Journal of pain and symptom management
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J Pain Symptom Manage · Dec 2023
ReviewImpact of an Institution-wide Goals of Care Program on the Timing of Referrals to Outpatient Palliative Care.
Palliative care has received increased interest since the COVID-19 pandemic due to its role in guiding goals of care (GOC) discussions. ⋯ There were no significant differences in OS among patients seen in the SCC before and after myGOC, likely related to a ceiling effect. More oncologists had ACP discussions with patients, and patients had lower symptom scores on ESAS after myGOC, likely indicating that more patients were referred for GOC discussions and ACP rather than for symptom distress.
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J Pain Symptom Manage · Dec 2023
ReviewTreatment Effect Estimates from Pilot Trials Are Unreliable.
The CONSORT guideline defines a pilot trial as a small-scale version of a desired future efficacy trial that is intended to answer the key questions of whether and how a larger study should be done. For example, a pilot trial might evaluate different approaches to data collection or outcome measurement. However, pilot trials are unreliable for assessing treatment efficacy due to the statistical phenomenon called sampling variability. ⋯ Treatment effect estimates from pilot trials should not be used to make future development decisions regarding a novel therapy because of the high risk of misleading conclusions.
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J Pain Symptom Manage · Dec 2023
Implementing a Serious Illness Risk Prediction Model: Impact on Goals of Care Documentation.
Goals of care conversations can promote high value care for patients with serious illness, yet documented discussions infrequently occur in hospital settings. ⋯ Implementation of a goals of care initiative using a mortality prediction model significantly increased goals of care documentation especially among high-risk patients. Further study to assess strategies to increase goals of care documentation for intermediate risk patients is needed especially by nonspecialty palliative care.
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J Pain Symptom Manage · Dec 2023
Navigating Stress in the Pediatric Intensive Care Unit Among Parents of Children with Severe Neurological Impairment.
Children with severe neurological impairment (SNI) make up nearly 50% of pediatric intensive care unit (PICU) admissions, yet little is known about their family caregiver experiences. ⋯ Parents and family caregivers of children with SNI employ various ways to navigate stress in the PICU. Themes from this study can be used to develop interventions that meet the psychosocial needs of parents and family caregivers of children with SNI during highly stressful times.
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J Pain Symptom Manage · Dec 2023
Should urine drug screen be done universally or selectively in palliative care patients on opioids?
Urine drug screen (UDS) is a useful test conducted in patients receiving opioids for chronic pain to aid in validating patient adherence to opioid treatment and to detect any nonmedical opioid use (NMOU). One controversial topic regarding its use in palliative care is whether to conduct the test universally and randomly in all patients who are receiving opioids for chronic pain irrespective of their level of risk for NMOU, or to conduct the test selectively in only those with a high risk for engaging in NMOU behaviors. In this "Controversies in Palliative Care" article, 3 expert clinicians independently answer this question. ⋯ They also underscored the need to improve clinician proficiency in UDS interpretation to enhance its utility. Two experts endorsed random UDS in all patients receiving opioids regardless of their risk profile while the other expert recommended targeted UDS until there is more clinical evidence to support universal, random testing. Use of more methodologically robust study designs in UDS research, examination of the cost-effectiveness of UDS tests, development of innovative programs to manage NMOU behaviors, and investigation of the impact of improved clinician proficiency in UDS interpretation on clinical outcomes, were important areas of future research that the experts identified.