Journal of pain and symptom management最新文献

{"title":"“Scarcity,” “Futility,” and “Moral Distress”: A Case Analysis of the Challenges of Sound Ethical Description","authors":"Benjamin W. Frush MD, MA ,&nbsp;Sean Gaffney MD, M. Ed","doi":"10.1016/j.jpainsymman.2025.07.025","DOIUrl":"10.1016/j.jpainsymman.2025.07.025","url":null,"abstract":"<div><div>Appropriate use of ethical terminology is critical to effective, goal-concordant care, particularly for patients who are critically ill or nearing the end of life. In this case analysis, we describe how the ethical terms “scarcity,” “futility,” and “moral distress” were used in ways that failed to accurately capture the clinical situation, and likely favored the viewpoints of the clinical team. While careful attention to accurate clinical and ethical terminology is challenging in cases like this, we argue it is essential to communicate honestly and effectively with patients and families grappling with difficult decisions in these contexts.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"70 5","pages":"Pages e332-e336"},"PeriodicalIF":3.5,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144775597","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":"Impact of Palliative Care on Psychosocial and Spiritual Outcomes in the Neonatal Intensive Care Unit","authors":"Matthew Lin MD ,&nbsp;Clara Horner MD ,&nbsp;Kaytlin Butler MDiv, BCC ,&nbsp;Olivia Bosworth BA ,&nbsp;Taylor Kiernan BA ,&nbsp;Jordan Nelson MD ,&nbsp;Kristyn Pierce MPH ,&nbsp;Deborah Dore LCSW ,&nbsp;Daniel Eison MD ,&nbsp;Sadaf Kazmi MD ,&nbsp;Christine Zawistowski MD","doi":"10.1016/j.jpainsymman.2025.07.028","DOIUrl":"10.1016/j.jpainsymman.2025.07.028","url":null,"abstract":"<div><h3>Context</h3><div>Pediatric palliative care (PPC) consultation for infants with life-limiting conditions provides parents and caregivers with opportunities to participate in advance care planning, shared decision-making, and to receive appropriate psychosocial and spiritual supports.</div></div><div><h3>Objectives</h3><div>To evaluate the impact of PPC consultation on spiritual, psychosocial, and communication outcomes for infants that died in the NICU.</div></div><div><h3>Methods</h3><div>Retrospective chart review of infants who died in a level IV NICU over a 10-year period (2014–2024). Mann-Whitney U and Chi-square or Fisher’s exact tests were used to evaluate demographic and medical differences between infants with and without PPC consultation. Regression analyses were used to evaluate the impact of PPC on psychosocial, spiritual, and communication outcomes after adjusting for relevant covariates.</div></div><div><h3>Results</h3><div>There were significant medical and demographic differences between infants with PPC and no PPC consultation. Infants with PPC consultation had significantly higher odds of referral to child life, participation in memory making activities, documentation of family meetings and advance care planning discussions, and a higher incidence rate ratio of NICU social work visits and family meetings during their admission after adjusting for potential confounders.</div></div><div><h3>Conclusion</h3><div>PPC consultation is associated with improved psychosocial, spiritual, and communication support utilization for seriously ill NICU infants and their families.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"70 5","pages":"Pages 470-480.e2"},"PeriodicalIF":3.5,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144775599","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":"Depression and Cancer Pain: Mediating Roles of Anxiety and Pain Beliefs","authors":"Eun-Jung Shim ,&nbsp;Hyeju Ha ,&nbsp;Chan-Woo Yeom ,&nbsp;Kyung-Lak Son ,&nbsp;Won-Hyoung Kim ,&nbsp;Bong-Jin Hahm","doi":"10.1016/j.jpainsymman.2025.07.030","DOIUrl":"10.1016/j.jpainsymman.2025.07.030","url":null,"abstract":"<div><h3>Context</h3><div>The psychological mechanisms linking depression and pain in cancer remain unclear despite consistent evidence of their strong association.</div></div><div><h3>Objectives</h3><div>To investigate psychological pathways underlying the relationship between depression and pain, mediated by anxiety and pain-related beliefs.