Journal of palliative medicine
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Background: The influence of pharmacogenomics on opioid response, particularly with COMT (rs4680) and OPRM1 (rs1799971) variants, has been studied individually and in combination. However, most studies are in a noncancer context and not all their possible variant combinations have been examined. Objectives: This study examined COMT (rs4680) and OPRM1 (rs1799971), and their allele combinations, in advanced cancer to examine associations with pain scores, opioid dose, and adverse effects. ⋯ Those with COMT AG/OPRM1 AA experienced higher average pain [aOR 1.55 (95% CI 1.03, 2.33), p = 0.04] and moderate-severe nausea [aOR 5.47 (95% CI 1.35, 22.21), p = 0.02] but reduced drowsiness [aOR 0.25 (95% CI 0.06, 1.02), p = 0.05]. Conclusions: Patients with cancer with the COMT alternate (A) allele have greater sickness response adverse effects, which may be responsible for the lower opioid doses observed. Significant results of two new COMT/OPRM1 genotype combinations are presented that have not previously been studied, with plausible phenotype descriptions suggested.
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Background: The majority of hospice patients are over the age of 65, and the majority of hospice deaths occur in private homes. As a hospice patient's disease progresses, death becomes imminent and family and friends gather around to say good-bye. These private vigils are the culmination of the hospice experience and reflect both the strengths and the challenges surrounding hospice care. ⋯ Co-coding of stories and validation of findings by hospice nurses and physicians assure the trustworthiness of the data. Results: Hospice staff share narratives related to family and caregiver burden, challenges with symptom management, frustrations with staffing shortages, and administrative burdens surrounding the experience of death vigils. Conclusions: The family and hospice clinician's experiences with the final act of dying at home are sometimes challenged by the intermittent nature of home care during the final days.
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Background: Clinical hypnosis appears to hold some promising effects for patients at end-of-life. Patients and health care professionals (HPs) are inclined to adopt the practice. Yet, the experience of hypnosis in this context remains under-researched. ⋯ Conclusions: The practice of hypnosis is very diverse and constrained by resources and limitations in institutional support. Patients and relatives identified that hypnosis had a positive impact to enable them to recognize and mobilize their personal resources toward greater self-empowerment. Our findings suggest that hypnosis might hold a real potential for patients and their relatives, thus warranting further study of its effects in palliative care.
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Therapeutic clinical relationships and skilled communication are foundational elements of high-quality hospice and palliative care. Both require that we draw on the most valuable, yet limited, resource in our practice: clinician time. ⋯ Equally, many skilled interventions, including serious illness communication, can occur during time-efficient encounters, which still preserve compassion and authentic presence. This report invites clinicians to reevaluate the meaning and use of time in modern palliative care practice and offers six strategies to enhance time-efficiency in daily clinical care.