Abstract：
BACKGROUND:Despite significant morbidity and mortality among patients with decompensated cirrhosis, reported rates of advance directive (AD) completion and goals of care discussions (GCDs) between patients and providers are very low. We aimed to improve these rates by implementing a hepatologist-led advance care planning (ACP) intervention. MEASURES:Rates of AD and GCD completion, as well as self-reported barriers to ACP. INTERVENTION:Provider-led ACP in patients with decompensated cirrhosis without a prior documented AD. OUTCOMES:Sixty-two patients were seen over 115 clinic visits. After the intervention, AD completion rates increased from 8% to 31% and GCD completion rates rose from 0% to 51%. Women (P = 0.048) and nonmarried adults (P = 0.01) had greater changes in AD completion compared to men and married adults, respectively. Needing more time during visits was seen as the major barrier to ACP among providers. CONCLUSIONS/LESSONS LEARNED:Addressing provider and system-specific barriers dramatically improved documentation rates of ACP.
journal_name
J Pain Symptom Managejournal_title
Journal of pain and symptom managementauthors
Patel A,Kogekar N,Agarwal R,Cohen C,Esteban JP,Pourmand K,Tsai E,Harty A,Pelham-Braithwaite A,Perumalswami P,Dieterich D,Schiano Tdoi
10.1016/j.jpainsymman.2019.12.355subject
Has Abstractpub_date
2020-04-01 00:00:00pages
864-870issue
4eissn
0885-3924issn
1873-6513pii
S0885-3924(19)31060-7journal_volume
59pub_type
杂志文章abstract：CONTEXT:Most deaths in intensive care units occur after limitation or withdrawal of life-sustaining therapies. Often these patients require opioids to assuage suffering; yet, little has been documented concerning their use in the medical intensive care unit. OBJECTIVES:To determine the dose and factors influencing the...
journal_title：Journal of pain and symptom management
pub_type： 杂志文章
doi：10.1016/j.jpainsymman.2010.10.256
更新日期：2011-07-01 00:00:00
abstract：:The HIV/AIDS epidemic in boys and men with hemophilia began in the early 1980s with the puzzling occurrence of systemic illness and fatal opportunistic infections in patients who had received plasma-derived clotting factor concentrates. This brief narrative describes one physician's experience in caring for patients w...
journal_title：Journal of pain and symptom management
pub_type： 杂志文章
doi：10.1016/j.jpainsymman.2013.02.017
更新日期：2013-07-01 00:00:00
abstract：CONTEXT:Rheumatoid arthritis (RA) is a chronic disease that often impacts patient's quality of life. For young people with RA, there is a need for rehabilitative approaches that have been shown to be safe and to lead to improved functioning. OBJECTIVES:This pilot study investigated the feasibility of a single-arm, gro...
journal_title：Journal of pain and symptom management
pub_type： 杂志文章
doi：10.1016/j.jpainsymman.2009.09.018
更新日期：2010-05-01 00:00:00
abstract：CONTEXT:There is an increasing use of palliative care units (PCUs) for the treatment of terminally ill cancer patients. Thus, it is important to evaluate the care and quality of life of terminally ill cancer patients treated in PCUs so that improvements can be made. Limited research has investigated the quality of dyin...
journal_title：Journal of pain and symptom management
pub_type： 杂志文章
doi：10.1016/j.jpainsymman.2012.04.010
更新日期：2013-04-01 00:00:00
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：:Brain death is a traumatic and sudden event following a severe injury to the brain. Most patients with brain death spend the last days of life in an intensive care unit (ICU), where some families will be approached to ask for organ donation. This qualitative study was carried out with relatives of patients who had die...
journal_title：Journal of pain and symptom management
pub_type： 杂志文章
doi：10.1016/j.jpainsymman.2008.04.013
更新日期：2009-04-01 00:00:00
abstract：:In a prospective open study, 61 consecutive patients with terminal cancer admitted to the hospital underwent cognitive assessment using the Mini-Mental State Questionnaire three times a week between admission and discharge or death. Mini-Mental State Questionnaire score upon admission was 28 +/- 1.5 in patients who we...
journal_title：Journal of pain and symptom management
pub_type： 杂志文章
doi：10.1016/0885-3924(92)90074-r
更新日期：1992-05-01 00:00:00
abstract：:The identification of a neuropathic pain syndrome in a cancer patient requires a focused clinical evaluation based on knowledge of common neuropathic pain syndromes. If a tumor is directly involved in the etiology of the pain, oncologic treatment is an initial consideration and may include surgery, radiation, or chemo...
