Journal of pain and symptom management最新文献

{"title":"“The Rest of the Story”: Social Determinants of Comfort Care","authors":"Annette Mendola PhD, HEC-C , Adam Tyson MD","doi":"10.1016/j.jpainsymman.2025.09.006","DOIUrl":"10.1016/j.jpainsymman.2025.09.006","url":null,"abstract":"","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"71 3","pages":"Pages e281-e286"},"PeriodicalIF":3.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146162138","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":"Meaning and Psychedelics in Palliative Care: A Narrative Review","authors":"William B. Alexander MD, PhD ,&nbsp;Eric D. Hansen MD ,&nbsp;Brian T. Anderson MD ,&nbsp;Ali John Zarrabi MD ,&nbsp;Andrew H. Rogers PhD ,&nbsp;Gregory Loewen DO, FCCP ,&nbsp;Zachary R. Ficarro PsyD ,&nbsp;Margaret H. Alexander PhD, MS, CGC ,&nbsp;Dylan Schaefer BS, BA ,&nbsp;Amy A. Case MD, FAAHPM","doi":"10.1016/j.jpainsymman.2025.10.015","DOIUrl":"10.1016/j.jpainsymman.2025.10.015","url":null,"abstract":"<div><h3>Context</h3><div>Meaning is a primary existential concern in those with advanced illnesses and functions as an important coping mechanism. Loss of meaning contributes to existential distress, and, in particular, may manifest as demoralization, a syndrome of poor coping that is associated with negative outcomes. Psychedelics are unique psychoactive compounds that, among other properties, are proposed to enhance meaning. In the palliative setting, psychedelic therapies are under investigation for existential distress, including demoralization.</div></div><div><h3>Objective</h3><div>To synthesize the literature on meaning in palliative care, including the clinical impact of loss of meaning, particularly demoralization, and evidence for proposed interventions including existential psychological interventions and psychedelic therapies.</div></div><div><h3>Methods</h3><div>We conducted a narrative review based on a structured search within Pubmed. Articles were screened for those addressing prespecified questions derived from our objectives, and results were synthesized in narrative format.</div></div><div><h3>Results</h3><div>Loss of meaning is a hallmark feature of demoralization syndrome, a prevalent and distinct condition linked with diminished quality of life, increased symptom burden, and increased suicide risk. Existential psychological interventions improve numerous psychosocial outcomes, although evidence for their efficacy in demoralization is limited. In psychedelic therapy, meaning-making is a typical feature, and existential interventions are commonly integrated. Finally, early clinical trial data indicate that psychedelic therapies show promise for existential distress, including demoralization.</div></div><div><h3>Conclusions</h3><div>Novel approaches are needed to address existential distress, especially when manifested as demoralization. Psychedelic therapy is a promising combined pharmacologic and psychological intervention that promotes meaning-making and shows potential for improving demoralization, warranting further investigation.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"71 3","pages":"Pages e299-e321"},"PeriodicalIF":3.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145421675","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 Care Needs in Pediatric Hematologic Oncology: Parent-Child Perspectives Across Stages","authors":"Xiangyue Jiao BSN, RN ,&nbsp;Junye Jiang MD ,&nbsp;Ling Yu BSN, RN ,&nbsp;Lei Cheng PhD, RN ,&nbsp;Hongsheng Wang MD ,&nbsp;Xiaowen Zhai MD","doi":"10.1016/j.jpainsymman.2025.12.006","DOIUrl":"10.1016/j.jpainsymman.2025.12.006","url":null,"abstract":"<div><h3>Context</h3><div>Children with hematologic malignancies undergo prolonged, intensive therapy that imposes physical, psychological, social, and spiritual challenges on patients and families. Although early palliative care is recommended, little is known about how these needs evolve across the illness course, especially in resource-limited settings.</div></div><div><h3>Objective</h3><div>To describe the dynamic palliative care needs of children with hematologic cancers and their families and to identify stage-specific opportunities for family-centered support.</div></div><div><h3>Methods</h3><div>A descriptive qualitative study was conducted at a national tertiary pediatric hospital in China. Semi-structured interviews were completed with 53 participants (32 parents and 21 children) from 32 families. Interviews focused on physical, psychological, social, and spiritual concerns across six phases: diagnosis, intensive treatment, maintenance/consolidation, recovery/follow-up, relapse/progression, and end of life. Data were transcribed and analyzed by inductive content analysis.