Journal of pain and symptom management
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J Pain Symptom Manage · May 2016
Chemotherapy Use in the Months Before Death and Estimated Costs of Care in the Last Week of Life.
Considerable attention has been paid to the disproportionately high costs of care for patients nearing death, yet little is known about the costs associated with chemotherapy use among end-stage cancer patients. ⋯ Chemotherapy for end-stage cancer patients is associated with higher estimated EOL care costs. Given evidence of limited benefit and potential harm of chemotherapy for end-stage cancer patients, the cost-effectiveness of such care is questioned and further study warranted.
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J Pain Symptom Manage · May 2016
Disparities Between Clinician and Patient Perception of Breakthrough Pain Control.
There are disparities in the level of symptom severity as perceived by patients and health professionals. There is limited information about patients' and clinicians' global assessment of breakthrough pain control, the need to change analgesics, and change in breakthrough pain over time. ⋯ There are significant differences in global impressions of breakthrough pain between patients and pain clinicians that become less disparate as a therapeutic relationship evolves. Therapeutic decisions were based on clinical rather than patient perceptions.
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J Pain Symptom Manage · May 2016
Randomized Controlled TrialMeasuring Depression-Severity in Critically-ill Patients' Families with the Patient Health Questionnaire (PHQ): Tests for Unidimensionality and Longitudinal Measurement Invariance, with Implications for CONSORT.
Families of intensive care unit patients are at risk for depression and are important targets for depression-reducing interventions. Multi-item scores for evaluating such interventions should meet criteria for unidimensionality and longitudinal measurement invariance. The Patient Health Questionnaire (PHQ), widely used for measuring depression severity, provides standard nine-, eight-, and two-item scores. However, published studies often report no (or weak) evidence of these scores' unidimensionality/invariance, and no tests have evaluated them as measures of depression severity in intensive care unit patients' families. ⋯ The longer eight- and nine-item PHQ scores appear inappropriate for assessing depression severity in this population, with constructs based on smaller subsets of items being more promising targets for future trials. The Consolidated Standards of Reporting Trials requirement for prespecified trial outcomes is problematic because unidimensionality/invariance testing must occur after trial completion. Consolidated Standards of Reporting Trials could be strengthened by endorsing rigorous assessment of composite scores and encouraging use of the most appropriate substitute, should trial-based evidence challenge the legitimacy of prespecified multi-item scores.