Journal of pain and symptom management
-
J Pain Symptom Manage · Jan 2016
Randomized Controlled Trial Comparative StudyDifferences in Physicians' Verbal and Nonverbal Communication with Black and White Patients at the End of Life.
Black patients are more likely than white patients to die in the intensive care unit with life-sustaining treatments. Differences in patient- and/or surrogate-provider communication may contribute to this phenomenon. ⋯ In this small regional sample, hospital-based physicians have similar verbal communication behaviors when discussing end-of-life care for otherwise similar black and white patients but exhibit significantly fewer positive, rapport-building nonverbal cues with black patients.
-
J Pain Symptom Manage · Jan 2016
Randomized Controlled TrialThe Influence of Race/Ethnicity and Education on Family Ratings of the Quality of Dying in the ICU.
Racial and ethnic differences in end-of-life care may be attributable to both patient preferences and health-care disparities. Identifying factors that differentiate preferences from disparities may enhance end-of-life care for critically ill patients and their families. ⋯ Minority race/ethnicity was associated with lower family ratings of quality of dying. This association was mediated by factors that may be markers of patient and family preferences (living will, death in the setting of full support); family member minority race/ethnicity was directly associated with lower ratings of quality of dying. Our findings generate hypothesized pathways that require future evaluation.
-
J Pain Symptom Manage · Jan 2016
"Doctor, Make My Decisions": Decision Control Preferences, Advance Care Planning, and Satisfaction with Communication Among Diverse Older Adults.
Culturally diverse older adults may prefer varying control over medical decisions. Decision control preferences (DCPs) may profoundly affect advance care planning (ACP) and communication. ⋯ Nearly one-fifth of diverse, older adults want doctors to make their medical decisions. Older age and lower readiness to ask questions were the only demographic variables significantly associated with low DCPs. Yet, older adults with low DCPs still engaged in ACP, asked questions, and reported communication satisfaction. Clinicians can encourage ACP and questions for all patients, but should assess DCPs to provide the desired amount of decision support.
-
J Pain Symptom Manage · Jan 2016
Comparative StudySymptom Clusters in Advanced Cancer Patients: An Empirical Comparison of Statistical Methods and the Impact on Quality of Life.
Symptom clusters in advanced cancer can influence patient outcomes. There is large heterogeneity in the methods used to identify symptom clusters. ⋯ The four identified symptom clusters were consistent across statistical methods and cancer types, although there were some noteworthy differences. Statistical derivation of symptom clusters is in need of greater methodological guidance. A psychosocial pathway in the management of symptom clusters may improve quality of life. Biological mechanisms underpinning symptom clusters need to be delineated by future research. A framework for evidence-based screening, assessment, treatment, and follow-up of symptom clusters in advanced cancer is essential.
-
J Pain Symptom Manage · Jan 2016
Comparative StudyUnique Correlates of Heart Failure and Cancer Caregiver Satisfaction With Hospice Care.
Heart failure patients, along with their informal caregivers are increasingly enrolling in hospice care. Caregiver satisfaction with hospice care is a key quality indicator. The role that diagnosis plays in shaping satisfaction is unclear. ⋯ This study generated hypotheses about unique factors related to caregiver satisfaction among two diagnosis cohorts that require further study, particularly the impact of race on satisfaction in the cancer cohort and the management of dyspnea in heart failure hospice patients.