Journal of pain and symptom management
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J Pain Symptom Manage · Jul 2020
Randomized Controlled TrialAssociations of caregiver-oncologist discordance in prognostic understanding with caregiver-reported therapeutic alliance and anxiety.
Discordance in prognostic understanding between caregivers of adults with advanced cancer and the oncologist may shape caregivers' views of the oncologist and bereavement outcomes. ⋯ A better understanding of how caregivers understand and come to terms with poor prognoses will guide interventions to improve cancer care delivery and outcomes of cancer treatment.
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J Pain Symptom Manage · Jul 2020
Suicide Attempt Following Determination of Ineligibility for Assisted Death: A Case Series.
Medical assistance in dying (MAID) and similar right-to-die laws are becoming increasingly common in jurisdictions across North America and elsewhere. To be eligible for MAID in Canada, requesters must have a serious illness, intolerable suffering, and a reasonably foreseeable natural death. They must also undergo two assessments to confirm eligibility. ⋯ All three cases had previous diagnoses of depressive disorders and mild cognitive impairment, and two cases had histories of suicide attempts. In at-risk patients, we speculate that the period surrounding a finding of MAID ineligibility may represent a period of particular vulnerability. Clinicians must be vigilant and prepared for the possibility of heightened risk, including risk of self-harm, after a finding of ineligibility for assisted death.
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J Pain Symptom Manage · Jul 2020
Spiritual Distress Manifested in a Teenager Following a Stem Cell Transplant.
A mother and nurse 20 years after her son's tragic death, after a high-risk stem cell transplant, learns that his major behavioral changes while in strict isolation came under the term of spiritual distress. Through her personal experience, the writer describes how her son's thoughts and feelings were expressed in behaviors, atypical for his usual demeanor. This article highlights the importance and value of healthcare providers listening to a parent's perceptions of their child's state of mind. Atypical behavior could be a manifestation of spiritual distress and requires further assessment from the health care team.
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J Pain Symptom Manage · Jul 2020
Creating a Palliative Care Inpatient Response Plan for COVID19 - The UW Medicine Experience.
The coronavirus disease 2019 (COVID-19) pandemic is stressing health care systems throughout the world. Significant numbers of patients are being admitted to the hospital with severe illness, often in the setting of advanced age and underlying comorbidities. Therefore, palliative care is an important part of the response to this pandemic. The Seattle area and UW Medicine have been on the forefront of the pandemic in the U.S. ⋯ Strategy planning for delivery of high-quality palliative care in the context of the COVID-19 pandemic represents an important area of need for our health care systems. We share our experiences of developing such a strategy to help other institutions conduct and adapt such strategies more quickly.
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J Pain Symptom Manage · Jul 2020
Comparing an artificial neural network to logistic regression for predicting ED visit risk among patients with cancer: a population-based cohort study.
Prior work using symptom burden to predict emergency department (ED) visits among patients with cancer has used traditional statistical methods such as logistic regression (LR). Machine learning approaches for prediction, such as artificial neural networks (ANNs), are gaining attention but are yet to be commonly applied in practice. ⋯ Although both models were similar in predictive performance using our data, ANNs have an important role in prediction because of their flexible structure and data-driven distribution-free benefits and should thus be considered as a potential modeling approach when developing a prediction tool.