Journal of pain and symptom management
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J Pain Symptom Manage · Sep 2021
Prevalence, predictors and correlates of religious and spiritual struggles in palliative cancer patients.
Religion and spirituality (r/s) are important resources in coping with cancer. However, there are aspects of r/s, such as religious and spiritual struggles, found to be associated with poorer outcomes. A new measure has been adapted from the Religious and Spiritual Struggles Scale (RSS) to assess r/s struggles: the RSS-14. This concise measure allows for the assessment of multiple types of r/s struggles for people from different religious backgrounds or none. ⋯ R/S struggles may compromise well-being for cancer patients receiving palliative care. Clinicians should consider periodic screening for r/s struggles and referrals for spiritual care if indicated.
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J Pain Symptom Manage · Sep 2021
"She's not ready to give up yet!": When a Family Member Overrides the Patient's Medical Decisions.
Autonomy, which gives individuals the right to make informed decisions about their medical treatment, is a central principle in Western bioethics. However, we often encounter patients for whom a family member seems to dominate medical decision-making, to the extent that clinicians become concerned that the patient is subject to excessive pressure or even coercion. In this article, we describe one such case and how we assess a decision-making process that involves family influence. ⋯ We must also attend to the emotional level of family members' statements. "I won't let you give up" might be more a statement of grief rather than a true reflection of their values or intent. Supporting the family member's coping may help to bring together what initially seem to be divergent goals. Exploring these decision-making dynamics is key to providing good palliative care.
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J Pain Symptom Manage · Sep 2021
ReviewObjectifying the Subjective: The Use of Heart Rate Variability as a Psychosocial Symptom Biomarker in Hospice and Palliative Care Research.
Measuring psychosocial symptoms in hospice and palliative care research is critical to understanding the patient and caregiver experience. Subjective patient-reported outcome tools have been the primary method for collecting these data in palliative care, and the growing field of biobehavioral research offers new tools that could deepen our understanding of psychosocial symptomatology. Here we describe one psychosocial biomarker, heart rate variability (HRV), and simple techniques for measurement in an adolescent and young adult cancer population that are applicable to palliative care studies. Complementing self-reported measures with objective biomarkers like HRV could facilitate a more nuanced understanding of physiologic and perceived well-being in patients with serious or life-limiting illness and inform future "precision supportive care" in hospice and palliative medicine.
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J Pain Symptom Manage · Sep 2021
ReviewCompassionate Deactivation of Pediatric Ventricular Assist Devices: A Review of 14 Cases.
Compassionate deactivation (CD) of ventricular assist device (VAD) support is a recognized option for children when the burden of therapy outweighs the benefits. ⋯ CD is the mode of death in more than half of our VAD non-survivors and is pursued for reasons primarily related to noncardiac events. Caregivers and providers both initiate CD discussions. Ventilatory and inotropic support is often withdrawn at time of CD with ensuing death.