The Use of Ketamine in Severe Cases of Refractory Pain Syndromes in the Palliative Care Setting: A Case Series

Abstract Background: Olanzapine is an atypical antipsychotic that has affinity for many central nervous system receptors. Its efficacy is supported by several studies in the prevention and treatment of chemotherapy-induced nausea and vomiting. No recommendations exist on the antiemetic use of olanzapine in the palliative care setting. The aim of this work is to complete the initial work of Fonte et al. published in 2015, to determine whether the literature supports the use of olanzapine as an antiemetic in palliative situations and, in practice, to propose a therapeutic schema adapted to the palliative setting. Methods: Systematic review of the literature according to the PRISMA criteria. We searched the PubMed, Cochrane, RefDoc, EMBase databases and the gray literature databases. The bibliographic search was conducted between November 2016 and August 2017. Results: Thirteen articles were included: 2 case studies, 3 case series, 3 retrospective studies, 2 prospective studies, 2 literature reviews. All studies concluded on the efficacy of olanzapine as an antiemetic in the palliative care setting. No serious adverse effects were reported. Based on the data from the literature review, we propose a therapeutic scheme adapted to the palliative care context. Conclusion : Action of olanzapine on many receptors and its tolerance profile make it an interesting antiemetic treatment in palliative medicine. But to date, studies are scarce and have a low statistical power. Further investigation is therefore needed to determine the benefit of this treatment in palliative care patients, compared to usual treatments.

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Continuing Methadone for Pain in Palliative Care

Pain Research and Management ◽

10.1155/2013/740379 ◽

2013 ◽

Vol 18 (2) ◽

pp. 83-86 ◽

Cited By ~ 5

Author(s):

Philippa Hawley ◽

Ryan Liebscher ◽

Jessica Wilford

Keyword(s):

British Columbia ◽

Palliative Care ◽

Care Setting ◽

Response Rate ◽

Family Physicians ◽

Perceived Barriers ◽

Refractory Pain ◽

Palliative Care Setting ◽

Knowledge Deficits

BACKGROUND: Methadone is one of the most important medications used for the treatment of refractory pain in the palliative care setting, and is usually initially prescribed by one of a limited number of physicians who have acquired authorization for its use. A lack of authorized physicians able to take over prescribing when the patient is stable is a barrier to accessing methadone for analgesia.OBJECTIVE: To determine the barriers to family physicians becoming authorized to prescribe methadone for pain in palliative care.METHODS: A survey exploring the perceived barriers to continuing methadone for pain in palliative care following initial prescription by a specialist was mailed to a randomly selected group of 870 family physicians in British Columbia.RESULTS: The response rate was 30.9%. Of the 204 responding physicians, 76.1% described themselves as positioned to provide ongoing palliative care to their patients. Within this group, 38 (18.6%) were already authorized to prescribe methadone for pain. The remaining 166 (81.4%) had significant knowledge deficits regarding methadone use in palliative care, but were largely aware of their deficits, and more than one-half were willing to learn more and to obtain an authorization if requested.CONCLUSIONS: Responding family physicians had mostly received little education regarding methadone for pain, but were aware of their need for education and were willing to learn. Physicians who had already become authorized were generally satisfied with the process of authorization, and believed the process of education through authorization was appropriate and not onerous.

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The use of olanzapine as an antiemetic in palliative medicine: a systematic review of the literature

10.21203/rs.2.18206/v1 ◽

2019 ◽

Author(s):

Gaëtan Saudemont ◽

Chloé Prod'Homme ◽

Arlette Da Silva ◽

Stephanie Villet ◽

Michel Reich ◽

...

Keyword(s):

Systematic Review ◽

Palliative Care ◽

Palliative Medicine ◽

Statistical Power ◽

Care Setting ◽

Case Series ◽

Review Of The Literature ◽

Palliative Care Setting ◽

Initial Work ◽

Bibliographic Search

Abstract Background: Olanzapine is an atypical antipsychotic that has affinity for many central nervous system receptors. Its efficacy is supported by several studies in the prevention and treatment of chemotherapy-induced nausea and vomiting. No recommendations exist on the antiemetic use of olanzapine in the palliative care setting. The aim of this work is to complete the initial work of Fonte et al. published in 2015, to determine whether the literature supports the use of olanzapine as an antiemetic in palliative situations and, in practice, to propose a therapeutic schema adapted to the palliative setting. Methods: Systematic review of the literature according to the PRISMA criteria. We searched the PubMed, Cochrane, RefDoc, EMBase databases and the gray literature databases. The bibliographic search was conducted between November 2016 and August 2017. Results: Thirteen articles were included: 2 case studies, 3 case series, 3 retrospective studies, 2 prospective studies, 2 literature reviews. All studies concluded on the efficacy of olanzapine as an antiemetic in the palliative care setting. No serious adverse effects were reported. Based on the data from the literature review, we propose a therapeutic scheme adapted to the palliative care context. Conclusion: Action of olanzapine on many receptors and its tolerance profile make it an interesting antiemetic treatment in palliative medicine. But to date, studies are scarce and have a low statistical power. Further investigation is therefore needed to determine the benefit of this treatment in palliative care patients, compared to usual treatments.

