{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T08:44:35Z","timestamp":1791794675454,"version":"4.3.4"},"reference-count":38,"publisher":"SAGE Publications","issue":"11","license":[{"start":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T00:00:00Z","timestamp":1782432000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Palliative Medicine"],"published-print":{"date-parts":[[2026,11,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Nausea and vomiting are distressing symptoms in palliative care. Due to a heterogeneous population and limited evidence, clinical management remains challenging. Guidelines often recommend an etiology-based treatment approach, but supporting evidence is scarce, particularly for noncancer patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>Evaluating the impact of a structured, etiology-based treatment pathway on nausea and vomiting burden and treatment quality in palliative care patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting\/Subjects:<\/jats:title>\n                    <jats:p>Single-center, before-after study in adult patients on a German tertiary palliative care unit, comparing symptom burden and treatment quality before (Phase 1, 15 months) and after (Phase 2, 12 months) implementation of the pathway.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements:<\/jats:title>\n                    <jats:p>Outcome measures were change in symptom burden score on day 3 (Integrated Palliative Care Outcome Scale ([IPOS]), treatment quality (quality indicator [QI]; burden reduction on IPOS), and duration of symptoms (days). Significance level was set at \u03b1 &lt; 0.01.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      In Phase 1, 172\/330 patients (52.1%) experienced 230 episodes of nausea\/vomiting, versus 139\/280 patients (49.6%) with 178 episodes in Phase 2. On day 3, symptom burden scores for nausea decreased to a greater extent in Phase 2 (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.007); vomiting showed a nonsignificant reduction (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.021). The QI (nausea) was met in 124\/178 (69.7%) versus 129\/156 (82.7%) (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.0056), and the QI (vomiting) was met in 66\/93 (71.0%) versus 81\/95 (85.3%) (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.0176) episodes. Symptom duration decreased from 3 (0\u201325) to 2 (0\u201323) days (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>The systematic etiology-based pathway significantly improved cause identification and treatment quality. While benefits were more pronounced in cancer patients, this structured approach provides a robust framework for enhancing antiemetic management in the palliative care setting. Further studies should investigate antiemetic treatment in noncancer patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10966218261462313","type":"journal-article","created":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T03:59:52Z","timestamp":1782532792000},"page":"1508-1516","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of a Structured Pathway on Nausea and Vomiting Treatment in Palliative Care: A Before-After Study"],"prefix":"10.1177","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-7011-1873","authenticated-orcid":false,"given":"Jennifer Marie","family":"Berner-Sharma","sequence":"first","affiliation":[{"name":"Department of Palliative Medicine, LMU University Hospital, Munich, Germany."},{"name":"Doctoral Program Clinical Pharmacy, LMU University Hospital, Munich, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaditya","family":"Berner-Sharma","sequence":"additional","affiliation":[{"name":"Core Facility Statistical Consulting, Helmholtz Center Munich, Munich, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Till","family":"Arnold","sequence":"additional","affiliation":[{"name":"Department of Palliative Medicine, LMU University Hospital, Munich, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Bausewein","sequence":"additional","affiliation":[{"name":"Department of Palliative Medicine, LMU University Hospital, Munich, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Constanze","family":"R\u00e9mi","sequence":"additional","affiliation":[{"name":"Department of Palliative Medicine, LMU University Hospital, Munich, Germany."},{"name":"Doctoral Program Clinical Pharmacy, LMU University Hospital, Munich, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,6,26]]},"reference":[{"key":"e_1_3_3_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/10499091251313757"},{"key":"e_1_3_3_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-018-4623-1"},{"key":"e_1_3_3_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2006.10.015"},{"key":"e_1_3_3_5_1","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2018.0622"},{"key":"e_1_3_3_6_1","doi-asserted-by":"publisher","DOI":"10.6004\/jadpro.2020.11.5.4"},{"key":"e_1_3_3_7_1","doi-asserted-by":"publisher","DOI":"10.1080\/15360288.2021.1900491"},{"key":"e_1_3_3_8_1","volume-title":"Erweiterte S3-Leitlinie Palliativmedizin f\u00fcr Patienten mit einer nicht-heilbaren Krebserkrankung","author":"AWMF","year":"2020","unstructured":"7.AWMF. 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