Journal of pain and symptom management最新文献

{"title":"Infusion of Sound: Personalized Receptive Music-Based Interventions During Infusion Sessions","authors":"Claire Lin BS, Diana Wang BA, Ishaani Khatri BS, Fred Schiffman MC MACP, Dana Guyer MD","doi":"10.1016/j.jpainsymman.2025.02.072","DOIUrl":"10.1016/j.jpainsymman.2025.02.072","url":null,"abstract":"<div><h3>Outcomes</h3><div>1. Participants will be able to analyze the impact of personalized music on managing physical symptoms (such as pain, anxiety, and nausea) and vital signs (heart rate and blood pressure) in oncology patients, and apply these insights to enhance patient care strategies.</div><div>2. Participants will be able to evaluate the emotional and psychological benefits of music interventions—such as increased resilience, relaxation, and spiritual comfort—and integrate these interventions into oncology settings to foster a healing-centered patient environment.</div></div><div><h3>Key Message</h3><div>We evaluated the benefits of personalized receptive music-based interventions (rMBIs) for patients receiving infusions for various indications. Our results highlight the efficacy of personalized rMBIs in managing symptom burden and improving overall well-being in patients receiving infusions. We encourage the utilization of personalized rMBIs as a non-pharmacological form of palliation, as they contribute to the creation of a healing-centered space.</div></div><div><h3>Abstract</h3><div>Non-pharmacological methods to manage symptoms associated with cancer and its treatments, including receptive music-based interventions (rMBIs), have gained traction due to their limited adverse effects and beneficial impact (1). rMBIs serve as an outlet to express emotions and lead to increased feelings of resilience, promoting endurance through treatment (2). Despite these benefits, implementation of personalized rMBIs in the infusion setting remains limited.</div></div><div><h3>Objectives</h3><div>This study provided patients at an academic community hospital with a personalized rMBI during their infusion session and measured changes in symptoms and vitals to assess intervention efficacy.</div></div><div><h3>Methods</h3><div>This is a self-controlled case series among patients receiving infusion therapy at a single institution. The rMBI involved listening to a 30-minute personalized Spotify playlist. Outcomes include vitals and symptom burden (measured with Edmonton Symptom Assessment Scale, ESAS) pre- and postrMBI; changes were analyzed with paired t-tests. Post-rMBI, patient reflections were collected and analyzed with a rapid qualitative analysis approach.</div></div><div><h3>Results</h3><div>50 participants were recruited. The indication for infusion was 50% for solid malignancy, 22% for hematologic malignancy, 12% for cytopenia, 8% for autoimmune conditions, and 8% for hydration. From the ESAS, rMBI led to significant decreases in pain (<em>p</em> = 0.006), tiredness (<em>p</em> = 2.576e-06), drowsiness (<em>p</em> = 0.046), anxiety (<em>p</em> = 0.002), nausea (<em>p</em> = 0.006), poor appetite (<em>p</em> = 0.037), and shortness of breath (<em>p</em> = 0.0007), and a significant increase in feelings of well-being (<em>p</em> = 4.936e-07). Heart rate (<em>p</em> = 2.158e-05) and systolic blood pressure (<em>p</em> = 0.01) also decreased post-","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 5","pages":"Pages e455-e456"},"PeriodicalIF":3.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143807170","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":"Developing an Advance Care Planning Resource for Transgender and Gender-Diverse Adults","authors":"Lauren Catlett MSN RN CNL","doi":"10.1016/j.jpainsymman.2025.02.035","DOIUrl":"10.1016/j.jpainsymman.2025.02.035","url":null,"abstract":"<div><h3>Outcomes</h3><div>1. After participating in this session, attendees should be able to identify at least two ways that advance care planning can help transgender and gender-diverse adults prepare for care in later life or during a serious illness.</div><div>2. After participating in this session, attendees should be able to implement at least one strategy to facilitate advance care planning among transgender and gender-diverse adults.</div></div><div><h3>Key Message</h3><div>A participatory approach was used to develop an advance care planning resource for transgender and gender-diverse (TGD) adults. The resource was designed to support TGD adults in making informed healthcare decisions and communicating with health professionals about their wishes for care in later life or during a serious illness.