Journal of pain and symptom management
-
J Pain Symptom Manage · Dec 2022
Randomized Controlled TrialVideo and In-Person Palliative Care Delivery Challenges Before and During the COVID-19 Pandemic.
Palliative care (PC) clinicians faced many challenges delivering outpatient care during the coronavirus-19 (COVID-19) pandemic. ⋯ Technical difficulties related to PC video visits improved, whereas in-person visit challenges related to absent patients' family members worsened during the pandemic.
-
J Pain Symptom Manage · Nov 2022
Randomized Controlled TrialVulnerability and Resilience: Phenomenological Analysis of Cancer Patients Value Directives.
Personal values are individual conceptions of the desirable appraisals and actions that guide our attitudes and behaviour. Advance care planning (ACP) now emphasises the consideration of personal life goals and values expressed as a Values Directive (VD) to guide discussions concerning medical treatment. ⋯ Cancer patients seek to make meaning of their experiences, concurrently posturing vulnerability and resilience, despite conflicting emotions and experiences. Given that the choices people make as they approach dying relate to their most deeply held values, ACP conversations should explore how patients draw from their values and life goals to optimise their adaptations to illness.
-
J Pain Symptom Manage · Oct 2022
Randomized Controlled Trial Multicenter StudySeriously ill patients' prioritized goals and their clinicians' perceptions of those goals.
Seriously ill patients whose prioritized healthcare goals are understood by their clinicians are likely better positioned to receive goal-concordant care. ⋯ A majority of seriously ill outpatients are cared for by clinicians who accurately perceive their patients' prioritized healthcare goals. However, a substantial portion are not and may be at higher risk for goal-discordant care. Interventions that facilitate goals-of-care discussions may help align care with goals, as recent discussions were associated with accurate perceptions of patients' prioritized goals.
-
J Pain Symptom Manage · Sep 2022
Randomized Controlled Trial Multicenter StudyHeterogeneity of treatment effect in a randomized trial of a communication intervention.
Interventions to promote serious illness conversations have shown promise in promoting high-quality care. However, in randomized trials, some participants may benefit more from the intervention than others. ⋯ Identifying heterogeneity of treatment effect can be a valuable exercise following completion of a randomized trial. Interactions between the intervention and patient income and self-assessed health suggest these factors could be used to design more effective interventions to enhance communication about goals of care.
-
J Pain Symptom Manage · Sep 2022
Randomized Controlled TrialTranscranial Direct Current Stimulation (tDCS): pain management in end-stage renal disease - report of an early randomized controlled trial.
Chronic pain in end-stage renal disease (ESRD) is an increasingly neglected clinical problem affecting more than 60% of patients. Long-term chronic pain could be associated with brain imbalance in circuits of pain matrix and is associated with poor quality of life (QoL) and mood disturbance. ⋯ Anodal tDCS over the motor cortex emerges as a potential therapeutic approach for improving pain, QoL, and mood in patients with ESRD.