Journal of pain and symptom management
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J Pain Symptom Manage · Feb 2025
Sights and Sounds of Respiratory Changes During Hospice Death Vigils: Hospice Caregivers Experience.
Research has documented common respiratory changes at the end of life for hospice patients. Some studies have noted these symptoms as distressing and challenging for families, and as a potential reason for emergency room visits and hospice benefit revocation. However, the experiences and emotions of family members regarding these respiratory changes in the final days, particularly when they are alone in a home setting, are not well documented. A recent study found 51% caregivers identified abnormal breathing as a challenge during their vigil experience. ⋯ Opportunities exist for hospice agencies to better address the caregiver distress caused by witnessing noisy breathing (death rattle), Cheyne-Stokes breathing, and agonal breathing. Further research is needed to identify standard definitions for these respiratory changes, their prevalence in the home hospice setting, and to develop practice standards and effective interventions to relieve caregiver distress.
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J Pain Symptom Manage · Feb 2025
Barriers to Serious Illness Conversations Among Patients with Advanced Cancer: A Qualitative Study.
Serious illness conversations (SICs) are discussions between clinicians and cancer patients about illness understanding, information preferences, and goals of care. Interventions to prompt SICs increase SIC rates and improve care delivery near the end of life. This embedded substudy examined SIC barriers and facilitators among "refractory" patients without an SIC despite enrollment in an SIC clinical trial. ⋯ Patient readiness remains an important barrier even after targeted SIC interventions. Future SIC interventions should consider approaches tailored to patient communication preferences and interventions involving personal interactions.