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1
المؤلفون: Sylvia L. Lin, Catherine Riffin, Karl Pillemer, M. Carrington Reid, Karlee S Patrick, Keela Herr
المصدر: Dementia (London)
مصطلحات موضوعية: Aged, 80 and over, Gerontology, Sociology and Political Science, business.industry, Family caregivers, Communication, Health Personnel, Pain, General Social Sciences, General Medicine, medicine.disease, Article, 03 medical and health sciences, 0302 clinical medicine, Caregivers, Humans, Medicine, Dementia, 030212 general & internal medicine, business, 030217 neurology & neurosurgery, Aged
الوصف: Background Pain in older persons with dementia is both under-detected and under-managed. Family caregivers can play an important role in addressing these deficiencies by communicating their care recipient’s symptoms and behaviors to medical providers, but little is known about how caregivers and providers approach pain-related discussions in the context of dementia. The goal of this study was to explore how ambulatory care providers and family caregivers of persons with dementia view pain communication. Methods In-depth, semi-structured interviews were conducted with family caregivers ( n = 18) and healthcare providers involved in dementia care ( n = 16). Interviews focused on three specific content areas: (1) caregivers’ roles in communicating about pain in persons with dementia, (2) challenges experienced when communicating about pain in persons with dementia, and (3) strategies and recommendations for optimizing communication in this context. All interviews were audio-recorded, transcribed, and analyzed using the constant comparative method of data analysis. Results Caregivers and providers described various roles that caregivers assumed in communication processes, such as serving as historians, interpreters, and advocates. They identified two key features of problematic communication—receipt of inadequate information and interpersonal conflict about the care recipient’s pain—and articulated how ambiguity around pain and dementia, as well as preexisting beliefs and emotions, contributed to communication challenges. They also offered several suggestions to improve caregiver–provider communication processes, including the use of (1) written records to enhance the accuracy of caregivers’ reports and ensure that providers had specific information to inform symptom management and treatment plans, (2) pain scales and follow-up discussions to establish baseline data and clarify treatment recommendations, and (3) collaboration and rapport-building strategies to validate the caregivers’ contributions and maximize a team-based decision-making. Conclusion Receipt of inadequate information and interpersonal conflict are key challenges to caregiver–provider communication regarding pain in persons with dementia. Written records, pain scales, and rapport-building strategies may help to address these challenges.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::25df70dd9706078c6c2ad2550d143bf1
https://doi.org/10.1177/14713012211036868 -
2
المؤلفون: Brittany T. Abel, Ronald D. Adelman, M. Carrington Reid, Jerad H. Moxley, Stephanie L. Tsai, Milagros D. Silva, Vishwas Singh, Rosanna Sobota, Renuka Gupta
المصدر: Am J Hosp Palliat Care
مصطلحات موضوعية: Physician-Patient Relations, Palliative care, Limited English Proficiency, business.industry, Communication, Health Personnel, Communication Barriers, General Medicine, Translating, computer.software_genre, Article, Death, 03 medical and health sciences, Cross-Sectional Studies, 0302 clinical medicine, Nursing, 030220 oncology & carcinogenesis, Limited English proficiency, Humans, Medicine, 030212 general & internal medicine, business, Healthcare providers, computer, Interpreter
الوصف: Background: Healthcare providers increasingly care for patients with Limited English Proficiency (LEP). There is limited research evaluating healthcare provider utilization practices, attitudes, perceived benefits and barriers regarding the use of medical interpreters in end of life (EOL) and goals of care (GOC) conversations. Objectives: To elicit healthcare providers’ opinions of the role, factors that impact decisions to use medical interpreters and perceived utility of using medical interpreters when conducting EOL and GOC conversations with LEP patients and their families. Design: Cross-sectional survey of internal medicine trainees and attending physicians from a U.S. medical center. Results: A total of 117 surveys were collected with a response