Journal of pain and symptom management
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J Pain Symptom Manage · Oct 2021
Prevalence and Factors Associated with Will-to-Live in Patients with Advanced Disease: Results from a Portuguese Retrospective Study.
Will-to-live (WtL) is a complex and multifactorial dimension of end-of-life experience. Health care decisions on assisted suicide and euthanasia are rarely based on WtL evidence-based discussions. ⋯ The factors associated with lower WtL scores are consistent with previous studies, indicating that these patients experience a myriad of physical, psychological and existential symptoms requiring an interdisciplinary palliative care approach. These factors pertaining to WtL should be made known, as Portugal considers how to navigate death-hastening legislation.
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J Pain Symptom Manage · Oct 2021
A National Survey of Challenges Faced by Hospices during the Opioid Crisis: Estimates of Pain Medication Shortages, Missing Medications, and Opioids Left in the Home Post-Death.
No national data exist on hospice medication shortages, the frequency that opioid medications go missing, and drug disposal practices. ⋯ Hospices face numerous challenges during the national opioid crisis. Interventions are needed to ensure access to needed treatments, mitigation of diversion, and safe medication disposal.
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J Pain Symptom Manage · Oct 2021
"We're performing improvisational jazz": Interprofessional pediatric palliative care fellowship prepares trainees for team-based collaborative practice.
Interprofessional education (IPE) prepares clinicians for collaborative practice, yet little is known about the effectiveness of postgraduate IPE. ⋯ This study demonstrates the feasibility and effectiveness of an interprofessional postgraduate fellowship in preparing clinicians for collaborative practice.
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J Pain Symptom Manage · Oct 2021
An Exploratory Study of Demographics and Outcomes for Patients Seen by Specialist Palliative Care Social Work in the Inpatient Setting at an Academic Medical Center.
Specialist palliative care social work (PCSW) across a four-team palliative care (PC) service in the inpatient setting at a tertiary academic medical center. ⋯ Involvement of PCSW increased dramatically over the study period. Compared to the rest of the PC team, when PCSW was involved, length of stay was longer, whole-person care components were more likely to be addressed, dyspnea was significantly improved, and pain was significantly worse when compared to those consults not seen by PCSW. Other symptoms such as nausea and anxiety as well as discharge characteristics such as death or hospice discharge were not significantly different with involvement of PCSW.
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J Pain Symptom Manage · Oct 2021
Training residents in virtual advance care planning: A new twist in telehealth.
Advance care planning (ACP) conversations represent an important physician skill, a need further highlighted by the COVID-19 pandemic. Most resident ACP training occurs in inpatient, settings, often featuring goals of care (GOC) conversations during a crisis. Outpatient clinics are valuable but underutilized settings to provide skills training for residents, yet little research has been done in these spaces. ⋯ This study illustrates the feasibility of a virtual format for ACP curriculum. The virtual community of practice created space for a metacognitive unmasking of prior resident unconscious incompetence. Also, inpatient, crisis-oriented late GOC conversation skills may translate poorly to the outpatient setting requiring early and ongoing GOC skills. Residents need more training to navigate ACP conversations in ambulatory environments.