Journal of pain and symptom management
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J Pain Symptom Manage · Sep 2017
Randomized Controlled TrialLevel of Care Preferences among Nursing Home Residents with Advanced Dementia.
Delivering goal-directed care is a hallmark of high-quality palliative care, but requires an understanding of preferences. ⋯ Most proxies select comfort as the preferred level of care for NH residents with advanced dementia. Discussions regarding prognosis, as well as inquiry about goals of care, are modifiable factors that may promote a preference for comfort care in this population.
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J Pain Symptom Manage · Sep 2017
Meaningful communication prior to death, but not presence at the time of death itself, is associated with better outcomes on measures of depression and complicated grief among bereaved family members of cancer patients.
Few studies have explored the clinical significance of the family's presence or absence at the moment of a patient's death and meaningful communication (saying "goodbye") in terms of post-bereavement outcomes. ⋯ Many families wished to be present at the moment of the patient's death; however, meaningful communication (saying "goodbye") between the patient and family members, and not their presence or absence itself, was associated with better outcomes on measures of depression or complicated grief. Health care professionals could consider promoting both mutual communication (relating to preparation for death) between family members and patients before imminent death, as well as the family's presence at the moment of death.
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J Pain Symptom Manage · Sep 2017
ReviewA systematic review of end of life care communication skills training for generalist palliative care providers: research quality and reporting guidance.
End-of-life care (EoLC) communication skills training for generalist palliative care providers is recommended in policy guidance globally. Although many training programs now exist, there has been no comprehensive evidence synthesis to inform future training delivery and evaluation. ⋯ Despite a proliferation of EoLC communication skills training interventions in the literature, evidence is limited by poor reporting and weak methodology. Based on our findings, we present a CONSORT statement supplement to improve future reporting and encourage more rigorous testing.
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J Pain Symptom Manage · Sep 2017
The conversion ratio from intravenous hydromorphone to oral opioids in cancer patients.
The lack of knowledge of the accurate conversion ratio (CR) between intravenous (IV) and oral hydromorphone and opioid rotation ratio (ORR) between IV hydromorphone and oral morphine equivalent daily dose (MEDD) may lead to poorly controlled pain or overdosing in cancer inpatients. ⋯ Our study found that 1 mg of IV hydromorphone is equivalent to 2.5 mg of oral hydromorphone and 11.46 mg of MEDD. Hydromorphone at doses ≥30 mg/day may require a lower ORR to other opioids.