Abstract:
CONTEXT:Conflicts between families and clinicians in pediatric end-of-life (EOL) care cause distress for providers, dissatisfaction for patients' families, and potential suffering for terminally ill children. OBJECTIVES:We hypothesized that family factors might influence clinician decision making in these circumstances. METHODS:We presented vignettes concerning difficult EOL decision making, randomized for religious objection to therapy withdrawal and perceived level of family involvement, to clinicians working in three Children's Hospital intensive care units. Additionally, attitudes about EOL care were assessed. RESULTS:Three hundred sixty-four respondents completed the questionnaire, for an overall response rate of 54%. Respondents receiving the "involved family" vignette were more likely to agree to continue medical care indefinitely (P<0.0005). Respondents were marginally more likely to pursue a court-appointed guardian for those patients whose families had nonreligious objections to withdrawal (P=0.05). Respondents who thought that a fear of being sued affected decisions were less likely to pursue unilateral withdrawal (odds ratio 0.8, 95% CI=0.6-0.9). Those who felt personal distress as a result of difficult EOL decision making, thought they often provided "futile" care, or those who felt EOL care was effectively addressed at the institution were less likely to want to defer to the parents' wishes (range of odds ratios 0.7-1). CONCLUSION:In this randomized vignette study, we have shown that family factors, particularly how involved a family seems to be in a child's life, affect what clinicians think is ethically appropriate in challenging EOL cases. Knowledge of how a family's degree of involvement may affect clinicians should be helpful to the clinical ethics consultants and offer some degree of insight to the clinicians themselves.
journal_name
J Pain Symptom Managejournal_title
Journal of pain and symptom managementauthors
Ruppe MD,Feudtner C,Hexem KR,Morrison WEdoi
10.1016/j.jpainsymman.2012.05.005subject
Has Abstractpub_date
2013-05-01 00:00:00pages
832-40issue
5eissn
0885-3924issn
1873-6513pii
S0885-3924(12)00308-9journal_volume
45pub_type
杂志文章,随机对照试验abstract:CONTEXT:Relaxation interventions are frequently used to promote symptom relief in palliative care settings, but little is known about the underlying mechanisms. OBJECTIVES:The present analysis aimed at examining the psychophysiological pathways of terminally ill patients' cardiovascular response to a live music therap...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jpainsymman.2016.01.008
更新日期:2016-08-01 00:00:00
abstract:CONTEXT:Oncology patients with persistent pain treated in outpatient settings and their family caregivers have significant responsibility for managing pain medications. However, little is known about their practical day-to-day experiences with pain medication management. OBJECTIVES:The aim was to describe day-to-day p...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jpainsymman.2013.12.242
更新日期:2014-11-01 00:00:00
abstract::Disturbances caused by skin problems may compromise the quality of life of cancer patients. The main complications affecting the skin comprise the dermatologic toxicity of anticancer therapy, bedsores, malignant ulcers, sores due to nonmetastatic cancer, pruritus, and infections. Most of the information available abou...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章,评审
doi:10.1016/0885-3924(91)90015-v
更新日期:1991-05-01 00:00:00
abstract:CONTEXT:Promoting patient value-concordant end-of-life care is a priority in health care systems but has rarely been examined in randomized clinical trials. OBJECTIVES:To examine the effectiveness of an advance care planning intervention in facilitating concordance between cancer patients' preferred and received life-...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jpainsymman.2019.04.010
更新日期:2019-07-01 00:00:00
abstract:CONTEXT:Cancer patients have impaired humoral and cellular immunity, and are more susceptible to infections; their immunological response is expected to be less effective than that of healthy people. OBJECTIVES:To assess the immune response to influenza vaccine in terminally ill cancer patients in a home palliative ca...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章
doi:10.1016/j.jpainsymman.2010.05.016
更新日期:2011-02-01 00:00:00
abstract:CONTEXT:Children and adolescents with cancer experience treatment-related, subjective adverse events (AEs). Identifying distinct groups of patients who predictably experience higher prevalence of AEs could guide patient care. OBJECTIVES:Study aims were to 1) identify groups of children and adolescents reporting AEs us...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章
doi:10.1016/j.jpainsymman.2020.10.017
更新日期:2020-10-20 00:00:00
abstract::To explore the factors that patients with malignant and nonmalignant pain consider when deciding whether to enroll in pain research studies, determine whether their views are different, and determine whether willingness to enroll in research is associated with pain severity, semi-structured interviews were conducted w...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章
doi:10.1016/s0885-3924(02)00527-4
更新日期:2002-11-01 00:00:00
