Journal of pain and symptom management
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J Pain Symptom Manage · Sep 2023
ReviewEvidence guiding withdrawal of mechanical ventilation at the end of life: a review: Running Title: Withdrawal of Mechanical Ventilation.
Distress at the end of life in the intensive care unit (ICU) is common. We reviewed the evidence guiding symptom assessment, withdrawal of mechanical ventilation (WMV) process, support for the ICU team, and symptom management among adults, and specifically older adults, at end of life in the ICU. ⋯ High quality studies support some practices in palliative WMV, while gaps in evidence remain for the WMV process, supporting the ICU team, and medical management of distress. Future studies should rigorously compare WMV processes and symptom management to reduce distress at end of life.
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J Pain Symptom Manage · Sep 2023
Observational StudyPEDIATRIC PALLIATIVE CARE AT HOME: A PROSPECTIVE STUDY ON SUBCUTANEOUS DRUG ADMINISTRATION.
The subcutaneous route is a useful alternative for drug administration in palliative care. Although there is scientific evidence on its use in adult patients, the literature in pediatric palliative care is almost nonexistent. ⋯ In the pediatric palliative care patients studied, the subcutaneous route is most frequently used for administering morphine and midazolam in continuous infusion. The main complication was induration, especially with longer dwell times or higher infusion rates. However, further studies are required to optimize management and prevent complications.
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J Pain Symptom Manage · Sep 2023
Integrated hospital- and home-based palliative care for cancer patients in Vietnam: People-centered outcomes.
Hospital-based palliative care (PC) linked to palliative home care is rarely accessible in low- and middle-income countries (LMICs). ⋯ Integration of hospital- and home-based PC for cancer patients is feasible and improves people-centered outcomes at low cost in Vietnam. These data suggest that benefits to patients, their families, and the health care system can accrue from integration of PC at all levels in Vietnam and other LMICs.
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J Pain Symptom Manage · Sep 2023
Awareness and actual knowledge of palliative care among older people: a Dutch national survey.
Lack of public knowledge of palliative care may be a barrier to timely use of palliative care and hinder engagement in advance care planning (ACP). Little research has been conducted on (the relationship between) awareness and actual knowledge of palliative care. ⋯ Knowledge of palliative care is limited, stressing the need for population-wide interventions, including information meetings. Attention should be paid to timely attention for palliative care needs. This might stimulate ACP and raise public knowledge of (im) possibilities of palliative care.
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J Pain Symptom Manage · Sep 2023
A Worksheet to Facilitate Discussions of Values for Patients with Metastatic Cancer: a Pilot Study.
Individual goals and values should drive medical decision making for patients with serious illness. Unfortunately, clinicians' existing strategies to encourage reflection and communication regarding patients' personal values are generally time-consuming and limited in scope. ⋯ The Values Worksheet was a feasible way to facilitate at-home discussions of goals and values for select patients with metastatic cancer. Further research should focus on identifying which patients are most likely to benefit from the Values Worksheet, and should employ the Worksheet as one tool to facilitate reflection on the questions that arise around serious illness, as an adjunct to serious illness conversations with a physician.