Journal of pain and symptom management
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J Pain Symptom Manage · Apr 2022
Normalization of Symptoms in Advanced Child Cancer: The PediQUEST-Response Case Study.
Children, adolescents and young adults with cancer continue to experience significant symptom suffering throughout their illness. ⋯ Normalization of symptoms is a pervasive barrier enacted by all involved in caring for children with advanced cancer. Strategies to overcome normalization are critical to ease child distress.
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J Pain Symptom Manage · Apr 2022
Differing conceptualizations of the goals of care discussion: A critical discourse analysis.
The goals of care discussion (GOCD) has been positioned as an improvement strategy to address discordance between care decisions made by seriously ill patients and care received. Interventions aimed at improving GOCDs however have had limited success. This may in part be due to the considerable variation in views on the essential components and expected outcomes of a GOCD. This variability, and consequently clinical approaches to GOCDs, may reflect fundamental differences in how the GOCD is conceptualized. ⋯ These findings offer clinical evidence for differing conceptualizations of the GOCD and orientations to goals as either person-centered or treatment-centered. This phenomenon may be in part discipline-based and has important implications for both clinical practice and training experiences.
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J Pain Symptom Manage · Apr 2022
ReviewIdentifying core domains to assess the 'quality of death':A scoping review.
There is growing recognition of the value to patients, families, society, and health systems in providing healthcare, including end-of-life care, that is consistent with both patient preferences and clinical guidelines. ⋯ The review affirms the need for a people-centered approach to managing the delicate process and period of accepting and preparing for the end of life. The identified structural and experiential factors pertinent to the "quality of death" will prove invaluable for future efforts aimed to quantify health system performance in the end-of-life period.
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J Pain Symptom Manage · Apr 2022
Multicenter StudyChallenges and strategies regarding sedation at the end of life in hospitals and nursing homes.
Sedation is an accepted, but controversially discussed and challenging measure to treat suffering at the end of life. Although most people die in hospitals or nursing homes, little is known how professionals in these settings deal with sedatives and sedation at the end of life. ⋯ To meet the identified challenges in a sustainable way and enable continuous improvement of quality of care, best practice recommendations, and other supportive measures have to address all identified levels of challenges.
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J Pain Symptom Manage · Apr 2022
Patients with acute respiratory failure at risk for high-intensity, costly care.
Patients with underlying chronic illness requiring mechanical ventilation for acute respiratory failure are at risk for poor outcomes and high costs. ⋯ Among patients with underlying chronic illness and acute respiratory failure, we identified characteristics associated with the highest costs of care. Identifying these patients may be of interest to healthcare systems and hospitals and serve as one indication to invest resources in palliative and supportive care programs that ensure this care is consistent with patients' goals.