Journal of pain and symptom management最新文献

{"title":"The Relationship Between ICD Knowledge and Goals of Care in a Diverse Patient Population","authors":"Sarah Godfrey MD, MPH ,&nbsp;Kelley Newcomer MD ,&nbsp;Nicholas Lorusso PhD ,&nbsp;Christopher Viamontes MD ,&nbsp;Brenden Garrett MD ,&nbsp;Nakul Patel BS ,&nbsp;Christine Chen MD ,&nbsp;Kristin S. Alvarez PharmD ,&nbsp;Nainesh Shah MD ,&nbsp;Melanie S. Sulistio MD","doi":"10.1016/j.jpainsymman.2025.08.019","DOIUrl":"10.1016/j.jpainsymman.2025.08.019","url":null,"abstract":"<div><h3>Background</h3><div>Implantable cardioverter defibrillators (ICDs) can be lifesaving, but ICD shocks are also associated with worse quality of life and emotional distress for patients and their families, particularly near the end of life. Shared decision-making regarding deactivation is critical, yet it can be challenging due to limited patient understanding of their devices. Existing ICD educational materials often lack cultural and linguistic inclusivity, contributing to disparities in end-of-life care for Black and Hispanic patients.</div></div><div><h3>Methods</h3><div>Patients with active ICDs at a large, urban safety net hospital completed a pre-survey, then watched a 7- to 9-minute video on the functions and deactivation of ICDs. Afterward, patients were surveyed about their ICD knowledge, preferences regarding four hypothetical end-of-life scenarios, and personal experiences.</div></div><div><h3>Results</h3><div>Of 50 participants, 58% were non-Hispanic Black, 24% non-Hispanic White, and 18% Hispanic White. ICD knowledge improved significantly from 47.4% to 80.8% (<em>P</em> &lt; 0.001). Knowledge improvement was similar for non-Hispanic Black and Hispanic White cohorts but lower for Hispanic White patients (<em>P</em> = 0.0001). Preferences for ICD deactivation changed for 72% of participants with hypothetical scenarios involving “being a caregiving burden” (<em>P</em> = 0.009) and “having no hope of recovery” (<em>P</em> = 0.001) showing the greatest increases in ICD deactivation preference.</div></div><div><h3>Conclusions</h3><div>Educational decision aids specific to a patient population can reduce disparities in ICD knowledge and promote informed decision-making, particularly in underserved populations. Improving patients’ understanding of their devices increased certainty and preference for ICD deactivation in end-of-life scenarios. Despite promising results, persistently lower knowledge in Hispanic White patients signals the need for tailored educational strategies.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"70 5","pages":"Pages 532-540.e4"},"PeriodicalIF":3.5,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958044","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":"Why It Might Be Premature to Establish a Guideline for Cancer-Related Fatigue","authors":"Mellar P. Davis MD, FCCP, FAAHPM","doi":"10.1016/j.jpainsymman.2025.08.028","DOIUrl":"10.1016/j.jpainsymman.2025.08.028","url":null,"abstract":"","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"70 5","pages":"Pages e348-e349"},"PeriodicalIF":3.5,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958089","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":"Unspoken.","authors":"Alexander Lalisan, Kimberly Woodman, Allison Silverstein","doi":"10.1016/j.jpainsymman.2025.08.022","DOIUrl":"10.1016/j.jpainsymman.2025.08.022","url":null,"abstract":"","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958031","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 MyPath Pain Pathway: Developing a Digital Patient-Centred Care Pathway for Cancer Pain.","authors":"Morena Shkodra, Amaia Urrizola, Marie Fallon, Per Sjøgren, Marieke van den Beuken-van Everdingen, Katarina Hagen, Lore Decoster, Daniela Mosoiu, Marianne Jensen Hjermstad, Tonje Lundeby, Stein Kaasa, Augusto Caraceni","doi":"10.1016/j.jpainsymman.2025.08.012","DOIUrl":"10.1016/j.jpainsymman.2025.08.012","url":null,"abstract":"<p><strong>Context: </strong>Cancer pain affects up to 45% of patients, with more than 30% experiencing moderate to severe pain. Despite established guidelines, over 40% of patients receive inadequate pain management, severely impacting their quality of life. While effective pain assessment is essential, a standardized approach is lacking in both research and clinical practice.</p><p><strong>Objectives: </strong>MyPath, a European Union-funded project, aims to implement a patient-centered care (PCC) approach across nine European cancer centers by systematically assessing and managing common symptoms and psychosocial issues to improve PCC for cancer patients. The aim of the present article is to describe the development of the clinical content for the MyPath Pain Care Pathway (PCP), based on patient reported outcomes (PROs) and clinical assessment, designed to offer standardized multidimensional pain management.</p><p><strong>Methods: </strong>Between September 2022 and August 2024, an international, multidisciplinary steering group developed a systematic method for assessing and diagnosing cancer pain using evidence-based guidelines.