Journal of pain and symptom management
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J Pain Symptom Manage · Jan 2020
Case ReportsIllness as transformative experience: Implications of philosophy for advance care planning.
Advance care planning has been shown to improve patient outcomes and is recommended as part of routine care for people with a life-limiting illness. Nevertheless, developing an advance care plan can be complex and challenging for both patients and family members, and the clinicians who support them. ⋯ We examine the implications of such "transformative experiences" for advance care planning, using the hypothetical case study of Jean, an older person with advanced kidney disease. Finally, we consider consequences for clinical practice and how an understanding of transformative experience might enhance current approaches to advance care planning.
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J Pain Symptom Manage · Jan 2020
A Longitudinal Study of Predictors of Constipation Severity in Oncology Outpatients with Unrelieved Pain.
Although constipation is a common symptom in oncology patients, it often goes unrecognized and untreated. In addition, little is known about characteristics associated with interindividual differences in constipation severity. ⋯ Our findings underscore the high prevalence of and large amount of interindividual variability in constipation severity. The characteristics associated with worse CAS scores can assist clinicians to identify high-risk patients and initiate prompt interventions.
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J Pain Symptom Manage · Jan 2020
Triaging the terminally ill - Development of the Responding to Urgency of Need in Palliative Care (RUN-PC) Triage Tool.
Evidence-based resource allocation is receiving increasing attention as we strive for equity, transparency, and cost-effectiveness across health care. In the context of finite resources, which of our patients with terminal illness should be prioritized for urgent palliative care? ⋯ Palliative care triage, which is complex and contextual, has been made more transparent through this discrete choice experiment. The Responding to Urgency of Need in Palliative Care triage tool provides an important step toward evidence-based assessment of priority for palliative care. Further research is underway to determine the validity of the tool in clinical practice and its impact on patient and caregiver outcomes.
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J Pain Symptom Manage · Jan 2020
The Role of a Symptom Assessment Tool in Shaping Patient-Physician Communication in Palliative Care.
Patients with cancer experience many symptoms that disrupt quality of life, and symptom communication and management can be challenging. The Edmonton Symptom Assessment System (ESAS) was developed to standardize assessment and documentation of symptoms, yet research is needed to understand patients' and caregivers' experiences using the tool and its ability to impact patient-provider aligned care. ⋯ The ESAS is beneficial in enhancing symptom communication when used as a guide to identify and understand patients' main concerns.
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J Pain Symptom Manage · Jan 2020
Which Cost Components Influence the Cost of Palliative Care in the Last Hospitalization? A Retrospective Analysis of Palliative Care vs. Usual Care at a Swiss University Hospital.
Although the number of studies on the economic impact of palliative care (PC) is growing, the great majority report costs from North America. ⋯ Studies measuring the impact of PC on hospital costs should analyze various cost components beyond total costs to understand wanted and potentially unwanted cost-reducing effects. An international definition of a set of cost components, specific for cost-impact PC studies, may help avoid superficial and potentially dangerous cost discussions.