Journal of pain and symptom management
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J Pain Symptom Manage · May 2009
ReviewEffectiveness of topical administration of opioids in palliative care: a systematic review.
The discovery of peripheral opioid receptors has become the scientific basis for topical use of opioids in malignant and nonmalignant ulcers and oropharyngeal mucositis. This systematic review aimed to assess the quality of published literature and to examine whether topical opioids are effective in controlling pain in palliative care settings. After a systematic literature review, 19 studies (six randomized controlled trials [RCTs] and 13 case reports) met the inclusion criteria for the review. ⋯ Because of the heterogeneity of the studies, meta-analysis was not possible. Despite clear clinical benefits described in small RCTs, there is a deficiency of higher-quality evidence on the role of topical opioids, and more robust primary studies are required to inform practice recommendations. N-of-1 trials should be encouraged for specific clinical circumstances.
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J Pain Symptom Manage · May 2009
Development of a novel location-based assessment of sensory symptoms in cancer patients: preliminary reliability and validity assessment.
We report on the development of a novel location-based assessment of sensory symptoms in cancer (L-BASIC) instrument, and its initial estimates of reliability and validity. L-BASIC is structured so that patients provide a numeric score and an adjectival description for any sensory symptom, including both pain and neuropathic sensations, present in each of the 10 predefined body areas. Ninety-seven patients completed the baseline questionnaire; 39 completed the questionnaire on two occasions. ⋯ We detected differences in L-BASIC responses among patients with cancer-related head or neck pain, chemotherapy-related neuropathy and breast cancer-related lymphedema. We conclude that L-BASIC provides internally consistent and temporally stable responses, while acknowledging that further refinement and testing of this novel instrument are necessary. We anticipate that future versions of L-BASIC will provide reliable and valid syndrome-specific measurement of defined clinical pain and symptom constructs in the cancer population, which may be of particular value in assessing treatment response in patients with such multiple complaints.
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J Pain Symptom Manage · May 2009
Controlled Clinical TrialControlled sedation for refractory symptoms in dying patients.
Terminally ill cancer patients near the end of life may experience intolerable suffering refractory to palliative treatment. Although sedation is considered to be an effective treatment when aggressive efforts fail to provide relief in terminally ill patients, it remains controversial. The aim of this study was to assess the need and effectiveness of sedation in dying patients with intractable symptoms, and the thoughts of relatives regarding sedation. ⋯ Interviewed relatives were actively involved in the process of end-of-life care, and the decision to sedate, and the efficacy of sedation, were considered appropriate by almost all relatives. Controlled sedation is successful in dying patients with untreatable symptoms, did not hasten death, and yielded satisfactory results for relatives. This study also points to the importance of palliative care and the experience of professionals skilled in both symptom control and end-of-life care.
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J Pain Symptom Manage · May 2009
Palliative radiotherapy in Medicare-certified freestanding hospices.
Hospice care is designed to provide a variety of services, including pain and symptom management, to terminally ill patients. Although palliative radiotherapy (PRT) has been shown to be effective in reducing pain and other symptoms related to tumor growth, only a few hospice patients receive this therapy. This analysis identifies Medicare-certified freestanding hospices that report use of radiotherapy using Medicare's Healthcare Cost Report Information System (HCRIS) dataset. ⋯ Overall, 23.8% of Medicare-certified freestanding hospices in the study population provided radiotherapy services in fiscal year 2002. Provision of radiotherapy services was associated with larger size (measured by total number of hospice days reported in the HCRIS), longer length of Medicare certification, not-for-profit status, and a higher proportion of patients surviving more than seven days after admission. The finding that size, length of Medicare certification, and profit status are associated with provision of radiotherapy services lends credence to suggestions that current reimbursement practices discourage the use of PRT in hospice care, particularly for low-volume hospices.
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J Pain Symptom Manage · May 2009
Optimizing the success of a palliative care consult service: how to average over 110 consults per month.
The widespread need for palliative care has prompted the development of hospital-based palliative care consult services to provide a more interdisciplinary approach to managing advanced illness and end-of-life concerns. Establishing a successful consult service is a challenging task. This is a descriptive study of the development of a palliative care consult service (PCCS) within a non-profit, multi-hospital health system, and the five successful strategies used to optimize growth over the first five years. ⋯ The program has prospered since its inception in 2002, with a 47% average annual growth over the first five years. The PCCS now averages 110 consults per month and has treated more than 3500 patients. This growth can be directly attributed to the five key strategies that have been used to plan, develop, and expand the program.