Abstract:
PURPOSE:To summarize evidence on conservative, nondialytic management of end-stage renal disease regarding 1) prognosis and 2) symptom burden and quality of life (QOL). METHODS:Medline, Cinahl, and Cochrane were searched for records indexed prior to March 1, 2011. Bibliographies of articles and abstracts from recent meetings were reviewed. Authors and nephrologists were contacted to identify additional studies. Articles were reviewed by two authors and selected if they described stage 5 chronic kidney disease (CKD) patients managed without dialysis, including one or more of the following outcomes: prognosis, symptoms, or QOL. Levels of evidence ratings were assigned using the SORT (Strength of Recommendation Taxonomy) system. Data was abstracted independently by two authors for descriptive analysis. RESULTS:Thirteen studies were included. In studies of prognosis, conservative management resulted in median survival of at least six months (range 6.3 to 23.4 months). Findings are mixed as to whether dialysis prolongs survival in the elderly versus conservative, nondialytic management. Any survival benefit from dialysis decreases with comorbidities, especially ischemic heart disease. Patients managed conservatively report a high symptom burden, underscoring the need for concurrent palliative care. Additional head-to-head studies are needed to compare the symptoms of age-matched dialysis patients, but preliminary studies suggest that QOL is similar. CONCLUSIONS:Conservative management is an important alternative to discuss when counseling patients and families about dialysis. Unlike withdrawal of dialysis in which imminent death is expected, patients who decline dialysis initiation can live for months to years with appropriate supportive care.
journal_name
J Palliat Medjournal_title
Journal of palliative medicineauthors
O'Connor NR,Kumar Pdoi
10.1089/jpm.2011.0207subject
Has Abstractpub_date
2012-02-01 00:00:00pages
228-35issue
2eissn
1096-6218issn
1557-7740journal_volume
15pub_type
杂志文章,评审abstract::Underutilization of hospice care continues to be a public health issue in the United States. Physician barriers related to incorrect knowledge and unfavorable attitudes have been hypothesized as part of the explanation. We conducted a mail survey of 264 area physicians, obtaining a response rate of 72% (n = 190). The ...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/10966210252785042
更新日期:2002-02-01 00:00:00
abstract:BACKGROUND:In 2017, the Ohio Pediatric Palliative Care and End-of-Life Network (OPPEN) published nine domains of high-quality care for pediatric home-based hospice and palliative care (HBHPC). Eight domains established by the National Consensus Project (NCP) were validated for pediatric HBHPC, and a ninth domain of "Co...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2018.0056
更新日期:2018-10-01 00:00:00
abstract:BACKGROUND:Actions in preparation for death and talks about death between advanced cancer patients and their families are considered essential to achieve a good death. However, little is known about the prevalence of such actions compared with talks and their association with bereaved families' psychological morbidity....
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2017.0267
更新日期:2018-03-01 00:00:00
abstract::Family members of intensive care unit (ICU) patients want to be involved in decision making, but they may not be best served by being placed in the position of having to solve problems for which they lack knowledge and skills. This case report presents an exemplar family meeting in the ICU led by a palliative care spe...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2011.0406
更新日期:2013-03-01 00:00:00
abstract::Relief of adverse events induced by chemotherapy is an important issue for patients, especially those with a poor prognosis, such as with pancreatic cancer. There are no reports of the relationship between gastroesophageal reflux disease (GERD) and chemotherapy, so we investigated the incidence of chemotherapy-induced...
