Journal of pain and symptom management
-
J Pain Symptom Manage · Sep 2023
Real world experience of change in psycho-existential symptoms in palliative care.
Psycho-existential symptoms in palliative care are addressed insufficiently. Routine screening, ongoing monitoring and meaningful treatment of psycho-existential symptoms may contribute to the relief of suffering in palliative care. ⋯ As we better recognize through screening patients carrying psycho-existential distress in palliative care programs, there is considerable room for improvement in ameliorating this suffering. Inadequate clinical skills, poor psychosocial staffing or a biomedical program culture may all contribute to inadequate symptom control. Person-centered care necessitates greater attention to authentic multidisciplinary care that ameliorates psycho-spiritual and existential distress.
-
J Pain Symptom Manage · Sep 2023
Integration of Palliative Care in Hematopoietic Cell Transplant: Pediatric Patient and Parent Needs and Attitudes.
Early integration of palliative care (PC) in hematopoietic cell transplantation (HCT) has demonstrated benefits, yet barriers remain, including perceived lack of patient/caregiver receptivity despite no data on attitudes toward PC and limited patient/caregiver reported outcomes in pediatric HCT. ⋯ Our findings suggest that patient/family receptivity should not be a barrier to early PC in pediatric HCT; obtaining patient reported outcomes is a priority in the setting of high symptom burden; and robust quality-of-life directed care with early PC integration is both indicated and acceptable to patients/caregivers.
-
J Pain Symptom Manage · Sep 2023
Should the surprise question be used as a prognostic tool for people with life-limiting illnesses?
The surprise question screening tool ("Would I be surprised if this person died within the next 12 months?") was initially developed to identify possible palliative care needs. One controversial topic regarding the surprise question is whether it should be used as a prognostic tool (predicting survival) for patients with life-limiting illnesses. In this "Controversies in Palliative Care" article, three groups of expert clinicians independently answered this question. ⋯ The experts all highlighted that the original rationale for the surprise question was to trigger a further conversation about future treatment and a potential shift in the focus of the care, identifying patients who many benefit from specialist palliative care or advance care planning; however, many clinicians find this discussion a difficult one to initiate. The experts agreed that the benefit of the surprise question comes from its simplicity: a one-question tool that requires no specific information about the patient's condition. More research is needed to better support the application of this tool in routine practice, particularly in noncancer populations.
-
J Pain Symptom Manage · Sep 2023
Increasing Trend and Effects of Pediatric Palliative Care on Children with Non-Cancer Diagnoses.
Pediatric palliative care (PPC), especially among noncancer pediatric patients, faces challenges including late referral, limited patient care, and insufficient data for Asian patients. ⋯ High disparities exist between children receiving PPC in cancer versus noncancer patients. The concept of PPC is gradually becoming accepted in noncancer children and is associated with more pain-relief medication and less suffering during end-of-life care.
-
J Pain Symptom Manage · Sep 2023
Retrospective Review of Follow-up Strategies for Patients Receiving Palliative Radiotherapy.
There is no current standard-of-care follow-up strategy for patients who receive palliative radiotherapy (PRT) for bone metastases. Within our institution there is currently a heterogenous practice in which some providers schedule routine follow up 1-3 months after initial PRT while others do follow up only as needed (PRN). ⋯ Having a planned follow-up appointment after the initial course of PRT improves identification of patients who would benefit from additional treatment, thus improving patient experience and quality of care.