Journal of pain and symptom management最新文献

{"title":"Should I Die Before Hospice Admission?","authors":"Sebastiano Mercadante MD, Marco Travia RN, Pierangela Scimone SW, Marcella Dabbene RN, Alessio Lo Cascio RN","doi":"10.1016/j.jpainsymman.2025.08.005","DOIUrl":"10.1016/j.jpainsymman.2025.08.005","url":null,"abstract":"","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"70 5","pages":"Pages e346-e347"},"PeriodicalIF":3.5,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859322","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":"35 Years of Palliative Care Progress: What Lies Ahead for Society Engagement?","authors":"Vilma A. Tripodoro MD, PhD ,&nbsp;Marie-Charlotte Bouësseau MD ,&nbsp;Stephen R. Connor PhD ,&nbsp;Carlos Centeno MD, PhD","doi":"10.1016/j.jpainsymman.2025.08.003","DOIUrl":"10.1016/j.jpainsymman.2025.08.003","url":null,"abstract":"<div><h3>Context</h3><div>While modern palliative care began over 50 years ago, its formal recognition by the WHO in 1990 marked a turning point. Since then, palliative care has evolved from a niche service for terminal cancer patients to a global health priority integrated into universal health coverage. Despite notable progress, serious suffering related to health conditions continues to rise, especially in low- and middle-income countries, calling for renewed ethical and strategic commitment.</div></div><div><h3>Objectives</h3><div>To critically review the historical trajectory of palliative care development, compare global frameworks, highlight regional disparities, and propose forward-looking strategies for evaluation and implementation.</div></div><div><h3>Methods</h3><div>This special article presents a narrative synthesis of key policy milestones, conceptual transitions, and global indicators in the development of palliative care. It contrasts two WHO-endorsed public health models: the 2007 “Umbrella” strategy and the 2021 “House” framework, analysing their complementarities and global relevance.</div></div><div><h3>Results</h3><div>Major shifts include broader definitions of palliative care, increased governmental engagement, expanded outcome measures, and stronger emphasis on equity and community involvement. Despite these advances, access remains deeply unequal across and within world regions. Recent initiatives, such as the WHO indicator framework and global commissions, provide renewed tools and ethical imperatives for progress.</div></div><div><h3>Conclusion</h3><div>The future of global palliative care depends on political will, fair allocation of resources, robust monitoring, and meaningful community participation. A renewed public health approach, grounded in compassion, human rights, and local empowerment, is essential to address the projected increase in health-related suffering by 2060 and to ensure that no one is left behind.</div></div><div><h3>Implications for Practice</h3><div>This article supports clinicians, policymakers, and researchers in aligning their practices with emerging global standards, ethical mandates, and community-based innovations to ensure that no one is left behind.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"70 5","pages":"Pages e291-e298"},"PeriodicalIF":3.5,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862291","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":"Career Trajectories After Palliative Care Training: A National E-Survey of Medical Interns in France","authors":"Guillaume Lawton MD ,&nbsp;Laurent Calvel MD, PhD ,&nbsp;Elise Perceau-Chambard MD ,&nbsp;Virginie Guastella MD, PhD ,&nbsp;Guillaume Economos MD, PhD ,&nbsp;Adrien Evin MD, PhD","doi":"10.1016/j.jpainsymman.2025.08.006","DOIUrl":"10.1016/j.jpainsymman.2025.08.006","url":null,"abstract":"<div><h3>Background</h3><div>Palliative care has become a crucial component of healthcare, with an increasing need for specialized training. In France, a new one-year palliative care diploma was introduced in 2019 to disseminate palliative care knowledge across various medical specialties. Offered in the final year of medical residency, the program includes 2 six-month internships in palliative care settings and four national seminars covering topics such as symptom management, ethics, and communication. However, the impact of this training on physicians' career paths remains underexplored.