Maintaining continuous subcutaneous infusion (CSCI) of symptom control medication is difficult when discharging palliative and end of life (EoL) patients.
Objectives
To determine the feasibility of using a single use elastomeric pump (EP) to deliver CSCI medication for 24 hours, as an alternative to syringe drivers (SDs) at discharge.
Methods
Palliative care inpatients on CSCIs leaving a tertiary hospital were prescribed an EP for day leave or discharge. We collected retrospective data over 12 months on the number of EPs administered, drug prescription, and adverse events. Hospital savings in terms of bed-days and loss of hospital pumps were extrapolated from this.
Results
A total of 107 EPs were administered to patients leaving hospital without issue. 16 patients were given 2 EPs to facilitate administration of incompatible drugs. Extrapolated costs indicate £59,060 was saved over 12-months.
Conclusions
EPs are a safe, effective, and cost-saving method to deliver CSCI medication for palliative care and EoL patients leaving hospital.
{"title":"Elastomeric Pumps for Continuous Subcutaneous Infusion of Symptom Control Medication on Discharge","authors":"Stephanie Gover MBiochem, MB, BChir , Chiara Creed MPharm, IPresc , Shumi Tattersfield MPharm, IPresc , Daniel Harper DipHE , Jane Neerkin MBBs, BSc(Hons)","doi":"10.1016/j.jpainsymman.2025.10.031","DOIUrl":"10.1016/j.jpainsymman.2025.10.031","url":null,"abstract":"<div><h3>Background</h3><div>Maintaining continuous subcutaneous infusion (CSCI) of symptom control medication is difficult when discharging palliative and end of life (EoL) patients.</div></div><div><h3>Objectives</h3><div>To determine the feasibility of using a single use elastomeric pump (EP) to deliver CSCI medication for 24 hours, as an alternative to syringe drivers (SDs) at discharge.</div></div><div><h3>Methods</h3><div>Palliative care inpatients on CSCIs leaving a tertiary hospital were prescribed an EP for day leave or discharge. We collected retrospective data over 12 months on the number of EPs administered, drug prescription, and adverse events. Hospital savings in terms of bed-days and loss of hospital pumps were extrapolated from this.</div></div><div><h3>Results</h3><div>A total of 107 EPs were administered to patients leaving hospital without issue. 16 patients were given 2 EPs to facilitate administration of incompatible drugs. Extrapolated costs indicate £59,060 was saved over 12-months.</div></div><div><h3>Conclusions</h3><div>EPs are a safe, effective, and cost-saving method to deliver CSCI medication for palliative care and EoL patients leaving hospital.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"71 2","pages":"Pages e162-e166"},"PeriodicalIF":3.5,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145459065","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}
Pub Date : 2025-11-04DOI: 10.1016/j.jpainsymman.2025.10.022
Kristen Vossler MD , Joanna Sharpless MD , Laura A. Schoenherr MD , Yuika Goto MD , Steven Z. Pantilat MD
{"title":"Stopping, Starting, and Continuing: The Benefits and Risks of Comfort Care Order Sets","authors":"Kristen Vossler MD , Joanna Sharpless MD , Laura A. Schoenherr MD , Yuika Goto MD , Steven Z. Pantilat MD","doi":"10.1016/j.jpainsymman.2025.10.022","DOIUrl":"10.1016/j.jpainsymman.2025.10.022","url":null,"abstract":"","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"71 2","pages":"Pages e211-e212"},"PeriodicalIF":3.5,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145459096","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}
Context: Pain and fatigue are among the most common and burdensome symptoms experienced by patients with advanced serious illness. However, few studies have captured their daily fluctuations using standardized, multidimensional tools.
Objectives: This study aimed to examine the factors associated with daily pain and fatigue severity among patients with advanced serious illness using the palliative care outcomes collaboration (PCOC) framework in a Taiwanese palliative care setting.
Methods: A retrospective observational study was conducted at a medical center in central Taiwan between July 2021 and September 2023. Patients admitted to the palliative care unit underwent daily assessments using validated PCOC instruments. Generalized estimating equations (GEE) were applied to identify factors associated with daily pain and fatigue scores. Covariates included demographic factors, co-occurring symptoms, palliative care phase (PCP), functional status, and caregiver concerns.
