Journal of pain and symptom management最新文献

{"title":"A Photo-Narrative Intervention for Children With Severe Neurological Impairment in the PICU.","authors":"Jori Bogetz, Ellie Oslin, Emma Meissner, Amy Trowbridge, Jordan Anderson, Liz Morris, Krysta S Barton, Joyce Yi-Frazier, R Scott Watson, Abby R Rosenberg","doi":"10.1016/j.jpainsymman.2024.11.021","DOIUrl":"10.1016/j.jpainsymman.2024.11.021","url":null,"abstract":"<p><strong>Context: </strong>Parents of children with severe neurological impairment (SNI) face barriers in the pediatric intensive care unit (PICU) to humanistic care. Photo-narratives are a promising strategy to share perspectives about well-being.</p><p><strong>Objective: </strong>This study describes the iterative refinement and lessons learned in adapting a photo-narrative intervention for children with SNI in the PICU.</p><p><strong>Methods: </strong>This qualitative study was conducted at an academic children's hospital. Participants included parents of children with SNI who completed the photo-narrative during interviews after their child's PICU discharge and provided feedback on intervention design, implementation, and impact. Parents then selected one to three of their child's PICU clinicians to participate. Data from sets of five parents and their corresponding clinicians were transcribed, deidentified, summarized using rapid qualitative analysis, and presented to our multidisciplinary study team who either accepted or dismissed changes. This cycle was repeated a total of three times with new participants to arrive at the final prototype.</p><p><strong>Results: </strong>Fifteen parents and 19 clinicians participated. Parents were a median of 39 years-old (range 28-55); 20% (n = 3) were fathers. Over half (n = 11) of clinicians had >5 years in their profession. Themes of refinement focused on: enhancing flexibility and ease for families; eliciting information to diminish disability-based biases; and streamlining integration in the PICU environment. Lessons learned included the ability of photos to share family perspectives on quality-of-life, contextualize the child's health status, and enhance child-clinician connection.</p><p><strong>Conclusion: </strong>Themes and lessons learned from the successful adaptation and refinement of a photo-narrative can inform other interventions designed to humanize care.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828632","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":"Bereaved Family Quality of Life Varies With Comorbid Psychological Distress and ICU-Care Quality","authors":"Fur-Hsing Wen Ph.D. ,&nbsp;Holly G. Prigerson Ph.D. ,&nbsp;Li-Pang Chuang M.D. ,&nbsp;Wen-Chi Chou M.D. ,&nbsp;Tsung-Hui Hu M.D. ,&nbsp;Chung-Chi Huang M.D. ,&nbsp;Siew Tzuh Tang D.N.Sc","doi":"10.1016/j.jpainsymman.2024.11.023","DOIUrl":"10.1016/j.jpainsymman.2024.11.023","url":null,"abstract":"<div><h3>Context</h3><div>Health-related quality of life (HRQOL) is highly endorsed, but HRQOL studies scarcely investigate the following: ICU family members; modifiable end-of-life (EOL) ICU-care factors; conjoint associations with prolonged grief disorder (PGD), post-traumatic stress disorder (PTSD), and depression; and long-term bereavement outcomes.</div></div><div><h3>Objectives</h3><div>Exploratorily investigate associations of PGD-PTSD-depressive-symptom states (resilient, subthreshold-depression dominant, PGD dominant, and PGD-PTSD-depression comorbid) and quality of EOL ICU care with families’ HRQOL 6–24 months post loss.</div></div><div><h3>Methods</h3><div>This cohort study examined symptoms of PGD (11 items of the PG-13), PTSD (Impact of Event Scale-Revised), and depression (Hospital Anxiety and Depression Scale), and HRQOL (Medical Outcomes Study 36-Item Short-Form Health Survey) among 303 ICU family members. Quality of EOL ICU care was measured by objective process-based care-quality indicators abstracted from medical records and classified by subjective family-assessed quality of patient dying and death (QODD). Associations were simultaneously examined by multivariate hierarchical linear modeling with resilient state and high QODD class as reference.