rate of 51%. In-person medical interpreters received higher ratings with regard to their helpfulness compared to telephone medical interpreters during EOL and GOC conversations. Being an attending physician and having received training in the use of a medical interpreter predicted higher composite scores reflecting greater awareness of the roles of medical interpreters and endorsement of best communication practices. In-person interpreters were viewed by a subset of participants as “standard of care” during EOL and GOC conversations. Conclusion: Having more years in practice and receiving training in the use of medical interpreters correlated with more favorable attitudes toward the role of medical interpreters and positive communication practices. Incorporating early training in the use of medical interpreters could help enhance communication practices and outcomes during EOL and GOC conversations with LEP patients.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::16de098def10ce1e012af01071f7bb27
https://doi.org/10.1177/10499091211015916 -
3
المصدر: Am J Hosp Palliat Care
مصطلحات موضوعية: Integrative Medicine, Palliative care, Scope (project management), business.industry, Palliative Care, Pain, General Medicine, Article, 03 medical and health sciences, 0302 clinical medicine, Nursing, Symptom relief, 030220 oncology & carcinogenesis, Hospice and Palliative Care Nursing, Humans, Pain Management, Medicine, 030212 general & internal medicine, Integrative medicine, business
الوصف: Background: The use of complementary and integrative medicine (CIM) continues to grow in palliative care. While research supports the use of many CIM therapies for symptom relief, the scope of provider-focused research on CIM remains poorly characterized. Objectives: We conducted a scoping review to characterize provider-focused research on CIM in palliative care in order to map existing evidence and identify knowledge gaps. Methods: We developed a protocol outlining the study population, concept, and context; then used a validated approach per the JBI manual and searched MEDLINE, EMBASE, CINAHL, and AMED. Results: We identified 34 studies that were conducted primarily in the US (n = 9) and UK (n = 6), focused mostly on nurse (n = 29) and physician (n = 22) providers, and employed questionnaires (n = 16) or qualitative (n = 15) methods. Studies investigated 58 CIM modalities, including massage (n = 13), music therapy (n = 12), and aromatherapy (n = 10), to address common symptoms including pain (n = 17), fatigue (n = 6), and nausea/vomiting (n = 6). Study outcomes included perceived benefits of CIM (n = 17) and types of CIM modalities that providers offer (n = 15). Uncommonly studied phenomena included referral patterns (n = 4), facilitators of provider recommendation of CIM (n = 3), and rates of CIM use (n = 3). Conclusion: Provider-focused research on CIM in palliative care can expand its scope by addressing perspectives of interdisciplinary providers, examining CIM modalities that patients report using, addressing symptoms commonly encountered in palliative care, and researching provider-use-focused outcomes. We identify these possibilities for future studies in addition to opportunities for systematic investigations to enhance the safe and efficacious delivery of CIM in the palliative care setting.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::f1be06a9817ba9b0af0718bf015055e4
https://doi.org/10.1177/10499091211011708 -
4
المصدر: Am J Hosp Palliat Care
مصطلحات موضوعية: medicine.medical_specialty, Icu patients, medicine.medical_treatment, 030204 cardiovascular system & hematology, urologic and male genital diseases, Article, law.invention, 03 medical and health sciences, 0302 clinical medicine, law, medicine, Humans, 030212 general & internal medicine, Renal replacement therapy, Intensive care medicine, End-stage kidney disease, Aged, Retrospective Studies, business.industry, Acute kidney injury, General Medicine, Acute Kidney Injury, medicine.disease, Intensive care unit, female genital diseases and pregnancy complications, Death, Renal Replacement Therapy, Intensive Care Units, Cross-Sectional Studies, Female, business