Results: Among 755 patients, fatigue and pain were the highest-scoring symptoms on the Symptom Assessment Scale. Pain severity was significantly associated with female sex, younger age, unstable clinical phase, sleep disturbance, appetite loss, bowel problems, and fatigue. Fatigue severity was linked to breathlessness, pain, appetite loss, and functional impairments, particularly in toileting and transferring among non-cancer patients. Subgroup analyses revealed differential patterns in cancer versus non-cancer populations. Specifically, we found that in cancer patients, fatigue was strongly associated with the unstable stage (phase 2), while this stage effect was not observed in non-cancer patients. Moreover, pain severity in cancer patients was more pronounced in females and younger patients, whereas in non-cancer patients, pain severity was more strongly linked to functional limitations (e.g., toileting ability) and psychosocial issues.
Conclusion: Using the PCOC framework for standardized patient assessment, we found that pain and fatigue are associated and comprehensive assessment is important as treatment of one may alleviate the other.
{"title":"Pain and Fatigue Interrelations in Terminally Ill Inpatients: A PCOC-Based Analysis.","authors":"Meng-Chen Chan, Cheng-Fu Lin, Jia-Jyun Wu, Chun-Li Wang, Sheng-Yun Lai, Wan-Ting Hsu, Pi-Shan Hsu, Shih-Yi Lin, Wei-Min Chu","doi":"10.1016/j.jpainsymman.2025.10.024","DOIUrl":"10.1016/j.jpainsymman.2025.10.024","url":null,"abstract":"<p><strong>Context: </strong>Pain and fatigue are among the most common and burdensome symptoms experienced by patients with advanced serious illness. However, few studies have captured their daily fluctuations using standardized, multidimensional tools.</p><p><strong>Objectives: </strong>This study aimed to examine the factors associated with daily pain and fatigue severity among patients with advanced serious illness using the palliative care outcomes collaboration (PCOC) framework in a Taiwanese palliative care setting.</p><p><strong>Methods: </strong>A retrospective observational study was conducted at a medical center in central Taiwan between July 2021 and September 2023. Patients admitted to the palliative care unit underwent daily assessments using validated PCOC instruments. Generalized estimating equations (GEE) were applied to identify factors associated with daily pain and fatigue scores. Covariates included demographic factors, co-occurring symptoms, palliative care phase (PCP), functional status, and caregiver concerns.</p><p><strong>Results: </strong>Among 755 patients, fatigue and pain were the highest-scoring symptoms on the Symptom Assessment Scale. Pain severity was significantly associated with female sex, younger age, unstable clinical phase, sleep disturbance, appetite loss, bowel problems, and fatigue. Fatigue severity was linked to breathlessness, pain, appetite loss, and functional impairments, particularly in toileting and transferring among non-cancer patients. Subgroup analyses revealed differential patterns in cancer versus non-cancer populations. Specifically, we found that in cancer patients, fatigue was strongly associated with the unstable stage (phase 2), while this stage effect was not observed in non-cancer patients. Moreover, pain severity in cancer patients was more pronounced in females and younger patients, whereas in non-cancer patients, pain severity was more strongly linked to functional limitations (e.g., toileting ability) and psychosocial issues.</p><p><strong>Conclusion: </strong>Using the PCOC framework for standardized patient assessment, we found that pain and fatigue are associated and comprehensive assessment is important as treatment of one may alleviate the other.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145459047","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}
Pub Date : 2025-11-04DOI: 10.1016/j.jpainsymman.2025.10.032
Meaghann S. Weaver MD, PhD, MPH, HEC-C , Kenneth A. Berkowitz MD, FCCP
As a contingency standard of care, telemedicine use surged during the COVID-19 pandemic.
The Medicare telehealth flexibilities introduced during the COVID-19 pandemic expired in September 2025. Any ongoing sustained pivot to telemedicine warrants purposeful attentiveness to ethical considerations and not just technology use as an end unto itself. Telemedicine has the potential to complement face-to-face care practices and enhance clinical interactions when its use is based on shared values. Values such as access, equity, justice, compassion, autonomy, and dignity warrant thoughtful use of telemedicine. Patients and families need to be able to trust that clinicians and health systems will place patient welfare and shared values above technical convenience. As demonstrated in this case description, upholding values fundamental to the practice of medicine in telemedicine can enhance patient connection and foster trustworthy postpandemic practices.
