Journal of pain and symptom management
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J Pain Symptom Manage · Apr 2010
Feasibility of discussing end-of-life care goals with inpatients using a structured, conversational approach: the go wish card game.
Establishing goals of care is important in advance care planning. However, such discussions require a significant time investment on the part of trained personnel and may be overwhelming for the patient. The Go Wish card game was designed to allow patients to consider the importance of common issues at the end of life in a nonconfrontational setting. ⋯ Average time to review the patient's rank list after the patient sorted their values in private was 21.8 minutes (range: 6-45 minutes). The rankings from the Go Wish game are similar to those from other surveys of seriously ill patients. Our results suggest that it is feasible to use the Go Wish card game even in the chaotic inpatient setting to obtain an accurate portrayal of the patient's goals of care in a time-efficient manner.
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J Pain Symptom Manage · Apr 2010
Is the presence of mild to moderate cognitive impairment associated with self-report of non-cancer pain? A cross-sectional analysis of a large population-based study.
Research, guidelines, and experts in the field suggest that persons with cognitive impairment report pain less often and at a lower intensity than those without cognitive impairment. However, this presupposition is derived from research with important limitations, namely, inadequate power and lack of multivariate adjustment. ⋯ Non-cancer pain was equally prevalent in people with and without cognitive impairment, which contrasts with the currently held opinion that cognitively impaired persons report noncancer pain less often and at a lower intensity.
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J Pain Symptom Manage · Apr 2010
Clinical TrialErrors in opioid prescribing: a prospective survey in cancer pain.
Cancer pain is debilitating and has multidimensional consequences. It can be treated adequately in up to 90% of patients by following pain management guidelines. Nevertheless, inadequate pain control remains a global problem. ⋯ Opioid prescribing errors were common. Females may be at greater risk of multiple errors. A PM consultation program is effective in identifying and correcting a wide variety of opioid prescribing errors.
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J Pain Symptom Manage · Apr 2010
How much does it cost a specialist palliative care unit to manage constipation in patients receiving opioid therapy?
The burden of constipation from the patient's perspective has been well described. The aim of this study was to evaluate the cost of managing constipation in patients taking opioids in a specialist palliative care inpatient unit. A retrospective review of the medical records of 58 patients (70 admissions) who died during a six-month period was undertaken to identify prescribing patterns for opioids and oral laxatives and tasks associated with managing constipation in these patients. ⋯ The most time-consuming activity was staff discussion about bowel management, which occurred at least once daily for doctors and twice for nurses and involved up to eight members of staff at a time. The cost of managing constipation is skewed in that it costs 30 pounds (49 USD) or less in 71% of admissions but exceeded 100 pounds (163 USD) in 5%. In the latter group, earlier and/or more effective intervention for constipation could lead to clinical and economic benefits.