</div></div><div><h3>Results</h3><div>Participants reported multidimensional needs that shifted over time. Symptom burden peaked at diagnosis, during intensive therapy, and at relapse or end of life. Emotional distress moved from shock to vigilance and anticipatory grief. Social strain involved disrupted schooling, caregiver overload, and peer isolation. Spiritual concerns, including hope, meaning, and dignity, were present from diagnosis and intensified during advanced illness. Parents and children expressed complementary views on coping and support.</div></div><div><h3>Conclusion</h3><div>Palliative care needs in pediatric hematologic oncology differ across treatment phases. Trajectory-informed, primary palliative care integrated with culturally responsive support may better anticipate evolving needs and strengthen family resilience.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"71 3","pages":"Pages 447-454"},"PeriodicalIF":3.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145756901","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":"Changes in Racial Differences in Palliative Care Awareness and Understanding From 2018 to 2024","authors":"Yujun Zhu PhD,&nbsp;Susan Enguidanos PhD, MPH","doi":"10.1016/j.jpainsymman.2025.08.017","DOIUrl":"10.1016/j.jpainsymman.2025.08.017","url":null,"abstract":"<div><h3>Context</h3><div>Over the past decade palliative care has expanded significantly across the U.S. healthcare system. However, little is known about recent U.S. population-level trends in palliative care awareness and understanding.</div></div><div><h3>Objectives</h3><div>This study aimed to examine changes in palliative care awareness and understanding from 2018 to 2024 across racial and ethnic groups.</div></div><div><h3>Methods</h3><div>We combined two waves of data from the Health Information National Trends Survey (HINTS), including 2,793 respondents from 2018 to 6,016 from 2024. Multivariable logistic regression models were used to examine the associations between palliative care awareness and understanding with various sociodemographic factors. Interaction terms between race and survey year were included to assess differences in trends across racial and ethnic groups over time.</div></div><div><h3>Results</h3><div>From 2018 to 2024, palliative care awareness increased across all racial and ethnic groups (29% to 51%), with the highest levels among non-Hispanic White participants (33% to 53%). In contrast, understanding of palliative care decreased across all groups (72% to 55%), with the steepest decline observed among non-Hispanic Black individuals (75% to 48%).</div></div><div><h3>Conclusion</h3><div>These findings suggest growing awareness but increasing confusion about palliative care, especially among minority groups, highlighting the need for improved and culturally responsive public education efforts.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"71 3","pages":"Pages e287-e293"},"PeriodicalIF":3.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146162139","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":"Early Specialized Palliative Care for Unresectable Pancreatic Cancer: A Quasi-Experimental Study","authors":"Inge Dufva MD, MSc ,&nbsp;Gitte Juhl MD, PhD ,&nbsp;Fahimeh Andersen MD ,&nbsp;Randi Beier-Holgersen MD ,&nbsp;Matthew Maddocks MSc, PhD","doi":"10.1016/j.jpainsymman.2025.11.025","DOIUrl":"10.1016/j.jpainsymman.2025.11.025","url":null,"abstract":"<div><h3>Context</h3><div>Patients with unresectable pancreatic cancer have a poor prognosis and often high health care requirements.</div></div><div><h3>Objectives</h3><div>To evaluate the impact of early specialized palliative care for patients with unresectable pancreatic cancer on hospital use.</div></div><div><h3>Methods</h3><div>Using a quasi-experimental design, newly diagnosed patients with unresectable pancreatic cancer diagnosed from October 2019 to February 2021 were offered specialized palliative care delivered as home-visits (<em>n</em> = 65). The retrospective control cohort were similar patients diagnosed between December 2017 and April 2019 (<em>n</em> = 60).</div><div>The primary endpoint was use of hospital care. Secondary outcomes included survival, quality of life and place of death.</div></div><div><h3>Results</h3><div>Median overall survival was significantly longer in the intervention cohort compared with the control cohort, 8.0 months (95% CI, 5.9–10.0) vs 4.9 months (95% CI, 3.5–6.3) (<em>P</em> = 0.029).