Abstract:
CONTEXT:There is little evidence on the symptoms experienced by those with advanced (Stage 5) chronic kidney disease (CKD), managed without dialysis, as they approach death. As palliative care extends to noncancer illnesses, understanding symptom prevalence and severity close to death will clarify which symptom interventions are most needed and which elements of (largely cancer-driven) models of palliative care best translate into end-of-life care for this population. OBJECTIVES:To determine symptom prevalence and severity in the last month of life for patients with Stage 5 CKD, managed without dialysis. METHODS:Longitudinal symptom survey in three U.K. renal units, using the patient-completed Memorial Symptom Assessment Scale-Short Form (MSAS-SF). We calculated the prevalence of individual symptoms (with 95% confidence intervals [CI] to reflect sample size), plus MSAS-SF subscales, in the month before death. Comparison is made with previously published data on symptoms in the last month of life in advanced cancer, also measured using the MSAS-SF. RESULTS:Seventy-four patients (mean age: 81 years; standard deviation [SD]: 6.8) were recruited (response rate: 73%); 49 (66%) died during follow-up (mean age: 81 years; SD: 5.7). "Month before death" symptom data were available for 43 (88%) of the 49 participants who died. Median time of data collection was 18 days from death (interquartile range: 12-26 days). More than half had lack of energy (86%; 95% CI: 73%-94%), itch (84%; 70%-93%), drowsiness (82%; 68%-91%), dyspnea (80%; 66%-90%), poor concentration (76%; 61%-87%), pain (73%; 59%-85%), poor appetite (71%; 57%-83%), swelling arms/legs (71%; 57%-83%), dry mouth (69%; 55%-82%), constipation (65%; 50%-78%), and nausea (59%; 44%-73%). Levels of distress correspond to prevalence, with the exception of dyspnea, which was disproportionately more distressing. The median number of symptoms reported was 16.6 (range: 6-27), rising to 20.4 (range: 7-34) if additional renal symptoms were included. On average, psychological distress was moderate (mean MSAS-PSYCH: 1.55) but with wide variation (SD: 0.50; range: 0.17-2.40), suggesting diverse levels of individual distress. The prevalence of both physical and psychological symptoms and the number reported were higher than those in advanced cancer patients in the month before death. CONCLUSION:Stage 5 CKD patients have clinically important physical and psychological symptom burdens in the last month of life, similar or greater than those in advanced cancer patients. Symptoms must be addressed through routine symptom assessment, appropriate interventions, and with pertinent models of end-of-life care.
journal_name
J Pain Symptom Managejournal_title
Journal of pain and symptom managementauthors
Murtagh FE,Addington-Hall J,Edmonds P,Donohoe P,Carey I,Jenkins K,Higginson IJdoi
10.1016/j.jpainsymman.2010.01.021subject
Has Abstractpub_date
2010-09-01 00:00:00pages
342-52issue
3eissn
0885-3924issn
1873-6513pii
S0885-3924(10)00391-Xjournal_volume
40pub_type
杂志文章abstract::This study sought to characterize the nature of breakthrough pain experienced by 22 hospice patients and to assess the perceptions of their respective caregivers. Questionnaires were administered by trained hospice nurses to determine key elements of episodic pains in this home-based terminally ill population. Eighty-...
journal_title:Journal of pain and symptom management
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doi:10.1016/s0885-3924(98)00045-1
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abstract::The influence of personality characteristics on how patients cope with various challenges at the end of life has not been extensively studied. In order to examine the association between end-of-life experience and neuroticism (defined within the personality literature as a trait tendency to experience psychological di...
journal_title:Journal of pain and symptom management
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abstract::Inadequate nursing education is a major impediment to effective pain relief for cancer patients throughout the world. This study was conducted to identify the level of cancer pain knowledge among baccalaureate student nurses and to determine whether specific activities affect this level of knowledge. Two questionnaire...
journal_title:Journal of pain and symptom management
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journal_title:Journal of pain and symptom management
pub_type: 杂志文章
doi:10.1016/j.jpainsymman.2010.04.017
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journal_title:Journal of pain and symptom management
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doi:10.1016/s0885-3924(00)00181-0
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abstract:CONTEXT:One palliative care approach that is increasingly being used at home for relieving intolerable suffering in terminally ill patients is continuous sedation until death. Its provision requires a multidisciplinary team approach, with adequate collaboration and communication. However, it is unknown how general prac...
journal_title:Journal of pain and symptom management
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更新日期:2015-01-01 00:00:00
abstract:CONTEXT:Clinicians often rely on documentation to relay information, and this remains the mainstay of interprofessional communication regarding patient care. However, there has been scant research focused on clinicians' documentation of dying in hospital and how this is communicated to other team members in patient cha...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章
doi:10.1016/j.jpainsymman.2018.05.013
更新日期:2018-09-01 00:00:00
abstract::Palliative care development and services were reviewed in the region represented by the six members of the Middle East Cancer Consortium: Cyprus, Egypt, Israel, Jordan, the Palestinian Authority, and Turkey. The multimethod review synthesized evidence from ethnographic field visits to inpatient units, home care hospic...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章
doi:10.1016/j.jpainsymman.2008.02.014
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journal_title:Journal of pain and symptom management
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journal_title:Journal of pain and symptom management
pub_type: 杂志文章
doi:10.1016/j.jpainsymman.2009.08.006
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journal_title:Journal of pain and symptom management
pub_type: 杂志文章
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abstract:CONTEXT:Although sporadic male predominance in hiccup patients has been reported, the association between gender differences and triggering factors has rarely been evaluated in patients with hiccups. OBJECTIVES:The aim of this study was to investigate whether gender differences exist in hiccup patients by analyzing al...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章,meta分析,评审
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journal_title:Journal of pain and symptom management
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journal_title:Journal of pain and symptom management
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journal_title:Journal of pain and symptom management
pub_type: 临床试验,杂志文章,多中心研究
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journal_title:Journal of pain and symptom management
pub_type: 临床试验,杂志文章
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journal_title:Journal of pain and symptom management
pub_type: 杂志文章,meta分析,评审
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journal_title:Journal of pain and symptom management
pub_type: 临床试验,杂志文章
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journal_title:Journal of pain and symptom management
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journal_title:Journal of pain and symptom management
pub_type: 临床试验,杂志文章
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journal_title:Journal of pain and symptom management
pub_type: 临床试验,杂志文章
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journal_title:Journal of pain and symptom management
pub_type: 杂志文章
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journal_title:Journal of pain and symptom management
pub_type: 杂志文章
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journal_title:Journal of pain and symptom management
pub_type: 杂志文章,随机对照试验
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更新日期:2016-08-01 00:00:00
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journal_title:Journal of pain and symptom management
pub_type: 临床试验,杂志文章,随机对照试验
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journal_title:Journal of pain and symptom management
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更新日期:2021-02-01 00:00:00
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journal_title:Journal of pain and symptom management
pub_type: 杂志文章
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更新日期:2009-02-01 00:00:00
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journal_title:Journal of pain and symptom management
pub_type: 杂志文章,多中心研究,随机对照试验
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journal_title:Journal of pain and symptom management
pub_type: 临床试验,杂志文章
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更新日期:1997-09-01 00:00:00
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journal_title:Journal of pain and symptom management
pub_type: 杂志文章,多中心研究
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