Journal of pain and symptom management
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J Pain Symptom Manage · Mar 2015
ReviewA systematic review of the demoralization syndrome in individuals with progressive disease and cancer: a decade of research.
Demoralization can be understood as a condition that results from existential conflict. It presents with symptoms of hopelessness and helplessness caused by a loss of purpose and meaning in life. It is a significant mental health concern given there can be an associated desire for hastened death. ⋯ Overall, this systematic review was limited by the extent of variability in the characteristics of studies. Patients who are single, isolated or jobless, have poorly controlled physical symptoms, or have inadequately treated anxiety and depressive disorders are at increased risk for demoralization. Clinical recognition of demoralization can trigger more focused interventions.
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J Pain Symptom Manage · Mar 2015
Organization of nursing and quality of care for veterans at the end of life.
The Veterans Health Administration (VA) has improved the quality of end-of-life (EOL) care over the past several years. Several structural and process variables are associated with better outcomes. Little is known, however, about the relationship between the organization of nursing care and EOL outcomes. ⋯ Improvement of the nurse work environment and nurse staffing in VA acute care facilities may result in enhanced quality of care received by hospitalized veterans at the EOL.
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J Pain Symptom Manage · Mar 2015
The sense of security in care--Relatives' Evaluation instrument: its development and presentation.
Relatives' sense of security in their family members' palliative home care is important, and a valid and reliable instrument is needed to measure this. ⋯ The SEC-R provides a three-component assessment of palliative home care settings using valid and reliable scales associated with other concepts. The SEC-R is a manageable means of assessment that may contribute to quality-of-care measures and to further research on relatives' sense of security in care.
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J Pain Symptom Manage · Mar 2015
Sickle cell disease patients with and without extremely high hospital use: pain, opioids, and coping.
Patients with sickle cell disease (SCD) and extremely high hospital use (EHHU) encounter significant challenges in pain management because of opioid medication use for pain and providers' concerns about addiction. ⋯ The prescription of opioid medications for SCD pain management exacerbates issues of distrust in the patient-provider relationship. Such issues dominate patient care in patients with EHHU. Patients with EHHU and providers may learn from the proactive nature of LHU patients' engagement with the health care system as further research and interventions are designed for EHHU.
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J Pain Symptom Manage · Mar 2015
Avoidable and unavoidable visits to the emergency department among patients with advanced cancer receiving outpatient palliative care.
Admissions to the emergency department (ED) can be distressing to patients with advanced cancer receiving palliative care. There is limited research about the clinical characteristics of these patients and whether these ED visits can be categorized as avoidable or unavoidable. ⋯ Nearly one-fourth of ED visits by patients with advanced cancer receiving palliative care were potentially avoidable. Proactive efforts to improve communication and support between scheduled appointments are needed.