Journal of pain and symptom management
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J Pain Symptom Manage · Apr 2016
Multicenter StudyClinicians' Perspectives on Managing Symptom Clusters in Advanced Cancer: A Semi-Structured Interview Study.
Managing symptom clusters or multiple concurrent symptoms in patients with advanced cancer remains a clinical challenge. The optimal processes constituting effective management of symptom clusters remain uncertain. ⋯ Management of symptom clusters, as both an art and a science, is currently fraught with uncertainty in decision making. Strengthening multidisciplinary collaboration, continuity of care, more pragmatic planning of clinical trials to address more than one symptom, and training in symptom cluster management are required.
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J Pain Symptom Manage · Apr 2016
Randomized Controlled Trial Multicenter StudyHow Accurately Do Consecutive Cohort Audits Predict Phase III Multisite Clinical Trial Recruitment in Palliative Care?
Audits have been proposed for estimating possible recruitment rates to randomized controlled trials (RCTs), but few studies have compared audit data with subsequent recruitment rates. ⋯ The retrospective consecutive case note audit in participating sites did not predict realistic recruitment rates, mostly underestimating the impact of study-specific inclusion criteria. These findings have implications for the applicability of the results of RCTs. Prospective pilot studies are more likely to predict actual recruitment.
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J Pain Symptom Manage · Apr 2016
Association Between Tobacco Use, Symptom Expression, Alcohol and Illicit Drug Use in Advanced Cancer Patients.
Limited knowledge exists examining the association between smoking status, symptom expression, and alcohol or illicit drug use. ⋯ In advanced cancer, patients who were former or current smokers were significantly more likely to have a history of CAGE positivity and illicit drug use compared with never smokers. Current smokers expressed significantly higher pain. A smoking history may be a marker of an increased risk of opioid misuse.
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J Pain Symptom Manage · Apr 2016
How Community Clergy Provide Spiritual Care: Toward a Conceptual Framework for Clergy End-of-Life Education.
Community-based clergy are highly engaged in helping terminally ill patients address spiritual concerns at the end of life (EOL). Despite playing a central role in EOL care, clergy report feeling ill-equipped to spiritually support patients in this context. Significant gaps exist in understanding how clergy beliefs and practices influence EOL care. ⋯ A conceptual framework informed by clergy perspectives of optimal spiritual care can guide EOL educational programming for clergy.
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J Pain Symptom Manage · Apr 2016
Case ReportsLocked-In Syndrome: Case Report and Discussion of Decisional Capacity.
Locked-in syndrome (LIS) is a rare neurologic disorder rendering an individual quadriplegic and anarthric with preserved self-awareness and normal if not near-normal cognition. A lesion to the ventral pons causes the classic form of LIS, and patients can typically interact with their environment with eye/eyelid movements. LIS patients may live for years with preserved quality of life (QoL) and cognitive function, but with severe disability. ⋯ The patient was determined to be decisional during the acute hospitalization, and he elected for life-prolonging care. This case emphasizes the importance of unbiased shared decision making, but also the importance of utilizing a practical framework to assess the decision-making capacity in these patients. We provide a suggested approach to determining decision-making capacity in similar cases or conditions.