</div></div><div><h3>Aim</h3><div>This study aimed to assess the current practices of physicians trained in palliative care, and how the training influenced their career choices.</div></div><div><h3>Methods</h3><div>A national e-survey was conducted, aimed at all physicians who completed the palliative care training course between 2019 and 2023. Data were collected through a 36-question survey covering training completion and current practices.</div></div><div><h3>Results</h3><div>We contacted 179 physicians. After excluding 40 responses from those who had not completed their diploma, the eligible sample consisted of 139 respondents. Of these, 81 complete responses were obtained, yielding a 58% response rate (81/139). Of these, 52 were currently practicing in specialized palliative care settings. Interestingly, 88.5% of those not practicing directly in palliative care still integrated a palliative dimension into their daily work. The proportion of physicians intending to work exclusively in palliative care tripled after the training course compared to before.</div></div><div><h3>Conclusion</h3><div>This study highlights the significant role of the palliative care training in shaping physicians' career paths and disseminating palliative care practices across medical specialties.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"70 5","pages":"Pages 523-531.e5"},"PeriodicalIF":3.5,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859319","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":"State Decision-Making Approaches in Seriously Ill People With Intellectual/Developmental Disability","authors":"Matthew Castillo MD, MS ,&nbsp;Arlen G. Gaines PhD, MSW ,&nbsp;Caitlyn M. Moore DNP, MS, ACHPN ,&nbsp;Cynthia X. Pan MD","doi":"10.1016/j.jpainsymman.2025.08.007","DOIUrl":"10.1016/j.jpainsymman.2025.08.007","url":null,"abstract":"<div><div>Hospice and palliative care (HAPC) clinicians supporting individuals with intellectual and developmental disabilities (IDD) navigate complex decision-making pathways while promoting autonomy and dignity. Approximately 1%–3% of the global population lives with IDD, and many healthcare professionals feel ill-prepared to meet their unique needs, particularly in serious illness planning. Advance care planning (ACP) for this population is complicated by historical discrimination, ongoing inequities, and inconsistent legal frameworks. Supported decision-making offers a rights-based alternative to surrogate decision-making, preserving individuals' autonomy. This manuscript presents the case of Mr. A, an adult with Down syndrome, to illustrate practical ACP and supported decision-making considerations across Maryland, New York, and Pennsylvania. Each state’s legal requirements for appointing a healthcare agent (HCA), determining capacity, and avoiding guardianship are discussed. Through thoughtful ACP and supported decision-making, Hospice and palliative care (HAPC) clinicians can promote appropriate autonomy for individuals with IDD, fostering inclusive serious illness discussions and ethical practices across diverse legal landscapes.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"70 5","pages":"Pages e337-e342"},"PeriodicalIF":3.5,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859323","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":"Early Supportive and Nutritional Care For Adults With Pancreatic Cancer: A Pilot Study","authors":"Yu Chen Lin PhD, MS ,&nbsp;Kea Turner PhD, MPH, MA ,&nbsp;Sahana Rajasekhara MD ,&nbsp;Dae Won Kim MD ,&nbsp;Tiago Biachi de Castria MD ,&nbsp;Oliver T. Nguyen MSHI ,&nbsp;Emma Hume MPH ,&nbsp;Olivia Sprow MPH ,&nbsp;Christina Santiago MS, RDN ,&nbsp;Jeanine Milano MS, RDN, CSO ,&nbsp;Diane Riccardi MPH, RD, LDN ,&nbsp;Nicole Nardella MS ,&nbsp;Mohammed Al-Jumayli MD ,&nbsp;Jennifer B. Permuth PhD, MS ,&nbsp;Sarah Hoffe MD ,&nbsp;Tim Hembree DO, PhD ,&nbsp;Young-Rock Hong PhD, MPH ,&nbsp;Jessica Y. Islam PhD, MPH ,&nbsp;Amir Alishahi Tabriz MD, PhD, MPH ,&nbsp;Pamela J. Hodul MD","doi":"10.1016/j.jpainsymman.2025.07.032","DOIUrl":"10.1016/j.jpainsymman.2025.07.032","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Context&lt;/h3&gt;&lt;div&gt;Individuals diagnosed with advanced pancreatic cancer face a poor prognosis, heightening the importance of interventions aimed at improving quality of life. Quality of life for individuals with pancreatic cancer is highly influenced by symptom burden and nutritional status. Programs are needed that coordinate palliative and nutrition care for this population.