Journal of pain and symptom management
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J Pain Symptom Manage · Jan 2024
ReviewEthical and practical considerations of perimortem gamete procurement for palliative care providers.
Requests for perimortem gamete procurement (PGP) typically arise by a surrogate decision maker after the unexpected death or incapacitation of a reproductive-aged individual. Palliative care clinicians should have a working knowledge of the medical, ethical, and practical considerations pertaining to such requests. ⋯ We review the technologies associated with PGP and posthumous assisted reproduction (PAR) and discuss the ethical and legal issues involved in such cases, including recent position statements from national and international reproductive health groups. Finally, we provider readers with a stepwise approach for considering requests for PGP.
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J Pain Symptom Manage · Jan 2024
ReviewMultilevel Determinants of Palliative Care Referral in Women with Advanced Ovarian Cancer: A Scoping Review.
Receipt of palliative care (PC) has long been suggested in practice for patients with advanced cancer for improved quality of life, mood, and prolonged survival. However, PC referrals in women with ovarian cancer remain suboptimal. ⋯ Various factors in the socioecological framework suggest that the decision for PC referral could be multifactorial and influenced by factors beyond the medical condition and status. Future research should aim to understand the impact of various socioecological factors on PC referral and examine PC referral experiences from the patient's perspective.
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J Pain Symptom Manage · Jan 2024
Comparative StudyComparison of the effects of OPRM1 A118G polymorphism using different opioids: A prospective study.
μ-opioid receptor gene (OPRM1) A118G polymorphism (rs1799971) causes loss of N-glycosylation sites at the extracellular domain of μ-opioid receptors. G-allele carriers show a limited response to morphine; however, studies investigating the impact of A118G polymorphism on the efficacy of opioids other than morphine are limited. ⋯ Tapentadol and methadone may be more suitable than hydromorphone, oxycodone, and fentanyl for G-allele carriers due to their dual mechanism of action and low susceptibility to OPRM1 A118G polymorphism.
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J Pain Symptom Manage · Jan 2024
The "Surprise Question" for Prognostication in People with Parkinson's Disease & Related Disorders.
Parkinson's disease and related disorders (PDRD) are fatal neurodegenerative disorders characterized by a fluctuating course that can complicate prognostication. The "surprise question" (SQ: "Would you be surprised if your patient died in the next year?") has been used to identify patients with limited prognosis but has not been assessed in PDRD. ⋯ The SQ is sensitive to 12-month mortality in PDRD, with a high negative predictive value. The SQ may be useful for identifying patients less likely to die within a year and may be useful for identifying patients with palliative care needs outside of end-of-life care. This latter use may assist in mobilizing early and timely referral to specialist palliative care.
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J Pain Symptom Manage · Jan 2024
We Care: A Wellness Intervention Project for Palliative Care Physicians.
There is a trend toward burnout in palliative care physicians. Due to this, a five-session curriculum has been designed with resiliency tools, coping skills, and spirituality in order to train palliative care fellows in an inpatient setting. More research is needed on this curriculum, but preliminary findings have shown a positive response.