Prescribing for Nausea in Palliative Care: A Cross-Sectional National Survey of Australian Palliative Medicine Doctors

Background: Palliative medicine physicians are challenged by lack of guidance regarding effectiveness and dosing of cannabis products in the setting of their emerging popularity. Objective: The aim of this study was to describe early patterns of tetrahydrocannabinol (THC) and cannabidiol (CBD) use in Florida following passage of the state’s first medical marijuana law. We describe here the perceived benefits, side effects, and beliefs expressed by patients in a single outpatient academic palliative medicine practice. Methods: A cross-sectional survey was performed of a sequential convenience sample of patients who presented to an outpatient academic palliative medicine clinic over a 3-month period. Results: In all, 24% (14/58) of respondents reported THC use, with half using THC on a daily basis. Patients reported improvements in pain, appetite, and nausea. In all, 71% (10/14) began using THC after the diagnosis of their chronic illness, and the most common form of usage was vaping. In all, 24% (14/58) of patients reported CBD use. Patients reported improvements in pain, and the most common form of usage was topical application. None of the patients had used CBD prior to the onset of their chronic illness. In all, 21% (3/14) of THC users and 21% (3/14) of CBD users thought that their substance was helping to cure their illness. Individual reported side effects in both groups were minimal. Conclusions: Approximately a quarter of outpatient palliative care patients use THC or CBD, often on a daily basis. Palliative care providers should be aware of the frequency, diverse usage, and beliefs behind cannabis product use in this patient population.

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Congenital Cardiothoracic Surgeons and Palliative Care: A National Survey Study

Journal of Palliative Care ◽

10.1177/0825859719874765 ◽

2019 ◽

Vol 36 (1) ◽

pp. 17-21 ◽

Cited By ~ 1

Author(s):

Emily Morell ◽

Jess Thompson ◽

Satish Rajagopal ◽

Elizabeth D. Blume ◽

Rachna May

Keyword(s):

Palliative Care ◽

Heart Disease ◽

National Survey ◽

Survey Study ◽

Inpatient Setting ◽

Provider Attitudes ◽

Cross Sectional ◽

Palliative Care Consultation ◽

Care Consultation ◽

Cardiothoracic Surgeon

Background: The majority of children with advanced heart disease in the inpatient setting die in an intensive care unit under 1 year of age following multiple interventions. While pediatric cardiology and palliative care provider attitudes have been described, little is known about pediatric cardiothoracic surgeon attitudes toward palliative care in children with advanced heart disease. Objective: To describe perspectives of pediatric cardiothoracic surgeons regarding palliative care in pediatric heart disease. Design: Cross-sectional web-based national survey. Results: Of the 220 surgeons who were e-mailed the survey, 36 opened the survey and 5 did not meet inclusion criteria (n = 31). Median years of practice was 23.5 (range: 12-41 years), and 87.1% were male. Almost all (90%) reported that they had experience consulting palliative care. While 68% felt palliative care consultation was initiated at the appropriate time, 29% felt it occurred too late. When asked the appropriate timing for palliative care consultation in hypoplastic left heart syndrome, 45% selected “at time of prenatal diagnosis” and 30% selected “when surgical and transcatheter options have been exhausted.” Common barriers to palliative care involvement included the perception of “giving up” (40%) and concern for undermining parental hope (36%). Conclusions: While a majority of pediatric cardiothoracic surgeons are familiar with palliative care, there is variation in perception of appropriate timing of consultation. Significant barriers to consultation still exist, including concern that parents will think they are “giving” up, undermining parental hope, and influence of palliative care on the medical care team’s approach.

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Pediatric Palliative Care Training in Fellowship: A National Survey of Adult Palliative Medicine Fellowship Directors and Pediatric Rotation Directors (S731)

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2015.12.034 ◽

2016 ◽

Vol 51 (2) ◽

pp. 423-424

Author(s):

Sonia Malhotra ◽

Robert Arnold

Keyword(s):

Palliative Care ◽

National Survey ◽

Palliative Medicine ◽

Pediatric Palliative Care ◽

Care Training

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Attitudes, Aptitudes, Barriers and Knowledge of Pain Physicians towards Palliative Care Practice – A National Survey, India

Indian Journal of Palliative Care ◽

10.25259/ijpc_325_20 ◽

2021 ◽

Vol 27 ◽

pp. 242-250

Author(s):

Renuka Shantharam Pai ◽

Geraldine Monteiro ◽

Subash D. Tarey

Keyword(s):

