Journal of pain and symptom management最新文献

{"title":"Quality of Virtual vs. In-Person Outpatient Palliative Care: Disparities by Language and Race","authors":"Sarah Nouri MD, MPH ,&nbsp;Steven Z. Pantilat MD ,&nbsp;Christine S. Ritchie MD, MSPH ,&nbsp;Courtney R. Lyles PhD ,&nbsp;Ying Shi PhD ,&nbsp;David O'Riordan PhD ,&nbsp;John Boscardin PhD ,&nbsp;Rebecca L. Sudore MD","doi":"10.1016/j.jpainsymman.2024.12.016","DOIUrl":"10.1016/j.jpainsymman.2024.12.016","url":null,"abstract":"<div><h3>Context</h3><div>Virtual visits have increased in outpatient, clinic-based palliative care (OPC). The association between virtual visits and OPC outcomes is largely unknown.</div></div><div><h3>Objectives</h3><div>(1) Examine the association between visit type (virtual vs. in-person) and screening (yes/no) for psychosocial, spiritual, and goals of care needs. (2) Assess effect modification by language.</div></div><div><h3>Methods</h3><div>We used data from the Palliative Care Quality Network (01/2017–03/2021). We conducted multivariable analyses adjusting for age, sex, diagnosis, self-reported race-ethnicity, and language, clustered by site, and included an interaction term to assess effect modification by language.</div></div><div><h3>Results</h3><div>Among 2684 patients, 29% had a virtual visit; 50% were ≥65 years old, 24% non-English preferred languages; 18% identified as Hispanic, 9% Black, 17% Asian, 6% Native Hawaiian/Pacific Islander. There were no differences by visit type in screening for psychosocial (aOR 0.87 vs. in-person visits, 95% CI 0.60–1.25), spiritual (aOR 0.81, 95% CI 0.57–1.15), or goals of care needs (aOR 1.05, 95% CI 0.85–1.31). Patients with non-English preferred languages (vs. English-speaking) had significantly lower odds of screening regardless of visit type. Patients identifying as Black (vs. White) also had significantly lower odds of screening.</div></div><div><h3>Conclusions</h3><div>There were no differences by visit type in screening for psychosocial, spiritual, and goals of care needs. Patients with preferred languages other than English were significantly less likely to be screened than English speakers, though there was no further difference by visit type. Patients identifying as Black were also significantly less likely to be screened. Addressing these disparities in core OPC elements is essential in providing equitable, high-quality OPC.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 4","pages":"Pages 385-392.e1"},"PeriodicalIF":3.2,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932180","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":"Perspectives on Implementing a Communication Facilitator Intervention From a Critical Care Setting","authors":"Jennifer Im MSc ,&nbsp;Erin Abu-Rish Blakeney PhD ,&nbsp;Danae Dotolo PhD ,&nbsp;Anna Ungar MPH ,&nbsp;Rebecca Barton MSN ,&nbsp;Bryan J. Weiner PhD ,&nbsp;Kathryn I. Pollak PhD ,&nbsp;Elizabeth Nielsen MPH ,&nbsp;Lisa Hudson BSN ,&nbsp;Nancy Kentish-Barnes PhD ,&nbsp;Claire Creutzfeldt MD ,&nbsp;Ruth A. Engelberg PhD ,&nbsp;J. Randall Curtis MD, MPH","doi":"10.1016/j.jpainsymman.2024.12.020","DOIUrl":"10.1016/j.jpainsymman.2024.12.020","url":null,"abstract":"<div><h3>Context</h3><div>Critically-ill patients and their families often experience communication challenges during their ICU stay and across care transitions. An intervention using communication facilitators may help address these challenges.</div></div><div><h3>Objectives</h3><div>Using clinicians’ perspectives, we identified facilitators and barriers to implementing a communication intervention.</div></div><div><h3>Methods</h3><div>Using purposive sampling, we conducted semi-structured interviews with 17 clinicians from an intensive care unit at an academic health center that participated in a randomized trial of communication facilitators. We used the Consolidated Framework for Implementation Research (CFIR) to guide data collection and analysis.