jpainsymman.2026.09.013","url":null,"abstract":"<p><strong>Background: </strong>Family team meetings (FTMs) support communication in pediatric ICUs, yet teams often lack standardized premeeting preparation, limiting effectiveness and consistency.</p><p><strong>Measures: </strong>The project team assessed feasibility (proportion of FTMs using a structured tool), clinician perceived knowledge and attitudes, and clinician and caregiver perceptions of FTM quality, communication, and preparedness.</p><p><strong>Intervention: </strong>The project team implemented a structured premeeting tool with targeted interdisciplinary clinician education in a cardiac ICU.</p><p><strong>Outcomes: </strong>The project team tracked 11 FTMs over 12 weeks. Structured premeeting use increased from 0% to 100% and was sustained across all weeks. Clinician perceived knowledge and attitude scores improved (P < 0.01). Most clinicians rated the tool as useful and appropriate. All surveyed caregivers reported that meetings met their needs.</p><p><strong>Conclusions: </strong>A structured premeeting process was feasible, acceptable, and improved clinician preparedness and perceived FTM quality. Standardizing team preparation may support more consistent, high-quality communication with families of critically ill children.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982886","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":"Clinician Readiness to Respond to Voluntary Assisted Dying Queries in Chronic Heart, Lung and Kidney Disease: Qualitative Analysis.","authors":"Rebecca Disler, Anthony May, Edward Zimbudzi, Emma E B Patterson, Michelle Baird, Venise Hon, Auxillia Madhuvu, Katrina Recoche, Kaori Shimoinaba, Kristen Glenister, Helen Hickson, DorAnne Donesky, Jennifer Philip","doi":"10.1016/j.jpainsymman.2026.09.010","DOIUrl":"10.1016/j.jpainsymman.2026.09.010","url":null,"abstract":"<p><strong>Background: </strong>End-of-life discussions remain under-represented in chronic heart, lung and kidney disease despite significant physical, psychological and existential burden. Voluntary assisted dying (VAD) discussions may represent valuable openings for dialogue about suffering, unmet need and care preferences in populations with limited access to such conversations. However, clinician confidence and preparedness remain low, and influencing factors are underexamined.</p><p><strong>Aims: </strong>Informed by the Theoretical Domains Framework (TDF), this study aimed to explore chronic disease clinicians' views on VAD conversations and strategies to support open, values-based dialogue.</p><p><strong>Methods: </strong>A national anonymous survey of Australian doctors, nurses, and allied health professionals working in lung, heart, and kidney disease was distributed via organizational emails and snowballing. Thematic analysis of free-text responses explored clinicians' perspectives, perceived challenges, and facilitators regarding engagement in VAD discussions.</p><p><strong>Results: </strong>Participants (n = 189; 98% of survey cohort) were predominantly nurses (70%), female (88%), aged ≥40 years, with ≥10 years' experience. Overall, 38% worked across multiple conditions; others in lung, kidney, or heart disease (29%, 23%, 11%, respectively). VAD was raised by patients/family with 56% of participants; however, 44% reported no VAD training. VAD-related conversations were constrained by interrelated influences across five TDF domains: own/community knowledge; perceived professional role and identity; beliefs about consequences; organizational/workplace culture; social influences.</p><p><strong>Conclusion: </strong>VAD conversations are common, but intersecting knowledge, ethical, professional, and systemic influences may lead clinicians to avoid or defer VAD queries. Targeted training and supportive organizational environments are needed to equip clinicians, particularly chronic disease nurses, to foster these moments for broader end-of-life dialogue.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148969414","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":"Integrating Care for Pain and Substance Use Disorders via Interprofessional Case Conferences.","authors":"Aidan Pillard, Madeline Villalba, Brandon Kasberg, Katrina Nickels, Lauren Kelly","doi":"10.1016/j.jpainsymman.2026.09.011","DOIUrl":"10.1016/j.jpainsymman.2026.09.011","url":null,"abstract":"<p><strong>Background: </strong>Patients with pain, serious illness, and co-occurring substance use disorders (SUD), particularly opioid use disorder, experience fragmented, suboptimal care, exacerbating negative health outcomes.</p><p><strong>Objectives: </strong>Interprofessional case conferences (ICCs) can address the complex needs of this patient population by fostering collaborative, coordinated care among clinicians across multiple disciplines. This article examines three innovative ICCs: the Geriatrics, Palliative, Addiction, and Pain Collaborative at the Icahn School of Medicine at Mount Sinai, the Interdisciplinary Pain Conference at the University of Kentucky, and Managing Addiction and Pain in Palliative Interdisciplinary Teams, a national virtual forum.</p><p><strong>Methods: </strong>We synthesize experiences, insights, and survey data from the creation, development, execution, and assessment of three ICCs designed to address systemic care fragmentation and clinician barriers to managing patients with co-occurring SUD, pain, and serious illness.