Palliative Care ◽

National Survey ◽

Poor Response ◽

Indian Society ◽

Care Practice ◽

Management Approach ◽

Limiting Factor ◽

Cross Sectional ◽

Policy Makers ◽

E Mail

Objectives: The bio-psycho-socio-spiritual model is a common management approach in palliative care (PC) and chronic pain medicine (CPM), adopted by PC Physicians and Pain Physicians (PPs), respectively. There is a dearth of services and personnel of PC in India. As PPs are familiar with pain management and the bio-psycho-socio-spiritual model, we hypothesised that they would be willing to incorporate PC in their practice and therefore, sought to understand their attitudes/aptitudes/barriers/knowledge towards it. Materials and Methods: We did a cross-sectional cohort study through a national survey of Indian PPs. The ten- item validated, survey questionnaire was mailed to 1300 PPs having E mail and registered with Indian Society for Study of Pain. Results: We received responses from 6.6% of the PPs. About 10.39% did not want to practice PC; the rest were either practicing or wanted to, or were unable to. 81.8% had <10 years CPM experience while the rest had 10–15 years. About 53.3% PPs had <10 years’ experience in PC; 10.4% had > 10 years and the rest had not practiced. About 70% were motivated by human suffering or had “personal reasons.” About 40.26% had no barriers; the rest cited stress or lack of infrastructure/knowledge/skills/time/financial compensation. The majority chose institutional courses for training and the popular choice of duration of the course was 3 months. The opinion on financial viability/non-viability of PC was equally divided among the respondents. About 62.3% had “knowledge” but half of them lacked “skills;” 27.6% lacked both; the rest had no inclination towards PC. About a third felt multi-disciplinary care was feasible while half felt that it was partially feasible. Conclusion: Policy-makers, at regional to global levels are strategizing options for popularizing PC since it supports the dualistic model of cure and care, most essential for both, chronic-debilitating or life-limiting illnesses. The poor response to our survey was a major limiting factor. However, among the respondents, the majority showed both aptitude and a favourable attitude for PC practice. The inability to identify major barriers for not choosing PC did not support our hypothesis. However, we feel that PPs are a cohort who can be motivated/ encouraged to take up some form of brief, comprehensive courses in PC so that they can be conversant with the specific knowledge and skills needed to practice the multi-dimensional aspects of PC in their own settings.

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Pediatric Palliative Care Programs in Children's Hospitals: A Cross-Sectional National Survey

PEDIATRICS ◽

10.1542/peds.2013-1286d ◽

2013 ◽

Vol 132 (6) ◽

pp. X10-X10

Keyword(s):

Palliative Care ◽

National Survey ◽

Pediatric Palliative Care ◽

Children's Hospitals ◽

Cross Sectional ◽

Children’S Hospitals

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End-of-life decision making by Austrian physicians - a cross-sectional study

BMC Palliative Care ◽

10.1186/s12904-019-0509-3 ◽

2020 ◽

Vol 19 (1) ◽

Author(s):

D. Jahn-Kuch ◽

A. Domke ◽

S. Bitsche ◽

H. Stöger ◽

A. Avian ◽

...

Keyword(s):

Palliative Care ◽

End Of Life ◽

Palliative Medicine ◽

Symptom Relief ◽

Postal Survey ◽

Cross Sectional ◽

End Of Life Decisions ◽

Legal Situation ◽

Additional Qualification ◽

Life Decisions

Abstract Background Austria has recently been embroiled in the complex debate on the legalization of measures to end life prematurely. Empirical data on end-of-life decisions made by Austrian physicians barely exists. This study is the first in Austria aimed at finding out how physicians generally approach and make end-of-life therapy decisions. Methods The European end-of-life decisions (EURELD) questionnaire, translated and adapted by Schildmann et al., was used to conduct this cross-sectional postal survey. Questions on palliative care training, legal issues, and use of and satisfaction with palliative care were added. All Austrian specialists in hematology and oncology, a representative sample of doctors specialized in internal medicine, and a sample of general practitioners, were invited to participate in this anonymous postal survey. Results Five hundred forty-eight questionnaires (response rate: 10.4%) were evaluated. 88.3% of participants had treated a patient who had died in the previous 12 months. 23% of respondents had an additional qualification in palliative medicine. The cause of death in 53.1% of patients was cancer, and 44.8% died at home. In 86.3% of cases, pain relief and / or symptom relief had been intensified. Further treatment had been withheld by 60.0%, and an existing treatment discontinued by 49.1% of respondents. In 5 cases, the respondents had prescribed, provided or administered a drug which had resulted in death. 51.3% of physicians said they would never carry out physician-assisted suicide (PAS), while 30.3% could imagine doing so under certain conditions. 38.5% of respondents supported the current prohibition of PAS, 23.9% opposed it, and 33.2% were undecided. 52.4% of physicians felt the legal situation with respect to measures to end life prematurely was ambiguous. An additional qualification in palliative medicine had no influence on measures taken, or attitudes towards PAS. Conclusions The majority of doctors perform symptom control in terminally ill patients. PAS is frequently requested but rarely carried out. Attending physicians felt the legal situation was ambiguous. Physicians should therefore receive training in current legislation relating to end-of-life choices and medical decisions. The data collected in this survey will help political decision-makers provide the necessary legal framework for end-of-life medical care.

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