Journal of pain and symptom management
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J Pain Symptom Manage · Sep 2015
Randomized Controlled TrialImproving Adherence to Cancer Treatment by Addressing Quality of Life in Patients with Advanced Gastrointestinal Cancers.
Many patients with potentially curable cancer do not complete their prescribed treatment regimens because of the toxicity. There is evidence that the common endpoints of many of these toxicities are amenable to quality of life (QOL)-directed interventions. ⋯ A structured multidisciplinary QOL-directed intervention delivered to patients undergoing CR may increase the proportion of patients who complete CR as planned and reduce unplanned hospitalizations. Utilization is an important outcome in QOL-directed intervention trials.
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J Pain Symptom Manage · Sep 2015
Multicenter StudyUnderstanding Models of Palliative Care Delivery in Sub-Saharan Africa: Learning From Programs in Kenya and Malawi.
The need for palliative care has never been greater. From being significantly present in only five African countries in 2004, palliative care is now delivered in nearly 50% of African countries; however, less than 5% of people in need receive it. To scale-up palliative care, we need greater knowledge about how different models of palliative care work within different health systems. ⋯ The models are also closely associated with the physical setting of services. Understanding how the services have developed because of, and indeed despite the geographical setting and the system level, provides us with a different set of indicators of program structure incorporated into the three models. The analysis of models provides pointers to future planning for palliative care.
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J Pain Symptom Manage · Sep 2015
Patient-Reported Outcomes for Determining Prognostic Groups in Veterans with Advanced Cancer.
Physicians overestimate survival in patients with advanced cancer. Patient-reported outcomes could provide another way to estimate survival. We previously reported four prognostic groups based on Karnofsky Performance Status, Functional Assessment of Cancer Therapy physical well-being subscale, and Memorial Symptom Assessment Scale-Short Form physical symptom distress subscale scores. ⋯ The four prognostic groups remained distinct in the prospective cohort. Small differences in patient-reported physical well-being can halve survival estimates. Patient-reported outcomes can correct for physician overestimate of prognosis. This study provides a way to use patient-reported outcomes for prognosis in patients with advanced cancer, with important implications for assessment.
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J Pain Symptom Manage · Sep 2015
A Model for Effective and Efficient Hospice Care: Proactive Telephone-Based Enhancement of Life Through Excellent Caring, "TeleCaring" in Advanced Illness.
A community-based non-profit hospice provider implemented "TeleCaring" as a quality improvement intervention to identify and take action on patient or caregiver needs or concerns, such as uncontrolled symptoms or prescription problems. ⋯ TeleCaring is a viable method to proactively identify home hospice patient or caregiver needs and adjust clinical services accordingly.
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In the U. S., hospices sometimes provide high-intensity "continuous care" in patients' homes. However, little is known about the way that continuous care is used or what impact continuous care has on patient outcomes. ⋯ Use of continuous care on the day before death is associated with a significant reduction in the use of inpatient care on the last day of life, particularly when patients are cared for by a spouse.