Journal of pain and symptom management最新文献

{"title":"Deep Diving into Billing and Coding with the Billing Boys","authors":"Christopher Jones MD MBA CPC FAAHPM,&nbsp;Phil Rodgers MD FAAHPM","doi":"10.1016/j.jpainsymman.2025.02.023","DOIUrl":"10.1016/j.jpainsymman.2025.02.023","url":null,"abstract":"<div><h3>Outcomes</h3><div>1. Describe time-based, complexity-based, and advance care planning billing, including when to use each in the most compliant, revenue-generating way.</div><div>2. Outline a model to utilize new Caregiver Training codes and complexity add-on codes.</div></div><div><h3>Abstract</h3><div>Palliative Care (PC) programs are growing nationally. Once niche services well under the fiscal radar, many PC programs now have 7-figure budgets and a dozen or more clinicians. As programs cost more, sponsoring institutions’ expectations for clinical revenue grow, leaving PC team members working longer hours to see more patients to help close the yawning budgetary gap. Billing rules created in 1995 were rewritten in 2023 and additional significant changes will be coming in 2024 and 2025. Two PC physicians who both represent AAHPM at the AMA's RUC and are responsible for the financial health of their teams will elevate clinicians’ knowledge of billing and clinical revenue changes. The session will open with a very brief reminder of commonly used billing codes – Evaluation and Management, Advance Care Planning, Face-to-Face and Non-Face-to-Face Prolonged Service Codes, Chronic and Complex Chronic Care Management Codes, and Principal Care Management Codes. 2023 updates of Medicare Evaluation and Management guidelines applicable across all settings will be reinforced. Possible changes to Advance Practice Provider Split Share billing and both new Caregiver Training codes and new complexity add-on codes will then be described with tips given to maximize practices’ financial health. Finally, the session will look to the future. Massive changes will occur in telehealth and likely advance care planning on January 1, 2025 as pandemic rules finally expire. Attendees will be provided with up-to-the-moment guidance on anticipated changes so that they can alter their financial projections and practice models to take advantage of these upcoming changes. PC programs’ costs have become more than an organization's financial rounding error. It is critical for all clinicians to understand billing and documentation at a deeper level and this session will help attendees to become comfortable with the many current and future changes.</div></div><div><h3>Reference</h3><div>CPT 2025 Professional Edition. American Medical Association. Chicago, IL. 2025.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 5","pages":"Page e420"},"PeriodicalIF":3.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143807041","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 Hole in the Safety Net: Life-sustaining Treatment for Undocumented Patients","authors":"Eunsong Park MD MPH,&nbsp;Gretchen Bell MD,&nbsp;Elizabeth Silversten MBE CCRN HEC-C,&nbsp;Michael Wiersema MDiv BCC-PCHAC,&nbsp;Paul DeSandre DO FAAHPM,&nbsp;Carina Oltmann LCSW MSSW,&nbsp;Anita Sundaramoorthy MD","doi":"10.1016/j.jpainsymman.2025.02.026","DOIUrl":"10.1016/j.jpainsymman.2025.02.026","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;1. Describe the constraints on the United States healthcare system in provision of long-term acute care to undocumented persons.&lt;/div&gt;&lt;div&gt;2. Recognize the critical role of multidisciplinary collaboration to advocating for optimal care for those whose options for care may be limited.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Key Message&lt;/h3&gt;&lt;div&gt;Life-sustaining treatment is often infeasible for undocumented patients within a fragmented healthcare system constrained by limited resources. Palliative Care is called to the table, not only to clarify goals of care, but also to collaboratively elucidate what is possible and to be present in the distress of what is unresolvable.