</div></div><div><h3>Results</h3><div>Physical and mental HRQOL were worse in the 3 more distressed symptom states, especially mental HRQOL which showed an incremental dose-response effect: subthreshold depression-dominant (β [95% CI]=-2.419 [-3.374, -1.464]), PGD-dominant (-8.366 [-10.116, -6.616]), and PGD-PTSD-depression comorbid (-14.736 [-17.772, -11.700]) states. Mental HRQOL was significantly worse in the 3 poorer QODD classes: moderate (-1.085 [-2.138, -0.032]), poor to uncertain (-4.362 [-5.616, -3.108]), and worst (-3.239 [-4.433, -2.045]). HRQOL was not associated with objective care-quality indicators.</div></div><div><h3>Conclusion</h3><div>Bereaved family members’ HRQOL was significantly associated with PGD-PTSD-depressive-symptom states and QODD classes—both modifiable through high-quality EOL ICU care.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 3","pages":"Pages 251-260.e3"},"PeriodicalIF":3.2,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142794821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Designing and Delivering a Poetry Workshop for Clinician Well-Being During the COVID-19 Pandemic: A Case Study","authors":"Halia Melnyk PhD, MPH, RN ,&nbsp;Jin Jun PhD, RN ,&nbsp;Jennifer L. Eramo MSN, RN ,&nbsp;Ann Scheck McAlearney ScD, MS ,&nbsp;Laura J. Rush DVM, PhD, RN ,&nbsp;Ramona G. Olvera PhD, MA ,&nbsp;David Hassler MFA ,&nbsp;Steven Radwany MD, FACP, FAAHPM ,&nbsp;Brittany Waterman MD","doi":"10.1016/j.jpainsymman.2024.11.019","DOIUrl":"10.1016/j.jpainsymman.2024.11.019","url":null,"abstract":"<div><h3>Context</h3><div>Facilitated poetry writing workshops are used in healthcare settings as a therapeutic approach to address stressful factors that negatively influence clinician well-being. However, owing to the novelty of this intervention and a tendency to combine poetry with other types of narrative-based techniques, proponents of poetic medicine are calling for harmonization across programs in the US. This would facilitate the study of poetry in medicine and the multiple facets of well-being it is said to promote. To address these points, we partnered with a well-established poetry center to develop and study a facilitated poetry writing workshop program for palliative care and emergency medicine clinicians during the COVID-19 pandemic.</div></div><div><h3>Objectives</h3><div>Our qualitative aim was to describe how the workshop provided a creative outlet for the sharing and processing of clinician experiences.</div></div><div><h3>Methods</h3><div>We conducted a multiple-case study of six workshop sessions using transcripts, model poems, writing prompts, and participant-created poems to describe the program's structure and processes.</div></div><div><h3>Results</h3><div>Our workshop contained the core components of reading, writing, and reflection; however, our program was unique in its inclusion of a website and a prewriting component. The facilitator's instruction on and fostering the use of poetic technique coupled with website interaction were key promoters of participant engagement with their peers in the processing of complex experiences and related emotions.</div></div><div><h3>Conclusion</h3><div>Healthcare systems seeking to incorporate poetry into their wellness programming may build upon our findings to create flexible workshops suited to their clinician audience and program intent.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 3","pages":"Pages e191-e199"},"PeriodicalIF":3.2,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791971","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":"Model for an International Case Sharing Program to Enhance Global Palliative Care Education","authors":"Megan Brandeland MD ,&nbsp;Alicha Chumintrachark MD ,&nbsp;Patama Gomutbutra MD ,&nbsp;Beth Scudder MA ,&nbsp;Brett Hendel-Paterson MD","doi":"10.1016/j.jpainsymman.2024.11.020","DOIUrl":"10.1016/j.jpainsymman.2024.11.020","url":null,"abstract":"<div><h3>Context</h3><div>In Thailand, the field of palliative medicine is growing but access and training remain limited. We sought to expand education of resident physicians at Chiang Mai University (CMU) in Thailand through development of an international case sharing program.