Journal of pain and symptom management
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J Pain Symptom Manage · Sep 2021
Compassion inequities and opioid use disorder: A matched case-control analysis examining inpatient management of cancer-related pain for patients with opioid use disorder.
The opioid epidemic spurred guidelines intended to reduce inappropriate prescribing. Although acute cancer-related pain was excluded from these recommendations, studies demonstrate reduced opioid prescribing for patients hospitalized with advanced cancer. ⋯ Our results suggest that patients with OUD receive lower quality inpatient management of cancer-related pain. Provider education and early involvement of pain specialists are crucial in delivering equitable and compassionate end-of-life care for patients with OUD.
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J Pain Symptom Manage · Sep 2021
Racial Disparities of Possessing Healthcare Power Attorney and Living Will among Older Americans: Do SES and Health Matter?
Most previous studies considered advance directives (AD) as one outcome, which conceals possible variations of individuals' decisions on two AD documents-living will (LW) and durable power of attorney for health care (PA). ⋯ The findings highlight the importance of examining the completions of two AD documents and indicate the necessity of developing distinct and concrete strategies to promote the completion of PA and LW.
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J Pain Symptom Manage · Sep 2021
"She's not ready to give up yet!": When a Family Member Overrides the Patient's Medical Decisions.
Autonomy, which gives individuals the right to make informed decisions about their medical treatment, is a central principle in Western bioethics. However, we often encounter patients for whom a family member seems to dominate medical decision-making, to the extent that clinicians become concerned that the patient is subject to excessive pressure or even coercion. In this article, we describe one such case and how we assess a decision-making process that involves family influence. ⋯ We must also attend to the emotional level of family members' statements. "I won't let you give up" might be more a statement of grief rather than a true reflection of their values or intent. Supporting the family member's coping may help to bring together what initially seem to be divergent goals. Exploring these decision-making dynamics is key to providing good palliative care.