Time to act for reappraising the educational system for universal access to opioid analgesics, for quality palliative care and cancer-related pain relief in East Asian countries

Abstract Background Towards the end of life, use of opioid analgesics becomes more common in patients to control pain and improve quality of life. While pain medication may help manage pain, unwanted cognitive side effects are frequently noted. This balancing act presents a trade-off for patients between pain relief and adverse effects, where the desire to relieve pain must be evaluated against the desire to maintain cognitive clarity and may represent a difficult decision for patients receiving palliative care. Our goal was to understand how patients’ decision making about pain medications balances the pain relief from those medications against the cognitive decline often associated with them. Methods We conducted qualitative semi-structured interviews with patients receiving home-based palliative care from a program in Toronto, Canada. Interview recordings were transcribed and analyzed using thematic analysis. Results Thirty-one interviews were conducted. Some patients preferred cognitive preservation over pain management because of a sense that cognition is central to their identity, the desire to maintain lucidity, a desire to continue participating in work or hobbies, and fear of addiction. Conversely, some patients preferred pain management over cognitive preservation because of a desire to avoid suffering, an inability to sleep without medications, or an acceptance of some cognitive compromise. A few patients attempted to find balance through tapering drugs, limiting their use of breakthrough analgesic doses, or using alternative strategies. Conclusions Decision making around pain and pain management is a highly preference-sensitive process—with no clear right or wrong decisions, only the preferences of each patient. The findings from this study may influence the design of future patient-facing decision aids around pain management. Future studies should pilot interventions to better assist patients with this decision.

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Palliative Care Physicians' Attitudes Toward Patient Autonomy and a Good Death in East Asian Countries

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2015.02.020 ◽

2015 ◽

Vol 50 (2) ◽

pp. 190-199.e1 ◽

Cited By ~ 34

Author(s):

Tatsuya Morita ◽

Yasuhiro Oyama ◽

Shao-Yi Cheng ◽

Sang-Yeon Suh ◽

Su Jin Koh ◽

...

Keyword(s):

Palliative Care ◽

Patient Autonomy ◽

East Asian ◽

Good Death ◽

Asian Countries

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“No thanks, I don’t want to see snakes again”: A qualitative study of pain management versus preservation of cognition in palliative care patients

10.21203/rs.3.rs-57944/v2 ◽

2020 ◽

Author(s):

Pete Wegier ◽

Jaymie Varenbut ◽

Mark Bernstein ◽

Peter G Lawlor ◽

Sarina R Isenberg

Keyword(s):

Palliative Care ◽

Pain Management ◽

Pain Relief ◽

Decision Aids ◽

Opioid Analgesics ◽

Structured Interviews ◽

Difficult Decision ◽

Pain Medications ◽

Home Based ◽

Control Pain

Abstract BackgroundTowards the end of life, use of opioid analgesics becomes more common in patients to control pain and improve quality of life. While pain medication may help manage pain, unwanted cognitive side effects are frequently noted. This balancing act presents a trade-off for patients between pain relief and adverse effects, where the desire to relieve pain must be evaluated against the desire to maintain cognitive clarity and may represent a difficult decision for patients receiving palliative care. Our goal was to understand how patients’ decision making about pain medications balances the pain relief from those medications against the cognitive decline often associated with them.MethodsWe conducted qualitative semi-structured interviews with patients receiving home-based palliative care from a program in Toronto, Canada. Interview recordings were transcribed and analyzed using thematic analysis.ResultsThirty-one interviews were conducted. Some patients preferred cognitive preservation over pain management because of a sense that cognition is central to their identity, the desire to maintain lucidity, a desire to continue participating in work or hobbies, and fear of addiction. Conversely, some patients preferred pain management over cognitive preservation because of a desire to avoid suffering, an inability to sleep without medications, or an acceptance of some cognitive compromise. A few patients attempted to find balance through tapering drugs, limiting their use of breakthrough analgesic doses, or using alternative strategies. ConclusionsDecision making around pain and pain management is a highly preference-sensitive process—with no clear right or wrong decisions, only the preferences of each patient. The findings from this study may influence the design of future patient-facing decision aids around pain management. Future studies should pilot interventions to better assist patients with this decision.