</div></div><div><h3>Abstract</h3><div>Transgender and gender-diverse (TGD) adults may face barriers like discrimination and marginalization within the U.S. healthcare system, compromising their access to competent and compassionate care (1). Moreover, few resources directly address issues central to the care of TGD adults in later life or during a serious illness (2). Further study is needed to develop advance care planning (ACP) resources that promote the agency of TGD adults within the healthcare system while centering their knowledge and lived experiences (3).</div></div><div><h3>Objectives</h3><div>The purpose of this study was to develop an ACP resource for TGD adults using a participatory approach.</div></div><div><h3>Methods</h3><div>This study was conducted between October 2023 and October 2024 and used qualitative descriptive methodology (4) informed by human-centered design principles (5). During semi-structured interviews, TGD adults aged 50 years old and older generated ideas for ACP resources to address challenges they may face in later life or during a serious illness. Subsequently, participants engaged in virtual group sessions focused on developing an ACP resource. Prototypes of the resource were reviewed iteratively by individuals with relevant professional and lived experience. Data were analyzed using thematic analysis.</div></div><div><h3>Results</h3><div>Twenty TGD adults from diverse racial and ethnic backgrounds participated in this study. Four themes and 16 ACP resource ideas were identified. One resource idea was developed into a user-friendly electronic healthcare decisions resource for TGD adults designed to facilitate shared decision-making with health professionals involved in their care. Participants envisioned the resource as part of a package of resources to help TGD adults prepare for their healthcare in later life or during a serious illness.</div></div><div><h3>Conclusion</h3><div>An ACP resource was co-developed by researchers and TGD adults to fill a gap in healthcare resources for this population. Using an innovative approach, this study foregrounds continued development of ACP resources in future communit","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 5","pages":"Pages e428-e429"},"PeriodicalIF":3.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143807028","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":"Scholarly Peer Review for the Busy Clinician","authors":"David Casarett MD MA FAAHPM,&nbsp;Lisa Pelzek-Braun MHA,&nbsp;Christopher Jones MD MBA CPC FAAHPM","doi":"10.1016/j.jpainsymman.2025.02.038","DOIUrl":"10.1016/j.jpainsymman.2025.02.038","url":null,"abstract":"<div><h3>Outcomes</h3><div>1. Describe the role of a peer reviewer in the publication process.</div><div>2. Summarize the components of Major and Minor Concerns and choose the appropriate Final Recommendation to share with editors.</div></div><div><h3>Key Message</h3><div>This session, presented by editors-in-chief of two major North American palliative care journals, will teach attendees how to perform high-quality Peer Review. Serving as a Peer Reviewer allows practicing clinicians a way to shape palliative care's body of research to ensure cutting edge care for our patients.</div></div><div><h3>Abstract</h3><div>As hospice and palliative care has grown over the last two decades, a literature base to inform the work of our front-line clinicians has been developed. Unfortunately, clinical research, even in HPM, often happens far from the bedside. Many clinicians want to participate in research but busy clinical roles and a lack of training in research methods and grant writing can present obstacles that may seem insurmountable (1). How then can practicing clinicians influence the cutting-edge care that research defines? In this session, the Editor-in-Chief and Managing Editor of the Journal of Palliative Medicine and the Editor-in-Chief of The Journal of Pain &amp; Symptom Management will prepare participants to become Peer Reviewers. The session will begin with a brief overview of academic publishing, including open access and subscription models, impact factors, and the complex process that takes a paper from submitted manuscript to final published paper. Core tenets of peer review, including timeliness, confidentiality, and constructive unbiased evaluation, will be shared. Attendees will then be taken through the elements of Peer Review, including first impressions, summarizing the paper, and describing Major and Minor Concerns. In addition, the implications of final recommendation (Accept/Minor Revision/Major Revision/Reject) will be discussed. Lastly, attendees will review several excerpts in small groups from past submitted manuscripts to find opportunities for authors to improve their papers. This session will offer attendees the opportunity to power the academic engine that drives our field forward, an engine that functions better when front-line clinicians help to steer the car.