</div></div><div><h3>Methods</h3><div>The participants were 140 adults with a confirmed cancer diagnosis, recruited from three university hospitals in South Korea between April 2024 and May 2025. Participants completed self-report questionnaires, including the M. D. Anderson Symptom Inventory, Hospital Anxiety and Depression Scale, and the Pain Beliefs and Perceptions Inventory.</div></div><div><h3>Results</h3><div>A serial-parallel mediation analysis revealed no significant direct effects of depression on pain severity. However, a significant indirect effect was observed through anxiety and the belief that pain is persistent (<em>Time</em>) (<em>b</em> = 0.101, 95% CI [0.032, 0.185]). This pathway differed significantly from other indirect effects. Higher depression levels were associated with greater anxiety, which, in turn, was associated with a stronger belief that pain is persistent, and ultimately, with higher pain severity.</div></div><div><h3>Conclusion</h3><div>Depression may indirectly contribute to greater pain severity in patients with cancer patients through anxiety and the belief that pain is persistent. These findings underscore the need to address emotional distress and maladaptive pain beliefs in the psychological management of cancer-related pain.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"70 5","pages":"Pages 481-489"},"PeriodicalIF":3.5,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144775598","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":"Dexmedetomidine Versus Midazolam for End-of-Life Sedation: The DREAMS Non-Blinded Randomized Clinical Trial","authors":"Benjamin Thomas MMed, FRACP, FAChPM ,&nbsp;Gregory Barclay MBBS, FRACGP, FAChPM ,&nbsp;Kylie Mansfield PhD ,&nbsp;Judy Mullan PhD ,&nbsp;Wing-Shan Angela Lo MMed, FRACP, FAChPM","doi":"10.1016/j.jpainsymman.2025.07.027","DOIUrl":"10.1016/j.jpainsymman.2025.07.027","url":null,"abstract":"<div><h3>Context</h3><div>End-of-life distress and delirium are common in palliative care inpatients, often requiring sedatives that diminish interaction. Current practices rely on clinical experience rather than evidence.</div></div><div><h3>Objectives</h3><div>To compare the sedative efficacy of subcutaneous dexmedetomidine versus midazolam in managing end-of-life distress while maintaining responsiveness, and to evaluate comparative effect on delirium in the terminal phase.</div></div><div><h3>Methods</h3><div>Single center randomized non-blinded clinical trial (ACTRN12621000052831) of palliative care inpatients in an Australian Local Health District admitted for end-of-life care. Patients received dexmedetomidine (0.5 µg/kg/h) or midazolam (0.25 mg/kg/day) via subcutaneous infusion for symptom management during the terminal phase. The primary outcome was responsiveness measured by mean Richmond Agitation Sedation Score-Palliative version (RASS-PAL) compared between treatment arms over the first 72 hours. Secondary outcomes included delirium severity (memorial delirium assessment score [MDAS]) and patient comfort (Patient Comfort Assessment [PCA]).</div></div><div><h3>Results</h3><div>Fifty two patients were randomized (median age 80 years [IQR 72–88]; 63% male) and included in the primary analysis. Mean RASS-PAL scores showed no significant difference between arms (dexmedetomidine vs. midazolam: day 1: −2.33 vs. −1.90; day 2: −2.44 vs. −2.86; day 3: −2.95 vs. −2.53; all <em>P</em> &gt; 0.05). Dexmedetomidine showed superior early delirium severity scores (day 1 MDAS: 6.5 vs. 8.8, <em>P</em> = 0.05) which did not persist. Protocol withdrawal occurred earlier in the midazolam arm (5 vs. 0 patients on day 1, <em>P</em> = 0.025). Patient comfort scores remained mild (PCA &lt; 3) in both arms.</div></div><div><h3>Conclusion</h3><div>Dexmedetomidine and midazolam can achieve sedative equivalence with similar RASS-PAL scores. Dexmedetomidine patients experienced lower initial delirium severity scores and fewer early withdrawals in secondary analysis. Current dosing guideline for midazolam may need revising.