Journal of pain and symptom management最新文献

Hemoptysis is a distressing symptom for both patients and families at end of life (EOL). In the acute care setting, this can be managed surgically or medically. However, research regarding interventions, such as nebulized tranexamic acid (TA) and nebulized factor VIIa, for palliative management of hemoptysis at EOL is limited. In our case series, we found that combination of nebulized recombinant factor VIIa and nebulized TA relieved hemoptysis in both pediatric cancer patients at the end of life. This case series highlights the potential use of this combination to reduce suffering and distress secondary to hemoptysis in the palliative setting.

Context: High-quality goals of care (GOC) conversations are essential to providing patient-centered care during clinical deterioration in hospitalized patients. However, the presence and quality of GOC documentation before deterioration events such as intensive care unit (ICU) transfer is unknown.

Objectives: To evaluate the quality of GOC documentation in hospitalized adults before ICU transfer and assess the association between high-quality documentation and code status change after transfer.

Methods: We reviewed records of 373 adult medicine patients transferred unplanned to the ICU at a university hospital over 24 months. We collected demographic data, pre-ICU hospitalization characteristics, and code status changes within 24 hours of transfer. The primary outcome was high-quality GOC documentation, defined as the presence of ≥2 of following components: prognosis, values/goals, surrogate decision maker, and intervention preferences. We analyzed data to assess factors associated with high-quality documentation and performed logistic regression to evaluate the relationship between documentation quality and code status changes after ICU transfer.

Results: Few patients (N = 80, 21.4%) had high-quality GOC documentation. The least frequent components documented were values/goals (16.1%) and prognosis (16.9%). Older age, frailty, specific comorbidities, palliative care consultation, longer pre-ICU hospitalization, and DNAR (do-not-attempt resuscitation) or multiple code statuses were associated with high-quality documentation (P < 0.05). High-quality GOC documentation was independently associated with odds of code status change after ICU transfer (OR, 3.41; 95% confidence interval [95% CI], 1.70-6.81).

Conclusion: High-quality GOC documentation was present in only one in five patients before ICU transfer and was associated with code status change within 24 hours of transfer.

Background: Pediatric palliative care (PPC) should be integrated throughout the disease trajectory and recognized as a fundamental component of pediatric healthcare systems.

Aim: To describe the development level of PPC in mainland China and elucidate the changing characteristics in this field over the past five years.

Methods: This is a cross-sectional study initiated by the PPC subspecialty group of the Pediatrics Society of the Chinese Medical Association. Study participants included all PPC teams in mainland China. The questionnaire was structured into five main sections: team characteristics, personnel composition, service quality, service types and contents, and support needs. This study compared the level of PPC development in mainland China in 2025 with that of 2019, with the 2019 data sourced from literature published by our team. Descriptive statistics were used to analyze the data.

Results: There were 36 PPC teams, covering 16 out of 31 (51.61%) provinces and municipalities in mainland China. The median total number of team members was 12 (9, 16). From 2019 to 2025, the number of teams decreased from 45 to 36. However, the total number of team members increased from 300 to 513, demonstrating significant structural improvements in PPC teams. With the improved team structure, the content of palliative care services has significantly expanded.

Conclusion: Over the past five years, the PPC system in mainland China has made improvements to its team structure and dynamics. Despite this progress, it continues to face interrelated challenges: severe resource shortages, inefficient resource utilization, and uneven geographical distribution of services.

Introduction: Care for urologic serious illness often includes surgery; preoperative shared decision making about patient goals of care is a cornerstone of good surgical quality of care.

Objective: To understand perspectives on improving perioperative communication about goals of care through a team approach for patients facing urologic serious illness.

Methods: We conducted 38 semi-structured interviews with Palliative Care Physicians (PC) (12), Urologists (13) and interdisciplinary clinicians (13) at fourteen geographically distributed Veteran Health Administration (VHA) sites. The analytic approach consisted of content analysis with dual review.

Results: We identified five unique themes: 1) Preoperative workflows may benefit from additional patient education as "patients are not [always] aware that we might be able to palliate their symptoms without surgery" 2) The goal of surgery is often something patients really need help understanding, e.g. "It's gonna help temporarily, but it's not gonna help long term" 3) PC is not in the position to clarify the goal of the surgery: "it's very hard for nonsurgeon to have robust a goals of care discussion with the patient who's co-managed with surgery unless surgery is able to give you a sense of what to expect." 4) A team approach to clarifying and navigating patient goals is warranted: "how do we work together to … [set] sort of real realistic expectations and goals for after the surgery?" 5) In coordination, Urologists and PC can offer complementary contributions to different parts of a goals of care conversation based on their expertise.

Conclusion: This work is an important initial step towards clarifying a PC-Urology team approach to goals of care and surgery conversations.

Background: Despite advances in systemic analgesic strategies for cancer patients suffering pain, a subset of patients remains unresponsive to standard treatment. Intrathecal infusion therapy offers targeted pain relief, with implantable pumps being particularly beneficial for those with longer life expectancies. Although recommended in clinical guidelines, implantable pumps remain underused. To support informed clinical decision-making, we conducted a systematic review and meta-analysis to evaluate the efficacy of this therapy in reducing refractory cancer-related pain.

Methods: This systematic review and meta-analysis followed the PRISMA guideline. We searched PubMed, Cochrane, BVS Lilacs, and Epistemonikos for cancer-related pain management using an intrathecal infusion system with an implantable pump and a follow-up of at least three months. The risk of bias was assessed using RoB-2 and ROBINS-I tools. Data extracted included pain intensity, adverse events and quality of life.

Results: Twelve articles were included: two randomized controlled trials and ten single-arm studies. Our meta-analysis of pain reduction found that mean pain intensity decreased by 4.37 points (95% CI -4.89 to -3.84) after three months of implantation, and by 3.30 (95% CI -5.49 to -1.12) after six months. The most frequently reported adverse events were postdural headache, nausea and vomiting. Although quality of life improved, further studies are needed for a comprehensive evaluation.

Conclusion: Implantable intrathecal infusion systems seem to be a viable alternative to manage refractory cancer-related pain; however, these findings should be interpreted carefully given the methodological limitations, including the lack of comparative design and the high risk of bias in the included studies.

Background: 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.

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 (e.g., family problems).

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.