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Abstract&lt;/h3&gt;&lt;div&gt;As a country, we have not agreed that all persons have a right to healthcare. As a result, healthcare for the vulnerable falls upon a safety net that is a patchwork. This safety net is limited in its ability to provide acute care to undocumented persons (1). We present such a case, focusing on the multidisciplinary collaboration critical to advocating for optimal care. A Spanish-speaking 38-year-old woman with lupus had a prolonged hospitalization which began with multiple occlusive DVTs. Her course was complicated by toxic megacolon requiring subtotal colectomy and multiple small bowel resections, resulting in an ileostomy with short-gut syndrome and total parenteral nutrition (TPN). Her remnant bowel was suspected to require a few years to reach its absorbative potential. TPN can be life-sustaining despite a substantial risk of complications (2,3), however long-term TPN posed challenges because the patient was undocumented and resided outside the hospital's funded catchment area (3,4). Palliative Care was consulted to clarify the patient's goals of care. The Palliative interdisciplinary team (IDT) provided vital psychosocial-spiritual support to the patient and her family amidst their distress concerning her uncertain prognosis and growing challenges to securing long-term parenteral nutrition. Her goals focused on caring for her children for as long as possible and in as functional a condition as was possible. The Palliative IDT collaborated with other stakeholders in the hospital to advocate for goal-concordant care (1,5). In a multidisciplinary meeting convened by Ethics, the care team identified potential options for optimizing her enteral nutrition and weaning the TPN. The Palliative IDT remained an advocate for the patient's goal of life-sustaining treatment, despite logistical obstacles to this end. Eventually, the patient was transitioned to gastrostomy tube for feeding and motility agents, though with sustained high output from her ileostomy, and discharged to a long-term acute care facility.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;References&lt;/h3&gt;&lt;div&gt;1. Parsi K, Hossa N. Complex discharges and undocumented patients: Growing ethical concerns. The Journal of Clinical Ethics. 2012;23(4):299-307. 2. Matarese LE. Nutrition and Fluid Optimization for ","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 5","pages":"Pages e421-e422"},"PeriodicalIF":3.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143807044","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 Care for People With Intellectual and Developmental Disabilities","authors":"Marsha Perales-Hull MD,&nbsp;Mary Scheerer MD","doi":"10.1016/j.jpainsymman.2025.02.095","DOIUrl":"10.1016/j.jpainsymman.2025.02.095","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;1. Participants will be able to understand more about the social, medical, legal and ethical concerns of patients with intellectual and developmental disabilities.&lt;/div&gt;&lt;div&gt;2. Participants will be able to appreciate how palliative care can be integrated into the care of people with intellectual and developmental disabilities to enhance their experiences nearing the end of life.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Key Message&lt;/h3&gt;&lt;div&gt;Patients with intellectual and developmental disabilities (IDD) make up approximately 2% of the U.S population. Patients with IDD are now dying of similar conditions found in the general population. Few are given access to care at end-of-life. This presentation addresses how palliative care can be integrated into the care of a patient with IDD.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Abstract&lt;/h3&gt;&lt;div&gt;Patients with intellectual and developmental disabilities (IDD) make up approximately 2% of the U.S population (5). Advances in medicine have increased life expectancy in patients with IDD and they are now dying of similar conditions found in the general population (3). However, few are given access to care at end-of-life (2). The objectives of this presentation are: 1) define what IDD is and why it is important to understand more about this patient population, 2) Identify legal concerns regarding patients with IDD, 3) Describe how hospice and palliative care can be integrated in their care, 4) Understand how an interdisciplinary approach to care can enhance the medical care of patients with IDD. Access to palliative and hospice care is a continuing disparity among this patient population and literature search shows that we need more research in how best to use palliative care to help patients with IDD and chronic life limiting illness.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;References&lt;/h3&gt;&lt;div&gt;1. Adam E, Sleeman KE, Brearley S, Hunt K, Tuffrey-Wijne I. The palliative care needs of adults with intellectual disabilities and their access to palliative care services: A systematic review. Palliat Med. 2020 Sep;34(8):1006-1018. doi: 10.1177/0269216320932774. Epub 2020 Jun 17. PMID: 32552409; PMCID: PMC7596767. 2. Friedman SL, Helm DT, Woodman AC. Unique and universal barriers: hospice care for aging adults with intellectual disability. Am J Intellect Dev Disabil. 2012 Nov;117(6):509-32. doi: 10.1352/1944-7558-117.6.509. PMID: 23167489. 