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"70 5","pages":"Pages 459-469"},"PeriodicalIF":3.5,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144794783","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":"Length of Stay by Pediatric Hospice Diagnoses: A Retrospective Experience from a Single Center","authors":"Emily Sierakowski MD ,&nbsp;Claudia Delgado Corcoran MD, MPH ,&nbsp;Dominic Moore MD ,&nbsp;Sydney Kronaizl MS, CCLS ,&nbsp;Tristan Peterson MDATA ,&nbsp;Jasmine Masih BSc ,&nbsp;Brandy Harman BS, BA ,&nbsp;Mark Harousseau MD","doi":"10.1016/j.jpainsymman.2025.07.031","DOIUrl":"10.1016/j.jpainsymman.2025.07.031","url":null,"abstract":"<div><h3>Context</h3><div>Pediatric hospice provides care for children during the final stages of a terminal illness, usually defined as a prognosis of six months or less. There is limited data to inform hospice utilization in children among different hospice diagnoses.</div></div><div><h3>Objective</h3><div>The objective of this study is to perform a retrospective analysis of pediatric hospice patients to better describe clinical trends and utilization among different hospice diagnoses.</div></div><div><h3>Methods</h3><div>This is a single center retrospective study of pediatric hospice patients enrolled in hospice from 2015–2023 (0–23 y). Using descriptive statistics, the study examines hospice diagnoses, hospice length of stay (LOS), and the type of hospice care, traditional or concurrent care hospice.</div></div><div><h3>Results</h3><div>One hundred fifty-five pediatric hospice patients met criteria. Children were divided into the four most common diagnostic categories: oncologic (<em>n</em> = 54), neurologic (<em>n</em> = 41), genetic/metabolic (<em>n</em> = 38), and cardiovascular (<em>n</em> = 22). Children who received concurrent care hospice had significantly longer median hospice LOS compared to traditional hospice care (33d vs. 14d; <em>P</em> &lt; 0.001). More than half of the children spent less than one month in hospice (90/155, 58%) with 20% having a late referral defined as hospice LOS ≤ 3 days. There were no statistically significant results between LOS in the four most common diagnostic categories.</div></div><div><h3>Conclusion</h3><div>Hospice LOS was not statistically different across diagnostic categories. Children enrolled in concurrent care hospice have statistically significant longer stays in hospice compared to traditional hospice. Short hospice stays and late referrals continue to occur.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"70 5","pages":"Pages e318-e324"},"PeriodicalIF":3.5,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144775600","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":"Pharmacist-led Opioid Deprescribing Pilot Clinic within Outpatient Palliative Care","authors":"Maria Felton Lowry PharmD, BCPS, BCGP ,&nbsp;Sydney Lee PharmD ,&nbsp;Makayla F. Hoke PharmD ,&nbsp;Emily R. Leung PharmD ,&nbsp;Hailey Roup PharmD ,&nbsp;Hope E. Linge ,&nbsp;Linda King MD ,&nbsp;Yael Schenker MD, MAS, FAAHPM","doi":"10.1016/j.jpainsymman.2025.07.020","DOIUrl":"10.1016/j.jpainsymman.2025.07.020","url":null,"abstract":"<div><h3>Background</h3><div>Patients with cancer receiving opioid therapy often follow with specialty palliative care after achieving remission. Strategies to reduce risks associated with ongoing opioid therapy in survivorship are needed.</div></div><div><h3>Measures</h3><div>Feasibility, safety, and impact.</div></div><div><h3>Intervention</h3><div>A pharmacist-led opioid deprescribing program, embedded within a specialty palliative care clinic, was designed for patients on long-term opioid therapy who have reached cancer remission.</div></div><div><h3>Outcomes</h3><div>In the nine-month pilot phase, 80% of referred patients established care with the pharmacist. One hundred seventeen pharmacist visits occurred: 20 in person, 52 telemedicine, and 45 telephone. The pharmacist spent an average of 72 minutes for initial and 45 minutes for follow-up visits. Oral morphine equivalents (OMEs) were reduced for 75% of referred patients, with an average of 22% reduction. No patients were hospitalized for uncontrolled pain or withdrawal.