</p><p><strong>Results/conclusions: </strong>Strategies to promote effective ICCs, including garnering institutional support, managing logistical considerations for busy clinicians, and enhancing interdisciplinary collaboration, are reviewed. ICCs directly address clinician discomfort, care fragmentation, and educational gaps, and survey data demonstrate these ICCs foster patient-centered treatment, increase collaboration, and improve clinician confidence in the management of co-occurring pain, serious illness, and SUD.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148969356","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":"Polypharmacy and Deprescribing Patterns in an Australian Palliative Care Unit: A Cohort Study.","authors":"Bessie Wong, Sam Maleki, Grace Walpole, Yok-Yin Lee, Emily Schembri, Jasmine Moustafa, Kaitlin Boc, Rachel Nakamura, Thu-Anh Luu, Vivek Babu Nooney","doi":"10.1016/j.jpainsymman.2026.09.009","DOIUrl":"10.1016/j.jpainsymman.2026.09.009","url":null,"abstract":"<p><strong>Context: </strong>Polypharmacy is prevalent in palliative care and may increase medication burden, adverse drug events, and clinically significant drug-drug interactions as goals of care shift.</p><p><strong>Objectives: </strong>To identify factors associated with polypharmacy and describe longitudinal medication use and discontinuation patterns in an Australian metropolitan palliative care unit (PCU).</p><p><strong>Methods: </strong>This retrospective cohort study included adults admitted to the PCU in 2023. Medications were assessed at five timepoints: preadmission (T1), admission (T2), day five (T3), final palliative care phase (P1), and discharge/death (T4). Factors associated with polypharmacy were evaluated using multilevel multivariable logistic regression. Medication discontinuation patterns were categorized with reference to OncPal and Hedman et al. criteria.</p><p><strong>Results: </strong>Among 386 patients, median age was 78 years (interquartile range 69-87). Polypharmacy was associated with admission for symptom management (adjusted Odds ratio [aOR] 4.07; 95% confidence interval [CI] 2.51-6.59) and endocrine comorbidity (aOR 1.73; 95% CI 1.10-2.72), while terminal phase (aOR 0.06; 95% CI 0.03-0.11) and age ≥80 years (aOR 0.34; 95% CI 0.18-0.66) were associated with lower odds. Preventive medications were frequently discontinued. Medications for which tapering is generally recommended, including proton pump inhibitors, beta-blockers, and antidepressants, were often ceased without an observed preceding dose reduction. Symptom-directed medications increased over time.</p><p><strong>Conclusion: </strong>Polypharmacy was more common among younger patients, those admitted for symptom management, and those with endocrine comorbidity. Medication burden changed throughout admission, with preventive therapies frequently discontinued and symptom-directed therapies maintained or increased. These findings highlight opportunities for medication review and deprescribing throughout the palliative care trajectory.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148955940","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":"Ketamine Analgesia for Refractory Mucositis Pain (KARM): A Prospective, Double-Blind, Randomized, Phase 2 Study of Ketamine for Oral and Pharyngeal Mucositis Pain.","authors":"Khunthong Peechatanan, Tim Edward Power, Jade Hudson, Shu Min Wong, Naomi T Katz, Stefan Musolino, Andrew A Somogyi, Peter Poon","doi":"10.1016/j.jpainsymman.2026.09.003","DOIUrl":"10.1016/j.jpainsymman.2026.09.003","url":null,"abstract":"<p><strong>Context: </strong>Oral and pharyngeal mucositis (OM) pain is often severe, distressing, and effective analgesic management remains challenging, particularly when pain is inadequately controlled with opioids. Ketamine, a potent NMDA-receptor antagonist, has shown promise in open-label studies.</p><p><strong>Objectives: </strong>This study evaluated the efficacy of ketamine versus an active placebo for treatment-related OM pain, alongside examining its pharmacokinetics, adverse effects, and the influence of CYP2B6 polymorphisms.</p><p><strong>Methods: </strong>Adults with OM and an average Brief Pain Inventory pain score ≥ 4/10 were randomized to receive either ketamine plus 5 mg midazolam or an active placebo consisting of midazolam 5 mg to maintain blinding administered as a 24-hour continuous subcutaneous infusion for 3-5 days. Ketamine doses were escalated from 100-300 mg/day. The primary endpoint was average pain severity, and that between-group comparisons were performed using a repeated-measures analysis evaluating the treatment-by-time interaction.</p><p><strong>Results: </strong>Linear mixed method analysis of 16 patients revealed a significant, clinically meaningful pain reduction in 77.8% of the ketamine group compared to 14.3% in the placebo group (P = 0.04). Compared to the placebo, ketamine significantly reduced average pain score (-5.40 vs. -0.72; P < 0.01), worst pain score (-5.82 vs. -1.1; P = 0.027), and verbal rating scale scores over time (-5.12 vs. -0.41; P < 0.01). Post hoc analysis confirmed these findings from Day 1 to 5 relative to baseline. Mean daily opioid requirements were significantly lower in the ketamine group compared to baseline (-1.29 mg vs. +64.63 mg; P = 0.028). Adverse effects were mild and typically psychomimetic, with no between-group differences. CYP2B6 *1 and *6 variants were identified (66.7% and 33.3% allelic frequencies, respectively), but genotypes showed no significant differences in ketamine metabolism, analgesic response, or adverse effects.