Journal of pain and symptom management
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J Pain Symptom Manage · Feb 2025
The distress and benefits of the Bereaved Family Survey: A mortality follow-back survey.
The Bereaved Family Survey is an important method for evaluating the quality of palliative care. ⋯ Bereaved family members experience both distress and benefits. There is need to devise ways to reduce distress and increase its benefits to continue assessing the quality of palliative care.
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J Pain Symptom Manage · Feb 2025
Are muscle and fat loss predictive of clinical events in pancreatic cancer? The importance of precision metrics.
Muscle and fat loss from cancer may have prognostic significance. Skeletal muscle and fat areas measured at L3 on a CT scan correlate with body muscle and fat mass. We wished to know if reduced skeletal muscle area or fat on diagnostic CT scans or changes from initial CT scans in patients with pancreatic cancer who died in 2018 and 2019 predicted mortality. ⋯ Muscle loss in men during chemotherapy of pancreatic cancer predicts mortality.
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J Pain Symptom Manage · Feb 2025
Case ReportsHypothalamic Hyperphagia in the Hospice Patient: Case Report and Discussion.
We present a case of insatiable appetite and harmful overeating in a hospice patient that showcases the burden of hypothalamic hyperphagia, a rare complication of brain cancer. While confounders exist such as progression of disease and prior tapering of dexamethasone, in this case the initiation of metformin was associated with substantial appetite reduction and resolution of our patient's debilitating food-seeking behaviors. We will explore metformin as a potential cost-effective option for palliation in a hospice setting and explore some of the physiologic mechanisms involved.
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J Pain Symptom Manage · Feb 2025
Barriers to Serious Illness Conversations Among Patients with Advanced Cancer: A Qualitative Study.
Serious illness conversations (SICs) are discussions between clinicians and cancer patients about illness understanding, information preferences, and goals of care. Interventions to prompt SICs increase SIC rates and improve care delivery near the end of life. This embedded substudy examined SIC barriers and facilitators among "refractory" patients without an SIC despite enrollment in an SIC clinical trial. ⋯ Patient readiness remains an important barrier even after targeted SIC interventions. Future SIC interventions should consider approaches tailored to patient communication preferences and interventions involving personal interactions.
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J Pain Symptom Manage · Feb 2025
"Mr. Smith Has No Mealtimes": Minimal Comfort Feeding for Patients with Advanced Dementia.
While Comfort Feeding Only is appropriate for patients with advanced dementia, its emphasis on assiduous hand-feeding that may prolong life for years fails to accommodate the preferences of those who do not want to continue living with this illness. Some have proposed advance directives to completely halt the provision of oral nutrition and hydration once a person has reached an advanced stage of dementia. ⋯ Rather than offering food and liquids proactively as with Comfort Feeding Only, caregivers provide nutrition and hydration only in response to signs of hunger and thirst. While further study is required to define and negotiate challenges in operationalizing this approach, MCF provides a framework that resolves competing ethical and clinical considerations in caring for those with advanced dementia.