Journal of pain and symptom management
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J Pain Symptom Manage · Oct 2022
Multicenter Study Observational StudyAre Prognostic Scores Better than Clinician Judgment? A Prospective Study using Three Models.
Several prognostic models such as the Palliative Performance Scale (PPS), Palliative Prognostic Index (PPI), Palliative Prognostic Score (PaP) have been developed to complement clinician's prediction of survival (CPS). However, few studies with large scales have been conducted to show which prognostic tool had better performance than CPS in patients with weeks of survival. ⋯ The PPS, PPI, PaP, and CPS had relatively good performance in patients admitted to PCUs with weeks of survival. CPS and PaP had significantly better performance than the PPS and PPI. CPS may be sufficient for experienced clinicians while PPS may help to improve prognostic confidence for inexperienced clinicians.
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J Pain Symptom Manage · Sep 2022
Randomized Controlled Trial Multicenter StudyHeterogeneity of treatment effect in a randomized trial of a communication intervention.
Interventions to promote serious illness conversations have shown promise in promoting high-quality care. However, in randomized trials, some participants may benefit more from the intervention than others. ⋯ Identifying heterogeneity of treatment effect can be a valuable exercise following completion of a randomized trial. Interactions between the intervention and patient income and self-assessed health suggest these factors could be used to design more effective interventions to enhance communication about goals of care.
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J Pain Symptom Manage · Sep 2022
Multicenter StudyA Multi-Centre COVID-19 Study Examining Symptoms and Medication Use in the Final Week of Life.
Guidelines exist to direct end-of-life symptom management in COVID-19 patients. However, the real-world symptom patterns, and degree of concordance with guidelines on medication use, and palliative care involvement has received limited attention. ⋯ Symptoms peaked in final three days of life. Earlier use of in fusional and breakthrough medications should be considered in anticipation of symptoms given high likelihood of dying in discomfort. Earlier palliative care referral for high-risk patients should be considered at hospital admission.
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J Pain Symptom Manage · Jul 2022
Multicenter Study Observational StudyAssociation of antipsychotic dose with survival of advanced cancer patients with delirium.
Delirium is common in patients with advanced cancer, and antipsychotics are widely used for its management. ⋯ Higher doses of antipsychotics were associated with increased mortality in terminally ill cancer patients with delirium. To minimize the potential mortality risk, antipsychotics should be started at low doses and titrated carefully.
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J Pain Symptom Manage · May 2022
Multicenter StudyPalliative and End-of-Life Care After Severe Stroke.
The distinct illness trajectory after acute ischemic stroke demands a better understanding of the utilization of palliative care consultations (PCC) for this patient cohort. This study sought to determine the prevalence, predictors, and outcomes associated with PCC for patients hospitalized with severe ischemic stroke. ⋯ Most patients with severe stroke do not receive PCC, even among those who experience in-hospital death. The results of this study indicate there are missed opportunities for PCC to help reduce suffering after severe stroke.