</div></div><div><h3>Objectives</h3><div>The goals of this project were to increase knowledge of core palliative care topics, to cultivate a culture of reflective clinical practice, and to create a model for collaboration in international palliative care education that can be replicated by other institutions.</div></div><div><h3>Methods</h3><div>We used a virtual case conference platform, in which two Family Medicine residents from CMU selected a challenging palliative care case. They prepared the case using an outline that included reflections on ethics, compassion and social responsibility. The residents presented the case in English to palliative care faculty from Thailand and Minnesota. Each case was followed by unstructured discussion.</div></div><div><h3>Results</h3><div>Over the course of 5.5 years (Nov 2018–Mar 2024), 14 cases were presented. Each case discussion included at least 3 to 7 core palliative care topics. The program was adopted as one of the core activities of the Department of Family Medicine at CMU and led to clinical practice changes.</div></div><div><h3>Conclusion</h3><div>We present a sustainable, convenient, low-cost, cross-cultural palliative care case conference model that has the potential to enrich palliative care education globally.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 3","pages":"Pages e200-e204"},"PeriodicalIF":3.2,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791940","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":"Identifying Factors Associated with Disparities in Accessing an Integrative Oncology Program","authors":"Noah Samuels MD ,&nbsp;Orit Gressel-Raz MD ,&nbsp;Nir Peled MD, PhD ,&nbsp;Nili Stein MPH ,&nbsp;Inbal Granot RN ,&nbsp;Eran Ben-Arye MD","doi":"10.1016/j.jpainsymman.2024.11.022","DOIUrl":"10.1016/j.jpainsymman.2024.11.022","url":null,"abstract":"<div><h3>Introduction</h3><div>Integrative oncology (IO) programs provide patients with evidence-based complementary medicine therapies within a supportive and palliative cancer care setting. This study retrospectively examined characteristics of patients with lung cancer predicting utilization of a freely-provided IO consultation at two medical centers in Israel.</div></div><div><h3>Methods</h3><div>Electronic medical files of 832 patients with lung cancer attending/not attending the IO consultation were searched for socio-demographic (age, gender, country of birth, place of residence, primary language spoken) and personal health (Body Mass Index; smoking; disability) characteristics; cancer-related parameters (primary tumor site, localized vs. metastatic); and reported pain- and emotional-related concerns.</div></div><div><h3>Results</h3><div>Only 120 (14.4%) of eligible patients attended the IO consultation, with multivariate analysis finding a significantly lower likelihood of attendance among patients who were older (OR: 0.98, 95% CI = 0.96-0.99; <em>P</em> = 0.02); male (OR: 0.53, 95% CI = 0.34-0.83; <em>P</em> = 0.005); primarily non Hebrew-speaking (i.e., primarily Arabic or Russian speakers; OR: 0.34, 95% CI = 0.14-0.82; <em>P</em> = 0.016); without disability (OR: 0.52, 95% CI = 0.33-0.92; <em>P</em> = 0.025); and not reporting pain (OR = 0.40,95% CI = 0.17-0.98-; <em>P</em> = 0.046).</div></div><div><h3>Conclusions</h3><div>The present study suggests that age, gender and culture-related factors (reflected by the patient's primary language) may contribute to disparities in accessing a freely-provided IO consultation, as shown in a diverse population of patients with lung cancer from two medical centers in Israel. Further research is needed to better understand the role of these programs within a diverse, equitable and inclusive setting of effective and safe integrative care of oncology patients.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 3","pages":"Pages e205-e210"},"PeriodicalIF":3.2,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791974","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":"Language Justice as Health Equity in Palliative Care: A Scoping Review","authors":"Sharon E. Bigger Ph.D., M.A., R.N., C.H.P.N., C.N.E. ,&nbsp;Daniela Obregon M.S., C.H.I. ,&nbsp;Christiana Keinath M.S.L.I.S. ,&nbsp;Katherine Doyon Ph.D., M.Ed., R.N., C.H.P.N.","doi":"10.1016/j.jpainsymman.2024.11.012","DOIUrl":"10.1016/j.jpainsymman.2024.11.012","url":null,"abstract":"<div><h3>Context</h3><div>Communication is the foundation of optimal healthcare provision. Linguistic diversity is a reality in palliative care settings.