Journal of palliative medicine
-
Abstract Background: Despite parent and physician reports of inadequate skill development, there are few guidelines for training the pediatric care team in sharing life-altering information (SLAI), i.e., "breaking bad news." The necessary skills for SLAI differ between pediatric and adult medical environments. ⋯ We propose pediatric-focused SLAI guidelines based on a modified SPIKES protocol. Focus on patient- and family-centered, culturally sensitive pediatric practices should be the basis for development of training that can be periodically reinforced. Future comprehensive training will incorporate experiential learning. SLAI requires a skill set that benefits from lifelong learning.
-
Perineal pain is a frequent complaint of patients with advanced cancer (colorectal, genitourinary, prostate), and often quite difficult to manage with significant impact on quality of life. Calcium channel blockers (CCBs) are potent inhibitors of intestinal smooth muscle contraction and have been shown to impact tone and motility of the gastrointestinal tract. As such, they have been used in various pain syndromes of the lower gastrointestinal tract, such as chronic anal fissure, to promote healing and improve pain. Here we describe two cases using oral diltiazem for malignancy-associated perineal pain and tenesmus. ⋯ Based on our experience with these two cases, we propose oral diltiazem for use as an adjunct therapy for management of chronic malignancy-associated perineal pain, specifically with characteristics of pressure-type pain and tenesmus.