Articles: palliative-care.
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Cardiac implantable electronic devices have transformed medicine as they improve quality of life and prevent premature death. In palliative care settings, deactivation of these devices must be discussed, particularly at end-of-life. In terminally ill patients it is consensual to recommend implantable cardioverter defibrillator deactivation once shocks are frequent and painful. ⋯ Regarding cardiac resynchronization therapy, deactivation is not recommended as it can worsen symptoms. Left ventricular assistance device deactivation at end-of-life is a well-accepted practice, since it has the benefit of ending the physical burden associated with the device. Advance care planning should be encouraged and patients should be informed that deactivation is possible.
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J Pain Symptom Manage · Nov 2024
Using Human-Centered Design to Improve Serious Illness Care for Older Adults with Advanced Dementia.
Older adults with advanced dementia increasingly receive potentially non-beneficial, high-intensity life-sustaining treatments and goal-discordant care in the United States. Interventions to address this issue have shown limited success. ⋯ The HCD process generated ideas at multiple healthcare system levels to address an enduring challenge in serious illness care by involving clinicians, researchers, and designers in intervention design.
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Background: This analysis examined regret from participation in cancer clinical trials (CCT) and explored associations between regret and symptom burden, symptom bother, therapeutic optimism, and the importance of spiritual beliefs. Methods: This is a secondary analysis of cross-sectional data from a study of American CCT patient-participants conducted from 2015 to 2019. Descriptive statistics, bivariate associations, and logistic regression were used to evaluate regret in this sample (n = 325). ⋯ The final regression model identified that younger age, symptom burden, and therapeutic optimism significantly predicted regret (p < 0.05). Conclusions: Understanding regret among research participants may improve CCT retention and ensure ethical research practices. Symptom experiences may play a key role in experiences of regret in CCT participation.
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Introduction: Sexual and gender minority (SGM) individuals face increased risk of receiving suboptimal care, including palliative care. Despite research demonstrating strategies to improve care, little is known about the experiences of palliative care clinicians providing care to these communities. Objectives: The primary aim of this study is to characterize attitudes and practices of palliative care physicians around providing care to SGM individuals. ⋯ Results: Four main themes represent perspectives on improving palliative care for SGM individuals: (1) increasing experience with and knowledge about SGM communities increases clinicians' confidence and competency; (2) standardizing inclusive sexual orientation and gender identity (SOGI) data collection and documentation can improve patient care; (3) addressing individual, systemic, and societal biases may improve palliative care provided to SGM individuals; and (4) knowing SOGI improves care quality. Conclusions: Clinicians must familiarize themselves with the importance of SOGI to the care provided as well as the palliative care needs of SGM communities. Institutions should provide tailored training around the unique needs of SGM patients and implement policies and tools that standardize sexual and gender orientation data collection and documentation.
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J Pain Palliat Care Pharmacother · Nov 2024
Family Caregivers in Palliative Care Therapeutic Management: An Integrative Review.
In palliative care, family caregivers are partners of multidisciplinary teams in the continuity of care at home. Effective therapeutic management provides optimal relief of distressing symptoms. It requires the acquisition of specific knowledge and care, but it also involves decision-making with ethical implications that increase the stress and burden on caregivers. ⋯ Family caregivers are presented as coordinating elements within the healthcare system. The role of family caregivers is multidimensional, with numerous tasks and skills needed to support their relatives. Therapeutic management is more than just administering medications and needs to keep up with growing and fluctuating needs.