{"title":"Values Considerations in Telemedicine: Pause Before Shifting","authors":"Meaghann S. Weaver MD, PhD, MPH, HEC-C , Kenneth A. Berkowitz MD, FCCP","doi":"10.1016/j.jpainsymman.2025.10.032","DOIUrl":"10.1016/j.jpainsymman.2025.10.032","url":null,"abstract":"<div><div>As a contingency standard of care, telemedicine use surged during the COVID-19 pandemic.</div><div>The Medicare telehealth flexibilities introduced during the COVID-19 pandemic expired in September 2025. Any ongoing sustained pivot to telemedicine warrants purposeful attentiveness to ethical considerations and not just technology use as an end unto itself. Telemedicine has the potential to complement face-to-face care practices and enhance clinical interactions when its use is based on shared values. Values such as access, equity, justice, compassion, autonomy, and dignity warrant thoughtful use of telemedicine. Patients and families need to be able to trust that clinicians and health systems will place patient welfare and shared values above technical convenience. As demonstrated in this case description, upholding values fundamental to the practice of medicine in telemedicine can enhance patient connection and foster trustworthy postpandemic practices.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"71 2","pages":"Pages e196-e200"},"PeriodicalIF":3.5,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145459106","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}
Pub Date : 2025-11-04DOI: 10.1016/j.jpainsymman.2025.10.027
Mellar P. Davis MD , Kari Bohlke ScD , Andrew Davies MBBS, MSc, MD
Opioid conversion, also known as opioid rotation or switching, is a critical strategy in cancer pain management, necessitated in up to 40% of patients undergoing opioid therapy. In 2025, five leading international organizations—MASCC, ASCO, AAHPM, HPNA, and NICSO—collaborated to produce the first global consensus guideline on opioid conversion in adults with cancer. This review provides clinical insights into the guideline’s recommendations, emphasizing individualized care, safety, and evidence-informed practice. Key components include comprehensive preconversion assessment, consensus-based conversion ratios, and vigilant postconversion monitoring. The guideline challenges traditional dose-reduction protocols and addresses controversial areas such as methadone use, transdermal fentanyl conversion, and bidirectional asymmetry. Broader considerations include socioeconomic disparities, stigma, pharmacogenetics, and geriatric-specific concerns. While the guideline offers a robust framework for safer opioid transitions, limitations include reliance on heterogeneous data and the need for clinician expertise. Future directions call for expanded access, education, and integration of personalized medicine approaches to optimize cancer pain management.
{"title":"Opioid Conversion in Adults With Cancer: MASCC-ASCO-AAHPM-HPNA-NICSO Guideline Clinical Insights","authors":"Mellar P. Davis MD , Kari Bohlke ScD , Andrew Davies MBBS, MSc, MD","doi":"10.1016/j.jpainsymman.2025.10.027","DOIUrl":"10.1016/j.jpainsymman.2025.10.027","url":null,"abstract":"<div><div>Opioid conversion, also known as opioid rotation or switching, is a critical strategy in cancer pain management, necessitated in up to 40% of patients undergoing opioid therapy. In 2025, five leading international organizations—MASCC, ASCO, AAHPM, HPNA, and NICSO—collaborated to produce the first global consensus guideline on opioid conversion in adults with cancer. This review provides clinical insights into the guideline’s recommendations, emphasizing individualized care, safety, and evidence-informed practice. Key components include comprehensive preconversion assessment, consensus-based conversion ratios, and vigilant postconversion monitoring. The guideline challenges traditional dose-reduction protocols and addresses controversial areas such as methadone use, transdermal fentanyl conversion, and bidirectional asymmetry. Broader considerations include socioeconomic disparities, stigma, pharmacogenetics, and geriatric-specific concerns. While the guideline offers a robust framework for safer opioid transitions, limitations include reliance on heterogeneous data and the need for clinician expertise. Future directions call for expanded access, education, and integration of personalized medicine approaches to optimize cancer pain management.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"71 2","pages":"Pages e141-e144"},"PeriodicalIF":3.5,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145459056","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}
Pub Date : 2025-11-04DOI: 10.1016/j.jpainsymman.2025.10.026
Rinat Nissim PhD , Shenhab Zaig MSc , Paige Chu BA , Nazanin Nouriany RN, MScN, CON(C) , Anna T. Santiago MPH, MSc , Jennifer Croke MD, MHPE, FRCPC , Breffni Hannon MB, BCh, BAO, BMedSci, MMedSci, MCFP
Context
Family caregivers of individuals with advanced cancer face significant psychological and practical burdens, yet support for them remains limited.
Objectives
This study aimed to develop and pilot a nurse-led screening and response protocol to address unmet support needs of family caregivers in an outpatient palliative care clinic (OPCC).
