Journal of pain and symptom management
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J Pain Symptom Manage · Sep 2016
Symptom Burden and End-of-Life Treatment Preferences in the Very Old.
End-of-life (EOL) treatment preferences among the very old (age 85+) may differ from preferences in younger aged populations because of high levels of symptom burden and disability and high risk of mortality. It is unclear if symptom burden or level of disability is more important for such preferences. ⋯ Preferences for more aggressive EOL treatment were not related to daily symptom distress but were significantly more likely to be endorsed among those with better mobility, suggesting that disability is an independent predictor of EOL treatment preferences in the very old.
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J Pain Symptom Manage · Sep 2016
Understanding Treatment Effect Terminology in Pain and Symptom Management Research.
Within health services and medical research, there is a wide variety of terminology related to treatment effects. Understanding differences in types of treatment effects is especially important in pain and symptom management research where nonexperimental and quasiexperimental observational data analysis is common. ⋯ Our goal is to facilitate appropriate reporting and interpretation of study results and to help investigators understand what information a decision maker needs when deciding whether to implement a treatment. Greater awareness of the reasons why treatment effects may differ across studies of the same patients in the same treatment settings can help policy makers and clinicians understand to whom a study's results may be generalized.
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J Pain Symptom Manage · Sep 2016
Cost Analysis and Policy Implications of a Pediatric Palliative Care Program.
In 2010, California launched Partners for Children (PFC), a pediatric palliative care pilot program offering hospice-like services for children eligible for full-scope Medicaid delivered concurrently with curative care, regardless of the child's life expectancy. ⋯ Through the provision of home-based therapeutic services, 24/7 access to medical advice, and enhanced, personally tailored care coordination, PFC demonstrated an effective way to reduce costs for children with life-limiting conditions by moving from costly inpatient care to more coordinated and less expensive outpatient care. PFC's home-based care strategy is a cost-effective model for pediatric palliative care elsewhere.
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J Pain Symptom Manage · Sep 2016
Level of Discomfort Decreases After the Administration of Continuous Palliative Sedation: A Prospective Multicenter Study in Hospices and Palliative Care Units.
A gold standard or validated tool for monitoring the level of discomfort during continuous palliative sedation (CPS) is lacking. Therefore, little is known about the course of discomfort in sedated patients, the efficacy of CPS, and the determinants of discomfort during CPS. ⋯ This study shows that CPS is associated with a decrease in the level of discomfort within an acceptable time frame, although in some sedated patients higher levels of discomfort in the last hours of life occurred. Although the DS-DAT seems to be of value for monitoring the level of discomfort during CPS, the results of this study should be interpreted within the constraints of the limitations, and further research on the psychometric properties of this tool is needed before the DS-DAT can be used in clinical practice.
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J Pain Symptom Manage · Sep 2016
Prospective Validation of the Objective Prognostic Score for Advanced Cancer Patients in Diverse Palliative Settings.
Prognostication is an essential part of palliative care to aid decision making and negotiate goals of care. The Objective Prognostic Score (OPS) is an easy-to-use prognosticating tool to predict survival among far-advanced cancer patients in palliative care units (PCUs) in Korea. ⋯ The OPS can be used for prognostication among advanced cancer patients in PCT, PCU, and HPC settings.