</div></div><div><h3>Results</h3><div>CFIR constructs of relative advantage, communication, and critical incidents facilitated the intervention's implementation. CFIR constructs of access to knowledge and information, relational connections, and clinician knowledge and belief hindered its implementation. Clinicians reported that facilitators provided continuity to patients and families, support in a trusting and proactive manner over transitions of care, and bridged communication between families and clinicians particularly during the Covid-19 pandemic. Limited information about the intervention prevented clinicians from working with facilitators earlier in the course of the intervention. Differences in beliefs regarding facilitator involvement during family meetings also hampered the intervention's implementation.</div></div><div><h3>Conclusions</h3><div>Future studies should incorporate implementation strategies that help connect facilitators to clinicians early in the intervention period which may improve role clarity and enhance collaboration.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 4","pages":"Pages 361-369.e4"},"PeriodicalIF":3.2,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927423","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":"How is Telehealth Used to Increase Access to Specialty Palliative Care? A Systematic Review","authors":"Rebecca N. Hutchinson M.D., M.P.H. ,&nbsp;Eric J. Chiu B.S. ,&nbsp;Shane C. Belin B.S. ,&nbsp;Michele Klein- Fedyshin M.S.L.S., B.A., B.S.N., R.N., A.H.I.P., F.M.L.A. ,&nbsp;Carolyn R. Impagliazzo M.P.H. ,&nbsp;Lucia Costanza B.A. ,&nbsp;Joshua Passarelli B.S. ,&nbsp;Pooja P. Patel M.S., M.P.H. ,&nbsp;Sumedha Sahay B.S., M.S. ,&nbsp;Allison Shen M.D. ,&nbsp;Vladislav Razskazovskiy B.S. ,&nbsp;Yael Schenker M.D., M.A.S., F.A.A.H.P.M.","doi":"10.1016/j.jpainsymman.2024.12.017","DOIUrl":"10.1016/j.jpainsymman.2024.12.017","url":null,"abstract":"<div><h3>Context</h3><div>Specialty palliative care remains inaccessible for many with serious illness, especially in rural areas. Telehealth may be one solution.</div></div><div><h3>Objectives</h3><div>To describe how telehealth increases access to specialty palliative care, describe facilitators and barriers to its use, and summarize evidence of patient benefits.</div></div><div><h3>Methods</h3><div>We conducted a systematic review using database-specific vocabulary and Boolean logic focusing on concepts “telemedicine,” “remote consultation,” “palliative medicine,” and “hospice care.” Included articles described original research evaluating a telehealth intervention addressing ≥2 National Consensus Project for Quality Palliative Care domains. Two researchers reviewed and abstracted articles; disagreements were resolved by consensus.</div></div><div><h3>Results</h3><div>Of 13,928 articles identified, 150 were eligible. Of these, 112 involved telemedicine (direct care from a clinician to a patient); 15 involved tele coaching (connection of non-palliative care clinician with a palliative care specialist to increase primary palliative care skills); 16 involved e-health (an app to monitor symptoms); and 7 involved e-consults (connection to a palliative care clinician to advise on a particular case). About two-thirds (65%) of articles were published since 2020. Common barriers included broadband issues, lack of familiarity with technology, and lack of access to a device. Facilitators included having a technology-skilled assistant and providing a device. Few studies assessed patient outcomes.</div></div><div><h3>Conclusion</h3><div>While telehealth is widely used to increase access to specialty palliative care, more evidence is needed to evaluate effectiveness. Further research is needed to understand how to overcome barriers prominent in rural settings and to optimize integration of multiple modalities of telehealth in specialty palliative care.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 4","pages":"Pages e303-e314"},"PeriodicalIF":3.2,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927361","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":"Complementary and Alternative Medicine Use in the Last Year of Life: The COMPASS Cancer Cohort Study","authors":"Irene Teo PhD ,&nbsp;Michelle Chow BSc ,&nbsp;Isha Chaudhry MSc ,&nbsp;Chetna Malhotra MBBS MD, MPH ,&nbsp;Semra Ozdemir PhD ,&nbsp;Eric A. Finkelstein PhD","doi":"10.1016/j.jpainsymman.2024.12.022","DOIUrl":"10.1016/j.jpainsymman.2024.12.022","url":null,"abstract":"<div><h3>Context</h3><div>There has been growing interest in the role of complementary and alternative medicine (CAM) as part of end-of-life care.