Journal of pain and symptom management
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J Pain Symptom Manage · Mar 2018
ReviewEnvironmental design for end-of-life care: An integrative review on improving quality of life and managing symptoms for patients in institutional settings.
The environment in which end-of-life (EOL) care is delivered can support or detract from the physical, psychological, social, and spiritual needs of patients, their families, and their caretakers. ⋯ Studies indicate several critical components of the physical environment that can reduce total suffering and improve quality of life for EOL patients, their families, and their caregivers. These factors should be considered when making design decisions for care facilities to improve physical, psychological, social, and spiritual needs at EOL.
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J Pain Symptom Manage · Mar 2018
Comparative StudyA Comparison of the Accuracy of Clinician Prediction of Survival Versus the Palliative Prognostic Index.
Survival predictions for advanced cancer patients impact many aspects of care, but the accuracy of clinician prediction of survival (CPS) is low. Prognostic tools such as the Palliative Prognostic Index (PPI) have been proposed to improve accuracy of predictions. However, it is not known if PPI is better than CPS at discriminating survival. ⋯ We found that PPI was more accurate than CPS when used to discriminate survival at 30 days, but not at 100 days. This study highlights the reason and timing for using PPI to facilitate survival predictions.
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J Pain Symptom Manage · Mar 2018
ReviewMethadone as first line opioid in cancer pain management: a systematic review.
The objective of this review was to assess the existent evidence for the use of methadone as a first-line therapy in cancer pain management. ⋯ Available data are not sufficient to draw net conclusion. However, open-label and controlled studies have shown that methadone may be effective as first-line drug in the management of cancer pain, providing analgesia and adverse effect profiles similar to those produced by other opioids. The finding that methadone doses tend to remain stable suggests that metabolic characteristics and extraopioid analgesic effects, as its well antihyperalgesic properties may be interesting potential advantages. Further studies should provide information regarding the long-term use of methadone or the need to switch from methadone to other opioids when a loss of analgesic response occurs.
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J Pain Symptom Manage · Mar 2018
Observational StudyDoes modality matter? Palliative care units associated with more cost-avoidance than consultations.
Inpatient palliative care (PC) is associated with reduced costs, but the optimal model for providing inpatient PC is unknown. ⋯ Both PCU and PCC are associated with lower hospital costs than UC. PCU is associated with a greater cost-avoidance effect than PCC, except where both interventions are provided early in the hospitalization. Both timely provision of PC for appropriate patients and creation of more PCUs may decrease hospital costs.
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J Pain Symptom Manage · Mar 2018
Minimal Clinically Important Difference of the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF) for Fatigue Worsening in Asian Breast Cancer Patients.
The minimal clinically important difference (MCID) of the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF), a questionnaire that measures cancer-related fatigue, has not been established in patients with cancer. ⋯ The MCID of the MFSI-SF identified by all approaches ranged from 4.50 to 10.79 points. The MCID can be used to interpret the clinical significance of fatigue deterioration in patients with breast cancer and to determine sample sizes for future clinical trials.