Journal of pain and symptom management
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J Pain Symptom Manage · Dec 2014
Multicenter StudyValidation of a measure of family experience of patients with serious illness: the QUAL-E (Fam).
Family members of seriously ill patients experience significant burden as they advocate with providers and participate in key decisions for loved ones. Most assessments focus on patient experience, yet family members' own quality of experience is central to comprehensive care. ⋯ The QUAL-E (Fam) is a companion instrument to the patient QUAL-E measure of quality of life at the end of life and is part of a package of assessment tools that can help evaluate the entire patient experience and contribute to quality care.
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J Pain Symptom Manage · Dec 2014
Randomized Controlled Trial Multicenter StudyA study to improve communication between clinicians and patients with advanced heart failure: methods and challenges behind the working to improve discussions about defibrillator management trial.
We report the challenges of the Working to Improve Discussions About Defibrillator Management trial, our novel, multicenter trial aimed at improving communication between cardiology clinicians and their patients with advanced heart failure (HF) who have implantable cardioverter defibrillators (ICDs). The study objectives are (1) to increase ICD deactivation conversations, (2) to increase the number of ICDs deactivated, and (3) to improve psychological outcomes in bereaved caregivers. The unit of randomization is the hospital, the intervention is aimed at HF clinicians, and the patient and caregiver are the units of analysis. ⋯ Third, we had to adapt our entry criteria to the changing landscape of ventricular assist devices and cardiac transplant eligibility. Here we present our novel solutions to the difficulties we encountered. Our work has the ability to enhance conduct of future studies focusing on improving care for patients with advanced illness.
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J Pain Symptom Manage · Dec 2014
Randomized Controlled TrialPalliative radiation before hospice: the long and the short of it.
Randomized data support shorter radiotherapy courses for management of cancer-related symptoms in the palliative setting. ⋯ This study found relatively long courses of radiotherapy before short lengths of survival on hospice. Future research is needed to identify barriers to shorter radiotherapy courses.
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J Pain Symptom Manage · Dec 2014
Randomized Controlled TrialMindfulness-oriented recovery enhancement ameliorates the impact of pain on self-reported psychological and physical function among opioid-using chronic pain patients.
Chronic pain impacts one-third of the U.S. population, and its effects are debilitating for individuals and costly to the medical system. Although opioids are commonly prescribed to address chronic pain, they confer risk for misuse and addiction in some patients and may not fully restore life function-particularly with regard to psychosocial factors. Because of the multiplicity of impacts that chronic pain may have on daily functioning, broad-spectrum behavioral interventions are needed. ⋯ Findings demonstrate preliminary efficacy of MORE as a treatment for pain-related functional impairments and suggest that effects may be more pronounced and durable for aspects of psychological function.
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J Pain Symptom Manage · Dec 2014
Chemotherapy-associated oral sequelae in patients with cancers outside the head and neck region.
Chemotherapy induces a wide array of acute and late oral adverse effects that makes symptom alleviation and information important parts of patient care. ⋯ Oral sequelae were frequently reported, and health care providers should be attentive to the presence and severity of these problems. Less than one-third of the patients remembered having received information about oral sequelae associated with chemotherapy. A continuous focus on how to diagnose, manage, and inform about oral cancer-related complications is advisable.