Journal of pain and symptom management
-
J Pain Symptom Manage · Feb 2022
Trends in palliative care consultations in critically ill patient populations, 2013-2019.
Critically ill patients have important palliative care (PC) needs in the intensive care unit (ICU), but specialty PC is often underutilized. ⋯ PC referrals in ICU patients with cancer are decreasing, while those for cardiovascular disease are increasing. Reasons for referrals in the ICU are commonly for goals of care; other reasons, like pain control are uncommon. Early goals of care conversations and further training in advance care planning should be emphasized in the ICU setting.
-
J Pain Symptom Manage · Feb 2022
Observational StudySuccess of a community-based delivery at recruiting individuals from underserved communities for an observational cohort study of an advance care planning intervention.
Underserved and minority populations are often reluctant to engage in advance care planning and/or research often due to distrust in healthcare and/or research institutions. ⋯ Use of the community-based delivery model successfully engaged undeserved communities in a research-based advance care planning related community outreach event. This model may be useful for overcoming underserved and minority populations' skepticism and distrust of healthcare and research that is a common barrier to progress in health agendas, especially advance care planning.
-
J Pain Symptom Manage · Feb 2022
Evaluating treatment tolerability using the toxicity index with patient-reported outcomes data.
Summarizing longitudinal symptomatic adverse events during clinical trials is necessary for understanding treatment tolerability. The Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) provides insight for capturing treatment tolerability within trials. Tolerability summary measures, such as the maximum score, are often used to communicate the potential negative symptoms both in the medical literature and directly to patients. Commonly, the proportions of present and severe symptomatic adverse events are used and reported between treatment arms among adverse event types. The toxicity index is also a summary measure previously applied to clinician-reported CTCAE data. ⋯ The toxicity index is a useful method when ranking patients from those with the least to most symptomatic adverse event burden. This study showed the toxicity index can be applied to PRO-CTCAE data. Though as a tolerability summary measure, further study is needed to provide a clear clinical or patient-facing interpretation of the toxicity index.
-
J Pain Symptom Manage · Feb 2022
The impact of aging on symptom prevalence and management in terminally ill patients with cancer.
With global population aging, the number of older patients with cancer is increasing. However, few data are available on palliative care for these patients. ⋯ We found age to be inversely related to symptom prevalence and medical interventions among terminally ill patients with cancer, contributing to the understanding of the experience of older patients with cancer.
-
J Pain Symptom Manage · Feb 2022
Advance Care Planning Documentation and Intensity of Care at the End of Life for Adults with Congestive Heart Failure, Chronic Kidney Disease, and Both Illnesses.
Heart failure (HF) and chronic kidney disease (CKD) are associated with high morbidity and mortality, especially in combination, yet little is known about the impact of these conditions together on end-of-life care. ⋯ Decedents with both HF and CKD had more ACP documentation and received more intensive end-of-life care than those with only 1 condition. These findings suggest that patients with co-existing HF and CKD may benefit from interventions to ensure care received aligns with their goals.