Journal of pain and symptom management
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A diagnosis of advanced chronic kidney disease (CKD), or end stage renal disease (ESRD) represents a significant life change for patients and families. Individuals often experience high symptom burden, decreased quality of life, increased health care utilization, and end-of-life care discordant with their preferences. Early integration of palliative care with standard nephrology practice in the outpatient setting has the potential to improve quality of life through provision of expert symptom management, emotional support, and facilitation of advance care planning that honors the individual's values and goals. ⋯ The development of a model of care that provides a new approach to clinical practice requires attention to relevant stakeholder concerns. PAR is a useful methodological approach that engages stakeholders and builds partnerships. This creation of shared ownership can facilitate innovation and practice change. We synthesized stakeholder concerns to build a conceptual model for an integrated nephrology and palliative care clinical program.
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J Pain Symptom Manage · Aug 2017
Addressing Patient Emotional and Existential Needs, During Serious Illness:Results of the Outlook Randomized Controlled Trial.
Few interventions exist to address patients' existential needs. ⋯ Outlook had an impact on social well-being and preparation compared with UC. The lack of impact on anxiety and depression differs from previous results among hospice patients. Results suggest Outlook is not demonstratively effective in populations not experiencing existential or emotional distress.
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J Pain Symptom Manage · Aug 2017
Depression - a major contributor to poor quality of life in patients with advanced cancer.
Quality of life (QoL) and depression are important patient-reported outcomes in cancer care. However, the relative importance of depression severity in predicting QoL remains unclear due to few methodologically sound studies. ⋯ Depression severity was the strongest single predictor of poorer QoL in this sample of patients with advanced cancer, after accounting for a wide range of clinically relevant variables. Future studies should investigate the contribution of psychosocial variables on QoL. Our findings emphasize the importance of managing depression to achieve the best possible QoL for these patients.
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J Pain Symptom Manage · Aug 2017
Neuropathic pain after breast cancer treatment: characterization and risk factors.
Neuropathic pain (NP) may be an important contributor to the morbidity burden of breast cancer. ⋯ NP and chronic NP were frequent in this population, being associated with anxiety and arm symptoms before breast cancer treatments and type of surgical management. These results highlight the need for monitoring the occurrence of this neurologic side effect of treatments and to develop strategies for reducing the morbidity burden of breast cancer.
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J Pain Symptom Manage · Aug 2017
Examining the effects of a home-based palliative heart failure program on quality of life, symptom burden, satisfaction with care and caregiver burden among patients with end-stage heart failure.
Provision of home-based palliative care for seriously ill patients is important, yet few home-based palliative care services specifically or exclusively focus on end-stage heart failure (ESHF) patients. ⋯ The HPHF program is effective in enhancing the QOL of ESHF patients, satisfaction with care and caregiver burden. The program has potential to reduce distress for some of the symptoms.