Journal of pain and symptom management
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J Pain Symptom Manage · Jul 2002
ReviewOpioid antagonists: a review of their role in palliative care, focusing on use in opioid-related constipation.
Opioid antagonists have well-established indications in the reversal of life-threatening opioid toxicity, but also hold considerable promise for other applications in palliative care practice, particularly management of opioid-related constipation. We briefly review current understanding of opioid receptors, focusing on their complex role in gastrointestinal physiology. ⋯ The literature on opioid-induced constipation and its treatment with opioid-antagonists is reviewed in detail. Finally, other potential uses of opioid antagonists in palliative care are described, especially strategies for reducing such opioid side effects as nausea and pruritus and for improving analgesia or reducing tolerance by concomitantly administrating both an opioid agonist and low dosages of an antagonist.
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J Pain Symptom Manage · Jul 2002
Randomized Controlled Trial Clinical TrialFamily satisfaction with end-of-life care for cancer patients in a cluster randomized trial.
The main aim of this study was to examine similarities and differences in satisfaction with care between 112 family members who were close to patients who had participated in an intervention with a comprehensive palliative care program and the 68 family members in a conventional care program (controls). The FAMCARE Scale measured satisfaction with care at one month after the time of death. ⋯ The respondents related to the patients in the intervention group reported significantly higher satisfaction with care than the respondents related to the patients in the control group. This difference remained unchanged after controlling for a range of other relevant factors: relationship to the deceased, sex and age of the respondent, sex and age of the patient, time since inclusion in the study, and place of death.
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J Pain Symptom Manage · Jul 2002
A measure of the quality of dying and death. Initial validation using after-death interviews with family members.
A reliable and valid measure of the quality of the dying experience would help clinicians and researchers improve care for dying patients. To describe the validity of an instrument assessing the quality of dying and death using the perspective of family members after death and to identify clinical correlates of a high quality death, a retrospective cohort study evaluated the 31-item Quality of Dying and Death (QODD) questionnaire. The questionnaire was administered to family members of patients who died in Missoula county Montana in 1996 and 1997. ⋯ Clinicians caring for dying patients should focus on improving communication with the patient and family and improving symptom assessment and treatment. Health care teams should focus on continuity of care, including having a team member familiar with the patient available for calls at nights and on weekends. Future work will assess the potential role of the QODD in improving the quality of the dying experience.