</div></div><div><h3>References</h3><div>1. Kelly J, Sadeghieh T, Adeli K. Peer Review in Scientific Publications: Benefits, Critiques, &amp; A Survival Guide. EJIFCC. 2014;25(3):227-243. Published 2014 Oct 24.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 5","pages":"Pages e430-e431"},"PeriodicalIF":3.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143807472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Palliative Story Exchange: Narrative Medicine and the Humanities","authors":"Richard Leiter MD MA,&nbsp;Rachel Rusch LCSW MSW MA APHSW-C,&nbsp;Alexis Drutchas MD","doi":"10.1016/j.jpainsymman.2025.02.044","DOIUrl":"10.1016/j.jpainsymman.2025.02.044","url":null,"abstract":"<div><h3>Outcomes</h3><div>1. Recognize how storytelling and narrative interventions foster meaning making and cultivate sustainability among palliative care professionals.</div><div>2. Participate in a live, in-person storytelling event focusing on authentic vulnerability, deep listening, and interprofessional connection.</div></div><div><h3>Abstract</h3><div>Palliative care (PC) faces a workforce crisis. Seriously ill patients surpass the supply of PC clinicians, and in their work, clinicians face repeated loss and extreme suffering which can lead to burnout and attrition. We urgently need interventions that foster thriving communities in this emotionally complex environment. Storytelling represents a promising path forward. In response to widespread loneliness and moral distress among PC clinicians, we created The Palliative Story Exchange (PSE), a storytelling intervention to build community, decrease isolation, and help clinicians rediscover the shared meaning in their work.</div></div><div><h3>Methods/approach</h3><div>Attendees will participate in a Palliative Story Exchange. In this session, volunteer storytellers will share personal stories about moments that they “are holding onto,” either from work or from at home. After each story, the facilitators will lead an interactive reflection with the group.</div></div><div><h3>Results</h3><div>To date, 84 interprofessional participants from practice locations across 10 different countries have completed a program evaluation survey. Responses demonstrate an increase in the connection that participants felt towards their work and the larger palliative care community after attending a PSE. Further, more than half of all free-text responses include terms such as, “meaningful,” “healing,” “powerful,” and “universal,” to describe their participation.</div></div><div><h3>Conclusions</h3><div>The PSE builds upon narrative medicine and healthcare worker wellness initiatives through a novel combination of storytelling, community co-creation using reflection, and shared meaning making. Initial survey data demonstrates that after attending a PSE, participants feel increased meaning in their work, in the significance of their own stories, and connection with the PC community.</div></div><div><h3>Reference</h3><div>Drutchas A, Rusch R, and Leiter R. The Palliative Story Exchange: An innovative storytelling intervention to build community, foster shared meaning, and improve sustainability. Palliative and Supportive Care. In press.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 5","pages":"Page e435"},"PeriodicalIF":3.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143807477","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":"Considering Inpatient Antibiotic Use at End of Life for Children With Cancer","authors":"Holly Spraker-Perlman MD,&nbsp;Gabriela Maron MD MS,&nbsp;Elizabeth Swift MSN CPNP-AC,&nbsp;Cynthia Marrero Sepulveda MD MS,&nbsp;Deena Levine MD FAAHPM","doi":"10.1016/j.jpainsymman.2025.02.066","DOIUrl":"10.1016/j.jpainsymman.2025.02.066","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;1. Recognize the prevalence of antibiotic use for children with cancer at end of life.&lt;/div&gt;&lt;div&gt;2. Understand the importance of re-addressing treatment choices, including antibiotic use, to reduce suffering and improve goal concordant care for children dying from cancer.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Key Message&lt;/h3&gt;&lt;div&gt;Children with cancer who die from their disease, or its complications often die in the inpatient setting, frequently receiving antibiotics at end of life. In some cases, antibiotics may prolong the dying process or contribute to suffering and may not be consistent with goal-concordant care. Though nuanced, communication surrounding use of antibiotics at end of life is critical.