TY  - JOUR
T1  - Integrative Management of Pain, Oral Symptoms, Nutritional Risk, and Medication-Related Problems in Advanced Chronic Disease
A1  - Peter Novak
A1  - Sophie Dubois
A1  - Thomas Müller
A1  - Anna Weber
A1  - Erik Johansson
JF  - Journal of Integrative Nursing and Palliative Care
JO  - J Integr Nurs Palliat Care
SN  - 3006-5550
Y1  - 2025
VL  - 6
IS  - 2
DO  - 10.51847/wosLuqPHIc
SP  - 394
EP  - 404
N2  - Patients with advanced chronic disease frequently experience pain, oral symptoms, nutritional problems, and complex medication regimens at the same time, yet these domains are commonly assessed and managed through separate clinical pathways. This integrative clinical review examined evidence published from 2017–2026 concerning the burden, interaction, assessment, and management of these domains in palliative and supportive care. Five targeted literature searches and supplementary evidence verification yielded 73 records or reports. After removal of four duplicates, 69 unique records underwent eligibility assessment; 30 clinical evidence units were retained for synthesis, supplemented by four methodological and reporting references. Evidence was heterogeneous in design, population, setting, and outcome definition and therefore was integrated without de novo quantitative pooling. Pain and oral morbidity were consistently important sources of symptom burden, while nutritional risk encompassed intake-limiting symptoms, cachexia-related concerns, psychological distress, and eating-related burden. Polypharmacy and potentially inappropriate medication use were frequent in advanced illness, although evidence for clinical benefits beyond reduction in medication burden remained variable. The strongest cross-domain evidence concerned relationships between oral symptoms and eating or feeding, whereas direct evidence connecting analgesic treatment with oral outcomes or medication burden with nutritional deterioration was less developed. Integrated management is therefore best understood as coordinated reassessment across distinct domains rather than as a single composite burden construct. Clinical integration should remain sensitive to patient goals, stage of illness, treatment burden, professional roles, and the strength of evidence supporting each proposed interaction.
UR  - https://journalinpc.com/article/integrative-management-of-pain-oral-symptoms-nutritional-risk-and-medication-related-problems-in-owr7kbmum8iz76h
ER  -