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;div&gt;To address this gap, we conducted a single-arm feasibility trial of Support Through Remote Observation and Nutrition Guidance Plus Supportive Care (STRONG+), a 12-week team-based digital intervention to reduce malnutrition and improve quality of life for individuals with advanced pancreatic cancer.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Participants initiating palliative chemotherapy were referred for early and ongoing dietitian-led nutrition counseling and supportive care visits led by a palliative care specialist during the first three months of chemotherapy. Participants also logged food intake daily and completed patient-reported outcome assessments monthly, data that was shared with the dietitian and palliative care specialist through a web-based dashboard. Feasibility and acceptability outcomes were compared against prespecified benchmarks. Preliminary effectiveness was evaluated based on change in patient outcomes between baseline and last follow-up at 16 weeks using linear and ordered logistic regression models. Outcomes included malnutrition risk assessed using the Patient-Generated Subjective Global Assessment Short Form and health-related quality of life measured using the FACT-G. Qualitative data obtained through interviews with participants, their caregivers, and clinicians was analyzed for themes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Among the 83 eligible patients who were invited to participate in the study, 50 patients consented to participate. A total of 12 individuals withdrew or died prior to study conclusion. Participants who completed the study (&lt;em&gt;N&lt;/em&gt; = 38) had a mean age of 65. Feasibility benchmarks were achieved for participant recruitment (60% vs. benchmark: 50%), attrition (24% vs. benchmark: 30%), study assessment completion (84% vs. benchmark: 70%), and adherence to nutritional counseling (68% vs. benchmark: 60%) and supportive care visits (61% vs. benchmark: 60%). Participants found the overall intervention to be highly acceptable (94% vs. benchmark: 70%). Caregivers also rated the intervention as highly satisfactory (87%). Compared to baseline, participants saw decreased malnutrition risk (&lt;em&gt;P&lt;/em&gt; &lt; .001) and improved general health-related quality of life (&lt;em&gt;P&lt;/em&gt; = .009) at the end of the study (16 weeks). Participants cited benefits of the intervention including increased knowledge about self-managing nutrition and improved symptom management. Participants provided recommendations for intervention refinement, such as providing recipes and more hands-on nutrition instruction.&lt;/div&gt;&lt;/","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"70 5","pages":"Pages 490-502"},"PeriodicalIF":3.5,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859320","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":"Guided Mindfulness of Death to Reduce Fear of Death in Cancer Patients: Randomized Controlled Study.","authors":"Tan Seng Beng, Leow Yong Wen, Ng Siew Yoong, Noor Elyna Binti Mohd Abdul Latif, Mohamad Iqbal Bin Mohamed Sanaf, Chua Wei Jing, Yong Chen Joyce, Diana Ng Leh Ching, Chai Chee Shee","doi":"10.1016/j.jpainsymman.2025.08.002","DOIUrl":"10.1016/j.jpainsymman.2025.08.002","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to assess the effectiveness of guided mindfulness of death in reducing fear of death in cancer patients.</p><p><strong>Methods: </strong>A parallel-group, nonblinded randomized controlled study was conducted at the University of Malaya Medical Centre, Malaysia, involving 52 cancer patients with moderate to severe fear of death. Participants were randomly assigned to either a mindfulness of death intervention group or a control group. The intervention consisted of four guided mindfulness exercises focusing on death awareness. Primary outcomes were measured using a numerical rating scale for fear of death (NRS) and the Death and Dying Distress Scale (DADDS), with secondary outcomes measured using the Suffering Pictogram.