</div><div>There was no difference in use of hospital care between the cohorts, but given the longer survival in the intervention cohort there were significant reductions in monthly hospital admissions, 0.8 vs 1.2 (<em>P</em> = 0.002), emergency department admissions, 0.4 vs 0.6 (<em>P</em> = 0.009) and days in hospital, 4.2 vs 7.2 (<em>P</em> = 0.001) in the intervention cohort compared with the control cohort.</div><div>The proportion of patients who died in hospital outside the palliative care unit was significantly lower in the intervention cohort compared with the control cohort, 14.5% vs 30.5% (<em>P</em> = 0.035).</div></div><div><h3>Conclusion</h3><div>Early specialized palliative care for patients with unresectable pancreatic cancer resulted in an increase in survival without an increase in use of hospital care.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"71 3","pages":"Pages 419-428"},"PeriodicalIF":3.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145648874","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":"African American Communities Speak to Clinician 1. Program Creation and Implementation Feasibility","authors":"Ronit Elk PhD, FAAHPM ,&nbsp;Shena Gazaway PhD, RN, CHPN ,&nbsp;Alvin L. Reaves III MD, MSc, FACP, FAAHPM ,&nbsp;Kartina Harrison RN, BSN, MSN, PCCN ,&nbsp;Ashley Nichols MD ,&nbsp;Michael D. Barnett MD, MS, FACP, FAAP, FAAHPM","doi":"10.1016/j.jpainsymman.2025.09.003","DOIUrl":"10.1016/j.jpainsymman.2025.09.003","url":null,"abstract":"<div><h3>Context</h3><div>Lack of appreciation of cultural differences compromises care for seriously ill African American patients, yet training programs for clinicians in providing culturally appropriate care is lacking. The goals of this study were to partner with a southern, African American community to create a training program for clinicians on how to communicate in a culturally congruent and respectful way with older southern, African Americans with serious illness and at end of life, and test program delivery feasibility.</div></div><div><h3>Methods</h3><div>Community Based Participatory Research guided the equitable partnership with the Community Advisory Board (CAB), the creation and implementation of two focus groups and the training videos created by the CAB The videos were incorporated into a training program based on Kolb’s Adult-based Learning Theory, and Donabedian’s model was used to determine program delivery feasibility.</div></div><div><h3>Results</h3><div>The CAB guided the study, and based on focus group feedback on cultural values and lived experiences, developed four videos, each highlighting a key message for clinicians- cultural, religious, and demand for equal care. These were ensconced within the training model, and a facilitation guide created for the three-hour training. Two pilot training sessions were held, with high rate of clinician attendance. Three months post-training clinicians reported a high rate of adhering to the community recommendations.</div></div><div><h3>Conclusion</h3><div>The first training program developed <em>by</em> African American community members <em>for</em> clinicians was feasible to implement and demonstrated moving participants from a defensive posture to one of recognizing systemic injustice within healthcare systems, and changing practice through empowerment and advocacy.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"71 3","pages":"Pages e231-e244"},"PeriodicalIF":3.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146161660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Journey of a Communication Skills Educator: Motivating Factors for Commitment and Sustainability","authors":"Kelli England BS, MS-2 ,&nbsp;Jori Bogetz MD ,&nbsp;Nancy Lau PhD ,&nbsp;Gordon J. Wood MD, MSCI ,&nbsp;Amy Trowbridge MD","doi":"10.1016/j.jpainsymman.2025.11.011","DOIUrl":"10.1016/j.jpainsymman.2025.11.011","url":null,"abstract":"<div><h3>Context</h3><div>Communication is critical to improving patient and family outcomes, yet clinicians remain undertrained. Effective communication training takes significant investments in personnel and programming. Little is known about what motivates and sustains clinician educators in such programs.</div></div><div><h3>Objectives</h3><div>This qualitative study aimed to learn more about 1) what motivates clinician communication skills educators (CSEs) to improve their own communication and educate others and 2) what sustains them in this work.</div></div><div><h3>Methods</h3><div>PedsTalk is a communication training program based on the VitalTalk model of small group role play within a single institution’s Department of Pediatrics. We conducted a thematic analysis of one-on-one interviews of PedsTalk faculty CSEs focused on the experiences that motivated them to improve their own communication and commitment to teaching and sustaining these skills.