</p><p><strong>Results: </strong>The MyPath PCP pain assessment includes five key components: pain etiology, location, intensity, flares, and treatment (including relief and dose-limiting side effects), in line with the ICD-11 classification. Data will be gathered through digitalized PROs and clinical consultation in the MyPath's digital solution, which will suggest individualized pain management strategies. The first version of the tool will be implemented in 2025, with further adaptations based on feedback from patients, caregivers, and healthcare professionals.</p><p><strong>Conclusions: </strong>The MyPath PCP represents a digital standardized pain assessment approach to improve the quality of pain management for cancer patients across clinical settings.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958037","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":"Pediatric Imminent Death Donation: Is It Ethical?","authors":"Gabriel Chain, Laura Pucillo, Mindy Dickerman, Richard James, Stephen Dunn, Elissa G Miller","doi":"10.1016/j.jpainsymman.2025.08.020","DOIUrl":"10.1016/j.jpainsymman.2025.08.020","url":null,"abstract":"<p><p>Imminent death donation (IDD) is a form of organ donation that would occur just prior to the withdrawal of life-sustaining technology (WOLST). While IDD may offer a valuable opportunity for organ donation, for example when donation after circulatory death (DCD) is not feasible, it raises significant ethical concerns, particularly in pediatric cases. Living organ donation from minors is performed only under exceptional circumstances, and with specific criteria including age-appropriate assent and a clear benefit to both donor and recipient. Pediatric IDD, therefore, presents even greater ethical complexity. We present the case of a parental request for living related kidney donation from their teenage son who suffered severe anoxic brain injury after a cardiac arrest but did not meet guidelines for death by neurologic criteria. He was ineligible for DCD as he was expected to live for hours to days following WOLST. Clinicians from critical care, transplant surgery, palliative care and our hospital ethics committee offer differing views on how to address this family's request. We present this complex issue, and the viewpoints considered during the care of this patient and his family.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958005","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":"Supportive Care When Substance Use and Cancer Intersect.","authors":"Charmaine S Lastimoso","doi":"10.1016/j.jpainsymman.2025.08.025","DOIUrl":"10.1016/j.jpainsymman.2025.08.025","url":null,"abstract":"","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958011","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":"AI in Palliative Care: A Scoping Review of Foundational Gaps and Future Directions for Responsible Innovation.","authors":"Selen Bozkurt, Soraya Fereydooni, Irem Kar, Catherine Diop Chalmers, Sharon L Leslie, Ravi Pathak, Anne M Walling, Charlotta Lindvall, Karl Lorenz, Ravi Parikh, Tammie Quest, Karleen Giannitrapani, Dio Kavalieratos","doi":"10.1016/j.jpainsymman.2025.08.009","DOIUrl":"10.1016/j.jpainsymman.2025.08.009","url":null,"abstract":"<p><strong>Background: </strong>Artificial intelligenc (AI) holds increasing promise for enhancing palliative care through applications in prognostication, symptom management, and decision support. However, the utilization of real-world data, the rigor of validation, and the transparency and reproducibility of these AI tools remain largely unexamined, posing critical considerations for their safe and ethical integration in sensitive end-of-life settings.</p><p><strong>Objectives: </strong>This scoping review systematically mapped the landscape of AI applications in palliative and hospice care, focusing on three key domains: (1) the purposes and data sources of AI models; (2) the methods and extent of model validation and generalizability; and (3) the degree of transparency and reproducibility.</p><p><strong>Methods: </strong>A comprehensive search was conducted across multiple databases (e.g., PubMed/MEDLINE, Embase.com, IEEE Xplore, Web of Science, ClinicalTrials.gov) from inception to December 31, 2023. Studies of any design applying AI (including machine learning or natural language processing) in palliative or hospice contexts for adults were included. Two independent reviewers screened studies and charted data on study context, patient population, data type, AI methodology, outcome, evaluation approach, and indicators of model generalizability, transparency and reproducibility.</p><p><strong>Results: </strong>From 4,747 unique records, 125 studies met inclusion criteria, with over half published in the last three years, predominantly from the United States. Most studies (86%) were retrospective proof-of-concept designs, with few randomized controlled trials (n = 7) or prospective evaluations (n = 6). AI applications primarily focused on mortality prediction (n = 63) in cancer populations (n = 62), followed by advance care planning (n = 18) and symptom assessment (n = 17). Structured electronic health record data were the most common input (n = 67, 54%). Transparency was limited, with only 19 studies (15%) sharing code and 14 (11%) providing data access; none adhered to AI-specific reporting guidelines. Ethical frameworks for evaluation were notably absent.