3. McGinley JM, Marsack-Topolewski CN. A Comparative Case Study of Hospice and Hospital End-of-Life Care for Aging Adults With Developmental Disabilities. Glob Qual Nurs Res. 2022 May 11;9:23333936221087626. doi: 10.1177/23333936221087626. PMID: 35572367; PMCID: PMC9102126. 4. Moore CM, Pan CX, Roseman K, Stephens MM, Bien-Aime C, Morgan AC, Ross W, Castillo MC, Palathra BC, Jones CA, Ailey S, Tuffrey-Wijne I, Smeltzer SC, Tobias J. Top Ten Tips Palliative Care Clinicians Should Know About Navigating the Needs of Adults with Intellectual Disabilities. J Palliat Med. 2022 Dec;25(12):1857-1864. doi: 10.1089/jpm.2022.0384.","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 5","pages":"Pages e467-e468"},"PeriodicalIF":3.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143807145","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 Lost Leading the Lost: A Surrogacy Conundrum","authors":"Jenay Powell MD","doi":"10.1016/j.jpainsymman.2025.02.061","DOIUrl":"10.1016/j.jpainsymman.2025.02.061","url":null,"abstract":"<div><h3>Outcomes</h3><div>1. Participants will develop a framework for thinking critically about and analyzing their experiences with evaluating capacity at the end of life.</div><div>2. Participants will think critically about evaluating the appropriateness of surrogate decision-makers at the end of life and how this might be incorporated into their practice.</div></div><div><h3>Key Message</h3><div>This presentation takes a case-based approach to crucial issues at the intersection of ethics and palliative care. It is a close dissection of how we think about capacity, surrogate decision-making, and what it means to act in the best interest of the patient.</div></div><div><h3>Abstract</h3><div>(The Case) Gertie is a 93-year-old with advanced dementia admitted with a UTI to a community hospital. She is essentially nonverbal, says one to two words in your 30-minute inpatient intake visit. She is accompanied by her lifelong friend, Dale. He has lived with her for more than 20 years and they have no other family. You and your team meet with Dale, in his 80s, at the bedside. They have never talked about what she would have at end-of-life. While Dale acknowledges that they need more help than he can provide at home, he is unsure of what his next decision should be. Information about hospice is provided. Two days later, you meet with Dale as planned. It becomes clear that he does not recall your last conversation. How do we decide what happens to Gertie?</div></div><div><h3>Results / Resolution</h3><div>In this case, an informal conversation was had with some of the Ethics consultants at an affiliated institution who provided additional clarity. Because Gertie was not safe to be discharged home, and there was no additional treatment to offer, the threshold for competency was fairly low, because there was no safe alternative. The decision was made to have her discharge to a nursing home facility with hospice overlay.</div></div><div><h3>Conclusion</h3><div>So often we ask patients to designate surrogate decisionmakers in the event they are incapacitated, but we may fail or be unable to verify the appropriateness or capacity of the surrogates themselves until we are already in a dire situation. In cases where surrogate decisionmakers are of advanced age, it might be reasonable to ask patients to nominate multiple surrogates who they feel might be able to call on to act in their best interests.</div></div><div><h3>References</h3><div>Appelbaum PS. Clinical practice. Assessment of patients' competence to consent to treatment. N Engl J Med. 2007 Nov 1;357(18):1834-40. doi: 10.1056/NEJMcp074045. PMID: 17978292.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 5","pages":"Pages e447-e448"},"PeriodicalIF":3.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143807218","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":"Housing as Palliative Care for People With SUD and SMI Dual Diagnosis","authors":"DorAnne Donesky PhD ANP-BC ACHPN FPCN","doi":"10.1016/j.jpainsymman.2025.02.055","DOIUrl":"10.1016/j.jpainsymman.2025.02.055","url":null,"abstract":"<div><h3>Outcomes</h3><div>1. Discuss a financially sustainable model for housing people who live with substance use disorder and serious mental illness in a family-style setting.</div><div>2. Examine the palliative care implications of managing a Sober Living Environment home for people living with serious mental illness and substance use disorder.</div></div><div><h3>Key Message</h3><div>Sober living homes are an opportunity for relieving the suffering of serious illness. This session presents a reproducible model that benefits residents with substance use disorder and serious mental illness who enjoy living in community, citizens who want to \"do something\" about the housing crisis, real estate investors, and the healthcare system. No one needs to live on the street!