Journal of pain and symptom management
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J Pain Symptom Manage · Mar 2019
Development of a Simulation-Based Mastery Learning Curriculum for Breaking Bad News.
Physician communication impacts patient outcomes. However, communication skills, especially around difficult conversations, remain suboptimal, and there is no clear way to determine the validity of entrustment decisions. The aims of this study were to 1) describe the development of a simulation-based mastery learning (SBML) curriculum for breaking bad news (BBN) conversation skills and 2) set a defensible minimum passing standard (MPS) to ensure uniform skill acquisition among learners. ⋯ We developed a SBML curriculum with a comprehensive assessment of BBN skills and a defensible competency standard. Future efforts will expand the mastery model to larger cohorts and assess the impact of rigorous education on patient care outcomes.
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Despite many nursing home residents experiencing pain, research about the multidimensional nature of nonmalignant pain in these residents is scant. ⋯ Identifying subgroups of residents with different patterns of pain and depressive symptoms highlights the need to consider physical and psychological components of pain. Expanding knowledge about pain symptom subgroups may provide a promising avenue to improve pain management in nursing home residents.
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J Pain Symptom Manage · Mar 2019
Safe and Appropriate Use of Methadone in Hospice and Palliative Care: Expert Consensus White Paper.
Methadone has several unique characteristics that make it an attractive option for pain relief in serious illness, but the safety of methadone has been called into question after reports of a disproportionate increase in opioid-induced deaths in recent years. The American Pain Society, College on Problems of Drug Dependence, and the Heart Rhythm Society collaborated to issue guidelines on best practices to maximize methadone safety and efficacy, but guidelines for the end-of-life scenario have not yet been developed. ⋯ The goal was to develop guidelines for safe and effective management of methadone therapy in hospice and palliative care. This article represents the consensus opinion of the hospice and palliative care experts for methadone use at end of life, including guidance on appropriate candidates for methadone, detail in dosing, titration, and monitoring of patients' response to methadone therapy.
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J Pain Symptom Manage · Mar 2019
End-of-Life Culture Change Practices in U.S. Nursing Homes in 2016/2017.
The nursing home (NH) culture change (CC) movement, which emphasizes person-centered care, is particularly relevant to meeting the unique needs of residents near the end of life. ⋯ NH-reported adoption of EOL-CC practices varies, and the presence of palliative care consults in NHs explains only some of this variation. Findings support the importance of evaluating EOL-CC practices separately from other culture change practices.
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J Pain Symptom Manage · Mar 2019
The effect of residential aged care size, ownership model and multi-chain affiliation on resident comfort and symptom management at the end of life.
In most resource-rich countries, a large and growing proportion of older adults with complex needs will die while in a residential aged care (RAC) facility. ⋯ Findings suggest that there are differences in the quality of end-of-life care given in RAC based on size, ownership model, and chain affiliation.