The American journal of hospice & palliative care
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Am J Hosp Palliat Care · Jan 2004
Case ReportsAcute pain in advanced cancer: an opioid dosing strategy and illustration.
Opioid dosing strategies for acute pain differ from strategies for chronic pain management. The basic principles of effective, safe dosing are rapid titration to the onset of analgesia followed by maintenance infusions based upon the titrated dose. This article presents guidelines and case histories for safe and effective dosing.
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We report a case of a patient with metastatic testicular cancer and intractable pain refractory to massive doses of oral, intravenous, and intrathecal (IT) opioids supported by analgesic adjuvants. During our efforts to control his pain, the patient exhibited opioid-induced hyperalgesia, an uncommon but important phenomenon seen with high-dose opioid therapy. With appropriate opioid adjustment--in this case reduction of intrathecal morphine dosage by a factor of 100--the condition rapidly resolved and the patient became pain-free and remained so until his death six weeks later. The keys to identifying this uncommon, but treatable, opioid side effect are recognizing it as a possibility when aggressive efforts to control pain with high doses of opioids, especially when administered neuraxially, are met with increasing pain.
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Little attention has been paid to documenting the quality and impact of hospice bereavement programs. While quality of life, quality of dying, and quality of end-of-life measures are common indicators of effective clinical service, they are not adequate gauges of quality from a bereavement perspective. ⋯ The purpose of this study was to evaluate whether hospice programs (n = 32) in the state of Ohio were meeting the NHPCO bereavement standards. Findings indicated that the participating hospice programs were 83 percent compliant at least some of the time.
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Am J Hosp Palliat Care · Sep 2003
Satisfaction of families using end-of-life care: current successes and challenges in the hospice industry.
This study examined the satisfaction of family members with the end-of-life care their loved ones received. Data were collected from 1,839 individuals receiving care from 17 different care agencies nationwide. ⋯ The timing of the referral was critical, with families rating services lower almost across the board when the referral to hospice was deemed "too late." Additionally, families expressed greater satisfaction when the patient's care was overseen by the hospice director, rather than a personal physician. Each of these findings has important implications for physicians, patients, and families as they begin to plan for end-of-life care.
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Am J Hosp Palliat Care · Sep 2003
An analysis of provider attitudes toward end-of-life decision-making.
The explosion of technological and biomedical interventions over the past half century appears to have enhanced the medical profession's ability to prolong life at a faster pace than society's ability to develop comprehensive bioethical laws governing end-of-life decisions. This study was conducted to determine if there was a correlation between educational and occupational backgrounds and participants' perceptions of end-of-life care. ⋯ Respondents were classified by type of education or background (technical, professional, or medical) and by level of involvement with patient care (direct or indirect). While the results showed a general consensus about the importance of respecting patients' end-of-life wishes, there were differences among respondents in regard to specific issues.