Journal of pain and symptom management
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We propose that the palliative care team response will occur in two ways: first, communication and second, symptom management. Our experience with discussing goals of care with the family of a COVID-positive patient highlighted some expected and unexpected challenges. We describe these challenges along with recommendations for approaching these conversations. We also propose a framework for proactively mobilizing the palliative care workforce to aggressively address goals of care in all patients, with the aim of reducing the need for rationing of resources.
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J Pain Symptom Manage · Jul 2020
Development of Subspecialty-Specific Reporting Milestones for Hospice and Palliative Medicine Fellowship Training in the U.S.
Continuing the transition to competency-based education, Hospice and Palliative Medicine (HPM) fellowship programs began using context-free reporting milestones (RMs) for internal medicine subspecialties in 2014 but quickly recognized that they did not reflect the nuanced practice of the field. This article describes the development of 20 subspecialty-specific RMs through consensus group process and vetting by HPM educators. A workgroup of content experts used an iterative consensus building process between December 2017 and February 2019 to draft new RMs and create a supplemental guide that outlines the intent of each RM, examples of each developmental trajectory, assessment methods, and resources to guide educators. ⋯ Most respondents agreed or strongly agreed that each RM represented a realistic progression of knowledge, skills, and behaviors, and that the set of milestones adequately discriminated between meaningful levels of competency. Similarly, respondents felt that the supplemental guide was a useful resource. The result is a set of carefully developed and broadly vetted RMs that represent a progression of development for HPM physicians during one year of clinical fellowship training.
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J Pain Symptom Manage · Jul 2020
Comparing an artificial neural network to logistic regression for predicting ED visit risk among patients with cancer: a population-based cohort study.
Prior work using symptom burden to predict emergency department (ED) visits among patients with cancer has used traditional statistical methods such as logistic regression (LR). Machine learning approaches for prediction, such as artificial neural networks (ANNs), are gaining attention but are yet to be commonly applied in practice. ⋯ Although both models were similar in predictive performance using our data, ANNs have an important role in prediction because of their flexible structure and data-driven distribution-free benefits and should thus be considered as a potential modeling approach when developing a prediction tool.
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J Pain Symptom Manage · Jul 2020
Theory-based Development of an Implementation Intervention Utilizing Community Health Workers to Increase Palliative Care Use.
Opportunities for the use of palliative care services are missed in African American (AA) communities, despite Level I evidence demonstrating their benefits. ⋯ Use of a theory-based approach to facilitate the implementation of a multi-component strategy provided a comprehensive means of identifying relevant barriers and enablers of CHWs as an agent to increase palliative care use in AA communities.
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J Pain Symptom Manage · Jul 2020
Healthcare professionals' reports of cancer pain cues among older people with delirium: a qualitative-quantitative content analysis.
Health care professionals (HCPs) currently judge pain presence and intensity in patients with delirium despite the lack of a valid, standardized assessment protocol. However, little is known about how they make these judgments. This information is essential to develop a valid and reliable assessment tool. ⋯ This study outlines how HCPs conduct pain assessment in patients who are delirious and, also, identifies pain behavior profiles for the subtypes of delirium.