Journal of pain and symptom management
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J Pain Symptom Manage · Dec 2019
Randomized Controlled TrialEfficacy of a decision aid consisting of a video and booklet on advance care planning for advanced cancer patients: randomized controlled trial.
Few randomized controlled trials of advance care planning (ACP) with a decision aid (DA) show an effect on patient preferences for end-of-life (EOL) care over time, especially in racial/ethnic settings outside the U.S. ⋯ ACP interventions that included a video and an accompanying book improved preferences for EOL care.
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J Pain Symptom Manage · Dec 2019
End-of-Life Concerns and Experiences of Living with Advanced Breast Cancer among Medically Underserved Women.
Breast cancer morbidity and mortality disproportionately affect medically underserved women. Most studies of the experience of living with advanced breast cancer do not focus on this population. A deeper understanding of racial/ethnic minorities' and low-income patients' experiences is needed to reduce breast cancer health and health care disparities. ⋯ Participants resiliently maintained engaged lives yet described extreme financial duress and perceived provider bias, which are known contributors to worse quality of life and health outcomes. Participants downplayed their desire to discuss dying to accommodate pressure to "stay positive" and to mitigate others' discomfort. Improving care for underserved women with advanced cancer will require addressing disparities from screening through hospice, developing personalized opportunities to discuss death and dying, and enhancing access to and affordability of medical and social support.
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J Pain Symptom Manage · Dec 2019
ReviewCancer Pain in People with Intellectual Disabilities:Systematic Review and Survey of Health Care Professionals.
Owing to life expectancy improvements for people with intellectual disabilities, their risk of developing cancer is increasing. Pain is an inevitable aspect of cancerous diseases. However, as pain experience and expression can be atypical in people with intellectual disabilities, this population is vulnerable to late diagnosis of cancer and undertreatment of cancer pain. ⋯ Cancer pain in people with intellectual disabilities is a topic lacking specific and comprehensive research within scientific literature. We suggest this is due to inherent difficulties regarding the complex interplay of comorbidities and communication issues in people with intellectual disabilities.
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J Pain Symptom Manage · Dec 2019
Randomized Controlled TrialBrief English and Spanish Survey Detects Change in Response to Advance Care Planning Interventions.
The validated 82-item Advance Care Planning (ACP) Engagement Survey measures a broad range of ACP behaviors but is long. ⋯ Shorter versions of the ACP Engagement Survey were able to detect within-group and between-group changes comparable with the 82-item version and can be useful for efficiently and effectively measuring ACP engagement in research and clinical settings.
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J Pain Symptom Manage · Dec 2019
Patients' and caregivers' contested perspectives on spiritual care for those affected by advanced illnesses: a qualitative descriptive study.
Spiritual care refers to practices and rituals addressing spiritual/religious concerns. It supports coping with loss and finding hope, meaning, and peace. Although integral to palliative care, its implementation is challenging. ⋯ Although many patients and caregivers did not resonate with the term "spiritual care," all described how the hospital's hospitality could affirm their values and strengthen coping. The phrase "spiritual care and hospitality" may optimally articulate and guide care in similar, pluralist inpatient palliative care contexts, recognizing that such care encompasses an interplay of generalist and specialist pastoral care staff and organizational and environmental qualities.