abstract:CONTEXT:The successful management of breakthrough pain depends on a combination of adequate assessment, appropriate (individualized) treatment, and adequate re-assessment. Currently, there is no fully validated clinical assessment tool for breakthrough pain in cancer patients. OBJECTIVES:The aim of this project was to...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章
doi:10.1016/j.jpainsymman.2013.10.026
更新日期:2014-10-01 00:00:00
abstract:CONTEXT:Cancer therapy-induced cognitive impairment adversely affects the quality of life of patients with cancer but cannot be detected by neuropsychological tests. OBJECTIVES:This study aimed to validate a Japanese version of the Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog) version 3, which ...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章
doi:10.1016/j.jpainsymman.2019.09.027
更新日期:2020-01-01 00:00:00
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
pub_type: 杂志文章
doi:10.1016/0885-3924(92)90134-4
更新日期:1992-11-01 00:00:00
abstract:CONTEXT:Chronic pain (CP) is a major concern in cancer survivors. Often under-reported by patients, it is both underassessed and undertreated by care providers. OBJECTIVES:To assess CP prevalence and related treatment in cancer survivors five years after diagnosis and to identify factors associated with prescribing op...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章
doi:10.1016/j.jpainsymman.2019.10.027
更新日期:2020-04-01 00:00:00
abstract::A mathematical rate is composed of a numerator, denominator, and time period of observation. Deciding who is in the denominator is a key, yet difficult task given the blurred boundaries of chronic illness, in examining the quality of care for dying patients. We propose two potential solutions. First, one could prospec...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章,评审
doi:10.1016/s0885-3924(98)00132-8
更新日期:1999-02-01 00:00:00
abstract::The effects of dronabinol on appetite and weight were evaluated in 139 patients with AIDS-related anorexia and > or = 2.3 kg weight loss in a multi-institutional study. Patients were randomized to receive 2.5 mg dronabinol twice daily or placebo. Patients rated appetite, mood, and nausea by using a 100-mm visual analo...
journal_title:Journal of pain and symptom management
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1016/0885-3924(94)00117-4
更新日期:1995-02-01 00:00:00
abstract::After years of second-class status, supportive care is increasingly being recognized for its importance. Included in this recognition is a concern for making more explicit the long-held conviction within medicine that no goal can logically be more important than optimal patient functioning and well-being. This effort ...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章
doi:10.1016/0885-3924(94)90129-5
更新日期:1994-04-01 00:00:00
abstract:CONTEXT:Symptom researchers have proposed a model of inflammatory cytokine activity and dysregulation in cancer to explain co-occurring symptoms including pain, fatigue, and sleep disturbance. OBJECTIVES:We tested the hypothesis that psychological stress accentuates inflammation and that stress and inflammation contri...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jpainsymman.2018.01.008
更新日期:2018-05-01 00:00:00
abstract::Patients with chronic pain often complain of difficulties with cognitive functioning. Previous studies suggest that these occur with no history of head trauma or neurological disease. This study examined potential predictors of cognitive complaints in 275 consecutive patients referred to a university pain management c...
journal_title:Journal of pain and symptom management
pub_type: 临床试验,杂志文章
doi:10.1016/s0885-3924(01)00267-6
更新日期:2001-05-01 00:00:00
abstract:CONTEXT:Hospice care is traditionally used for patients with advanced cancer, but it is increasingly considered for patients with end-stage heart failure. OBJECTIVES:We compared enrollment patterns and clinical events of hospice patients with end-stage heart failure with those of patients with advanced cancer. METHOD...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章
doi:10.1016/j.jpainsymman.2012.03.006
更新日期:2013-03-01 00:00:00
abstract::The psychometric characteristics of the Faces Pain Scale (FPS) were evaluated in three groups of preschool and school-aged children (3. 5-4.5; 4.5-5.5 and 5.5-6.5 years, respectively). The FPS was adequately comprehended by even young children. It was easily administered and was valid and discriminating. It did not, h...
journal_title:Journal of pain and symptom management
pub_type: 临床试验,杂志文章
doi:10.1016/s0885-3924(00)00171-8
更新日期:2000-08-01 00:00:00
abstract:CONTEXT:Chemotherapy-related nausea is experienced by most cancer patients receiving chemotherapy. Although vomiting is managed well with current antiemetics, nausea is difficult to manage and little is understood about its development. OBJECTIVES:The aim was to determine whether nausea exists as part of a symptom clu...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章
doi:10.1016/j.jpainsymman.2011.11.003
更新日期:2012-11-01 00:00:00
abstract::This study compared the effects of nebulized versus subcutaneous morphine on the intensity of dyspnea in cancer patients. Patients with a resting dyspnea intensity > or =3 on a 0-10 scale (0=no dyspnea, 10=worst possible dyspnea) who received regular oral or parenteral opioids were included. On day 1, patients receive...
