Journal of pain and symptom management
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J Pain Symptom Manage · Jan 2019
ReviewA Systematic Review and Gap Analysis of Advance Care Planning Intervention Components and Outcomes Among Cancer Patients Using the Transtheoretical Model of Health Behavior Change.
Despite the benefits of advance care planning (ACP), cancer patients rarely engage in ACP. ACP is a process that parallels health behavior change. This makes the Transtheoretical Model of Health Behavior Change (TTM) an important framework for understanding how to increase ACP among cancer patients. ⋯ ACP likely requires "high touch" interventions to induce behavior change. ACP interventions that are stage-matched, use diverse mechanisms to engage ACP (i.e., processes of change), address ACP as a process, and monitor engagement across the illness trajectory are needed for cancers patients and their caregivers.
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J Pain Symptom Manage · Jan 2019
Randomized Controlled TrialConcordance between Proxy Level of Care Preference and Advance Directives among Nursing Home Residents with Advanced Dementia: A Cluster Randomized Clinical Trial.
Care consistent with goals is the desired outcome of advance care planning (ACP). ⋯ Better alignment between preferences for comfort-focused care and advance directives is needed in advanced dementia. An ACP video may help achieve that goal.
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Cancer is a major cause of morbidity and mortality for older individuals. Palliative care is essential to improve the outcome of cancer treatment in terms of quality of life and treatment satisfaction. This review examines the influence of spirituality on aging in general and on the management of older cancer patients. ⋯ Gerotranscendence, the more urgent search for meaning by older than younger individuals, confirms the importance of spirituality in this phase of life. Spirituality has also improved the quality of life and reduced the risk of disease and death for the patient's caregiver. Addressing patient and caregiver spirituality may render the palliative care of cancer more effective and may also aid in detection and management of spiritual pain, which may prevent healing at the end of life.
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J Pain Symptom Manage · Jan 2019
Observational StudyFactors related to Adherence to Opioids in Black Patients with Cancer Pain.
Cancer pain relief is often inadequate because of poor adherence to pain medication, especially for black patients. ⋯ Findings confirm pain medication adherence is poor and pain was not well relieved. Multiple factors influence adherence to around-the-clock opioids. Clinicians need to partner with patients by providing a personalized pain treatment plan including an in-depth assessment of treatment choices and adherence.
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J Pain Symptom Manage · Jan 2019
Design and Implementation of Patient Portal-Based Advance Care Planning Tools.
Electronic health record-based portal tools may help patients engage in advance care planning (ACP). We designed and implemented portal-based ACP tools to enable patients to create a medical durable power of attorney (MDPOA). ⋯ Patients demonstrated willingness to use the portal to complete an MDPOA and rated the new ACP tools as highly usable. Future work will optimize population-based outreach strategies to engage patients in ACP through the portal.