Journal of pain and symptom management
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J Pain Symptom Manage · May 2021
ReviewDo the clinical management guidelines for Covid-19 in African Countries reflect the African quality palliative care standards? A review of current guidelines.
Palliative care should be a component of COVID-19 management to relieve suffering, improve patient outcomes and save cost. ⋯ Comprehensive palliative care which addresses physical, psychological, social and spiritual concerns must be prioritized within case management guidelines in African countries.
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J Pain Symptom Manage · May 2021
Observational StudySelection Bias in Observational Studies of Palliative Care: Lessons Learned.
Palliative care (PC) programs are typically evaluated using observational data, raising concerns about selection bias. ⋯ This case study demonstrates that selection of comparison groups impacts the magnitude of measured and unmeasured confounding, which may change effect estimates. The substantial impact of confounding on effect estimates in this study raises concerns about the evaluation of novel serious illness care models in the absence of randomization. We present key lessons learned for improving future evaluations of PC using observational study designs.
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J Pain Symptom Manage · May 2021
Older age: A protective factor against perceived dignity related distress in patients with advanced cancer?
Most older adults will face threats to loss of health and social support, which can affect their perceived dignity. Although problems with perceived dignity increase in the context of cancer, the specific experience for those older compared with younger patients with advanced cancer has not been described despite its contributions to the wish to hasten death (WTHD). ⋯ Older age could be a protective factor against the perception of loss of dignity in patients with advanced cancer, a more positive perspective of the aging experience.
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J Pain Symptom Manage · May 2021
Chronic Opioid Therapy in Cancer Survivors at a Specialty Oncology Pain Clinic: Opioid Dosing, Efficacy and Safety Over Five Years of Pain Management.
There are limited data regarding long-term safety and efficacy in cancer survivors receiving chronic opioid therapy. With conflicting recommendations on opioid-prescribing practices and lack of available outcome data, this study aimed to provide a longitudinal perspective on opioid prescribing in cancer survivors. A retrospective chart review at a comprehensive cancer care center pain clinic used data from pain clinic provider notes from 2013 to 2018. ⋯ Functional status was satisfactory in 58% at Year 0 and increased to 91% of patients meeting their functional goals at Year 5. In a carefully monitored group of cancer survivors with persistent pain, chronic opioid therapy was safely managed during extended periods without significant opioid escalation or evidence of serious adverse events including aberrant behaviors. This population benefited when opioid therapy was managed with a focus on function rather than reduction of pain intensity scores.
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J Pain Symptom Manage · May 2021
Providing End-of-Life Care for Patients With Left Ventricular Assist Devices: Experience of a Hospice Agency.
Patients with left ventricular assist devices (LVADs) need expert palliative care at the end of life. In the U.S., hospice may provide this care, but few patients enroll, and information about hospice experience with LVAD-implanted patients is limited. ⋯ To provide specialist palliative care to LVAD-implanted patients, hospices must be prepared to manage complex and highly varied needs. To do this, hospices must have adequate staff support and access to acute care.