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Abstract&lt;/h3&gt;&lt;div&gt;Despite efforts to enhance end-of-life (EOL) care for cancer patients through decreased utilization of aggressive medical treatments and hospital-based services (1,2) including curbing antibiotics at EOL to promote stewardship (3,4), 87% of hospitalized adult cancer patients studied received antibiotics in the last week of life, while &lt; 50% had a documented infection.(5) Many children with advanced cancer die in the inpatient setting, and despite best efforts to provide goal-concordant care, antibiotic use might not be addressed due to population-based routine use of antibiotics for prophylaxis and empiric treatment, healthcare practitioners beliefs and/or discomfort with EOL communication to facilitate shared decision-making. Better understanding of antibiotic prescription practices for children with cancer nearing EOL is essential to inform guidelines for best practices.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;div&gt;To improve communication and documentation around antibiotic use at EOL to promote goal-concordant care, we aim to describe antibiotic use in children nearing EOL at an academic children's cancer center.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Through retrospective chart review, data was abstracted for children with malignancy experiencing inpatient death to determine the incidence of antibiotic, antiviral, and antifungal use in the last 2 weeks of life. Prescription and microbiological data were correlated to determine presence of infection. Progress notes were reviewed to determine if discussion surrounding antibiotic utilization was documented either by the Palliative Care (PC) or Infectious Disease (ID) teams. Patient demographics, disease and EOL variables were also compiled.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Over a 10-year period 303 children died inpatient with 73.6% (n=223) receiving antibiotics at EOL. Most antibiotics were given without evidence of infection (65.9% with negative ID testing). Patients concurrently received 1-5 antibiotics at time of death. Seventy-nine patients (26%) had documented discussions regarding changing or discontinuing antimicrobials.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;The use of antibiotics at the EOL for children with cancer is prevalent. Standardi","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 5","pages":"Page e451"},"PeriodicalIF":3.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143806988","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":"Relationship Between Clinician Empathy and Perceived Racial Discrimination in Simulated Encounters","authors":"Nicoy Downie MD,&nbsp;Keonna Hyacinth BS,&nbsp;Rachel Aideyan BS,&nbsp;Elizabeth Chuang MD MPH","doi":"10.1016/j.jpainsymman.2025.02.060","DOIUrl":"10.1016/j.jpainsymman.2025.02.060","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;1. Identify the importance of reducing clinician implicit bias in the end-of-life setting.&lt;/div&gt;&lt;div&gt;2. Identify key limitations in the understanding of empathy and its relationship to communication in the end-of-life setting.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Key Message&lt;/h3&gt;&lt;div&gt;Clinician implicit bias causes decreased quality of communication in end of life (EOL) care for minoritized patients. Implicit bias is mitigated by perspective-taking which may increase empathy for the outgroup. This small study did not show a relationship between physician empathy and perceived discrimination during a standardized EOL communication. Understanding the relationship between empathy and communication requires more targeted measurement.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Abstract&lt;/h3&gt;&lt;div&gt;Physician implicit racial bias can result in poor communication patterns and inequitable end-of-life (EOL) care. Perspective-taking is a key component of evidence-based bias mitigation strategies. It may function by increasing empathy towards the outgroup. However, the effect of empathy on patient and family outcomes remains unknown.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;div&gt;To assess the relationship between physicians’ empathy and perceived racial discrimination and communication in simulated encounters with Black standardized caregivers.