Journal of pain and symptom management
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J Pain Symptom Manage · Sep 2014
ReviewSymptom clusters in patients with advanced cancer: a systematic review of observational studies.
Advanced cancer patients typically experience multiple symptoms, which may influence patient outcomes synergistically. The composition of these symptom clusters (SCs) differs depending on various clinical variables and the timing and method of their assessment. ⋯ Although the articles reviewed revealed four groups of symptoms that tended to cluster, there is limited consistency in the way in which SCs and variables associated with them are identified. This is largely due to a lack of agreement about a robust, clinically relevant definition of SCs. Future research should focus on patients' subjective experience of SCs to inform a clinically relevant definition of SCs and how they are managed over time.
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J Pain Symptom Manage · Sep 2014
Multicenter StudyThe influence of patients' quality of life at the end of life on bereaved caregivers' suicidal ideation.
Recent studies have shown that patients' quality of life at the end of life (QOL@EOL) affects the psychosocial adjustment of bereaved family caregivers. ⋯ The more caregivers perceive their loved ones' QOL@EOL to be poor, the greater their risk for suicidal ideation in bereavement over and above prior levels of suicidal ideation. Caregivers of patients who have poor QOL@EOL appear to be a group of caregivers to target for reduction of suicidal risk.
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J Pain Symptom Manage · Sep 2014
Multicenter StudyNurse and physician barriers to spiritual care provision at the end of life.
Spiritual care (SC) from medical practitioners is infrequent at the end of life (EOL) despite national standards. ⋯ SC training is suggested to be critical to the provision of SC in accordance with national care quality standards.
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J Pain Symptom Manage · Sep 2014
Does adherence to National Comprehensive Cancer Network guidelines improve pain-related outcomes? An evaluation of inpatient cancer pain management at an academic medical center.
Evidence-based guidelines are in place for the management of cancer-related pain, yet adherence remains problematic throughout health systems because of efficacy and safety concerns. ⋯ Adherence to NCCN guidelines remains insufficient, with nonadherence being associated with inadequate analgesia. Opioid-tolerant patients remain at higher risk for guideline nonadherence and inadequate analgesia. Quality improvement initiatives should target opioid-tolerant patients.
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J Pain Symptom Manage · Sep 2014
Management of ethical issues related to care of seriously ill dialysis patients in free-standing facilities.
There are few data on the frequency and current management of clinical ethical issues related to care of seriously ill dialysis patients in free-standing dialysis facilities. ⋯ The scope of ethical challenges was extensive, how these challenges were managed varied widely, and there were limited resources for assistance. Multifaceted efforts, encompassing endeavors at the individual, facility, organization, and national levels, are needed to support staff in improving the management of ethical challenges in dialysis facilities.