Journal of pain and symptom management
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Most patients will lose decision-making capacity at the end of life. Little is known about the quality of care received by patients who have family involved in their care. ⋯ Family involvement at the end of life is associated with receipt of palliative care consultation and a chaplain visit and a higher likelihood of a DNR order. Clinicians should support early advance care planning for vulnerable patients who may lack family or friends.
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J Pain Symptom Manage · Dec 2014
Is race/ethnicity related to the presence or severity of pain in colorectal and lung cancer?
Developing interventions to address racial/ethnic cancer pain disparities requires exploration of the role of socioeconomic status, health status, and pain severity from the time of diagnosis. ⋯ Although the odds of experiencing pain differed only for multiracial patients, among those reporting pain, both blacks and multiracial individuals reported higher pain severity than whites. Sociodemographic status, health status, and depression were associated with severity but did not explain the disparity. Interventions to address these disparities will need to focus on reported severity and patient-level factors.
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J Pain Symptom Manage · Dec 2014
Improving the evidence base in palliative care to inform practice and policy: thinking outside the box.
The adoption of evidence-based hierarchies and research methods from other disciplines may not completely translate to complex palliative care settings. The heterogeneity of the palliative care population, complexity of clinical presentations, and fluctuating health states present significant research challenges. The aim of this narrative review was to explore the debate about the use of current evidence-based approaches for conducting research, such as randomized controlled trials and other study designs, in palliative care, and more specifically to (1) describe key myths about palliative care research; (2) highlight substantive challenges of conducting palliative care research, using case illustrations; and (3) propose specific strategies to address some of these challenges. ⋯ Although randomized controlled trials have their place whenever possible, alternative designs may offer more feasible research protocols that can be successfully implemented in palliative care. Therefore, this article highlights "outside the box" approaches that would benefit both clinicians and researchers in the palliative care field. Ultimately, the selection of research designs is dependent on a clearly articulated research question, which drives the research process.
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J Pain Symptom Manage · Dec 2014
Repeated assessments of symptom severity improve predictions for risk of death among patients with cancer.
Although prior studies show the importance of self-reported symptom scores as predictors of cancer survival, most are based on scores recorded at a single point in time. ⋯ If available, researchers should consider including changing information on symptom scores, as opposed to only baseline information on symptom scores, when examining hazard of death among patients with cancer. Worsening of pain, fatigue, and appetite may be a flag for impending death.
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J Pain Symptom Manage · Dec 2014
Differential expression of genes related to mitochondrial biogenesis and bioenergetics in fatigued prostate cancer men receiving external beam radiation therapy.
This prospective study explored relationships between expression changes of genes related to mitochondrial biogenesis/bioenergetics and fatigue in men with prostate cancer receiving external beam radiation therapy (EBRT). ⋯ Genes related to oxidative phosphorylation, energy production, and mitochondrial membrane integrity are associated with worsening fatigue during EBRT. Further investigation of the pathways involved with this association may explain mechanisms behind the development of fatigue in this population.