Journal of Pain and Symptom Management

Nicholas Jennings, Kenneth Chambaere, Stacey Chamely, Cheryl C Macpherson, Luc Deliens, Joachim Cohen
CONTEXT: Empirical information on circumstances of dying from advanced illness in developing countries remain sparse. Evidence indicates that out-of-hospital end-of-life care can have significant benefits like increased satisfaction for the patient and caregivers, and cost-effective for a healthcare system. Services that are aimed to deliver care at private homes may be a good model for low- and middle-income countries or other low-resourced settings. OBJECTIVES: To examine specialised, generalist and informal palliative care provision, and to describe the end-of-life care goals and treatments received...
July 7, 2020: Journal of Pain and Symptom Management
Mei-Ling Lo, Chung-Chi Huang, Tsung-Hui Hu, Wen-Chi Chou, Li-Pang Chuang, Ming Chu Chiang, Fur-Hsing Wen, Siew Tzuh Tang
BACKGROUND: /Aim: Essential indicators of high-quality end-of-life care in intensive care units (ICUs) have been established but examined inconsistently and predominantly with small samples, mostly from Western countries. Our study goal was to comprehensively measure end-of-life-care quality delivered in ICUs using chart-derived process-based quality measures for a large cohort of critically ill Taiwanese patients. STUDY DESIGN: and participants: For this observational study, patients with APACHE II score >20 or goal of palliative care and with ICU stay exceeding 3 days (N=326) were consecutively recruited and followed until death...
July 7, 2020: Journal of Pain and Symptom Management
Joseph Arthur, Tonya Edwards, Zhanni Lu, David Hui, Bryan Fellman, Eduardo Bruera
CONTEXT: Healthcare provider education is an effective strategy to improve knowledge and competencies in opioid prescribing practices. However, there are very few studies regarding this among providers of patients with cancer pain and nonmedical opioid use (NMOU). The aim of our study was to assess participants' attitudes, beliefs, and self-perceived confidence in caring for patients with cancer pain and NMOU before and after attending an opioid educational seminar on the use and nonmedical use of opioids in cancer patients...
July 6, 2020: Journal of Pain and Symptom Management
Erica Frechman, Mary S Dietrich, Rachel Lane Walden, Cathy A Maxwell
CONTEXT: Advance Care Planning (ACP) is essential to elicit goals, values, and preferences of care in older adults with serious illness and on trajectories of frailty. An exploration of ACP uptake in older adults may identify barriers and facilitators. OBJECTIVE: To conduct an integrative review of research on the uptake of ACP in older adults, and create a conceptual model of the findings. METHODS: Using Whittemore and Knafl's methodology, we systematically searched four electronic databases of ACP literature in older adults from 1996 through December 2019...
July 6, 2020: Journal of Pain and Symptom Management
Joanna Veazey Brooks, Claire Poague, Taynara Formagini, Andrew W Roberts, Christian T Sinclair, Carla C Keirns
CONTEXT: Patients with cancer face symptoms due to disease and treatment, and pain is common and complex. The opioid crisis may complicate patients' and clinicians' experiences of managing pain in cancer care. OBJECTIVES: In our study of perceptions and experiences with palliative care at an outpatient cancer center, we examined communication around symptom management throughout cancer care, and pain and its management emerged as particularly salient. The objective of this paper is to describe, from the perspectives of patients, caregivers, and oncology healthcare professionals, the role of palliative care in navigating the complicated dynamics of pain management amidst the opioid crisis...
July 6, 2020: Journal of Pain and Symptom Management
Astrid Dh Brys, Frank Stifft, Caroline M Van Heugten, Maurizio Bossola, Giovanni Gambaro, Bert Lenaert
CONTEXT: Fatigue is prevalent among hemodialysis (HD) patients and associated with depressive mood. To advance our understanding of its etiology and develop appropriate treatments, reliable measurement instruments are needed. However, conventional fatigue and mood questionnaires are prone to bias due to their retrospective nature and may misrepresent or overestimate actual symptom experience (i.e., the so-called 'memory-experience' gap). Experience sampling Methodology (ESM) overcomes this limitation through repeated real-time assessments in patients' natural environment, thereby providing reliable and ecologically valid data...
July 6, 2020: Journal of Pain and Symptom Management
Daniella Lipnick, Michael Green, Elizabeth Thiede, Theresa J Smith, Erik B Lehman, Ms Rhonda Johnson, In Seo La, Debra Wiegand, Benjamin H Levi, Lauren Jodi Van Scoy
CONTEXT: Spokespersons serving as surrogate decision-makers for their loved ones report high levels of stress. Despite known benefits, advance care planning (ACP) conversations often do not occur. More information is needed to understand spokesperson stress during ACP. OBJECTIVES: To: 1) explore if and how spokespersons perceive stress related to ACP conversations; 2) compare factors related to stress; and 3) assess whether ACP intervention impacted stress. METHODS: Secondary, mixed methods analysis with data transformation of semi-structured interviews occurring during a 2x2 factorial (four armed), randomized controlled trial that compared standard online ACP to a comprehensive, online ACP decision aid...
