Journal of pain and symptom management
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J Pain Symptom Manage · Jan 2017
Timing of Advance Directive Completion and Relationship to Care Preferences.
Given recent Medicare rules reimbursing clinicians for engaging in advance care planning, there is heightened need to understand factors associated with the timing of advance directive (AD) completion before death and how the timing impacts care decisions. ⋯ Early documentation of care wishes may not be associated with an increased likelihood of electing aggressive care; however, ADs completed in the last months of life have higher rates of election of aggressive care.
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J Pain Symptom Manage · Jan 2017
Psychosocial Assessment by Hospice Social Workers: A Content Review of Instruments from a National Sample.
Hospice social workers are charged with completing a psychosocial assessment for every new enrollee. This assessment is part of the patient's comprehensive assessment and serves to inform the plan of care and key quality indicators. ⋯ Hospice social workers should consider modifying their assessment practices to include a comprehensive array of assessment topics pertinent to patients and families. An accurate, comprehensive assessment that contributes to a holistic, interdisciplinary approach will likely lead to better clinical outcomes.
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Although many family members who make surrogate decisions report problems with communication, there is no validated instrument to accurately measure surrogate/clinician communication for older adults in the acute hospital setting. ⋯ The survey shows high reliability and validity in measuring communication experiences for hospital surrogates. The scale has promise for measurement of communication quality and is predictive of important outcomes, such as surrogate satisfaction and well-being.
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J Pain Symptom Manage · Jan 2017
Caregivers' perspectives on the use of long term oxygen therapy for the treatment of refractory breathlessness: a qualitative study.
Despite limited clinical evidence, long-term oxygen therapy (LTOT) is used for the management of refractory breathlessness in people with life-limiting illnesses who are not necessarily hypoxemic. ⋯ Caregivers find caring for someone with refractory breathlessness extremely distressing. The benefits of LTOT are often overestimated, whereas its potential harms are underestimated. As significant stakeholders of people receiving LTOT, caregivers should be provided with opportunities to collaborate with clinicians in evidence-based decision making, efforts should be made to provide them with information and education about the most effective pharmacological and nonpharmacological strategies to manage refractory breathlessness in a palliative care setting including the appropriate use of LTOT to enable them to do so.
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J Pain Symptom Manage · Jan 2017
Continuous deep sedation: A proposal for performing more rigorous empirical research.
Continuous deep sedation until death (CDS) is a type of palliative sedation therapy, and it has recently become a focus of intense debate. Marked inconsistencies in intervention procedures (i.e., what is CDS?) and unstandardized descriptions of patient backgrounds lead to difficulty in comparing the results in the literature. The primary aim of this article was to propose a conceptual framework to perform empirical studies on CDS. ⋯ This article proposes a provisional definition of two types of CDS. Defining CDS using the intervention protocol and describing patient backgrounds using validated prognostic tools enable comparisons and interpretations of empirical research about CDS. More empirical studies are urgently needed.