journal_title:Journal of palliative medicine
pub_type: 临床试验,杂志文章
doi:10.1089/jpm.2009.0404
更新日期:2010-07-01 00:00:00
abstract:BACKGROUND:Opioid dose escalation may cause hyperalgesia, mediated by the N-methyl-D-aspartate (NMDA) pathway. Methadone is an atypical opioid that inhibits hyperalgesia through NMDA-blockade, especially at low doses. OBJECTIVE:To evaluate the efficacy of using very-low-dose methadone as the sole long-acting opioid ag...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2012.0612
更新日期:2013-06-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:In 2014, Nova Scotia released a provincial palliative care strategy and implementation working groups were established. The Capacity Building and Practice Change Working Group, comprised of health professionals, public advisors, academics, educators, and a volunteer supervisor, was asked to se...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2017.0655
更新日期:2018-07-01 00:00:00
abstract:BACKGROUND:Heart failure (HF) and palliative care (PC) organizations recommend early PC to improve the quality of life of patients living with HF. OBJECTIVE:We conducted a two-phase formative evaluation study to translate a cancer-focused concurrent PC intervention into one that would be appropriate for rural-dwelling...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2013.0680
更新日期:2014-09-01 00:00:00
abstract:BACKGROUND:Methadone is an attractive medication for treating children with advanced cancer with pain as it is the only long-acting opioid available as a liquid. However, it is not frequently used due to concerns about potential toxicities and side effects. OBJECTIVE:Evaluate the efficacy and safety of methadone as th...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2017.0712
更新日期:2018-09-01 00:00:00
abstract:OBJECTIVE:To describe the growth and outcomes of the Palliative Care Research Cooperative Group (PCRC). BACKGROUND:Despite advances, significant gaps remain in the evidence base to inform care for people with serious illness. To generate this needed evidence and bolster research capacity, the Palliative Care Research ...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2017.0138
更新日期:2017-06-01 00:00:00
abstract:BACKGROUND:Residents struggle with advance care planning (ACP) discussions in the inpatient setting, and may not be aware of newer models for ACP that stress the importance of giving prognostic information and making a recommendation about cardiopulmonary resuscitation to patients and families. METHODS:A controlled st...
journal_title:Journal of palliative medicine
pub_type: 杂志文章,随机对照试验
doi:10.1089/jpm.2010.0383
更新日期:2011-03-01 00:00:00
abstract:BACKGROUND:This case report describes a patient whose persistent hiccups significantly improved with the use of vinegar. CASE PRESENTATION:A patient with an adenocarcinoma of the colon and hepatic metastases developed hiccups the day following chemotherapy with FOL-FOX (folinic acid (leucovorin), 5-fluorouracil, oxali...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2014.0391
更新日期:2015-05-01 00:00:00
abstract:BACKGROUND:Few studies have focused on men as caregivers at the end-of-life. The objective of this secondary data analysis was to examine the experiences of men involved in end-of-life caregiving, focusing on caregiver strain. METHODS:We used a random sample of Oregon death certificates to telephone survey family care...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2005.8.1167
更新日期:2005-12-01 00:00:00
abstract:INTRODUCTION:Place of death is considered a quality indicator of end-of-life care and enabling people to die where they choose is an important aspiration of palliative care. This study aims to examine the association between involvement of palliative care services and place of death. METHODS:Data about patient charact...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2010.0279
更新日期:2010-12-01 00:00:00
abstract:INTRODUCTION:Percutaneous stenting is established in the palliation of malignant biliary obstruction. We examined the indications, success rate, complications, and long-term postoperative course of patients undergoing this procedure. METHODS:All patients undergoing percutaneous transhepatic cholangiography (PTC) and m...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2010.0205
更新日期:2010-11-01 00:00:00
abstract:OBJECTIVES:To examine the effect of patient-directed electronic messages on health care proxy (HCP) use. DESIGN:Randomized control trial using an electronic message intervention to encourage patients to complete an HCP document. SETTING:General medical practice at a large tertiary care teaching institution. PARTICIP...
journal_title:Journal of palliative medicine
pub_type: 杂志文章,随机对照试验
doi:10.1089/jpm.2006.9.1320
更新日期:2006-12-01 00:00:00
abstract::Achieving the best quality of life for patients and their families when a disease becomes progressive and no longer remains responsive to curative therapy is the primary goal of palliative care. A comprehensive care plan focusing on control of physical symptoms as well as psychological, social, and spiritual issues th...
