Journal of pain and symptom management
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Delirium is a condition of acute onset and fluctuating course in which a person's level of consciousness and cognition become disturbed. Delirium is a common and distressing phenomenon in end-of-life care, yet it is underrecognized and undertreated. ⋯ We propose three themes that explain the distressing nature of delirium in palliative care: 1) experiences of relational tension; 2) challenges in recognizing the delirious person; and 3) struggles to interpret the meaning of delirious behaviors. By approaching end-of-life delirium from a perspective of relational ethics, attention is focused on the implications for the therapeutic relationship with patients and families when delirium becomes part of the dying trajectory.
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J Pain Symptom Manage · Aug 2014
Multicenter Study Comparative StudyComparative effectiveness of senna to prevent problematic constipation in pediatric oncology patients receiving opioids: a multicenter study of clinically detailed administrative data.
Pediatric oncology patients often receive prolonged courses of opioids, which can result in constipation. ⋯ Initiating senna therapy, compared with other oral bowel medications, diminishes the subsequent risk of surrogate markers of problematic constipation in this population.
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J Pain Symptom Manage · Aug 2014
ReviewClinical practice guidelines for delirium management: potential application in palliative care.
Delirium occurs in patients across a wide array of health care settings. The extent to which formal management guidelines exist or are adaptable to palliative care is unclear. ⋯ Delirium clinical guidelines are available but the level of evidence is limited. More robust evidence is required for future guideline development.
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Delirium is a common, distressing neuropsychiatric complication for patients in palliative care settings, where the need to minimize burden yet accurately assess delirium is hugely challenging. ⋯ Given the unique characteristics of patients in palliative care settings, further contextually sensitive studies of delirium assessment are required in this population.
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J Pain Symptom Manage · Aug 2014
ReviewEthical challenges and solutions regarding delirium studies in palliative care.
Delirium occurs commonly in settings of palliative care (PC), in which patient vulnerability in the unique context of end-of-life care and delirium-associated impairment of decision-making capacity may together present many ethical challenges. ⋯ Delirium research in PC patients must meet the common standards for such research in any setting. Certain features unique to PC establish a need for extra diligence in meeting these standards and the employment of assessments, consent procedures, and patient-family interactions that are clearly grounded on the tenets of PC.