</div></div><div><h3>Results</h3><div>Seventeen CSEs participated, representing eight specialties. The majority had seven or more years of experience in their field (post-training). Thematic content analysis revealed three major themes: <em>Drive</em>: My choices reflect what matters to me; <em>Growth</em>: My efforts have impact; and <em>Connection</em>: What sustains me. The relationship between communication and health equity was highlighted across themes. These themes that emerged mapped onto the primary sources of intrinsic motivation according to self-determination theory: autonomy, competence, and relatedness, respectively.</div></div><div><h3>Conclusion</h3><div>CSEs are intrinsically motivated by the drive to work on what matters to them, opportunities for growth as a communicator and educator, and their connection to others in this work. Educators and leaders can utilize these factors to build and sustain momentum in their programs.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"71 3","pages":"Pages 362-372"},"PeriodicalIF":3.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145604424","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":"Symptom Relief From Tub Bathing in Terminal Cancer: A Multicenter, Controlled Observational Study","authors":"Eriko Hayashi RN, PhD ,&nbsp;Junko Takano RN, MSN ,&nbsp;Sachiko Okayama RN ,&nbsp;Yoshinobu Matsuda MD ,&nbsp;Yuka Kashiwagi RN, MSN ,&nbsp;Naoko Kajisa RN ,&nbsp;Tetsuya Matuura MD ,&nbsp;Kaori Morofushi RN ,&nbsp;Kaori Toriizuka RN ,&nbsp;Mitsunori Miyashita RN, PhD ,&nbsp;Nao Tamai RN, PhD","doi":"10.1016/j.jpainsymman.2025.11.017","DOIUrl":"10.1016/j.jpainsymman.2025.11.017","url":null,"abstract":"<div><h3>Context</h3><div>Previous studies have shown that bathing of terminal cancer patients led to significant immediate improvements in symptoms, but the earlier work had various limitations.</div></div><div><h3>Objectives</h3><div>This study aimed to determine the effects of bathing on physical and mental symptoms in terminal cancer patients in Japan.</div></div><div><h3>Methods</h3><div>This was a prospective, controlled, observational study involving terminal cancer patients in palliative care wards at multiple institutions in Japan. In routine care, nurses assisted participants who wished to take a warm bath (at 40%–45°C) lasting about 10 minutes during the day. The severity of seven symptoms, including pain, fatigue, sleepiness, unpleasant sleepiness, mood, anxiety, and lack of appetite, was self-assessed on a scale of 0–10 (0: none, 10: unbearable distress) on the day before bathing, day of bathing, morning and evening of the following day, and 30 minutes after bathing on the day of bathing only. Patient background, physical condition, drug information, and care environment before and after hospitalization were evaluated. Differences in scores before and after bathing, changes the day before and the day after, and comparisons between the bathing and nonbathing groups were evaluated; effect sizes were calculated; and logistic regression analysis was performed. This study involved a within-subject comparison design, evaluating each patient on a bathing day and a corresponding nonbathing day.</div></div><div><h3>Results</h3><div>A total of 146 terminal cancer patients (86 men; median age 78.5 ± 12.3 years) were evaluated. Significant symptom relief was seen not only on the day of bathing, but also continuing to the following day, especially for fatigue and mood.</div></div><div><h3>Conclusion</h3><div>Bathing is effective in ameliorating the symptoms of terminal cancer patients.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"71 3","pages":"Pages 394-402"},"PeriodicalIF":3.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145595983","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":"Screening Protocols for Identifying Palliative Care Needs in Primary Care: a scoping review.","authors":"Keryn Johnson, Arjun Poudel, Animut Alebel Ayalew, Jack Thepsourinthone, Stacey Heer, Deidre Morgan, Judy Mullan, Andrew Bonney, Sabina Clapham","doi":"10.1016/j.jpainsymman.2026.02.018","DOIUrl":"10.1016/j.jpainsymman.2026.02.018","url":null,"abstract":"<p><strong>Context: </strong>Early identification of palliative care needs in primary care is increasingly recognized as essential, yet the implementation of screening tools remains inconsistent and challenging.