journal_title:Journal of palliative medicine
pub_type: 杂志文章,评审
doi:10.1089/jpm.2006.9.391
更新日期:2006-04-01 00:00:00
abstract:BACKGROUND:Respiratory signs and symptoms are commonly encountered by physicians who care for cancer patients. Supplemental oxygen (SOx) has long been used for treatment of hypoxic respiratory insufficiency, but data reveal mixed efficacy results. The use and outcome patterns of technologically advanced oxygen delivery...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2011.0005
更新日期:2011-07-01 00:00:00
abstract:: Background: Mobile health (mHealth) is a promising tool for improving health outcomes. However, the benefits of using mHealth in palliative care are under studied. Objective: As a first step to designing meaningful palliative c...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2019.0216
更新日期:2020-02-01 00:00:00
abstract:: Background: Insufficient knowledge of palliative radiotherapy (PRT) among hospice and palliative medicine (HPM) physicians is thought to be a barrier to the provision of high-quality palliative care. Objective: To assess the ne...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2019.0118
更新日期:2020-02-01 00:00:00
abstract:: Background: End-of-life dreams and visions (ELDVs) are prevalent experiences that provide comfort and meaning to dying individuals. Limited research has examined the impact of ELDVs on the bereaved. Objective: This study aimed ...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2019.0093
更新日期:2020-01-01 00:00:00
abstract:OBJECTIVE:Describe the establishment of the palliative care quality network (PCQN) with guidance on how teams can develop similar collaborations. BACKGROUND:In the current healthcare environment, palliative care (PC) teams must be able to demonstrate value and provide efficient care while supporting the clinicians who...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2016.0514
更新日期:2017-08-01 00:00:00
abstract:: Objective: To systematically capture patient- and family-centered data to understand variability and opportunities in end-of-life care delivery across settings in an integrated health care delivery system. Background: Improving...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2019.0265
更新日期:2020-06-01 00:00:00
abstract:BACKGROUND:Families with young children often struggle to talk about and cope with a parent's life-threatening illness and potential death. Adult interdisciplinary palliative medicine teams often feel unprepared to facilitate the open communication with these children that has been shown to reduce anxiety, depression, ...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2012.0019
更新日期:2012-12-01 00:00:00
abstract::Stroke is a leading cause of disability and mortality worldwide. Recent advances in stroke care now enable patients with severe ischemic stroke owing to large vessel occlusion to safely undergo endovascular thrombectomy (EVT) up to 24 hours since their time of last known well, with the goal of improving functional out...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2019.0667
更新日期:2020-05-14 00:00:00
abstract:OBJECTIVE:The purpose of the study was to describe the perceptions of community residence (CR) staff who have cared for older adults with developmental disabilities (ADDs) that are at the end of life. DESIGN:This exploratory, descriptive study utilized qualitative methods that involved semistructured interviews with C...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2012.0408
更新日期:2013-09-01 00:00:00
abstract:INTRODUCTION:The World Health Organization (WHO) explicitly recommends the integration of palliative care (PC) early in the disease trajectory as part of the WHO definition of PC. Our comprehensive cancer center decided: (1) to include this recommendation in the administrative directives for principles of cancer care a...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2010.0016
更新日期:2010-10-01 00:00:00
abstract:OBJECTIVE:There is a dearth of international research on hospice physiotherapy. This study aims to profile hospice physiotherapy in an Irish setting in order to inform practice internationally. DESIGN:The study design consisted of a retrospective chart audit over 6 months. SETTING:The study took place at a specialist...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2011.0480
更新日期:2012-07-01 00:00:00
abstract::Alzheimer's dementia and related dementias are incurable illnesses for which curative treatment currently does not exist, and the efficacy of remittive treatment is extremely limited. Persons with advanced dementia commonly develop fever and are at high risk for death. We preformed a systematic review of outcome follo...
journal_title:Journal of palliative medicine
pub_type: 杂志文章,评审
doi:10.1089/109662103322144664
更新日期:2003-06-01 00:00:00
abstract:BACKGROUND:Living at home is an important factor for maintaining high quality of life among patients. Many studies have discussed parameters associated with place of death, but no studies have yet clarified which factors influence the length of stay at home during the end of life. OBJECTIVE:The aim of this study was t...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2016.0455
更新日期:2017-08-01 00:00:00