Journal of pain and symptom management
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J Pain Symptom Manage · Apr 2020
Clinical consumption of opioid analgesics in China: a retrospective analysis of the national and regional data 2006-2016.
The annual consumption of opioid analgesics in the U.S. was more than 10 times the world average, whereas that in China was at a moderate level within Asia but much lower than the worldwide average. The opposite situations of opioid use in the U.S. and China revealed totally different problems in the developed versus developing world, that is, overuse versus underuse of opioids. ⋯ The clinical consumption of opioid analgesics for the treatment of moderate-to-severe pain in mainland China was far below the international level. The annual per capita of clinical consumption was lower, and the adequacy of cancer pain treatment was poorer in less developed areas. All these findings call for actions to strengthen pain management.
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J Pain Symptom Manage · Apr 2020
Patterns of Symptom Management Medication Receipt at End-of-Life Among Medicare Beneficiaries with Lung Cancer.
Older adults with advanced lung cancer experience high symptom burden at end of life (EOL), yet hospice enrollment often happens late or not at all. Receipt of medications to manage symptoms in the outpatient setting, outside the Medicare hospice benefit, has not been described. ⋯ Symptom management medication receipt was common and increasing toward EOL. Lower use by males, older adults, and nonwhites may reflect poor access or poor patient-provider communication. Further research is needed to understand these patterns and assess adequacy of symptom management in the outpatient setting.
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J Pain Symptom Manage · Apr 2020
Does receipt of recommended elements of palliative care precede in-hospital death or hospice referral?
Palliative care aligns treatments with patients' values and improves quality of life, yet whether receipt of recommended elements of palliative care is associated with end-of-life outcomes is understudied. ⋯ Goals-of-care discussions by different types of clinicians commonly precede end-of-life care in hospital or hospice. However, engagement with specialty palliative care reduced in-hospital death and increased hospice referral. Understanding the causal pathways of goals-of-care discussions may help build primary palliative care interventions to support patients near the end of life.
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J Pain Symptom Manage · Apr 2020
Improving Advance Care Planning in Outpatients with Decompensated Cirrhosis: A Pilot Study: Advance Care Planning in Patients with Decompensated Cirrhosis.
Despite significant morbidity and mortality among patients with decompensated cirrhosis, reported rates of advance directive (AD) completion and goals of care discussions (GCDs) between patients and providers are very low. We aimed to improve these rates by implementing a hepatologist-led advance care planning (ACP) intervention. ⋯ Addressing provider and system-specific barriers dramatically improved documentation rates of ACP.