</p><p><strong>Conclusions: </strong>Low-dose continuous subcutaneous ketamine infusion appears effective and well-tolerated for opioid-refractory moderate to severe OM pain.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148945225","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":"Family Distress Related to Death Rattle and Agonal Breathing: A Nationwide Post-bereavement Survey.","authors":"Sena Yamamoto, Tatsuya Morita, Harue Arao, Hiroyuki Otani, Maho Aoyama, Masanori Mori, Satoru Tsuneto, Mitsunori Miyashita","doi":"10.1016/j.jpainsymman.2026.09.006","DOIUrl":"10.1016/j.jpainsymman.2026.09.006","url":null,"abstract":"<p><strong>Context: </strong>Death rattle and agonal breathing are distressing for most families. Healthcare providers often explain these signs as a part of the natural dying process.</p><p><strong>Objectives: </strong>This study aimed to screen for post-traumatic stress disorder (PTSD) related to death rattle and agonal breathing among bereaved families, and to explore factors associated with positive screening results.</p><p><strong>Methods: </strong>A nationwide, cross-sectional study was conducted using a self-administered questionnaire among bereaved families of patients who died of cancer at 140 palliative care units/inpatient hospices in Japan. PTSD was screened based on reported re-experiencing symptoms using the PTSD 3-Item Brief Screening. The degree of distress caused by death rattle and agonal breathing, whether they had received explanations of these signs, and how they perceived the signs were also assessed.</p><p><strong>Results: </strong>Of the 1068 available responses, 311 and 392 participants recognized death rattle and agonal breathing, respectively. The proportion screened positive was 26.9% for death rattle and 26.0% for agonal breathing among participants who perceived that these signs had been very distressing. Participants with greater distress due to death rattle and agonal breathing were significantly more likely to have PTSD symptoms (odds ratios: 2.07 and 1.89, respectively). The provision of an explanation was significantly associated with greater acceptance of these signs as a part of the natural dying process, but was not a significant variable for screening results.</p><p><strong>Conclusion: </strong>Bereaved family members exposed to death rattle and agonal breathing may have PTSD symptoms. Communication and care strategies to address family distress are needed.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148945217","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 Time Is Now for an Upstream Palliative Approach to Alzheimer's Disease and Related Disorders.","authors":"Brianna Morgan, Abraham A Brody, Jori Fleisher, Joshua Chodosh","doi":"10.1016/j.jpainsymman.2026.09.004","DOIUrl":"10.1016/j.jpainsymman.2026.09.004","url":null,"abstract":"","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148930120","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":"Positive Effect of Methylphenidate for Cancer-Related Cognitive Impairment: A Pilot Randomized Trial.","authors":"Jessica Boivin, Anne Dagnault, Maman Joyce Dogba, Vicky Tessier, Pierre R Gagnon, Aida Eslami, Christophe Grenier, Bruno Gagnon","doi":"10.1016/j.jpainsymman.2026.08.010","DOIUrl":"10.1016/j.jpainsymman.2026.08.010","url":null,"abstract":"<p><strong>Context: </strong>Breast cancer and its treatments can cause cancer-related cognitive impairment (CRCI). Methylphenidate (MPH) may help improve cognitive function.</p><p><strong>Objectives: </strong>We evaluated the feasibility of using MPH to manage cancer-related cognitive impairment in women after breast cancer treatment in a pilot randomized, double-blind, placebo-controlled trial.</p><p><strong>Methods: </strong>Women who completed treatment for breast cancer ≥6 months prior and had documented cognitive dysfunction at trial entry were randomized to MPH or placebo (10 mg/day for 14 days, increased to 20 mg/day for an additional 14 days if tolerated). Patient-reported outcomes, including the Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog) and neuropsychological tests were administered on Days 0 (baseline), 15, and 29.</p><p><strong>Results: </strong>Twenty women (mean age = 50.2) were enrolled and randomized (MPH: n = 9; placebo: n = 11). All completed the study. Most had received chemotherapy (80%) in addition to surgery and radiotherapy and were taking hormonal therapy during study participation. Self-reported side effects were mild to moderate and transient. A linear mixed-effects model suggested greater improvement in FACT-Cog Perceived Cognitive Impairments scores in the MPH group compared to the placebo group on Day 29 (mean difference = 10.1, P = 0.02). No between-group differences were observed in neuropsychological test scores. MPH did not worsen physical, psychological, or sleep-related symptoms compared to placebo.