</div></div><div><h3>Conclusion/Lessons learned</h3><div>Opioid deprescribing clinic was time-intensive and patients required close monitoring for implementation of patient-specific opioid deprescribing plans.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"70 5","pages":"Pages e305-e310"},"PeriodicalIF":3.5,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765012","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":"Reflections on Cultural Humility in the End-Stages of Parkinson's: The Journey of a Mandarin-speaking Patient.","authors":"Nithya Krishnamurthy, Brendan Ross, Teresa Wang, Shruti Mutalik","doi":"10.1016/j.jpainsymman.2025.07.016","DOIUrl":"10.1016/j.jpainsymman.2025.07.016","url":null,"abstract":"","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144760377","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 Italian Version of the FAMCARE-P13 Questionnaire: A Validation Study","authors":"Giacomo Massa MD ,&nbsp;Gabriele Tinè MSc ,&nbsp;Ernesto Zecca MD ,&nbsp;Rosalba Miceli PhD ,&nbsp;Alessandra Pigni MD ,&nbsp;Viviana Fusetti PhD ,&nbsp;Antonino Tallarita BSc ,&nbsp;Sara Alfieri PhD ,&nbsp;Chiara Vela MScN ,&nbsp;Cinzia Brunelli PhD ,&nbsp;Augusto Caraceni Prof.","doi":"10.1016/j.jpainsymman.2025.07.017","DOIUrl":"10.1016/j.jpainsymman.2025.07.017","url":null,"abstract":"<div><h3>Purpose</h3><div>The FAMCARE-P13 is a tool designed to evaluate patients' satisfaction with received healthcare. This self-reported questionnaire has already been adapted and validated in different languages but not Italian. The study aims to examine the cultural adaptation of the Italian version of the FAMCARE-P13 questionnaire and evaluate its psychometric properties in outpatients with advanced cancer.</div></div><div><h3>Methods</h3><div>The FAMCARE-P13, a questionnaire of 13 items scored on a 5-point Likert scale (from 1 = “very dissatisfied” to 5 = “very satisfied”), was culturally adapted into Italian through forward-back translation by native Italian and English speakers. The questionnaire was then administered to a balanced sample of outpatients with five advanced cancer histologies. The following psychometric analyses were performed: Confirmatory Factor Analysis to test the presence of a single latent factor, Cronbach's α to test internal consistency, intraclass correlation coefficient to evaluate test-retest reliability after 3 days, and a known-group validity analysis.</div></div><div><h3>Results</h3><div>A total of 300 patients completed the questionnaire. Confirmatory factor analysis fully supported a one-factor structure of the tool, with the model exhibiting robust fit indices, specifically a comparative fit index of 0.96 and a Tucker-Lewis Index of 0.95. The satisfaction was closely related to doctors' availability and availability to communicate. Cronbach's α was 0.95 (95% CI: 0.94–0.95), showing satisfactory internal consistency. Test-retest analysis showed stability over time, with a global intraclass correlation coefficient of 0.91 (<em>P</em>-value &lt; 0.0001).</div></div><div><h3>Conclusion</h3><div>The Italian version of the FAMCARE-P13 questionnaire appears valid for assessing the satisfaction with the care received by patients with advanced cancer.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"70 4","pages":"Pages 392-399.e2"},"PeriodicalIF":3.5,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144753609","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":"Estimating the Number of Services & Patients Receiving Specialized Palliative Care Globally in 2025","authors":"Stephen R. Connor PhD ,&nbsp;Eduardo Garralda MA ,&nbsp;Vilma A. Tripodoro MD, PhD ,&nbsp;Carlos Centeno MD, PhD","doi":"10.1016/j.jpainsymman.2025.07.018","DOIUrl":"10.1016/j.jpainsymman.2025.07.018","url":null,"abstract":"<div><h3>Context</h3><div>Palliative care is an essential component of every health-care system. Information on the status of palliative care service delivery is necessary to understand the gap between current capacity and population-level need.</div></div><div><h3>Objectives</h3><div>To estimate the number of specialized palliative care providers worldwide and the number of patients they served in 2025, in comparison to 2017.