Journal of pain and symptom management
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J Pain Symptom Manage · Jan 2018
ReviewThe effectiveness of advance care planning in improving end of life outcomes for people with dementia and their carers: A systematic review and critical discussion.
End-of-life care for people with dementia can be poor, involving emergency hospital admissions, burdensome treatments of uncertain value, and undertreatment of pain and other symptoms. Advance care planning (ACP) is identified, in England and elsewhere, as a means of improving end-of-life outcomes for people with dementia and their carers. ⋯ There is a need for more high-quality outcome studies, particularly using randomized designs to control for confounding. These need to be underpinned by sufficient development work and process evaluation to clarify the appropriateness of outcome measures, explore implementation issues and identify "active elements."
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J Pain Symptom Manage · Jan 2018
Multicenter Study Comparative StudyComparing the palliative care needs of patients with hematologic and solid malignancies.
Hematologic cancer patients use palliative care services less frequently than their solid tumor counterparts. Prior work suggests that these patients have a sizable symptom burden, but comparisons between hematologic and solid tumor patients near the end of life are limited. ⋯ Hematologic and solid tumor patients have significant symptom burden at time of referral to palliative care services. Blood cancer patients may have unique concerns warranting targeted attention, including substantial drowsiness and tiredness. Our findings suggest a need to optimize palliative care usage in the hematologic cancer population.
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J Pain Symptom Manage · Jan 2018
Case ReportsIs There Ever a Role for the Unilateral Do Not Attempt Resuscitation Order in Pediatric Care?
Care for children as they near the end of life is difficult and very complex. More difficult still are the decisions regarding what interventions are and are not indicated during these trying times. Occasionally, families of children who are nearing the end of life disagree with the assessment of the medical team regarding these interventions. ⋯ The authors posit that such a unilateral do not attempt resuscitation order is only appropriate in very limited circumstances in pediatric care. Instead, focus should be placed on open discussion between parents and members of the clinical team, shared decision making, and maintenance of the clinician-parent relationship while simultaneously supporting members of the clinical team who express discomfort with parental decisions. The authors propose an alternative framework for approaching such a conflict based on clinician-parent collaboration and open communication.
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J Pain Symptom Manage · Jan 2018
Reflection on the Role of the Spirit in Finding Meaning and Healing as Clincians.
Reflections on the Role of the Spirit in Finding Meaning and Healing as Clinicians is based on a presentation for the George Washington Spirituality and Health Summer Institute on July 13, 2017. The presentation invited health care professionals to explore contemplative practices as ways to invite the Spirit to strengthening their resilience in caring for themselves and others. ⋯ This reflection draws on resilience research that finds that contemplative practices such as deep breathing, meditation, reflective writing, and peer or community support enhance ways of meaning making and healing. Contemplative practices are provided, which can connect clinicians to the Spirit with the purpose of leading to increased meaning and healing in self and relationships.