Journal of pain and symptom management
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J Pain Symptom Manage · Apr 2020
ReviewPulmonary arterial hypertension: A palliative medicine review of the disease, its therapies and drug interactions.
Pulmonary arterial hypertension (PAH) is often a progressive and ultimately fatal disease. It is characterized by an elevated mean pulmonary arterial pressure because of disease of the small pulmonary arterioles. PAH leads to a constellation of symptoms, including dyspnea, fatigue, syncope, chest discomfort, and peripheral edema. ⋯ This review describes disease-targeted therapies and their effects on symptoms, physical functioning, and health-related quality of life. We also review the unique physiology of PAH and its implication for palliative interventions. Pharmacological interactions with, and precautions related to commonly used palliative care medications, are discussed.
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J Pain Symptom Manage · Apr 2020
Patterns of Symptom Management Medication Receipt at End-of-Life Among Medicare Beneficiaries with Lung Cancer.
Older adults with advanced lung cancer experience high symptom burden at end of life (EOL), yet hospice enrollment often happens late or not at all. Receipt of medications to manage symptoms in the outpatient setting, outside the Medicare hospice benefit, has not been described. ⋯ Symptom management medication receipt was common and increasing toward EOL. Lower use by males, older adults, and nonwhites may reflect poor access or poor patient-provider communication. Further research is needed to understand these patterns and assess adequacy of symptom management in the outpatient setting.
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J Pain Symptom Manage · Apr 2020
Does receipt of recommended elements of palliative care precede in-hospital death or hospice referral?
Palliative care aligns treatments with patients' values and improves quality of life, yet whether receipt of recommended elements of palliative care is associated with end-of-life outcomes is understudied. ⋯ Goals-of-care discussions by different types of clinicians commonly precede end-of-life care in hospital or hospice. However, engagement with specialty palliative care reduced in-hospital death and increased hospice referral. Understanding the causal pathways of goals-of-care discussions may help build primary palliative care interventions to support patients near the end of life.
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J Pain Symptom Manage · Apr 2020
Improving Advance Care Planning in Outpatients with Decompensated Cirrhosis: A Pilot Study: Advance Care Planning in Patients with Decompensated Cirrhosis.
Despite significant morbidity and mortality among patients with decompensated cirrhosis, reported rates of advance directive (AD) completion and goals of care discussions (GCDs) between patients and providers are very low. We aimed to improve these rates by implementing a hepatologist-led advance care planning (ACP) intervention. ⋯ Addressing provider and system-specific barriers dramatically improved documentation rates of ACP.
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J Pain Symptom Manage · Apr 2020
Prevalence of QTc prolongation in patients with advanced cancer receiving palliative care - a cause for concern?
Medications commonly used for symptom control along with other known risk factors have the potential to prolong ventricular repolarization as measured by the QT interval (the time from the start of the Q wave to the end of the T wave) on a standard electrocardiogram (ECG). ⋯ Although almost 20% of patients receiving palliative care had prolongation of QTc, the possibility of serious consequences appeared to be low despite the frequent occurrence of risk factors.