Methods
English-speaking adult family caregivers of patients attending an (OPCC) in a tertiary cancer center in Canada were recruited. Participants completed repeated needs screenings and engaged in follow-up nurse consultations, offering a tailored response. A satisfaction with care scale was administered at baseline and six months, and qualitative interviews explored participants’ experiences.
Results
Of 31 family caregivers enrolled, all completed needs screening and a follow-up consultation at least once, and 61% completed both baseline and six-month measures. A pre-post analysis demonstrated a statistically significant improvement in satisfaction with psychosocial care. In qualitative interviews with a subset of 11 participants, family caregivers highlighted the value of receiving support independently from the patient, the acknowledgment of their needs as caregivers, having guidance to resolve concerns, and the facilitation of end-of-life planning.
Conclusion
Routine screening and response protocols for family caregivers may help facilitate timely and tailored support. Early implementation may enhance recruitment and engagement.
{"title":"“I Had a Needle, But This Program Gave Me the Thread”: A Caregiver Screening and Response Protocol","authors":"Rinat Nissim PhD , Shenhab Zaig MSc , Paige Chu BA , Nazanin Nouriany RN, MScN, CON(C) , Anna T. Santiago MPH, MSc , Jennifer Croke MD, MHPE, FRCPC , Breffni Hannon MB, BCh, BAO, BMedSci, MMedSci, MCFP","doi":"10.1016/j.jpainsymman.2025.10.026","DOIUrl":"10.1016/j.jpainsymman.2025.10.026","url":null,"abstract":"<div><h3>Context</h3><div>Family caregivers of individuals with advanced cancer face significant psychological and practical burdens, yet support for them remains limited.</div></div><div><h3>Objectives</h3><div>This study aimed to develop and pilot a nurse-led screening and response protocol to address unmet support needs of family caregivers in an outpatient palliative care clinic (OPCC).</div></div><div><h3>Methods</h3><div>English-speaking adult family caregivers of patients attending an (OPCC) in a tertiary cancer center in Canada were recruited. Participants completed repeated needs screenings and engaged in follow-up nurse consultations, offering a tailored response. A satisfaction with care scale was administered at baseline and six months, and qualitative interviews explored participants’ experiences.</div></div><div><h3>Results</h3><div>Of 31 family caregivers enrolled, all completed needs screening and a follow-up consultation at least once, and 61% completed both baseline and six-month measures. A pre-post analysis demonstrated a statistically significant improvement in satisfaction with psychosocial care. In qualitative interviews with a subset of 11 participants, family caregivers highlighted the value of receiving support independently from the patient, the acknowledgment of their needs as caregivers, having guidance to resolve concerns, and the facilitation of end-of-life planning.</div></div><div><h3>Conclusion</h3><div>Routine screening and response protocols for family caregivers may help facilitate timely and tailored support. Early implementation may enhance recruitment and engagement.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"71 2","pages":"Pages e156-e161"},"PeriodicalIF":3.5,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145459052","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}
The aim of this umbrella review is to synthesize pooled prevalence of existing evidence on depressive morbidity among informal cancer caregivers.
Method
This umbrella review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the protocol was registered in PROSPERO (CRD420251032522). A comprehensive search of major databases was performed to identify relevant studies. Predefined inclusion and exclusion criteria were applied. The corrected covered area (CCA) was calculated to assess overlap, and the methodological quality of included reviews was evaluated using the AMSTAR 2 tool.
Results
This umbrella review included four systematic reviews and meta-analyses, comprising a total of 160 primary studies with 40,605 participants worldwide. The pooled global prevalence of depression among informal caregivers of cancer patients was 38% (95% confidence intervals, 95% CI: 28%–48%). However, prevalence estimates varied widely, ranging from 4 to 55%, likely due to differences in the depression assessment tools used across studies.
Conclusion and recommendation
In conclusion, this review reveals a high prevalence of depression among informal caregivers of cancer patients a burden comparable to or exceeding that observed in other chronic illnesses and global crises such as the COVID-19 pandemic. Integrating routine mental health screening using validated tools such as the CES-D or PHQ-9 into oncology care is essential. Structured interventions including counseling, psych-education, and respite care should be embedded within care pathways. Future research should prioritize standardized assessment tools and caregiver-focused strategies to enhance comparability and guide best practices. Policymakers must invest in caregiver mental health to ensure sustainable and compassionate cancer care systems.
