Journal of pain and symptom management
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J Pain Symptom Manage · Apr 2012
It is "too late" or is it? Bereaved family member perceptions of hospice referral when their family member was on hospice for seven days or less.
Many family members of patients enrolled in hospice for less than seven days state that the hospice referral was made "at the right time." ⋯ Whereas family members identified expected concerns with communication, more than one in three stated an earlier hospice referral was not possible.
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J Pain Symptom Manage · Apr 2012
Review Case ReportsTo stent or not to stent: an evidence-based approach to palliative procedures at the end of life.
Patients near the end of life often undergo invasive procedures, such as biliary stenting for obstructive jaundice, with the intent of relieving symptoms. We describe a case in which the medical team and a patient and family are considering a second palliative biliary stent despite the patient's limited life expectancy. We review available evidence to inform the decision, focusing on the specific question of whether the benefits of palliative biliary stents in patients with advanced cancer outweigh the risks. ⋯ Studies had high attrition rates, results for improvements in symptoms and quality of life were mixed, and rates of complications and short-term mortality were high. In conclusion, the limited evidence does not support that the benefits of palliative biliary stents in this population outweigh the risks. We propose that primary care teams consider and discuss the larger picture of the goals of care with patients and families when considering offering these procedures, as well as benefits and potential harms, and consider involving palliative care services early, before consultation with an interventionist.
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J Pain Symptom Manage · Apr 2012
Multicenter StudyIs oxycodone efficacy reflected in serum concentrations? A multicenter, cross-sectional study in 456 adult cancer patients.
The relationship between oxycodone and metabolite serum concentrations and clinical effects has not previously been investigated in cancer pain patients. ⋯ This study of patients receiving oxycodone for cancer pain confirms previous observations that there is most likely no association between serum concentrations of opioid analgesics and clinical effects.
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J Pain Symptom Manage · Apr 2012
Multicenter StudyQuality of life and experience of care in women with metastatic breast cancer: a cross-sectional survey.
Despite developments in the medical management of metastatic breast cancer, little is known about the quality of life (QoL) and experience of care in women with it. ⋯ Despite improvements in treatment and survival of women with metastatic breast cancer, this group reports high symptom burden and dissatisfaction with elements of their care, indicating that alternative models of service delivery should be explored.
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J Pain Symptom Manage · Apr 2012
ReviewDyspnea in idiopathic pulmonary fibrosis: a systematic review.
Little is known about the treatment and correlates of dyspnea in idiopathic pulmonary fibrosis (IPF). ⋯ Sildenafil and pulmonary rehabilitation should be considered as potential therapies for dyspnea in selected patients with IPF. Supplemental oxygen and opioids may be additional potential therapies; however, the evidence supporting their use is weak. Additional research should focus on the management of functional status and comorbidities as potential treatments for dyspnea.