Journal of palliative medicine
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Cancer-related lymphedema management in palliative care remains a challenge for health care professionals. We conducted a systematic review of the published literature related to the effectiveness of cancer-related lymphedema management in the palliative care setting. ⋯ Five case studies were identified addressing closed-controlled subcutaneous drainage; one retrospective study on manual lymphatic drainage (MLD); two case studies on compression therapy; and three case studies on complete decongestive therapy (CDT). All studies were rated in the category of "effectiveness not established" due to study limitations in design and sample size. Few studies included objective measures of outcomes, and there were no randomized controlled trials. There is a need for larger, well-designed research studies to test the effectiveness of management of cancer-related lymphedema in palliative care.
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Randomized Controlled Trial
Improving residents' code status discussion skills: a randomized trial.
Inpatient Code Status Discussions (CSDs) are commonly facilitated by resident physicians, despite inadequate training. We studied the efficacy of a CSD communication skills training intervention for internal medicine residents. ⋯ A focused, multimodality curriculum can improve resident performance of simulated CSDs. Skill improvement lasted for at least 2 months after the intervention. Further studies are needed to assess skill retention and to set minimum performance standards.
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Descriptive studies of cancer family caregivers demonstrate role-related psychosocial and physical burden; however, little is known about which factors contribute to or obviate burden. Systematic reviews of caregiver intervention studies demonstrate mixed results, perhaps because some caregiver needs are still unknown and not adequately addressed. The purpose of our study was to explore the lived experience of being a caregiver for an adult with lung or colon cancer, so as to guide the development of future intervention studies. ⋯ This study implicates several intervention components to be developed and tested as favorably supporting caregivers, namely, reinforcing positive aspects of caregiving, cultivating open communication, and acknowledging the prior experiences and social foundation of the caregiver's life that can be supportive or burdensome.
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Hospice and palliative care providers need ways to measure and improve care processes. We tested feasibility, usability, reliability, and validity of Prepare, Embrace, Attend, Communicate, Empower (PEACE) quality measures for palliative care. ⋯ PEACE quality measures are feasible and reliable, and may be useful to examine and improve the quality of palliative care for seriously ill hospitalized patients as well as for patients in hospice. Research is needed to test measures for actionability and responsiveness to intervention.