Journal of palliative medicine
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Oncology providers often find it difficult to discuss end-of-life issues with patients and assume that patients are reluctant to think about the issues involved. This study examined whether or not patients with metastatic breast cancer had advance directives, and if so, with whom they discussed written plans for end-of-life decisions. ⋯ The majority of patients gathered information about advance directives and had made written plans, yet few discussed these plans with their providers. Explicit discussion of advance directives and patient preferences regarding end-of-life care are lacking in this setting. Facilitation of doctor-patient communication about end-of-life care is needed in order to provide quality patient care at this difficult time.
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The American Academy of Pediatrics recommends that pediatricians become knowledgeable in and comfortable with providing palliative care. ⋯ Efforts to improve education in pediatric palliative care are needed. A palliative care team could facilitate palliative care education through engaging trainees in "real-life" interactions. The role of physicians in providing spiritual support and the need for educating physicians in obtaining emotional support for themselves merit further investigation.
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There are relatively well-defined and preferred therapies for neuropathic pain including newer generation anticonvulsants (such as gabapentin), TCAs, and opioids in select patients. In patients with ongoing pain despite treatment with these agents, or who are intolerant to them, venlafaxine or duloxetine may be helpful. There are no comparative studies between nontricyclics for neuropathic pain, thus an agent should be selected based on its side effect profile, cost, and familiarity with use.
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Randomized Controlled Trial
Development, feasibility, and acceptability of the Family/Adolescent-Centered (FACE) Advance Care Planning intervention for adolescents with HIV.
To develop, adapt, and ensure feasibility, acceptability, and safety of the Family/Adolescent-Centered (FACE) Advance Care Planning intervention. ⋯ Existing advance care planning models can be adapted for age, disease, and culture. Adolescents with HIV/AIDS were satisfied with an advance care planning approach that facilitated discussion about their end-of-life wishes with their families. Families acknowledged a life-threatening condition and were willing to initiate end-of-life conversations when their adolescents were medically stable.