</div></div><div><h3>Objectives</h3><div>This study prospectively examined the prevalence, predictors and outcomes of ingestible CAM use among cancer patients in their last year of life in Singapore.</div></div><div><h3>Methods</h3><div>This study (N = 427) utilized data across 12 months (four time points) prior to patient death. Utilizing mixed effects logistic regressions, we examined sociodemographic, clinical (symptom burden) and treatment-related factors associated with CAM use. Subsequently, the association between patient quality of life (i.e., physical, social, emotional, functional well-being) and CAM use were examined.</div></div><div><h3>Results</h3><div>Half of the patients (50%) reported using CAM at least once in the last year of life while 36% of patients reported using CAM in the last 3 months of life. Among CAM users, 67% reported using western herbal supplements while 56% reported using traditional Chinese medicine. Further, 27–28% of patients used CAM consistently (i.e., for six months or more). Most patients (73%) reported using CAM as a complementary treatment. Patients who were ethnically Chinese (OR: 5.59, 95% <em>CI</em>: 2.29–13.69), reported less financial difficulties (OR: 0.82, 95% <em>CI</em>: 0.69–0.98), and believed in other curative treatments for cancer (OR: 2.39, 95% <em>CI</em>: 1.00–5.70) were more likely to use CAM. Controlling for time, CAM use (<em>β:</em> 0.60, <em>CI</em>: 0.01–1.19) was associated with higher social well-being.</div></div><div><h3>Conclusions</h3><div>A significant proportion of terminal cancer patients reported using CAM as a complementary treatment in the last year of life.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 4","pages":"Pages e257-e264"},"PeriodicalIF":3.2,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927283","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":"Should an Acute Palliative Care Unit be Mandatory for Cancer Centers and Tertiary Care Hospitals?","authors":"Sebastiano Mercadante MD ,&nbsp;Camilla Zimmermann MD, MPH, PhD ,&nbsp;Jenny Lau MD, MSc ,&nbsp;Declan Walsh MD","doi":"10.1016/j.jpainsymman.2024.10.010","DOIUrl":"10.1016/j.jpainsymman.2024.10.010","url":null,"abstract":"<div><div>Acute palliative care units have been developing in the last years and their clinical activity and characteristics have been described, despite large differences in different countries. One controversial topic is whether such units should be mandatory as standard in comprehensive cancer centers or even in tertiary hospitals.</div><div>In this “Controversies in Palliative Care” article, three expert clinicians independently answer this question. Specifically, each group provides a synopsis of the key studies that inform their thought processes, share practical advice on their clinical approach, and highlight the opportunities for future research. Interestingly, all three experts arrived at similar conclusions. They underscored the importance of an acute palliative care unit, which provides a different pattern of activities in comparison with typical inpatient hospices, generally caring for patients who have a limited expected survival</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 1","pages":"Pages e70-e77"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468138","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":"Essential Advance Care Planning Intervention Features in Low-Income Communities: A Qualitative Study","authors":"Christine C. Kimpel PhD, RN, MA ,&nbsp;Erica Frechman PhD, AGPCNP-BC, ACHPN, NEA-BC, FPCN ,&nbsp;Lorely Chavez MPH ,&nbsp;Cathy A. Maxwell PhD, RN, FAAN","doi":"10.1016/j.jpainsymman.2024.09.018","DOIUrl":"10.1016/j.jpainsymman.2024.09.018","url":null,"abstract":"<div><h3>Context</h3><div>Older adults with low socioeconomic status (SES) participate in advance care planning (ACP) at lower rates than those with higher SES. Community feedback is an essential component of intervention design for communities with fewer social and health resources to ensure that the intervention is relevant and meaningful.