الوصف: Background: We know little about the end-of-life suffering and symptoms of intensive care unit (ICU) decedents in general and those who undergo renal replacement therapy (RRT) in particular. Objectives: To examine differences in end-of-life suffering and various symptoms’ contribution to suffering between ICU decedents who did not undergo RRT, those who underwent RRT for end-stage kidney disease (ESKD), and those who underwent RRT for acute kidney injury (AKI). Methods: This is a cross-sectional study conducted at a quaternary-level referral hospital September 2015-March 2017. Nurses completed interviews about ICU patients’ suffering and symptoms in their final week. We dichotomized overall suffering into elevated and non-elevated and each symptom as contributing or not to a patient’s suffering. Results: Sixty-four nurses completed interviews on 165 patients. Median patient age was 67 years (interquartile range 57, 78); 41% were female. In a multivariable model, undergoing RRT for AKI (odds ratio [OR] 2.95, 95% confidence interval [CI] 1.34-6.49) was significantly associated with elevated suffering compared to no RRT; undergoing RRT for ESKD was not. Adjusting for length of stay, AKI-RRT patients were more likely than non-RRT patients to have fecal incontinence (OR 2.21, 95% CI 1.00-4.93), painful broken skin (OR 2.41, 95% CI 1.14-5.12), and rashes (OR 3.61, 95% CI 1.35-9.67) contributing to their suffering. Conclusions: Undergoing RRT for AKI was associated with elevated suffering in the last week of life in ICU decedents. Painful broken skin, rashes, and fecal incontinence were more likely to contribute to suffering in AKI-RRT patients than in non-RRT patients. How to reduce suffering associated with AKI-RRT in ICU patients merits further study.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::0d3907a3722d5f1009169ab336d40b79
https://doi.org/10.1177/10499091211005707 -
5Quality of opioid prescribing in older adults with or without Alzheimer disease and related dementia
المؤلفون: Marco Pahor, Almut G. Winterstein, Babette Brumback, Yu-Jung Jenny Wei, Steven T. DeKosky, Roger B. Fillingim, Laurence M. Solberg, Cheng Chen, M. Carrington Reid, Siegfried Schmidt
المصدر: Alzheimer’s Research & Therapy, Vol 13, Iss 1, Pp 1-14 (2021)
Alzheimer's Research & Therapyمصطلحات موضوعية: Alzheimer’s disease and related dementias, medicine.medical_specialty, Palliative care, Neurology, Cognitive Neuroscience, Prescription opioids, Inappropriate prescribing, Neurosciences. Biological psychiatry. Neuropsychiatry, Disease, Medicare, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Alzheimer Disease, Internal medicine, Medicine, Dementia, Humans, 030212 general & internal medicine, Practice Patterns, Physicians', RC346-429, Aged, business.industry, Research, Chronic pain, medicine.disease, United States, Analgesics, Opioid, Neuropathic pain, Neurology (clinical), Neurology. Diseases of the nervous system, Chronic Pain, business, 030217 neurology & neurosurgery, Geriatric psychiatry, Cohort study, RC321-571
الوصف: Background Pain is common among individuals with Alzheimer’s disease and related dementias (ADRD), and use of opioids has been increasing over the last decade. Yet, it is unclear to what extent opioids are appropriately prescribed for patients with ADRD and whether the appropriateness of opioid prescribing differs by ADRD status. The objective of this study is to compare the quality of opioid prescribing among patients with or without ADRD who have chronic noncancer pain. Methods A nationally representative cohort study of Medicare beneficiaries aged 50 years or older who had chronic pain but who had no cancer, hospice, or palliative care from 2011 to 2015. Four indicators of potentially inappropriate opioid prescribing were measured in patients residing in communities (75,258 patients with and 435,870 patients without ADRD); five indicators were assessed in patients in nursing homes (NHs) (37,117 patients with and 5128 patients without ADRD). Each indicator was calculated as the proportion of eligible patients with inappropriate opioid prescribing in the year after a chronic pain diagnosis. Differences in proportions between ADRD and non-ADRD groups were estimated using a generalized linear model adjusting for covariates through inverse probability weighting. Results Patients with ADRD versus those without had higher concurrent use of opioids and central nervous system–active drugs (community 44.1% vs 33.3%; NH 58.8% vs 54.1%, both P P P = 0.003) but lower use in NHs (26.9% vs 36.0%, P Conclusion Potential inappropriate opioid prescribing in 2 areas of pain care was more common among patients with ADRD than among patients without ADRD in community or NH settings. Further studies aimed at understanding the factors and effects associated with opioid prescribing patterns that deviate from guidelines are warranted.
