Journal of pain and symptom management
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J Pain Symptom Manage · Sep 2021
Combining multiple decedent data sources for a population-based picture of end-of-life health care utilization.
Although health systems need to track utilization and mortality, it can be difficult to obtain reliable information on patients who die outside of the health system. This leads to missing data and introduces the potential for bias. ⋯ We describe a method to supplement EHR data with decedent information across data sources. While additional decedent data improves the accuracy of death data in the health system, patient healthcare utilization is biased towards those who use the health system at the end of life.
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J Pain Symptom Manage · Sep 2021
Long-term daily administration of aprepitant for the management of intractable nausea and vomiting in children with life-limiting conditions: a case series.
Nausea and vomiting is a common symptom in children through their end of life journey. Aprepitant, a NK-1 antagonist, has become a potent weapon in the fight against chemo-induced nausea and vomiting. However, its use in palliative care for refractory nausea and vomiting has been limited due to limited experience or evidence of continuous use. Emerging evidence suggests that continuous use is not only safe, but also effective in patients with nausea and vomiting refractory to multiple lines of antiemetic therapy. ⋯ Our review suggests a role for aprepitant in management of refractory nausea and vomiting, demonstrating safety and efficacy. This case series is the first report of aprepitant use in this manner in the paediatric palliative care setting.
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J Pain Symptom Manage · Sep 2021
Observational StudyThe challenges of caring for people dying from COVID-19: a multinational, observational study (CovPall).
Systematic data on the care of people dying with COVID-19 are scarce. ⋯ Palliative care services were often overwhelmed, yet felt ignored in the COVID-19 response. Palliative care needs better integration with health care systems when planning and responding to future epidemics/pandemics.
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J Pain Symptom Manage · Sep 2021
Genetic Predictors of Response to Acupuncture or Cognitive Behavioral Therapy for Insomnia in Cancer Survivors: An Exploratory Analysis.
Insomnia is a common problem affecting cancer survivors. While effective nonpharmacological treatments are available, it is unknown whether individual genetic characteristics influence treatment response. ⋯ In cancer survivors, specific variants in the COMT and NFKB2 genes are potentially associated with response to acupuncture but not to CBT-I. Confirming these preliminary results will help inform precision insomnia management for cancer survivors.
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J Pain Symptom Manage · Sep 2021
Improving end-of-life care for persons living with dementia: Bereaved caregivers' observations and recommendations.
Dementia is a terminal diagnosis that requires significant caregiving support across the trajectory of decline through to death. Experiences and perspectives from bereaved caregivers can help identify ways to improve the end-of-life care experience of persons dying with dementia. ⋯ End-of-life care for PLWD has significant room for improvement. Efforts to train healthcare providers should focus on helping them meet the complex informational, emotional, and social support needs of PLWD and their caregivers across the trajectory of decline.