Journal of pain and symptom management
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J Pain Symptom Manage · Dec 2014
Legal barriers in accessing opioid medicines: results of the ATOME quick scan of national legislation of eastern European countries.
Overregulation of controlled medicines is one of the factors contributing to limited access to opioid medicines. ⋯ The selected countries have in common as main barriers prescribing and dispensing restrictions, the use of stigmatizing language, and incorrect use of definitions. The practical impact of these barriers identified using a quick scan method needs to be validated by other means.
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J Pain Symptom Manage · Dec 2014
Complexities in euthanasia or physician-assisted suicide as perceived by Dutch physicians and patients' relatives.
The practice of euthanasia and physician-assisted suicide (EAS) is always complex, but some cases are more complex than others. The nature of these unusually complex cases is not known. ⋯ First, the process toward EAS may be disrupted, causing a complex situation. Second, the course of the process toward EAS is influenced not only by the patient and his/her attending physician but also by the relatives who are involved. Communicating and clarifying expectations throughout the process may help to prevent the occurrence of unusually complex situations.
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J Pain Symptom Manage · Dec 2014
Cancer symptom clusters: an exploratory analysis of eight statistical techniques.
Statistical methods to identify symptom clusters (SC) have varied between studies. The optimal statistical method to identify SC is unknown. ⋯ Seven SC identified from both prevalence and severity data were consistently present irrespective of the statistical analysis used. There were only minor variations in the number of clusters and their symptom composition between analytical techniques. All seven clusters originally identified were confirmed. Four consistent SC were found in all analyses: aerodigestive, fatigue/anorexia-cachexia, nausea/vomiting, and upper GI. Our results support the clinical importance of the SC concept.
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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.