Journal of pain and symptom management
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J Pain Symptom Manage · Nov 2020
Physician-Predicted Prognosis and Palliative Radiotherapy Treatment Utilization at the End-of-Life: An Audit of a Large Cancer Center Network.
At our institution, clinical pathways capture physicians' prognostication of patients being evaluated for palliative radiotherapy. We hypothesize a low utilization rate of long-course radiotherapy (LCRT) and stereotactic ablative radiotherapy (SAbR) among patients seen at the end of life, especially those with physician-predicted poor prognosis. ⋯ Although most patients were predicted to have a limited prognosis, LCRT and SAbR were commonly prescribed at the end of life.
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J Pain Symptom Manage · Nov 2020
Will you hear me? Have you heard me? Do you see me? Adding Cultural Humility to Resource Allocation and Priority Setting Discussions in the care of African-American patients with Covid-19.
The coronavirus disease 2019 (COVID-19) pandemic has refocused our attention on health care disparities affecting patients of color, with a growing body of literature focused on the etiology of these disparities and strategies to eliminate their effects. In considering the unique impact COVID-19 is having on African American communities, added measure must be given to ensure for sensitivity, empathy, and supportive guidance in medical decision making among African American patients faced with critical illness secondary to COVID-19. In this article, we explore the applications of cultural humility over cultural competency in optimizing the care we provide to African American patients faced with critical health care decisions during this pandemic. In turn, we charge one another as health care providers to consider how ethical principles and guidance can be applied to honor African American patients' unique stories and experiences.
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J Pain Symptom Manage · Nov 2020
Deep natural language processing to identify symptom documentation in clinical notes for patients with heart failure undergoing cardiac resynchronization therapy.
Clinicians lack reliable methods to predict which patients with congestive heart failure (CHF) will benefit from cardiac resynchronization therapy (CRT). Symptom burden may help to predict response, but this information is buried in free-text clinical notes. Natural language processing (NLP) may identify symptoms recorded in the electronic health record and thereby enable this information to inform clinical decisions about the appropriateness of CRT. ⋯ A deep NLP algorithm can be trained to capture symptoms in patients with CHF who received CRT with promising precision and recall.
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J Pain Symptom Manage · Nov 2020
The Experience of Emergency Department Providers with Embedded Palliative Care during COVID.
Although the importance of palliative care (PC) integration in the emergency department (ED) has long been recognized, few formalized programs have been reported, and none have evaluated the experience of ED clinicians with embedded PC. ⋯ ED clinicians' perception of embedded PC was overall positive, with an emphasis on the impact related to task management, enrichment of PC skills, providing support for the team, and improved care for ED patients.
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J Pain Symptom Manage · Nov 2020
What If I Get Seriously Ill? A Virtual Workshop for Advance Care Planning During COVID-19.
The coronavirus disease 2019 has brought public attention to questions regarding the type of care individuals would want to receive in the event of becoming suddenly critically ill. Advance care planning (ACP) is one way to help individuals and families address these questions. However, social distancing, stay-at-home orders, and hospital visitor restrictions have raised new barriers to facilitating these conversations. ⋯ We found that using a virtual format allowed us to reach a large and geographically diverse audience. Participants were likely to recommend the workshop to friends and family. There was no change in ACP engagement between the postsession surveys between the first and second parts of the workshop.