Articles: palliative-care.
-
Palliative care providers are frequently called to consult on patients with tenuous hemodynamics caused by an underlying serious illness. In this article, we describe a patient with end-stage renal disease who developed hypotension and severe pain due to calciphylaxis. ⋯ We describe challenges encountered when trying to attend to the providers' concerns and guide shared medical decision making with the patient and family. We also summarize the current limited knowledge about the effect of opioids on hemodynamics and highlight a topic in need of further exploration.
-
J Pain Symptom Manage · Sep 2022
Close Encounters of the First Kind: An interdisciplinary ethics of care approach mitigates moral injury and family division in the midst of COVID-19.
In this compelling personal narrative describing a case from the front lines of the COVID-19 pandemic, a palliative care physician harnesses the creative powers and strengths of the interdisciplinary team to provide compassionate care to a critically ill patient and his family. The author describes the process of identifying a surrogate decision maker from among the patient's many adult children-several of whom were estranged from him and each other-and facilitating weighty decisions about his end-of-life care. Over the course of this journey, the author grapples with her inner biases and struggles with the emotional trauma associated with bearing witness to extraordinary suffering and social isolation imposed by COVID-19. Not only does the ethics of care approach embodied here lead to the creation of enduring vibrant works of art for this patient and others, but it also affirms a guiding principle of palliative care in which interdisciplinary collaboration is marshalled in the service of cultivating relationships, upholding responsibilities, and intensifying empathy among persons tied together by a common narrative.
-
J Pain Symptom Manage · Sep 2022
Provider Perceptions for Withdrawing Life Sustaining Therapies at a Large Pediatric Hospital.
More than 74% of pediatric deaths occur in an intensive care unit (ICU), with 40% occurring after withdrawal of life-sustaining therapies (WOLST). No needs assessment has described provider needs or suggestions for improving the WOLST process in pediatrics. ⋯ While participants' self-rated confidence was high, it varied between disciplines. Participants identified opportunities for improved communication and planning before a WOLST. Future work includes development and implementation of a best practice guideline to address gaps and standardize care delivery.
-
Palliative medicine · Sep 2022
Stakeholder perspectives of a pilot multicomponent delirium prevention intervention for adult patients with advanced cancer in palliative care units: A behaviour change theory-based qualitative study.
Theory-based and qualitative evaluations in pilot trials of complex clinical interventions help to understand quantitative results, as well as inform the feasibility and design of subsequent effectiveness and implementation trials. ⋯ This theory-informed qualitative study identified multiple influences on the delivery and documentation of a pilot multicomponent non-pharmacological delirium prevention intervention in four palliative care units. Findings inform future definitive studies of delirium prevention in palliative care.Australian New Zealand Clinical Trials Registry, ACTRN12617001070325; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373168.
-
In 10% to 30% cancer-pain cases standard analgesic therapy fails to provide effective pain relief. Interventional techniques, such as peripheral nerve blocks, neuraxial analgesia along with neurolytic blocks may be used for such refractory pain. Peripheral nerve blocks can be used when pain occurs in the territory of one or more peripheral nerves, but rarely as main therapy. ⋯ Neurolysis is the targeted destruction of a nerve or nerve plexus, using chemicals, radiofrequency ablation (RFA), cryoablation, and neurosurgical procedures; however, it rarely completely eliminates pain because patients frequently experience coexisting somatic and neuropathic pain as well. Complex conditions of palliative patients along with limited high-quality randomized controlled trials limit the use of interventional procedures. Even so, some cancer patients benefit from interventional procedures to achieve pain alleviation and consequently improve quality of life.