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Physicians caring for seriously ill patients in the hospital completed a simulated encounter with a Black standardized caregiver (patient's daughter). Physicians’ empathy was assessed using the Interpersonal Reactivity Index (IRI) and physicians self-reported their communication skill level. Standardized caregivers completed the Discrimination in Medical Settings and CollaborRATE scales to measure perceived discrimination and communication. We used general linear modeling to evaluate these relationships controlling for physician gender, race, ethnicity and specialty.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Forty-two physicians were included. 22 were women (52%), 15 internists (36%), 14 intensivists (33%) and 7 oncologists (17%). Most were White (23, 55%) or Asian (15, 36%). Four identified as Hispanic (10%). There was a weak correlation (&lt;em&gt;r&lt;/em&gt; = 0.24, &lt;em&gt;P&lt;/em&gt; = 0.12) between physician empathy and CollaborRATE scores. There were no correlations between physician empathy and perceived discrimination (&lt;em&gt;r&lt;/em&gt; = 0.12, &lt;em&gt;P&lt;/em&gt; = 0.44) or between physician self-reported communication skills and perceived discrimination (&lt;em&gt;r&lt;/em&gt; = -0.05, &lt;em&gt;P&lt;/em&gt; = 0.74) or CollaborRATE score (&lt;em&gt;r&lt;/em&gt; = 0.01, &lt;em&gt;P&lt;/em&gt; = 0.94). These results did not change when controlling for potential confounders.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;The lack of correlation between empathy and perceived discrimination does not support empathy as a key target for reducing the effects of implicit bias. However, this study is limited by the small sample size and measurement of global empathy rather than empathy towards a s","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 5","pages":"Pages e446-e447"},"PeriodicalIF":3.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143807133","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":"HIV in Young Adulthood: Leveraging Palliative Care to Address Disparities and Goals","authors":"Ella Sorscher MD MBE,&nbsp;Khaliah Johnson MD,&nbsp;Victor Cornett LMSW","doi":"10.1016/j.jpainsymman.2025.02.027","DOIUrl":"10.1016/j.jpainsymman.2025.02.027","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;1. Utilizing this case-based approach, participants will self-report the ability to analyze and evaluate social barriers to access to and engagement with therapies for pediatric and young adult patients with Human Immunodeficiency Virus in the United States.&lt;/div&gt;&lt;div&gt;2. Applying the case discussion, participants will self-report the ability to help enhance patient engagement in comprehensive, outpatient HIV treatment—including medication adherence—through identifying goals and minimizing suffering.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Key Message&lt;/h3&gt;&lt;div&gt;Young patients with HIV/AIDS from historically marginalized backgrounds are vulnerable due to social marginalization and are less likely to benefit from therapeutic advancements. Even when able to engage in treatment, they are at increased risk for long-term sequelae, high symptom burden, and shortened life span. Integrated, outpatient palliative care for pediatric patients with HIV supports goals throughout disease trajectory.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Abstract&lt;/h3&gt;&lt;div&gt;Youth with advanced Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS) in the United States face stigma and socio-economic barriers to access antiretroviral therapy (ART), leading to increased morbidity and mortality. Outpatient palliative care integrated into a pediatric HIV clinic is uniquely situated to foster trust in the medical system, minimize suffering, and boost ART adherence.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Case Description&lt;/h3&gt;&lt;div&gt;DP is a 24-year-old man with a history of HIV/AIDS, incarceration, depression, sexual abuse, and housing instability. His HIV has been complicated by challenges to adherence; AIDS-defining illnesses; and progressive, severe neuropathy. Our outpatient palliative care team was introduced to DP after multiple hospitalizations for HIV-related complications in the setting of DP not taking ART. Over several visits, we elicited his hope to pursue an independent life, currently stymied by neuropathic pain that left him largely bed-bound, dependent, and isolated. Characterizing his goals increased DP's trust with the medical team and adherence to ART. Despite these changes, his viral load remains high with concern for genotypic resistance. There is a chance that DP will never be virologically controlled and his HIV will continue to advance. Given this, our longitudinal, outpatient relationship with DP has become more imperative as we navigate trust and elicit evolving goals amidst medical uncertainty.