Journal of palliative medicine
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Randomized Controlled Trial
Assessing palliative care unit inpatients for residential aged care placement: is it worth it?
Increasing demand for palliative care unit (PCU) admissions has led to a stronger focus on discharge planning. This has resulted in shorter inpatient length of stays (LOS), and stable patients not requiring specialist palliative care services being referred for placement in residential aged care facilities (RACFs). The process of placement is time-consuming and can be distressing to patients and families, so RACF placement should only be proposed in patients whose prognosis is relatively good (i.e., weeks to months). ⋯ Over one-third of all patients died before discharge to an RACF could take place. The rate of death before discharge was higher among patients who had cancer. Patients suffering from NCSLC need to be more carefully selected for placement as only one-third of these patients survived to discharge.
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Palliative medicine providers are often consulted to provide guidance for pain relief for a diverse population. End-of-life care is often challenging, balancing optimum pain relief with minimal side effects. Patients with both renal and hepatic dysfunction are particularly challenging when considering appropriate treatments. ⋯ This case discussion highlights an end-of-life pain symptom management challenge, and the associated pharmacological background. Ultimately, with no ideal pharmaceutical option, individualization of therapy will be crucial. Collaboration of palliative medicine providers and pharmacists may concurrently provide the best possible care at the best possible time and in the optimal location.
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Major depressive disorder (MDD) is a common and debilitating illness in patients with cancer. However, the optimal treatment of depression in these patients remains uncertain, with limited evidence to support the use of pharmacologic therapy. We conducted a pilot study to evaluate the feasibility of an antidepressant clinical trial in the oncology population and the process of symptom-oriented selection of antidepressants (citalopram or mirtazapine) in patients with cancer and MDD. ⋯ Conducting antidepressant clinical trials is challenging in the oncology population. We approached but did not meet our feasibility goals. Depression and quality of life (QOL) scores improved with both mirtazapine and citalopram, but evidence-based pharmacologic treatments for depression in cancer patients are needed.
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Communication with patients and families is an essential component of high-quality care in serious illness. Small-group skills training can result in new communication behaviors, but past studies have used facilitators with extensive experience, raising concerns this is not scalable. ⋯ A communication skills intervention using newly trained facilitators was associated with improvement in trainees' skills in giving bad news and expressing empathy. Improvement in communication skills did not vary by trainee characteristics.