</div></div><div><h3>Objectives</h3><div>To identify the state of the literature on language interpreting in palliative care and to examine inclusion of stakeholders in dissemination products.</div></div><div><h3>Methods</h3><div>Our scoping review included three databases using search terms “advance care planning,” “goals of care,” “hospice care,” “palliative care,” combined with “communication barriers,” “interpreter,” and “translating.” We included original research, reports on tools or curricula, and opinion pieces. Four National Consensus Project (NCP) Guidelines were selected a priori to inform the coding schema. Health equity, specific to language justice, framed the study.</div></div><div><h3>Results</h3><div>In 31 included products, we identified four themes. Some reflected more than one theme: Language discordance as a communication barrier, gap, or challenge (n = 27), value added by qualified medical interpreters (n = 13), training for interpreters and palliative care professionals (n = 12), and inclusion of interpreters in the palliative care team (n = 9). All studies reflected at least one, and up to four, of the NCP guidelines. Eighteen products acknowledged language-based inequity, 8 described steps to mitigate language-based inequity, 3 described language-justice-based interventions associated with outcomes, and none described accomplishing language justice.</div></div><div><h3>Conclusion</h3><div>To provide equitable care reflecting language justice, investigators and clinicians should include interpreters, patients, and families as integral team members. The increase in number of interventional studies suggests evidence of the value interpreters add to the palliative care team. Collaborating with linguistically diverse stakeholders reflects language justice and holds promise for ensuring optimal communication.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 3","pages":"Pages 269-288"},"PeriodicalIF":3.2,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791937","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":"Using Human-Centered Design to Improve Serious Illness Care for Older Adults With Advanced Dementia","authors":"Lara Chehab MPH ,&nbsp;Sofia Weiss Goitiandia MA, MSc ,&nbsp;Lorraine Pereira BA ,&nbsp;Kevin Jung ,&nbsp;April Chen MD ,&nbsp;Devika Patel MS ,&nbsp;Julia Axelrod BA ,&nbsp;Lingsheng Li MD, MHS ,&nbsp;Ivor Williams ,&nbsp;Dan Dohan PhD ,&nbsp;Amanda Sammann MD, MPH ,&nbsp;Elizabeth Dzeng MD, PhD, MPH","doi":"10.1016/j.jpainsymman.2024.11.015","DOIUrl":"10.1016/j.jpainsymman.2024.11.015","url":null,"abstract":"<div><h3>Context</h3><div>Older adults with advanced dementia increasingly receive potentially non-beneficial, high-intensity life-sustaining treatments and goal-discordant care in the United States. Interventions to address this issue have shown limited success.</div></div><div><h3>Objectives</h3><div>To use human-centered design (HCD) with clinicians caring for older adults with advanced dementia to develop intervention ideas to reduce high-intensity, goal-discordant treatments near the end of life.</div></div><div><h3>Methods</h3><div>We used the first two steps of HCD, <em>inspiration,</em> and <em>ideation</em>, to understand clinicians’ perspectives regarding challenges in providing goal-concordant care for older adults with advanced dementia and to generate intervention ideas. In inspiration, we conducted in-depth interviews with clinicians caring for older adults with advanced dementia. We analyzed interviews using thematic analysis to identify themes and insights, which we synthesized into design opportunities using HCD. In ideation, we completed structured brainstorming sessions with study investigators, physicians, and designers to generate ideas for interventions at different healthcare system levels.