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Career Trajectories After Palliative Care Training: A National E-Survey of Medical Interns in France 姑息治疗培训后的职业轨迹:法国医疗实习生全国电子调查。
IF 3.5 2区 医学
Journal of pain and symptom management Pub Date : 2025-08-13 DOI: 10.1016/j.jpainsymman.2025.08.006
Guillaume Lawton MD , Laurent Calvel MD, PhD , Elise Perceau-Chambard MD , Virginie Guastella MD, PhD , Guillaume Economos MD, PhD , Adrien Evin MD, PhD
{"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}
引用次数: 0
State Decision-Making Approaches in Seriously Ill People With Intellectual/Developmental Disability 智力/发育障碍重症患者的国家决策方法。
IF 3.5 2区 医学
Journal of pain and symptom management Pub Date : 2025-08-13 DOI: 10.1016/j.jpainsymman.2025.08.007
Matthew Castillo MD, MS , Arlen G. Gaines PhD, MSW , Caitlyn M. Moore DNP, MS, ACHPN , Cynthia X. Pan MD
{"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}
引用次数: 0
Early Supportive and Nutritional Care For Adults With Pancreatic Cancer: A Pilot Study 成年胰腺癌患者的早期支持和营养护理:一项初步研究。
IF 3.5 2区 医学
Journal of pain and symptom management Pub Date : 2025-08-13 DOI: 10.1016/j.jpainsymman.2025.07.032
Yu Chen Lin PhD, MS , Kea Turner PhD, MPH, MA , Sahana Rajasekhara MD , Dae Won Kim MD , Tiago Biachi de Castria MD , Oliver T. Nguyen MSHI , Emma Hume MPH , Olivia Sprow MPH , Christina Santiago MS, RDN , Jeanine Milano MS, RDN, CSO , Diane Riccardi MPH, RD, LDN , Nicole Nardella MS , Mohammed Al-Jumayli MD , Jennifer B. Permuth PhD, MS , Sarah Hoffe MD , Tim Hembree DO, PhD , Young-Rock Hong PhD, MPH , Jessica Y. Islam PhD, MPH , Amir Alishahi Tabriz MD, PhD, MPH , Pamela J. Hodul MD
{"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}
引用次数: 0
Guided Mindfulness of Death to Reduce Fear of Death in Cancer Patients: Randomized Controlled Study. 引导死亡正念减少癌症患者对死亡的恐惧:随机对照研究。
IF 3.5 2区 医学
Journal of pain and symptom management Pub Date : 2025-08-13 DOI: 10.1016/j.jpainsymman.2025.08.002
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
{"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}
引用次数: 0
Do No Harm. 不要伤害。
IF 3.5 2区 医学
Journal of pain and symptom management Pub Date : 2025-08-12 DOI: 10.1016/j.jpainsymman.2025.07.035
Danielle Chammas
{"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}
引用次数: 0
Assessing Perceptions of Positive and Negative Content within Goals of Care Notes 评估护理笔记目标中积极和消极内容的感知。
IF 3.5 2区 医学
Journal of pain and symptom management Pub Date : 2025-08-11 DOI: 10.1016/j.jpainsymman.2025.07.033
Gina M. Piscitello MD, MS , Emiliano Garcia-Fuentes , Robert M. Arnold MD , Jane Schell MD, MHS , Katrina E. Hauschildt PhD, BCPA
{"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}
引用次数: 0
First-Ever Global Ranking of Palliative Care: 2025 World Map Under the New WHO Framework 首份姑息治疗全球排名:世卫组织新框架下的2025年世界地图。
IF 3.5 2区 医学
Journal of pain and symptom management Pub Date : 2025-08-07 DOI: 10.1016/j.jpainsymman.2025.07.026
Vilma A. Tripodoro MD, PhD , Jesús Fernando López Fidalgo PhD , Juan José Pons PhD , Stephen R. Connor PhD , Eduardo Garralda MA , Fernanda Bastos MD , Álvaro Montero MA , Laura Monzón Llamas MSc , Ana Cristina Béjar MD , Daniela Suárez MSc , Carlos Centeno MD, PhD
{"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}
引用次数: 0
Design and Implementation of a Primary Palliative Care Education Program for Hematology-Oncology Advanced Practice Providers: Insights From a Three-Year Cohort 设计和实施血液肿瘤学高级实践提供者的初级姑息治疗教育计划:来自三年队列的见解。
IF 3.5 2区 医学
Journal of pain and symptom management Pub Date : 2025-08-06 DOI: 10.1016/j.jpainsymman.2025.07.024
Olivia C. West MSN, APRN, AG-ACNP-BC , Catherine McCarty PA-C, MPH, CAQ-PMHC , Rajiv Agarwal MD, MSCI , Mohana Karlekar MD
{"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}
引用次数: 0
“Scarcity,” “Futility,” and “Moral Distress”: A Case Analysis of the Challenges of Sound Ethical Description “稀缺”、“无用”与“道德困境”:健全伦理描述挑战的个案分析。
IF 3.5 2区 医学
Journal of pain and symptom management Pub Date : 2025-08-05 DOI: 10.1016/j.jpainsymman.2025.07.025
Benjamin W. Frush MD, MA , Sean Gaffney MD, M. Ed
{"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}
引用次数: 0
Impact of Palliative Care on Psychosocial and Spiritual Outcomes in the Neonatal Intensive Care Unit 姑息治疗对新生儿重症监护室心理社会和精神结果的影响。
IF 3.5 2区 医学
Journal of pain and symptom management Pub Date : 2025-08-05 DOI: 10.1016/j.jpainsymman.2025.07.028
Matthew Lin MD , Clara Horner MD , Kaytlin Butler MDiv, BCC , Olivia Bosworth BA , Taylor Kiernan BA , Jordan Nelson MD , Kristyn Pierce MPH , Deborah Dore LCSW , Daniel Eison MD , Sadaf Kazmi MD , Christine Zawistowski MD
{"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}
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