journal_title：Journal of pain and symptom management
pub_type： 杂志文章,评审
doi：10.1016/s0885-3924(97)00009-2
更新日期：1997-08-01 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：:The doses of opioid analgesics required to control pain in patients with cancer may result in somnolence and reduced interaction with family members. Psychostimulants such as dextroamphetamine (DA, Dexedrine) or methylphenidate (MP, Ritalin) have been used in adults to counteract the sedation of opioid analgesia. We r...
journal_title：Journal of pain and symptom management
pub_type： 杂志文章
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更新日期：1994-02-01 00:00:00
abstract：:Spirituality is about what is of utmost value; it is a values lens that asks "what really matters most to me, my family, our community, our country, and our world." This personal reflection comes from a New Zealand academic who works in the spirituality and health care research field. Although largely biographical, th...
journal_title：Journal of pain and symptom management
pub_type： 杂志文章
doi：10.1016/j.jpainsymman.2018.12.331
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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：:There is little objective data on how cancer and its therapy affect physical activity. The main aims of this pilot study were 1) to compare physical activity in patients receiving palliative chemotherapy and healthy controls, and 2) to explore the relationship between patients' activity, quality of life (QoL), and cli...
journal_title：Journal of pain and symptom management
pub_type： 杂志文章
doi：10.1016/j.jpainsymman.2006.09.024
更新日期：2007-06-01 00:00:00
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journal_title：Journal of pain and symptom management
pub_type： 杂志文章,meta分析,评审
doi：10.1016/j.jpainsymman.2012.02.022
更新日期：2013-03-01 00:00:00
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journal_title：Journal of pain and symptom management
pub_type： 杂志文章
doi：10.1016/j.jpainsymman.2010.01.024
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journal_title：Journal of pain and symptom management
pub_type： 临床试验,杂志文章
doi：10.1016/s0885-3924(01)00353-0
更新日期：2001-12-01 00:00:00
abstract：:Patients (n = 231) diagnosed with solid tumors and undergoing chemotherapy were randomly assigned to the experimental arm (n = 114) or to conventional care (n = 117). A symptom severity index based on summed severity scores across 15 symptoms was the primary outcome. Building on previously published work, an analysis ...
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.2006.02.013
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journal_title：Journal of pain and symptom management
pub_type： 杂志文章
doi：10.1016/j.jpainsymman.2019.08.009
更新日期：2020-01-01 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
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journal_title：Journal of pain and symptom management
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更新日期：1990-02-01 00:00:00
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journal_title：Journal of pain and symptom management
pub_type： 杂志文章
doi：10.1016/j.jpainsymman.2005.03.010
更新日期：2005-09-01 00:00:00
abstract：:Cancer-related fatigue (CRF) is a significant clinical symptom. Effective assessment of CRF attributes from the patients' perspective is essential. This study tested the psychometric properties of the Wu Cancer Fatigue Scale (WCFS). A total of 172 outpatients with breast cancer, who were at various stages and on vario...
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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更新日期：2006-09-01 00:00:00
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journal_title：Journal of pain and symptom management
pub_type： 杂志文章
doi：10.1016/j.jpainsymman.2009.04.007
更新日期：2009-07-01 00:00:00
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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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更新日期：2006-04-01 00:00:00
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journal_title：Journal of pain and symptom management
pub_type： 杂志文章
doi：10.1016/j.jpainsymman.2017.12.333
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abstract：:Advanced dementia patients may be at substantial risk for undetected or undertreated pain. To examine the treatment of pain following hip fracture, a prospective cohort study was conducted in an academic teaching hospital. Fifty-nine cognitively intact elderly patients with hip fracture and 38 patients with hip fractu...
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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更新日期：2000-04-01 00:00:00
abstract：:Safety and efficacy data from a study of slow intrathecal (IT) ziconotide titration for the management of severe chronic pain are presented. Patients randomized to ziconotide (n = 112) or placebo (n = 108) started IT infusion at 0.1 microg/hour (2.4 microg/day), increasing gradually (0.05-0.1 microg/hour increments) o...
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：2006-05-01 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：2016-08-01 00:00:00
abstract：:Cancer is one of the major causes of death in Cuba, and in current practice, patients are not usually informed of their diagnosis. Palliative care is an emerging discipline in this country. Cuban cancer patients with advanced disease completed the Palliative Outcome Scale (POS), and the researcher elicited patients' k...
journal_title：Journal of pain and symptom management
pub_type： 杂志文章
doi：10.1016/j.jpainsymman.2008.02.015
更新日期：2009-03-01 00:00:00
