Journal of pain and symptom management
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J Pain Symptom Manage · Feb 2018
Patterns and Outcomes of Care in Children with Advanced Heart Disease Receiving Palliative Care Consultation.
Although access to subspecialty pediatric palliative care (PPC) is increasing, little is known about the role of PPC for children with advanced heart disease (AHD). ⋯ PPC involvement for children with AHD focuses on goals of care and psychosocial support. Findings suggest that PPC involvement at end of life supports goal-concordant care. Further research is needed to clarify the impact of PPC on patient outcomes.
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J Pain Symptom Manage · Feb 2018
Which research questions are important for the bereaved families of palliative care cancer patients? A nationwide survey.
Bereaved family members are present from diagnosis to the end of life and can look back and evaluate the experience; in addition, the family itself is also an important subject in the care of the patient. Therefore, although it is essential to determine the priority research issues from the viewpoint of the patients and health care workers, it is also crucial to know the important research themes from the viewpoint of the bereaved family members. ⋯ The findings of this study can be used as a research agenda for palliative care, which should take first priority in the future, and could be carried out using limited resources.
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J Pain Symptom Manage · Feb 2018
Case ReportsMoral Distress at the End of a Life: When Family and Clinicians Do Not Agree on Implantable Cardioverter-Defibrillator Deactivation.
A 63-year-old man with end-stage ischemic cardiomyopathy presented with incessant ventricular tachycardia. He had been hospitalized multiple times in the past year for severe heart failure. As he approached end of life and was regularly receiving defibrillator shocks, his care team recommended deactivation of his implantable cardioverter-defibrillator. ⋯ This possibility forces the examination of values regarding prolongation of life, sometimes producing disagreement among stakeholders. Although ethical consensus holds that defibrillator deactivation is legal and ethical, disagreements about life prolongation may complicate decision making. The ethical, technical, and medical complexity involved in this case speaks to the need for clear, prospective communication involving the patient, the patient's family, and members of the care team.
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J Pain Symptom Manage · Feb 2018
Practice patterns of medications for patients with malignant bowel obstruction using a nationwide claims database and the association between treatment outcomes and concomitant use of H2-blockers/proton pump inhibitors and corticosteroids with octreotide.
Malignant bowel obstruction impairs the quality of life in patients with advanced cancer. Octreotide, acid-suppressing medications such as H2-receptor antagonists (H2-blockers) and proton pump inhibitors (PPIs), and corticosteroids are often used in combination for symptom control. ⋯ Octreotide alone was used in the majority of patients, and the concomitant use of corticosteroids was more likely to be associated with early NGT removal.
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J Pain Symptom Manage · Feb 2018
The Nexus between the Documentation of End-of-life Wishes and Awareness of Dying: A Model for Research, Education and Care.
The convergence of medical treatment that can extend life with written medical orders that make it possible to refuse such treatment brings the differential dynamics of contemporary end-of-life decision making into sharp focus. Communication between families and clinicians can be confusing, uncertain, and pressured when death is imminent. These situations create distress that ultimately influences the end-of-life experience for people who are dying and those who care for them. ⋯ Four decisional contexts emerged from the intersection of awareness of dying and documentation of wishes: 1) Aware Documented, 2) Aware Undocumented, 3) Unaware Documented, and 4) Unaware Undocumented. This generalizable model, which is agnostic of setting, can help clinicians more astutely recognize the clinical situation when death is imminent, assess patients and caregivers, and intervene to help focus conversation and direct decision making. The model can also inform research, education, and care for people in some of the most vulnerable moments of life.