The American journal of hospice & palliative care
-
Am J Hosp Palliat Care · Feb 2011
ReviewReview article: terminal delirium in geriatric patients with cancer at end of life.
Terminal delirium is a common symptom that is frequently underdiagnosed in geriatric patients with cancer at end of life and is a major cause of distress for the patient as well as their family. This article explores the hyperactive and hypoactive delirium subtypes as well as the pathophysiology of terminal delirium and the theory of acetylcholine deficiency and dopamine excess. ⋯ The use of the Confusion Assessment Method (CAM) is discussed as a means of delirium diagnosis and the Memorial Delirium Assessment scale (MDAS) is presented as a tool to measure its severity. Lastly, nonpharmacologic and pharmacologic treatment measures are reviewed and an algorithm is presented to assist the clinician in the identification and management of terminal delirium.
-
to evaluate satisfaction with inpatient hospice goals at the end of life and to determine steps for program improvement. ⋯ clarification and focus on goals of care improves satisfaction with end-of-life care.
-
Am J Hosp Palliat Care · Feb 2011
End-of-life experiences: reaching out for compassion, communication, and connection-meaning of deathbed visions and coincidences.
A recent study shows that the greatest fear for many Britons is to die alone. More than half the complaints received by the UK National Health Service (NHS) concern end-of-life care, with an emphasis on spiritual matters. ⋯ They lack the confidence and/or training to recognize or discuss spiritual aspects of death and dying or to affirm the spiritual needs of the dying person. Our end-of-life experience (ELE) research suggests that deathbed visions (DVs) and deathbed coincidences (DCs) are not uncommon, and that the dying process appears to involve an instinctive need for spiritual connection and meaning, requiring compassionate understanding and respect from those who provide end-of-life care.
-
Am J Hosp Palliat Care · Feb 2011
Prevalence of opioid-related dysuria in patients with advanced cancer having pain.
The aim of this study was to assess the prevalence of opioid-induced dysuria in patients with advanced cancer having pain and to evaluate the possible factors associated. A consecutive sample of cancer patients admitted to an acute pain relief and palliative care unit during 8 months was surveyed. Most patients (147, 86.5%) were receiving opioids at admission. ⋯ Opioid switching during admission was correlated to the occurrence of dysuria. Patients with chronic cancer pain receiving opioid therapy present a prevalence of bladder dysfunction of about 15%, which is influenced by several concomitant factors. Given the complex clinical picture of advanced cancer patients, further studies should be performed to explore the presence of dysuria in patients with no pain and not receiving opioids to know the real weight of opioid therapy with respect to other variables.
-
Am J Hosp Palliat Care · Dec 2010
Clinical TrialTreatment of cancer-related chest wall pain using spinal cord stimulation.
it has been estimated that 15% to 40% of chronic cancer pain has a neuropathic component, and this type of pain often responds poorly to opioids. In an attempt to provide increased pain relief for patients with intractable cancer pain, unconventional agents and interventional management approaches have received considerable attention. Spinal cord stimulation (SCS) has been used with increased frequency for the treatment of intractable cancer pain. ⋯ SCS provides an effective, alternative treatment option for select patients with cancer-related chest wall pain who have failed conservative treatment. SCS may provide pain relief with advantages over conservative treatments and more invasive techniques.