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Collusion in palliative care: an exploratory study with the Collusion Classification Grid

Palliative & Supportive Care ◽

10.1017/s1478951519000142 ◽

2019 ◽

Vol 17 (6) ◽

pp. 637-642

Author(s):

Friedrich Stiefel ◽

Kenji Nakamura ◽

Kunihiko Ishitani ◽

Céline Bourquin ◽

Michael Saraga

Keyword(s):

Palliative Care ◽

Care Setting ◽

Clinical Decision Making ◽

Negative Impact ◽

Case Series ◽

Clinical Decision ◽

Conceptual Clarity ◽

Palliative Care Setting ◽

Different Types ◽

The Impact

AbstractObjectiveCollusion is a largely unconscious, dynamic bond, which may occur between patients and clinicians, between patients and family members, or between different health professionals. It is widely prevalent in the palliative care setting and provokes intense emotions, unreflective behavior, and negative impact on care. However, research on collusion is limited due to a lack of conceptual clarity and robust instruments to investigate this complex phenomenon. We have therefore developed the Collusion Classification Grid (CCG), which we aimed to evaluate with regard to its potential utility to analyze instances of collusion, be it for the purpose of supervision in the clinical setting or research.MethodSituations of difficult interactions with patients with advanced disease (N = 10), presented by clinicians in supervision with a liaison psychiatrist were retrospectively analyzed by means of the CCG.Result1) All items constituting the grid were mobilized at least once; 2) one new item had to be added; and 3) the CCG identified different types of collusion.Significance of resultsThis case series of collusions assessed with the CCG is a first step before the investigation of larger samples with the CCG. Such studies could search and identify setting-dependent and recurrent types of collusions, and patterns emerging between the items of the CCG. A better grasp of collusion could ultimately lead to a better understanding of the impact of collusion on the patient encounter and clinical decision-making.

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Meeting the social, emotional and psychological needs of patients in a cancer palliative care setting: Student Nurses� experiences from Karachi, Pakistan

i-manager’s Journal on Nursing ◽

10.26634/jnur.1.1.1364 ◽

2011 ◽

Vol 1 (1) ◽

pp. 38-43

Author(s):

Nasreen Sulaiman Lalani ◽

◽

Shabana D. Lakhani ◽

Muslim Shah ◽

◽

...

Keyword(s):

Palliative Care ◽

Care Setting ◽

Student Nurses ◽

Psychological Needs ◽

Social Emotional ◽

The Social ◽

Palliative Care Setting

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Validation of the Phase II Feasibility Study in a Palliative Care Setting

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909112471422 ◽

2012 ◽

Vol 30 (8) ◽

pp. 752-758 ◽

Cited By ~ 9

Author(s):

Cindy Lee ◽

Ryash Vather ◽

Anne O’Callaghan ◽

Jackie Robinson ◽

Briar McLeod ◽

...

Keyword(s):

Palliative Care ◽

Feasibility Study ◽

Phase Ii ◽

Care Setting ◽

Palliative Care Setting

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Outcome measures for holistic, complex interventions within the palliative care setting

Complementary Therapies in Clinical Practice ◽

10.1016/j.ctcp.2007.10.001 ◽

2008 ◽

Vol 14 (1) ◽

pp. 25-32 ◽

Cited By ~ 12

Author(s):

Elizabeth Anita Thompson ◽

Tina Quinn ◽

Charlotte Paterson ◽

Helen Cooke ◽

Deidre McQuigan ◽

...

Keyword(s):

Palliative Care ◽

Outcome Measures ◽

Care Setting ◽

Complex Interventions ◽

Palliative Care Setting

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Bereaved spouses' adjustment after the patients' death in palliative care

Palliative & Supportive Care ◽

10.1017/s1478951507000594 ◽

2007 ◽

Vol 5 (4) ◽

pp. 397-404 ◽

Cited By ~ 24

Author(s):

Maria E. Carlsson ◽

Ingrid M. Nilsson

Keyword(s):

Palliative Care ◽

Sleep Disturbance ◽

Care Setting ◽

Significant Decline ◽

First Year ◽

Inclusion Criteria ◽

Life Situation ◽

Palliative Care Setting ◽

Advanced Home Care ◽

Grief Reactions

ABSTRACTObjectives:To improve the support to bereaved spouses during the year after the patient's death, a project was started consisting of three visits by a nurse (after 1, 3, and 13 months) with conversations about the patient's death and the spouse's life situation. The aim of this study was to describe the bereaved spouse's situation and adaptation during the first year after the loss.Methods:Spouses of patients cared for by The Advanced Home Care Team (APHCT) in Uppsala, Sweden, were invited to participate in the project. Each participant was encouraged to talk freely about his or her situation, but enough direction was given to ensure that all items listed on a standardized questionnaire were covered.Results:Fifty-one spouses met the inclusion criteria and were invited to participate and 45 accepted. The subjects felt quite healthy but were tired and suffered from sleep disturbance. The grief reactions had initially been high but showed a significant decline from 1 to 13 months (p < .01). Forty-nine percent had experienced postbereavement hallucinations.Significance of results:This study showed that the bereaved spouses felt quite healthy and adjusted quite well to their new life situation, after the patient's death in a palliative care setting. The grief reactions had initially been high but showed a significant decline during the year.

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