Journal of pain and symptom management
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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.
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J Pain Symptom Manage · Jan 2019
Multicenter StudyHeart Rate Variability as an indicator of nociceptive pain in disorders of consciousness?
Heart rate variability is thought to reflect the affective and physiological aspects of pain and is emerging as a possible descriptor of the functional brain organization contributing to homeostasis. ⋯ Our results suggest a less complex autonomic response to noxious stimuli in VS/UWS patients. Such method may help to better understand sympathovagal response to potentially painful stimulation in brain-injured patients.
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J Pain Symptom Manage · Jan 2019
Pre-Ventricular Assist Device Palliative Care Consultation: A Qualitative Analysis.
In 2013, the Centers for Medicare and Medicaid Services issued a mandate requiring that all patients undergoing destination therapy ventricular assist device (DT VAD) implantation have access to a palliative care team before surgery. Subsequently, many VAD programs implemented a mandatory preimplantation palliative care consultation for patients considering DT VAD. However, little is known about the quality of these consults. ⋯ One-time preimplantation palliative care consultations at our institution do not lead to completion of preparedness planning or even general palliative care assessment. Further work is needed to determine the most effective way to integrate palliative care into preimplantation care.
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J Pain Symptom Manage · Jan 2019
Changes in the Care Setting of First Consults to Palliative and Supportive Care over a 7-Year Period.
Optimal benefits from palliative care (PC) are achieved when first consults (PC1) occur early, in the outpatient setting. Late PC1, like those in the intensive care unit (ICU), limit these benefits. ⋯ PC1 total annual number has increased, and the proportion of PC1 at ICU, a very late clinical setting, is decreasing. Further efforts are needed to integrate PC in hematologic cancer care.