Journal of palliative medicine
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Purpose: Individual genetic variation can affect both pain expression and opioid response. Large cohort datasets are required to validate evidence influencing genomic factors in opioid response. This study examined the feasibility of establishing an opioid pharmacogenomics registry for cancer patients containing longitudinal matched clinical, symptom, pharmacological, and genomic data, with an a priori feasibility target of 50 participants within 12 months. ⋯ Fifty-eight participants were recruited (median age 63.7, 45% female, 83% complete data), with the most frequent diagnosis being lung cancer (n = 18, 33%) and oxycodone the most frequently prescribed opioid (n = 30, 52%). Qualitative data indicated positive engagement from both patients and clinicians. Conclusion: Establishing a longitudinal opioid pharmacogenomic registry in patients with cancer receiving palliative care is feasible and readily acceptable.
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Most children with cancer and their parents desire honest communication about prognosis, even when prognosis is poor. Unfortunately, many parents perceive deficits in communication about prognosis, and strategies are needed to encourage timely person-centered prognostic discussions. ⋯ In this case series, we examine the seed planting approach more closely, identifying language strategies that clinicians used to help patients and families gain insight into prognostic gravity as their illness evolved. Although further research is needed to measure the full impact of a seed planting approach, this case series explores a longitudinal communication strategy with potential to improve prognostic communication across an advancing illness course.
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In the young and rapidly evolving field of hospice and palliative medicine (HPM), the transition from early to mid-career can be a precarious time. The high rates of burnout and low rates of work-life balance and satisfaction found in mid-career jeopardize our field's ability to maintain a healthy workforce. ⋯ A web of mentors/connections, academic map, and continuing education to enhance teaching skills are several concrete tools explored. To sustain a robust HPM workforce, such practical and structured supports during the particularly challenging mid-career transition are crucial.