Current opinion in supportive and palliative care
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Curr Opin Support Palliat Care · Mar 2009
ReviewWhen cancer symptoms cannot be controlled: the role of palliative sedation.
Palliative sedation, the intentional lowering of consciousness for refractory and unbearable distress, has been much discussed during the last decade. In recent years, much research has been published about this subject that will be discussed in this review. The review concentrates on: a brief overview of the main developments during the last decade, an exploration of current debate regarding ethical dilemmas, the development of clinical guidelines, and the application of palliative sedation. ⋯ Caregivers should apply palliative sedation proportionally, guided by the symptoms of the patient without striving for deep coma and without motives for life shortening. Clinical and multidisciplinary assessment of refractory symptoms is recommended as is patient monitoring during sedation. Future research should concentrate on proportional sedation rather than continuous deep sedation exclusively, preferably in a prospective design.
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Pain is probably the most feared symptom in cancer, and pain control has received considerable attention. Adequate pain management requires precise and thorough assessment including universally accepted definitions; an area with a great potential for improvement. There is still little consensus on how to categorize or classify cancer pain. The recent literature was reviewed in order to evaluate the development in cancer pain classification and assessment, respectively. ⋯ There is still no universally accepted tool for cancer pain assessment or general agreement on which domains to include in a classification system. In order to improve cancer pain management and research, we need to agree internationally on how to classify and assess cancer pain. Consensus can only be achieved through worldwide research collaborative work employing a systematic, stepwise process based on the existing body of knowledge, patient and expert opinions and clinical validation studies.
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Curr Opin Support Palliat Care · Mar 2009
ReviewDo cannabinoids have a role in cancer pain management?
Historically cannabinoids have been used for both therapy and recreation, yet the elucidation of the endocannabinoid system and their chemistry has been relatively recent. Prohibition of cannabis has meant few clinical trials, especially in cancer pain. This review will consider previous animal and clinical data and assess more recent investigations of clinical effectiveness of cannabinoids in pain and specifically cancer pain. ⋯ Cannabinoids may be a useful addition to current analgesic treatments. The evidence supports a possible role for cannabinoids in refractory cancer pain. However, to realize the full potential of cannabinoids suggested by preclinical data, it is likely that peripheral CB1 or CB2 receptors or modulation of endocannabinoids will have to be targeted to achieve analgesia without dose limiting side effects.
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Depression is prevalent in patients receiving palliative care. Though effective management strategies exist, depression is often not recognised and, therefore, not treated. This review will assess recent research on the detection of depression in palliative care and recommend directions for future research. ⋯ The ability to detect cases of depressive disorder may be less important than the ability to detect depressive symptoms remediable to treatment. This is reflected in the recent interest in conceptualising and detecting psychological distress. Evidence-based guidelines on the detection and management of depression in palliative care are needed to help standardise practice and improve patient outcomes.
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Curr Opin Support Palliat Care · Mar 2009
ReviewThe assessment and management of family distress during palliative care.
In the advanced stages of illness, families manage multiple caregiving demands while facing the emotional task of preparing for the loss of their loved one. Palliative care settings are well suited to identifying families at risk for elevated distress, and providing support as they navigate this process. This review summarizes current research in the assessment and management of family distress at the end of life. ⋯ The knowledge gained from current research on what is most salient to family members during palliative care is critical for ensuring effective delivery of supportive services and collaborative engagement in those services.