Journal of pain and symptom management
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J Pain Symptom Manage · Nov 2024
Impact of a criteria-based inpatient Palliative Oncology consultation model on end-of-life outcomes.
Early, integrated palliative care (PC) improves outcomes in advanced cancer; however, inpatient PC referrals still exceed outpatient referrals nationwide. Recognizing need for enhanced integration, our cancer center implemented a criteria-based PC consultation model in inpatient oncology. ⋯ Embedded, criteria-based PC consultation in inpatient oncology was associated with earlier PC involvement, longer hospice LOS, and reduced EOL care intensity.
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J Pain Symptom Manage · Nov 2024
ReviewSymptoms of Hematologic Tumors Patients after CAR-T Therapy: a Systematic Review and Meta-Analysis.
Patients with hematologic neoplasms after Chimeric antigen receptor T-cell (CAR-T) therapy have multiple syndromes, with corresponding symptoms. ⋯ Patients with hematologic neoplasms treated by CAR-T suffer from multiple symptoms, including depression, fatigue, and so on. Instruments used to evaluate symptoms and the evaluating time may influence the outcome of symptom assessment.
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J Pain Symptom Manage · Nov 2024
"Mr. Smith Has No Mealtimes": Minimal Comfort Feeding for Patients with Advanced Dementia.
While Comfort Feeding Only is appropriate for patients with advanced dementia, its emphasis on assiduous hand-feeding that may prolong life for years fails to accommodate the preferences of those who do not want to continue living with this illness. Some have proposed advance directives to completely halt the provision of oral nutrition and hydration once a person has reached an advanced stage of dementia. ⋯ Rather than offering food and liquids proactively as with Comfort Feeding Only, caregivers provide nutrition and hydration only in response to signs of hunger and thirst. While further study is required to define and negotiate challenges in operationalizing this approach, MCF provides a framework that resolves competing ethical and clinical considerations in caring for those with advanced dementia.
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J Pain Symptom Manage · Nov 2024
Pediatric Palliative Care Simulation Improves Resident Learning Outcomes: an 11-Year Review.
Many general pediatrics residents lack sufficient opportunities to conduct difficult conversations with families, particularly about end-of-life care. Simulation learning is an effective means of practicing professional skills. A pediatric palliative care (PPC) physician is uniquely suited to mentor residents and fellows learning to lead difficult conversations through simulation. Co-facilitation of the simulated difficult conversation by a bereaved parent or family member enhances the learning experience. ⋯ Simulations with bereaved parent actors improved general pediatrics residents' performance and comfort during difficult conversations and are transportable to diverse settings.
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J Pain Symptom Manage · Nov 2024
Genomic Study in Opioid-Treated Cancer Patients Identifies Variants Associated With Nausea-Vomiting.
Opioids are the mainstay therapy for patients affected by cancer pain. However, about 10%-20% of patients do not benefit from the received analgesic treatment or experience side effects. Genetic variability might account for the variation in individual responses to opioids, both in terms of efficacy and toxicity. ⋯ This is the first GWAS, performed in more than two thousand individually genotyped patients treated with opioids for cancer pain, that investigated the genetic bases of opioid-induced nausea-vomiting. Although further studies are needed to confirm our findings and to characterize the functional role of the identified variants, our results emphasize the importance of performing large pharmacogenomic studies to identify germline variants associated with opioid response, with the ultimate goal of tailoring cancer pain therapies.