</div></div><div><h3>Methods</h3><div>Previous estimates from a sample of countries representing each World Bank income group in 2017, using typical case purposive sampling, were used to project numbers of patients served based on reported numbers of services, as collected through the most recent Global Palliative Care Mapping Study covering 201 countries.</div></div><div><h3>Results</h3><div>In 2025, the estimated number of specialized palliative care service delivery teams worldwide reached approximately 33,700 - representing a 35.6% increase from the 25,000 identified in 2017. Service delivery expanded across all WHO regions. The estimated number of patients served rose from almost 7 million in 2017 to approximately 10.4 million in 2025. This figure represents roughly 14% of the total global need for palliative care. However, this estimate includes both primary and specialist care needs, while this study focuses exclusively on specialist services. A substantial portion of the remaining need may be addressed through the development and integration of primary-level palliative care.</div></div><div><h3>Conclusion</h3><div>Despite notable growth in service availability, significant disparities persist, particularly in low- and middle-income countries. While over half of the need appears to be met in high-income countries, only 4.4% is addressed by specialist provision in low and middle-income countries. The contribution of primary-level care remains unknown.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"70 5","pages":"Pages 422-426"},"PeriodicalIF":3.5,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144753608","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":"Timely Documentation of CPR Codes and Medical Treatment Preferences in the EHRs of Nursing Homes","authors":"Gary Y.C. Yeung MD ,&nbsp;Martin Smalbrugge MD, PhD ,&nbsp;Martine C. de Bruijne MD, PhD ,&nbsp;Mariska Bot PhD ,&nbsp;Hylco Bouwstra MD, PhD ,&nbsp;Nienke Fleuren MD ,&nbsp;Karlijn J. Joling PhD","doi":"10.1016/j.jpainsymman.2025.07.022","DOIUrl":"10.1016/j.jpainsymman.2025.07.022","url":null,"abstract":"<div><h3>Context</h3><div>Timely documentation of cardiopulmonary resuscitation (CPR) code and medical treatment preferences in electronic health records (EHR) is important for translating advance care planning conversations into actionable medical orders.</div></div><div><h3>Objectives</h3><div>To examine documentation rates of CPR code and medical treatment preferences within the recommended first six weeks of admission in Dutch nursing homes (NHs) from 2017 to 2022.</div></div><div><h3>Methods</h3><div>This retrospective cohort used EHR from 74 Dutch NHs. We assessed the prevalence of documented CPR codes and medical treatment preferences within six weeks of admission, and the median days until first documentation. To examine whether timely documentation odds improved annually, logit generalized estimating equation models -accounting for clustering of residents within NHs– were used, stratified by NH care type, and adjusted for resident factors.</div></div><div><h3>Results</h3><div>We included 163,180 residents. CPR code and medical treatment preferences was documented within 6 weeks of admission for 88% and 64% of the residents, respectively. The median time to first documentation were 0.5-2 days across care types. Overall, between 2017 and 2022, timely documentation of CPR code increased from 82% to 92% and for medical treatment preferences from 56% to 70%. Recent admission year was associated with higher odds of timely documentation for both type of orders in psychogeriatric and somatic care, and for CPR in rehabilitation care.</div></div><div><h3>Conclusion</h3><div>Most residents had documented CPR code and medical treatment preference within the recommended six weeks of admission, with rates improving from 2017 to 2022. The improvement coincided with a national quality indicator introduced in 2018 and the COVID-19 pandemic.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"70 5","pages":"Pages 427-436.e1"},"PeriodicalIF":3.5,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731871","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}