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“No Thanks, I Don’t Want to See Snakes Again”: A Qualitative Study of Pain Management Versus Preservation of Cognition in Palliative Care Patients

10.21203/rs.3.rs-57944/v1 ◽

2020 ◽

Author(s):

Pete Wegier ◽

Jaymie Varenbut ◽

Mark Bernstein ◽

Peter G Lawlor ◽

Sarina R Isenberg

Keyword(s):

Decision Making ◽

Palliative Care ◽

Pain Management ◽

Pain Relief ◽

Decision Aids ◽

Opioid Analgesics ◽

Structured Interviews ◽

Difficult Decision ◽

Home Based ◽

Control Pain

Abstract BackgroundTowards the end of life, use of opioid analgesics becomes more common in patients to control pain and improve quality of life. While pain medication may help manage pain, unwanted cognitive side effects are frequently noted. This balancing act presents a trade-off for patients between pain relief and adverse effects, where the desire to relieve pain must be evaluated against the desire to maintain cognitive clarity and may represent a difficult decision for patients receiving palliative care. Our goal was to understand how patients’ decision making about pain medications balances the pain relief from those medications against the cognitive decline often associated with them.MethodsWe conducted qualitative semi-structured interviews with patients receiving home-based palliative care from a program in Toronto, Canada. Interview recordings were transcribed and analyzed using thematic analysis.ResultsThirty-one interviews were conducted. Some patients preferred cognitive preservation over pain management because of a sense that cognition is central to their identity, the desire to maintain lucidity, a desire to continue participating in work or hobbies, and fear of addiction. Conversely, some patients preferred pain management over cognitive preservation because of a desire to avoid suffering, an inability to sleep without medications, or an acceptance of some cognitive compromise. A few patients attempted to find balance through tapering drugs, limiting their use of breakthrough analgesic doses, or using alternative strategies. ConclusionsDecision making around pain and pain management is a highly preference-sensitive process—with no clear right or wrong decisions, only the preferences of each patient. The findings from this study may influence the design of future patient-facing decision aids around pain management. Future studies should pilot interventions to better assist patients with this decision.

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Factors related to spiritual well-being in the last days of life in three East Asian countries: An international multicenter prospective cohort study

Palliative Medicine ◽

10.1177/02692163211022179 ◽

2021 ◽

pp. 026921632110221

Author(s):

Yusuke Hiratsuka ◽

Sang-Yeon Suh ◽

Sun-Hyun Kim ◽

Shao-Yi Cheng ◽

Seok-Joon Yoon ◽

...

Keyword(s):

Palliative Care ◽

East Asian ◽

Well Being ◽

Asian Countries ◽

Factors Associated ◽

Spiritual Well Being ◽

Palliative Care Units ◽

Multicenter Prospective Cohort Study ◽

International Multicenter ◽

Multicenter Prospective Cohort

Background: Some factors associated with spiritual well-being in dying patients have previously been reported. However, there has been no cross-cultural study comparing factors related to spiritual well-being. The current investigation may shed light on this under-investigated area through a comparison of diverse factors. Aim: We aimed to (1) examine factors associated with spiritual well-being in the last days and (2) compare those factors across three East Asian countries. Design: This is an international multicenter prospective cohort study. Setting/participants: Newly admitted inpatients with far advanced cancer in palliative care units in Japan, Korea and Taiwan were enrolled. Each patient was classified into one of two groups based on spiritual well-being score in the last days of life. Univariate and multivariate analyses were performed to identify the factors related to better spiritual well-being score in each country. Results: A total of 1761 patients treated at 37 palliative care units from January 2017 to September 2018 were analyzed. Seven variables were significant in Japan, three in Korea, and five in Taiwan. “Good death scale [acceptance],” “fatigue” and “expressed wish for hastened death” were unique in Japan. “Visit from a pastoral care worker within 48 h of death” was unique in Korea. “Patient’s preferences for place of death,” “dyspnea” and “continuous deep sedation” were unique in Taiwan. Conclusions: This study found novel factors related to spiritual well-being in the last days of life, several of which differed according to country. Recognition of factors associated with spiritual well-being can improve the quality of palliative care.

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