</div></div><div><h3>Abstract</h3><div>Some people living with both Substance Use Disorder (SUD) and Serious Mental Illness (SMI) have come to realize that living in a Sober Living Environment (SLE) home is their best opportunity to live a life of dignity and serenity (1). A family became aware of some long-term SLE residents who were being evicted because the SLE owner had died, so they purchased a different home three years ago and started a new SLE.</div></div><div><h3>Objectives</h3><div>Describe the development of a new SLE, discuss the factors that affect the success of the home, and explore the steps for real estate investors to partner with community mentors to reproduce a financially sustainable SLE.</div></div><div><h3>Discussion</h3><div>Using a palliative care lens focused on relief of suffering, the SLE owner has committed to creating a family-style environment with the residents, where each person's strengths are appreciated. Five residents who are over the age of 60 plan to live at the SLE for the rest of their lives. The “senior residents,” two of whom have more than 10 years of sobriety, serve as mentors for younger residents who typically stay between 2 and 18 months. Residents are completely independent in meals and daily activities. They are required to attend weekly house meetings, complete daily chores, attend two 12-step meetings per week, remain abstinent from drugs and alcohol, and participate in treatment for their SMI. With double occupancy, residents are able to afford rent out of disability or retirement income that pays for all expenses of the home.</div></div><div><h3>Conclusion</h3><div>This SLE provides a model that could be reproduced as a community partnership that benefits multiple segments of society. Residents who have a long history of sobriety and enjoy living in SLE environments are important team members, in collaboration with investors, the healthcare team, and community mentors.</div></div><div><h3>References</h3><div>1. Polcin, D. L., Mericle, A. A., Braucht, G. S., &amp; Wittman, F. D. (2023). Moving social model recovery forward: Recent research on sober living houses. Alcoholism treatment quarterly, 41(2), 173-186.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 5","pages":"Page e443"},"PeriodicalIF":3.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143807237","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":"Updates in Insomnia: New Developments for an Often-Forgotten Symptom","authors":"Tyler Luonuansuu MD,&nbsp;Claudia Chou MD,&nbsp;Leslie Siegel PharmD,&nbsp;Erin Taylor LICSW MSW","doi":"10.1016/j.jpainsymman.2025.02.042","DOIUrl":"10.1016/j.jpainsymman.2025.02.042","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;1. Participants will be able to describe the neurotransmitter-based mechanisms governing consciousness and sleep and recognize how they can be applied to rationally treat common scenarios in palliative care.&lt;/div&gt;&lt;div&gt;2. Participants will be able to describe recent developments in the treatment of insomnia such as ongoing use of orexin antagonists to reduce incidence of delirium, mechanisms and effects of medical marijuana and psychedelics on sleep, and efficacy of virtual cognitive behavioral therapy for insomnia.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Key Message&lt;/h3&gt;&lt;div&gt;Insomnia is a highly prevalent yet often forgotten symptom in palliative care. Due to limited understanding of the mechanistic basis of the symptom, effective treatments were often limited to medication classes with high adverse effect burden (ex. benzodiazepines). This is rapidly changing with new medication classes such as DORAs and cannabinoids and a new, organized approach to treatment is needed.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Abstract&lt;/h3&gt;&lt;div&gt;Insomnia is a highly prevalent symptom in the palliative care population, with an estimated median prevalence of 49.5% (1). Etiology is often polyfactorial with physical disease, medication adverse effects, psychological and social factors all playing a role. Historic treatment of insomnia utilized agents such as melatonin agonists, benzodiazepines, non-benzodiazepine GABA receptor modulators, histamine receptor antagonists, and antipsychotics. These carry risk of adverse effects, limited efficacy, and in some situations, both. These obstacles can contribute to a sense of therapeutic nihilism for both patient and provider. While, at first, this may seem like an almost impossibly complex symptom with limited treatment options, research has progressed