Journal of pain and symptom management
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J Pain Symptom Manage · Nov 2018
ReviewAdvance Care Planning With Patients Who Have End-Stage Kidney Disease: A Systematic Realist Review.
Patients with end-stage kidney disease have a high mortality rate and disease burden. Despite this, many do not speak with health care professionals about end-of-life issues. Advance care planning is recommended in this context but is complex and challenging. We carried out a realist review to identify factors affecting its implementation. ⋯ We identified two intervention stages-1) training for health care professionals that addresses concerns, optimizes skills, and clarifies processes and 2) use of documentation and processes that are simple, individually tailored, culturally appropriate, and involve surrogates. These processes work as patients develop trust in professionals, participate in discussions, and clarify values and beliefs about their condition. This leads to greater congruence between patients and surrogates; increased quality of communication between patients and professionals; and increased completion of advance directives. Advance care planning is hindered by lack of training; administrative complexities; pressures of routine care; patients overestimating life expectancy; and when patients, family, and/or clinical staff are reluctant to initiate discussions. It is more likely to succeed where organizations treat it as core business; when the process is culturally appropriate and takes account of patient perceptions; and when patients are willing to consider death and dying with suitably trained staff.
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J Pain Symptom Manage · Nov 2018
Multicenter StudyCharacteristics associated with physical function trajectories in older adults with cancer during chemotherapy.
Studies on physical function trajectories in older adults during chemotherapy remain limited. ⋯ While several symptoms were associated with decrements in PCS scores at enrollment in older adults with cancer receiving chemotherapy, morning fatigue was the only symptom associated with decreases in physical function over time. Regular assessments of symptoms and implementation of evidence-based interventions should be considered to maintain physical function in older adults during chemotherapy.
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J Pain Symptom Manage · Nov 2018
Multicenter Study Comparative Study Pragmatic Clinical TrialQuality of Life Trends in People With and Without Cancer Referred to Volunteer-Provided Palliative Care Services (ELSA): A Longitudinal Study.
Trends in symptoms and functional ability are known toward the end of life, but less is understood about quality of life, particularly prospectively following service referral. ⋯ Referral triggers for those with and without cancer may be different. People with cancer can be expected to have a more rapid decline in quality of life from the point of service referral. This may indicate greater support needs, including from volunteer-provided palliative care services.
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J Pain Symptom Manage · Nov 2018
Dyspnea in Amyotrophic Lateral Sclerosis: Rasch-Based Development and Validation of a Patient-Reported Outcome (DALS-15).
Dyspnea is a cardinal but often underestimated symptom in amyotrophic lateral sclerosis (ALS). The lack of a satisfying assessment tool leads to diagnostic uncertainty and bears the risk that established life-prolonging and symptom-relieving therapeutic options will not be adequately applied. ⋯ The DALS-15 satisfies strictest modern measurement criteria and has interval scale properties. It fills an important gap in assessment and could be most helpful to optimize symptom management in patients with ALS.
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J Pain Symptom Manage · Nov 2018
Third-Year Medical Students' Reactions to Surgical Patients in Pain: Doubt, Distress, and Depersonalization.
Medical students have limited instruction about how to manage the interpersonal relationships required to care for patients in pain. ⋯ These observations about patient-doctor relationships suggest that there is a larger problem among clinicians relating to patient distress and personal processing of the emotional nature of patient care. Efforts to address this problem will require explicit instruction in skills to develop a personal strategy for managing the emotionally challenging aspects of clinical work.