</div></div><div><h3>Results</h3><div>During inspiration, we developed seven themes about clinicians’ experiences providing serious illness care for older adults with advanced dementia. We identified six instances where two or more themes were in tension. We synthesized these tensions into five insight statements capturing clinicians’ key challenges, which we reframed as three design opportunities. Brainstorming sessions conducted as part of ideation generated 132 solution ideas for these three opportunities, with participants selecting nine for testing.</div></div><div><h3>Conclusion</h3><div>The HCD process generated ideas at multiple healthcare system levels to address an enduring challenge in serious illness care by involving clinicians, researchers, and designers in intervention design.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 3","pages":"Pages e228-e239"},"PeriodicalIF":3.2,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of a Reiki Volunteer Program within Two Cancer Infusion Centers","authors":"Natalie L. Dyer PhD ,&nbsp;Samuel N. Rodgers-Melnick MPH, LPMT, MT-BC ,&nbsp;Karen E. Fink BSN, RN ,&nbsp;Santosh Rao MD ,&nbsp;Jessica Surdam MPH ,&nbsp;Jeffery A. Dusek PhD","doi":"10.1016/j.jpainsymman.2024.11.017","DOIUrl":"10.1016/j.jpainsymman.2024.11.017","url":null,"abstract":"<div><h3>Context</h3><div>Reiki is a biofield therapy from Japan currently used in many US hospitals. Evidence supports Reiki's effectiveness for addressing cancer and treatment-related symptoms such as pain and anxiety. However, no study to date has assessed changes in nausea following Reiki received during infusion treatments or assessed patients from multiple healthcare locations.</div></div><div><h3>Objectives</h3><div>To evaluate a Reiki program for outpatients with cancer and other chronic illnesses receiving infusion treatments (e.g., chemotherapy) at two University Hospitals infusion centers.</div></div><div><h3>Methods</h3><div>Participants in the outpatient infusion clinics completed Edmonton Symptom Assessment System measures of pain, fatigue, anxiety, nausea, and well-being before and after receiving a 15–20-minute Reiki session during their infusion. Data analysis included means and 95% confidence intervals (CI) of single-session effects on measures where the pre-session score was ≥1 and analysis of post-session comments.</div></div><div><h3>Results</h3><div>Between March 2022 and February 2024, 392 Reiki sessions were provided to 268 unique patients (mean age 63.3 ± 13.9, 57.5% female, 71.6% White, 26.5% Black/African American). Participants reported clinically significant mean [95% CI] improvements (≥1 unit) in pain (-1.78 [-2.38, -1.18]), fatigue (-1.33 [-1.85, -0.82]), anxiety (-2.09 [-2.68, -1.50]), nausea (-2.30 [-2.95. -1.62), and wellbeing (1.37 [0.95, 1.79]). Participants also commented that the Reiki session was a positive experience helpful for promoting relaxation and symptom reduction.</div></div><div><h3>Conclusions</h3><div>Outpatients receiving Reiki during infusion reported clinically significant improvements in all symptoms, high levels of satisfaction, and a qualitatively positive healing experience. More research is needed to assess long term changes following Reiki, including with an expanded program at additional healthcare locations.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 3","pages":"Pages e211-e219"},"PeriodicalIF":3.2,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755022","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":"Navigating Uncertainty during Family Meetings in the Pediatric Cardiac Intensive Care Unit: A Qualitative Investigation of Team Communication and Family Engagement","authors":"Colette Gramszlo PhD ,&nbsp;Arzu Cetin MS ,&nbsp;Jennifer K. Walter MD, PhD, MS","doi":"10.1016/j.jpainsymman.2024.11.014","DOIUrl":"10.1016/j.jpainsymman.2024.11.014","url":null,"abstract":"<div><h3>Context</h3><div>Uncertainty is a known barrier to effective communication during family meetings in the pediatric cardiac intensive care unit (CICU), however, limited data has characterized patterns of communication during these meetings, limiting our ability to make best practice recommendations to clinicians.</div></div><div><h3>Objectives</h3><div>To characterize how uncertainty is communicated by cardiac critical care teams during family meetings, to characterize family responses to uncertainty, and to explore how expressions of uncertainty impact specific responses.