in recent years, from longstanding knowledge of sleep cycles (N1-REM sleep) to a relatively complete understanding of the mechanisms behind consciousness and sleep regulation at the level of cerebral structures and neurotransmitters (2). This has paved the way for discussions of a mechanistic approach to treating insomnia rationally by neurotransmitter target. This has led to significant milestones in the treatment of insomnia such as the development of dual orexin antagonists (DORAs) and increasing understanding of the hypnotic effects of complementary treatments such as cannabinoids and serotonergic psychedelics (3-4). DORAs have been found to prolong REM sleep by blunting the effects of the excitatory neuropeptide orexin (5). Significant research shows that DORAs may be the first hypnotics which reduce incident delirium which could represent a major milestone in palliative care treatment of insomnia (6). Further, the nonpharmacologic treatment of insomnia has been undergoing significant changes through the increasing uptake and validation of cognitive behavioral therapy for insomnia (CBT-I) delivered electronically which could significantly democratize access to CBT-I for medically under","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 5","pages":"Pages e433-e434"},"PeriodicalIF":3.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143807468","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":"Co-Design & Collaboration: Global Pediatric Palliative Care Research to Address Care Inequities","authors":"Marta Salek MD MPH,&nbsp;María Reyna MA,&nbsp;Debora Rebollo De Campos MSN,&nbsp;Joliza Caneba MD,&nbsp;Xuan Zhou MD,&nbsp;Ximena García-Quintero MD MSc,&nbsp;Michael McNeil MD MPH","doi":"10.1016/j.jpainsymman.2025.02.034","DOIUrl":"10.1016/j.jpainsymman.2025.02.034","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;1. Participants will learn about the application of three distinct research methodologies and their applications to answer research questions related to pediatric palliative care.&lt;/div&gt;&lt;div&gt;2. Participants will learn about three ongoing research studies that aim to support decision-making, pain management, and expanding pediatric palliative care access and consider the application of the research results to local practice in the United States.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Key Message&lt;/h3&gt;&lt;div&gt;Over 97% of children needing palliative care provision live in low- and middle-income countries. Despite this need, most pediatric palliative care (PPC) research has been conducted in high-income countries. Generated knowledge may not translate across contexts and cultures. Here, we describe research co-designed to improve PPC access.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Abstract&lt;/h3&gt;&lt;div&gt;Over 97% of children needing palliative care live in low-and middle-income countries (LMICs) with most lacking access. However, most pediatric palliative care (PPC) research has been conducted in high-income countries. Generated knowledge may not translate across countries, contexts, and cultures. To address this inequity and address local challenges, collaborative co-design and building research capacity is imperative. Here, we describe examples of collaborative research to improve PPC access globally.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;Provide three examples of research initiatives to address inequities in PPC provision co-designed with partners in LMICs.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;The first is a mixed methods project studying physician perceptions towards PPC for children with cancer designed in response to partners voicing a need to address inequities to PPC access. The second is a quality improvement (QI) initiative to reduce needle-based procedural pain in children designed in response to partners voicing challenges related to pain management in LMICs. Finally, the third is a qualitative study assessing patient and caregiver approaches to decision-making for children with poor-prognosis cancer at diagnosis that was designed in response to partners voicing challenges to decision-making for these children.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The mixed methods study has now been adapted by regional experts and distributed to 129 countries, with findings guiding local educational, advocacy, and research initiatives. The QI initiative was piloted in four hospitals and then expanded to 26 around the world with &gt;50% reduction in pain. The qualitative study was designed for use in three culturally distinct countries and results will contribute to future intervention design to support complex decision-making. These initiatives contributed to building local research capacity.