July 6, 2020: Journal of Pain and Symptom Management
Cuixia Yan, Rita Cheung, Cho Lee Wong, Ho Yu Cheng, Fengying Liu, Haiying Huang, Celeste Ewig, Chi-Kong Li, Hui Zhang, Yin Ting Cheung
OBJECTIVES: Children with cancer are exposed to repeated painful and invasive procedures. This study examines Chinese parents' stress and perception towards their children's procedural pain-control. METHODS: We recruited 265 parents of children (aged <18 years) diagnosed with hematological cancer (74.7%) and solid tumors (25.3%) from two major public hospitals. Parents used a scale (0-10) to rate perceived pain experienced by their child when undergoing lumbar puncture (LP), bone marrow aspirate or/and biopsy...
July 5, 2020: Journal of Pain and Symptom Management
Shinichiro Morioka, Masanori Mori, Tomomi Suzuki, Marika Yokomichi, Jun Hamano, Tatsuya Morita
BACKGROUND: Antimicrobials are frequently prescribed to terminally-ill patients with cancer; however, physicians' practice patterns regarding antimicrobial use vary widely. This study aimed to systematically identify factors that determine physicians' attitudes toward the management of infectious diseases in terminally-ill patients with cancer. METHODS: A nationwide cross-sectional survey involving 600 oncologists, 600 infectious diseases physicians, 600 palliative care physicians, and 220 home care physicians was conducted between November 2017 and January 2018...
July 4, 2020: Journal of Pain and Symptom Management
Betty R Ferrell, George Handzo, Tina Picchi, Christina Puchalski, William E Rosa
The COVID-19 crisis has amplified the importance of palliative care to countless patients suffering with and dying from this disease, as well as to their families, communities, and the worldwide cadre of overburdened healthcare workers. Particularly urgent is the need for spiritual care specialists and generalists to address spiritual suffering given the degree of isolation, loneliness, and vulnerability caused by this pandemic. Although spiritual care has long been recognized as one of the domains of quality palliative care, it is often not fully integrated into practice...
July 3, 2020: Journal of Pain and Symptom Management
Jori F Bogetz, Anna Revette, Abby R Rosenberg, Danielle DeCourcey
CONTEXT: Children with complex chronic conditions (CCCs) have high morbidity and mortality. While these children often receive palliative care services, little is known about parental preparedness for their child's end of life (EOL). OBJECTIVES: This study aimed to elucidate aspects important to preparedness at EOL among bereaved parents of children with CCCs. METHODS: In this cross-sectional study, parents of children who received care at Boston Children's Hospital and died between 2006-2015 completed 21 open-response items querying communication, decision-making, and EOL experiences as part of the Survey of Caring for Children with CCCs...
July 3, 2020: Journal of Pain and Symptom Management
Erica C Kaye, Melanie Gattas, Ashley Kiefer, Jason Reynolds, Kristina Zalud, Chen Li, Zhaohua Lu, Justin N Baker
CONTEXT: Most hospice nurses across Tennessee, Arkansas, and Mississippi report significant discomfort with provision of pediatric palliative and hospice care (PPHC). How best to target and modify variables to increase nurse comfort levels is not well understood. OBJECTIVE: To determine whether modifiable variables are associated with increased hospice nurse comfort with PPHC provision in the community. METHODS: A cross-sectional survey was developed, pilot-tested, and distributed to hospice nurses across a tristate region to assess nurse training experiences and comfort with PPHC provision...
July 2, 2020: Journal of Pain and Symptom Management
Abby R Rosenberg, Krysta Barton, Courtney Junkins, Samantha Scott, Miranda C Bradford, Angela Steineck, Nancy Lau, Liam Comiskey, Joyce P Yi-Frazier
Conducting palliative care research can be personally and professionally challenging. While limitations in funding and training opportunities are well-described, a less recognized barrier to successful palliative care research is creating a sustainable and resilient team. In this special report, we describe the experience and lessons-learned in a single palliative care research lab. In the first few years of the program, 75% of staff quit, citing burnout and the emotional tolls of their work. To address our sustainability, we translated resilience theory to practice...
