Journal of pain and symptom management
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J Pain Symptom Manage · Dec 2020
Randomized Controlled TrialThe Feasibility and Acceptability of a Cognitive Behavioral Therapy-based intervention for Patients with Advanced Colorectal Cancer.
Advanced colorectal cancer and its treatment can bring about challenges associated with psychological distress. ⋯ The CBT-based intervention was feasible and acceptable to patients in Singapore. There is no sufficient evidence to warrant a larger trial in this sample with low baseline distress. Future work should identify and target those who are most in need of support.
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J Pain Symptom Manage · Dec 2020
Using Grounded Theory to Inform the Human-Centered Design of Digital Health in Geriatric Palliative Care.
Digital health offers innovative mechanisms to engage in palliative care, yet digital systems are typically designed for individual users, rather than integrating the patient's caregiving "social convoy" (i.e., family members, friends, neighbors, formal caregiving supports) to maximize benefit. As older adults with serious illness increasingly rely on the support of others, there is a need to foster effective integration of the social convoy in digitally supported palliative care. ⋯ Digital health provides an opportunity to expand the reach of geriatric palliative care interventions. This paper documents human-centered preferences of geriatric palliative care digital health to ensure technologies are relevant and meaningful to health care providers, patients, and the caregiving social convoy.
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J Pain Symptom Manage · Dec 2020
Grief Before and During the COVID-19 Pandemic: Multiple Group Comparisons.
Grief researchers are concerned that the coronavirus disease 2019 (COVID-19) pandemic will precipitate increases in severe, persistent, and disabling grief, termed prolonged grief disorder or persistent complex bereavement disorder. We recently demonstrated that higher grief levels are experienced after COVID-19-related bereavement than natural bereavement. Death circumstances during the pandemic (e.g., reduced social support, limited opportunities for death rituals) may also hamper the grief process for non-COVID-19-related bereavement, yet no quantitative research has specifically addressed this issue. ⋯ Among all bereaved persons, grief severity was no different during the pandemic compared with before the pandemic. However, experiencing a recent loss during the pandemic elicited more severe acute grief reactions than before the pandemic, suggesting that dealing with loss may be more difficult during this ongoing health crisis.
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J Pain Symptom Manage · Dec 2020
Case ReportsCan Orthodox Jewish Patients Undergo Palliative Extubation? A Challenging Ethics Case Study.
According to Jewish law/ethics, continuous life-sustaining therapy may not be withdrawn after its introduction, unless the patient has improved and no longer has a medical indication for the treatment. We report the case of an 88-year-old Orthodox Jewish patient, on invasive mechanical ventilation, with severe anoxic brain injury after multiple cardiac arrests. Although the patient's son informed the palliative care team that his father did not want to be in pain or to linger in a vegetative state when terminally ill, the mechanical ventilation was keeping him alive with a poor neurological prognosis. ⋯ Following intermediation by the hospital Rabbi, the definition of what would be a "reasonable expectation" and "reasonable amount of time" was established by the family Rabbi as "over 50%" and "on the order of hours," respectively. Following pulmonary consultation, the patient underwent palliative extubation and, 12 hours after the procedure, died comfortably surrounded by the family. In conclusion, the collaborative and interdisciplinary work among the family Rabbi, hospital Rabbi, and the various medical teams allowed the development of a plan that met all of the patient's personal and religious wishes and beliefs.
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J Pain Symptom Manage · Dec 2020
Observational StudyHow COVID-19 Changed Advance Care Planning: Insights from the West Virginia Center for End-of-Life Care.
Coronavirus disease 2019 (COVID-19) led to increased attention nationally on advance care planning. ⋯ COVID-19 resulted in a new sense of urgency regarding advance care planning by West Virginians with increased attention to document their wishes and ensure that they were in the registry.