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;Research addressing inequities in global PPC provision must be collaboratively co-designed with partners in LMICs and ideally led by LMIC investig","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 5","pages":"Pages e427-e428"},"PeriodicalIF":3.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143807471","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":"Overcoming Communication Barriers Impairing Equitable Access to Advanced Therapies: A Case Study","authors":"Pablo Da Silva MD MPH,&nbsp;Janet Abrahm MD FACP FAAHPM FASCO","doi":"10.1016/j.jpainsymman.2025.02.028","DOIUrl":"10.1016/j.jpainsymman.2025.02.028","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;1. To highlight the influence of language barriers on patient selection for advanced therapies (e.g., left ventricular assist device (LVAD)).&lt;/div&gt;&lt;div&gt;2. To identify the role of palliative care team in offering strategies for improving communication between healthcare teams and patients and families for whom English is not the language of choice.&lt;/div&gt;&lt;div&gt;3. To explore the role of the palliative care team in overcoming barriers to comprehensive patient assessments, including social support, when treatment decisions are made for patients for whom English is not the language of choice.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Key Message&lt;/h3&gt;&lt;div&gt;This case study examines how language barriers and inadequate exploration of social support can impede equitable access to advanced therapies for non-English-speaking patients and their families. It also explores the role of the palliative care team in overcoming these challenges.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Abstract&lt;/h3&gt;&lt;div&gt;Language barriers and inadequate communication can contribute to lack of equity in patient care, particularly in complex medical situations. Communicating in the patient's language of choice and exploring their social support system is crucial to overcoming barriers to equitable decisions regarding advanced therapies.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Case&lt;/h3&gt;&lt;div&gt;A 51-year-old non-English speaking patient presented with multiple chronic conditions, including type 2 diabetes mellitus, chronic pain, arthritis with wheelchair dependency, heart failure with reduced ejection fraction (EF 11%), and a history of cardiogenic shock. He was evaluated for a left ventricular assist device (LVAD) in the cardiac critical care unit, with an interpreter facilitating communication. Palliative care (PC) expressed no reservations about the patient's candidacy for an LVAD. However, the LVAD committee declined the procedure due to concerns about the patient's home care support, ambulation, and his history of not transitioning from oxycodone to Suboxone. The primary team did not inform the patient and his family clearly that he would need to transition from oxycodone to suboxone if he wished to be an LVAD candidate. The team did not explore the family's willingness to take turns caring for him, and incorrect assumptions may have contributed to the committee's denial of the LVAD.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;We will discuss the significant impact of ineffective communication and language barriers on patient outcomes, particularly in the decision-making process for offering life-altering therapies such as LVADs. We will detail the role of the PC team in (1) sharing effective strategies that healthcare providers (HCPs) can use to ensure patients and their families receive clear, comprehensive information in their language of choice; and (2) teaching HCPs how to explore family support systems effectively, enhancing treatment decisions and eliminating barriers that deny access to advanced therapies to patients a","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 5","pages":"Page e423"},"PeriodicalIF":3.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143807040","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":"Lessons in Leadership Using the Art of Poker","authors":"Virginia (Ginger) Marshall MSN ACNP-BC ACHPN FPCN, HPNA HPCC HPNF,&nbsp;Holli Martinez MSN FNP-BC ACHPN FPCN","doi":"10.1016/j.jpainsymman.2025.02.082","DOIUrl":"10.1016/j.jpainsymman.2025.02.082","url":null,"abstract":"<div><h3>Outcomes</h3><div>1. Participants will be able to describe three initiatives which can be employed to strengthen leadership skills.</div><div>2. Participants will be able to list three practices which can be used to mentor and support direct reports or team members.