journal_title:Journal of pain and symptom management
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/j.jpainsymman.2004.08.016
更新日期:2005-06-01 00:00:00
abstract:CONTEXT:Patients from minority ethnic groups experience lower rates of referrals to end-of-life (EoL) care services, higher levels of dissatisfaction with services, and perceive some services as culturally inappropriate. OBJECTIVES:To systematically review original studies of minority ethnic groups and EoL care in the...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章,评审
doi:10.1016/j.jpainsymman.2011.04.012
更新日期:2012-02-01 00:00:00
abstract::Opioids are thought to worsen the performance of psychomotor tasks due to their sedating and mental-clouding effects. As a result, some safety regulations currently restrict the use of opioids when driving or using heavy equipment. We investigated the psychomotor effects of long-term opioid use in 144 patients with lo...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章
doi:10.1016/s0885-3924(03)00310-5
更新日期:2003-10-01 00:00:00
abstract:CONTEXT:Evidence from prior public health emergencies demonstrates palliative care's importance to manage symptoms, make advance care plans, and improve end-of-life outcomes. OBJECTIVE:To evaluate the preparedness and capacity of palliative care services in the Middle-East and North Africa region to respond to the COV...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章
doi:10.1016/j.jpainsymman.2020.10.025
更新日期:2021-02-01 00:00:00
abstract::Oxcarbazepine is a second-generation antiepileptic drug (AED) with proven efficacy in managing partial epileptic seizures, with or without secondary generalization, in adults and children. The overlap between the underlying pathophysiologic mechanisms of some epilepsy models and neuropathic pain models supports the ra...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章,评审
doi:10.1016/s0885-3924(03)00067-8
更新日期:2003-05-01 00:00:00
abstract:CONTEXT:The use of unidimensional pain scales such as the Numerical Rating Scale (NRS), Verbal Rating Scale (VRS), or Visual Analogue Scale (VAS) is recommended for assessment of pain intensity (PI). A literature review of studies specifically comparing the NRS, VRS, and/or VAS for unidimensional self-report of PI was ...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章,评审
doi:10.1016/j.jpainsymman.2010.08.016
更新日期:2011-06-01 00:00:00
abstract:CONTEXT:Dyspnea is one of the most distressing symptoms in patients with cancer, and often worsens with breakthrough episodes on exertion. We hypothesized that fentanyl given prophylactically may alleviate breakthrough dyspnea. OBJECTIVES:To determine the feasibility of conducting a randomized trial of subcutaneous fe...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jpainsymman.2013.03.017
更新日期:2014-02-01 00:00:00
abstract::The burden of constipation from the patient's perspective has been well described. The aim of this study was to evaluate the cost of managing constipation in patients taking opioids in a specialist palliative care inpatient unit. A retrospective review of the medical records of 58 patients (70 admissions) who died dur...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章
doi:10.1016/j.jpainsymman.2009.09.007
更新日期:2010-04-01 00:00:00
abstract:CONTEXT:Breakthrough cancer pain (BTCP) is a heterogeneous condition, and there are no internationally agreed standardized criteria to diagnose it. There are published algorithms to assist with diagnosis, but these differ in content. There are no comparative data to support use. OBJECTIVES:To compare the diagnostic ab...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章,多中心研究
doi:10.1016/j.jpainsymman.2015.05.006
更新日期:2015-10-01 00:00:00
abstract:CONTEXT:Fatigue is a distressing persistent sense of physical tiredness that is not proportional to a person's recent activity. Fatigue impacts patients' treatment decisions and can limit their self-care activities. Although significant interindividual variability in fatigue severity has been noted, little is known abo...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章
doi:10.1016/j.jpainsymman.2015.02.015
更新日期:2015-08-01 00:00:00
abstract::The use of intrathecal diamorphine via an implanted portal system is described for pain control in a patient suffering from vertebral metastatic disease. The complication of myoclonic spasms affecting the lower half of the body occurred after 14 days, when increasing the bolus dose to 40 mg. The spasms lasted for 3 hr...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章
doi:10.1016/0885-3924(93)90192-x
更新日期:1993-10-01 00:00:00