Journal of pain and symptom management
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J Pain Symptom Manage · Oct 2014
Propensity scores: a practical method for assessing treatment effects in pain and symptom management research.
When conducting research on pain and symptom management interventions for seriously ill individuals, randomized controlled trials are not always feasible or ethical to conduct. Secondary analyses of observational data sets that include information on treatments experienced and outcomes for individuals who did and did not receive a given treatment can be conducted, but confounding because of selection bias can obscure the treatment effect in which one is interested. Propensity scores provide a way to adjust for observable characteristics that differ between treatment and comparison groups. This article provides conceptual guidance in addition to an empirical example to illustrate two areas of propensity score analysis that often lead to confusion in practice: covariate selection and interpretation of resultant treatment effects.
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J Pain Symptom Manage · Oct 2014
Perceptions of health status and survival in patients with metastatic lung cancer.
Cognitive awareness of having a terminal illness is associated with critical treatment decisions and outcomes. However, little is known about the course and correlates of such perceptions in patients with metastatic lung cancer. ⋯ A minority of patients with metastatic NSCLC acknowledged being terminally ill. Those reporting that they were seriously and terminally ill had shorter survival compared with those who did not consider themselves terminally ill, even after adjusting for decline in physical and functional well-being.
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Palliative care services have been reported to be a less expensive alternative to traditional treatment; however, little is known about how to measure the cost of delivering quality palliative care. ⋯ A standardized methodology and framework for costing palliative care are presented. The framework allows a country or provider of care to substitute their own local costs to generate cost information relevant to the health-care system. In Romania, this allowed the palliative care provider community to advocate for a consistent payment system.
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J Pain Symptom Manage · Oct 2014
The effectiveness of the Geritalk communication skills course: a real-time assessment of skill acquisition and deliberate practice.
Communication skills are critical in Geriatrics and Palliative Medicine because these patients confront complex clinical scenarios. We evaluated the effectiveness of the Geritalk communication skills course by comparing pre- and post-course real-time assessment of the participants leading family meetings. We also evaluated the participants' sustained skills practice. ⋯ This intensive training and family meeting assessment offers evidence-based communication skills training.
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Accurate documentation of inpatient code status discussions (CSDs) is important because of frequent patient care handoffs. ⋯ Documentation quality of inpatient CSDs was poor. Our findings highlight the need to improve the quality of resident and attending CSD documentation.