</div></div><div><h3>Objectives</h3><div>To understand the perspectives for potential interventions, we aimed to qualitatively explore participant priorities for ACP intervention development.</div></div><div><h3>Methods</h3><div>Using a qualitative descriptive design, we recruited and conducted individual and one-time, semi-structured interviews with older adults (aged 50+) with low income (&lt; $20,000/year) (n = 20), Recruitment methods included flyers and in-person recruitment and purposive and snowball sampling methods. Following a thematic analysis plan, themes emerged from recursive transcript review by two independent coders and inductive categorization of the most robust codes.</div></div><div><h3>Results</h3><div>Two themes captured participants’ perspectives regarding ACP intervention development: 1) specialist advocacy and reliability and 2) person-centered communication. Older adults with low SES prioritize ACP communication that is driven by their goals and that is led by trustworthy specialists that advocate for their needs.</div></div><div><h3>Conclusion</h3><div>Our work highlights that intervention preferences were informed by the prior strain and struggle of waiting on other kinds of health and social services. We propose an adapted model for community research collaboration to promote equity in addition to practice and policy recommendations.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 1","pages":"Pages e46-e52"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11659033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348666","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":"One Stone, Two Birds: Response to Letter to the Editor by Gurunthalingam et al.","authors":"Wenting Xu MD ,&nbsp;Lin Wang MD ,&nbsp;Cheng Tan MD, PhD","doi":"10.1016/j.jpainsymman.2024.10.019","DOIUrl":"10.1016/j.jpainsymman.2024.10.019","url":null,"abstract":"","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 1","pages":"Pages e100-e102"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142558007","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":"Advance Care Planning Bundle: Using Technical and Adaptive Solutions to Promote Goal Concordant Care","authors":"Sara Brigham DO ,&nbsp;Lori Olson MD, FACP ,&nbsp;Jessica Kalender-Rich MD ,&nbsp;Ben Skoch DO, MBA ,&nbsp;Joanna Veazey Brooks MBE, PhD ,&nbsp;Casey Pickering MS, MHSA, RN, CCRN ,&nbsp;Dustin Pierce RN, CPHQ ,&nbsp;Angella Herrman BSN, RN, NI-BC ,&nbsp;Maritza Campos MSN, RN, NI-BC ,&nbsp;Randa Hallock RN, MSN ,&nbsp;Karin Porter-Williamson MD, FAAHPM","doi":"10.1016/j.jpainsymman.2024.09.014","DOIUrl":"10.1016/j.jpainsymman.2024.09.014","url":null,"abstract":"<div><h3>Background</h3><div>Advance Care Planning (ACP) is critical to achieve goal-aligned care for patients. However, optimal implementation requires complex coordination and alignment across a healthcare system.</div></div><div><h3>Measures</h3><div>A survey of rapid response providers assessed usefulness of the ACP quality improvement bundle and perceptions of use and adherence.</div></div><div><h3>Intervention</h3><div>We implemented a bundle of advance care planning tools and interventions using the technical-adaptive framework. These included orders, documentation templates and processes, and standard education.</div></div><div><h3>Outcomes</h3><div>Ninety-three rapid response providers completed the survey. 80.5% reported that overall, these quality improvement efforts have been very helpful or somewhat helpful in improving their ability to provide care consistent with the patient's goals.</div></div><div><h3>Conclusions/Lessons Learned</h3><div>Implementation of technical and adaptive tools as a bundle for Advance Care Planning shows promise to improve and sustain goal-aligned care. Quality Improvement in ACP is a complex, iterative process involving both structural change and behavioral adaptation.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 1","pages":"Pages e53-e60"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289572","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":"Developing a Scale for Home-Visit Nurses to Start End-of-life Discussions with Cancer Patients","authors":"Kurumi Asaumi RN, PhD ,&nbsp;Masataka Oki RN, PhD ,&nbsp;Wataru Ohashi PhD","doi":"10.1016/j.jpainsymman.2024.09.003","DOIUrl":"10.1016/j.jpainsymman.2024.09.003","url":null,"abstract":"<div><h3>Context</h3><div>Home-visit nurses find it challenging to determine the appropriate time to initiate end-of-life discussions with cancer patients.