</p><p><strong>Objectives: </strong>To identify the implementation of screening tool protocols in primary care for early identification of patients with palliative care needs, and to describe enablers or barriers influencing their uptake and integration into routine practice. This review also sought to map the methodologies, theoretical frameworks, and screening measures employed.</p><p><strong>Methods: </strong>This scoping review was guided by the Arksey and O'Malley framework. Literature was retrieved from the MEDLINE, CINAHL, Scopus, and Cochrane databases, focusing on screening tools for early identification of palliative care needs in primary care. Articles published in English between January 2015 and March 2025 were included. The Consolidated Framework for Implementation Research (CIFR) was used as an overarching categorizing structure for synthesizing the identified barriers and facilitators.</p><p><strong>Results: </strong>A total of 3,140 articles were identified, and 174 were included for full-text screening. In total, 25 studies were included in the review. The implemented tools varied in their application and integration within primary care settings. Key barriers to implementing palliative care screening protocols in primary care included time constraints, doubts about the tool's value, limited resources, poor communication, unfavorable funding models, and sociocultural attitudes toward palliative care. Facilitators included integration with electronic health records, the presence of clinical champions, early reframing of palliative care, clearly defined roles, and tailored training initiatives.</p><p><strong>Conclusion: </strong>Implementation of screening tools in primary care remains challenging due to contextual, organizational, and individual-level factors. Successfully embedding these tools into practice requires tailored context-sensitive strategies that are co-designed with interprofessional communication and informed by the principles of implementation science.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147326311","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":"Geriatric Vulnerability and Symptom Burden as Determinants of Palliative Care in Respiratory Disease.","authors":"Daniela Josefina Cataneo-Piña, Ana Patricia Navarrete-Reyes, Lidia Aurora Mondragón-Posadas, Brenda Paola Castillo-Marmolejo, Adriana Bautista-Ruiz, Blanca Patricia Sánchez-Hernández, Natalia Sánchez-Garrido, Ivette Buendía-Roldán","doi":"10.1016/j.jpainsymman.2026.02.019","DOIUrl":"10.1016/j.jpainsymman.2026.02.019","url":null,"abstract":"<p><strong>Background: </strong>Older adults hospitalized with chronic respiratory diseases frequently experience high symptom burden and geriatric syndromes, yet palliative care (PC) referral remains inconsistent. Understanding how symptom burden and geriatric vulnerability influence PC utilization may support more equitable, needs-based referral models.</p><p><strong>Objectives: </strong>To examine the association between symptom burden, geriatric syndromes, and inpatient PC consultation in adults aged ≥75 years hospitalized for respiratory diseases, and to assess whether ESAS-derived symptom clusters identify patients at increased risk of in-hospital mortality.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study at a national respiratory referral centre in Mexico, including 449 patients with complete Edmonton Symptom Assessment System (ESAS) data and comprehensive geriatric assessment. K-means clustering identified low-, moderate-, and high-burden symptom profiles. Multivariable logistic regression evaluated factors associated with PC consultation and in-hospital mortality.</p><p><strong>Results: </strong>Only 30% of patients received a PC consultation, more frequently among those with lung cancer than non-malignant respiratory diseases. Independent of diagnosis, PC consultation was associated with ADL dependence, pressure ulcers, and increasing symptom burden. Compared with the low-burden cluster, the odds of consultation were threefold higher in the moderate-burden cluster and fivefold higher in the high-burden cluster. In-hospital mortality increased across symptom clusters and was highest among patients receiving PC.</p><p><strong>Conclusions: </strong>Symptom burden and geriatric syndromes provide a more equitable framework for identifying PC needs than diagnosis alone. Systematic integration of ESAS and geriatric assessment into respiratory care may facilitate earlier, needs-based PC referral, particularly in health systems with limited PC capacity.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147326334","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}