Journal of pain and symptom management
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J Pain Symptom Manage · Nov 2011
Case ReportsResponding to surrogate requests that seem inconsistent with a patient's living will.
Clinicians may feel conflicted when a patient's legal decision maker is making decisions that seem inconsistent with a patient's living will. We provide evidence-based information to help clinicians consider whether a surrogate's inconsistent decisions are ethically appropriate. ⋯ When appropriate, clinicians should respect surrogates' interpretations of patient values and take steps to decrease surrogate stress during the decision-making process. Finally, if clinicians are cognizant of their own values and preferences, they may recognize how these may affect their responses to certain clinical cases.
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J Pain Symptom Manage · Nov 2011
Prevalence and predictors of sleep difficulty in a national cohort of women with primary breast cancer three to four months postsurgery.
Mounting evidence suggests that many cancer patients suffer from sleep difficulty, but there is conflicting evidence regarding the prevalence and predictors of this adverse symptom. ⋯ These findings indicate that a high proportion of women with breast cancer experience sleep difficulty. Depression and poorer physical functioning appear to be robust predictors of sleep difficulty, whereas other predictors may depend on sample characteristics, including menopausal status.
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J Pain Symptom Manage · Nov 2011
Collecting data on quality is feasible in community-based palliative care.
Quality measurement in palliative care requires robust data from standardized data collection processes. We developed and tested the feasibility of the Quality Data Collection Tool version 1.0 (QDACTv1.0) for use in community-based palliative care. ⋯ Standardized data collection is feasible in routine community-based palliative care and is valuable for quality monitoring.
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J Pain Symptom Manage · Nov 2011
Navigating tensions: integrating palliative care consultation services into an academic medical center setting.
Despite rapid proliferation of hospital-based palliative care consultation services (PCCSs) across the country, there is little description of the dynamic processes that the PCCS and the non-PCCS hospital cultures experience during the institutionalization of a successful PCCS. ⋯ An in-depth understanding of the dynamic interaction of the infrastructures and processes of a successful institutionalization, in their unique complexity, may help other PCCSs identify and negotiate attributes of their own circumstances that will increase their chances for successful and sustainable implementation.
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J Pain Symptom Manage · Nov 2011
Implementation and evaluation of a network-based pilot program to improve palliative care in the intensive care unit.
Intensive care unit (ICU) care could be improved by implementation of time-triggered evidence-based interventions including identification of a patient/family medical decision maker, the patient's advance directive status, and cardiopulmonary resuscitation preferences by Day 1; offer of social work and spiritual support by Day 3; and a family meeting establishing goals of care by Day 5. We implemented a program to improve care for ICU patients in five Department of Veterans Affairs' ICUs. ⋯ ICU nurse teams can be engaged to improve care under the aegis of a collaborative quality improvement project.