Journal of pain and symptom management最新文献

Context: 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.

Objective: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Context and objectives: Patients with cancer living in war zones face significant quality of life (QoL)-related challenges. This study examined an integrative oncology (IO) intervention in northern Israel for pain and autonomic response.

Methods: This prospective, randomized, controlled and pragmatic study examined an IO intervention with manual-relaxation, with acupuncture (Group A) or without (Group B). ESAS (Edmonton Symptom Assessment Scale), EORTC QLQ-C30 (European Organization for Research and Treatment of Cancer QoL Questionnaire), and MYCAW (Measure Yourself Concerns and Wellbeing) tools were used to examine QoL. Heart rate and variability (HRV) were measured at baseline and 15 minutes post-treatment, comparing frequency-domain variable changes (e.g., LN Power Total, Power HF, Power LF, Power VLF).

Results: Of 125 patients, Groups A (67) and B (58) had similar demographic and cancer-related characteristics. ESAS pain scores improved in both groups post-treatment (A, P < 0.001; B, P = 0.002), as did anxiety, depression, and fatigue. At three weeks, Group B reported greater improvement on ESAS pain (P = 0.039) and MYCAW pain-related concerns (P = 0.025), both showing within-group improvement on EORTC pain. HRV showed greater change in Group A, with decreased LN Power Total (P = 0.006), LN Power LF (P = 0.02), and LN Power VLF (P = 0.026). While Relative Power HF increased marginally (P = 0.054), heart rate decreasing more significantly in Group B (P = 0.005).

Conclusions: IO treatments led to reduced pain among patients with cancer living in a war zone, with no additive effect of acupuncture. HRV changes suggest enhanced parasympathetic activity, with acupuncture-treated patients showing additional frequency-domain changes attributed to decreased sympathetic tone.

Context: Although hospice policies vary in where they permit staff to be physically located during key stages of the medical aid in dying (MAID) procedure, data needed to inform best practices concerning if and how clinicians themselves are present are lacking.

Objectives: To (1) assess the sample proportion of clinician presence during each individual stage of the MAID procedure and (2) typologize the distinct trajectories of clinician presence across stages of the MAID procedure.

Methods: We used secondary cross-sectional survey data from a convenience sample of interdisciplinary US hospice clinicians indicating permissive state and organizational MAID participation policies. Participants reported whether they had ever been present during medication self-administration, after medication self-administration, and after death by indicating if they had been in the same room, in the same residence but not the same room, or never present. We assessed presence and typologized trajectories via frequency and percentage.

Results: The sample comprised 106 hospice physicians, nurses, social workers, and chaplains. The sample majority reported never having been present during any stage. Across stages, the sample demonstrated 13 distinct trajectories of clinician presence. The most common trajectories illustrated uniformity in physical location across stages. The remaining trajectories reflected transitions in physical locations across stages. Transition subgroups depicted increasing proximity to bedside, increasing distance from bedside, and a combination of both.

Conclusions: High variability in hospice clinician presence throughout the MAID procedure may differentially affect patient care. Future best-practices research should explore stakeholder experiences of trajectories and stratify trajectories by professional discipline.

Context: Advance care planning (ACP) may prepare older adults for future health problems including cognitive and physical decline. Depressive symptoms are observed among those engaging in ACP. However, the directionality of the association between ACP engagement and depressive symptoms remains uncertain.

Objectives: To investigate bidirectional associations between engaging in ACP and depressive symptoms in older adults at a within-person level after accounting for cognitive and physical decline.

Methods: A longitudinal study design using random intercept cross-lagged panel models. Community-dwelling older adults from the Longitudinal Aging Study Amsterdam (LASA) with three assessments at T0 (2015-2016), T1 (2018-2019), and T2 (2021-2022). Discussion of end-of-life wishes with a physician was used as a proxy measure for ACP engagement.

Results: Participants included 1669 older adults (mean [SD] age, 69.7 [7.7] years at T0; 923 [55.3%] were women). Poor cognition at T0 was associated with having discussed end-of-life wishes at T1 (β = -0.12 [95% CI, -0.23 to -0.01]), that was prospectively associated with increased depressive symptoms (0.12 [0.01 to 0.24]), decreased cognition (-0.13 [-0.22 to -0.04]), and decreased physical performance (-0.16 [-0.27 to -0.04]) at T2.

