Journal of pain and symptom management
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J Pain Symptom Manage · Apr 2023
High Flow Nasal Cannula in patients with cancer at the end of life.
High flow nasal cannula (HFNC) is frequently used to manage dyspnea in patients with cancer near the end of life. Because HFNC is restricted to the in-patient setting, patients on HFNC need to be liberated from it to be discharged from the hospital. ⋯ Only a minority of patients with cancer at the end of life can be liberated from HFNC, and only a minority are discharged alive. This information is important when discussing goals of care with patients and their families before initiating HFNC.
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J Pain Symptom Manage · Apr 2023
A Call for the Creation of LGBTQ+ Competencies for Hospice and Palliative Medicine (HPM) Fellowship Programs.
LGBTQ+ people and their families have unique needs, concerns, and issues when navigating serious illness. ⋯ Learning to provide culturally competent care is essential for all HPM providers. Our group recommends specific clinical training competencies with plans to pilot them in upcoming academic years. Creating curricular recommendations will help guide fellowship programs education in the care of LGBTQ+ patients with serious illness.
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J Pain Symptom Manage · Apr 2023
Racial Disparities in Health Beliefs and Advance Care Planning Among Patients Receiving Maintenance Dialysis.
Among people receiving maintenance dialysis, little is known about racial disparities in the occurrence of prognostic discussions, beliefs about future health, and completion of advance care planning (ACP) documents. ⋯ We found no significant difference in the frequency of prognostic discussions between Black (11.9%) versus White patients (7%) (P=0.15). However, Black patients (19%) had lower odds of believing that their health would worsen over the next 12 months (OR 0.22, CI 0.12, 0.44) and reporting completion of any ACP-related document (OR 0.5, CI 0.32, 0.81) compared to White patients CONCLUSION: Racial differences exist in beliefs about future health and completion of ACP-related documents. Systemic efforts to investigate differences in health beliefs and address racial disparities in the completion of ACP-related documents are needed.
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J Pain Symptom Manage · Apr 2023
Randomized Controlled TrialEffects of Spiritual Care on Well-being of Intensive Care Family Surrogates: A Clinical Trial.
Critical illness of a family member is associated with high emotional and spiritual distress and difficult medical decisions. ⋯ Proactive, semistructured spiritual care delivered by chaplains improves well-being for ICU surrogates. Results provide evidence for inclusion of chaplains in palliative and intensive care teams.
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J Pain Symptom Manage · Apr 2023
Hospital Opioid Usage and Adverse Events in Patients with End-Stage Liver Disease.
Patients with end-stage liver disease (ESLD) commonly experience pain and other symptoms that result in a poor quality of life. Few studies have examined opioid usage, adverse events (AEs), and other outcomes in ESLD patients receiving opioid analgesia. ⋯ Opioid administration was not an independent risk factor for the number of AEs in hospitalized patients with ESLD, whereas anxiety and more liver-related complications increased AE risk. Our findings suggest that opioids have an appropriate and reasonably safe role in alleviation of pain in patients with ESLD.