</p><p><strong>Conclusion: </strong>This pilot study provides preliminary evidence that MPH may have clinically relevant effects on perceived cognitive dysfunction in women after breast cancer treatment and supports evaluation in a larger phase III trial.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794442","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":"Biopsychosocial Antecedents and Symptom Burden Among Children Undergoing Cancer Treatment: A Systematic Review.","authors":"Mays Basha, Rachel Hawn, Alicia Kilfoy, Lindsay Jibb, Kathleen E Montgomery","doi":"10.1016/j.jpainsymman.2026.08.020","DOIUrl":"10.1016/j.jpainsymman.2026.08.020","url":null,"abstract":"<p><strong>Context: </strong>Children experience burden from several symptoms during cancer treatment. Despite research describing symptoms, the antecedents associated with symptom burden are not well understood.</p><p><strong>Objectives: </strong>To collate and synthesize knowledge on antecedents of symptom burden among children undergoing cancer treatment.</p><p><strong>Methods: </strong>A multisite team registered a protocol with PROSPERO and conducted a comprehensive search using a variety of search terms for articles that reported a relationship between antecedents and symptom burden in children (<18 years) undergoing cancer treatment. Screening was conducted using Covidence Software, and data were extracted using a REDCap database.</p><p><strong>Results: </strong>After screening and full-text review of 5254 articles, 74 articles were included in the final analysis. Results related to age, gender, disease progression, treatment intensity, and time since diagnosis showed that although nonsignificant instances were more common, the significant findings demonstrated a clear and consistent directionality: older age, female gender, shorter time since diagnosis or treatment, relapse or metastatic disease, and high-intensity treatment were all associated with greater symptom burden. In contrast, some antecedents, such as biomarkers, showed a higher proportion of significant associations, but the directionality of these associations was mixed, indicating heterogeneity across studies. Finally, for race, ethnicity, cancer type, and treatment type, the literature showed mostly nonsignificant findings with inconsistent directional patterns, suggesting limited and variable evidence for these antecedents.</p><p><strong>Conclusion: </strong>Future research should investigate antecedents with consistent significant relationships with symptom burden as potential mechanisms underlying symptom burden and inform intervention development to enable early detection of children at risk for high symptom burden.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919704","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":"Palliative Electroconvulsive Therapy in Serious Illness: A Narrative Review and Conceptual Framework.","authors":"Gregg A Robbins-Welty, Paul Noufi, Morgan Nakatani, Madeline Brown, Ali John Zarrabi, Ann Schwartz","doi":"10.1016/j.jpainsymman.2026.09.005","DOIUrl":"10.1016/j.jpainsymman.2026.09.005","url":null,"abstract":"<p><strong>Context: </strong>Severe depression, catatonia, psychosis, and agitation can become major sources of suffering in serious illness, impairing communication, decision-making, and quality of life (QOL). Although electroconvulsive therapy (ECT) may offer rapid relief of these syndromes, its role as a palliative intervention remains poorly defined.</p><p><strong>Objectives: </strong>To review the literature relevant to palliative electroconvulsive therapy (PECT), clarify how the term has been conceptualized, and examine the clinical contexts in which ECT may serve palliative goals in serious illness care.</p><p><strong>Methods: </strong>We conducted a narrative review of literature relevant to ECT in serious illness and palliative contexts using PubMed and PsycINFO through February 2026. English-language case reports, case series, reviews, and observational studies were screened for relevance. Findings were synthesized using a deductive, theory-driven approach guided by a previously proposed four-domain conceptual framework for PECT.</p><p><strong>Results: </strong>Thirty-four studies met inclusion criteria, consisting primarily of case reports and case series. No randomized controlled trials or standardized PECT protocols were identified. Literature clustered across four overlapping evidence areas: ECT in explicit palliative or end-of-life settings; ECT for psychiatric syndromes complicating serious illness; ECT for severe behavioral and psychological symptoms of dementia; and ECT used with palliative intent in treatment-refractory psychiatric illness. Across contexts, reports described rapid improvement in severe neuropsychiatric symptoms, restoration of communication or decision-making capacity, reduction of behavioral distress, and improved participation in goal-concordant care.</p><p><strong>Conclusion: </strong>PECT is a promising but underutilized intervention in serious illness. Greater conceptual clarity, interdisciplinary collaboration, and structured clinical pathways may help expand appropriate access to PECT.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919701","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}