Conclusion: Older adults appear at risk for having depressive symptoms following discussing end-of-life wishes with their physicians. End-of-life communication may reflect an ongoing trajectory of cognitive decline which could result in further functional decline and increased depressive symptoms. A better understanding of how and which elements of end-of-life discussions are associated with the mood of older adults will provide implications for the implementation of ACP.

Context: Breathlessness is the most common and distressing symptom in lung cancer, but no systematic review has examined the effectiveness of mindfulness-based interventions on breathlessness.

Objectives: To evaluate the effectiveness of mindfulness-based interventions on breathlessness, pulmonary function, and psychological well-being in lung cancer.

Methods: According to the PRISMA guidelines, we conducted a systematic search across ten databases from inception to February 2025. Only randomized controlled trials were included.

Results: Fourteen RCTs from 15 papers (N = 1190) were included. Pooled results: compared with a control, mindfulness-based interventions did not show a significant improvement in breathlessness [SMD = -0.44, 95% CI: -0.92 to 0.05, n = 5]; indicated a significant improvement in pulmonary function including vital capacity [MD = 0.44 L, 95% CI: 0.18-0.70, n = 2], peak expiratory flow [MD = 14.72 L/s, 95% CI: 6.14-23.30, n = 2], forced expiratory volume in one second (FEV₁) [MD = 0.49 L, 95% CI: 0.17-0.81, n = 9], forced vital capacity (FVC) [MD = 0.55 L, 95% CI: 0.28-0.83, n = 8], FEV₁/FVC [MD = 8.02%, 95% CI: 5.77-10.28, n = 6]; indicated a significant reduction in psychological distress including depressive symptoms [SMD = -1.28, 95% CI: -2.25 to -0.31, n = 6], and anxiety [SMD = -1.54, 95% CI: -2.34 to -0.74, n = 7]. Subgroup analysis: patients receiving mindfulness-based respiratory function interventions indicated significant improvements in breathlessness [SMD = -0.53, 95% CI: -0.86 to -0.21], FEV₁ [MD = 0.28 L, 95% CI: 0.17-0.39], and FVC [MD = 1.29, 95% CI: 0.64-1.95], compared with those receiving respiratory function intervention.

Conclusion: Mindfulness-based interventions did not demonstrate a statistically significant improvement in self-reported breathlessness compared to controls. However, subgroup analysis indicated that combining mindfulness with respiratory function training may offer additional benefits for alleviating breathlessness. Further high-quality RCTs are needed to determine the optimal intervention dosages and long-term impact of mindfulness-based interventions on improving breathlessness.

Context: Evaluation of palliative care programs in nursing homes often includes symptom assessments. For residents with cognitive impairment, proxy symptom reports, such as those from family members or nursing home staff, may be used as outcome measures.

Objectives: This analysis compares differences between family and staff proxy reports of symptoms of nursing home residents with moderate to severe cognitive impairment.

Methods: Data were collected as part of a clinical trial, conducted in 16 nursing homes (NHs) in Indiana and Maryland (U.S.). We calculated the difference in total modified End-of-Life Dementia Comfort Assessment in Dying (EOLD-CAD) scores between family and staff respondents for 194 residents, and quantified characteristics associated with discordance.

Results: About half of responding staff were licensed nurses and 37% were certified nursing assistants. Adult children of residents were the most common (57%) family respondents. There was fair agreement between the respondent groups (kappa = 0.26) for the total modified EOLD-CAD scale. Overall, family members reported higher symptom burden than staff. Some symptoms, including discomfort, pain, restlessness and agitation, were reported as more burdensome by both groups of proxies vs. symptoms such as gurgling or choking. Proxy symptom reports on residents with more advanced cognitive impairment were less likely to be substantially discordant (OR = 0.50, 95% CI 0.26, 0.99, P = 0.047).

Conclusion: Proxies are often used to report symptom experiences for people living with cognitive impairment. Multiple perspectives may be needed to obtain a fuller picture of symptom burden in this population.

Registration: CLINICALTRIALS.GOV: NCT04520698.