</div></div><div><h3>Objective</h3><div>This study aimed to develop the Timing of End-of-Life Discussions (T-EOLD) scale to help home-visit nurses determine the appropriate time to initiate end-of-life discussions with cancer patients and to test its reliability and validity.</div></div><div><h3>Methods</h3><div>The scale items were developed based on qualitative data extracted from interviews, literature reviews, and expert panel discussions. We conducted a preliminary study involving 93 home-visit nurses and evaluated the construct validity, consistency, and test-retest reliability of the scale. Finally, using a sample of 234 home-visit nurses, we conducted the primary study and assessed the construct validity and scale consistency.</div></div><div><h3>Results</h3><div>A total of 41 items were initially developed. Floor effect, item-total correlation, good-poor, and exploratory factor analysis in the preliminary and primary studies yielded a three-factor, 16-item model. The model's goodness-of-fit was CFI = 0.94, GFI = 0.90, AGFI = 0.87, and RMSEA = 0.06. Cronbach's alpha for the overall scale was 0.91.</div></div><div><h3>Conclusions</h3><div>The reliability and validity of the T-EOLD is acceptable, as it is an appropriate scale that home-visit nurses can use to determine the time to initiate end-of-life discussions with cancer patients. However, further study is required to examine T-EOLD's clinical utility, both nationally and internationally.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 1","pages":"Pages 1-9.e1"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289573","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":"Parental Attitudes Towards Palliative Care in Pediatric Oncology: Insights From Bereaved Families","authors":"Isaac Martinez BA ,&nbsp;Elizabeth S. Davis MSPH ,&nbsp;Courtney E. Wimberly MS ,&nbsp;Lisa Towry M.Ed ,&nbsp;Emily E. Johnston MD, MS ,&nbsp;Kyle M. Walsh PhD","doi":"10.1016/j.jpainsymman.2024.09.001","DOIUrl":"10.1016/j.jpainsymman.2024.09.001","url":null,"abstract":"<div><h3>Context</h3><div>Palliative care (PC) has shown significant growth in the US and is associated with improved patient and caregiver experiences. Nevertheless, there are concerns that PC is underutilized in pediatric oncology. Understanding parental attitudes towards PC is crucial to improving PC utilization.</div></div><div><h3>Objectives</h3><div>This study aimed to explore bereaved parent attitudes towards PC in pediatric oncology.</div></div><div><h3>Methods</h3><div>This study used data from Alex's Lemonade Stand: My Childhood Cancer Bereavement Survey. The survey included questions regarding bereaved parents' attitudes towards PC.</div></div><div><h3>Results</h3><div>The survey included 72 bereaved families. Parents completed the survey a median of 11 years after their child's death. PC was involved in 71% of cases. These families were more likely to have do not resuscitate (DNR) orders, an advanced care plan, hospice care, a planned death location, and for their child to die outside the hospital. Although most parents (86%) agreed that it is a doctor's obligation to inform all patients with cancer about PC. PC referrals appeared to happen later than parents preferred. Lack of PC involvement was primarily due to PC not being offered or sudden death of the child.</div></div><div><h3>Conclusions</h3><div>Parental hesitancy should not be viewed as a barrier to PC involvement. Although parents held mixed attitudes about PC, families accepted PC, desired earlier referrals, and believed it was a doctor's obligation to offer PC. These findings highlight the need for timely PC referrals, improved education, and increased awareness of PC services to enhance the integration of PC in pediatric oncology.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 1","pages":"Pages e27-e36"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289577","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}