Journal of pain and symptom management
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J Pain Symptom Manage · Jan 2019
ReviewControl and context are central for people with advanced illness experiencing breathlessness: A systematic review and thematic-synthesis.
Breathlessness is common and distressing in advanced illness. It is a challenge to assess, with few effective treatment options. To evaluate new treatments, appropriate outcome measures that reflect the concerns of people experiencing breathlessness are needed. ⋯ People with advanced illness living with breathlessness have concerns in multiple domains, supporting a concept of "total breathlessness." This adapted model can help to guide comprehensive clinical assessment and inform future outcome measurement in clinical practice and research.
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J Pain Symptom Manage · Jan 2019
ReviewA Systematic Review of Training in Symptom Management in Palliative Care within Postgraduate Medical Curriculums.
Symptom management is a priority area within palliative care core competencies for generalist providers. Although several educational initiatives exist, a comprehensive evidence synthesis on the effectiveness of symptom management training on trainees' learning and patient-reported outcomes is lacking. ⋯ Current educational training programs in symptom management appear to improve trainees' comfort, preparedness, and knowledge in assessing and managing patients' symptoms at the end of life. More rigorous research to evaluate the impact of this training on residents and organizational performance is now required.
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Little is known about the hopes patients with advanced (incurable) cancer have for their treatment. ⋯ Advanced cancer patients harbor a range of treatment hopes. These hopes often are not discussed with key members of the health care team. Younger age and lack of discussion of hopes with primary care physicians may lead to less realistic hopes for cure.
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J Pain Symptom Manage · Jan 2019
ReviewA Systematic Review and Gap Analysis of Advance Care Planning Intervention Components and Outcomes Among Cancer Patients Using the Transtheoretical Model of Health Behavior Change.
Despite the benefits of advance care planning (ACP), cancer patients rarely engage in ACP. ACP is a process that parallels health behavior change. This makes the Transtheoretical Model of Health Behavior Change (TTM) an important framework for understanding how to increase ACP among cancer patients. ⋯ ACP likely requires "high touch" interventions to induce behavior change. ACP interventions that are stage-matched, use diverse mechanisms to engage ACP (i.e., processes of change), address ACP as a process, and monitor engagement across the illness trajectory are needed for cancers patients and their caregivers.
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J Pain Symptom Manage · Jan 2019
Randomized Controlled TrialConcordance between Proxy Level of Care Preference and Advance Directives among Nursing Home Residents with Advanced Dementia: A Cluster Randomized Clinical Trial.
Care consistent with goals is the desired outcome of advance care planning (ACP). ⋯ Better alignment between preferences for comfort-focused care and advance directives is needed in advanced dementia. An ACP video may help achieve that goal.