</p><p><strong>Conclusion: </strong>AI in palliative care remains in early development, showing promise in areas such as prognosis and documentation support. However, limited validation, insufficient cross-site testing, and lack of transparency currently limit clinical applicability. Future research should emphasize external validation, inclusion of broader patient data, and adoption of open science practices to ensure these tools are reliable, safe, and trustworthy.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957688","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 Pediatric Palliative Care: A National Survey of Clinic Structures and Operations","authors":"Ashley Kiefer Autrey MD ,&nbsp;Caroline Stafford MD ,&nbsp;Casie James MD ,&nbsp;Suraj Sarvode Mothi MPH ,&nbsp;Elissa G. Miller MD ,&nbsp;Alexis Morvant MD, MA ,&nbsp;Erica C. Kaye MD, MPH","doi":"10.1016/j.jpainsymman.2025.08.004","DOIUrl":"10.1016/j.jpainsymman.2025.08.004","url":null,"abstract":"<div><h3>Context</h3><div>Inpatient pediatric palliative care (PPC) programs are increasingly expanding into the outpatient setting; however, limited information is available to guide clinic operationalization.</div></div><div><h3>Objectives</h3><div>We asked outpatient PPC (OPPC) clinicians about their clinic structure and operations to support future programmatic growth.</div></div><div><h3>Methods</h3><div>In 2019, national palliative care organizations reported 48 freestanding children’s hospitals with specialty PPC programs. As part of a larger study on OPPC services, a PPC liaison at each hospital was asked to complete an online survey regarding clinic operations and metrics of success.</div></div><div><h3>Results</h3><div>Out of 36 respondents, 28 (78%) reported provision of OPPC in a clinic setting. Most OPPC clinics were located within another subspecialty clinic and managed by PPC (64%) and/or non-PPC subspecialty staff (54%). Respondents reported utilizing various clinic models including floating (62%), freestanding (50%), and/or embedded (39%), with more than half (58%) using more than one model. Fifty percent of PPC clinicians restricted their schedule to specific half day clinics, offering a median of 2.5 half day clinics per week. OPPC clinic schedules typically consisted of two 60-minute initial consultations and one to five 30- to 60-minute follow-up appointments per week. Most respondents self-reported that their OPPC program design and workflow facilitated the provision of high-quality care; however, only half of respondents felt their program design and workflow was successful and promoted team resilience.</div></div><div><h3>Conclusion</h3><div>Hospital-based OPPC clinic operationalization varies significantly across the nation, with many programs utilizing more than one clinic model simultaneously. It remains unclear how various clinic structures and workflow practices influence OPPC program sustainability and success.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"70 5","pages":"Pages 514-522.e2"},"PeriodicalIF":3.5,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957904","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":"PC-FACS August 13, 2025","authors":"","doi":"10.1016/j.jpainsymman.2025.08.008","DOIUrl":"10.1016/j.jpainsymman.2025.08.008","url":null,"abstract":"","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"70 5","pages":"Pages 541-546"},"PeriodicalIF":3.5,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958019","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":"Are we Growing Leaders? Exploring Leadership Training in Hospice and Palliative Medicine Fellowship.","authors":"Lynn A Flint, Greg Wallingford, Paul Tatum, Julie Bruno, Helen Fernandez, Elise C Carey","doi":"10.1016/j.jpainsymman.2025.07.015","DOIUrl":"10.1016/j.jpainsymman.2025.07.015","url":null,"abstract":"<p><strong>Background: </strong>Although leadership competencies are recognized as critical to the practice of hospice and palliative medicine (HPM), the specific leadership content that matters most, and whether that content is taught in fellowships, remain unclear.</p><p><strong>Objectives: </strong>The purpose of this study was to characterize the current state of leadership curricula in HPM fellowships and understand which leadership topics fellowship program directors (PDs) consider to be most important to include in a leadership curriculum for fellows.</p><p><strong>Methods: </strong>A needs assessment survey was sent to 194 individuals identified as PDs by the American Academy of Hospice and Palliative Medicine (AAHPM). Descriptive statistics were used for analysis.</p><p><strong>Results: </strong>Most respondents reported that leadership topics are important for fellows to learn. Six topic areas related to communication and self-management were rated as having great need or were included in existing curricula by more than 60% of respondents. PDs identified ten topics to be of great need for fellows, all but one of which were included in at least 40% of programs' curricula. Negotiation was the exception being included in only 20% of programs' curricula. The response rate was 20%.</p><p><strong>Conclusion: </strong>Respondents rated leadership topics as important for training, yet many topics are not included in fellowship curricula.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957717","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}