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;Young patients with HIV like DP remain a vulnerable group due to social marginalization and perpetuated distrust of medical systems and therefore are less likely to benefit from therapeutic advancements. Even when fully able to engage in treatment, they are at increased risk for long-term sequelae, high symptom burden, and shortened life spans compared to non-infected counterparts. While still evolving, the team's relationship with DP illustrat","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 5","pages":"Pages e422-e423"},"PeriodicalIF":3.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143807045","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":"HPNA & HPNF Nessa Coyle 2025: T.E.A.M. – Reflections From an Unexpected Leader","authors":"Holli Martinez MSN FNP-BC ACHPN FPCN","doi":"10.1016/j.jpainsymman.2025.02.080","DOIUrl":"10.1016/j.jpainsymman.2025.02.080","url":null,"abstract":"<div><h3>Outcomes</h3><div>1. Analyze the role of nurse leadership in fostering a collaborative team environment, highlighting how embracing challenges can enhance team dynamics and individual contributions.</div><div>2. Analyze the role of nurse leadership in fostering a collaborative team environment, highlighting how embracing challenges can enhance team dynamics and individual contributions.</div></div><div><h3>Abstract</h3><div>Discover the power of teamwork and leadership in T.E.A.M. - Reflections From an Unexpected Leader. Inspiring discussion will explore the journey of stepping into leadership, embracing unexpected challenges, and fostering a collaborative environment where every team member's contribution shines.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 5","pages":"Page e459"},"PeriodicalIF":3.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143807053","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":"Symptomatic Estuary, Where Palliative Meets Hospice: Terminally Ill Advanced Complex Symptom Management","authors":"Neil Miransky DO,&nbsp;Samuel Perna III DO FAAHPM,&nbsp;Michelle Krichbaum PharmD BCPP,&nbsp;Laura Meyer-Junco PharmD BCPS CPE FASCP","doi":"10.1016/j.jpainsymman.2025.02.075","DOIUrl":"10.1016/j.jpainsymman.2025.02.075","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;1. Propose rational pharmacologic management in the complex adult and pediatric patient with refractory nausea/vomiting, bowel obstruction, anorexia, refractory agitation, delirium and/or hallucinations, and fatigue.&lt;/div&gt;&lt;div&gt;2. Evaluate the benefits and limitations of hospice versus palliative services for complex patients at the end of life.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Abstract&lt;/h3&gt;&lt;div&gt;This continuing education session will provide an in-depth exploration of the pharmacologic management and care transition strategies for adult and pediatric patients experiencing complex and refractory symptoms. Healthcare professionals often encounter challenging cases where standard treatment protocols fail, necessitating a more nuanced and individualized approach. This preconference course will utilize evidence-based pharmacologic strategies to manage a wide variety of palliative topics including: refractory nausea/vomiting, bowel obstruction, anorexia, refractory agitation, delirium, hallucinations, and fatigue in both adult and pediatric populations. Considerations for patients with renal and hepatic insufficiency will also be addressed. These topics will be explored using a multi-disciplinary, case-based, and discussion-centered approach. Preconference participants should expect to actively engage with the presenters, drawing upon their experience with complex cases. This session will critically assess the benefits and limitations of various hospice versus palliative care programs for complex patients nearing the end of life. Participants will gain insights into the nuanced differences between these services, enabling them to make informed decisions that align with the unique needs and preferences of each patient. By the end of this session, participants will be outfitted with practical skills and knowledge to enhance the quality of care for patients with complex, refractory symptoms. Participants will be better equipped to determine if, and how their program will be able to meet the needs of each complex case.