Journal of pain and symptom management
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J Pain Symptom Manage · Oct 2006
ReviewMethodological challenges in measuring quality care at the end of life in the long-term care environment.
Understanding what constitutes quality end-of-life care from the perspective of the patient, their family, and health care professionals has been a priority for many researchers in the past few decades. Literature in this area has helped describe many of the barriers to measuring the quality of care in various environments, such as the hospital, hospice, and home. ⋯ This environment is expected to provide care to an increasing number of dying persons with the concurrent aging of the population in many Western countries and demand for more formal services. In this review, the methodological issues involved in measuring quality care at the end of life are examined, with specific attention given to the challenges encountered in the long-term care environment.
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The influence of personality characteristics on how patients cope with various challenges at the end of life has not been extensively studied. In order to examine the association between end-of-life experience and neuroticism (defined within the personality literature as a trait tendency to experience psychological distress), a measure of neuroticism was administered to a cohort of dying cancer patients. Various other measures of physical, psychological, and existential distress were also measured to explore their possible connection to patient personality style. ⋯ This association is expressed across the psychological, existential and, to a lesser extent, physical and social domains of end-of-life distress. This may help clinicians identify vulnerable individuals who are most likely to have poorer adjustments and may benefit from earlier targeted interventional approaches. Exploring the relationship between various facets of personality and end-of-life distress, and mapping this information against optimal therapeutic responses, remains the challenge for future research broaching this intriguing and largely ignored area of palliative care.
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J Pain Symptom Manage · Oct 2006
A survey of perceptions with pain management in Spanish inpatients.
The aim of this study was to document the satisfaction with pain management in a Spanish inpatient population and its relationship with pain ratings. Two hundred fifty inpatients of four departments were interviewed: Surgery, Orthopedics, Gynecology, and Internal Medicine. A 32-item questionnaire was used, and the main variables evaluated were pain severity, dissatisfaction with pain management and caregivers, and patient expectations regarding pain relief. ⋯ Regression analysis showed that "Dissatisfaction with Pain Management" was dependent on "Pain Now," "Least Pain," and "Dissatisfaction with Medical Staff," with statistically significant beta weight values of 0.277, 0.197, and 0.280, respectively. The study shows that patients were highly satisfied with pain management, even when they were in pain. Moreover, it establishes that patient dissatisfaction with treatment was highly related to the satisfaction with caregivers and pain intensity.
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J Pain Symptom Manage · Oct 2006
Clinical TrialThe addiction behaviors checklist: validation of a new clinician-based measure of inappropriate opioid use in chronic pain.
This study introduces the Addiction Behaviors Checklist (ABC), which is a brief (20-item) instrument designed to track behaviors characteristic of addiction related to prescription opioid medications in chronic pain populations. Items are focused on observable behaviors noted both during and between clinic visits. ⋯ Interrater reliability and concurrent validity data are presented, as well as a cut-off score for use in determining inappropriate medication use. The psychometric findings support the ABC as a viable assessment tool that can increase a provider's confidence in determinations of appropriate vs. inappropriate opioid use.
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J Pain Symptom Manage · Oct 2006
Multicenter StudySymptom distress and quality-of-life assessment at the end of life: the role of proxy response.
This study sought to advance understanding of the relationships among proxy and patient reports of symptom distress and quality of life (QOL). English-speaking adults (n=86), their nurses (n=86), and family caregivers (n=49) from 11 hospice/palliative care organizations completed the Memorial Symptom Assessment Scale (MSAS) and McGill Quality of Life Questionnaire (MQOL) at hospice/palliative care enrollment, at 1 week, 2 weeks, then monthly until death or discharge. ⋯ MQOL correlations were higher for nurse-patient than for patient-caregiver dyads. Based on small differences between ratings but only moderate levels of correlation, proxy response appears to be a fair substitute for patient response, suggesting that symptom and QOL reports should be obtained from all available respondents throughout the course of clinical care or research in the hospice/palliative care setting.