Journal of pain and symptom management
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J Pain Symptom Manage · Jan 2019
Managing chronic pain in cancer survivors prescribed long-term opioid therapy: a national survey of ambulatory palliative care providers.
Chronic pain, or pain lasting more than three months, is common among cancer survivors, who are often prescribed long-term opioid therapy (LTOT). ⋯ Palliative care providers are comfortable with many aspects of managing chronic pain in cancer survivors on LTOT, although challenges persist, including the lack of systems-based approaches and training in addiction treatment.
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Cancer is a major cause of morbidity and mortality for older individuals. Palliative care is essential to improve the outcome of cancer treatment in terms of quality of life and treatment satisfaction. This review examines the influence of spirituality on aging in general and on the management of older cancer patients. ⋯ Gerotranscendence, the more urgent search for meaning by older than younger individuals, confirms the importance of spirituality in this phase of life. Spirituality has also improved the quality of life and reduced the risk of disease and death for the patient's caregiver. Addressing patient and caregiver spirituality may render the palliative care of cancer more effective and may also aid in detection and management of spiritual pain, which may prevent healing at the end of life.
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J Pain Symptom Manage · Jan 2019
Design and Implementation of Patient Portal-Based Advance Care Planning Tools.
Electronic health record-based portal tools may help patients engage in advance care planning (ACP). We designed and implemented portal-based ACP tools to enable patients to create a medical durable power of attorney (MDPOA). ⋯ Patients demonstrated willingness to use the portal to complete an MDPOA and rated the new ACP tools as highly usable. Future work will optimize population-based outreach strategies to engage patients in ACP through the portal.
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J Pain Symptom Manage · Jan 2019
Changes in the Care Setting of First Consults to Palliative and Supportive Care over a 7-Year Period.
Optimal benefits from palliative care (PC) are achieved when first consults (PC1) occur early, in the outpatient setting. Late PC1, like those in the intensive care unit (ICU), limit these benefits. ⋯ PC1 total annual number has increased, and the proportion of PC1 at ICU, a very late clinical setting, is decreasing. Further efforts are needed to integrate PC in hematologic cancer care.
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J Pain Symptom Manage · Jan 2019
Personalized goal for dyspnea and clinical response in advanced cancer patients.
The clinical response after comprehensive symptom management is difficult to determine in terms of a clinically important difference. Moreover, therapies should try to reach the threshold perceived by the individual patient for the determination of a favorable response to a treatment. ⋯ Patient Dyspnea Goal Response and Patient Global Impression seem to be relevant for evaluating the effects of a comprehensive management of symptoms, including dyspnea, assisting decision making process. Some factors may be implicated in determining the individual target and clinical response. A personalized symptom goal may translate in terms of therapeutic intervention, according to the achievement of the patients' expectations. High values of dyspnea intensity, a lower Karnofsky level, as well as high level of Dyspnea Intensity Goal (that is less patients' expectations) favor the achievement of the target.