Journal of pain and symptom management
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J Pain Symptom Manage · Feb 2018
Observational StudyEffects of Androgen Deprivation Therapy on Pain Perception, Quality-of-Life and Depression in Men with Prostate Cancer.
Previous animal and human research suggests that testosterone has antinociceptive properties. Castration in male rodents increases pain perception which is reversed by testosterone replacement. Pain perception also improves in hypogonadal men with testosterone therapy. However, it remains unclear whether androgen deprivation therapy (ADT) in men with prostate cancer (PCa) is associated with an increase in pain perception. ⋯ ADT in men with PCa is associated with worsening of depression scores and QOL but is not associated with changes in clinical pain or pain sensitivity.
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J Pain Symptom Manage · Feb 2018
ReviewSafety and effectiveness of palliative drug treatment in the last days of life - a systematic literature review.
Dying patients commonly experience potentially distressing symptoms. Palliative care guidelines recommend opioids, anticholinergics, antipsychotics, and benzodiazepines for symptom relief. ⋯ There is a lack of evidence concerning the effectiveness and safety of palliative drug treatment in dying patients, and the reviewed evidence provides limited guidance for clinicians to assist in a distinct and significant phase of life.
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J Pain Symptom Manage · Feb 2018
Outcomes that Define Successful Advance Care Planning: A Delphi Panel Consensus.
Standardized outcomes that define successful advance care planning (ACP) are lacking. ⋯ A large, multidisciplinary Delphi panel developed an Organizing Framework and rated the importance of ACP outcome constructs. Top rated outcomes should be used to evaluate the success of ACP initiatives. More research is needed to create reliable and valid measurement tools for the highest rated outcomes, particularly "care consistent with goals."
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J Pain Symptom Manage · Feb 2018
Advance Care Planning Documentation Practices and Accessibility in the Electronic Health Record: Implications for Patient Safety.
Documenting patients' advance care planning (ACP) wishes is essential to providing value-aligned care, as is having this documentation readily accessible. Little is known about ACP documentation practices in the electronic health record. ⋯ Half of chronically ill, older participants had documented ACP, including one-third with documented discussions. However, half of the patients with completed legal forms/orders had no accompanying documented explanatory discussions, and the majority of documented discussions were not easily accessible, even when wishes had changed. Ensuring that patients' preferences are documented and easily accessible is an important patient safety and quality improvement target to ensure patients' wishes are honored.
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J Pain Symptom Manage · Feb 2018
Unmet palliative care needs among patients with end-stage kidney disease: a national registry study about the last week of life.
End-stage kidney disease (ESKD) is characterized by high physical and psychological burden, and therefore, more knowledge about the palliative care provided close to death is needed. ⋯ Even if death is expected, most patients dying with ESKD had unmet palliative care needs regarding symptom management, advance care planning, and bereavement support.