</div></div><div><h3>Methods</h3><div>We conducted a retrospective study of 58 family meetings recorded in a pediatric CICU. Participants were families of patients admitted to the CICU and members of the interprofessional CICU team. We coded uncertainty statements expressed by clinicians and family responses to uncertainty statements. Codes were extracted and analyzed for thematic content.</div></div><div><h3>Results</h3><div>We identified three themes around which clinicians expressed uncertainty: prognosis, treatment trajectories, and discharge planning. Expressions were most frequently unburied (62.3%) and implicit (66.5%). Five themes were identified within family responses to uncertainty: Brief acknowledgment (36.7%); clarification (30.0%); summary (12.3%); child information (12.3%); and emotions, preferences, and reflections (8.6%). Brief acknowledgements often followed lengthy, complex medical information provided by clinicians. Families often responded to implicitly communicated uncertainty by summarizing, clarifying, and providing additional details about their experiences, observations, and preferences.</div></div><div><h3>Conclusions</h3><div>Our results encourage clinicians to communicate uncertainty in an unburied and explicit manner, which may reduce the burden on families to engage in effective communication strategies, such as clarifying and summarizing opaquely stated information.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 3","pages":"Pages 261-268"},"PeriodicalIF":3.2,"publicationDate":"2024-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716519","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":"Large Language Models to Identify Advance Care Planning in Patients With Advanced Cancer","authors":"Nicole D. Agaronnik BS ,&nbsp;Joshua Davis BS ,&nbsp;Christopher R. Manz MD, MSHP ,&nbsp;James A. Tulsky MD ,&nbsp;Charlotta Lindvall MD, PhD","doi":"10.1016/j.jpainsymman.2024.11.016","DOIUrl":"10.1016/j.jpainsymman.2024.11.016","url":null,"abstract":"<div><h3>Context</h3><div>Efficiently tracking Advance Care Planning (ACP) documentation in electronic heath records (EHRs) is essential for quality improvement and research efforts. The use of large language models (LLMs) offers a novel approach to this task.</div></div><div><h3>Objectives</h3><div>To evaluate the ability of LLMs to identify ACP in EHRs for patients with advanced cancer and compare performance to gold-standard manual chart review and natural language processing (NLP).</div></div><div><h3>Methods</h3><div>EHRs from patients with advanced cancer followed at seven Dana Farber Cancer Center (DFCI) clinics in June 2024. We utilized GPT-4o-2024-05-13 within DFCI's HIPAA-secure digital infrastructure. We designed LLM prompts to identify ACP domains: goals of care, limitation of life-sustaining treatment, hospice, and palliative care. We developed a novel hallucination index to measure production of factually-incorrect evidence by the LLM. Performance was compared to gold-standard manual chart review and NLP.</div></div><div><h3>Results</h3><div>60 unique patients associated with 528 notes were used to construct the gold-standard data set. LLM prompts had sensitivity ranging from 0.85 to 1.0, specificity ranging from 0.80 to 0.91, and accuracy ranging from 0.81 to 0.91 across domains. The LLM had better sensitivity than NLP for identifying complex topics such as goals of care. Average hallucination index for notes identified by LLM was less than 0.5, indicating a low probability of hallucination. Despite lower precision compared to NLP, false positive documentation identified by LLMs was clinically-relevant and useful for guiding management.</div></div><div><h3>Conclusion</h3><div>LLMs can capture ACP domains from EHRs, with sensitivity exceeding NLP methods for complex domains such as goals of care. Future studies should explore approaches for scaling this methodology.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 3","pages":"Pages 243-250.e1"},"PeriodicalIF":3.2,"publicationDate":"2024-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716427","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}