Journal of Pain and Symptom Management

CONTEXT: A systematic review of the wish to hasten death among people with life-limiting conditions was published in 2011. Since then, other reviews and primary studies have been published that have added to knowledge regarding the conceptual definition, aetiology and assessment of the wish to hasten death. OBJECTIVES: To provide an updated synthesis of the literature on the wish to hasten death in people with life-limiting conditions. METHODS: An overview of systematic reviews and primary studies was conducted, using an integrative review method...

CONTEXT: The Preference-Aligned Communication and Treatment (PACT) Project is a multi-site quality improvement effort that has been shown to increase the frequency of goals of care (GOC) conversations in hospitalized patients with serious illness. OBJECTIVES: To evaluate the effect of PACT on goal-discordant care and resource utilization. METHODS: Hospitals enrolled in a multi-year mentored implementation quality improvement initiative to facilitate GOC conversations for seriously ill hospitalized patients...

CONTEXT: Few studies have compared the prognostic value of scoring systems based on physical and blood parameters in terminally ill patients with cancer. OBJECTIVES: This study evaluated the prognostic abilities of Palliative Prognostic Index (PPI), Laboratory Prognostic Score (LPS), and Palliative Prognostic Score (PaP). METHODS: We included 989 terminally ill patients with cancer who consulted for admission to our palliative care unit. We compared the discriminative abilities of PPI, LPS, and PaP for 7-, 14-, 30-, 60-, and 90-day mortality...

CONTEXT: Recent studies show increasing use of mechanical ventilation among people living with dementia. There are concerns that this trend may not be driven by patient preferences. OBJECTIVES: To better understand decision-making regarding mechanical ventilation in people living with dementia. METHODS: This was an electronic health record-based retrospective cohort study of older adults with dementia (n=295) hospitalized at one of two teaching hospitals between 2015 and 2019 who were supported with mechanical ventilation (n=191) or died without mechanical ventilation (n=104)...

INTRODUCTION: This study explores the feasibility and effects of music therapy on anticipatory nausea and vomiting, stress, pain and quality of life in adolescents undergoing chemotherapy. METHODS: This is a single group, quasi-experimental study using pre/post-test design.. Participants received four individual sessions of music therapy (MT), led by a certified music therapist. State-Trait-Anxiety Inventory Y-1, and a 0-4 Likert scale for pain, nausea and vomiting were recorded...

CONTEXT: Internationally, studies suggest that inadequate comprehension of the concept of palliative care and misconceptions about it hinder the effective use of palliative care, especially in developing nations. OBJECTIVE: To assess the awareness of the adult population in Jordan regarding palliative care. METHODS: The study used a cross-sectional design and an online self-administered questionnaire survey. The recruitment method was convenience snowball sampling of three thousand nine hundred forty-two Jordanian adults covering 12 governorates...

CONTEXT: Parents of children who die in the pediatric intensive care unit (PICU) carry memories of their child's suffering throughout a lifelong grieving experience. Given their prolonged time at the bedside, PICU nurses are poised to attend to dying children's suffering. OBJECTIVES: We aimed to explore how PICU nurses identify, assess, and attend to EOL suffering. METHODS: Interpretive descriptive qualitative study with thematic analysis of virtual focus groups from a geographically diverse sample of PICU nurses...

CONTEXT: Pain is a prevalent symptom in patients with serious illness and often requires interventional approaches for adequate treatment. Little is known about referral patterns and collaborative attitudes of palliative physicians regarding pain management specialists. OBJECTIVES: To evaluate referral rates, co-management strategies, and beliefs of palliative physicians about the value of Pain Medicine specialists in patients with serious illness. METHODS: A 30-question survey with demographic, referral/practice, and attitudes/belief questions was mailed to 1000 AAHPM physician members...

No abstract text is available yet for this article.

BACKGROUND: Opioids are a first-line treatment for severe cancer pain. However, clinicians may be reluctant to prescribe opioids for patients with concurrent substance use disorders (SUD) or clinical concerns about non-prescribed substance use. MEASURES: Patient volume, 60-day retention rate, and use of sublingual buprenorphine to treat opioid use disorder. INTERVENTION: We created the Palliative Harm Reduction and Resiliency Clinic, a palliative care clinic founded on harm reduction principles and including formal collaboration with addiction psychiatry...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

CONTEXT: Palliative care played a leading role in the COVID-19 pandemic. However, little is known regarding health system leadership's perceptions. BACKGROUND: This study aimed to explore the perceptions, understanding, and utilization of palliative care before compared to during the COVID-19 pandemic among health system leadership. METHODS: Semi-structured, in-depth interviews were conducted with leaders in a large healthcare system based in Massachusetts, United States...

CONTEXT: Rural older adult Americans receive more intense treatment at end of life. Studies indicate that those who participate in goals of care conversations receive care more concordant with their values. Yet, rates of documented goals of care discussions are lower in rural and Black communities. Although multi-factorial, the role that rural family caregivers (FCGs)play in decision-making for ill loved ones is understudied. OBJECTIVE: This study aimed to explore rural FCGs cultural values, beliefs, and attitudes about serious illness and treatment decision-making and to understand how these factors influence their decision-making around goals of care for their family members...

CONTEXT: Racial disparities in advance care planning (ACP) have been consistently identified in the literature. Few interventions have been designed to address the disparities identified. OBJECTIVES: To assess the feasibility, acceptability, and preliminary efficacy of a culturally sensitive, pilot ACP intervention for African American patients diagnosed with cancer in a safety net healthcare system. METHODS: Eligible patients with stage II, III or IV breast, lung, colorectal, or prostate cancer were identified from the electronic health record, recruited, and randomized to the intervention group or usual care control group...

Inequities and gaps in palliative care access are a serious impediment to health systems especially low- and middle-income countries and the accurate measurement of need across health conditions is a critical step to understanding and addressing the issue. Serious Health-related Suffering (SHS) is a novel methodology to measure the palliative care need and was originally developed by The Lancet Commission on Global Access to Palliative Care and Pain Relief. In 2015, the first iteration - SHS 1.0 - was estimated at over 61 million people worldwide experiencing at least 6 billion days of SHS annually as a result of life-limiting and life-threatening conditions...

CONTEXT: A quarter of palliative care (PC) clinicians' consultations are now requested from the intensive care unit (ICU). Despite this high usage, a standardized set of quality metrics for PC delivery in the ICU does not exist. OBJECTIVES: To explore PC clinicians' views on how to best measure quality of care delivery in their role as a consultant in the ICU setting. METHODS: Secondary analysis of a parent dataset consisting of qualitative data from semi-structured interviews exploring ways to optimize PC clinicians' role in the ICU...

No abstract text is available yet for this article.

BACKGROUND: Malignant Fungating Wounds (MFWs) occur among 5-15% of patients with terminal cancers, the uncontrollable symptoms result in serious psychosocial issues, thereby reducing the quality of life. Caring for MFWs impacts caregivers, including healthcare personnel. While existing studies are patient-focused, the impact of care experiences and associated support for nurses has not been examined. AIM: To explore the experiences in caring for patients with MFWs among nurses in Taiwan...

CONTEXT: Opioid therapy is a cornerstone for treatment of cancer-related pain, but standardized management practices for patients with cancer and aberrant urine drug test (UDT) results are lacking. OBJECTIVES: To identify the prevalence of UDT ordering (both screening and definitive testing) in the oncology setting and to examine clinician management practices for patients with cancer on opioid therapy with aberrant definitive UDT results. METHODS: We conducted a retrospective chart review of patients with cancer on opioid therapy at an academic cancer center in the United States...