Journal of pain and symptom management
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The will to live (WTL) is an important factor to consider in the context of providing resource-oriented palliative care. Until now, there has been no major review of the existing research on this subject. ⋯ A considerable yet unconnected body of studies assesses the WTL. Its assessment in clinical routine could promote resource-oriented and patient-centered care.
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J Pain Symptom Manage · Apr 2021
The association between hospital end-of-life care quality and the care received among patients with heart failure.
Improving end-of-life care (EOLC) quality among heart failure patients is imperative. Data are limited as to the hospital processes of care that facilitate this goal. ⋯ Patients with heart failure who die in VA hospitals with higher overall EOLC quality receive more supportive EOLC. Research is needed that integrates care processes and develops scalable best practices in EOLC across health care systems.
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J Pain Symptom Manage · Apr 2021
Clinical TrialRelationships between advanced cancer patients' worry about dying and illness understanding, treatment preferences, and advance care planning.
Patients with advanced cancer often worry about dying. Less is known about the role of worry in decision making regarding future care. ⋯ Patients with advanced cancer who worry about dying are more likely to identify as terminally ill and desire life-extending treatment and are less likely to engage in ACP. Understanding how patients cope with worry and make medical decisions is important in providing quality care to these patients.
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J Pain Symptom Manage · Apr 2021
Mortality Risk for Patients with Stage IV Cancer and Acute Illness Hospitalization.
Cancer prognosis data often come from clinical trials which exclude patients with acute illness. ⋯ Acute illness hospitalization is a sentinel event in Stage IV cancer. Short-term mortality is high; nutritional decline increases risk. For patients with Stage IV cancer, acute illness hospitalization should trigger goals of care discussions.
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J Pain Symptom Manage · Apr 2021
"Has Anything Changed Since Then?": A framework to incorporate prior GOC conversations into decision making for acutely ill patients.
When assuming care for a seriously ill hospitalized patient, we should find documentation of previous decisions about goals of care so that our conversation takes advantage of previous discussions and reduces decision-making burden on the patient, particularly when the patient is clinically declining and time is short. This article presents a framework to help clinicians incorporate prior goals of care conversations into decision-making for an acutely ill patient. ⋯ If there is conflict or uncertainty about the patient's preferences, clinicians should engage in a more comprehensive goals-of-care conversation, which involves exploring the patient's understanding of their illness, patient values, and reasonable treatment options, before offering a plan. By giving the patient the ability to opt out of a previous decision they made about goals of care, rather than another choice, we make it more likely that they will receive care consistent with their known wishes.