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المصدر: Clin J Pain
مصطلحات موضوعية: media_common.quotation_subject, Pain medication, MEDLINE, Psychological therapy, Article, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, Surveys and Questionnaires, Prevalence, medicine, Humans, Pain Management, Aged, media_common, business.industry, Fatalism, Chronic pain, Pain management, medicine.disease, humanities, Treatment engagement, Analgesics, Opioid, Anesthesiology and Pain Medicine, Neurology (clinical), Chronic Pain, business, 030217 neurology & neurosurgery, Clinical psychology
الوصف: OBJECTIVES In this study of 154 community-dwelling older adults with chronic noncancer pain, we sought to assess participants' beliefs about pain as well as pain management treatments and to determine the influence of those beliefs on participants' willingness to undertake 3 physician-recommended pain treatments, that is, a pharmacologic, physical, and psychological therapy. MATERIALS AND METHODS A 16-item questionnaire was employed to ascertain participants' pain beliefs, divided into 4 subscales representing: (1) negative beliefs about pharmacological treatments, (2) positive beliefs about physical treatment approaches, for example, exercise, (3) positive beliefs about psychological treatments, and (4) fatalistic beliefs about pain. Participants were asked to rate their willingness to undertake a pharmacologic, physical, or psychological therapy if their physician recommended that they do so. Agreement with each belief was measured, and we examined willingness to undertake each treatment as a function of pain belief subscale scores after controlling for relevant covariates. RESULTS Positive beliefs about physical treatments (eg, benefits of exercise) were the most strongly endorsed items on the pain beliefs questionnaire. All 3 treatment-focused pain beliefs subscales were significantly associated with willingness to undertake that form of treatment (eg, negative beliefs about pain medication use were associated with decreased willingness to take pain medication). Fatalistic attitudes were significantly associated with a decreased willingness to undertake physical treatments. DISCUSSION These results support the notion that patients' beliefs about pain and pain treatments can have important effects on treatment engagement and, if assessed, can help guide clinical management of chronic pain in older adults.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::d9802a0a89ded6ae3c64431691a0d434
https://doi.org/10.1097/ajp.0000000000000909 -
7
المؤلفون: Janet H. Van Cleave, Clara Scher, Eva Liang, M. Carrington Reid, Emily Petti, Lauren Meador
المصدر: Pain Manag Nurs
مصطلحات موضوعية: medicine.medical_specialty, MEDLINE, CINAHL, Affect (psychology), Ambulatory Care Facilities, Article, 03 medical and health sciences, 0302 clinical medicine, Pain assessment, Acute care, Humans, Medicine, 030212 general & internal medicine, Pain Measurement, Advanced and Specialized Nursing, Nursing practice, Inpatients, 030504 nursing, business.industry, Hospitalization, Mood, Ambulatory, Physical therapy, Nursing Care, 0305 other medical science, business
الوصف: Background One of the critical components in pain management is the assessment of pain. Multidimensional measurement tools capture multiple aspects of a patient's pain experience but can be cumbersome to administer in busy clinical settings. Aim We conducted a systematic review to identify brief multidimensional pain assessment tools that nurses can use in both ambulatory and acute care settings. Methods We searched PUBMED/MEDLINE, PsychInfo, and CINAHL databases from January 1977 through December 2019. Eligible English-language articles were systematically screened and data were extracted independently by two raters. Main outcomes included the number and types of domains captured by each instrument (e.g., sensory, impact on function, temporal components) and tool characteristics (e.g., administration time, validity) that may affect instrument uptake in practice. Results Our search identified eight multidimensional assessment tools, all of which measured sensory or affective qualities of pain and its impact on functioning. Most tools measured impact of pain on affective functioning, mood, or enjoyment of life. One tool used ecological momentary assessment via a web-based app to assess pain symptoms. Time to administer the varying tools ranged from less than 2 minutes to 10 minutes, and evidence of validity was reported for seven of the eight tools. Conclusions Our review identified eight multidimensional pain measurement tools that nurses can use in ambulatory or acute care settings to capture patients’ experience of pain. The most important element in selecting a multidimensional pain measure, though, is that one tool is selected that best fits the practice and is used consistently over time.
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المؤلفون: Charles Henderson, XinQi Dong, M. Carrington Reid, Matthew J Wynn, Jo Anne Sirey, Elissa Kozlov
المصدر: Palliat Support Care
مصطلحات موضوعية: Male, Gerontology, Palliative care, Sample (statistics), Article, Mean difference, 03 medical and health sciences, 0302 clinical medicine, LIVING STATUS, Humans, Cognitive status, Medicine, Cognitive Dysfunction, Cognitive impairment, General Nursing, Aged, Community based, 030214 geriatrics, business.industry, Palliative Care, Age Factors, Montreal Cognitive Assessment, General Medicine, Middle Aged, Psychiatry and Mental health, Clinical Psychology, Female, New York City, business, 030217 neurology & neurosurgery
الوصف: ObjectiveGiven a large number of community-based older adults with mild cognitive impairment, it is essential to better understand the relationship between unmet palliative care (PC) needs and mild cognitive impairment in community-based samples.MethodParticipants consisted of adults ages 60+ receiving services at senior centers located in New York City. The Montreal Cognitive Assessment (MoCA) and the Unmet Palliative Care Needs screening tool were used to assess participants’ cognitive status and PC needs.ResultsOur results revealed a quadratic relationship between unmet PC needs and mild cognitive impairment, controlling for gender, living status, and age. Participants with either low or high MoCA scores reported lower PC needs than participants with average MoCA scores, mean difference of the contrast (low and high vs. middle) = 2.15, P = 0.08.Significance of resultsThis study is a first step toward elucidating the relationship between cognitive impairment and PC needs in a diverse community sample of older adults. More research is needed to better understand the unique PC needs of older adults with cognitive impairment living in the community.