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;References&lt;/h3&gt;&lt;div&gt;NCCN Clinical Practice Guidelines in Adult Cancer Pain (NCCN Guidelines) for Adult Cancer Pain Version 2.2024. National Comprehensive Cancer Network, Inc. 2024. All rights reserved. Accessed [Sept, 26 2024]. To view the most recent and complete version of the guideline, go online to NCCN.org. NCCN Clinical Practice Guidelines in Palliative Care (NCCN Guidelines) for Adult Cancer Pain Version 1.2024. © National Comprehensive Cancer Network, Inc. 2024. All rights reserved. Accessed [September, 26 2024]. To view the most recent and complete version of the guideline, go online to NCCN.org. Girard, T. D., et al. (2018). Haloperidol and ziprasidone for treatment of delirium in critical illness. N Engl J Med, 379(26), 2506-2516. Khorassani, F., &amp; Saad, M. (2019). Intravenous olanzapine for the management of agitation: review of the literature. Ann Pharmacother, 53(8), 853-859. Sher, Y., et al","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 5","pages":"Pages e457-e458"},"PeriodicalIF":3.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143807171","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":"Evaluating Clinician Perspectives on Tracheostomy Placement in Children With Severe Neurologic Injury","authors":"Stockton Beveridge MD,&nbsp;Katherine Maddox MD,&nbsp;Yarah Ghotmi MD","doi":"10.1016/j.jpainsymman.2025.02.063","DOIUrl":"10.1016/j.jpainsymman.2025.02.063","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;1. Participants will appreciate the diversity of clinician sentiment surrounding destination tracheostomy placement in children with SNI, and the role that professional/subspecialty lens plays in shaping that perspective.&lt;/div&gt;&lt;div&gt;2. Participants will be able to consider and weigh the ethical principles at place in children with SNI being considered for destination tracheostomy placement: among these are autonomy, beneficence, non-maleficence, futility, shared decision making, and the zone of parental discretion.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Key Message&lt;/h3&gt;&lt;div&gt;Destination tracheostomy placement in children with severe neurologic injury is a weighty decision fraught with moral distress and competing ethical principles. There is evidence that professional lens impacts both extent of moral distress and which ethical principles are given primacy by providers.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Abstract&lt;/h3&gt;&lt;div&gt;“Destination” tracheostomies are increasingly considered in children with permanent severe neurologic injury (SNI) [1]. Though life-prolonging, the decision is weighty given the likelihood of high morbidity, increased healthcare utilization, and the lifestyle change required of caregivers [2-3]. There is evidence of added provider distress and concomitant conflict where provider and caregiver values disagree [4-6]. National surveys on provider perspectives are few, narrow in scope, and do not consider how the subspecialty lens influences provider perspectives.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;div&gt;To evaluate the diversity of clinician sentiment surrounding destination tracheostomy placement in children with SNI, to evaluate how varied subspecialty lenses impact that perspective, and to review the complex ethical principles surrounding these cases.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A national survey of clinicians who care for children with tracheostomies. The survey introduced an example case of destination tracheostomy placement in a child with SNI and then evaluated professional experience and perspectives.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Four hundred and thrity-eight initial respondents represented a diversity of subspecialty and professional experience. Respondents were divided on whether tracheostomy should be offered in the example case (55.4%) revealing significant discordance both with how many felt their institution would offer tracheostomy (90.2%) and how few would select tracheostomy if the child were their own (1.4%). There was significant discordance between respondents’ rating of quality-of-life in the example case (mean 27.7 ± 19.2) and respondent assumption for how caregivers would rate quality-of-life (mean 58.6 ± 16.0). Respondents reported regular moral distress in these situations (41.5% “sometimes,” 43.2% “frequently/always”). Respondents varied in judging whether caregivers or clinicians should bear primary responsibility for the decision. Only 18.5% of respondents reported institutional protocols for mana","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 5","pages":"Pages e448-e449"},"PeriodicalIF":3.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143807220","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}