{"title":"Burden Beyond the Bedside: A Global Synthesis of Depression in Informal Cancer Caregivers: An Umbrella Review","authors":"Tesfaye Engdaw Habtie MSc , Molalign Aligaz Adisu MSc , Sefineh Fenta Feleke MSc , Tegene Atamenta Kitaw MSc","doi":"10.1016/j.jpainsymman.2025.10.033","DOIUrl":"10.1016/j.jpainsymman.2025.10.033","url":null,"abstract":"<div><h3>Objective</h3><div>The aim of this umbrella review is to synthesize pooled prevalence of existing evidence on depressive morbidity among informal cancer caregivers.</div></div><div><h3>Method</h3><div>This umbrella review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the protocol was registered in PROSPERO (CRD420251032522). A comprehensive search of major databases was performed to identify relevant studies. Predefined inclusion and exclusion criteria were applied. The corrected covered area (CCA) was calculated to assess overlap, and the methodological quality of included reviews was evaluated using the AMSTAR 2 tool.</div></div><div><h3>Results</h3><div>This umbrella review included four systematic reviews and meta-analyses, comprising a total of 160 primary studies with 40,605 participants worldwide. The pooled global prevalence of depression among informal caregivers of cancer patients was 38% (95% confidence intervals, 95% CI: 28%–48%). However, prevalence estimates varied widely, ranging from 4 to 55%, likely due to differences in the depression assessment tools used across studies.</div></div><div><h3>Conclusion and recommendation</h3><div>In conclusion, this review reveals a high prevalence of depression among informal caregivers of cancer patients a burden comparable to or exceeding that observed in other chronic illnesses and global crises such as the COVID-19 pandemic. Integrating routine mental health screening using validated tools such as the CES-D or PHQ-9 into oncology care is essential. Structured interventions including counseling, psych-education, and respite care should be embedded within care pathways. Future research should prioritize standardized assessment tools and caregiver-focused strategies to enhance comparability and guide best practices. Policymakers must invest in caregiver mental health to ensure sustainable and compassionate cancer care systems.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"71 2","pages":"Pages e123-e132"},"PeriodicalIF":3.5,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145459063","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}
Pub Date : 2025-10-31DOI: 10.1016/j.jpainsymman.2025.10.017
Maria Cassidy MBChB, MRCP, PGCME , Sarah Longwell MBChB, MRCP, PGCME , Salma Khanche
Objectives
Clinical induction for resident doctors rotating into new posts is vital for patient safety. Hospices provide repeated induction sessions to individual rotating doctors with limited resources. We proposed that a shared online learning resource could improve efficiency.
Six of nine hospices surveyed responded; the majority reported clinical induction is resource intensive and were interested in an online resource. 22 resident doctors completed the pilot resource. 50% completed a feedback survey; 100% respondents rated the resource good or excellent and 100% agreed it met their learning needs. 102 users have now accessed the resource; knowledge check quiz scores are 74%–86%, with at least 20% improvement in confidence scores post resource completion.
Conclusion
We have successfully developed a re-usable online learning resource for more efficient clinical induction within Marie Curie hospices. We propose that this could be adopted by other hospices.
Pub Date : 2025-10-30DOI: 10.1016/j.jpainsymman.2025.10.015
William B Alexander, Eric D Hansen, Brian T Anderson, Ali John Zarrabi, Andrew H Rogers, Gregory Loewen, Zachary R Ficarro, Margaret H Alexander, Dylan Schaefer, Amy A Case
Context: 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.
Objective: 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.
Methods: 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.
Results: 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.
Conclusions: 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.
{"title":"Meaning and Psychedelics in Palliative Care: A Narrative Review.","authors":"William B Alexander, Eric D Hansen, Brian T Anderson, Ali John Zarrabi, Andrew H Rogers, Gregory Loewen, Zachary R Ficarro, Margaret H Alexander, Dylan Schaefer, Amy A Case","doi":"10.1016/j.jpainsymman.2025.10.015","DOIUrl":"10.1016/j.jpainsymman.2025.10.015","url":null,"abstract":"<p><strong>Context: </strong>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.</p><p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-10-30","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}
Pub Date : 2025-10-30DOI: 10.1016/j.jpainsymman.2025.10.016
Vilma A. Tripodoro MD, PhD , Pedro Pérez-Cruz MD, MPH , Marina Khoury MD , Martha Ximena León MD , José Mario López Saca MD , Verónica Veloso BA , Ángela Acero MD, PhD , Sebastián Soto-Guerrero MPH, BSW, BPhil , Marco Rodríguez BA , Michelle Uchida MD , Ida Korfage PhD , Agnes van der Heide MD, PhD , CO-LIVE Latin America research group
Context
The COVID-19 pandemic exposed critical weaknesses in end-of-life care (EOLC), particularly in Latin America, where fragmented health systems and inequities intensified suffering.