</p><p><strong>Results: </strong>The intervention group experienced a significant reduction in fear of death scores, overall suffering score, and total suffering score, compared to the control group. Feedback from participants indicated that while most found the exercises beneficial, some reported discomfort or conflict with their religious beliefs, particularly in exercises involving body decomposition and near-death visualizations.</p><p><strong>Conclusions: </strong>Mindfulness of death exercises effectively reduce fear of death, distress, and suffering in cancer patients. However, the intervention may not be suitable for all due to cultural and religious factors, underscoring the need for tailored approaches in clinical settings.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859321","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":"Do No Harm.","authors":"Danielle Chammas","doi":"10.1016/j.jpainsymman.2025.07.035","DOIUrl":"10.1016/j.jpainsymman.2025.07.035","url":null,"abstract":"","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144847095","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":"Assessing Perceptions of Positive and Negative Content within Goals of Care Notes","authors":"Gina M. Piscitello MD, MS ,&nbsp;Emiliano Garcia-Fuentes ,&nbsp;Robert M. Arnold MD ,&nbsp;Jane Schell MD, MHS ,&nbsp;Katrina E. Hauschildt PhD, BCPA","doi":"10.1016/j.jpainsymman.2025.07.033","DOIUrl":"10.1016/j.jpainsymman.2025.07.033","url":null,"abstract":"<div><h3>Context</h3><div>Clinician documentation of negative content in electronic health record notes is known to exist.</div></div><div><h3>Objectives</h3><div>To assess community members and clinicians perceptions about negative content within goals of care conversation (GOCC) notes.</div></div><div><h3>Methods</h3><div>We conducted a mixed-methods study of community member and clinician perspectives about positive, neutral, and negative content within GOCC notes written by clinicians across 14 hospitals. We used thematic analysis to identify perceptions of positive and negative content.</div></div><div><h3>Results</h3><div>A total of 12 participants reviewed 65 GOCC notes, 6 community members (50%), and 6 clinicians (50%). Participants were 33% Black, 33% White, 25% Asian, and 17% Hispanic/Latino with median age 33 years (range 22–68). While community members and clinicians shared similar perceptions about positive content within GOCC notes (i.e., kind language, description of patient values, and clear documentation), they differed in their perceptions about negative content within GOCC notes. Community members perceived 1) concerns about patient or family understanding, 2) descriptions of bad patient health, and 3) a lack of empathy as negative content. Clinicians perceived 1) poor writing, 2) lack of important information, and 3) clinician judgmental descriptions about patients and families as negative content.</div></div><div><h3>Conclusion</h3><div>While both community members and clinicians identified negative content within GOCC notes, our findings demonstrate low agreement among these groups about what constitutes negative content within GOCC notes. Our findings may be used to guide clinicians in how best to document GOCC notes read by clinicians, patients, and families.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"70 5","pages":"Pages 503-513.e1"},"PeriodicalIF":3.5,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144847094","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":"First-Ever Global Ranking of Palliative Care: 2025 World Map Under the New WHO Framework","authors":"Vilma A. Tripodoro MD, PhD ,&nbsp;Jesús Fernando López Fidalgo PhD ,&nbsp;Juan José Pons PhD ,&nbsp;Stephen R. Connor PhD ,&nbsp;Eduardo Garralda MA ,&nbsp;Fernanda Bastos MD ,&nbsp;Álvaro Montero MA ,&nbsp;Laura Monzón Llamas MSc ,&nbsp;Ana Cristina Béjar MD ,&nbsp;Daniela Suárez MSc ,&nbsp;Carlos Centeno MD, PhD","doi":"10.1016/j.jpainsymman.2025.07.026","DOIUrl":"10.1016/j.jpainsymman.2025.07.026","url":null,"abstract":"<div><h3>Context</h3><div>Despite progress in policy and advocacy, global palliative care development remains highly uneven, with large segments of the population lacking access to quality services. A new WHO framework has provided an updated methodology for assessing national palliative care systems.</div></div><div><h3>Objectives</h3><div>To assess the current state of palliative care development worldwide using the WHO framework and to produce the first global ranking of countries based on their performance across 14 indicators.