Journal of pain and symptom management
-
J Pain Symptom Manage · Feb 2018
ReviewHow well do current measures assess the impact of advance care planning on concordance between patient preferences for end of life care and the care received: A methodological review.
Research has begun to focus on whether Advance Care Planning (ACP) has the capacity to influence care, and to examine whether ACP can be effective in meeting patients' wishes at the end of their lives. Little attention has been paid, however, to the validity and clinical relevance of existing measures. ⋯ Methodological variations and weaknesses compromise the validity of study results, and prevent meaningful comparisons between studies or synthesis of the results. Effectively evaluating whether ACP interventions enhance a patient's capacity to receive the care they want requires harmonization of research. This demands standardization of methods across studies, validating of instruments, and consensus based on a consistent conceptual framework regarding what constitutes a meaningful outcome measure.
-
J Pain Symptom Manage · Feb 2018
ReviewSafety and effectiveness of palliative drug treatment in the last days of life - a systematic literature review.
Dying patients commonly experience potentially distressing symptoms. Palliative care guidelines recommend opioids, anticholinergics, antipsychotics, and benzodiazepines for symptom relief. ⋯ There is a lack of evidence concerning the effectiveness and safety of palliative drug treatment in dying patients, and the reviewed evidence provides limited guidance for clinicians to assist in a distinct and significant phase of life.
-
J Pain Symptom Manage · Feb 2018
Randomized Controlled TrialWhich physicians' behaviors on death pronouncement affect family-perceived physician compassion? A randomized, scripted, video-vignette study.
Although the death of a loved one is a devastating family event, little is known about which behaviors positively affect families' perceptions on death pronouncements. ⋯ To convey compassion on death pronouncement, we recommend that physicians initiate prompt examination, explain that the physician has received a sign-out, perform examination respectfully, ascertain the time of death with a wristwatch, and reassure the families that the patient did not experience pain.
-
J Pain Symptom Manage · Feb 2018
A Longitudinal Study of PROMIS Pediatric Symptom Clusters in Children Undergoing Chemotherapy.
Children in treatment for cancer experience multiple, troubling, and interrelated symptoms. Analyzing the interrelatedness of symptoms and how that changes during treatment could yield clinically relevant patient profiles to guide patient care. ⋯ Children experiencing troubling symptoms during cancer treatment are heterogeneous. With respect to the PROMIS symptom measures, two a priori unknown distinct latent profiles of patients were identified in a course of chemotherapy, and the transitions in the profile status were significantly predicted by a baseline single-item fatigue measure.
-
J Pain Symptom Manage · Feb 2018
Clinical TrialThe impact of supporting family caregivers pre-bereavement on outcomes post-bereavement: Adequacy of end of life support and achievement of preferred place of death.
The investigation of the situation of bereaved family caregivers following caregiving during the end-of-life phase of illness has not received enough attention. ⋯ The results from this study provide evidence that the CSNAT intervention has a positive impact on perceived adequacy of support of bereaved family caregivers and achievement of preferred place of death according to caregivers. The benefits gained by caregivers in being engaged in early and direct assessment of their support needs before bereavement reinforce the need for palliative care services to effectively support caregivers well before the patient's death.