</div></div><div><h3>Abstract</h3><div>Shuffle the deck and elevate your leadership game! In this hands-on session, palliative care professionals will explore the art of leadership through the strategic lens of poker. Just as poker players assess risks, make critical decisions under pressure, and understand the importance of reading people, attendees will learn to enhance their leadership skills in clinical and corporate environments. Participants will engage in interactive activities that draw parallels between poker strategies and leadership tactics, such as calculating risks, managing team dynamics, and maintaining a \"poker face\" in challenging situations. By the end of the session, attendees will be equipped with innovative tools and insights to lead with confidence and decisiveness in the high-stakes world of palliative care. This session concludes with some non-cash poker play. Come ready to learn and use new skills at the poker table.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 5","pages":"Page e460"},"PeriodicalIF":3.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143807055","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":"Reconstructing Palliative Care Clinical Practice: Interrogating and Innovating","authors":"Terry Altilio LCSW APHSW-C,&nbsp;Vickie Leff MSW LCSW APHSW-C","doi":"10.1016/j.jpainsymman.2025.02.088","DOIUrl":"10.1016/j.jpainsymman.2025.02.088","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;1. Identify foundational concepts from a variety of scholars and fields to interrogate the history of palliative care practice and inform practice going forward and mitigate unintended consequences.&lt;/div&gt;&lt;div&gt;2. Identify the challenges and opportunities implicit in the work of palliative, hospice to influence and mitigate bias and inequities.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Abstract&lt;/h3&gt;&lt;div&gt;This workshop engages participants in a process of interrogating foundational constructs and paradigms developed over the last half century during which Palliative Care has evolved. The intention is to make visible the dogmas we inhabit, disrupting assumptions and encouraging innovation by integrating the work of scholars beyond the siloed world of palliative care. We explore concepts, beliefs and values from the humanities that build on the evolution of serious illness care and enrich the lens through which we see, evaluate and engage this essential relational work. This interactive workshop is intended for all professions, at any point in their careers. Using a variety of perspectives, theories, and philosophies we integrate video and patient family descriptions to explore the rich tapestry of experience which joins patients, families, and staff. As we deconstruct our past and present, we invite a shared imagining of practice going forward. Drawing on scholars and clinicians such as Foucault, Nichols, DeGruy, Laws, Wailoo, we illustrate where the work of these leaders intersect in aspects of clinical practice such as Family, Pain, Ethics, Language and Sustainability. Some of the concepts that are interwoven throughout the workshop include: testimonial injustice, relational autonomy, axiology of culture, delegitimization, response shift and structural competence Challenging the existing transactional healthcare paradigm with inclusive, relational and justice lens offers the chance for enriched conversations, focused activism and innovative options in education and practice with an intention of enhancing practice skills and mitigating inequities across healthcare settings.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;References&lt;/h3&gt;&lt;div&gt;Chambon, A., Irving, A. (1999). Reading Foucault for Social Work: Columbia University Press. Fricker, M. (2007). Epistemic Injustice: Power and the Ethics of Knowing: Oxford University Press. Hansen, H., &amp; Metzl, J. (2016). Structural Competency in the U.S. Healthcare Crisis: Putting Social and Policy Interventions Into Clinical Practice. J Bioeth Inq, 13(2), 179-183. doi:10.1007/s11673-016-9719-z Jimenez, G., Tan, W. S., Virk, A. K., Low, C. K., Car, J., &amp; Ho, A. H. Y. (2018). Overview of Systematic Reviews of Advance Care Planning: Summary of Evidence and Global Lessons. J Pain Symptom Manage, 56(3), 436-459.e425. doi:10.1016/j.jpainsymman.2018.05.016 Laws, T. (2021). How Should We Respond to Racist Legacies in Health Professions Education Originating in the Flexner Report? AMA Journal of Ethics, 23(4), e271-275. McIntee, M. F","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 5","pages":"Pages e461-e462"},"PeriodicalIF":3.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143807061","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}