</div></div><div><h3>Methods</h3><div>A cross-sectional, mixed-methods study was conducted across 201 countries and territories between 2023 and 2025. Trained national consultants conducted a structured survey based on WHO indicators. Scores were assigned across six domains: policy, essential medicines, service delivery, education, research, and community empowerment. Responses were validated and analyzed to produce a Global Development Score and to classify countries into four development levels: Emerging, Progressing, Established, and Advanced.</div></div><div><h3>Results</h3><div>Of the 201 countries assessed, 40% were classified as Emerging and 28% as Progressing, representing half the global population. Only 14% reached the Advanced level, and 17% were classified as Established. Significant gaps in access to essential medicines and specialized education persist—even in some high-income settings. Despite limited resources Thailand, Uganda,Chile, and Uruguay stand out as regional examples of advanced development.</div></div><div><h3>Conclusion</h3><div>This study presents the first global ranking of palliative care development based on WHO indicators. The results highlight persistent disparities and offer a tool for targeted improvement. The Global Development Score enables countries to benchmark progress, identify gaps, and develop strategic responses to expand access and alleviate serious health-related suffering.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"70 5","pages":"Pages 447-458"},"PeriodicalIF":3.5,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812158","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":"Design and Implementation of a Primary Palliative Care Education Program for Hematology-Oncology Advanced Practice Providers: Insights From a Three-Year Cohort","authors":"Olivia C. West MSN, APRN, AG-ACNP-BC ,&nbsp;Catherine McCarty PA-C, MPH, CAQ-PMHC ,&nbsp;Rajiv Agarwal MD, MSCI ,&nbsp;Mohana Karlekar MD","doi":"10.1016/j.jpainsymman.2025.07.024","DOIUrl":"10.1016/j.jpainsymman.2025.07.024","url":null,"abstract":"<div><h3>Background</h3><div>Palliative care (PC) integration within oncology leads to improved patient-reported outcomes. However, oncology teams are increasingly tasked with providing PC as demand for such services continues to outpace the number of available PC specialists. Additionally, the number of oncologists nationally has remained stable, which has led to greater responsibility for advanced practice providers (APPs), many of whom never received formal PC training. Unfortunately, despite strong advocacy for training within APP programs, PC is not consistently offered.</div></div><div><h3>Purpose</h3><div>Our aim was to create a comprehensive PC certificate course for Hematology/Oncology APPs that was cost neutral with objective learning assessments to ensure all graduates could competently deliver PC.</div></div><div><h3>Interventions</h3><div>Our 12-month curriculum consisted of six didactic lectures, six parallel case studies, and 40 h of experiential clinical time with the inpatient PC service. To achieve certification, participants were required to attend all lectures, complete clinical hours, and pass both a validated clinical communication assessment, the ACP CAT, and a multiple-choice medical knowledge exam.</div></div><div><h3>Results</h3><div>We have successfully graduated three cohorts (<em>n</em> = 18). All participants achieved certification and reported increased confidence in providing primary PC independently.</div></div><div><h3>Conclusion</h3><div>Our PC certificate program for Hematology/Oncology APPs delivers multimodal education through both didactic content and clinical emersion. It additionally leverages a train the trainer model to allow graduates to both competently deliver primary PC and become content experts to teach future participants. While this program was designed for Hematology/Oncology APPs, it can be easily adapted to meet PC needs in other specialties and institutions.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"70 5","pages":"Pages e325-e331"},"PeriodicalIF":3.5,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144799432","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}