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9
المؤلفون: Brittany T. Abel, Milagros D. Silva, Ronald D. Adelman, M. Carrington Reid, Stephanie Tsai, Rosanna Sobota
المصدر: J Pain Symptom Manage
مصطلحات موضوعية: Spoken word, China, Palliative care, media_common.quotation_subject, Context (language use), computer.software_genre, Article, 03 medical and health sciences, 0302 clinical medicine, Perception, Humans, Medicine, 030212 general & internal medicine, General Nursing, Language, media_common, Physician-Patient Relations, Medical education, business.industry, Communication, Communication Barriers, Translating, Death, Anesthesiology and Pain Medicine, 030220 oncology & carcinogenesis, Limited English proficiency, Neurology (clinical), business, computer, Interpreter, Qualitative research, Meaning (linguistics)
الوصف: Context Research has shown that using medical interpreters in language-discordant patient-provider encounters improves outcomes. There is limited research evaluating the views of medical interpreters on best interpreter practices when they are used to break bad news or participate in end-of-life (EOL) conversations. Objectives To develop insights from medical interpreters about their role when interpreting discussions regarding EOL issues, identify practices interpreters perceive as helping to improve or hinder patient-provider communication, and obtain suggestions on how to improve communication during EOL conversations with Spanish-speaking and Chinese-speaking patients. Methods Semistructured interviews were conducted with Spanish or Chinese medical interpreters. Participants were recruited until thematic saturation was reached. Twelve interviews were conducted, audiotape recorded, transcribed, and analyzed using standard qualitative methods. Results Six major themes were identified: medical interpreters' perceived comfort level during EOL interpretation; perception of interpreter role; communication practices perceived as barriers to effective communication; communication practices felt to facilitate effective communication; concrete recommendations how to best use medical interpreters; and training received/perceived training needs. Conclusion Medical interpreters provide literal interpretation of the spoken word. Because of cultural nuances in Chinese-speaking and Spanish-speaking patients/family members during EOL conversations, medical interpreters can translate the meaning of the message within a specific cultural context. Conducting premeetings and debriefings after the encounter are potentially important strategies to maximize communication during EOL conversations.
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المصدر: Pain
مصطلحات موضوعية: Adult, medicine.medical_specialty, MEDLINE, PsycINFO, CINAHL, Article, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, Internal medicine, Humans, Medicine, business.industry, Chronic pain, Publication bias, medicine.disease, Intervention studies, Analgesics, Opioid, PsyArXiv|Social and Behavioral Sciences, Anesthesiology and Pain Medicine, Neurology, Meta-analysis, bepress|Social and Behavioral Sciences, Female, Observational study, Neurology (clinical), Chronic Pain, PsyArXiv|Social and Behavioral Sciences|Emotion, business, 030217 neurology & neurosurgery
الوصف: Importance: Chronic non-cancer pain (CNCP) is a significant health burden among adults. Standard behavioral therapies typically focus on targeting negative affect and yield only modest treatment effects. Objective: To systematically review and investigate the association between positive affect (PA) and pain severity among adults with chronic non-cancer pain. Data Sources: Databases search included MEDLINE (PubMed), PsycINFO, CINAHL, ProQuest Dissertations and Theses, OLASTER, Open Grey, PeerJ, and PsyArXiv (inception to September 24, 2018). Study Selection: We analyzed studies that: 1) employed a daily diary, longitudinal, laboratory, or intervention study design; 2) enrolled individuals with CNCP (pain ≥ 12 weeks); and 3) reported full quantitative results on outcomes. Data Extraction and Synthesis: At least 2 researchers independently screened articles, extracted data, and assessed the risk of bias. The main meta-analysis was followed by subgroup analyses. All analyses were performed using random-effects models. Formal tests for heterogeneity (Q-statistic; I2) and publication bias (p-curve and p-uniform*) were performed. Main Outcome: Pain severity. Results: We analyzed 26 studies with 2702 participants. Positive affect was associated with reduced pain severity in both observational and experimental studies. In subgroup analyses, only gender demonstrated a consistent effect: Higher PA was associated with lower pain in observational studies that had higher percentages of female participants. Conclusion and Relevance: Positive affect is associated with a reduction in pain severity, with the strongest association observed among women with CNCP.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::c29c91f44ab1bbf1250dce1a89261766
https://doi.org/10.1097/j.pain.0000000000001828
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