July 1, 2020: Journal of Pain and Symptom Management
Ludovica De Panfilis, Paolo Giorgi Rossi, Elisa Mazzini, Luca Pistolesi, Luca Ghirotto, Antonio Noto, Sandra Cuocolo, Massimo Costantini
INTRODUCTION: Advance directives are legal documents which individuals draw up to declare their treatment preferences and to appoint well-informed proxies to safeguard patient autonomy in critical situations when that individual is temporarily or no longer able to communicate these preferences. On December 22, 2017, the Italian Parliament approved the first law on end of life ("Provisions for informed consent and advance directives" L.219/2017), after a heated public and political debate lasting almost twenty years...
June 30, 2020: Journal of Pain and Symptom Management
Yen-Ting Ko, Ming-Chung Ko, Chao-Ming Huang, Hsin-Yi Lien, Lin-Chung Woung, Sheng-Jean Huang
OBJECTIVES: This study aimed to evaluate the trends of utilization of palliative care and aggressive end-of-life care for patients who died of cancers and those who died of non-cancer diseases in hospitals. METHODS: The medical records of patients who died in a public hospital due to cancer or other diseases were reviewed. The proportion of those who received palliative care, admitted to intensive care unit (ICU) within 30 days of death, died in ICU, and received cardiopulmonary resuscitation (CPR) within 3 days of death in 2013-2014, 2015-2016, and 2017-2018, respectively, was investigated...
June 30, 2020: Journal of Pain and Symptom Management
Andrés Vargas, Carolina Torres, Anna Küller-Bosch, Belén Villena
CONTEXT: Palliative radiotherapy is effective in the management of symptoms resulting from advanced cancer. However, it remains underutilised. In developed countries, many factors have been linked to this phenomenon but data in developing and low income countries, particularly in Latin America, are lacking. OBJECTIVES: To conduct a cross-sectional survey to explore palliative care physicians' knowledge of palliative radiotherapy and to investigate possible factors that limit patient referral...
June 29, 2020: Journal of Pain and Symptom Management
Takaaki Hasegawa, Ryuichi Sekine, Tatsuo Akechi, Satoshi Osaga, Tetsuya Tsuji, Toru Okuyama, Haruka Sakurai, Kento Masukawa, Maho Aoyama, Tatsuya Morita, Yoshiyuki Kizawa, Satoru Tsuneto, Yasuo Shima, Mitsunori Miyashita
CONTEXT: In end-of-life care, rehabilitation for cancer patients is considered to be an important means for improving patients' quality of death and dying (QODD). OBJECTIVES: To determine whether the provision of rehabilitation for cancer patients in palliative care units is associated with the achievement of a good death. METHODS: This study involved a cross-sectional, anonymous, self-report questionnaire survey of families of cancer patients who died in palliative care units in Japan...
June 29, 2020: Journal of Pain and Symptom Management
Jennifer Dickman Portz, Kelsey Lynett Ford, Katherine Doyon, David B Bekelman, Rebecca S Boxer, Jean S Kutner, Sara Czaja, Sheana Bull
CONTEXT: Digital health offers innovative mechanisms to engage in palliative care, yet digital systems are typically designed for individual users, rather than integrating the patient's caregiving "social convoy" (i.e. family members, friends, neighbors, formal caregiving supports) to maximize benefit. As older adults with serious illness increasingly rely on the support of others, there is a need to foster effective integration of the social convoy in digitally supported palliative care...
June 29, 2020: Journal of Pain and Symptom Management
Israt Yasmeen, Karla D Krewulak, Cherri Zhang, Henry T Stelfox, Kirsten M Fiest
CONTEXT: Alternative pain management interventions involving caregivers may be valuable adjuncts to conventional pain management interventions. OBJECTIVE: Use systematic review methodology to examine caregiver-facilitated pain management interventions in a hospital setting and whether they improve patient, caregiver, provider or health system outcomes. METHODS: We searched MEDLINE, EMBASE, PsycINFO, CINAHL, and Scopus databases from inception to April 2020...
June 29, 2020: Journal of Pain and Symptom Management
Madelon Heijltjes, Ghislaine van Thiel, Judith Rietjens, Agnes van der Heide, Alexander de Graeff, Johannes van Delden
BACKGROUND: The use of continuous sedation until death (CSD) has been highly debated for many years. It is unknown how the use of CSD evolves over time. Reports suggest that there is an international increase in the use of CSD for terminally ill patients. OBJECTIVE: To gain insight in developments in the use of CSD in various countries and subpopulations. DESIGN: We performed a search of the literature published between January 2000 and April 2020, in Pubmed, Embase, CINAHL, Psycinfo and the Cochrane Library by using the PRISMA guidelines...
June 26, 2020: Journal of Pain and Symptom Management
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