Journal of palliative medicine
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Methadone is a useful analgesic for neuropathic and nociceptive pain. However, there is little information about the use of methadone in the final days of life when a patient cannot swallow, discouraging its use by many palliative care physicians. ⋯ The cases reviewed suggest that methadone is well tolerated and effective when switched to the buccal route in patients at the end of life on a palliative care unit.
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The number of palliative care consultation services is growing, yet little is known about how program characteristics change over time. ⋯ Fewer than half of hospitals in California offer a palliative care program and many close over time. Making palliative care consultation services a condition of participation by insurers could make hospital palliative care consultation services universal. Mechanisms need to be established to improve staffing levels, maintain the interdisciplinary nature of palliative care consultation services, and accommodate demand for services.
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Surveys demonstrate < 20% of radiation oncologists in the United States offer single-fraction palliative radiotherapy (RT) even though it is an acceptable standard of care. A study was conducted to investigate whether this held true for those practicing within the Veterans Healthcare Administration (VHA). ⋯ A majority of radiation oncologists within the VHA offer single-fraction therapy to their patients. These data ensure access to palliative RT is not limited within this health care system by a preference for prolonged treatment courses that may discourage patients and clinicians from seeking this care.
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Malignant bowel obstruction (MBO) is a common condition among palliative patients and has limited management options. There is a paucity of widely accepted national and international evidence-based guidelines to direct the management of MBO in palliative patients. ⋯ Variation in practice for managing MBO was evident among doctors in New Zealand. There is a need for national and international evidence-based guidelines to help define best management for the differing severities of this problematic condition.