Journal of pain and symptom management
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J Pain Symptom Manage · Sep 2022
Observational StudyPolypharmacy in children and young people with life-limiting conditions from 2000-2015: a repeated cross-sectional study in England.
Polypharmacy is often appropriate for children with life-limiting conditions but is associated with an increase in hospitalizations and inappropriate prescribing, and can affect the quality of life of children and their families as they manage complex medication schedules. Despite this, little is known about polypharmacy in this population. ⋯ Children with life-limiting conditions have a high prevalence of polypharmacy and some children are at greater risk than others. More research is needed to understand and address the factors that lead to problematic polypharmacy in this population.
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J Pain Symptom Manage · Sep 2022
Observational StudyQuality of life in adolescents and young adults: the role of symptom burden.
Adolescents and young adults (AYAs) with cancer report worse health-related quality of life (HRQOL) than other age groups. Symptom burden is a modifiable predictor of HRQOL. ⋯ The symptom experience among AYAs with advanced cancer is unique. Separate evaluation of AYA's symptoms may optimize management and improve HRQOL.
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J Pain Symptom Manage · Sep 2022
Provider Perceptions for Withdrawing Life Sustaining Therapies at a Large Pediatric Hospital.
More than 74% of pediatric deaths occur in an intensive care unit (ICU), with 40% occurring after withdrawal of life-sustaining therapies (WOLST). No needs assessment has described provider needs or suggestions for improving the WOLST process in pediatrics. ⋯ While participants' self-rated confidence was high, it varied between disciplines. Participants identified opportunities for improved communication and planning before a WOLST. Future work includes development and implementation of a best practice guideline to address gaps and standardize care delivery.
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J Pain Symptom Manage · Sep 2022
Observational StudyAre opioid infusions used inappropriately at end of life? Results from a quality/safety project.
Opioid continuous infusions are commonly used for end-of-life (EOL) symptoms in hospital settings. However, prescribing practices vary, and even the recent literature contains conflicting protocols and guidelines for best practice. ⋯ Potentially inappropriate opioid infusions are prevalent at our hospital, an academic medical center with an active PC team and existing contracts for in-hospital hospice care. Furthermore, potentially inappropriate opioid infusions are associated with increased patient and staff distress. We are developing an interdisciplinary intervention to address this safety issue.
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J Pain Symptom Manage · Sep 2022
Randomized Controlled Trial Multicenter StudyHeterogeneity of treatment effect in a randomized trial of a communication intervention.
Interventions to promote serious illness conversations have shown promise in promoting high-quality care. However, in randomized trials, some participants may benefit more from the intervention than others. ⋯ Identifying heterogeneity of treatment effect can be a valuable exercise following completion of a randomized trial. Interactions between the intervention and patient income and self-assessed health suggest these factors could be used to design more effective interventions to enhance communication about goals of care.