Journal of pain and symptom management
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J Pain Symptom Manage · Oct 2017
Multicenter StudyEvaluation of Emergency Department Management of Opioid-Tolerant Cancer Patients with Acute Pain.
There are no previously published studies examining opioid doses administered to opioid-tolerant cancer patients during emergency department (ED) encounters. ⋯ Patients with daily home use less than 200 OMEs generally received adequate initial PRN opioid doses during their ED visit. However, patients with higher home opioid usage were at increased likelihood of being undertreated.
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J Pain Symptom Manage · Oct 2017
Opioid prescribing among cancer and non-cancer patients: Time trend analysis in the elderly using administrative data.
In 2007, Cancer Care Ontario introduced a provincial symptom screening program, which included pain, for cancer patients. Over this same time, opioid prescribing has been increasingly scrutinized among non-cancer patients. The study purpose was to see if opioid prescribing changed among older adults after 2007 in the context of changing opioid regulations, and whether effects were different among patients with a cancer history. ⋯ Overall prescribing rates for cancer patients aged ≥65 years remain unchanged over time, in spite of the introduction of a provincial symptom screening program. Decreasing prescription rates in some drug sub-classes were observed. The potential impact of these changes on the quality of symptom control for cancer patients needs further investigation.
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J Pain Symptom Manage · Oct 2017
Randomized Controlled TrialThe TAILORED Study: A Randomized Controlled Trial to Improve Surrogate Decision Making.
Patients with terminal illnesses often require surrogate decision makers. Prior research has demonstrated high surrogate stress, and that despite standards promoting substituted judgment, most patients do not want their surrogates to make pure substituted judgments for them. It is not known how best to help loved ones fulfill the surrogate role. ⋯ TAILORED patients and surrogates who completed the study adopted a more mutual decision-making style, balancing their own wishes with what the surrogate thinks would be best for them. Surrogates reported less stress and more satisfaction. Confidence was high at baseline and did not change. There was a modest increase in caregiver burden. These findings suggest that interventions like TAILORED might positively impact surrogate decision making.
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J Pain Symptom Manage · Oct 2017
A novel use of peer coaching to teach primary palliative care skills: Coaching consultation.
We aim to address palliative care workforce shortages by teaching clinicians how to provide primary palliative care through peer coaching. ⋯ Peer coaching can be provided in the inpatient setting to teach primary palliative care and potentially extend the palliative care work force.
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J Pain Symptom Manage · Oct 2017
Palliative Care Clinicians Caring for Patients Before and After Continuous Flow-Left Ventricular Assist Device.
Left ventricular assist devices (LVADs) are an available treatment option for carefully selected patients with advanced heart failure. Initially developed as a bridge to transplantation, LVADs are now also offered to patients ineligible for transplantation as destination therapy (DT). Individuals with a DT-LVAD will live the remainder of their lives with the device in place. ⋯ There has been increased emphasis on involving palliative care (PC) specialists in LVAD programs, specifically the DT-LVAD population, from the pre-implantation process through the end of life. Palliative care specialists are well poised to provide education, guidance, and support to patients, families, and clinicians throughout the LVAD journey. This article addresses the complexities of the LVAD population, describes key challenges faced by PC specialists, and discusses opportunities for building collaboration between PC specialists and LVAD teams.