Objectives
To examine bereaved relatives’ perceptions of EOLC during the pandemic in five Latin American countries, identify predictors of perceived adequacy, and assess alignment with the Core Outcome Set (COS) for best care for the dying person, a consensus-based set of patient-centered outcomes for end-of-life care.
Methods
A cross-sectional online survey of bereaved relatives was conducted in Argentina, Brazil, Chile, Colombia, and El Salvador (2021–2023) using an adapted iCODE questionnaire (Care of the Dying Evaluation). The primary outcome, perceived “adequate care” in the last 48 hours of life, was based on two iCODE items. Logistic regression identified associated factors.
Results
Among 1,125 respondents, 51% perceived care as adequate, varying from 45% in Argentina and Colombia to 81% in El Salvador (P < 0.001). Independent predictors included personal care support (P < 0.001), emotional support (P < 0.001), trust in professionals (P < 0.001), symptom relief (P ≤ 0.001), effective communication (P = 0.012), and family involvement in decision-making (P = 0.045). COVID-19 restrictions were negatively associated with perceived adequacy. Alignment of our findings with the COS domains revealed persistent gaps in spiritual support, shared decision-making, and communication.
Conclusion
Perceptions of EOLC adequacy during the pandemic varied across Latin America. Relational, emotional, and physical aspects of care strongly influenced relatives’ assessments. The COS offers a practical framework to identify and address care gaps. Its adoption could promote holistic, culturally sensitive EOLC, essential to improving care in the region.
{"title":"Beyond the Pandemic: End-of-Life Care Lessons From Latin America to Inform Future Health Emergencies","authors":"Vilma A. Tripodoro MD, PhD , Pedro Pérez-Cruz MD, MPH , Marina Khoury MD , Martha Ximena León MD , José Mario López Saca MD , Verónica Veloso BA , Ángela Acero MD, PhD , Sebastián Soto-Guerrero MPH, BSW, BPhil , Marco Rodríguez BA , Michelle Uchida MD , Ida Korfage PhD , Agnes van der Heide MD, PhD , CO-LIVE Latin America research group","doi":"10.1016/j.jpainsymman.2025.10.016","DOIUrl":"10.1016/j.jpainsymman.2025.10.016","url":null,"abstract":"<div><h3>Context</h3><div>The COVID-19 pandemic exposed critical weaknesses in end-of-life care (EOLC), particularly in Latin America, where fragmented health systems and inequities intensified suffering.</div></div><div><h3>Objectives</h3><div>To examine bereaved relatives’ perceptions of EOLC during the pandemic in five Latin American countries, identify predictors of perceived adequacy, and assess alignment with the Core Outcome Set (COS) for best care for the dying person, a consensus-based set of patient-centered outcomes for end-of-life care.</div></div><div><h3>Methods</h3><div>A cross-sectional online survey of bereaved relatives was conducted in Argentina, Brazil, Chile, Colombia, and El Salvador (2021–2023) using an adapted iCODE questionnaire (Care of the Dying Evaluation). The primary outcome, perceived “adequate care” in the last 48 hours of life, was based on two iCODE items. Logistic regression identified associated factors.</div></div><div><h3>Results</h3><div>Among 1,125 respondents, 51% perceived care as adequate, varying from 45% in Argentina and Colombia to 81% in El Salvador (<em>P</em> < 0.001). Independent predictors included personal care support (<em>P</em> < 0.001), emotional support (<em>P</em> < 0.001), trust in professionals (<em>P</em> < 0.001), symptom relief (<em>P</em> ≤ 0.001), effective communication (<em>P</em> = 0.012), and family involvement in decision-making (<em>P</em> = 0.045). COVID-19 restrictions were negatively associated with perceived adequacy. Alignment of our findings with the COS domains revealed persistent gaps in spiritual support, shared decision-making, and communication.</div></div><div><h3>Conclusion</h3><div>Perceptions of EOLC adequacy during the pandemic varied across Latin America. Relational, emotional, and physical aspects of care strongly influenced relatives’ assessments. The COS offers a practical framework to identify and address care gaps. Its adoption could promote holistic, culturally sensitive EOLC, essential to improving care in the region.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"71 2","pages":"Pages 280-289"},"PeriodicalIF":3.5,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145421692","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号