Journal of pain and symptom management
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J Pain Symptom Manage · Oct 2024
Outpatient Training During Hospice and Palliative Medicine Fellowship: A National Survey.
Outpatient palliative care (PC) has strong evidence demonstrating impact across serious illnesses, resulting in growing demand for skilled outpatient PC clinicians. However, there is limited literature examining the existing state and quality of outpatient PC education during postgraduate training. ⋯ Our survey of US HPM fellowships identified multiple gaps between outpatient and inpatient PC education and training during fellowship and raises concern about the adequacy of outpatient PC training. To prepare the HPM workforce to meet the diverse needs of seriously ill populations and ensure adequate access, outpatient PC training requires reform.
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J Pain Symptom Manage · Oct 2024
Opioid Access among Advanced Cancer Patients in Low- and Middle-Income Countries in Asia.
Most cancer-associated pain is experienced in low- and middle-income countries (LMICs) due to inequitable access to opioids. ⋯ Study findings emphasize the importance of palliative care training-even a minimal amount-in supporting access to opioids for advanced cancer patients. This study also highlights pragmatic site-level policies, such as extended morphine prescription durations, enabling access.
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J Pain Symptom Manage · Oct 2024
Exploring Pediatric Code Status, Advance Care Planning, and Mode of Death Disparities at End of Life.
Children from marginalized groups are at risk for worse medical outcomes, yet little is known about their end of life experiences. ⋯ Palliative care services are engaged with most children at end of life and is accessible to marginalized patient groups. Spanish-speaking patients have different code status orders and modes of death at end of life. Further studies are needed to elucidate explanatory factors for differences revealed and multicenter studies are needed to characterize more widespread experiences.
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J Pain Symptom Manage · Oct 2024
Frequency of Comfort Care and Palliative Care Consultation after ST-elevation Myocardial Infarction.
ST-elevation myocardial infarction (STEMI) remains a leading cause of death despite advances in revascularization and post-STEMI care. Especially for patients with a poor prognosis, there is increasing emphasis on comfort-focused care. ⋯ Transition to comfort-focused care before death after STEMI is common, particularly in those with cardiogenic shock and/or treated with MCS, highlighting the critical status of such patients. Although increasingly employed in recent years, palliative care consults remain rare and are often employed late in the hospitalization.
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J Pain Symptom Manage · Oct 2024
The Spiritual Dimension of Parents' Experiences Caring for a Seriously Ill Child: An Interview Study.
Parents of children with life-threatening conditions may have to balance their personal, family, and professional lives in the anticipation of child loss and the demands of providing medical care for their child. The challenges these parents are confronted with may lead to specific care needs. In this paper we explore the spiritual dimension of caring for a child with a life-threatening condition from the parents perspective. ⋯ The spiritual dimension plays a central role in the experiences of parents who care for children with life-threatening conditions, but they receive little support in this dimension, and care needs often go unnoticed. If we want to provide high-quality pediatric palliative care including adequate spiritual support for parents, we should focus on the wide range of their spiritual experiences, and provide support that focuses both on loss of meaning as well as on where parents find growth, joy or meaning.